Neurologic Examination Flashcards
Any detectable change produced by neural activation of an effector
Behavior
If restricted to one part of the examination, this is the most efficient method of physical diagnosis
Inspection
site of deposition of the Kayser-Fleischer ring
Descemet membrane
Kayser-Fleischer ring can be found in what other conditions aside from Wilson hepatolenticular degeneration?
Aceruloplasmimemia, Primary biliary cirrhosis, Hardikar syndrome, hypercupremia
A unilateral corneal arcus is diagnostic of what condition?
Carotid Artery Stenosis
Intercanthal distance of normal eyes in the newborn
1.9 cm
Condition when the medial orbital walls and consequently the eyes are set too far apart?
Orbital Hypertelorism
Facial hemangiomas in Sturge-Weber Syndrome occurs in what distribution of the trigeminal nerve?
V1 distribution
Pathologic bruits become audible over the carotids after how many % stenosis?
50%
Peripheral ocular motor nerves consists of
III, IV, VI and carotid sympathetic nerve
T/F: The mind projects afferent impulses to their usual site of origin in all sensory systems
True
The retinopretectal tract is for
pupilloconstriction to light
The retinohypothalamic tract is for
diurnal cycle of sleep and wakefulness
The retinogeniculate tract is for
vision
Cones mediate
central field of vision, visual acuity, color vision
Rods mediate
peripheral field of vision, night vision and motion detection
Extent of the total field of peripheral vision
180 degrees wide
A central scotoma that blends with the blind spot is called
centrocecal scotoma (paracentral-near the point of central vision but detached from it)
Eye to eye distance during the confrontation testing
50cm
Characteristics of cortical blindness
1) complete blindness with no light perception and no response to a menacing gesture
2) loss of smooth pursuit
3) No optokinetic nystagmus
4) Normal pupillary reactions, fundoscopic examination and no nystagmus
5) Denial of blindness
T/F: Visible pulsations occur in nearly 90% of normal patients when both eyes are examined.
True
Swollen disc, normal vision
papilledema
Swollen disc, blurred vision
papillitis
Normal disc, blurred vision
Acute retrobulbar neuritis
Muscle with the strongest depressant action when the eye is adducted
Superior Oblique
Muscle with the strongest depressant action when the eye is abducted
Inferior Rectus
The only EOM that originates anteriorly?
Inferior oblique
Upward deviation of an eye only during occlusion of central vision?
Hyperphoria
A patient with right lateral rectus palsy would tend to keep the head turned to the ________.
right
T/F: When the patient complains of diplopia, the false image projects in the opposite direction as the direction of the eye deviation
True
Mediates the smooth pursuit system
Retino-geniculo-occipito-parieto-frontal-tegmental pathways
Alexander’s Law
Looking in the direction of the fast phase of a jerk nystagmus increases its amplitude
If the patient can move the jaw to the right but not to the left, the ___________ muscle is paralysed.
Right lateral pterygoid muscle
Which chewing muscle can you most readily palpate to check for atrophy?
Masseter
Many axial muscles that ordinarily contract symmetrically have __________ UMN innervation.
bilateral
The freest unilateral facial movement normally is
lip retraction
CN IX exclusively supplies this muscle?
Stylopharyngeus
In a normal patient, he/she should swallow a glass of tap water at a rate exceeding ___ ml/s.
10 ml/s
If the palate fails to elevate when the patient says Ah but does not elevate during the gag reflex, there is a lesion of the ____.
UMN
The most reliable sign of CN XII lesion?
hemiatrophy
In activating muscles for voluntary contractions, the cerebrum communicates with the cerebellum via the corticopontocerebellar pathway, which ends mainly in the ________ lobe of the cerebellum.
Posterior
T/F: The Geniculate ganglion is the only ganglion of CN VII.
True
T/F: The muscles are strongest when acting from their shortest position.
True
Muscles required in arm abduction
supraspinatus, deltoid, scapular muscles
Muscles that hold the scapula in place against the chest wall
serratus anterior and trapezius
T/F: If some abdominal muscles are weak, the umbilicus will migrate away from the pull of the intact muscles during strong abdominal contraction.
True
T/F: No normal person show percussion myotonia because it indicates a primary disease of the muscle.
True
T/F: Hung-up reflexes are mostly seen in patients with hypothyroidism.
True
T/F: Using the counterpressure method of reinforcement to elicit muscle stretch reflex, the patient contract weakly the muscle being tested.
True
T/F: Fibrillations begin about three weeks after denervation and continue for as long as the denervated muscle fiber remains alive, until the final stage of denervation atrophy when the muscle fibres die.
True
T/F: The resistance in the catch-and-yield sequence of spasticity is simply a muscle stretch reflex which then fades out as the muscle spindles readjust.
True
T/F: Clasp-knife spasticity indicates a lesion of the pyramidal tract whereas lead-pipe rigidity indicates a lesion of the extrapyramidal tracts.
True
T/F: The sciatic nerve divides into two large branches just proximal to the knee; the branch to the toe flexors is the tibial nerve and the branch to the extensors is the peroneal nerve.
True
First spinal reflex to return after spinal shock
Anal reflex
Minimum rate of conduction of myelinated nerve fibers
3m/s
Most sensitive area for temperature discrimination
forehead
T/F: Pain of neurogenic origin arises from some form of heightened sensitivity from a lesion that affects the peripheral or central nervous system, apart from stimulation of local pain endings
True
T/F: The crossed, straight leg-raising sign is nearly pathognomonic of a herniated disc.
True
T/F: When testing proprioception, using digit 4 presents the greatest challenge to and therefore the best test of position sense.
True
What is the minimum number of trials that the patient must get right to make chance unlikely in testing proprioception?
5
T/F: The gag reflex is often absent in healthy adults and studies in stroke patients have not shown a consistent relation between an absent gag reflex and swallowing problems
True
T/F: A consistent difference of more than 10-20 mmHg between the two arms suggest proximal occlusive disease, usually of one of the subclavian arteries
True
This is the keystone cerebral lobe
Parietal lobe
This cerebral lobe attaches the four lobes to the hemispheric hilus
Limbic lobe
Regarded as the axis of symmetry of the brachial plexus
C7
T/F: C1 does not have a sensory branch
True
T/F: The reticular formation extends through the tegmentum from the rostral end of the spinal cord into the caudal end of the diencephalon
True
T/F: The retinal image is reversed not only laterally but also vertically.
True
T/F: Hemianopia is detected by using one stimulus whereas visual inattention is detected by using simultaneous stimuli.
True
T/F: Because of the absence of visible pulsations in some normal persons, the presence of pulsation is more important tan its absence.
True
The drusen or hyaloid bodies pressing up from beneath the nerve fiber layer may cause this condition?
pseudopapilledema
Optic nerve hypoplasia associated with underdevelopment of septal region, hypothalamus and pituitary gland
septooptic dysplasia
It is the only ocular muscle that originates anteriorly.
Inferior oblique muscle
Two major actions of the lateral pterygoid muscles
Lateral movement and opening of the jaw
T/F: Interruption of sensory afferents from the muscle will not cause paralysis.
True
The patient has areflexia, hypotonia, loss of sensation but no atrophy, weakness or EMG abnormalities noted. Where is the lesion?
Dorsal root
Usual time required for the denervation signs such as fibrillations to appear
3 weeks
2 cranial nerves that supply sensory fibers to the olfactory epithelium
I, V
Cortical representation of gustatory sensation
Insular cortex (island of reil) Adjacent parietal operculum (area 43 of brodmann)
T/F: To present the most uniform sound, hold the tuning fork prongs perpendicular, not parallel to the patient’s ears.
True
T/F: Vertigo means a specific sense of dysequilibrium as though the person or the world were spinning around or undergoing a swerving or tilting movement.
True
T/F: Positional nystagmus provides an objective sign of organic disease of the labyrinthine system
True
Tullio phenomenon accompanied by tinnitus, hearing loss and ear pressure sensitivity is attributed to what condition?
Perilymphatic fistula and superior canal dehiscence
T/F: The cerebellum has no clinically evident role in the conscious appreciation of sensation despite massive sensory connections.
True
Largest lobe of the cerebellum
Posterior lobe
It is the most sensitive clinical test for gait ataxia
tandem walking
T/F: Nerve fibers conducting faster than 3m/s are myelinated.
True
It is the most sensitive area for temperature discrimination.
Forehead
It is the part of the dorsal horn that relays pain and temperature.
Substantia gelatinosa of Rolando
It is the largest branch of the median nerve.
Anterior interosseous nerve
T/F: In testing position sense, where chance has a 50% success rate, the smallest number of trials the patient must get right to make chance unlikely is five trials.
True
It means the inability to perform a voluntary act even though the motor system, sensory system and mental status are relatively intact.
Apraxia
T/F: Apraxic patients are often unaware of their deficits and may do an act automatically that they cannot do on command.
True
It is submerged area between the transverse temporal gyri and the posterior end of the Sylvian fissure.
Planum Temporale
It is a false sensory perception based on natural stimulation of a sensory receptor.
Illusion
It is a false sensory perception not based on natural stimulation of a sensory receptor.
Hallucination
It is a false belief that reason cannot dispel.
Delusion
It means the inability to locate, identify and orient one’s body parts.
Autotopagnosia
A sign where an unconscious patient show a variety of mutterings, shivers, myoclonias, patterned movements of choreiform or aimless picking at the bedclothes.
Carphologia
