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Physical Diagnosis Exam 3 (Lauren) > Neurologic Exam > Flashcards

Neurologic Exam Flashcards

1
Q

What kind of deep tendon reflexes would you get if you had LOWER motor neuron disease?

A

Hypoactive

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2
Q

What is the score for movement with full resistance

A

5

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3
Q

How do you test CN XI?

A

Shoulder shrug

Head rotation

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4
Q

What can cause an abnormal superficial abdomen reflex?

A

Central and peripheral pathologies

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5
Q

What nerve root and peripheral nerve do knee extension?

A

L3 L4

Femoral

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6
Q

What nerve root and peripheral nerve do ankle plantar flexion?

A

S1

Plantar

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7
Q

When is it helpful to test discriminative sensations?

A

When touch and position sense are slightly impaired

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8
Q

What can cause athetosis?

A

Cerebral palsy

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9
Q

What kind of nerve injury can cause a steppage gait?

A

Lower motor neuron

Peripheral nerve

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10
Q

What are the 2 ways to fail the CN XII test and what does each mean?

A

Tongue deviates away: central lesion

Tongue deviates to weak side: peripheral lesion

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11
Q

What nerve root and peripheral nerve root are we testing when we ask the patient to extend their wrists (like revving a motorcycle)?

A

C6 C7

Radial

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12
Q

What can cause a positive pronator drift test?

A

Upper motor neuron lesion

Stroke

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13
Q

What dermatome is the ulnar forearm?

A

T1

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14
Q

What is the score for movement against gravity only

A

3

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15
Q

What is a steppage gait?

A

“Foot drop”

Patient lifts leg high and foot slaps floor

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16
Q

What is an ataxic gait?

A

One that lacks coordination and stability

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17
Q

What can cause a pt to fail the CN II exam?

A

Visual field defect secondary to retinal embolus, optic neuritis, pituitary tumor, stroke

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18
Q

What can cause someone to have a scissors gait?

A

Spinal cord disease

Spasticity disorders

Cerebral palsy

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19
Q

What disease can cause intention tremors?

A

Multiple sclerosis

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20
Q

Is CN X motor, sensory or both?

A

Both.

Motor: palate, pharynx, larynx

Sensory: pharynx, larynx

Cardiac, thorax, and abdomen

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21
Q

What is dystonia?

A

Twisted posture of large body parts

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22
Q

What can cause a positive finger to nose test?

A

Intention tremor like MS

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23
Q

What nerve root and peripheral nerve do hip flexion

A

L2, L3

Femoral

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24
Q

How do we test CN V?

A

Facial sensation

Clench jaw and lateral jaw movement

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25
Q

What muscles does CN V provide motor innervation to?

A

Masseter

Temporal

Lateral pterygoids

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26
Q

What could an abnormal body position indicate?

A

Mono or hemiparesis (stroke)

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27
Q

What can cause a pt to have a non functioning CN I

A

Anosmia

Head trauma

Parkinson disease

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28
Q

What CN would cause an asymmetric smile

A

7

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29
Q

What dermatome is the ring finger and pinky?

A

C8

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30
Q

If you see scapular winging, what CN is broken

A

CN XI

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31
Q

Is clonus always a sign of upper motor neuron disease?

A

No, it may be normal if it is present BILATERALLY

Asymmetry indicates abnormality*****

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32
Q

When are postural tremors seen?

A

When affected area maintains posture

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33
Q

What is a scissors gait

A

Legs advance slowly and thighs cross

Stiff gait and short steps

Look like walking through water

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34
Q

What is an abnormal gait due to loss in proprioception?

A

Sensory ataxia

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35
Q

What cranial nerve would cause anosmia?

A

1

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36
Q

How would you test CN I?

A

Ask pt to smell a familiar scent

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37
Q

What is the score for joint motion, but only in the absence of gravity

A

2

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38
Q

What CN may be affected if pt has disequilibrium, vertigo, or nystagmus?

A

CN VIII

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39
Q

What can cause dyskinesiaS?

A

Parkinson disease

Psychoses

Medications

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40
Q

How do you do the Romberg test?

A

Have patient stand with feet together and their eyes closed

See if they lose balance

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41
Q

What are the 4 components of a sensory exam?

A

Light touch

Pain and temperature (sharp/dull)

Position and vibration (wiggling toe up and down, placing tuning fork on joint)

Discriminative sensation

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42
Q

What nerve root and peripheral nerve do thumb opposition? (OK sign 👌

A

C8 T1

Median

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43
Q

What is athetosis?

A

Slow, twisting, writhing movements

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44
Q

How do you test the cremasteric reflex?

A

Stroke proximal inner thigh and see if the testicle on the same side rises (NORMAL to rise)

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45
Q

What CN would cause shoulder droop?

A

11

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46
Q

What is upper motor neuron disease?

A

CNS lesions along descending corticospinal tract

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47
Q

What CN isn’t functioning if pt has eyelid ptosis?

A

CN III (eyelid droops)

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48
Q

What can cause an ataxic gait?

A

Cerebellar disease🧠

Loss of proprioception

Intoxication 🍻

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49
Q

What nerve root and peripheral nerve do elbow flexion

A

C5, C6

Musculocutaneous

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50
Q

How do you check for clonus?

A

Alternate dorsiflexinf and plantar flexing the patients ankle, then forcefully dorsiflex the ankle

Evaluate for rhythmic oscillations

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51
Q

What dermatome is the middle finger?

A

C7 🖕

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52
Q

How do you test for Kernig sign?

A

While patient is lying on back, flex their hip and knee, then straighten the knee.
Back pain and resistance indicate meninges irritation, but their hamstrings could also be tight

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53
Q

What can cause tics?

A

Tourette’s syndrome

Medications

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54
Q

What does dysdiadochokinesis mean

A

Slow, clumsy, irregular movement

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55
Q

What is a normal response to babinksi?

A

Toes flex

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56
Q

What is the score range given to score deep tendon reflexes?

A

0-4

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57
Q

What are the 3 cranial nerves of speech?

A

9, 10 and 12

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58
Q

What can cause a patient to have an absent cremasteric reflex?

A

Upper motor neuron injury

Lower motor neuron injury

L1 L2 nerve injury

Ilioinguinal injury due to a hernia repair

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59
Q

What are the two ways someone can fail the CN VII test and what does each one mean?

A

Peripheral: Bell’s palsy

Central: cerebral infarct

60
Q

What is the score for a normal Deep tendon reflex?

A

+2

61
Q

What nerve root and peripheral nerve do hip extension?

A

L4 L5

Gluteal

62
Q

What nerve root and peripheral nerve are we checking when we try to squeeze a patient’s spread fingers together?

A

C8 T1

Ulnar

63
Q

What dermatome is the lateral and plantar foot?

A

S1

64
Q

What is a score given for visible contraction, but no movement?

A

1

65
Q

What is the range of scores we can give for muscle strength

A

0-5

66
Q

How do you test CN III?

A

EOM’s (H pattern)

Pupillary light reflex

67
Q

What never root and peripheral nerve do wrist extension?

A

C6, C7

Radial

68
Q

What nerve root and peripheral nerve do elbow extension?

A

C6, C7

Radial

69
Q

What kind of gait is sensory ataxia?

A

Unsteady, wide based

Throw feet forward, bring heel down, then toes with a double tap*

They watch the ground to see where they’re going

70
Q

What nerve root and peripheral nerve do knee flexion?

A

L5 S1

Sciatic

71
Q

What dermatome is the belly button

A

T10

72
Q

What are dyskinesiaS?

A

Bizarre, rhythmic, repetitive movements

73
Q

What can cause akathisia?

A

Medications, especially antipsychotics and Compazine

74
Q

How do you do the pronator drift test?

A

Eyes closed, elevate arms to shoulder and palms up

See if their arm drifts down or pronates

75
Q

When are the three types of tremor

A

Static

Postural

Intention

76
Q

What must you ALWAYS do when checking deep tendon reflexes

A

Check bilaterally and compare

77
Q

What is cog-wheel rigidity and what disease is it associated with?

A

Increased resistance throughout range of motion. “Stop-and-go” effect through ROM maneuver

Parkinson disease

78
Q

How do you test CN X?

A

Ask them to say “Ahhhh”

Look for palate elevation, quality of “ah” and uvula midline

79
Q

What nerve root is checked when you do the patellar reflex

A

L4

80
Q

How would you test someone’s ability to concentrate and focus attention?

A

Serial 7’s

Spell WORLD backwards

81
Q

What muscle does CN IV do and how do you test it?

A

Superior oblique which does downward and internal rotation of the eye

Tested with EOMs test

82
Q

When are intention tremors seen

A

Absent at rest and appear with movement

83
Q

What can cause a patient to fail the CN V tests?

A

Trigeminal neuralgia

84
Q

How do you test nuchal rigidity?

A

Flex the patients head toward their chest and look for pain and resistance

85
Q

What can cause sensory ataxia?

A

Loss of proprioception

86
Q

What dermatome is the lateral upper arms?

A

C5

87
Q

How do you test CN II?

A

Visual fields

Acuity

Fundoscopic

Pupillary light reflex

88
Q

How do you test CN VIII

A

Gross hearing

Gait

(It is the vestibulocochlear nerve so it does hearing and balance)

89
Q

What dermatome is the radial forearm and thumb?

A

C6

90
Q

What tests recent memory?

A

Asking pt to repeat the 3 words you gave them 5 minutes prior

91
Q

What tests would you perform in a patient that complains of headache, neck stiffness, and fever?

A

Brudzinski

Nuchal rigidity

Kernig

92
Q

What is a score for an increased deeep tendon reflex?

A

+3

93
Q

What does the Romberg test test for?

A

Position sense

94
Q

How would you check sensory for a patient who complains of intermittent neck pain and numbness and tingling into the right arm?

A

Evaluate sensation bilaterally in a dermatomal pattern

95
Q

How would you test sensory for a screening exam of a patient with a history of diabetes, who denies numbness and tingling?

A

Check sharp and dull sensation distally and move proximally

96
Q

What are the two ways a pt can “fail” the heel to shin test and what does each one mean?

A

Heel overshoots the knee- cerebellar disease

Heel lifts too high off shin- position sense absent

97
Q

What test is performed by placing a familiar object in the patients hand

A

Stereognosis

98
Q

What nerve root and peripheral nerve do ankle dorsiflexion?

A

L4 L5

Peroneal

99
Q

What nerve roots are checked when you test the biceps reflex

A

C5, C6

100
Q

What nerve roots are checked when you do the brachioradialis reflex?

A

C5 C6

101
Q

What kind of deep tendon reflexes would you get with upper motor neuron disease

A

Hyperactive, may have clonus

102
Q

What muscle does CN VI innervate?

A

Lateral rectus

It is the Abducens nerve

103
Q

What are the 2 ways to do the rapid alternating movements test?

A

Slapping thighs

Tapping fingers

104
Q

What is an abnormal babinksi response?

A

Great toe extends and other toes fan out

105
Q

What is akathisia?

A

Inability to sit still

106
Q

Why do you need to carefully titrations the doses of antipsychotic medications

A

Akathisia side effect

107
Q

How do you test CN IX/

A

Gag reflex

108
Q

What are the 4 ways to test discriminative sensation?

A

Stereognosis (put familiar object in hand)

Grapesthesia (draw number on hand)

Two-point discrimination (do you feel 1 or 2 points)

Extinction (touch pt in same place on both sides of body)

109
Q

What can cause a positive rapid alternating movements test?

A

Cerebellar disease

Causes slow, clumsy, irregular movement

110
Q

Wat are tics?

A

Brief repetitive twitching

111
Q

What can cause postural tremors?

A

Hyperthyroidism

Anxiety

Fatigue

Can just be benign

112
Q

What dermatome is the knee and medial shin?

A

L4

113
Q

If a patient has a steppage gait, which muscles are weak?

A

Tibialis anterior

Toe extensor

114
Q

What nerve root and peripheral nerve do finger abduction?

A

C8, T1

Ulnar

115
Q

What nerve root is checked when you do the Achilles reflex

A

S1

116
Q

What dermatome is the inguinal region

A

L1

117
Q

What can cause dystonia?

A

Medications

Spasmodic torticollis

118
Q

What kind of tremor is the pill-rolling tremor seen with parkinson disease

A

Static- seen at rest

119
Q

What does a Parkinsonism Gait look like?

A

Stooped over

Arms flexed

Shuffling short steps

Slow to start

Decreased arm swing

Stiff turns

120
Q

What nerve root is checked with babinksi

A

L5 S1

121
Q

What CN do you think isn’t functioning if the pt is experiencing esotropia and horizontal diplopia?

A

CN VI

Esotropia: inward drifting of eye

CN VI is abducens and innervates the lateral rectus

122
Q

What nerve roots are checked when you do the triceps reflex?

A

C6 C7

123
Q

What nerve root and peripheral nerve do shoulder abduction?

A

C5

Axillary

124
Q

What tests do you perform to evaluate a patient’s’ position sense?

A

Romberg

Joint position (toe up or down)

125
Q

Upper or lower motor neuron disease:

Weakness

Spasticity

Positive babinksi sign

A

Upper

126
Q

What is lower motor neuron disease?

A

Diseases of spinal nerve roots or peripheral nerves

127
Q

How do you test CN XII?

A

Wag tongue

128
Q

What is the score for a hyperactive deep tendon reflex with clonus

A

+4

129
Q

What dermatome is the anterior/proximal thigh

A

L3

130
Q

What dermatome is the lateral shin and dorsal foot to the big toe**

A

L5

131
Q

Is CN VII motor, sensory or both?

A

Both.

Does muscles of facial expression and does taste on anterior tongue

132
Q

What can cause chorea?

A

Huntington disease

Rheumatic fever

133
Q

How do you do the Brudzinski sign?

A

Flex the patients neck while they’re lying flat on their back and see if their hips and knees flex

134
Q

What dermatome is the nipple line

A

T4

135
Q

What kind of nerve injury can cause spastic hemiparesis?

A

Corticospinal tract lesions

136
Q

Upper or lower motor neuron disease:
Weakness

Atrophy

Fasiculations

A

Lower

137
Q

What nerve root and peripheral nerve do wrist flexion?

A

C7 C8

Median

138
Q

What tests remote memory?

A

Asking pt well known dates, events, or locations

139
Q

What is a score for a diminished deep tendon reflex

A

+1

140
Q

What is chorea?

A

Brief, jerky, rapid, unpredictable movements

141
Q

What can cause Parkinsonian gait?

A

Basal ganglia abnormalities (like Parkinson’s disease)

142
Q

When are static tremors seen?

A

At rest

143
Q

What is spastic hemiparesis gait?

A

Arm is flexed and held close to side with wrists and fingers also flexed

Drags toe, circles leg stiffly outward and might lean trunk to the other side to clear the affected leg

Ankles are plantar flexed and inverted

144
Q

What is required for a deep tendon reflex to get a score of. +4?

A

Clonus

145
Q

What nerve root and peripheral nerve are we checking when we ask patient to make the OK sign?

A

C8 T1

Median nerve

146
Q

Is CN IX motor, sensory or both?

A

Both.

Motor: pharynx

Sensory: posterior tongue

Physical Diagnosis Exam 3 (Lauren) (4 decks)

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