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Neurology > Neurologic Examination > Flashcards

Neurologic Examination Flashcards

1
Q

Tools for a neurologic examination

A
  • Reflex hammer/Pleximeter
  • Hemostat
  • Lens
  • Light
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2
Q

Things to assess when looking at the patient

A
  • Mental status (Are they aware?)
  • Posture (is head moving independently)
  • Gait evaluation (ataxia?)
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3
Q

Conscious proprioception - describe how to do. What is normal?

A
  • Make sure they’re square
  • Flip the feet over, contact the floor, and replace the limb
  • DO they have the ability to replace the limb?
  • Normal is replacing within 1 sec; compare all 4 legs to each other
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4
Q

Conscious proprioception pathway

A
  • Goes from the foot to the cortex and efferent motor pathway
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5
Q

Where could CP deficits possibly localize?

A
  • Foot, leg, spinal cord, brain
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6
Q

What are other ways to test conscious proprioception?

A
  • Hopping
  • Hemiwalking
  • Wheelbarrowing
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7
Q

What’s the difference between a reflex and a response?

A
  • Responses go to the cortex, while reflexes do NOT
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8
Q

How many spinal cord segments are there for dogs and cats?

A
  • 8 cervical
  • 13 thoracic
  • 7 lumbar
  • 3 sacral
  • 5 caudal
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9
Q

Thoracic intumescence - which SPINAL CORD segments?

A
  • C6, C7, C8, T1, T2
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10
Q

Pelvic intumescence, which spinal cord segments?

A

L4, L5, L6, L7, S1

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11
Q

How many synapses are in the patellar reflex?

A
  • Monosynaptic
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12
Q

Which spinal cord segments and nerves are involved in the patellar reflex (i.e. where could the lesion be if there’s an absent or decreased patellar reflex)?

A
  • L4-6 spinal cord segments and nerve roots

- Also femoral nerve

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13
Q

Femoral nerve function

A
  • Innervates the quadriceps for extension of the stifle
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14
Q

How many synapses are in the withdrawal reflex in both the forelimb and hindlimb?

A
  • Polysynaptic for both
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15
Q

Which spinal cord segments and nerves are involved in the withdrawal reflex in the hindlimb (i.e. where could the lesion be if there’s an absent or decreased withdrawal reflex)?

A
  • L6-S1

- Sciatic nerve

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16
Q

Which spinal cord segments and nerves are involved in the withdrawal reflex in the forelimb (i.e. where could the lesion be if there’s an absent or decreased withdrawal reflex)?

A
  • C6-T2

- Multiple nerves

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17
Q

Function of sciatic nerve

A
  • Innervates muscles for flexion of the limb
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18
Q

What does positive deep pain sensation require?

A
  • CORTICAL response such as crying, biting, or trying to get away
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19
Q

Does intact withdrawal of the hind limb suggest that the patient can feel it?

A
  • No
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20
Q

When is the only time you need to do deep pain testing?

A
  • If there’s no motor in the hind limbs
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21
Q

What are the other spinal reflexes that are less reliable but can still be done?

A
  • Biceps reflex
  • Triceps reflex
  • Extensor carpi radialis reflex
  • Gastrocnemius reflex
  • Cranial tibial reflex
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22
Q

Cutaneous trunci reflex - what should you see if it’s intact?

A
  • Should see a BILATERAL CONTRACTION

- Travels up bilaterally

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23
Q

What is a pinch dermatome?

A
  • The area of skin for an individual dorsal root
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24
Q

What is being tested with the cutaneous trunci reflex?

A
  • Travels up bilaterally and exits at C8-T1

- Both lateral thoracic nerve (C8-T1)

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25
Q

CN I

  • Which nerve?
  • Sensory/Motor/Both
  • What does it do?
A
  • Olfactory nerve
  • Sensory
  • Smell!
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26
Q

CN II

  • Which nerve?
  • Sensory/Motor/Both
  • What does it do?
A
  • Optic nerve
  • Sensory
  • Vision!
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27
Q

CN III

  • Which nerve?
  • Sensory/Motor/Both
  • What does it do?*
A
  • Oculomotor nerve
  • Motor
  • Extraocular muscles: medial, dorsal, ventral rectus; ventral oblique; levator palpebrae; constrict muscles of the pupil (parasympathetic)
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28
Q

CN IV

  • Which nerve?
  • Sensory/Motor/Both
  • What does it do?*
A
  • Trochlear nerve
  • Motor
  • Contralateral dorsal oblique (skeletal muscle)
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29
Q

CN V

  • Which nerve?
  • Sensory/Motor/Both
  • What does it do?
A
  • Trigeminal nerve
  • BOTH
  • See separate flashcard for the different parts
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30
Q

CN VI

  • Which nerve?
  • Sensory/Motor/Both
  • What does it do?*
A
  • Abducens nerve
  • Motor
  • Lateral rectus and retractor bulbi
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31
Q

CN VII

  • Which nerve?
  • Sensory/Motor/Both
  • What does it do?
A
  • Facial nerve
  • BOTH
  • Sensory to middle ear, blood vessels of head; sensory to palate, rostral 2/3 of tongue for taste
  • Motor to muscles of facial expression (ears, eyelid - orbicularis oculi, cheeks, lips, rostral digastricus; mandibular/submandibular salivary glands, lacrimal glands***, nasal glands)
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32
Q

CN VIII

  • Which nerve?
  • Sensory/Motor/Both
  • What does it do?
A
  • Vestibulocochlear nerve
  • Sensory
  • Hearing and vestibular system
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33
Q

CN IX

  • Which nerve?
  • Sensory/Motor/Both
  • What does it do?
A
  • Glossopharyngeal
  • Both
  • Sensory to the CAROTID body and sinus; caudal tongue and rostral pharynx
  • Motor to pharyngeal muscles (skeletal); zygomatic/parotid salivary lands
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34
Q

CN X

  • Which nerve?
  • Sensory/Motor/Both
  • What does it do?
A
  • Vagus
  • Both
  • Sensory to AORTIC body/sinus, pharynx, larynx, thoracic/abdominal cavity; caudal pharynx and larynx
  • Motor to the pharynx, larynx, esophagus; esophagus, organs of the thorax/abdomen
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35
Q

CN XI

  • Which nerve?
  • Sensory/Motor/Both
  • What does it do?
A
  • Accessory
  • Motor
  • Motor to esophagus, organs of thorax and abdomen via parasympathetic by joining the vagus; motor to the pharynx, larynx, esophagus by joining the vagus
  • External branch is motor to the trapezius, sternocephalicus, brachicephalicus
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36
Q

CN XII

  • Which nerve?
  • Sensory/Motor/Both
  • What does it do?
A
  • Hypoglossal

- Motor to the tongue (skeletal)

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37
Q

Frontal lobe - which cortex?

A
  • Motor cortex
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38
Q

Parietal lobe - which cortex?

A
  • Somatosensory cortex
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39
Q

Occipital lobe - which cortex?

A
  • Visual cortex
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40
Q

Temporal lobe - which cortex?

A
  • Auditory cortex, behavioral cortex
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41
Q

Which CN are supratentorial?

A
  • CN I and CN II (olfactory and optic)
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42
Q

Which CN are infratentorial?

A
  • CN 3-12
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43
Q

An animal comes in with facial paralysis, difficulty swallowing, lateral strabismus - are you thinking supratentorial or infratentorial?

A
  • Thinking infratentorial
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44
Q

Where do most CNs exit?

A
  • Through some important holes in the bottom of the skull
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45
Q

Mnemonic for CNs

A
  • Some
  • Say
  • Marry
  • Money
  • But
  • My
  • Brother
  • Says
  • Big
  • Brains
  • Matter
  • More
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46
Q

CN I - where are cell bodies? Where do axons enter through?

A
  • Cell bodies in olfactory epithelium of the ethmoid

- Axons enter through the cribriform plate to reach the olfactory bulb

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47
Q

CN II - where are cell bodies? Where do axons enter through?

A
  • Cell bodies in the ganglionic layer of the retina

- Axon enters the optic canal

48
Q

Pathway of CN II - and at what point does it become contralateral?

A
  • Cell bodies in the ganglionic layer of the retina –> axon enters optic canal –> optic chiasm –> optic tract* –> optic radiation* –> occipital lobe (visual cortex)*
49
Q

What are the three branches of CN V?

A
  • Ophthalmic
  • Maxillary
  • Mandibular
50
Q

Ophthalmic branch of CN V

  • Sensory/Motor/Both
  • What does it do?
A
  • Sensory to the eyeball and MEDIAL canthus
51
Q

Maxillary branch of CN V

  • Sensory/Motor/Both
  • What does it do?
A
  • Sensory to the maxilla

- Lateral canthus maybe?

52
Q

Mandibular branch of CN V

  • Sensory/Motor/Both
  • What does it do?
A
  • Sensory to mandible

- MOTOR to the muscles of mastication (masseter, temporalis, caudal digastricus (skeletal)

53
Q

Which cranial nerve is sensory to the carotid body?

A
  • Glossopharyngeal
54
Q

Which cranial nerve is sensory to the aortic body?

A
  • Vagus
55
Q

Which CNs have parasympathetic function?

A
  • CN III (constricts pupil)
  • CN VII (motor to mandibular/submandibular salivary glands, lacrimal glands, and nasal glands)
  • CN IX (motor to zygomatic and parotid salivary glands)
  • CN X (motor to esophagus, organs of the thorax and abdomen)
  • CN XI (joins with vagus)
56
Q

Which nerve is responsible for lacrimal secretions? What is the consequence if this nerve is damaged?

A
  • Facial nerve

- If it’s damaged, the patient may have dry eyes, so you need to make sure that you’re providing artificial tears

57
Q

Menace response: Which CN are being tested with the afferent and efferent pathways?

A
  • Afferent: Optic nerve

- Efferent: Facial nerve (blink)

58
Q

Optic nerve pathway for the menace response (remember it again and indicate which parts of the pathway are contralateral)

A
  • Optic chiasm (ipsilateral)
  • Optic tract*
  • Thalamus (lateral geniculate)*
  • Visual/occipital cortex*
  • Motor/frontal cortex*
  • Descending tracts (ipsilateral)
  • Cerebellar influence (ipsilateral)
  • I would draw this out too to help it make more sense
59
Q

What should you check with pupil size?

A
  • That they are symmetrical in normal room light
60
Q

Pupillary light reflex - where should you be testing the reflex?

A
  • In a dark room with a very bright light
61
Q

Afferent and efferent pathways of pupillary light reflex

A
  • Afferent: Optic nerve

- Efferent: Oculomotor nerve

62
Q

Pathway of optic nerve for PLR

  • Indicate which are contralateral
A
  • Optic chiasm
  • Optic tract*
  • Pretectal area*
63
Q

Does the PLR require a cortical response?

A
  • No
64
Q

What is a positive PLR response that you would expect?

A
  • Bilaterally leads to direct and indirect pupillary constriction
65
Q

Draw out the PLR pathway

A
  • Just do it
66
Q

What is the oculovestibular reflex?

A
  • Doll’s eye reflex or physiologic nystagmus
67
Q

Which CN are being tested with oculovestibular reflex?

A
  • CN 8 (vestibular component)
  • MLF (Medial longitudinal fasciculus)
  • CN 3 (oculomotor nerve)
  • CN 4 (trochlear nerve)
  • CN 6 - abducent nerve
68
Q

Positive response for ocular sensation

A
  • Third eyelid retracting

- Feel the eyelid retract, blink, and eye goes up

69
Q

Afferent and efferent pathways for ocular sensation

A
  • Afferent: Trigeminal nerve (CN V - ophthalmic branch)

- Efferent: Facial nerve (blink) and abducent nerve (eyeball retraction and elevation of the third eyelid)**

70
Q

Afferent and efferent pathways for the palpebral reflex

A
  • Afferent: Trigeminal nerve (CN v) - maxillary and ophthalmic branches
  • Efferent: Facial nerve –> blink
71
Q

Which is sensory to medial and lateral canthus for trigeminal nerve branches?

A
  • Medial canthus: ophthalmic branch

- Lateral canthus: maxillary branch

72
Q

Afferent and efferent pathways for facial reflex

A
  • Afferent: Trigeminal nerve (CN V for ophthalmic/maxillary/mandibular branches)
  • Efferent: Facial nerve (CN VII) for blink and twitch
73
Q

What is the facial response? How does it differ from the facial reflex?

A
  • Should have a cortical jerking away response or trying to bite
  • Different than twitching which is the facial reflex
74
Q

Facial response afferent and efferent pathways

A
  • Afferent is ophthalmic branch of the trigeminal nerve

- Descending pathway is to move the head/body away from the stimulus (pull-away response)

75
Q

Facial response afferent pathway and which are contralateral?

A
  • Thalamus*
  • Somatosensory/parietal cortex*
  • Motor cortex*
76
Q

Which side is damaged if no facial response on the right side?

A
  • Something wrong with the contralateral cortex, i.e. the left side
77
Q

Which CN is responsible for jaw tone?

A
  • Mandibular branch

- CN V

78
Q

Which nerves responsible for facial symmetry?

A
  • CN V (without it, atrophy of the mandibular muscles like the temporalis muscle, digastricus)
  • CN VII (drooping)
79
Q

Which nerves involved in the gag reflex?

A
  • CN 9 and CN 10
80
Q

Which nerve responsible for innervation of the tongue?

A
  • CN 12
81
Q

What are the last parts of the neurologic examination?

A
  • Neck movement
  • Spinal palpation
  • Rectal examination
82
Q

Describe the perineal reflex

A
  1. Constriction of the anus (anal tone)

2. Flexion of the tail

83
Q

Which nerves involved with constriction of the anus with the perineal reflex?

A
  • Pudendal nerve

- S1-S3

84
Q

Which nerves involved in flexion of the tail for the spinal cord reflex?

A
  • Caudal spinal cord segments
85
Q

What does a positive response for deep pain sensation look like?

A
  • CORTICAL response such as crying, biting or trying to get away
86
Q

Who do you test deep pain sensation in?

A
  • Paralyzed patients only
87
Q

Prognosis for deep pain negative?

A
  • Poor prognosis for recovery
88
Q

Supratentorial brain regions?

A
  • Cerebral hemisphere
  • Thalamus
  • Pituitary
89
Q

Infratentorial brain regions?

A
  • Cerebellum

- Brainstem

90
Q

What are the spinal cord segments?

A
  • C1-C5
  • C6-T2
  • T3-L3
  • L4-S3
  • Caudal
91
Q

What are clinical signs in the thoracic limbs if you have a lesion cranial to the thoracic intumescence?

A
  • UMN signs (i.e. hypermetria, decreased CPs, normal to increased reflexes)
92
Q

What are clinical signs in the thoracic limbs if you have a lesion at the thoracic intumescence?

A
  • LMN signs (i.e. decreased withdrawal reflexes, decreased CPs)
93
Q

What makes up the lower motor neuron unit?

A
  • Spinal cord segments (C6-T2, L4-sacral)
  • Peripheral nerves - afferent and efferent
  • Neuromuscular junction
  • Muscle (effector organ)
94
Q

What are the parts of the PNS with the LMN?

A
  • Peripheral afferent and efferent nerves
  • Neuromuscular junction
  • Muscle (effector organ)
95
Q

What are the CNS parts of the lower motor neuron unit?

A
  • Spinal cord segments (i.e. C6-T2, L4-sacral)
96
Q

UMN signs

  • Reflexes
  • Muscle tone
  • Type of atrophy
A
  • NORMAL to increased spinal REFLEXES
  • Normal to increased muscle tone
  • Disuse muscle atrophy
97
Q

LMN signs

  • Reflexes
  • Muscle tone
  • Type of atrophy
A
  • Decreased to absent spinal reflexes
  • Decreased to absent muscle tone
  • Neurogenic muscle atrophy
98
Q

How long does it take to have disuse muscle atrophy?

A
  • Slowly over time
99
Q

How long does it take to have neurogenic muscle atrophy?

A
  • within 7-10 days (VERY ACUTE)
  • Limbs are completely atrophied
  • If muscle isn’t working, it’s LMN
100
Q

How long does primary myopathic atrophy take?

A
  • Variable amount of time
101
Q

Clinical signs in thoracic limbs and pelvic limbs if lesion is in the brain?

A
  • UMN to both
102
Q

Clinical signs in thoracic limbs and pelvic limbs if lesion is in C1-C5?

A
  • Thoracic: UMN

- Pelvic: UMN

103
Q

Clinical signs in thoracic limbs and pelvic limbs if lesion is in C6-T2?

A
  • Thoracic: LMN

- Pelvic: UMN

104
Q

Clinical signs in thoracic limbs and pelvic limbs if lesion is in T3-L3?

A
  • Thoracic: normal

- Pelvic: UMN

105
Q

Clinical signs in thoracic limbs and pelvic limbs if lesion is in L4-S1/3?

A

Thoracic limbs: Normal

Pelvic limbs: LMN

106
Q

Case:

CP deficits in both pelvic limbs

Normal patellar reflexes bilaterally

Normal withdrawal reflexes bilaterally

Lesion is where?

A
  • T3-L3
  • UMN problem to pelvis

Tone is normal to increased

Disuse atrophy

107
Q

Case:

CP deficits to both pelvic limbs

Decreased patellar reflexes bilaterally

Decreased withdrawal reflexes bilaterally?

A
  • LMN problem to pelvis
  • L4-S1 or

bilateral femoral and sciatic nerves

  • Tone is decreased to absent
  • neurogenic atrophy
108
Q

Case:

CP deficits to both pelvic limbs

Decreased patellar reflexes bilaterally

Normal withdrawal reflexes

A

L4-L6 or femoral nerve bilaterally

109
Q

Case:

CP deficits to both pelvic limbs

Increased patellar reflexes bilaterally

Absent withdrawal reflexes bilaterally

A
  • Bilateral sciatic nerve OR

- CNS lesion at L6-S1

110
Q

Why increased patellar reflexes with sciatic nerve deficits or lesion at L6-S1?

A
  • UMN –> T3-L3

OR Pseudohyperreflexia

111
Q

Describe pseudohyperreflexia?

A
  • Due to loss of antagonistic muscles from lack of sciatic/L6-S1 function
112
Q

Case:

  • CP deficits to all four limbs
  • Normal spinal reflexes in all four limbs
A
  • Brain (infratentorial or supratnetorial) or C1-C5

- Likely C1-C5 if no mentation changes or CN deficits

113
Q

Case:

  • CP deficits to all four limbs
  • Normal spinal reflexes to the pelvic limbs
  • Decreased withdrawal reflexes in the thoracic limbs
A
  • C6-T2
114
Q

Case:

CP deficits to all four limbs

Decreased patellar and withdrawal reflexes in the pelvic limbs

Decreased withdrawal reflexes in the thoracic limbs

A
  • Diffuse LMN
  • Either C6-T2 and L4-S1 OR
  • ALl the peripheral nerves within the limbs
115
Q

What is the name for all the peripheral limbs being affected?

A
  • Polyneuropathy

Neurology (14 decks)

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