Oct3 A2-Neurological Exam

Question 1

weakness, spasticity and increased reflexes in right arm and leg (UMN lesion) + LMN facial weakness (anywhere from VII nucleus to the nerve before it branches) + normal mental status and language: where is the lesion

Answer 1

if look at neuro map, the UMNs, after get through cortex and brain, pass through the brainstem, which is also where VII nucleus is
*answer = brainstem

Question 2

parts of the neuro exam and very imp part

Answer 2

• observation
• mental status
• language
• CNs
• motor (bulk, tone, power, arms, legs)
• reflexes
• coordination
• sensation
• gait

Question 3

first thing to test in the neuro exam ** have to do it first

Answer 3

test the digit span (for mental status): say 5 to 7 digits and they have to repeat them
IT TESTS ATTENTION

Question 4

mental status testing in neuro exam vs psychiatric exam

Answer 4

• neuro = emphasize cognitive functions (memory, judgement, visuaspatial ability)
• psychiatry = emphasize mood and content of patient’s thoughts (their affect, the flow of their ideas)
• *neuro doesn’t always exam mental status**

Question 5

pyramid of the hierarchy of basic cognitive functions

Answer 5

1. awake
2. alert
3. appropriate
4. attention
   * just describe what you see*

Question 6

delirium def

Answer 6

acute fluctuating mental status usually caused by a systemic toxic or metabolic problem. attention is impaired***

Question 7

dementia def

Answer 7

chronic progressive impairment in mental status caused by a focal abnormality in the brain. attnetion is usually preserved*** (until late)

Question 8

pt with difficulties in the digit span test: meaning

Answer 8

• more likely delirium

- can’t do complicated cognitive things like calculation

Question 9

language vs speech

Answer 9

• language = higher COGNITIVE fct = decode or encode written or spoken symbols of communication
• speech = ability to produce sounds of spoken language (it is a MOTOR function)

Question 10

name for problems of language

Answer 10

aphasias

Question 11

imp thing about CN testing in neuro exam

Answer 11

test them in order

Question 12

imp things in motor exam part of neuro exam

Answer 12

• test muscle tone (decreased tone is less worrysome in adults. problem in babies) (increased tone = prob in adults): will test resist to passive movement, spasticity = UMN, rigidity = basal ganglia problems. focus on checking if increased tone
• bulk (look and feel + check fasciculations)
• power

Question 13

how to check for muscle bulk

Answer 13

• normal convex shape = bulking out
• abnormal concave shape = caving in
• deltoid, forearm, first dorsal interosseus, edge of tibia (more prominent when tibialis anterior shrinked bc of decreased bulk*

Question 14

spasticity charact

Answer 14

• velocity dependent**
• felt with a fast movement
• feel a sudden increase in resistance, spastic catch

Question 15

rigidity charact

Answer 15

• not velocity dependent
• can be ct, described as wheel pipe
• described as cog-wheel (engrenage)

Question 16

5 point scale of motor power

Answer 16

5 = normal
5- = can't overcome
4+ = just overcome
4 = moderate resist
4- = just resist
3 = no resist
2 = not vs gravity
1 = glicker

Question 17

UMN lesion charact

Answer 17

• weakness (decreased muscle power)
• increased reflexes and tone
• positive Babinski

Question 18

LMN lesion charact

Answer 18

• weakness (decreased muscle power)
• decreased reflexes and normal tone
• decreased bulk
• fasciculations
• negative Babinski

Question 19

cerebellum anatomy and fct

Answer 19

• midline of cerebellum (the vermis) coordinates axial movements
• each cerebellar hemisphere coordinates the ipsilateral limb movement
• axial movements = eye movement, speech, gait
• limb movement = hand movement, heel to shin test, etc.

Question 20

how to test for axial limb coordination

Answer 20

finger (of examiner) to nose (of patient) test

Question 21

how to test for sensation in neuro exam + imp principles of sensory testing

Answer 21

test pinprick sensation

• is the most sensitive
• sensory testing is subjective
• you need to have a specific question in mind

Question 22

how to test gait

Answer 22

ask pt to walk

• can check things like circumduction
• swinging of the arms
• balance
• etc

Question 23

main things of neuro exam (for this lecture)

Answer 23

• observation
• test digit span before any cognitive test
• language and speech are not the same thing
• test CNs in order
• know how to test muscle tone (is the resistance to passive movement at a joint)
• know UMN vs LMN
• axial vs limb movements
• test pinprick sensation
• watch the person walk