Neurologic exam 2 Flashcards
Components of neuro exam
Gait, coordination, motor, reflexes, sensory, mini-mental status exam
How to test gait
walk normally, walk on heels, walk on toes, walk heel to toe
How to test coordination
Fine finger movement, finger to nose test, rapid alternating movements, heel to shin test
How to test motor
Look for muscle atrophy and check extremity tone, assess upper extremity strength with pronator drift and strength of wrists or finger extensors, walk on heels and toes
What to test in motor exam
Bulk, movement, tone, strength
Bulk
compare body side to side, define with hypertrophy or wasting, note deformities, claw hand, klumpke’s paralysis, erb’s palsy
Myoclonus
rapid shock-like muscle jerks
Chorea
rapid jerky twitches similar to myoclonus but more random in location and more likely to blend into one another, common in Huntington’s
Athetosis
slow, writhing movements of limbs
Ballismus
large amplitude flinging limb movement
Tics
abrupt, stereotyped, coordinated movements or vocalizations
Dystonia
maintenance of abnormal posture or repetitive twisting movements
What to inspect for carpal tunnel
the thenar muscles
Fasiculations may be caused by
low calcium, electrolyte imbalance
muscle tone
ask pt to relax and let you move arm or hand, passively flex and extend elbow and wrist, pronate and supinate forearm
Spasticity
clasp knife phenomenon, when limb is moved rapidly, catches, then releases, greatest in flexors of upper extremity and extensors of lower`
Spasticity may be present in
umn lesion in CVA
Rigidity
increased resistance throughout movement
Lead pipe rigidity
applies to resistance that is uniform throughout movement
Rigidity
increased resistance throughout movement, accentuated when pt is distracted, maybe present in Parkinson’s
Lead pipe rigidity
applies to resistance that is uniform throughout movement
Cogwheel rigidity
rhythmic interruption of resistance, producing a ratchet-like effect
Paratonia
increased resistance that becomes less prominent when pt is distracted, otherwise unable to relax, common with dementia or anxiety
Muscle strength
maneuvers against resistance, test one side to the other, test each joint in isolation
Upper extremities strength
shoulder abduction, elbow extension, elbow flexion, wrist extension, wrist flexion, finger extension, finger flexion, finger abduction
Lower extremities strength
hip flexion, hip extension, knee flexion and extension, ankle dorsiflexion and plantar flexion
Medical research council scale
0=no contraction, 1=visible twitch but no movement, 2=weak contraction, not against gravity, 3= weak able to overcome gravity, 4= weak contraction able to overcome some but not much resistance, 5= normal
monoparesis
weakness of single limb
hemiparesis
weakness on one side
paraparesis
weakness of both lower extremities
quadriparesis
weakness of all four limbs
reflexes
subconscious and involuntary, check for lesion on pathway, requires sensory input synapsing within spinal cord to a motor output directly innervating muscle fibers
How to do a reflex test
talk while testing, compare each side
Biceps
C5*, C6
Supinator
C5, C6*
Triceps
C7*, C8
Knee
L3*, L4
Ankle
S1*, S2
Ankle
S1*, S2
Reflex grading
2 is normal, 0 absent, 4 clonus
Plantar reflexes
extension of toes in UMN lesions above the S1 level of the spinal cord
Abdominl reflexes
absence of umbilicus pulling towards a stroked quadrant in UMN lesion between T9-T12
Cremasteric reflex
absence of ipsilateral elevation of testicle in lesions L1 and L2
Anal reflex
anal sphincter contraction, S2,3,4
Goals of exam
determine exact areas of sensory dysfunction, modality of sensory dysfunction, establish origin of dysfunction
Upper extremities dermatome
antecubital fossa C5, tip of middle finger or center of palm C7, tip of little finger or ulna aspect of hand C8, axilla T1
Lower extremities dermatome
below groin along medial thigh L2, medial knee L3, cneter of top of foot, toes L 2,3,4 lateral heel L5, lateral foot or toe L5, behind knee S1, behind knee medially or scrotum S2
Cortical sensation
mediated by parietal lobes, represents ability to integrate primary sensory stimuli %,
Double simultaneous stimulation
ask pt to close eyes and touch on one side and then both, if parietal lesion, pt may not be able to feel on one side
Graphesthesia
identification of letter or number on hand
