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PD Block 3 > Neurological Exam > Flashcards

Neurological Exam Flashcards

1
Q

Cerebrum

A

“Upper Brain” separated into 2 hemispheres by the median longitudinal fissure. Each hemisphere is composed of convolutions called gyri (gyrus singular) and 4 lobes. Each lobe is separated by a deep separation called a sulcus (sulci plural). The cerebrum is charged with our upper cognitive ability as well as motor control, sensations, and senses.

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2
Q

Cerebellum

A

“Lower Brain” located inferior to the cerebrum and posterior to the brainstem. Primarily functions to help smooth out voluntary motor movements.

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3
Q

Frontal lobe

A

The most anterior lobe of the brain. Responsible for voluntary motor movements. The most posterior gyrus on the frontal lobe is the precentral gyrus and is home to the motor homunculus. Left is usually home to Broca speech center.

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4
Q

Parietal lobe

A

Most superior lobe of the brain. Responsible for most conscious perception of sensory stimuli except for the special senses. The special senses make a stop here before going to the appropriate lobe for interpretation. The most anterior gyrus on the lobe is the post central gyrus and is home to the sensory homonculus.

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5
Q

Occipital lobe

A

Most posterior lobe. Charged with interpreting visual sensory data.

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6
Q

Temporal lobe

A

Most lateral lobe. Charged with interpreting sound, taste and smell. Also home to the Wernicke speech center.

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7
Q

Limbic System

A
  • Composed of the group of structures between the diencephelon and the cerebrum. Responsible for emotions, consciousness, and memory.
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8
Q

Brainstem

A

“Primitive Brain” connects the spinal cord to the cerebrum. Made up of 3 structures: Midbrain, Pons, and Medulla. Responsible for most of the involuntary functions of the body. Decussation of the nerve fibers happens in the medulla resulting in opposite sides of the brain controlling opposite sides of the body.

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9
Q

Cranial nerves I-XII

A

Pneumonic for remembering sensory/motor/both for cranial nerves: Some Say Marry Money But My Brother Says Big Brains Matter Most.

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10
Q

Basal ganglia

A

Controls subconscious motor movements. IE cyclic motions like walking or when you grab an object you consciously move your hand and wrist, but unconsciously the basal nuclei stabilize and move shoulder and elbow.

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11
Q

Spinal cord

A

Resides in the vertebral foramen. Separates into the Cauda Equina in the lumbar spine. Primary functions are to interface between the brain and PNS as well as house reflex centers.

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12
Q

Ascending spinal tracts

A

Carry sensory information from the PNS toward the brain.

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13
Q

Descending spinal tracts

A

Carry motor information from the brain toward the PNS.

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14
Q

Spinal nerves

A

Leave the spinal cord via the intervertebral foramen between each pair of vertebra. Composed of 2 roots, a dorsal root and a ventral root. The dorsal root as an enlargement called the dorsal root ganglion. The dorsal root is responsible for taking sensory stimuli form the PNS into the spinal cord. The ventral root has no enlargement and is responsible for taking the motor stimuli from the spinal cord to the PNS.

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15
Q

Differentiation between an upper motor neuron lesion and lower motor neuron lesion

A

Genererally The upper neurons modify and tone down reflexes of lower nerves and fine tune the movements.
Upper: Weakness, increased reflexes, and tone (NO atrophy or fasciculations)
Lower: Weakness, atrophy, fasciculations, decreased reflexes and tone

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16
Q

Voluntary nervous system

A

Somatic Nervous System (SNS)

LOOK UP

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17
Q

Autonomic nervous system

A

A

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18
Q

Glascow Coma Scale and its usefulness in evaluating level consciousness

A

Used to quantify consciousness; assesses function of cerebral cortex. Best for emergencies.
LOOK UP

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19
Q

Equipment and supplies necessary to examine the neurological system

A

Penlight, tongue blade, tuning forks, familiar objects (paper clips, coins, keys), cotton wisp, monofilament, reflex hammer, vials of aromatic substances

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20
Q

Mental status/ memory

A

Assess for orientation (person, place, time, purpose), ask patient to remember three words, and have them recall the words later in the exam

21
Q

Cranial nerve status

A

Taste and smell not normally assessed unless suspect for an abnormality

22
Q

Proprioception & cerebellar function

A

One test for each of the following is given: Rapid rhythmic alternating movements, accuracy of movement, balance (usually Romberg test), gait, and heel to toe walking.

  • Rapid Rhythmic alternating movement – pat the knees rapidly alternating between palm and back of hand.
  • Accuracy of movements
    1. finger to finger test (pt touches his nose then your finger) with patients eyes open.
    2. Finger to nose test, pt touches his nose, with eyes closed, alternating hands
    3. Heel to shin test, pt moves heel up and down his shin in a straight line.
  • Romberg test, pts stands with feet together and arms at their side, first with eyes open, then closed. Small sway is normal, loss of balance is (+)Romberg sign.
  • observe pts gait. Then have pt walk heel to toe to exaggerate any unexpected finding in the gait exam.
23
Q

Motor function

A

When performing the motor exam, look for symmetry between the sides of the body. Also, both the proximal and distal muscles of the upper and lower extremities should be tested. To test muscle strength, the examiner applies maximum force to the extremity while the patient pushes against that force. Muscle strength is graded on a scale of 0 to 5.

24
Q

Superficial reflexes

A

stroke each quadrant of the abdomen looking for contraction near the umbilicus for contraction.
Stroke inner thigh for cremastic reflex, scrotum will rise on the same side
Check plantar flexion by stroking the lateral side of the foot from heel to toe, toes should flex.

25
Q

Deep tendon reflexes

A

pt should be relaxed, palpate to locate the tendon, briskly tap tendon with a flick of the wrist, alternate sides comparing results. (biceps, brachioradial, triceps, patellar, achilles,

26
Q

Assessment of sensation pathways

A

Dermatomes: are sensory & motor fibers of each spinal nerve that supply and receive information in a specific body distribution
● If talking about sensory fibers we say “dermatome”, if its motor related we usually say “myotome”
–To test sensation have the patient identify various sensory stimuli with their eyes closed, locations per lab instructions (don’t forget to compare side to side):
● dorsal web space of thumb and index finger = C6
● Pad of long finger = C7
● Pad of the little finger = C8
● Medical aspect of foot = L4
● Web space of great toe = L5
● Lateral aspect of foot = S1

27
Q

Where to assess: Sharp, soft, and dull; Vibratory sensation; Temperature; 2 point discrimination

A

a

28
Q

Method for scoring deep tendon reflexes, the locations for assessing DTRs and the spinal nerve enervation for each location

A 
Scoring: 
0=No response
1+=Sluggish or diminished response
2+=Active or expected response
3+=More brisk than expected, slightly hyperactive
4+=Brisk, hyperactive, with intermittent or transient clonus
Locations: 
Biceps: C5&C6
Brachioradial: C5&C6
Triceps: C6, C7 & C8
Patellar: L2, L3, & L4
Achilles: S1&S2
29
Q

Superficial reflexes, including their assessment and significance

A
  • Abdominal reflex: patient is supine, stroke each quadrant of abd with edge (tongue blade). -Upper abd reflexes are elicited by stroking up&away from umbilicus; lower abd reflexes are elicited by stroking down &away from umbilicus
  • Cremasteric reflex: stroke inner thigh with edge from proximal to distal, testicle and scrotum should rise on stroked side.
  • Plantar reflex: stroke lateral side of foot from heel to ball and then curve across the ball of foot to medial side. Normal reflex is plantar flexion of all toes.
30
Q

Common variation of neurological function seen in infants and elders

A

Infants:
Achilles & brachioradial tendon reflexes appear at 6 months of age.
When deep tendon reflexes are tested, use a finger or stethoscope head, rather than reflex hammer, to tap the tendon.
In plantar reflex, a positive Babinski sign (fanning of the toes and dorsiflexion of the great toe) is found until 16-24 months of age.
Posture & movement should be inspected for rhythmic twitching of facial, extremity, and trunk musculature.
Elders:
Same as for the adult
Assessing functional status is essential in determining the impact of any illness on the patient
Medications can impair central nervous system function and cause slow reaction times, tremors, and anxiety.
May have diminished smell & taste sensations, reduced ability to differentiate colors, slower adjustment to changes in lights, decreased corneal reflex, hearing loss, and a reduced gag reflex.
Gait is typically characterized by shorter steps with less lifting of the feet as proprioception declines.

31
Q

Oculocephalic reflex (Doll’s eyes)

A

A test to evaluate brainstem injury by assessing EOMs in a comatose patient. In a conscious patient, eyes will follow head movement when briskely moved side to side.
In a comatose patient, if the brainstem is intact, the eyes will lag behind and then slowly catch up deviating contralaterally. In a comatose patient, if the brainstem is injured, the eyes will follow the direction of head rotation (like in a conscious patient).

32
Q

Kernig/ Brudzinski sign

A

Kerning: A sign of meningeal irritation evidenced by back pain and resistance to straightening when attempting to extend/straighten the leg after flexing the hip and knee.
Brudzinski: A sign of meningeal inflammation evidenced by involuntary flexion of hips and knees when neck is flexed in a supine position.

33
Q

Gower Sign

A

A clinical sign of muscular dystrophy in childhood, indicative of weakness of the hip and knee extensors. Children with muscular dystrophy cannot stand up from a kneeling position without using their arms to push themselves erect by moving their hands up their legs and then their thighs.

34
Q

Clonus

A

Spasmodic alternation of muscular contractions between antagonistic muscle groups caused by hyperactive stretch reflex from an upper motor neuron lesion. Usually, sustained pressure or stretch of one of the muscles inhibits the reflex

35
Q

Romberg sign

A

The inability to maintain body balance when eyes are shut and feet are close together. Positive sign when patient sways and falls when eyes are closed. This is seen in sensory ataxia following traumatic brain injury.

36
Q

Pronator drift

A

A test of cerebellar function and proprioception. Positive test is when patient’s arm drifts when eyes are closed and arms are outstretched/palms up.

37
Q

Decorticate/ decerebrate posturing

A

Decorticate: The characteristic posture of a patient with a lesion at or above the upper brainstem. The patient is rigidly still with arms flexed, fists clenched, and legs extended
Decerebrate: The rigid body position assumed by a patient who has lost cerebral control of spinal reflexes. The patient’s arms are stiff and extended, the forearms are pronated, and the DTRs exaggerated.

38
Q

Spasticity/ flaccidity

A

Spasticity: A motor disorder characterized by increased muscle tone, exaggerated tendon jerks, and clonus. Result of an upper motor neuron lesion. Stiff, awkward movements.
Flaccidity: Relaxed, flabby; having defective or absent muscular tone.

39
Q

Hemiplegia/ paraplegia

A

Hemiplegia: Loss of motor function and sensation (paralysis) of one side of body
Paraplegia: Paralysis of the lower portion of body and both legs. Caused by lesion involving spinal cord.

40
Q

Delerium

A

‘Confused with disordered perceptions.” -PKM; An acute, reversible state of disorientation and confusion. No drowsiness, hallucinations or delusions; difficulty in focusing attention

41
Q

Dementia

A

A progressive, irreversible decline in mental function, marked by memory impairment, and often deficits in reasoning, judgment, abstract thought, registration, comprehension, learning, task execution, and use of language.

42
Q

Depression

A

A mood disorder marked by loss of interest of pleasure in living. 75% of diagnosed mental health disorders in primary care d/t anxiety or depression. May observe: decreased attention span, disorientation to time, impairment in constructional ability. MMSE DOES NOT diagnose depression.

43
Q

Stupor

A

A state of altered mental status in which a person is arousable only with vigorous or unpleasant stimulation. Arousable to painful stimuli

44
Q

Coma

A

A state of unconsciousness from which one cannot be aroused. “Neither awake nor aware.”

45
Q

Lethargy

A

Sleepiness, drowsiness, somnolence, or mental sluggishness. “Drowsy, but appropriate when aroused.”

46
Q

Parasthesia

A

An abnormal or unpleasant sensation that results from injury to one or more nerves, often described as numbness, tingling, burning sensations.

47
Q

Receptive/ expressive aphasia

A

Wernicke’s aphasia. “Fluent, rapid, effortless, inflection and articulation good, but sentences lack meaning (paraphasias), words malformed or invented (neologisms); incomprehensible.” Pt typically unaware of difficulties

48
Q

Vertigo

A

The sensation of moving around in space or of having objects move about the person.

49
Q

Areflexia/ hyperflexia/ hypoflexia

A

Areflexia:Absence of reflexes.
Hyperflexia:Overactive or over-responsive reflex.
Hypoflexia:A diminished function of the reflexes.

PD Block 3 (10 decks)

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