The Neurological Exam Flashcards
Define validity
the quality of being logically or factually sound
Define reliability
the quality of producing the same results repeatedly
_______ measures the proportion of actual positives which are correctly identified as such.
_______ the proportion of negatives which are correctly identified as such.
Sensitivity
Specificity
Sensitivity is aka as the true _____.
Specificity is aka as the true _____.
negative
What things must be assessed during the functional assessment?
(Think MR CLOCK)
- Memory
- Reasoning
- Consciousness
- Language
- Orientation
- Calculation
- Knowledge
Short-term memory is considered normal if the patient is able to recall a set of words after how long?
5 minutes
When is long-term memory considered normal?
When a patient is able to correctly recall facts about the past
Abstract reasoning is a function of which lobe?
The frontal lobe
Deficits in abstract reasoning may indicate what?
dementia
What conscious state can be defined as arousable with repeated stimulation?
obtunded
A patient who requires a painful stimulus for arousal is considered to be in what conscious state?
Stuporous (light coma)
A patient that is unable to be aroused regardless of stimulus is considered to be in what conscious state?
Comatose (deep coma)
For the Glasgow Coma Scale, a patient is assigned a score up to 15 points based on responses to 3 areas, what are these 3 areas?
- Eye opening
- Verbal responses
- Motor responses
According to the Glasgow coma scale a score less than __ is considered a coma
8
What are the 3 types of aphasia?
- Receptive
- Expressive
- Global
What is receptive aphasia aka?
Wernicke’s aphasia
Describe receptive/Wernicke’s aphasia
Patients have difficulty comprehending language
Where is Wernicke’s area located?
On the posteriosuperior aspect of the temporal lobe in the dominant hemisphere
What is expressive aphasia aka?
Broca’s
Describe expressive/Broca’s aphasia
Patients have difficulty producing spoken language
Where is Broca’s area located?
In the inferior aspect of the frontal lobe of the dominant hemisphere just anterior to primary motor strip
What is global aphasia?
A combination of receptive and expressive aphasia
Dysarthria is associated with what?
cerebellar disease
Dysphonia is associated with what?
CN X dysfunction
What is the difference between dysarthria and dysphonia?
- Dysarthria patients have problems with speech articulations
- Dysphonia patients have difficulties with sound production
What refers to a patient’s knowledge of the present circumstances?
Orientation
What is the typical presentation of a lesion in the brain (CVA, TBI, or tumor)
unilateral somatosensory deficits on opposite side of lesion
What is diabetes mellitus?
A metabolic disease in which the body fails to produce or adequately use insulin
What is MS?
A progressive autoimmune disease that causes demyelination of the axons in the CNS
What is Guillain-Barré syndrome?
A nonprogressive autoimmune disease in which demyelination of axons in PNS occurs
What is Hansen’s disease?
A chronic bacterial infection (aka leprosy) that primarily affects skin and peripheral nerves.
What are the 3 main sensory systems that require screening?
- Visual
- Vestibular
- Somatosensory
Testing a patient for light touch is testing which tract?
Spinothalamic
A monofilament of ___ (10 g) of pressure is required for protective function on the dorsal and plantar surfaces of the foot
5.07
Testing a patient for sharp/dull touch is testing which tract?
Spinothalamic
Testing a patient for vibration sense is testing which tract?
posterior column
When testing the posterior column via vibration you should start at ____ joints and then work your way ______.
distal
proximally
Testing a patient for temperature sense is testing which tract?
Spinothalamic
Why is temperature testing often omitted?
Because it is easier to test pain sensation rather than temperature and both are carried via the spinothalamic tract
Position sense (proprioception) is carried via which spinal tract?
Posterior colmns
How is a joint space test performed?
With the patient’s eyes closed the clinician places either the index finger (UE) or great toe (LE) on the uninvolved side to a position and then asks the patient to mirror with the involved extremity
When testing a patient’s discriminative sensation you are testing which tract?
Posterior column (plus portions of the cerebral cortex)
Patients with lesions in the somatosensory cortex have impairments with what?
- Stereognosis
- Graphesthesia
- 2-point discrimination
- Point localization
What is stereognosis?
The ability to identify objects by touch
What is Graphesthesia?
The ability to identify writing on the skin solely by touch
What is normal 2 point discrimination on the pads oft the fingers?
5 mm
What testing should be performed at a minimum?
Light touch
What is the most common source of uncoordination?
cerebellar dysfunction
What 4 things are necessary for coordination?
- Balance
- Vision
- Muscle function
- ROM
What do cerebellum disturbances stem from?
Lack of motor coordination
List a few things that can cause cerebellar damage
- CVA
- Head trauma
- Alcoholism
- 1° and metastatic tumors
- Toxins (Chemotherapy)
- MS
- Friedreich’s ataxia
What are the 5 global signs of cerebellar dysfunction?
- Ataxia
- Tremor
- Hypotonia
- Dysarthria
- Deviations in eye control
What must you test if you believe a patient has some sort of cerebellar dysfunction?
One test of the UE, one test of the LE, and one test of unsupported stance or gait
What is Diadochokinesia
The ability to perform alternating movements of the extremities
Rebounding is indicative of a cerebellar lesion. What does this mean?
When pushing down on patient’s arms they do not have the ability to stop the downward motion quickly and then in an effport to correct this they move past horizontal , followed by a downward motion again before stopping.
In patients up to 60 years of age they should be able to tandem walk __ steps without losing their balance
20
What can be defined as the ability to orient one’s self to their surrounding environment while simultaneously maintaining their COG within the BOS
balance
Dysfunction of the visual, somatosensory, and vestibular systems can lead to what?
vertigo
Where does the processing of somatosensory information occur?
In the basal ganglia, cerebellum and supplemental motor area
What is responsible for all movements that control posture & maintain balance?
The peripheral motor system
What are the 3 strategies that occur to maintain balance?
- ankle
- hip
- stepping
What role does cognition play on balance?
Decision making is difficult, balance strategies cannot be relearned or remembered, and dangerous situations may not be remembered
A 67% on the Activities-specific Balance Confidence (ABC) Scale can predict a fall __% of the time
84
Balance tests must be performed on patients who exhibit any of the following 6 conditions…
- History of falls or episodes of instability
- Known or suspected CNS dysfunction that affects postural stability
- Frequent LE injuries (ankle sprains)
- Recent surgeries of LEs
- Deconditioning, weakness, or if using an AD for ambulation
- Over 65 years of age
In order to be considered an UMN lesion where must the lesion occur? This means they are considered conditions of the ______ nervous system.
In the brain or spinal cord
central
In order to be considered an LMN lesion where must the lesion occur? This means they are considered conditions of the ______ nervous system.
Within the spinal nerve roots or peripheral branches
peripheral
What are a few symptoms of CNS dysfunction
- increased muscle tone
- increased spacticty
- hyperactive DTRs
- positive pathological reflexes (Babinski, Hoffman, etc.)
In what types of pathologies does hypotonia occur?
- Down syndrome
- some types of CP
- diseases of the PNS
In what types of pathologies does hypertonia occur?
- CVA
- TBI
- SCI
Describe the role of modulation following a serious insult to the CNS
Initially the CNS goes into a state of shock which results in hypotonia. After this period of shock, signals begin firing again but the modulation signals are lost which leads to hypertonia
What can be defined as the manifestation of hypertonicity in which the resistance to passive motion is rate or velocity dependent?
Spasticity
Spasticity is common in ____ motor neuron lesions and typically manisfests in the _____ of the arms and the _____ of the legs
upper
flexors
extensors
What is a tell tale sign of spasticity?
If you feel greater resistance as you increase speed of passive motion
If a lesion occurs on the right side of the brain what can be expected?
abnormal reflexes on the left side
If a lesion occurs in the spinal cord what can be expected?
abnormal reflexes bilaterally below the level of the lesion
Define clonus
Abnormal rapid, reflexive, back and forth motion that continues until the stretch on the tendon is removed
Describe reflex testing (5+, 4+, 3+, 2+, 1+, 0)
5+ sustained clonus 4+ hyperreflexive with clonus 3+ more reflexive than normal 2+ normal 1+ diminished 0.5+ reflex is only initiated with reinforcement 0 no response
What is the flexor withdrawal reflex?
It is a secondary response to the Babinski test in which the hip and knee flex when the plantar surface is stroked
A positive Hoffman’s test indicates dysfunction of which tract?
corticospinal
What are the 5 most important tracts to assess?
- Lateral corticospinal tract
- Dorsal columns
- Lateral spinothalamic tract
- Spinocerebellar tracts
- Vestibulospinal tracts
