Neurology Exam Flashcards
Structure? Cranial Nerves
General Inspection
5Qs: sight, smell, hearing, swallow, speech/ dry eyes/ mouth
4 eyes: visual fields, pupils (direct, consensual, swinging), fundoscopy, eye movements
3 face: raise eye brows, squeeze eyes shut, show teeth - against resistance
2 mouth: uvula, tongue
Structure? Limbs
Inspection - wasting, fasciculation, tremor, myoclonic jerks, deformity/ posture, pronator drift Tone, clonus Power Reflexes Coordination Sensation- pin prick, vibration Gait Romberg's
Power Upper Limb Nerve Roots
Shoulder abduction C5
Elbow flexion C5/6 and elbow extension C7
Wrist flexion C7 and wrist extension C7
Finger extension C7, flexion C8 and abduction T1
Thumb abduction T1
Power Lower Limb Nerve Roots
Hip flexion L1/2/3 and extension L5/ S1
Knee flexion L5/S1 and extension L3/4
Ankle dorsiflexion L4/L5 and plantarflexion S1/S2
Reflexes Upper Limb Nerve Roots
Biceps C5
Supinator C5/6
Triceps C7
Reflexes Lower Limb Nerve Roots
Knee L3/4
Ankle S1/2
Plantar - UMN lesion
Sensation Upper Limb Nerve Roots
Shoulder C5 Thenar eminence C6 Middle finger C7 Little finger C8 Medial arm T1
Sensation Lower Limb Nerve Roots
ASIS L1 Lateral upper thigh L2 Knee upper L3 Medial shin L4 Lateral shin L5 Little toe S1 Back of leg S2
Eye signs
Ptosis Miosis Mydriasis Kayser Fleischer Rings Argyll Robertson pupil Holme- Adie pupil RAPD External ophthalmoplegia CN III, IV, VI nerves Papilloedema
Ptosis
Unilateral: - CNIII palsy - Horner's syndrome Bilateral - Myasthenia gravis - Muscular Dystrophies - Mitochondrial Disorders
Miosis
Small pupil
- Opioids
- Horner’s
Kayser Fleischer Rings
Copper deposition
- Wilson’s disease
Argyll- Robertson Pupil
Small, irregular pupils
No response to light, response to accommodation
- Diabetes
- Syphilis
Holme- Adie Pupil
Dilated pupil
Benign
Once constricted remains small for a long time
Relative Afferent Pupillary Defect
'Marcus Gunn Pupil' Swinging light test Lesion anterior to optic chiasm Affected eye dilates when light shone on it - Retinal detachment - Optic nerve e.g. optic neuritis
Mydriasis
- CNIII palsy
- Holmes Adie
- Traumatic iridoplegia
- Pheochromocytoma
- Congenital
- Drugs e.g. sympathomimetic, topical mydriatics (tropicamide), anticholinergics
External Ophthalmoplegia
- Mitochondrial disease
- Myasthenia Gravis
- LEMS
- ## Miller Fisher Syndrome
CN III palsy
Eye down and out
Associated with mydriasis, ptosis
CN IV palsy
Nasal upshoot Superior oblique (eye down and rotated in)
CN VI palsy
Can't abduct Lateral rectus (abduction)
Papilloedema
Raised intracranial pressure
- Increased CSF: hydrocephalus
- Haematoma
- Aneurysm
- Tumour
- Infection: meningitis, encephalitis
- CVST
- Idiopathic
CN VII Palsy
Paralysis of facial muscles
LMN - Bell’s Palsy, no sparing of the forehead
Mouth
Uvula - deviates away from lesion - vagus nerve Tongue - deviates towards lesion - hypoglossal nerve - fasciculations
Pronator Drift
Down and pronates
- Muscular weakness due to UMN lesion
Up and pronates
- Cerebellar disease
Cerebellar Ataxia
Intention tremor Dysmetria- past pointing Dysdiadochokinesia Ataxia Slurred/ scanning speech
Sensory Ataxia
Loss of proprioception = sensory ataxia
Parkinsonism
Bradykinesia
Rigidity
Tremor
(Postural instability)
Bradykinesia
Pincers
Foot tapping
Tremor Parkinsonism
Unilateral
Pill rolling
Resting
Count down from 10 - distraction
Rigidity
Cogwheel rigidity
Parkinson’s Gait
Reduced arm swing
Shuffling
Freezing
Stooped
Essential Tremor
Action tremor
Family history
Bilateral
Chorea
Dance like involuntary movements- hyperkinetic Athetosis and ballismus Causes - Genetic: Huntington's - Drug induced: Phenothiazines, L dopa - Immune mediated: SLE, post infectious - Infectious: HIV, syphillis - Structural: stroke, brain tumours - Metabolic/ toxic: hyperglucaemia, CO poisoning
Dystonia
Involuntary co-contraction of agonist and antagonist muscles
Abnormal posturing
Parkinson’s Assessment
EOB: walking aids, hypomimia, tremor
Tremor: resting, worse on distraction (count back from 10), postural (hands outstretched), action (perform an action e.g. take pen out of hand), finger to nose,
Bradykinesia: rapid pincers - reduction in speed, cadence and amplitude
Rigidity: increase tone, cogwheel (if not increased, ask patient to perform task with other limb
(Power, tone reflexes all normal)
Gait: stooped posture, difficulty initiating movement, short, shuffling steps, reduced/ absent arm swing, festination, difficulty turning, freezing phenomenon
Eye movements: vertical gaze palsy (progressive supranuclear palsy) and nystagmus (cerebellar pathology)
Speech: Dysarthria or staccato (cerebellar), baby hippopotamus, hypophonia
Other: postural BP, micrographia, cognition
Power MRC 0-5`
0 No contraction 1 Twitch 2 No gravity 3 Against gravity 4 Reduced power against resistance 5 Normal Power
