Neurological Exam Flashcards
1
Q
Components of the neuro exam
A
MRS MC
metnal status
reflexes
sensroy
motor system
cranial nerves
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
3
Q
progressive onset
A
neoplasms and degenerative diseases
4
Q
intermittent, relapsing episodes
A
demyelinating diseases such as MS
certain vascular diseases
5
Q
components of mental status exam
A
LAO
level of alertness
appropriateness of response
oreitnation
6
Q
telencephalon refers to what CN level
A
I
7
Q
diencephalon is what CN level
A
II
8
Q
mesencephalon or ___ is _____ levels
A
midbrain, III-IV
9
Q
metencephalon or ___ is what level
A
pons, V
10
Q
myelencephalon or ___ is what level
A
medulla, IX-XII
11
Q
pontomuedulary junction
A
6-8
12
Q
oculomotor nerve does
A
extraocular movements
supplies levator palpebrae muscle
efferent limb of pupillary light reflex
13
Q
trigeminal motor portion and what reflex
A
jaw movements
corneal reflex, afferent limb
14
Q
what cranial nerve is this: swallowing, rise of palate, and gag relfex
A
glossopharyngeal
15
Q
gag reflex, swallowing, phonation
A
vaus (X)
16
Q
olfactory test use what odors
A
non-irritating, familiar
17
Q
oculomotor test, loss of smell with what
A
smoking, sinus disease, head trauma, aging, parkinsons, cocaine use
18
Q
loss of smell indicates
A
ipsilateral lesion
19
Q
optic nerve test
A
visual acuity/field test optic disc papilledema, atrophy, pallor retina for hemorrhages pupillary light reflex
20
Q
lesion to optic nerve anterior to chiasm cause
A
ipsilateral blindness
21
Q
pupillary light reflex afferent is __ efferent is __
A
II, III
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
23
Q
near reaction for what nerve
A
CN III
24
Q
second effect of CN III lesion
A
external strabismus
down and out position of the eye
25
aneursms
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
26
diabetes mellitus ccan cause what weakness
extraocular m weakness
27
CN IV lesions
-vulnerable to ____
lesion results in
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
28
cranial nerve VI lesion seen in pts with
subarachnoid hemorrhage, late syphilis and trauma
29
CN VI lesion cause
convergent (medial) strabismus (estropia)
-can't abduct eye
horizontal diplopia
30
trigeminal nerve testing
facial sensation V1,2,3
muscles of mastication
corneal reflex
31
trigeminal lesions cause
decreased sensation of face
loss corneal reflex
weakness of m of mast
jaw deviation toward the weak side
32
corneal blink reflex afferent and efferent
CN V is afferent
| CN VII is efferent
33
facial nerve fnct
motor: muscles of facial expression, eye and mouth closure
sensory: anterior 2/3 tongue taste
parasympathetic: secretion saliva and tears
gen sen: external ear
34
lesions of CN VII
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
supranuclear (central) facial palsy
CN VII
- spares upper face, usually assoicated with hemiplegia
- important in detering if weakness is central or peripheral in nature
36
rinne test
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
lesion of CN VIII vestibular diviions
dysequilibrium and nystagmus
38
lesion of CN VIII cochlear division
destructive lesions lead to sensorineural hearing loss
irritaive lesion can cause tinnitus (ring in ears)
39
weber test in conductive hearing loss sound goes to ___ ear
| in sensorineural hearing loss sound lateralizes to ___ ear
impaired
good
40
CN IX motor, sensory, reflex
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
gag reflex afferent is _ efferent is _
A- IX
| E- X
42
vagus innervates muscles of
pharynx and larynx minus stylopharyngeus
visceral afferent from mucosa of esophagus to mid transverese colon
parasymp to smooth m to same areas
43
testing for vagus
listen for voice hoarseness and nasal tone
check gag reflex
check for difficulty swallowing
look for symmetric elevation of soft palate, midline, uvula
44
lesion of X result in
dysphonia, dysphagia, dyspnea, loss gag or cough
45
lesion of IX
loss gag, loss sensation in pharynx and post 1/3 tongue, slight dysphagia
46
CN XII lesion results in
tongue deviation to weak side
| inablity to push tongue to opposite cheek
47
CN XII innervates all intrinsic and extrinsic tongue m except
palatoglossus (X)
48
dysarthria
dysphasia
aphasia
slurred speech
partial or complete impairment of ability to communicate
inability to get words out or understand whats said
49
pattern of muscular weakness for UMN
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
LMN pattern m weakness
weak flexor i arms, weak extensors in legs
m disease
MNJ
51
pinprick and temp test for
spinothalamic tract
52
proprioception, 2-pt tactile discrim and vibratory
posterior columns
53
light touch
both pathways
54
stereognosis
ability to id shapes of objects, or recognize objects placed in the hand
55
graphesthesia
ability to indeity numbers written on the palm
56
pattern of sensory loss: brainstem
ipsilateral loss in face, contralateral in body
57
thalamic sensory loss
hemisensory loss of all modalities
58
cortical loss
intact primary sensation, loss cortical sensations
59
UMN summary lesion
```
hemiparesis
hyperreflexia
hemianesthesia
babinski sign pos
paraparesis
```
60
LNM and babinski sign
negative
61
DTR 3
brisk, spread to involve movement across more than one jt
62
DTR +4/4
hyperactive with clonus
63
hyperactive inidcate lesion in ___
| hypoactive inicate lesion in __
CNS
| PNS
64
babinski sign
UMN dysfunction
abnormal when sole of foot scratched fomr heel toward toes and across transverse arch,
-great toe extends, remainder spread
65
clonus
UMN sign, abnormal pattern of neuromuscular activity characterized by rapidly alternating involuntary contraction and relaxation of skeletal muslce
66
abdominal reflex
T10-12
| stroke abdomen causes umbilicus to move toward area of stimulation
67
cremasteric reflex
afferent L1
efferent L2
storking inner thigh causes scrotum to rise on stroked side
68
anal wink reflex
S4,S5
useful for cauda equina or lesions that affect sacral region
-note contraction
69
cerebellar coordination testing
finger to nose
heel to shin
rapid alternating movement
saccades
70
saccades tests for
contralateral cerebral hemisphere thorugh PPRF with cerebellar component
71
romberg test is a test of
proprioception
72
name this gait: anteroflexed posture, festinating, small steps, en bloc turns, decreased arm swing
parkinsonian
73
name this gate: feet cross over with toes dragged, seen in cerebral palsy or MS
scissoring
74
name gate: high steppage, broad based, seen with post column damage and peripheral neuropathy
sensory ataxia
75
name gate: small steps, feed do not leave ground, seen in forntal lobe processes and hydrocephalus
magnetic
76
name gate: gait is all over the palace as if the pt is falling, but does not fall, usual cause is psychogenic
astasia-abasia (fnct)
77
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
hemiplegic
78
name gate: myopthic (m) disease, hip sway or waddle in a side to side type fasion
waddling pelvis
79
name gait: unable to keep foot up during heel walk, due to _____ lesion
usual what neuropath or radiculopath
foot drop
UMN or LMN
usual LMN lesion is peroneal neurophathy or L5 radiculopathy
80
resting tremor indicates
basal ganglia disease (parkinsons)
81
kernig's sign
pt supine, flex thigh then straight leg, pt wil experience pain in neck
meningitic sign
82
brudzinski's sign
pt supine, lift pts head, nkees will come up in response
| meningitic sign
83
decorticate posutre in coma
both arms flexed, legs stiff and extended
| lesion above brainstem in thalamus
84
decerebrate posutre in coma
arms extended and legs stiff and extended
| brainstem lesion in midbrain
