Neurology/ Neurologic Exam Flashcards
What are the components of a complete neurologic exam?
Mental status, cranial nerves, motor and sensory functions, reflexes
What information can be used to determine mental status?
Alertness, orientation, language, memory, abstraction, construction
What terms can be used to describe levels of consciousness?
- 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)
Which type of aphasia is characterized by fluent speech but impaired comprehension?
Wernicke aphasia (also described as a word salad)
Which type of aphasia is characterized by nonfluent speech but intact comprehension?
Broca aphasia (also described as broken speech)
Cranial nerve I
Olfaction
Cranial nerve II
- Vision (assess visual fields and acuity and perform funduscopic exam)
- pupillary light reflex(mediated by cranial nerves II and III)
Cranial nerves III, IV, and VI
Eye movements
Cranial nerve V
Facial sensation and muscles of mastication
Cranial nerve VII
Muscles of facial expression
Cranial nerve VIII
Hearing
Cranial nerves IX and X
Palatal movement
Cranial nerve XI
Head rotation (sternocleidomastoid muscle) and shoulder elevation (trapezius muscle)
Cranial nerve XII
Tongue movement
What is the defect in internuclear ophthalmoplegia?
Lesion in the medial longitudinal fasciculus
What condition presents with internuclear ophthalmoplegia?
Multiple sclerosis
What symptoms will the patient with internuclear ophthalmoplegia report and what signs can be observed?
- 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.
How can a central lesion of cranial nerve VII be distinguished from a peripheral lesion?
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.
What defect occurs following unilateral paralysis of the hypoglossal nerve (cranial nerve XII)?
The tongue deviates to the affected side (the tongue licks the side of the lesion)
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?
3 (0 = no contraction, 5 = normal strength able to overcome full resistance)
What signs are characteristic of upper motor neuron lesions?
- Hyperreflexia
- spasticity
- weakness
- positive Babinski (hallux dorsiflexes and the other toes fan out)
What signs are characteristic of lower motor neuron lesions?
Hyporeflexia, atrophy, fasciculations
Describe pronator drift.
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.
How are normal reflexes graded?
2 (0 = absent, 4 = clonus)
Name the nerve root that provides sensation to these areas. Thumb and index finger
C6
Name the nerve root that provides sensation to these areas. Middle finger
C7
Name the nerve root that provides sensation to these areas Fourth and fifth fingers
C8
Name the nerve root that provides sensation to these areas.1st (great) toe
L5
Name the nerve root that provides sensation to these areas.5th toe and lateral foot
S1
What tests can be done to assess coordination?
Rapid alternating movements, finger-to-nose, tandem gait
Describe two rapid alternating movement tests.
- 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.
- Have the patient tap the distal joint of the thumb with the tip of the ipsilateral index finger as rapidly as possible.
Describe the finger-to-nose test.
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.
What is a tandem gait?
Walking in a straight line heel-to-toe
What physical exam findings suggest cerebellar dysfunction?
- 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)
The mini-mental state examination (MMSE) can be used to screen for which condition?
Cognitive impairment (or dementia)
How long does it take to administer the MMSE?
5-10 minutes
What is the maximum attainable score on the MMSE? 30
What are the MMSE questions pertaining to Orientation?
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]
What are the MMSE questions pertaining to Registration?
- 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.
What are the MMSE questions pertaining to Attention and calculation?
- Start at 100 and subtract 7.
- Stop after 5 times. [1 point for each correct answer; maximum of 5 points]
What are the MMSE questions pertaining to Recall?
Repeat the names of the three objects(done for registrations). [1 point for each; maximum of 3 points]
What are the MMSE questions pertaining to Language?
- 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]
