Neurologic Exam Flashcards
What kind of deep tendon reflexes would you get if you had LOWER motor neuron disease?
Hypoactive
What is the score for movement with full resistance
5
How do you test CN XI?
Shoulder shrug
Head rotation
What can cause an abnormal superficial abdomen reflex?
Central and peripheral pathologies
What nerve root and peripheral nerve do knee extension?
L3 L4
Femoral
What nerve root and peripheral nerve do ankle plantar flexion?
S1
Plantar
When is it helpful to test discriminative sensations?
When touch and position sense are slightly impaired
What can cause athetosis?
Cerebral palsy
What kind of nerve injury can cause a steppage gait?
Lower motor neuron
Peripheral nerve
What are the 2 ways to fail the CN XII test and what does each mean?
Tongue deviates away: central lesion
Tongue deviates to weak side: peripheral lesion
What nerve root and peripheral nerve root are we testing when we ask the patient to extend their wrists (like revving a motorcycle)?
C6 C7
Radial
What can cause a positive pronator drift test?
Upper motor neuron lesion
Stroke
What dermatome is the ulnar forearm?
T1
What is the score for movement against gravity only
3
What is a steppage gait?
“Foot drop”
Patient lifts leg high and foot slaps floor
What is an ataxic gait?
One that lacks coordination and stability
What can cause a pt to fail the CN II exam?
Visual field defect secondary to retinal embolus, optic neuritis, pituitary tumor, stroke
What can cause someone to have a scissors gait?
Spinal cord disease
Spasticity disorders
Cerebral palsy
What disease can cause intention tremors?
Multiple sclerosis
Is CN X motor, sensory or both?
Both.
Motor: palate, pharynx, larynx
Sensory: pharynx, larynx
Cardiac, thorax, and abdomen
What is dystonia?
Twisted posture of large body parts
What can cause a positive finger to nose test?
Intention tremor like MS
What nerve root and peripheral nerve do hip flexion
L2, L3
Femoral
How do we test CN V?
Facial sensation
Clench jaw and lateral jaw movement
What muscles does CN V provide motor innervation to?
Masseter
Temporal
Lateral pterygoids
What could an abnormal body position indicate?
Mono or hemiparesis (stroke)
What can cause a pt to have a non functioning CN I
Anosmia
Head trauma
Parkinson disease
What CN would cause an asymmetric smile
7
What dermatome is the ring finger and pinky?
C8
If you see scapular winging, what CN is broken
CN XI
Is clonus always a sign of upper motor neuron disease?
No, it may be normal if it is present BILATERALLY
Asymmetry indicates abnormality*****
When are postural tremors seen?
When affected area maintains posture
What is a scissors gait
Legs advance slowly and thighs cross
Stiff gait and short steps
Look like walking through water
What is an abnormal gait due to loss in proprioception?
Sensory ataxia
What cranial nerve would cause anosmia?
1
How would you test CN I?
Ask pt to smell a familiar scent
What is the score for joint motion, but only in the absence of gravity
2
What CN may be affected if pt has disequilibrium, vertigo, or nystagmus?
CN VIII
What can cause dyskinesiaS?
Parkinson disease
Psychoses
Medications
How do you do the Romberg test?
Have patient stand with feet together and their eyes closed
See if they lose balance
What are the 4 components of a sensory exam?
Light touch
Pain and temperature (sharp/dull)
Position and vibration (wiggling toe up and down, placing tuning fork on joint)
Discriminative sensation
What nerve root and peripheral nerve do thumb opposition? (OK sign 👌
C8 T1
Median
What is athetosis?
Slow, twisting, writhing movements
How do you test the cremasteric reflex?
Stroke proximal inner thigh and see if the testicle on the same side rises (NORMAL to rise)
What CN would cause shoulder droop?
11
What is upper motor neuron disease?
CNS lesions along descending corticospinal tract
What CN isn’t functioning if pt has eyelid ptosis?
CN III (eyelid droops)
What can cause an ataxic gait?
Cerebellar disease🧠
Loss of proprioception
Intoxication 🍻
What nerve root and peripheral nerve do elbow flexion
C5, C6
Musculocutaneous
How do you check for clonus?
Alternate dorsiflexinf and plantar flexing the patients ankle, then forcefully dorsiflex the ankle
Evaluate for rhythmic oscillations
What dermatome is the middle finger?
C7 🖕
How do you test for Kernig sign?
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
What can cause tics?
Tourette’s syndrome
Medications
What does dysdiadochokinesis mean
Slow, clumsy, irregular movement
What is a normal response to babinksi?
Toes flex
What is the score range given to score deep tendon reflexes?
0-4
What are the 3 cranial nerves of speech?
9, 10 and 12
What can cause a patient to have an absent cremasteric reflex?
Upper motor neuron injury
Lower motor neuron injury
L1 L2 nerve injury
Ilioinguinal injury due to a hernia repair
What are the two ways someone can fail the CN VII test and what does each one mean?
Peripheral: Bell’s palsy
Central: cerebral infarct
What is the score for a normal Deep tendon reflex?
+2
What nerve root and peripheral nerve do hip extension?
L4 L5
Gluteal
What nerve root and peripheral nerve are we checking when we try to squeeze a patient’s spread fingers together?
C8 T1
Ulnar
What dermatome is the lateral and plantar foot?
S1
What is a score given for visible contraction, but no movement?
1
What is the range of scores we can give for muscle strength
0-5
How do you test CN III?
EOM’s (H pattern)
Pupillary light reflex
What never root and peripheral nerve do wrist extension?
C6, C7
Radial
What nerve root and peripheral nerve do elbow extension?
C6, C7
Radial
What kind of gait is sensory ataxia?
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
What nerve root and peripheral nerve do knee flexion?
L5 S1
Sciatic
What dermatome is the belly button
T10
What are dyskinesiaS?
Bizarre, rhythmic, repetitive movements
What can cause akathisia?
Medications, especially antipsychotics and Compazine
How do you do the pronator drift test?
Eyes closed, elevate arms to shoulder and palms up
See if their arm drifts down or pronates
When are the three types of tremor
Static
Postural
Intention
What must you ALWAYS do when checking deep tendon reflexes
Check bilaterally and compare
What is cog-wheel rigidity and what disease is it associated with?
Increased resistance throughout range of motion. “Stop-and-go” effect through ROM maneuver
Parkinson disease
How do you test CN X?
Ask them to say “Ahhhh”
Look for palate elevation, quality of “ah” and uvula midline
What nerve root is checked when you do the patellar reflex
L4
How would you test someone’s ability to concentrate and focus attention?
Serial 7’s
Spell WORLD backwards
What muscle does CN IV do and how do you test it?
Superior oblique which does downward and internal rotation of the eye
Tested with EOMs test
When are intention tremors seen
Absent at rest and appear with movement
What can cause a patient to fail the CN V tests?
Trigeminal neuralgia
How do you test nuchal rigidity?
Flex the patients head toward their chest and look for pain and resistance
What can cause sensory ataxia?
Loss of proprioception
What dermatome is the lateral upper arms?
C5
How do you test CN II?
Visual fields
Acuity
Fundoscopic
Pupillary light reflex
How do you test CN VIII
Gross hearing
Gait
(It is the vestibulocochlear nerve so it does hearing and balance)
What dermatome is the radial forearm and thumb?
C6
What tests recent memory?
Asking pt to repeat the 3 words you gave them 5 minutes prior
What tests would you perform in a patient that complains of headache, neck stiffness, and fever?
Brudzinski
Nuchal rigidity
Kernig
What is a score for an increased deeep tendon reflex?
+3
What does the Romberg test test for?
Position sense
How would you check sensory for a patient who complains of intermittent neck pain and numbness and tingling into the right arm?
Evaluate sensation bilaterally in a dermatomal pattern
How would you test sensory for a screening exam of a patient with a history of diabetes, who denies numbness and tingling?
Check sharp and dull sensation distally and move proximally
What are the two ways a pt can “fail” the heel to shin test and what does each one mean?
Heel overshoots the knee- cerebellar disease
Heel lifts too high off shin- position sense absent
What test is performed by placing a familiar object in the patients hand
Stereognosis
What nerve root and peripheral nerve do ankle dorsiflexion?
L4 L5
Peroneal
What nerve roots are checked when you test the biceps reflex
C5, C6
What nerve roots are checked when you do the brachioradialis reflex?
C5 C6
What kind of deep tendon reflexes would you get with upper motor neuron disease
Hyperactive, may have clonus
What muscle does CN VI innervate?
Lateral rectus
It is the Abducens nerve
What are the 2 ways to do the rapid alternating movements test?
Slapping thighs
Tapping fingers
What is an abnormal babinksi response?
Great toe extends and other toes fan out
What is akathisia?
Inability to sit still
Why do you need to carefully titrations the doses of antipsychotic medications
Akathisia side effect
How do you test CN IX/
Gag reflex
What are the 4 ways to test discriminative sensation?
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)
What can cause a positive rapid alternating movements test?
Cerebellar disease
Causes slow, clumsy, irregular movement
Wat are tics?
Brief repetitive twitching
What can cause postural tremors?
Hyperthyroidism
Anxiety
Fatigue
Can just be benign
What dermatome is the knee and medial shin?
L4
If a patient has a steppage gait, which muscles are weak?
Tibialis anterior
Toe extensor
What nerve root and peripheral nerve do finger abduction?
C8, T1
Ulnar
What nerve root is checked when you do the Achilles reflex
S1
What dermatome is the inguinal region
L1
What can cause dystonia?
Medications
Spasmodic torticollis
What kind of tremor is the pill-rolling tremor seen with parkinson disease
Static- seen at rest
What does a Parkinsonism Gait look like?
Stooped over
Arms flexed
Shuffling short steps
Slow to start
Decreased arm swing
Stiff turns
What nerve root is checked with babinksi
L5 S1
What CN do you think isn’t functioning if the pt is experiencing esotropia and horizontal diplopia?
CN VI
Esotropia: inward drifting of eye
CN VI is abducens and innervates the lateral rectus
What nerve roots are checked when you do the triceps reflex?
C6 C7
What nerve root and peripheral nerve do shoulder abduction?
C5
Axillary
What tests do you perform to evaluate a patient’s’ position sense?
Romberg
Joint position (toe up or down)
Upper or lower motor neuron disease:
Weakness
Spasticity
Positive babinksi sign
Upper
What is lower motor neuron disease?
Diseases of spinal nerve roots or peripheral nerves
How do you test CN XII?
Wag tongue
What is the score for a hyperactive deep tendon reflex with clonus
+4
What dermatome is the anterior/proximal thigh
L3
What dermatome is the lateral shin and dorsal foot to the big toe**
L5
Is CN VII motor, sensory or both?
Both.
Does muscles of facial expression and does taste on anterior tongue
What can cause chorea?
Huntington disease
Rheumatic fever
How do you do the Brudzinski sign?
Flex the patients neck while they’re lying flat on their back and see if their hips and knees flex
What dermatome is the nipple line
T4
What kind of nerve injury can cause spastic hemiparesis?
Corticospinal tract lesions
Upper or lower motor neuron disease:
Weakness
Atrophy
Fasiculations
Lower
What nerve root and peripheral nerve do wrist flexion?
C7 C8
Median
What tests remote memory?
Asking pt well known dates, events, or locations
What is a score for a diminished deep tendon reflex
+1
What is chorea?
Brief, jerky, rapid, unpredictable movements
What can cause Parkinsonian gait?
Basal ganglia abnormalities (like Parkinson’s disease)
When are static tremors seen?
At rest
What is spastic hemiparesis gait?
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
What is required for a deep tendon reflex to get a score of. +4?
Clonus
What nerve root and peripheral nerve are we checking when we ask patient to make the OK sign?
C8 T1
Median nerve
Is CN IX motor, sensory or both?
Both.
Motor: pharynx
Sensory: posterior tongue
