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Neurological Exam Flashcards

1
Q

What are the components of a NEUROLOGICAL EXAMINATION

A 
Mental State
Speech 
Cranial Nerves
Examination of Limbs & Trunk:
- posture
- wasting
- tone
- power
- reflexes
- sensation
- coordination & gait
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2
Q

BICEPS JERK

Major segmental innervation & peripheral nerve

A

C5(6)

Musculocutaneous nerve

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3
Q

SUPINATOR JERK

Major segmental innervation & peripheral nerve

A

C5/6

Radial nerve

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4
Q

TRICEPS JERK

Major segmental innervation & peripheral nerve

A

C7(8)

Radial nerve

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5
Q

FLEXOR FINGER JERK

Major segmental innervation & peripheral nerve

A

C6-T1

Median and Ulnar n.

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6
Q

KNEE JERK

Major segmental innervation & peripheral nerve

A

L3/4

Femoral

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7
Q

ANKLE JERK

Major segmental innervation & peripheral nerve

A

S1(2)

Medial popliteal and sciatic n.

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8
Q

TRAPEZIUS

Nerve and major root supply of muscle

A

C3/4

Spinal accessory n.

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9
Q

RHOMBOIDS

Nerve and major root supply of muscle

A

C4/5

Brachial plexus

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10
Q

SERRATUS ANTERIOR

Nerve and major root supply of muscle

A

C5 C6 C7

Brachial plexus

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11
Q

PECTORALIS MAJOR

Nerve and major root supply of muscle

A

Clavicular C5/6
Sternal C6, C7, C8

Brachial plexus

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12
Q

SUPRASPINATUS

Nerve and major root supply of muscle

A

C5/6

Brachial plexus

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13
Q

INFRASPINATUS

Nerve and major root supply of muscle

A

C5/6

Brachial plexus

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14
Q

LATISSIMUS DORSI

Nerve and major root supply of muscle

A

C6, C7, C8

Brachial plexus

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15
Q

TERES MAJOR

Nerve and major root supply of muscle

A

C5, C6, C7

Brachial plexus

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16
Q

DELTOID

Nerve and major root supply of muscle

A

C5/6

Axillary n.

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17
Q

BICEPS

Nerve and major root supply of muscle

A

C5/6

Musculocutaneous n.

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18
Q

BRACHIALIS

Nerve and major root supply of muscle

A

C5/6

Musculocutaneous n.

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19
Q

TRICEPS

Nerve and major root supply of muscle

A

Long head/lateral head/medial head
C6, C7, C8
Radial n.

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20
Q

BRACHIORADIALIS

Nerve and major root supply of muscle

A

C5/6

Radial n.

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21
Q

EXTENSOR CARPI RADIALIS LONGUS

Nerve and major root supply of muscle

A

C5/6

Radial n.

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22
Q

SUPINATOR

Nerve and major root supply of muscle

A

C6/7

Posterior interosseous n.

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23
Q

EXTENSOR CARPI ULNARIS

Nerve and major root supply of muscle

A

C7/8

Posterior interosseous n.

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24
Q

FLEXOR DIGITORUM SUPERFICIALIS

Nerve and major root supply of muscle

A

C7, C8, T1

Posterior interosseous n.

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25
Q

ABDUCTOR POLLICIS BREVIS

Nerve and major root supply of muscle

A

C7/8

Posterior interossesous n.

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26
Q

EXTENSOR POLLICIS BREVIS

Nerve and major root supply of muscle

A

C7/8

Posterior interossesous n.

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27
Q

EXTENSOR INDICIS

Nerve and major root supply of muscle

A

C7/8

Posterior interossesous n.

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28
Q

PRONATOR TERES

Nerve and major root supply of muscle

A

C6/7

Median n.

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29
Q

FLEXOR CARPI RADIALIS

Nerve and major root supply of muscle

A

C6/7

Median n.

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30
Q

FLEXOR DIGITORUM SUPERFICIALIS

Nerve and major root supply of muscle

A

C6, C7, C8

Median n.

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31
Q

ABDUCTOR POLLICIS BREVIS

Nerve and major root supply of muscle

A

C8, T1

Median n.

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32
Q

FLEXOR POLLICIS BREVIS

Nerve and major root supply of muscle

A

C8, T1

Median n.

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33
Q

OPPONENS POLLICIS

Nerve and major root supply of muscle

A

C8, T1

Median n.

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34
Q

LUMBRICALS I and II

Nerve and major root supply of muscle

A

C8, T1

Median n.

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35
Q

FLEXOR DIGITORUM PROFUNDUS I and II

Nerve and major root supply of muscle

A

C7/8

Anterior interosseous n.

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36
Q

FLEXOR POLLICIS LONGUS

Nerve and major root supply of muscle

A

C7/8

Anterior interosseous n.

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37
Q

FLEXOR CARPI ULNARIS

Nerve and major root supply of muscle

A

C7, C8, T1

Ulnar n.

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38
Q

FLEXOR DIGITORUM PROFUNDUS III and IV

Nerve and major root supply of muscle

A

C7/8

Ulnar n.

39
Q

HYPOTHENAR MUSCLES

Nerve and major root supply of muscle

A

C8, T1

Ulnar n.

40
Q

ADDUCTOR POLLICIS

Nerve and major root supply of muscle

A

C8, T1

Ulnar n.

41
Q

FLEXOR POLLICIS BREVIS

Nerve and major root supply of muscle

A

C8, T1

Ulnar n.

42
Q

PALMAR INTEROSSEI

Nerve and major root supply of muscle

A

C8, T1

Ulnar n.

43
Q

DORSAL INTEROSSEI

Nerve and major root supply of muscle

A

C8, T1

Ulnar n.

44
Q

LUMBRICALS III and IV

Nerve and major root supply of muscle

A

C8, T1

Ulnar n.

45
Q

ILIOPSOAS

Nerve and major root supply of muscle

A

L1, L2, L3

Femoral n.

46
Q

QUADRICEPS FEMORIS

Nerve and major root supply of muscle

A

L1, L2, L3
Femoral n.

Recuts femoris
Vastus medius
Vastus lateralis
Vastus intermedius

47
Q

ADDUCTOR LONGUS

Nerve and major root supply of muscle

A

L2, L3, L4

Obturator n.

48
Q

ADDUCTOR MAGNUS

Nerve and major root supply of muscle

A

L2, L3, L4

Obturator n.

49
Q

GLUTEUS MEDIUS and MINIMUS

Nerve and major root supply of muscle

A

L4, L5, S1

Superior gluteal n.

50
Q

TENSOR FASCIA LATAE

Nerve and major root supply of muscle

A

L4, L5, S1

Superior gluteal n.

51
Q

GLUTEUS MAXIMUS

Nerve and major root supply of muscle

A

L5, S1, S2

Inferior gluteal n.

52
Q

SEMITENDINOSUS

Nerve and major root supply of muscle

A

L5, S1, S2

Sciatic and tibial n.

53
Q

BICEPS FEMORIS

Nerve and major root supply of muscle

A

L5, S1, S2

Sciatic and tibial n.

54
Q

SEMIMEMBRANOSUS

Nerve and major root supply of muscle

A

L5, S1, S2

Sciatic and tibial n.

55
Q

GASTROCNEMIUS and SOLEUS

Nerve and major root supply of muscle

A

S1/2

Sciatic and tibial n.

56
Q

TIBIALIS POSTERIOR

Nerve and major root supply of muscle

A

L4/5

Sciatic and tibial n.

57
Q

FLEXOR DIGITORUM LONGUS

Nerve and major root supply of muscle

A

L5, S1, S2

Sciatic and tibial n.

58
Q

FLEXOR HALLUCIS LONGUS

Nerve and major root supply of muscle

A

L5, S1, S2

Sciatic and tibial n.

59
Q

SMALL MUSCLES OF FOOT

Nerve and major root supply of muscle

A

S1/2

Sciatic and tibial n.

60
Q

TIBIALIS ANTERIOR

Nerve and major root supply of muscle

A

L4/5

Sciatic and common peroneal n.

61
Q

EXTENSOR DIGITORUM LONGUS

Nerve and major root supply of muscle

A

L5, S1

Sciatic and common peroneal n.

62
Q

EXTENSOR HALLUCIS LONGUS

Nerve and major root supply of muscle

A

L5, S1

Sciatic and common peroneal n.

63
Q

EXTENSOR DIGITORUM BREVIS

Nerve and major root supply of muscle

A

L5, S1

Sciatic and common peroneal n.

64
Q

PERONEUS BREVIS

Nerve and major root supply of muscle

A

L5, S1

Sciatic and common peroneal n.

65
Q

PERONEUS LONGUS

Nerve and major root supply of muscle

A

L5, S1

Sciatic and common peroneal n.

66
Q

DYSARTHRIA

A

Dysarthria is due to impaired coordination of the lips, palate, tongue and larynx and may result from extrapyramidal, brainstem or cerebellar le- sions. The volume and content of the speech will be normal but the enunciation will be distorted

67
Q

SPASTIC DYSARTHRIA

A

This is due to bilateral upper motor neurone disease due to pseudobulbar palsy, motor neurone disease or brainstem tumours.

68
Q

ATAXIC DYSARTHRIA

A

This is due to incoordination of the muscles of speech; the words are often staccato or scanning and the rhythm is jerky. This type of dysarthria is seen in cerebellopontine angle tumours, cerebellar lesions, multiple sclerosis and phenytoin toxicity.

69
Q

RIGID DYSARTHRIA

A

This is characteristic of Parkinson’s disease. In severe cases the phenomenon of palilalia is seen.

70
Q

EXPRESSIVE DYSPHAGIA

A

This is due to a lesion affecting either Broca’s area in the lower part of the precentral gyrus or the left posterior temporoparietal region. If the latter region is affected the patient may have a nominal dysphasia, in which the ability to name objects is lost but the ability to speak is retained.

71
Q

RECEPTIVE DYSPHAGIA

A

This results from lesions in Wernicke’s area, which is the posterior part of the superior temporal gyrus and the adjacent pari- etal lobe.

72
Q

ALEXIA

A

Inability to understand written speech.

Alexia with agraphia (inability to write) is due to a lesion in the left angular gyrus often accompanied by nominal dysphasia, acalculia, hemianopia and visual agnosia

73
Q

GERTSMANN SYNDROME

A

consists of finger agnosia for both the patient’s own finger and the examiner’s finger, acalculia, right/left disorientation and agraphia without alexia. It is found in lesions of the dominant hemisphere in the region of the angular gyrus.

74
Q

Common causes of ANOSMIA

A

Olfactory nerve lesions from head injury, tumours involving the floor of the anterior cranial fossa
- olfactory groove meningiomas

75
Q

Examination of OLFACTORY NERVE

A

It is important to use non-irritant substances
when testing olfaction, as irritating
compounds (e.g. ammonia) will cause irritation
of the nasal mucosa. The stimulus is then perceived
by the general sensory fibres of the trigeminal
nerve.

76
Q

Examination of OPTIC NERVE

A

Visual acuity
Colour vision
Fundoscopy
Pupillary light reflex

77
Q

Foraml assessment of VISUAL FIELDS

A

Bjerrum screen

Goldmann perimeter

78
Q

Pattern of visual field loss and anatomical site of lesion

A

Total visual loss - optic nerve lesion

Altitudinous hemianopia - partial lesion of the optic nerve due to trauma or vascular accident

Homonymous hemianopia - lesion of the optic tract, radiation or calcarine cortex

Bitemporal hemianopia - optic chiasm lesion e.g. pituitary tumour, craniopharyngioma or suprasellar meningioma

79
Q

FUNDOSCOPIC EXAMINATION

A

Optic disc
Vessels
Retina

A pale optic disc is due to optic atrophy which
may be either primary, as a result of an optic
nerve lesion caused by compression or demyelination,
or consecutive, which follows severe
swelling of the disc.

Papilloedema is due to raised intracranial pressure and is evident by:
• blurring of the disc margins
• filling in of the optic cup
• swelling and engorgement of retinal veins,
with loss of normal pulsation of the veins
• haemorrhages around the disc margin (if severe)

80
Q

Examination of OCCULOMOTOR, TROCHLEAR and ABDUCENS nerves

A

Position of Eyelid
Pupils - size, shape, equality: direct/consensual
Extraocular movements

81
Q

PTOSIS

A

Due to paralysis of the levator palpebrae
superioris as a result of a 3rd cranial nerve lesion
or due to weakness of the tarsal muscle due to a
sympathetic lesion (Horner’s syndrome).

82
Q

MIOSIS

A

Unilateral constricted pupil oftenindicates a lesion in the sympathetic supply tothe pupillary dilator muscle.

83
Q

HORNER’S SYNDROME

A

Horner’s syndrome, in its complete state, consists
of miosis, ptosis, enophthalmos and dryness
and warmth of half of the face.

Due to a lesion of the sympathetic supply such as results from an intracavernous carotid artery aneurysm, or a Pancoast’s tumour of the apex of the lung.

84
Q

MYRDRIASIS

A

Dilated pupil secondary to paralysis of the parasympathetic fibres originating from the Edinger-Westphalia nucleus in the midbrain.
- Seen in CN III palsy

Causes: enlarging PCA aneurysm, tentorial herniation from raised ICP with herniated uncus of the temporal lobe compressing the CN III

85
Q

ARGYLL-ROBERTSON pupil

A

Small, irregular pupil not reacting to light

Reacting to accommodation but responding poorly to mydriatics

Usually caused by syphilis.

86
Q

HOLMES-ADIE pupil

A

Myotopic pupil

Usually occurs in young woman and presents as unilateral dilatation of one pupil with failure to react to light.

In the complete syndrome the knee and ankle jerks are absent.

87
Q

LATERAL RECTUS

A

CN VI moves the eye horizontally outwards.

88
Q

MEDIAL RECTUS

A

CN III moves the eye horizontally inwards.

89
Q

SUPERIOR RECTUS

A

CN III elevatest eh eye when it is turned outwards.

90
Q

INFERIOR OBLIQUE

A

CN III elevates the eye when it is turned inwards.

91
Q

INFERIOR RECTUS

A

CN III depresses the eye when it is turned outwards.

92
Q

SUPERIOR OBLIQUE

A

CN IV derpesses the eye when it is turned inwards

93
Q

Impaired CONJUGATE OCCULAR EYE MOVEMENT

A

The centre control of conjugate lateral gaze is situated in the posterior frontal lobe, with input from the occipital lobe.

Final common pathway for controlling conjugate movement is the brainstem - median longitudinal bundle

Frontal lobe lesion causes contralateral paralysis of conjugate gaze (i.e. eyes deviated towards lesion)

Lesion of brainstem causes ipsilateral paralysis of conjugate gaze (i.e. eyes deviated away from lesion)

Neurosurgery (4 decks)

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