PRELIMS: Approach to pt with Neurologic Disease

Question 1

Key components of history taking?

Answer 1

Chief complaint, history of present problem, functional history, psychosocial history, medications/allergies.

Question 2

Main areas in a general neurologic examination?

Answer 2

Vital signs, neck stiffness, carotid bruit, cardiac murmurs, cyanosis.

Question 2

Components of the mental status exam?

Answer 2

Alertness, orientation, memory, language, apraxia, logic/abstraction.

Question 2

Corneal Reflex - Pathway?

Answer 2

Sensory: CN V1 (trigeminal nerve) → Brainstem → Motor: CN VII (facial nerve).

Question 2

Essential instruments for a neuro exam?

Answer 2

Neuro hammer, pen light, pin/cotton/tongue depressor, stethoscope.

Question 2

Types of apraxia?

Answer 2

Ideomotor, constructional, dressing.

Question 2

Glasgow Coma Scale - Eye Opening?

Answer 2

: 1) No response, 2) Opens to pain, 3) Opens to verbal stimuli, 4) Spontaneous.

Question 2

Corneal Reflex Test?

Answer 2

Use a large Q-tip with a cotton wisp to touch the cornea. Look for blinking response. Test both eyes.

Question 2

Glasgow Coma Scale - Verbal Response?

Answer 2

1) No response, 2) Incomprehensible sounds, 3) Inappropriate words, 4) Disoriented and converses, 5) Oriented and converses.

Question 2

Cognitive Skills - Dominant Hemisphere?

Answer 2

Language pattern, comprehension, naming, reading, writing, calculation.

Question 2

Cognitive Skills - Non-dominant Hemisphere?

Answer 2

Spatial awareness, dressing, copying patterns, geographical agnosia, constructional apraxia.

Question 2

Glasgow Coma Scale - Motor Response?

Answer 2

1) No response, 2) Decerebrate rigidity, 3) Decorticate rigidity, 4) Flexion withdrawal, 5) Localizes pain, 6) Obeys command.

Question 2

Trigeminal Nerve (jaw reflex)- Pathway?

Answer 2

: Sensory pathways for touch and pain from face to brainstem; motor pathways to masseter muscle.

Question 3

Control of Eye Movement Pathway?

Answer 3

: Originates in r frontal cortex → descends → decussates at pons → descends into pprf → connects to ipsilateral 6th nucleus and contralateral oculomotor nucleus via MLF.

Question 3

CN 8 - Auditory Nerve Test?

Answer 3

Rinne test: Tuning fork on mastoid process, then near ear. Compare bone and air conduction.

Question 3

How to elicit Trigeminal Nerve - Jaw Reflex?

Answer 3

Palpate masseter while patient bites down hard. Test sensation by asking patient to close eyes and identify “sharp” or “dull” touch at V1, V2, V3 bilaterally.

Question 3

CN 7 - Facial Nerve Assessment?

Answer 3

Inspect for asymmetry. Ask patient to raise eyebrows, smile, frown, puff cheeks, and close eyes tightly against resistance.

Question 3

CN 9 & 10 - Glossopharyngeal and Vagus Nerves Test?

Answer 3

Ask patient to say “ahh” and observe for palatal and uvula symmetry.

Question 3

CN 11 - Spinal Accessory Nerve Test?

Answer 3

Shrug shoulders against resistance. Turn head against resistance and palpate sternomastoid muscle.

Question 4

CN 12 - Hypoglossal Nerve Test?

Answer 4

: Ask patient to stick out tongue and move it laterally against resistance.