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Neurology > Neurological Exam > Flashcards

Neurological Exam Flashcards

0
Q

What structures are required for consciousness?

A

One cerebral hemisphere and reticular activating system

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1
Q

Level of alertness

A

Best verbal or motor response that can be elicited from a pt in response to a specific stimulus

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2
Q

Aphasia

A

Acquired disorder in production or understanding of language due to a lesion involving the dominant cerebral hemisphere.

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3
Q

Expressive aphasia

A

I.e Broca’s aphasia - significant difficulty producing language but preserved understanding; pts usually have a right hemiparesis due to involvement of adjacent motor cortex

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4
Q

Receptive aphasia

A

I.e Wernicke’s aphasia - fluent, nonsensical speech with numerous paraphrasic errors and markedly impaired understanding

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5
Q

What do patients with Wernicke’s aphasia frequently also have?

A

Contralateral homonymous hemianopsia due to involvement of adjacent optic radiation s

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6
Q

Lesion location of conduction aphasia

A

Arcuate fasciculus

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7
Q

Anomic aphasia

A

Lesion in post. Inferior temporal lobe with specific deficit in naming things

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8
Q

What are the 6 ways you can assess aphasia?

A 
Fluency
Naming
Comprehension
Repetition 
Reading 
Writing
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9
Q

Agnosia

A

Defect in recognizing a complex stimulus; due to defects involving association cortex ESP in parietal and temporal lobes

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10
Q

Anosognosia

A

Denial of illness

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11
Q

Asomatognosia

A

Denial of half of one’s body

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12
Q

Prosopagnosia

A

Inability to recognize faces

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13
Q

Ideomotor apraxia

A

Inability to perform motor tasks in command

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14
Q

Ideational apraxia

A

Inability to plan a series of complex tasks (how would you set the table for dinner)

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15
Q

Constructional apraxia

A

Inability to copy complex figures

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16
Q

5 ways you can test cognition

A 
Orientation 
Memory
Intellect
Abstraction
Judgment
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17
Q

How do u assess pts memory

A

Ask them to immediately recall three objects and after 5 minutes ask them again

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18
Q

At which locations should you auscultate the skull? What do bruits signify?

A

Over the orbits, mastoid processes and temporal bones

Bruits over these areas can indicate AVM

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19
Q

What should you assess on the spine in physical exam

A
  • check for scoliosis
  • palpation to detect tenderness
  • ROM in 6 cardinal directions (cervical and lumbar)
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20
Q

Positive straight leg test implies…

A

Compression or irritation of nerve roots L4-S2

- pain may be increased with dorsiflexion of the foot

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21
Q

Menigismus

A

Severe neck pain that is made profoundly worse with neck flexion

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22
Q

Brudzinski sign

A

Spontaneous flexion of the legs at the hips and knees following neck flexion

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23
Q

Kernig sign

A

Resistance to knee extension when the hips are flexed

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24
Q

When is it especially important to evaluate the olfactory nerve ie sense of smell

A

After head trauma bc cribiform plate may be sheared off

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25
Q

What type of tumors cause neurologic loss if smell by invading cribiform plate

A

Basal meningiomas

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26
Q

What does visual acuity evaluate

A

Only macular vision, which is the central 5 degree of the visual field

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27
Q

How do you evaluate visual neglect

A

Pt keeps both eyes open and looks are examiners nose, examiner presents bilateral simultaneous stimuli and pt is asked to localize the stimuli

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28
Q

Marcus gunn pupil

A

Deafferented pupil that constricts to consensual but not direct light; due to lesion in CN 2

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29
Q

Hutchinson pupil

A

Dilated pupil that does not respond to direct or consensual light; due to lesion in CN 3

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30
Q

Adies tonic pupil

A

Dilated pupil with impaired light response and slow constriction to near vision; lesion to the parasympathetics

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31
Q

Argyle Robertson pupil

A

Small, irregular pupil that constricts to near vision by not to light; lesion in pretectum

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32
Q

Vestibulocular reflex (oculocephalic) ie dolls eyes

A

Reflex fixates image on the retina with respect to head and neck motion; vestibular nuclei project to CN 3,4 and 6 via MLF to maintain stable visual field despite head motion

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33
Q

Visual pursuit

A

Reflex that fixates the image on retina with respect to image motion; image motion is sensed by occipital cortex that then relays the information in a crossed manner to lateral gaze center in pons and then via MLF to CN 3,4,6

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34
Q

Nystagmus

A

Rhythmic, oscillatory involuntary eye movement of one or both eyes that may occur spontaneously or be evoked by a specific direction of gaze

35
Q

Main causes of ptosis

A

Lesions to CN 3 which innervates the levator palpebrae OR the superior tarsal muscle which is innervated by the sympathetic nervous system

36
Q

How can u distinguish a sympathetic lesion causing ptosis from a CN 3 lesion causing ptosis

A

Sympathetic lesion will have accompanying small pupil (Horner’s) while CN 3 lesion will have large pupil

37
Q

Corneal reflex

A

Afferent - ophthalmic division of trigeminal

Efferent - facial nerve

38
Q

Muscles of mastication

A

Temporalis, masseter, lateral and medial pterygoid mm

- innervated by mandibular division of trigeminal nerve

39
Q

What do you see in Bell’s palsy?

A

Lower motor neuron lesion - ipsilateral weakness of entire half of face

40
Q

Facial weakness due to UMN lesion (corticobulbar tract)

A

Contralateral weakness of lower half of face

41
Q

Pattern of sound localization with the Weber test

A

Normally sound should be heard in both ears

- sound localizes to bad ear in conductive hearing loss and to good ear in sensorineural hearing loss

42
Q

Latency period before onset of nystagmus in peripheral vs central vertigo

A

Peripheral is 2-20 sec, whereas central has no lag period

43
Q

Duration of nystagmus in peripheral vs central vertigo

A

Peripheral is less than 1 min

Central is greater than 1 min

44
Q

Which is more severe vertigo.. Peripheral or central?

A

Peripheral - it also demonstrates fatigability

45
Q

What do you see with a lesion of the hypoglossal nerve

A

Atrophy of ipsilateral half of tongue

Tongue will deviate towards the side of lesioned nerve when protruding

46
Q

Denervation atrophy

A

Profound form of muscle atrophy seen with LMN lesions

47
Q

Disuse atrophy

A

Milder form of muscle atrophy that can be seen with a variety of clinical settings

48
Q

What is a fasciculation and what could it mean?

A

Worm like contractions of muscle due to random discharge of an entire motor unit - may be seen with anterior motor horn disorders I.e ALS

49
Q

Myoclonus

A

Sudden contractions of a muscle or group of muscles that move an entire limb across a joint; commonly seen with metabolic or hereditary neuro disorders

50
Q

Muscle tone

A

Resistance of muscle to passive stretch - can be assessed by moving a relaxed limb passively through an entire ROM

51
Q

What is spasticity and what does it imply?

A

Increased muscle tone that has a catch which varies with position and is velocity dependent
- implies UMN lesion

52
Q

Rigidity

A

Steady resistance to movement at all speeds and positions; superimposed tremor can lead to cogwheeling

53
Q

Lead pipe rigidity implies a lesion in…

A

Basal ganglia - substantia nigra or striatum

54
Q

Paratonia - gegenhalten and mitgehen

A

Inability to relax the muscle

  • gegenhalten: opposes the examiner
  • mitgehen: assists the examiner
55
Q

Paratonia implies a lesion in…

A

Bihemispheric lesion

56
Q

What is ‘functional testing’ of UE and LE

A

UE: ask pt to raise arms over their head, ability to touch chin to chest
LE: ability to raise from a chair w/o using hands, ability to walk on toes/heels

57
Q

Pronator drift

A

Strongly indicates UMN lesion

58
Q

How do you assess protopathic sensation

A

Pain (pinprick) and temperature (cold tuning fork)
- carried by small, Unmyelinated fibres, travel contralaterally in lateral spinothalamic tract to brain stem reticular formation and thalamus

59
Q

How do you test epicritic sensation

A

Ex, fine touch, vibration, proprioception

60
Q

Stereognosis

A

Ability to identify objects by touch alone ex. Place a coin in pts hand and ask them to close their eyes and identify it

61
Q

Graphesthesia

A

Ability to recognize numbers drawn on palm of hand

62
Q

Two point discrimination

A

Test with paper clip, normal subjects have detection threshold of 2 mm at tip of index finger

63
Q

Double simultaneous stimulation

A

Right and left sides of the body are touched at the same time and the patient is asked to localize both stimuli with eyes closed

64
Q

Romberg test

A

Functional sensory testing - ask pt to stand with feet together and eyes closed, if they sway/fall to one side then Romberg is positive
- dysfunction implies lesion to either vestibular apparatus or proprioception

65
Q

Pt cannot stand well with feet together and eyes open - what does this imply

A

Lesion of cerebellum is expected

66
Q

How do you assess truncal stability in a pt

A

Observe pts balance while they are sitting or standing with feet together and eyes open; truncal ataxia suggests cerebellar vermis lesion

67
Q

How do you assess limb coordination?

A

Finger to nose and heel to shin tests

68
Q

Inability to ‘check’ movements indicates lesions of…

A

Ipsilateral cerebellar hemisphere

Severe sensory disturbances causing altered proprioception

69
Q

How can you evaluate vestibular coordination

A

Compass turning - ask pt to march in place with eyes closed, rotation of body in one direction is suggestive of ipsilateral vestibular pathology

70
Q

Clonus

A

Rhythmic series of involuntary mm contractions induced by a sudden passive stretch to a muscle; indicative of hyperreflexia

71
Q

Abdominal reflexes

A

Stroke skin lightly in all 4 quadrants, look for deviation of umbilicus toward the quadrant that is stroked

  • upper quads are t6-t9
  • lower quads are t10-12
72
Q

What nerve roots are needed for anal wink reflex

A

s3-5

73
Q

The cremasteric reflex is mediated by what nerve roots

A

L1-2

74
Q

Bulbocavernous reflex

A

Squeezing glans penis and observing for contraction of external anal sphincter; requires nerve roots s3-4

75
Q

When do frontal release signs occur

A

Normally present in infancy, reappear with advanced age or diffuse cortical or bihemispheric damage

76
Q

What are the 4 frontal release signs

A

Snout reflex
Palmomental reflex
Grasp reflex
Glabellar sign

77
Q

Inability to perform tandem gait indicates..

A

Altered proprioception or midline cerebellar lesions

78
Q

An asymmetric, hemiplegic gait

A

Upper motor neuron disorder

79
Q

Asymmetric, steppage (foot drop) gait

A

Peroneal nerve palsy

80
Q

Asymmetric, antalgic gait

A

Foot or leg lakn

81
Q

Wide based, sensory ataxic gait (foot slap)

A

Lesion in posterior columns

82
Q

Wide based, gait apractic gait (gait ignition failure)

A

Bihemispheric lesions usually frontal lobe dysfunction

83
Q

Narrow based, spastic scissor gait

A

Bilateral UMN lesions

84
Q

Narrow based festinating gait

A

Basal ganglia ( substantia nigra)

Neurology (15 decks)

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