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PD Block 3 > neurological exam > Flashcards

neurological exam Flashcards

1
Q

frontal lobe

A
  • motor cortex associated with voluntary skeletal movement and fine repetitive motor movements (including eye movements)
  • executing functions, thinking, planning, organizing, problem solving, emotions, behavior control, personality
  • VOLUNTARY MOVEMENT, BEHAVIOR
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2
Q

parietal lobe

A
  • processing sensory data that is received (special senses)
  • perception, making sense of the world, arithmetic, spelling
  • recognition of body parts and awareness of position (proprioception) are dependent on this
  • SENSES: PAIN, TEMP (controls conscious perception of stimuli)
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3
Q

occipital lobe

A

vision (and interp of visual data)

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4
Q

temporal lobe

A

memory, understanding, language

-perception and interpretation of sounds and determination of their source (and taste and smell)

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5
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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6
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.
-control involuntary fx of body like HR, breathing, sleeping, eating.

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7
Q

cerebellum

A

Lower Brain, inferior to cerebrum and posterior of brainstem. Controls fine tuning of motor movements, balance, posture.

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8
Q

cranial nerves 1- 12

A

Oh, Oh, Oh, To, Touch, And Feel, Virgin, Girls, Vaginas, And, Hymens

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9
Q

basal nuclei (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.
-subconcious motor movement

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10
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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11
Q

ascending spinal tracts

A

Carry sensory information from the PNS toward the brain.

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12
Q

descending spinal tracts

A

Carry motor information from the brain toward the PNS.

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13
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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14
Q

upper vs lower motor neuron lesion

A
  • *upper: Babinski sign, above anterior horn of SC, weakness, spasticity, etc
  • *lower: in motor region of BS, atrophy, wasting (lower SC)
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15
Q

voluntary NS

A

aka Somatic Nervous System (SNS). Somatic motor control. CNS conducts impulses to skeletal muscles.

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16
Q

ANS

A

Visceral motor control. CNS conducts impulses to cardic muscles, smooth muscles, glands.

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17
Q

Glascow Coma Scale

A
  • eye opening, motor response, verbal response
  • 15 is good, 3 is bad (lowest)
  • A Coma Score of 13 or higher correlates with a mild brain injury, 9 to 12 is a moderate injury and 8 or less a severe brain injury.
  • assess function of cerebral cortex
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18
Q

exam/eval of mental status/memory

A

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

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19
Q

exam/eval of cranial nerve status

A

Taste and smell not normally assessed unless suspect for an abnormality.

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20
Q

graphesthesia

A

draw in patients hand and have them tell you what you are drawing (simple number)

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21
Q

sterognosis

A
  • give them an object to ID with their hands (different per hand)
  • based on touch and manipulation
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22
Q

trigeminal nerve

A
  • CN 5
  • motor: clench teeth (masseter, temp muscles), move jaw from side to side (pherygoidius m)
  • sensory: check 3 divisions (sharp, dull, light touch)
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23
Q

facial nerve

A
  • CN 7

- elevate eyebrows, close eyes tight (resist opening by examiner), puff out cheeks, smile and show teeth

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24
Q

vestibulocochlear nerve

A
  • CN 8
  • Acoustic nerve
  • hearing
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25
Q

glossopharyngeal nerve and Vagus nerve

A
  • CN 9 and 10

- tested with gag reflex (say ah and ask patient to swallow)

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26
Q

spinal accessory nerve

A
  • CN 11

- traps and SCN (shoulder shrug and head tilt)

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27
Q

hypoglossal nerve

A
  • CN 12
  • extend tongue, check lateral strength by pressing on cheek, listen for dysarthria (listen to speech, are they tripping over tongue?)
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28
Q

dermatome

A

-sensory and motor fibers of each spinal nerve that supply and receive info in specific body distribution

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29
Q

exam/eval of proprioception and cerebellar functions

A

-rapid rhythmic alternative movements, accuracy of movement, balance, giant and heel toe walking

30
Q

rapid rhythmic alternative movement

A

-pat the knees rapidly alternative between palm and back of hand

31
Q

accuracy of movements

A

1: finger to finger test (pt touches nose then finger with eyes open)
2: finger to nose test (pt touches his nose, with eyes closed, alternating hands)
3: hell to shin test (pt moves heel up and down his shin in straight line)

32
Q

romberg test

A

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.

33
Q

observe pts gait

A

Then have pt walk heel to toe to exaggerate any unexpected finding in the gait exam.

34
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.
35
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.
36
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)

37
Q

dermatome vs myotome

A

If talking about sensory fibers we say “dermatome”, if its motor related we usually say “myotome”

38
Q

how to test sensation of dermatomes

A

-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

39
Q

sharp sensation

A

-simultaneously touch two areas on each side of the body with a sharp edge and ask the patient to tell you how many stimuli they felt and where
○If incorrect could be a condition called extinction phenomenon

40
Q

soft sensation

A

-superficial touch test using a cotton wisp or your fingertip (light strokes) - have the patient tell you where the sensation was felt (avoid areas with hair and do not depress the skin)

41
Q

dull sensation

A

a trick (want to make sure can feel soft and sharp on both sides)

42
Q

superficial pain

A

alternate sharp & smooth points in an unpredictable pattern and have the patient identify which it is - if not intact you need to check temperature sensation and deep pressure

43
Q

position of joints in space

A

-raise or lower the joint of either the great toe or a finger and ask the patient which joint was moved

44
Q

vibratory sensation

A

-place the stem of the tuning fork against a bony prominence (128 Hz tuning fork)
●Performed on the upper and lower extremities: begin at toe and finger joints (DIP joints), then if needed check sternum, shoulder, elbow, wrist, shin, and ankle
●Ask if they feel a buzzing or tingling sensation, then ask when it stops

45
Q

temperature

A

-tested if superficial pain sensation is NOT intact
●Roll test tubes in hot or cold water and place against the skin; alternate in unpredictable patterns at various sites
●Also test deep pressure sensation by squeezing a large muscle - should feel discomfort

46
Q

2 point discrimination

A

-find the distance at which the patient can no longer tell the difference between 2 separate points (feels like one)
●Usually done on fingertips, using a paperclip

47
Q

oculocephalic reflex (Dolls 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).
48
Q

kernig sign

A

-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.

49
Q

brudzinski’s sign

A

-A sign of meningeal inflammation evidenced by involuntary flexion of hips and knees when neck is flexed in a supine position.

50
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.
51
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.
52
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.

53
Q

decorticate posturing

A
  • 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
54
Q

decerebrate posturing

A
  • 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.
55
Q

spasticity

A
  • A motor disorder characterized by increased muscle tone, exaggerated tendon jerks, and clonus.
  • Result of an upper motor neuron lesion.
  • Stiff, awkward movements.
56
Q

flaccidity

A

-Relaxed, flabby; having defective or absent muscular tone.

57
Q

hemiplegia

A

-Loss of motor function and sensation (paralysis) of one side of body

58
Q

paraplegia

A
  • Paralysis of the lower portion of body and both legs.

- Caused by lesion involving spinal cord.

59
Q

delirium

A
  • “Confused with disordered perceptions.”
  • An acute, reversible state of disorientation and confusion. –No drowsiness, hallucinations or delusions; difficulty in focusing attention
60
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.

61
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.
62
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)

63
Q

coma

A

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

64
Q

lethargy

A

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

65
Q

paresthesia

A

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

66
Q

receptive 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.
67
Q

expression aphasia

A
  • Broca’s Aphasia.
  • “Nonfluent, slow, few words, laborious effort, inflection and articulation impaired, words meaningful but carefully selected.
  • Patient usually aware of inability and feels frustrated.
68
Q

vertigo

A

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

69
Q

areflexia

A

absence of reflexes

70
Q

hyperflexia

A

overactive and over responsive reflex

71
Q

hyporeflexia

A

a diminished function of reflexes

PD Block 3 (7 decks)

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