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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
Cognitive Functions - Remote Memory
Ask pt about birthdays, anniversaries, SSN (ehh...), names of schools attended, job held, or past historical events ## Footnote *Only ask things you know the answer to*
26
Cognitive Function Evaluation - Recent Memory
Ask the patient about today's weather, today's appointment time, how he/she got to the appointment, who is the current president
27
Cognitive Function Evaluation - Short Term Memory
**Three Word Recall** - ask pt to remember 3 unrelaed terms and tell them you will re-ask in 5 minutes
28
Cognitive Functions - Naming/Follwing Instructions (2 tests)
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
CN I (Olfactory) Exam
Occlude each nostril and test different smells
30
CN II (Optic) Eval
1. Test visual acuity c Snellen eye chart or hand-held card 2. Inspect fundi 3. Screen visual fields by confrontation
31
CN II-III (Optic, Oculomotor) Exam
1. Inspect size and shape of pupils 2. Test reactions to light and accomodation
32
CN III, IV, VI (Oculomotor, Trochlear, Abducens) Evaluation
1. Test EOM c 6 cardinal directions of gaze 2. Lid elevation 3. Check convergence
33
CN V (Trigeminal) Evaluation
1. Palpate temporal and masseter muscles while pt clenches teeth 2. Test forehead, cheeks, and jaw on each side for sharp/dull sensation
34
CN VIII (Facial) Evaluation
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
CN VIII (Acoustic) Evaluation
Test hearing, lateralization, and air/bone conduction
36
CN IX, X (glossopharyngeal, vagus) Evaluation
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
CN XI (spinal accessory) Evaluation
* Assess strength as pt shrugs shoulders against your hands * Note contraction of opposite SCM, and force as pt turns head against your hands
38
CN XII (Hypoglossal) Evaluation
Ask pt to protrude tongue and move it side to side; assess symmetry, atrophy
39
Motor System Examination | (3 aspects)
*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
Tremor ID | (differentiate b/w real and fake)
Grab the limb unexpectedly Real - tremor continues Fake - tremor will stop
41
Muscle Strength Grading System | (0-5 scale)
* 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
Muscular Strength Eval | (6 muscle groups, evals for each)
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
Coordination Examination | (4)
* **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
General Principles, Sensory Examination | (3)
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
Sensory System Tests | (5, c procedures)
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
Stereognosis
Place a ey or familiar object in pt's hand and ask pt to ID it
47
Number Identification (graphesthesia)
Outline a large number on the pt's hand and ask the pt to ID it
48
Two-Point Discrimination
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
Point Localization
Lightly touch a point on the pt's skin and ask the pt to point to that spot
50
Extinction
Touch an area on both sides of teh body at the same time and ask if the pt feels 1 or 2 spots
51
Deep Tendon Reflex Principles | (6)
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
Reflex Grading | (4+ to 0 system)
* 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
Deep Tendon Reflexes | (6)
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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