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Neurology > Phys DIE > Flashcards

Phys DIE Flashcards

1
Q

5 assessments of the nervous system

A
  1. cerebral function: mental status
  2. brainstem function: cranial nerves
  3. spinal cord function: motor and sensory dermatome testing
  4. Integration: corticosensory function
  5. Cerebellar function, tests of movement
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2
Q

Tools for nervous system assessment

A
  1. penlight
  2. ophthalmoscope
  3. visual acuity card
  4. disposable sharp object
  5. 128hz tuning fork
  6. tuning hammer
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3
Q

Mental status assessment includes (4)

A
  1. appearance and behavior
  2. emotional stability
  3. cognitive abilities
  4. Speech and language
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4
Q

3 components of orientation

A

person
place
time
AAOX3

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5
Q

Cognitive ability testing

A
  • assess cognition: the execution of complex mental processes
  • learning, perceiving, decision-making, memory
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6
Q

How to test memory

A
  • recent: 3 item recall

- remote: historical or verifiable information

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7
Q

Mini-mental state exam

A
  • 11 items that test orientation, registration, attention nd calculation, recall, and language
  • positive test is 24-26 of 30
  • doesn’t work on pt with severe depression, they “don’t give a shit”
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8
Q

Mini-mental state exam

- language

A
  • naming (hand, finger, nail)
  • comprehension/commands - repetition of a phrase
  • reading: word, phrase, passage
  • writing: name or sentence
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9
Q

How to test CN I

A

Olfaction

  • test each nostril separately with a non-volatile substance such as coffee beans or cloves
  • usually only test if there is a loss of taste or behavior issues (frontal lobe has a lot to do with behavior)
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10
Q

How test CN II

A
  • visual acuity (Rosenbaum, Snellen, Maxwell charts)

- peripheral vision (the best test ever)

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11
Q

How test CN III

A
  • extraocular eye movement (SLOW)
  • direct and consensual pupillary response to light
  • accommodation and convergence
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12
Q

How test CN IV

A

(superior oblique)

- extraocular eye movements

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13
Q

How test CN V

A
  • Blink reflex (testing sensation of V1)
  • Facial sensation: light touch in all three distributions (V1 - V3) bilaterally (6 touches)
  • Pain in all 6 areas only if trigeminal lesion
  • Motor: when patient bites down, feel for symmetry in the masseter and temporal muscles symmetry
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14
Q

How test CN VII

A
  • facial muscle strength: smile, raise eyebrows, puff cheeks
  • taste (anterior 2/3): place salt water on tongue
  • blink reflex (along with CN V)
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15
Q

How test CN VIII

A
  • finger rub test
  • Weber
  • Rinne
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16
Q

How to truly test hearing

A

audiologist :) the CN tests are just testing gross function

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17
Q

How test CN IX

A
  • Palatal and uvula elevation
  • sensation portion of gag reflex
  • speech

*if talking and swallowing, nerve should be intact

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18
Q

How test CN X

A
  • Palatal and uvula elevation
  • motor portion of gag reflex
  • speech

*if talking and swallowing, nerve should be intact

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19
Q

How test CN XI

A
  • shoulder shrug (trapezius) against pressure

- head turn (SCM) against pressure

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20
Q

How test CN XII

A
  • inspection for atrophy and fasciculations
  • tongue protrusion (lick wound)
  • lateral movement of tongue (press against hand on outside of cheek)
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21
Q

What does the fundoscopic exam test?

A
  • not any CN
  • the fundus can give some neuro information
  • papilledema
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22
Q

Motor function

- inspection/palpation

A
  • posture
  • tremors
  • fasciculations
  • bulk
  • atrophy
  • joint malalignment
  • asymmetry
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23
Q

Two types of tremor

A
  1. intention (cerebellar tremor)

2. Resting tremor

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24
Q

Intention tremor

A
  • ataxia

- goes away when movement stops

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25
Q

Resting tremor

- describe

A
  • Parkinson’s disease, basal ganglia

- best observed when there is no movement

26
Q

Resting tremor examples

A
  • pill rolling
  • cogwheel rigidity: jerky muscle flexion
  • flattened affect
  • shuffling gait
  • arrested gait
  • not present during sleep
27
Q

Muscle tone testing

- overview

A
  • pt contracts muscle against resistance
  • quickly release muscle and watch for jerking response (clonus, cogwheel)
  • check each UE and LE separately, compare
  • check for symmetry and appropriateness for development and age
28
Q

Fine motor movement tests (2)

A
  • precision finger tap

- toe tap

29
Q

Strength grading

A

0: no movement or contraction
1: flicker but no movement
2: horizontal plane, voluntary movement but not enough to overcome gravity
3: movement overcomes gravity but not resistance
4: voluntary movement capable of overcoming resistance
5: normal strength

30
Q

Individual muscle groups to test UE

A
  1. arm abduction: deltoids/axillary nerve
  2. Elbow flexors: biceps/ musculocutaneous nerve
    3: Elbow extensors: triceps/radial nerve
    4: wrist flexors: flexor carpi ulnaris and radialis/median nerve
  3. Wrist extensors: extensor carpi/radial nerve
31
Q

Additional UE strength tests

A
  • grip strength (squeeze fingers)
  • abduction/adduction of fingers: ulnar nerve
  • touch thumb to 5th finger and don’t let me pull through: median and ulnar
32
Q

Individual muscle groups to test LE

A
  1. Hip flexors: iliopsoas/LS plexus
  2. Knee extensors: quadriceps/femoral nerve
  3. Knee flexors: hamstrings/sciatic nerve
  4. Ankle dorsiflexors: anterior tibialis/deep peroneal nerve
  5. Ankle plantar flexors: gastrocnemius/tibial nerve
33
Q

Additional LE strength tests

A
  • move great toe up and down

- inversion/eversion of foot against resistance

34
Q

5 things to test when testing sensation

A
  1. light touch
  2. pain (sharp and dull)/temperature
  3. Proprioception
  4. two point discrimination
  5. vibration
35
Q

How to test sensation

A
  • test pain sharp pain and light touch first
  • if can’t feel touch, then test proprioception and vibration
  • if can’t feel pain, then test temperature
36
Q

How to test sensation if in a rush

A
  • test lowest dermatomes: fingers and big toe
37
Q

How to test proprioception

A
  • pt closes eyes
  • move finger (or other joint) up and down, stop
  • ask patient which direction it is pointed
  • hold joint on sides, not on top and bottom
38
Q

What is the first sensation to go in DM

A
  • vibration
39
Q

What is light touch testing?

A

dorsal column

40
Q

what is pain and temperature testing?

A

spinothalamic tract

41
Q

What is proprioception testing?

A

dorsal column

42
Q

What is two point discrimination testing

A

dorsal column

43
Q

What is vibration testing

A

dorsal column

44
Q

Cortical sensation

- 3 tests list

A
  1. Graphesthesia
  2. Stereognosis
  3. Tactile extinction
45
Q

Graphesthesia

A

ID letter/number drawn on palm

46
Q

Stereognosis

A

ID objects based on touch

47
Q

Tactile extinction

A

ID touch simultaneously on both sides of body

- if have a loss, will only be able to identify touch on one side

48
Q

What do abnormalities of cortical sensation tests indicate?

A
  • lesion in contralateral somatosensory cortex
  • seen in Alzheimers
  • get an MRI!
49
Q

Reflexes

- how to grade

A 
0 absent
1+ trace
2+ normal
3+ brisk
4+ non-sustained clonus
5+ sustained clonus
50
Q

what to look for when testing reflexes

A
  • symmetry!!
51
Q

What are signs of upper motoneuron issue

A
  • hyperreflexia
  • fasciculations
  • disuse atrophy
52
Q

What are signs of lower motoneuron issue

A
  • hyporeflexia

- atrophy

53
Q

What are the five places to test reflexes and associated nerve

A
  1. Achilles (S1-S2)
  2. Patellar (L3-L4)
  3. Brachioradialis (C5-C6)
  4. Biceps (C5-C6)
  5. Triceps (C7-C8)
54
Q

Additional reflex test

A

Plantar response/Babinksi

  • run back side of hammer up outside of foot and across pad of foot
  • NL: downward contraction of toes
  • Babinski (positive test): upward great toe with fanning of other (UMN issue)
55
Q

5 ways to test cerebellar function

A
  1. finger to nose to finger
  2. heel to shin
  3. rapid alternative movements
  4. tap each finger with thumb
  5. tap the floor
56
Q

How to test gait and station

A
  • Observation of stance, posture, leg swing
  • toe-walking gait
  • heel-walking gait
  • stand on one foot and hop up and down
  • tandem (heal to toe) gait
  • Romberg: stand on one leg with arms out and close eyes
57
Q

What sensations used to stand in place?

- when remove vision, what is tested?

A
  • vision, proprioception, vestibular sense

- exposes upper motoneuron lesions if drift to side or fall sideways

58
Q

Meningitis

- triad presentation

A

fever
HA
neck stiffness

59
Q

Meningitis

- two signs

A
  1. Kernig’s sign: unwilling to extend leg at knee d/t pain

2. rudzinski’s sign: passive flexion of head induces flexion of lower limbs (into fetal position?)

60
Q

Cauda equina syndrome

  • what nerves
  • name of presentation
  • common sx
A
  • Nerve roots below L1-L2
  • saddle numbness S2-S5
  • urinary dysfunction (atonic bladder and constipation)
  • decreased rectal tone

Neurology (11 decks)

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