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Physical Diagnosis > Neurologic Exam > Flashcards

Neurologic Exam Flashcards

1
Q

Common/Concerning NS Symptoms

(8)

A
  1. HA
  2. Dizziness/vertigo
  3. Weakness - generalized, proximal, or distal
  4. Numbness
  5. Abnormal/lack of sensation
  6. LOC, syncope, or near-syncope
  7. Seizure
  8. Tremors/involuntary movements
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2
Q

Principles for all Neuro Exam Components

(3)

A
  1. Mental status
  2. Symmetric or asymmetric findings
  3. In the event of asymmetry ,do causative lesions lie in CNS or PNS?
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3
Q

NS Eval Categories

(7)

A

Organize your thoughts into these categories

  1. Mental status
  2. Speech
  3. Language
  4. Cranial nerves
  5. Motor system
  6. Sensory system
  7. Reflexes
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4
Q

Mental Status Exam (MSE)

(2 functions, 4 qualifications)

A

*Function: *

  1. help identify neurological disease
  2. distinguish focal deficits from difficuse processes

*Qualifications: Make sure the pt is *

  1. Alert
  2. Cooperative
  3. Attentive
  4. Understands the language
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5
Q

Level of Consciousness

A

Alertness or state of awareness of the environment

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6
Q

Attention

A

The ability to focus or concentrate over time on one task or activity - an inattentive or distractable prson c impaired consciousness has difficulty giving a hx or responding to questions.

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7
Q

Memory

A

The process of registering/recording info. Separated into two categories:

  1. Recent/short term - minutes, hours, days
  2. Remote/long term - intervals of years

Tested by asking for immediate repetition of material, followed by storage or retention of info

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8
Q

Orientation

A

Awareness of personal identitiy, place and time; *requires both memory and attention *

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9
Q

Perceptions

A

Sensory awareness of objects in the environment and their interrelationships (external stimuli)

*Also refers to internal stimuli such as dreams and hallucinations *

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10
Q

Thought processes

A

The logic, coherence, and relevance of the patient’s thought as it leads to selected goals, or *how *people think

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11
Q

Insight

A

Awareness that symptoms or distrubed behaviors are normal or abnormal

*Example - distinguishing b/w daydreams and hallucinations that seem real *

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12
Q

Judgement

A

Process of comparing and evaluating alternatives when deciding on a coiurse of action; reflects values that may or may not be based on reality and social conventions or norms

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13
Q

Mood

A

A more sustained emotion that may color a person’s view of the world (mood is to affect as climate is to weather)

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14
Q

Language

A

A complex symbolic system for expression, receiving, and comprehending words; as with consciousness, attention and memory

Language is essential for assessing other mental functions

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15
Q

Higher Cognitive Functions

A

Assessed by vocabulary, fund of information, abstract thinking, calculations, construction of objects that have two or three dimensions

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16
Q

Mental Status Exam Components

(5)

A
  1. Appearance/behavior
  2. Speech/language
  3. Mood
  4. Thoughts/perceptions
  5. Cognitive function -
    • memory, attention
    • infromation
    • vocabulary
    • calculations
    • abstract thinking
    • constructional ability
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17
Q

Level of Consciousness + Eval Techniques

(5 levels, techniques, and 4 abnormal responses)

A

See chart

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18
Q

Posture Evaluations

(3)

A
  1. Observe if pt is in bed or walking around
  2. Note body posture
  3. Observe pace, range, and character of movements
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19
Q

Personal Hygiene Observations

A
  1. Clothing - cleaned, pressed, fastened properly?
  2. Grooming - skin, hair, nails, teeth
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20
Q

Facial Expression Observations

A
  • Appropriateness for the topic
  • Face at rest
  • Symmetry
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21
Q

Speech and Language Evaluation

(5 aspects)

A
  1. Quality - talkative vs silent
  2. Rate - slow or fast
  3. Volume - appropriate/inappropriate, loud/soft
  4. Word articulation - spoken clearly and distinctly vs mumbling
  5. Fluency - rate, flow, and melody of speech/content
    • ​hesitancies/gaps in flow and rhythm
    • disturbed inflections or monotone
    • circumlocutions - phrases/sentences are substituted for a word (“what you write with” instead of “pen”)
    • Paraphasias - malformed words (“I write with a den”)
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22
Q

Mood Assessment Technique

A

“How are your spirits?”

23
Q

Orientation Evaluation

A

Figure out knowledge of person, place, and time

For patients you know, preface this with the fact that you have to ask a lot of questions

24
Q

Cognative Evaluation, Attention

(2 methods)

A
  • Serial 7’s - “starting from a hundred, subtract 7, and keep subtracting 7 until I tell you to stop”
  • **Spelling backward **- you say a 5 letter word and spell it: W O R L D, ask the pt to spell it backward
25
Q

Cognitive Functions - Remote Memory

A

Ask pt about birthdays, anniversaries, SSN (ehh…), names of schools attended, job held, or past historical events

Only ask things you know the answer to

26
Q

Cognitive Function Evaluation - Recent Memory

A

Ask the patient about today’s weather, today’s appointment time, how he/she got to the appointment, who is the current president

27
Q

Cognitive Function Evaluation - Short Term Memory

A

Three Word Recall - ask pt to remember 3 unrelaed terms and tell them you will re-ask in 5 minutes

28
Q

Cognitive Functions - Naming/Follwing Instructions

(2 tests)

A
  1. Ask pt to name 2 items found in room
  2. Ask pt to read this card and do what it says (card reads, “CLOSE YOUR EYES”)
29
Q

CN I (Olfactory) Exam

A

Occlude each nostril and test different smells

30
Q

CN II (Optic) Eval

A
  1. Test visual acuity c Snellen eye chart or hand-held card
  2. Inspect fundi
  3. Screen visual fields by confrontation
31
Q

CN II-III (Optic, Oculomotor) Exam

A
  1. Inspect size and shape of pupils
  2. Test reactions to light and accomodation
32
Q

CN III, IV, VI (Oculomotor, Trochlear, Abducens) Evaluation

A
  1. Test EOM c 6 cardinal directions of gaze
  2. Lid elevation
  3. Check convergence
33
Q

CN V (Trigeminal) Evaluation

A
  1. Palpate temporal and masseter muscles while pt clenches teeth
  2. Test forehead, cheeks, and jaw on each side for sharp/dull sensation
34
Q

CN VIII (Facial) Evaluation

A
  1. Assess face or asymmetry, tics, abnormal movements
  2. Ask pt to raise eyebrows, frown, close eyes tightly, snow teeth (grimace), smile, puff both cheeks
35
Q

CN VIII (Acoustic) Evaluation

A

Test hearing, lateralization, and air/bone conduction

36
Q

CN IX, X (glossopharyngeal, vagus) Evaluation

A
  1. Assess if voice is hoarse
  2. Assess swallowing
  3. Assess palate movmenet as pt says “ah”
  4. Test gag reflex, warning pt first
37
Q

CN XI (spinal accessory) Evaluation

A
  • Assess strength as pt shrugs shoulders against your hands
  • Note contraction of opposite SCM, and force as pt turns head against your hands
38
Q

CN XII (Hypoglossal) Evaluation

A

Ask pt to protrude tongue and move it side to side; assess symmetry, atrophy

39
Q

Motor System Examination

(3 aspects)

A

Position, movement, muscle bulk, tone

  • Observe
    • Body position
    • Involuntary movements (tremors, tics, fasciculations)
  • Inspect muscle bulk, ntoe any atrophy
  • Assess muscle tone
    • Flex and extend the arm and lower leg for residual tension → slight resistance to passive stretch
40
Q

Tremor ID

(differentiate b/w real and fake)

A

Grab the limb unexpectedly

Real - tremor continues

Fake - tremor will stop

41
Q

Muscle Strength Grading System

(0-5 scale)

A
  • 0 - no muscular contraction
  • 1 - barely detectable flicker/trace of contraction
  • 2 - active movement of body part c gravity eliminated
  • 3 - active movement against gravity
  • 4 - active movement against gravity and some resistance
  • 5 - active movement agaisnt full resistance s evident fatigue; normal muscle strength
  • Ask pt to move actively against opposing resistance - if opposition resistance is evident then pt receives a grade 5*
  • If pt can only move against gravity assign grade 3*
42
Q

Muscular Strength Eval

(6 muscle groups, evals for each)

A
  1. Biceps/triceps, wrist - flexion + extension
  2. Handgrip, finger - abduction/adduction + thumb opposition
  3. Trunk - flexion, extension, lateral bending
  4. Thorax - expansion, diaphragmatic excursion during respiration
  5. Hip - flexion, extension, abduction, and adduction
  6. Knee and ankle - flexion, extension
43
Q

Coordination Examination

(4)

A
  • Rapidly alternating movements -
    • pt turns hand rapidly over and back on thigh
    • taps tip of index finger rapidly on distal thumb
    • taps ball of foot rapidly on your hand
  • Point-to-point movements -
    • Pt touches nose then your index finger as you move it to different positions
    • Pt moves heel from opposite knee down the shin to the big toe
  • Gait - watch pt do the following
    • Walk across the room
    • Walk heel/toe
    • Walk on toes then heels
    • Hops in place
  • Stance
    • Romberg test - pt stand c feet together and eyes open, then eyes closed for 30-60 sec s support (positive if pt loses balance)
    • Pronator drift - pt stands for 20-30 sec c both arms straight forward, palms up, and eyes closed; tap arms briskly downward (pronation and downward drift of arm is a positive test)
44
Q

General Principles, Sensory Examination

(3)

A
  1. Compare symetric areas on both sides of the body
  2. When testing **pn, temp, and touch, **compared distal c proximal extremities
  3. Map out boundaries of any area of sensory loss or hypersesitivity
45
Q

Sensory System Tests

(5, c procedures)

A
  1. Pain - have pt differentiate between sharp or dull or compare 2 sensations bilaterally on similar dermatomes (use a disposable object like cotton swab or pin)
  2. Light touch - cotton wisp
  3. Vibration - tap 128 -hz tuning fork on your hand, then place it on the DIP joint of the pt’s finger. ask pt if you feel a buxx, tell when it stops. Likewise test over the joint of the big toe
  4. Proprioception - hold big toe by its sides b/w thumb and index finger, pull it away from the other toes and mov it up then down. Ask the pt to ID the direction of movement
  5. Descrimative sensation - evaluated ability of sensory cortex to analyze and interpret sensations. Perform tests if pt struggles c proprioception
    • ​Stereognosis
    • Graphesthesia
    • Two-point descrimination
    • Point localization
    • Extinction
46
Q

Stereognosis

A

Place a ey or familiar object in pt’s hand and ask pt to ID it

47
Q

Number Identification (graphesthesia)

A

Outline a large number on the pt’s hand and ask the pt to ID it

48
Q

Two-Point Discrimination

A

Using two ends of an opened paper clip/pins, touch the finger pad in two places simultaneously. Ask pt to ID 1 vs 2 touches

49
Q

Point Localization

A

Lightly touch a point on the pt’s skin and ask the pt to point to that spot

50
Q

Extinction

A

Touch an area on both sides of teh body at the same time and ask if the pt feels 1 or 2 spots

51
Q

Deep Tendon Reflex Principles

(6)

A
  1. Select properly weighted hammer
  2. Encourage pt to relax; position limbs properly and symmetrically
  3. Hold reflex hammer loosely b/w thumb and index finger so that it swings freely in an arc
  4. Strike the tendon c a brisk direct movement; use the minimum force needed to obtain a response
  5. Use reinforcement when needed to distract pt
    • ​Upper body - clench teeth or push down on bed c thighs
    • Lower body - lock fingers and try to pull hands apart
  6. Grade the response
52
Q

Reflex Grading

(4+ to 0 system)

A
  • 4+ ; very brisk, hyperactive, c clonus (rhythmic oscillations b/w flexion and extension)
    • Clonus - usually elicited @ ankle
  • 3+ ; brisker than average; possibly but not necessary indicative of disease
  • 2+ ; average, normal
  • 1+ ; somewhat diminished, low normal
  • 0 ; no response
53
Q

Deep Tendon Reflexes

(6)

A
  1. Biceps reflex (C5-C6)
  2. Triceps reflex (C6, C7, C8)
  3. Supinator or brachioradialis (C5, C6)
  4. Knee reflex (L3-L4)
  5. Ankle reflex (Primarily S1-S2)
  6. Babinski’s sign (L5-S1)

Physical Diagnosis (10 decks)

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