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Psych 301 > Neurological Examination > Flashcards

Neurological Examination Flashcards

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1
Q

what is a neurological examination?

A
  • series of tests conducted by a neurologist to evaluate the integrity of the nervous system for many reasons
  • Ex. Post-trauma/stroke, suspected neurodegenerative changes, following exposure to a neurotoxic agent
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2
Q

localization of neurological exam (where could damage have occurred?)

A
  • Cerebral Hemisphere (Telencephalon)
  • Internal Capsule
  • Brainstem (Where? Diencephalon, Mesencephalon, Metencephalon, or Myelencephalon?)
  • Spinal Cord
  • Cranial Nerves
  • Neuromuscular Junction
  • Muscle
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3
Q

common components to know before conducting neurological exam

A
  • patient history
  • Cranial nerve function
  • Motor function (ex. Reflex)
  • Somatosensory function
  • Coordination
  • Mental status
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4
Q

components to know: patient history

A
  • Age, education, and handedness -> right-handed people have language centers in left part of brain
  • Past medical history
  • Use of medication and/or recreational drugs
  • Family medical history
  • Disease process
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5
Q

components to know -> patient history -> disease process

A
  • Temporal profile: sudden vs. Gradual; acute vs. Chronic
  • Change over time: static, improvement, worsening
  • Identify triggers/relievers of symptoms
  • Gauge severity of symptoms
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6
Q

cranial nerves

A
  • All are peripheral (“peripheral damage” refers to cranial nerves; “central damage” refers to brain stem)
  • Olfactory
  • Optic
  • Oculomotor
  • Trochlear
  • Trigeminal
  • Abducens
  • Facial
  • Vestibulocochlear
  • Glossopharyngeal
  • Vagus
  • Accessory
  • Hypoglossal
  • “Oh, Only Officers Try To Allow For Very Good Vacations And Holidays”
  • “Some Say Money Matters, But My Brother Says Big Brains Matter More”
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7
Q

cranial nerves: olfactory

A
  • sensory

- smell

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8
Q

cranial nerves: optic

A
  • sensory

- vision

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9
Q

cranial nerves: oculomotor

A
  • motor

- eye/eyelid movement

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10
Q

cranial nerves: trochlear

A
  • motor

- eye movement

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11
Q

cranial nerves: trigeminal

A
  • both

- facial sensation, jaw muscles

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12
Q

cranial nerves: abducens

A
  • motor

- eye movement

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13
Q

cranial nerves: facial

A
  • both

- taste from anterior tongue, muscles of facial expression

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14
Q

cranial nerves: vestibulocochlear

A
  • sensory

- sound, balance

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15
Q

cranial nerves: glossopharyngeal

A
  • both

- taste from posterior tongue, muscles of pharynx

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16
Q

cranial nerves: vagus

A
  • both

- ear canal sensation, motor control of heart, lungs, viscera, larynx, etc.

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17
Q

cranial nerves: accessory

A
  • motor

- movement of muscles of head rotation and shoulder shrug

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18
Q

olfactory nerve: test, what it’s assessing, what dysfunction could look like

A
  • Test: smell stuff with eyes closed
  • Assessing: Ethmoid ridge and TBI
  • Damage: mild head injury can damage/shear nerves
19
Q

optic nerve: test, what it’s assessing, what dysfunction could look like

A
  • Test: Standard visual acuity test (Snellen chart), visual field confrontation, pupillary light reflex
  • Assessing: whether visual info sent to both sides of brain
  • Damage: Papilledema and intracranial pressure
20
Q

Oculomotor, Trochlear, Abducens: test, what they’re assessing, what dysfunction could look like

A
  • Test: follow object/light without moving head
  • Assessing: gaze restrictions
  • Damage: issues caused by lesions
21
Q

trigeminal: tests/assessment

A
  • Facial somatosensation (sharp vs. Light tip)

- Palpating jaw, checking for motor function

22
Q

facial: test/assessment

A

Looking for facial asymmetries (ex. Bell’s Palsy)

23
Q

vestibulocochlear: test/assessment

A
  • Auditory perception
  • Balance
  • Vestibular senses (labyrinth)
24
Q

glossopharyngeal and vagus: test/assessment

A
  • Swallowing and voice

- Gag reflex

25
Q

accessory: test/assessment

A
  • Shrugging of shoulders

- Head resistance

26
Q

hypoglossal: test/assessment

A

Stick out the tongue, lateral movement

27
Q

motor function: what to examine, what damage looks like

A
  • Key features to examine:
    • Gross appearance of muscle
    • Muscle tone, strength
  • Upper vs. lower motor lesions: Effect on reflexes (ex. Babinsky reflex)
28
Q

Mental Status Exam (MSE) -> what does it measure?

A
  • Attention and orientation
  • Language
  • Memory
  • Visuospatial function
  • Executive functions
29
Q

MSE: attention and orientation -> tests

A
  • Observe the patient’s alertness
  • Spelling a word backwards
  • Counting backwards from 20
  • Auditory vigilance
  • Current whereabouts, time
30
Q

MSE: attention and orientation -> regions involved

A
  • Focal cortical or subcortical regions

- Origin may be diffuse (ex. Toxin)

31
Q

MSE: attention and orientation -> problems

A
  • Contralateral neglect = failure to attend to left side of the world (perception is there, but attention is not)
  • Anosognosia = failure of individual to self-report that they have a disorder; understanding the world by literally not having the ability to acknowledge the disorder (medication can help with this)
32
Q

MSE: language -> tests/what you’re looking for

A
  • Fluency
  • Naming
  • Repetition
  • Prosody
  • Comprehension
  • Reading
  • Writing
  • Praxis (ability to carry out a motor ability you know when it’s requested)
  • Language problems
33
Q

MSE: language -> language problems

A
  • Aphasia: problems with language production and/or comprehension
  • Alexia: problems with reading
  • Agraphia: problems with writing
  • Apraxia: problems with praxis
34
Q

MSE: language -> regions involved

A

focal or diffuse damage to the left hemisphere language network

35
Q

MSE: memory -> tests/looking for what

A
  • Digit span (increasing digits you have to memorize, magic number = 7)
  • Pointing span (increasing pointing to corners of room, memorizing order)
  • Verbal, visual object learning
  • Past public/personal events
  • Factual knowledge
36
Q

MSE: memory -> regions involved

A

medial temporal structures (eg. Hippocampus), thalamus, basal forebrain, prefrontal cortex

37
Q

MSE: visuospatial functions -> tests/looking for what

A
  • Line cancellation
  • Copy of geometric designs
  • Judgment of line orientation
  • Object/face/colour recognition
  • visuospatial problems
38
Q

MSE: visuospatial functions -> visuospatial problems

A
  • Prosopagnosia: failure to recognize faces
  • Constructional apraxia: difficulty putting pieces of an object together
  • Dressing apraxia: difficulty getting dressed
39
Q

MSE: visuospatial functions -> regions involved

A

right hemisphere’s attention network; temporal lobe

40
Q

MSE: executive functions -> tests/looking for what

A
  • Judgment (presenting situation, making judgment calls based on it)
  • Verbal fluency (“think of as many words starting with the letter F as you can”)
  • Luria 3-step
  • Drawing loops, alternating patterns
  • Oral trail-making test
41
Q

MSE: executive functions -> regions involved

A

prefrontal cortex and/or associated projections

42
Q

cranial nerves: hypoglossal

A

Movement of tongue muscles (speech, swallowing)

43
Q

Halstead-Reitain Neuropsychological Test Battery vs. Syndrome Analysis Scheme

A
  • HRNTB: quantitative approach, used in USA; battery of different tests used to examine deficits associated with brain lesions
  • SAS: qualitative approach, used in USSR; theory-based, hypothesizes relationship of cause and lesion, interviews/examines patients
44
Q

Luria’s major contribution to neuropsychology

A
  • Clinical approach he developed
    • main points: psychological systems represent functional processes, individualized/case analysis is best method of clinical research, analysis of errors is most important observation when testing a patient
    • note: “testing” = specific set of tests used; “approach” = clinical use of tests

Psych 301 (18 decks)

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