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PCM II Final Exam > Neurological Exam > Flashcards

Neurological Exam Flashcards

1
Q

Components of the neuro exam

A

MRS MC

metnal status
reflexes
sensroy

motor system
cranial nerves

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2
Q

abrupt or sudden onset/actue onset folloed by gradual improvement is typical of

A

cerebral hemorrhages
vascular diseases
infections and head trauma

CIV

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3
Q

progressive onset

A

neoplasms and degenerative diseases

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4
Q

intermittent, relapsing episodes

A

demyelinating diseases such as MS

certain vascular diseases

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5
Q

components of mental status exam

A

LAO

level of alertness
appropriateness of response
oreitnation

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6
Q

telencephalon refers to what CN level

A

I

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7
Q

diencephalon is what CN level

A

II

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8
Q

mesencephalon or ___ is _____ levels

A

midbrain, III-IV

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9
Q

metencephalon or ___ is what level

A

pons, V

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10
Q

myelencephalon or ___ is what level

A

medulla, IX-XII

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11
Q

pontomuedulary junction

A

6-8

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12
Q

oculomotor nerve does

A

extraocular movements
supplies levator palpebrae muscle
efferent limb of pupillary light reflex

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13
Q

trigeminal motor portion and what reflex

A

jaw movements

corneal reflex, afferent limb

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14
Q

what cranial nerve is this: swallowing, rise of palate, and gag relfex

A

glossopharyngeal

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15
Q

gag reflex, swallowing, phonation

A

vaus (X)

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16
Q

olfactory test use what odors

A

non-irritating, familiar

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17
Q

oculomotor test, loss of smell with what

A

smoking, sinus disease, head trauma, aging, parkinsons, cocaine use

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18
Q

loss of smell indicates

A

ipsilateral lesion

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19
Q

optic nerve test

A 
visual acuity/field test
optic disc
papilledema, atrophy, pallor
retina for hemorrhages
pupillary light reflex
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20
Q

lesion to optic nerve anterior to chiasm cause

A

ipsilateral blindness

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21
Q

pupillary light reflex afferent is __ efferent is __

A

II, III

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22
Q

opticokinetic nystagmus

asymmetric loss

A
  • normal physiologic response to fixating on a moving target

- asymmetric loss can be due to frontal or parietal lesion on side which tape is moving

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23
Q

near reaction for what nerve

A

CN III

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24
Q

second effect of CN III lesion

A

external strabismus

down and out position of the eye

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25
Q

aneursms

A

area of weakened arterial blood vessel walls causing dilation of arterial segment
-internal carotid
post communicating artery within cavernous sinus causes similar findings as brainstem herniation

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26
Q

diabetes mellitus ccan cause what weakness

A

extraocular m weakness

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27
Q

CN IV lesions
-vulnerable to ____
lesion results in

A

head trauma

EW VH

extorsion of eye (eye postion drifts laterally)
Weakness of downward gaze (weakness sup ob)

vertical diplopia- increases when looking down
head tilting- to opp side of the lesion

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28
Q

cranial nerve VI lesion seen in pts with

A

subarachnoid hemorrhage, late syphilis and trauma

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29
Q

CN VI lesion cause

A

convergent (medial) strabismus (estropia)
-can’t abduct eye

horizontal diplopia

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30
Q

trigeminal nerve testing

A

facial sensation V1,2,3
muscles of mastication
corneal reflex

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31
Q

trigeminal lesions cause

A

decreased sensation of face
loss corneal reflex
weakness of m of mast
jaw deviation toward the weak side

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32
Q

corneal blink reflex afferent and efferent

A

CN V is afferent

CN VII is efferent

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33
Q

facial nerve fnct

A

motor: muscles of facial expression, eye and mouth closure
sensory: anterior 2/3 tongue taste
parasympathetic: secretion saliva and tears

gen sen: external ear

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34
Q

lesions of CN VII

A

paralysis of m of facial expression
-wideneed palpebral fissure and increased nasolabial fold (bells palsy)

loss of corneal reflex
hyperacusis
crocodile tears syndrome
-pt shed tears when chewing

35
Q

supranuclear (central) facial palsy

A

CN VII

  • spares upper face, usually assoicated with hemiplegia
  • important in detering if weakness is central or peripheral in nature
36
Q

rinne test

A

confirms presence of conduction deafness of affected ear
-strike tuning fork and place on mastoid process, when tone is gone place over external aud meatus
-should hear again
-if not the nconduction deafness present
if is normal then somatosensory loss other ear

37
Q

lesion of CN VIII vestibular diviions

A

dysequilibrium and nystagmus

38
Q

lesion of CN VIII cochlear division

A

destructive lesions lead to sensorineural hearing loss

irritaive lesion can cause tinnitus (ring in ears)

39
Q

weber test in conductive hearing loss sound goes to ___ ear

in sensorineural hearing loss sound lateralizes to ___ ear

A

impaired

good

40
Q

CN IX motor, sensory, reflex

A

innervates stylopharyngeus m which elevates and widens pharynx on swallowing

sensroy: taste to posterior 1/3 of tongue, sensation to palate and pharynx and skin of external ear

afferent limb of gag reflex

41
Q

gag reflex afferent is _ efferent is _

A

A- IX

E- X

42
Q

vagus innervates muscles of

A

pharynx and larynx minus stylopharyngeus

visceral afferent from mucosa of esophagus to mid transverese colon

parasymp to smooth m to same areas

43
Q

testing for vagus

A

listen for voice hoarseness and nasal tone
check gag reflex
check for difficulty swallowing
look for symmetric elevation of soft palate, midline, uvula

44
Q

lesion of X result in

A

dysphonia, dysphagia, dyspnea, loss gag or cough

45
Q

lesion of IX

A

loss gag, loss sensation in pharynx and post 1/3 tongue, slight dysphagia

46
Q

CN XII lesion results in

A

tongue deviation to weak side

inablity to push tongue to opposite cheek

47
Q

CN XII innervates all intrinsic and extrinsic tongue m except

A

palatoglossus (X)

48
Q

dysarthria
dysphasia
aphasia

A

slurred speech
partial or complete impairment of ability to communicate
inability to get words out or understand whats said

49
Q

pattern of muscular weakness for UMN

A

hypertonia, hyperreflexia

pyramidal pattern of weakness
(weak extensors in arms, weak flexors in legs

pronator drift
-after 2 mintues afrms drift down and supinate

50
Q

LMN pattern m weakness

A

weak flexor i arms, weak extensors in legs
m disease
MNJ

51
Q

pinprick and temp test for

A

spinothalamic tract

52
Q

proprioception, 2-pt tactile discrim and vibratory

A

posterior columns

53
Q

light touch

A

both pathways

54
Q

stereognosis

A

ability to id shapes of objects, or recognize objects placed in the hand

55
Q

graphesthesia

A

ability to indeity numbers written on the palm

56
Q

pattern of sensory loss: brainstem

A

ipsilateral loss in face, contralateral in body

57
Q

thalamic sensory loss

A

hemisensory loss of all modalities

58
Q

cortical loss

A

intact primary sensation, loss cortical sensations

59
Q

UMN summary lesion

A 
hemiparesis
hyperreflexia
hemianesthesia
babinski sign pos
paraparesis
60
Q

LNM and babinski sign

A

negative

61
Q

DTR 3

A

brisk, spread to involve movement across more than one jt

62
Q

DTR +4/4

A

hyperactive with clonus

63
Q

hyperactive inidcate lesion in ___

hypoactive inicate lesion in __

A

CNS

PNS

64
Q

babinski sign

A

UMN dysfunction
abnormal when sole of foot scratched fomr heel toward toes and across transverse arch,
-great toe extends, remainder spread

65
Q

clonus

A

UMN sign, abnormal pattern of neuromuscular activity characterized by rapidly alternating involuntary contraction and relaxation of skeletal muslce

66
Q

abdominal reflex

A

T10-12

stroke abdomen causes umbilicus to move toward area of stimulation

67
Q

cremasteric reflex

A

afferent L1
efferent L2

storking inner thigh causes scrotum to rise on stroked side

68
Q

anal wink reflex

A

S4,S5

useful for cauda equina or lesions that affect sacral region

-note contraction

69
Q

cerebellar coordination testing

A

finger to nose

heel to shin

rapid alternating movement

saccades

70
Q

saccades tests for

A

contralateral cerebral hemisphere thorugh PPRF with cerebellar component

71
Q

romberg test is a test of

A

proprioception

72
Q

name this gait: anteroflexed posture, festinating, small steps, en bloc turns, decreased arm swing

A

parkinsonian

73
Q

name this gate: feet cross over with toes dragged, seen in cerebral palsy or MS

A

scissoring

74
Q

name gate: high steppage, broad based, seen with post column damage and peripheral neuropathy

A

sensory ataxia

75
Q

name gate: small steps, feed do not leave ground, seen in forntal lobe processes and hydrocephalus

A

magnetic

76
Q

name gate: gait is all over the palace as if the pt is falling, but does not fall, usual cause is psychogenic

A

astasia-abasia (fnct)

77
Q

name this gate: usually due to UMN such as storke, circumducted gait (leg swing in circular type pattern), decreased ar swing ipsilateral to affected leg

A

hemiplegic

78
Q

name gate: myopthic (m) disease, hip sway or waddle in a side to side type fasion

A

waddling pelvis

79
Q

name gait: unable to keep foot up during heel walk, due to _____ lesion

usual what neuropath or radiculopath

A

foot drop
UMN or LMN
usual LMN lesion is peroneal neurophathy or L5 radiculopathy

80
Q

resting tremor indicates

A

basal ganglia disease (parkinsons)

81
Q

kernig’s sign

A

pt supine, flex thigh then straight leg, pt wil experience pain in neck
meningitic sign

82
Q

brudzinski’s sign

A

pt supine, lift pts head, nkees will come up in response

meningitic sign

83
Q

decorticate posutre in coma

A

both arms flexed, legs stiff and extended

lesion above brainstem in thalamus

84
Q

decerebrate posutre in coma

A

arms extended and legs stiff and extended

brainstem lesion in midbrain

PCM II Final Exam (4 decks)

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