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2b > Neurological examination > Flashcards

Neurological examination Flashcards

1
Q

What is the structure of a neurological examination

A 
Romberg test
Walking
Cranial Nerves
Motor system 
Sensory system
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2
Q

What position is needed for the Romberg test

A

Feet next to each other
Eyes closed
Arms stretched out
Hands supinated

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3
Q

Which centres are responsible for balance

A

Cerebellum, proprioception, vestibulum, eyes

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4
Q

What does balance being worse on eye closure suggest

A

Proprioceptive problem

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5
Q

What needs to be determined with power problems

A

Central or peripheral

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6
Q

What does pronatory drift suggest

A

A pyramidal lesion

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7
Q

What should you look out for when assesseing water

A

Posture
Balance
Stride length
Arm swing

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8
Q

Acute history reasons

A

Vascular, toxins, drugs, trauma

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9
Q

Subacute history reasons

A

Infections, inflammation, tumours

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10
Q

Chronic history reasons

A

Neurodegenerative conditions

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11
Q

Name four walking patterns

A

Hemiplegic, scissoring, steppage, parkinsonian gait

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12
Q

What is the test for meningism

A

Take head of patient in both hands, move forwards and backwards

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13
Q

Causes of meningism

A

Meningism, subarachnoid haemorrhage

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14
Q

Who shows scissoring gate

A

Cerebral palsy

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15
Q

Who shows hemiplegic gate

A

Hemplegics

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16
Q

How to test CN2

A

Shine light into one eye.
Bring light from side
Both pupils will constrict
(Direct and indirect light reflexes)

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17
Q

Do people keep their glasses on for visual activity tests

A

Yes. If they dont have glasses with them, can use the pinhole test

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18
Q

Testing visual fields

A

Eyes at same level as patient

Both the patients fields should be the same

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19
Q

Fundoscopy

A

Use your right eye to look into the patients right eye, looking for papilloedema

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20
Q

Which reflex are you looking for with fundoscopy

A

Red reflex

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21
Q

How do you test eye movements

A

Tell patient to keep head still and follow the finger with their eyes. T

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22
Q

What are you testing with the eye movements examination

A

3,4,6 CNs and cortical eye fields

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23
Q

How does right 6th nerve palsy show

A

Cant move the eye to the right

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24
Q

How does 3rd nerve palsy show

A

Ptosis and mydriasis

Eyes out and down

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25
What are you looking for
Sclera completely going, and if the sides are different
26
Which shapes are you doing with the object for the patient to follow
H and I
27
Which nerve is tested by the corneal reflex
Efferent trigeminal
28
Motor function of the trigeminal
Jaw closure and mastication
29
Which nerve is responsible for jaw jerk
Efferent V3
30
What is sparing of the forehead a sign of
Upper CNVII (eg after stroke) lesion
31
What is all facial muscles on the affected side being weak a sign of
Lower CNVII (Bells palsy) lesion
32
What is all facial muscles on the affected side being weak a sign of
Lower CNVII (Bells palsy) lesion
33
How to test trigeminal sensory
Use cotton wool then a pin, testing each division on both sides. Ask them if it feels the same on both sides. Start by testing on chest
34
How to test trigeminal motoro
Ask them to clench teeth | Get them open mouth and then test the power in different directions
35
How to test jaw jerk
As them to open their mouth and then test reflex
36
How to test facial motor
``` Raise eyebrows Stop doctor opening eyes Smile Pout Puff out cheeks ```
37
What is bells sign
Ask them to smile and the eye moves up
38
How to test 9th and 10th
Say aaargh Movements of palate Swallow reflex
39
Right vagal nerve palsy would cause uvula and palate to move in what direction
Towards the left
40
Swallow reflex tests which nerves
9th afferent | 10th efferent
41
Which two muscles are innervated by the accessory nerve
Sternocleidomastoid and trapezius
42
How do you test sternocleidomastoid
Turn head to opposite side, and make them resist force
43
How do you test trapezius
Shoulder strug and make them resist force
44
Right 12th nerve palsy would cause the tongue to move to which side
To the right
45
Does a 10th nerve palsy cause move towards or away? | Does a 12th nerve palsy cause move towards or away?
Vagal away | 12th towards
46
What position should the tongue be in for examination
Relaxed | If projected, fasciculation cant be seen
47
What position should the tongue be in for examination
Relaxed | If projected, fasciculation cant be seen
48
Why use a tuning fork
To compare air and bone conduction. It should be louder in the air. Louder on the mastoid process would suggest a problem with the outer ear such as wax
49
Why use a tuning fork
To compare air and bone conduction. It should be louder in the air. Louder on the mastoid process would suggest a problem with the outer ear such as wax
50
What five things do you look at for the motor system
``` Inspection Tone Power Reflexes Coordination ```
51
What is tone
Resistance of the muscle to heightened movement
52
When is tone high
UMN
53
When is tone low
LMN
54
Describe UMN changes
Increased spastic tone Pyramidal pattern of weakness increased tendon relexes
55
Describe LMN changes
``` Descreased muscle mass -atrophy and fasciculations Decreased tone Peripheral weakness Decreased tendon weakensses ```
56
What is spasticity
Velocity dependent First increase, then decrease Selectivity Typical of UMN
57
What is rigidity
Increased tone over entire radius of joint movement | Seen in parkinsons
58
What do you look for in Power
Symmetry/asymmetry Pattern of weakness Grade the power
59
What do you look for in Power
Symmetry/asymmetry Pattern of weakness Grade the power
60
Define fasciculation
Involuntary small muscle movement
61
What does proximal weakness suggest
A problem with the muscle
62
What does distal weakness suggest
Nerve
63
When is a reflex pathologically brisk
- brisker than the other side - widening of reflex zone - spread of reflex response
64
Which directions do you test the hip in
Abduction, adduction, flexion, extension
65
Which directions do you test the knee in
Flexion and extension
66
Which directions do you test the ankle in
Dorsiflexion and plantar flexion
67
What does impaired coordination suggest
Cerebellar damage
68
What are the tests for coordination
Heel to shin (finger nose) Rapid alternating movements
69
How to test plantar responses
Scratch lateral border of foot then towards big toe. Normal response is big toe goes up. In adults its an UMN sign
70
What is a <2yr olds response to babinski
Big toe goes down
71
What are the four main qualities of sensation
Light touch and pin prick | Joint position sense and vibration
72
How can you reinforce reflexes
Clench teeth or across chest
73
Upper limb reflexes
Biceps Triceps Suppinator
74
Lower limb reflexes
Knee | Ankle
75
How do you test finger nose coordination
Get the patient to alternate touching their nose and your finger
76
Why do peripheral nerves show a glove and stocking distribution
As only the cell body has mitochondria to make ATP so the distal parts are low on ATP first
77
What is an eye which can acommodate but not the light a sign of
Syphilis
78
What is fatigueability a sign of
Myasthenia gravis
79
Which nerve controls the corneal reflex
Trigeminal
80
The motor division of the 1st branch of the facial nerve is responsible for
Stapedius, tightening the tympanic membrane
81
Where is the lesion if there is forehead sparing
Upper motor neurone

2b (28 decks)

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