Neurology 1.3 Flashcards
What is the significance of a careful history during a neurological exam?
hx can be used to get most of the necessary information in localizing a lesion which gives rise to a neurologic complaint
In a neurological exam, how is mental status evaluated?
alert, oriented to person, place, time ( patient gives a cogent medical history)
In a neurological exam, how is speech evaluated?
fluent, normal syntax, comprehension, repetition
In a neurological exam, how are cranial nerves evaluated?
visual fields, extra ocular movements, fundoscopic exam, facial symmetry and facial sensation, and hearing is normal
In a neurological exam, how are motor nerves evaluated?
mass, tone and strength of muscles (compare bilaterally)
In a neurological exam, how are sensory nerves evaluated?
light touch, pin prick and double simultaneous stimulation
In a neurological exam, how is gait evaluated?
stepping, toe-heel walking, turning; be observant
In a neurological exam, how is cerebellar function evaluated?
finger nose finger, heal shin, no involuntary movements
In a neurological exam, how are reflexes evaluated?
upper and lower extremities, toes planter bilaterally
In a neurological exam, how is cerebrovascular function evaluated?
carotid, orbital or cranial bruits
In a neurological exam, how is musculoskeletal function evaluated?
range of motion axial and appendicular structures, normal Osteopathic exam
Which neurological exam requires the most patient cooperation?
sensory nerve function
What is the goal directed behavior of executive functioning in testing mental status?
complex set of activities (involves, volition, planning, purpose, action, and effective performance). Activities of daily living affected.
What is praxis?
(idiomotor apraxia; can’t do a simple task when asked, but can do it involuntarily); tested during mental status exam
What is Gerstmann Syndrome and how is it tested?
left posterior hemispheric lesion;
1) R-L confusion (touch left shoulder, etc.)
2) Finger agnosia (inability to recognize fingers, pinky? Index/)
3) Agraphia (inability to write; couldn’t write name)
4) Acalculia (inability to calculate 2=+1=, 4+2=?)
Which domains are affected in Gerstmann Syndrome?
1) visuospatial (r-l confusion, fingers)
2) praxis (can’t write name)
3) calculation (dyscalculia)
Which domains are unaffected in Gerstmann Syndrome?
1) level of consciousnes
2) memory
3) mood
4) thought content
What is the Montreal Cognitive Assessment test?
MoCA; test short term memory, visual spatia, repetition of words, executive functioning, attention, concentration, working memory, orientation
What is CN I?
olfactory nerve; important test in early CNS degenerative disorder assesment
What is CN II?
optic nerve; visual fields and acuity, also tested with fundoscopic exam
What is inspected in a fundoscopic exam?
1) disc margins
2) venous pulsations
3) retinal vessels
4) retina
5) macula
What is anisocoria?
asymmetric pupils; pupillary defect in CN III
What is CN III?
oculomotor; anisocoria, Horner’s syndrome
Which nerves are being tested with eye movements?
CN III, IV, VI; ptosis, EOM, nystagmus
What is Internuclear Opthalmoplegia?
INO; produced by lesion of medial longitudinal fasciculus which connects CN VI with CN III
How is Internuclear Opthalmoplegia tested?
impaired adduction on affected side with nystagmus in the other abducting eye
What is CN IV?
trochlear nerve
What is CN V?
trigeminal nerve; facial sensation and mastication muscles
What is CN VI?
abducens nerve
What is CN VII?
facial nerve; controls facial muscles; lesion is usually peripheral; Bell’s Palsy
What is Bell’s Palsy?
peripheral weakness or paralysis of one side of the face causing facial droop; CN VII
What is CN VIII?
vestibulocochlear nerve; hearing, balance
Which nerves test palatal movement?
CN IX, X; “say ahh”, gag reflex
Which nerves test dysarthria?
CN VII, IX, X, XII; articulation errors and voice quality
Which nerves test head rotation and shoulder elevation?
CN XI (sternocleidomastoid and trapezius)
What is CN IX?
glossopharyngeal nerve
What is CN X?
vagus nerve
What is CN XI?
spinal accessory nerve; head rotation and shoulder elevation
What is CN XII?
hypoglossal nerve; tongue weakness
What is monoparesis?
weakness of a single limb
What is hemiparesis?
weakness of one side of the body
What is paraparesis?
weakness of both lower extremities
What is quadraparesis?
weakness of all four limbs
What is plegia?
complete or nearly complete paralysis of the involved limbs
What is diplegia?
applied mainly to bilateral facial paralysis
What is spasticity?
clasp knife (give and catch) requires additional force; part of muscle tone
What is rigidity?
increased resistance throughout range of motion; part of muscle tone
What is rapid alternating movements?
hands on thighs and rapidly supinate; pronate hands for 10 seconds
What is dysdiadochokinesis?
inability to perform rapid alternating movements slow or irregular; movement disorder
What is point to point movements?
index finger from axaminer’s to nose and back and forth
What is dysmetria?
inability to perform point to point movements
What is heel down shin?
side down from know to top of foot
What is the Rhomberg test?
patient stands still, feet together, then ask patient to close eyes and extend arms; positive if significant and immediate loss of balance (be prepared to make a catch)
What is the cerebrovascular evaluation?
auscultate for carotid, orbital and cranial bruits
What is a false positive of a cerebrovascular test?
anemia
hypermetabolic state
pressing too hard with stethoscope
What is a false negative of a cerebrovascular test?
total occlusion
