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VET 404: Neurology > Neurological Exam > Flashcards

Neurological Exam Flashcards

1
Q

goal of neurological exam

A

localize lesions within the nervous system, list possible causes, and evaluate severity/prognosis

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2
Q

requirements for a reflex

A

intact peripheral (sensory and motor) nerves
intact spinal cord/brainstem
NO cerebral input/processing

results in involuntary movement

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3
Q

requirements for a response

A

intact ascending/descending pathways
intact spinal cord/brainstem
intact cerebrum

results in voluntary movement

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4
Q

upper motor neurons

A

neurons that travel from cerebrum to spinal cord and synapse onto LMNs or interneurons

cell bodies: cerebrum
axons: travel to spinal cord

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5
Q

upper motor neuron function

A

controls voluntary movement
overall INHIBITORY to lower motor neurons
results in DECREASED firing of LMNs

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6
Q

lower motor neurons

A

neurons that connect CNS with effectors

cell bodies: spinal cord
axons: peripheral spinal/cranial nerves

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7
Q

lower motor neuron function

A

final effectors of voluntary movement
functional default is “on” - constantly firing
results in INCREASED muscle tone and contraction (if uncontrolled by UMN)

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8
Q

signs of UMN dysfunction

A

increased reflexes
increased tone
mild, slow atrophy

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9
Q

signs of LMN dysfunction

A

decreased reflexes
decreased tone
severe, rapid atrophy

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10
Q

signs of C1-C5 lesions

A

thoracic limbs: UMN signs
pelvic limbs: UMN signs

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11
Q

signs of C6-T2 lesions

A

thoracic limbs: LMN signs
pelvic limbs: UMN signs

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12
Q

signs of T3-L3 lesions

A

thoracic limbs: normal
pelvic limbs: UMN signs

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13
Q

signs of L4-caudal lesions

A

thoracic limbs: normal
pelvic limbs: LMN signs

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14
Q

steps of a neuro exam

A
  1. observation (mentation, posture, gait)
  2. cranial nerves
  3. postural reactions
  4. segmental reflexes
  5. palpation
  6. +/- sensation
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15
Q

mentation

A

normal
obtunded
stuporous/semi-comatose
comatose

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16
Q

obtunded

A

decreased responsiveness to environment

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17
Q

stuporous/semi-comatose

A

only responds to noxious stimuli

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18
Q

comatose

A

does not respond to any stimuli

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19
Q

opisthotonus

A

an abnormal posture where the head and neck are extended dorsally; thoracic limbs are extended and rigid

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20
Q

3 lesions that cause opisthotonus

A
  1. decerebrate
  2. decerebellate
  3. schiff-sherrington posture
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21
Q

decerebrate

A

severe lesion to the midbrain causing functional separation of the cerebrum from the rest of the body

mentation: comatose
posture: opisthotonus w/ severe UMN signs
reflexes: normal (if nerves intact)

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22
Q

decerebellate

A

lesions to the cerebellum (trauma, cerebellar hypoplasia)

mentation: normal
posture: opisthotonus w/ flexion or extension of pelvic limbs
voluntary movement is normal

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23
Q

schiff-sherrington posture

A

T3 - L5 lesion; causes disruption of an ascending inhibitory pathway up to the thoracic limbs that the spinal cord sends itself; causes disinhibition of LMNs of thoracic limbs –> increased firing

mentation: normal
posture: opisthotonus
voluntary movement is possible

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24
Q

gait descriptors

A

ambulatory or nonambulatory
paresis
paralysis
lameness
ataxia
circling (in direction of lesion)
dysmetria

mono - one limb
hemi - both limbs on one side
para - both pelvic limbs
tetra - all four limbs

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25
Q

cranial nerve reflexes/responses

A
  1. olfactory
  2. menace response
  3. visual tracking
  4. pupillary light reflex
  5. corneal reflex
  6. palpebral reflex
  7. nystagmus
  8. trigeminofacial reflexes
  9. symmetry
  10. gag reflex
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26
Q

olfactory nerve test

A

blindfold patient and see if they can localize food/treats

not often done - complete loss of olfaction required to see deficits

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27
Q

menace response

A

make a menacing gesture towards the eye
patient should blink

afferent: CN II
efferent: CN VII

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28
Q

visual tracking

A

drop a soundless/scentless object (cotton ball) in the visual field
patient should track it as it falls

afferent: CN II
contralateral cerebrum

29
Q

pupillary light reflex

A

shine a light in one eye
both pupils should constrict

afferent: CN II
efferent: CN III

30
Q

isocoric

A

equal pupils

31
Q

anisocoria

A

unequal pupil size

32
Q

miosis

A

small/constricted pupil

33
Q

mydriasis

A

dilated pupil

34
Q

corneal reflex

A

trigeminofacial reflex
touch a damp cotton swab to the cornea
patient should blink and retract globe

afferent: CN V (1)
efferent: CN VII & VI

35
Q

palpebral reflex

A

trigeminofacial reflex
touch the medial and lateral cantos of the eye
patient should blink

afferent: CN V (1 & 2)
efferent: CN VII

36
Q

physiologic nystagmus

A

vestibulo-ocular reflex - NORMAL
move patients head side to side or up and down
eye globes should move to follow the movement in fast/slow pattern

afferent: CN VIII
efferent: CN III, IV, VI

37
Q

spontaneous nystagmus

A

pathologic nystagmus - ABNORMAL
alternating smooth pursuit in one direction followed by saccadic movement in the other direction in the ABSENCE of movement

fast phase moves AWAY from the side of the lesion

38
Q

trigeminofacial reflexes

A

afferent: CN V
efferent: CN VII

corneal and palpebral
vibrissae: stimulate whiskers; should blink
lip pinch: pinch maxillary/mandibular lip; should pull lip/move away
nasal stimulation: stimulate inside nares; should move away

39
Q

facial symmetry

A

evaluate muscle mass on head/face

efferent: CN VII, CN V(3)

40
Q

gag reflex

A

place fingers at the back of the throat
patient should gag

afferent: CN IX, X
efferent: CN IX, X, XII

41
Q

conscious proprioception

A

awareness of oneself in space; awareness of all sensory information from the rest of the body

requires sensory and motor function
deficits indicate neurological disease but do not localize lesion

42
Q

postural reactions

A
  1. proprioceptive placing
  2. hopping
  3. wheelbarrowing
  4. extensor postural thrust
  5. visual placing
  6. tactile placing
43
Q

proprioceptive placing

A

paw knuckling; flip a single paw over while supporting rest of weight
patient should flip paw back over

44
Q

hopping

A

life one limb off the ground and push patient off center in opposite direction
patient should hop on weight bearing leg to adjust center of gravity

45
Q

wheelbarrowing

A

carry pelvic limbs and push forward
patient should walk forward on thoracic limbs

46
Q

extensor postural thrust

A

hold up animal and lower slowly until pelvic limbs reach the ground
patient should adjust feet placement once reaching the ground

47
Q

visual placing

A

carry animal towards a surface while extending limb towards the surface
patient should put paw onto oncoming surface

47
Q

tactile placing

A

carry animal blindfolded towards a surface and lightly touch paw to the surface
patient should put paw on top of surface

48
Q

pelvic limb reflexes

A
  1. patellar reflex
  2. gastrocnemius reflex
  3. flexion/withdrawal reflex
  4. perineal reflex
49
Q

patellar reflex

A

evaluates femoral nerve (L4, 5, 6)
percuss patellar tendon
normal: quadriceps contracts, stifle extends

50
Q

gastrocnemius reflex

A

evaluates sciatic nerve (L6, 7, S1)
percuss common calcaneal tendon
normal: contraction of caudal thigh muscles

51
Q

flexion/withdrawal reflex

A

pelvic: sciatic nerve
thoracic: musculocutaneous nerve
stimulate interdigital skin
normal: flexion of the limb

52
Q

perineal reflex

A

evaluates pudendal nerve (S1, 2, 3)
stimulate skin on each side of perineal region
normal: contraction of anal sphincter

53
Q

thoracic limb reflexes

A
  1. biceps reflex
  2. triceps reflex
  3. flexion/withdrawal reflex
54
Q

biceps reflex

A

evaluates musculocutaneous nerve
stretch biceps and percuss insertion of biceps tendon onto the radius
normal: contraction of the biceps

55
Q

triceps reflex

A

evaluates radial nerve
flex elbow to stretch triceps and percuss insertion of triceps onto the olecranon
normal: contraction of the triceps

56
Q

cutaneous trunci reflex

A

bilateral reflex
pinch the skin around the T3 - L3 region of the spine
normal: cutaneous trunci in C8 - T1 region should contract bilaterally

afferent: T3 - L3 cutaneous nerve
efferent: lateral thoracic nerve

57
Q

lesion in T3 - L3 region effect on cutaneous trunci reflex

A

absence of reflex caudal to the site of the lesion
blocks ascending sensory pathways from below site

58
Q

lesion in C6 - T2 region effect on cutaneous trunci reflex

A

ipsilateral loss of cutaneous trunci contraction regardless of side of stimulation
LMN lesion blocks motor info to one side)

59
Q

palpation

A

palpate the head and along the vertebral column to evaluate muscle tone and mass
(check for symmetry, atrophy)
move the head through range of motion

60
Q

hyperesthesia

A

abnormal increase in sensitivity to stimuli; apparent painfulness

61
Q

nociception

A

the physiological system by which a person feels pain

62
Q

what are nociceptive pathways protected by

A

spinal cord - difficult to have loss of function

63
Q

prognoses for loss of nociception

A

poor
loss of superficial pain = 85% chance of return to function
loss of deep pain = 50% chance of return to function

64
Q

when is testing for nociception indicated

A

paralyzed limbs only
(ambulatory limbs do not need to be tested because already functional)

65
Q

order of spinal cord loss/regain of function

A

lost in descending order, regained in ascending order
1. proprioceptive placing
2. voluntary movement
3. superficial pain
4. deep pain

66
Q

superficial nociception test

A

use hemostats to pinch interdigital skin and look for a response
(NOT a reflex - patient should turn head up, look at limb, vocalize, etc)

67
Q

deep nociception test

A

pinch over a digit (stimulate periosteum) and look for a response
(NOT a reflex - patient should do more than just limb flexion)

VET 404: Neurology (23 decks)

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