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PCM 4 FINAL TEST EVER > The abnormal neuro exam > Flashcards

The abnormal neuro exam Flashcards

1
Q

Components of a neuro exam

A
  1. Mental Status Exam
  2. Cranial Nerves
  3. Cerebellum
  4. Strengths
  5. Deep tendon reflexes
  6. Sensory testing
  7. Gait
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2
Q

Components of the mental Status Exam

A

LOL AMEN

Level of consciousness
Orientation
Language

Attention
Memory
Executive/intellectual function
non-dominant hemisphere

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3
Q

Alert definition

A

Fully awake without stimulation, and able to cooperate in a history and physical exam

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4
Q

Lethargic definition

A

Patient prefers to sleep, but will stay awake with minimal verbal or physical stimualtion

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5
Q

Stuporous definition

A

Patient requires repeated physical stimulation to stay awake

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6
Q

Comatose definition

A

A sleep like state in which the patient CANNOT be awakened. No further mental status testing is possible

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7
Q

Causes of abnormal level of consciousness

A
  1. The pt has a new problems such as a decline in function of an organ system
  2. A new medication has produced an adverse effect
  3. Bacterial infection has spread to the blood
  4. Pts hematocrit, glucose, or partial pressure of oxygen has declined or the partial pressure of CO2 has risen
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8
Q

How to test for orientation

A

Person, place, and date

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9
Q

Aphasia means _____ is damaged

A

A patient’s dominant hemisphere

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10
Q

Broca’s aphasia

A

Frontal lobe

Usually accompanied by hemiplegia, retained understanding, brief ‘telegraphic’ output

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11
Q

Wernicke’s aphasia

A

Superior temporal lobe

- fluent, poor understanding

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12
Q

Anomia

A

Inability to name objects

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13
Q

Agraphia

A

Limitations in writing

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14
Q

Dysarthria

A

Slurred or thick speach

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15
Q

Apraxia

A

Loss of skilled movements and gestures
- Partial damage to the dominant lobe, resulting in the loss of complex, multi-step actions- pts cannot carry out these tasks, even though they have sufficient motor and sensory function

Likely due to damage to connections b/w different sites in the cerebral cortex

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16
Q

Gestmann syndrome

A

Damage to the angular gyrus of the dominant parietal lobe

  1. Acalcula
  2. Agraphia
  3. Inability to distinguish the left and right sides of the pt
  4. Inability to distinguish the individual fingers
17
Q

How is attention evaluated?

A
  1. Do the months (or the days of the week) forward and then backwards
  2. Serial sevens, subtracting seven starting from 100
  3. Read a series of letters, asking the patient to raise his hand when he hears the letter “A”
  4. Have the patient spell “WORLD” forwards and backwards
18
Q

Delirium

A

Acute confusional state

  • Suggests a diffuse systemic problem is affecting large sections of the brain
  • Presents either as a hyper-reactivity to environmental stimulation or extreme sleepiness
19
Q

Delirium causes

A
  • Sepsis
  • New medications
  • Alcohol withdrawal
20
Q

Who is more prone to delirium?

A

Demented patients

21
Q

Where does memory localize to?

A

B/L medial temporal lobe damage –> hippocampus

22
Q

Anterograde

A

Recent memory, or the ability to store new information up to a few days

23
Q

Retrograde

A

More distant memories including autobiographical or historical

24
Q

Executive function

A

Includes the important functions of insight, judgment, and making important decisions

  • Verbal fluency- ask the pt to name as many members of a category as they can
  • Healthy pts can name 20 or more in a minute, demented elderly pts wil name less than 12
25
Q

The loss of executive function is diagnostic of?

A

Dementia

26
Q

Parietal lobe functions

A
  • Visual-spatial skills
  • Constructions
  • Awareness of one’s own body or the environment, especially to the left visual field
27
Q

Temporal lobe damage results in?

A

Loss of musical abilities and a tendency to psychiatric disturbances such as psychosis, depression, bipolar disorder, and anxiety

28
Q

Occipital lobe damage results in?

A

Left homonymous hemianopia and prosopagnosia

- Inability to recognize faces

29
Q

Hemispatial neglect

A

not appreciating that there are people or objects in the left side of the room or on the left side of a drawing or photograph, in spite of preserved vision

30
Q

Anosognosia

A

the inability to recognize hemiparesis in a patient’s left arm or left leg; very common immediately after a stroke

31
Q

Dressing agnosia

A

inability to button clothes or put an arm in a sleeve on the left side, or to shave or put on make up on the left side of the face

32
Q

Prosopagnosia

A

Inability to recognize familiar faces, congenital or acquired

33
Q

Cranial nerves

A
  1. Olfactory
  2. Optic
  3. Oculomotor
  4. Trochlear
  5. Trigeminal
  6. Abducens
  7. Facial
  8. Acoustic (Now called Vestibulo-Cochlear)
  9. Glossopharyngeal
  10. Vagus
  11. Accessory
  12. Hypoglossal
34
Q

Abnormal pupil reactions results from?

A

Problem with afferent CN II and efferent CN III

35
Q

What does lack of constructional skills indicate?

A

A problem in the nondominant (right) parietal lobe

  • Can be tested by having the pt draw a clock
  • May also reveal hemispatial neglect

PCM 4 FINAL TEST EVER (8 decks)

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