Neurology/ Neurologic Exam

Question 1

What are the components of a complete neurologic exam?

Answer 1

Mental status, cranial nerves, motor and sensory functions, reflexes

Question 2

What information can be used to determine mental status?

Answer 2

Alertness, orientation, language, memory, abstraction, construction

Question 3

What terms can be used to describe levels of consciousness?

Answer 3

• Alert (normal level of consciousness)
• lethargy (arouses to your voice but appears drowsy)
• obtundation (arouses to gentle shaking)
• stupor (arouses after painful stimuli)
• coma (unarousable to painful stimuli)

Question 4

Which type of aphasia is characterized by fluent speech but impaired comprehension?

Answer 4

Wernicke aphasia (also described as a word salad)

Question 5

Which type of aphasia is characterized by nonfluent speech but intact comprehension?

Answer 5

Broca aphasia (also described as broken speech)

Question 6

Cranial nerve I

Answer 6

Olfaction

Question 7

Cranial nerve II

Answer 7

• Vision (assess visual fields and acuity and perform funduscopic exam)
• pupillary light reflex(mediated by cranial nerves II and III)

Question 8

Cranial nerves III, IV, and VI

Answer 8

Eye movements

Question 9

Cranial nerve V

Answer 9

Facial sensation and muscles of mastication

Question 10

Cranial nerve VII

Answer 10

Muscles of facial expression

Question 11

Cranial nerve VIII

Answer 11

Hearing

Question 12

Cranial nerves IX and X

Answer 12

Palatal movement

Question 13

Cranial nerve XI

Answer 13

Head rotation (sternocleidomastoid muscle) and shoulder elevation (trapezius muscle)

Question 14

Cranial nerve XII

Answer 14

Tongue movement

Question 15

What is the defect in internuclear ophthalmoplegia?

Answer 15

Lesion in the medial longitudinal fasciculus

Question 16

What condition presents with internuclear ophthalmoplegia?

Answer 16

Multiple sclerosis

Question 17

What symptoms will the patient with internuclear ophthalmoplegia report and what signs can be observed?

Answer 17

• This is a disorder of conjugate lateral gaze in which the affected eye demonstrates impaired adduction.
• If the lesion affects the right eye, then the patient will report diplopia when looking to the left.
• On left lateral gaze, the right eye will not adduct.
• Convergence is generally preserved.

Question 18

How can a central lesion of cranial nerve VII be distinguished from a peripheral lesion?

Answer 18

With peripheral lesions, the upper and lower muscles of facial expression are weak. With central lesions, only the lower muscles are weak, since the forehead gets input from the motor strips of both cerebral hemispheres.

Question 19

What defect occurs following unilateral paralysis of the hypoglossal nerve (cranial nerve XII)?

Answer 19

The tongue deviates to the affected side (the tongue licks the side of the lesion)

Question 20

According to the Medical Research Council scale, what strength rating should be given to a muscle with weak contraction that is able to overcome gravity but no additional resistance?

Answer 20

3 (0 = no contraction, 5 = normal strength able to overcome full resistance)

Question 21

What signs are characteristic of upper motor neuron lesions?

Answer 21

• Hyperreflexia
• spasticity
• weakness
• positive Babinski (hallux dorsiflexes and the other toes fan out)

Question 22

What signs are characteristic of lower motor neuron lesions?

Answer 22

Hyporeflexia, atrophy, fasciculations

Question 23

Describe pronator drift.

Answer 23

Have the patient stretch out his/her arms with the elbows extended and palms facing up, and then close his/her eyes. Watch for 10 seconds for arm pronation or downward drift. A unilateral pronator drift suggests an ipsilateral upper motor neuron lesion.

Question 24

How are normal reflexes graded?

Answer 24

2 (0 = absent, 4 = clonus)

Question 25

Name the nerve root that provides sensation to these areas. Thumb and index finger

Answer 25

C6

Question 26

Name the nerve root that provides sensation to these areas. Middle finger

Answer 26

C7

Question 27

Name the nerve root that provides sensation to these areas Fourth and fifth fingers

Answer 27

C8

Question 28

Name the nerve root that provides sensation to these areas.1st (great) toe

Answer 28

L5

Question 29

Name the nerve root that provides sensation to these areas.5th toe and lateral foot

Answer 29

S1

Question 30

What tests can be done to assess coordination?

Answer 30

Rapid alternating movements, finger-to-nose, tandem gait

Question 31

Describe two rapid alternating movement tests.

Answer 31

1. With the patient seated, have the patient strike the palmar surface of his/her hand onto the ipsilateral thigh, raise the hand, turn it over, and then strike the back of the hand on the same place on the thigh. Have the patient do this movement as rapidly as possible. 2. Have the patient tap the distal joint of the thumb with the tip of the ipsilateral index finger as rapidly as possible.

Question 32

Describe the finger-to-nose test.

Answer 32

Have the patient touch your index finger and then his/her nose alternately as rapidly and accurately as possible. Move your finger about so that the patient has to alter directions and extend his/her arm fully to reach it.

Question 33

What is a tandem gait?

Answer 33

Walking in a straight line heel-to-toe

Question 34

What physical exam findings suggest cerebellar dysfunction?

Answer 34

* Dysdiadochokinesis (the inability to quickly follow one movement with its opposite) * dysmetria (clumsy, unsteady, and inappropriately varying speed, force, and direction of movements during the finger-to-nose test) * ataxic gait (one that lacks coordination)

Question 35

The mini-mental state examination (MMSE) can be used to screen for which condition?

Answer 35

Cognitive impairment (or dementia)

Question 36

How long does it take to administer the MMSE?

Answer 36

5-10 minutes

Question 37

What is the maximum attainable score on the MMSE? 30

Question 38

What are the MMSE questions pertaining to Orientation?

Answer 38

What is the (year) (season) (date) (day) (month)? [1 point for each; start with the year then narrow; maximum of 5 points] Where are we (country) (state) (town) (hospital) (floor)? [1 point for each; maximum of 5 points]

Question 39

What are the MMSE questions pertaining to Registration?

Answer 39

* Repeat these three objects (eg, apple, car, chair). * Ask the patient to repeat all three after you have said them [1 point for each correct answer; maximum of 3 points]. * Then, repeat them until he/she learns all three.

Question 40

What are the MMSE questions pertaining to Attention and calculation?

Answer 40

* Start at 100 and subtract 7. * Stop after 5 times. [1 point for each correct answer; maximum of 5 points]

Question 41

What are the MMSE questions pertaining to Recall?

Answer 41

Repeat the names of the three objects(done for registrations). [1 point for each; maximum of 3 points]

Question 42

What are the MMSE questions pertaining to Language?

Answer 42

* Name these objects. Point to a pencil and watch. [1 point for each; maximum of 2 points] * Repeat the following: “No ifs, ands, or buts” [1 point; maximum of 1 point] * Follow this three-stage command: “Take a paper in your hand, fold it in half, and put it on the floor.” [1 point for each; maximum of 1 point] * Silently read this sentence and do what is asked: “Close your eyes.” [1 point; maximum of 1 point] * Write a sentence. [1 point for a complete sentence; maximum of 1 point] Copy this design. Show a picture of intersecting pentagons. [1 point; maximum of 1 point]