1.3 The Detailed Neurologic Examination in Adults Flashcards Preview

NMSK B Test 1 > 1.3 The Detailed Neurologic Examination in Adults > Flashcards

Flashcards in 1.3 The Detailed Neurologic Examination in Adults Deck (97):
1

What would you check to exam the Metal status of a patient?

Alert, oriented to person, place, time ( patient gives a cogent medical history).

2

What is apraxia?

-Ex. Idiomotor apraxia
-Can’t do a simple task when asked, but can do it involuntarily.

3

What is visual spatial perception?

-Relative when patient has difficulty losing objects (getting lost)
-copy/draw (a clock, overlapping pentagons, etc.).

4

How do yo check executive function?

Goal directed behavior- a complex set of activities (involves, volition, planning, purpose, action, and effective performance). Activities of daily living affected. Depends on working memory, mental flexibility, design fluency, motor programming, ability to inhibit responses

5

How do you check Mood an thought content?

Eye contact, blunting, spontaneous speech, (ask family members for help here).

6

How would you check speech of the patient?

fluent, normal syntax, comprehension, repetition.

7

How would you check the (in general) cranial nerves for?

visual fields, extra ocular movements, fundoscopic exam, facial symmetry and facial sensation, and hearing is normal.

8

How would you check motor function for?

Mass, tone, and strength

9

How would you check a patients sensory for?

light touch, pin prick and double simultaneous stimulation.

10

How would you check a patients giant for?

- Stepping, toe-heel walking, turning; be observant.

11

How would you check the patients cerebrallar for?

Finger nose finger, no involuntary movements

12

Where would you check the patients reflex

upper and lower extremities, toes planter bilaterally

13

What would you check for a patient's cerebrovascular?

Carotid, orbital or cranial bruits

14

What are the general things you would look at during the musculo-skeletal exam?

range of motion axial and appendicular structures, normal Osteopathic exam.

15

What would you check to access the level of consciousness for a patient?

- Arousal (alert, attentive, sleepy, lethargic, unresponsive)
- Able to focus and direct cognitive processes, resist distraction, sustain attention (attention affects other areas including memory and executive functioning).

16

What would you do to check a patients short term memory?

Immediate: (short term; read a sentence and comprehend, digit span recall).

17

What would you do to check a patients long term memory?

i.Recent (new material as remembering three words in 5 minutes)

ii.Remote (Memories of TV shows, news events)

iii.Episodic (dates, events, personal experiences) vs. Semantic (word meaning, phrases, facts).

18

What is implicit memory?

-Implicit memory (aka, non declarative, unconscious

19

What is explicit memory?

Declarative, factual

20

What is acalculia?

inability to calculate

21

What is agraphia?

inability to write; couldn’t write name

22

What is Gerstmann syndrome?

Left posterior hemispheric lesion

23

What is Finger agnosia?

Inability to recognize fingers, pinky? Index

24

What are examples of visuospatial issues?

R-L confusion, fingers

25

What areas do the clock drawing test cover?

-single task- covers multiple cognitive domains)
-level of consciousness (alert), visual spatial perception, praxis.

26

What is the name of Cr N II?

Optic Nerve

27

What is the first step after finding a patient has asymmetric pupils?

Finding which one is abnormal

28

What is anisocoria?

-Is a condition characterized by an unequal size of the eyes' pupils.
-Normal in 10-20% of the population

29

What are issues that can cause anisocoria?

1) Due to efferent pupillary defect (parasympathetics) carried in Cr N lll
2) Defect in sympathetics (carried in brainstem> upper cervical spinal cord then outside the CNS in cervical ganglion to eye).

30

What is Horner's syndrome?

-droopy eyelid (ptosis)
-Constriction of pupil of eye
-SMALL pupil is the abnormal one and due to a lesion of Sympathetic tract.

31

What is a pancoast tumor?

-Apical lung mass
-Can cause anisocoria on small pupil side with droopy eyelid (ptosis)
-this is part of what is called Horner’s Syndrome. (small pupil with ptosis)

32

Who is most likely to get a Pancoast tumor?

-Most common with smokers

33

What cranial nerves are involved in eye movement?

Cr N III,IV, VI

34

What is internuclear Opthalmoplegia?

Produced by lesion of the medial longitudinal fasciculus (MLF); this pathway connects Cr. N. VI nucleus on one side with Cr.N. III nucleus on the other, allowing for conjugate horizontal gaze. A MLF lesion is manifest by impaired adduction on affected side, accompanied by nystagmus in the other, abducting eye.

35

What cranial nerve is involved with facial sensation?

Cr N V

36

How do you test Cr N V?

Touch with cotton, corneal reflex with cotton wisp when feasible,

37

What are the three branches of facial sensation?

-three braches; ophthalmic, maxillary and mandibular;

38

What is Bell's palsy?

Peripheral weakness or paralysis of one side of the face causing a facial droop; drooling, eye issues with tearing (excessive, dry eye); loss of taste, pain behind ear a facial nerve (Cr N VII) lesion.

39

What cranial nerve is involved with facial strength?

Cr N VII

40

How do you test facial strength?

-close eyes tight, wrinkle forehead, smile

41

What is the name of CN1?

Olfactory

42

What is the name of CN2?

Optic

43

What is the name of CN3?

Oculomotor

44

What is the name of CN4?

Trochlear

45

What is the name of CN5?

Trigeminal

46

What is the name of CN6?

Abducens

47

What is the name of CN7?

Facial

48

What is the name of CN8?

Vestibulocochlear

49

What is the name of CN9?

Glossopharyngal

50

What is the name of CN10?

Vagus

51

What is the name of CN11?

Accessory

52

What is the name of CN12?

Hypoglossal

53

Which cranial nerves are sensory only?

CN 1, 2, 8

54

Which cranial nerves are motor only?

CN 3, 4, 6, 11, 12

55

Which cranial nerves are mixed actions?

CN 5, 7, 9, 10

56

What is the function of CN1?

-Olfactory
-Smells

57

What is the function of CN2?

- Optic
-Sees

58

What is the function of CN 3, 4, and 6?

-Moves eyes
-CN3 Constricts pupils
-Accommodates
- CN3: Oculomotor
- CN4: Trochlear
- CN6: Abducens

59

What is the function of CN5?

-Chews and feels front of head
- Trigeminal

60

What is the function of CN7?

-Moves the face, tastes, salivates, cries
- Facial

61

What is the function of CN8?

-Hears, regulates balance
-Vestibulocochlear

62

What is the function of CN9?

-Tastes, salivates, swallows, monitors carotid body and sinus.
- Glossopharyngeal

63

What is the function of CN10?

-Tastes swallows, lifts palate, talks, communication and from thoraco-abdominal viscera
-Vagus

64

What is the function of CN11?

-Turns head, lifts shoulders
-Acessory

65

What is the function of CN12?

-Moves tongue
-Hypoglossal

66

What Cranial nerve is involved with the gag reflex?

-Vagus (Cr N 10)
- 20% of patients do not have gag reflex.

67

What tests do you do to check Cr N VII?

-Hearing (finger rub)
-Weber/ Rinne for conduction vs. sensorineural hearing loss

68

What is dysarthria?

Articulation errors

69

What nerves are involved in dysarthria?

Cr N VII, IX, X, XII

70

What nerve causes tongue weakness?

CN XII- Hypoglossal Nerve
-Atrophy and fasciculations are often prominent with peripheral lesions.
-Tongue deviates to the side of the peripheral nerve lesion

71

What is the grading system for muscle strength created by?

MRC- Medical Research Council

72

What is the 0/5 on the muscle strength grading system?

no discernable muscle or muscle fiber contraction

73

What is the 1/5 on the muscle strength grading system?

flicker/twitch of muscle fiber movements without movement of joint/limb

74

What is the 2/5 on the muscle strength grading system?

weak contraction (cannot overcome gravity

75

What is the 3/5 on the muscle strength grading system?

weak contraction (able to overcome gravity but no additional resistence)

76

What is the 4/5 on the muscle strength grading system?

weak contraction (able to overcome minimal resistence

77

What is the 5/5 on the muscle strength grading system?

Full Strength

78

What are the limitations of the muscle grading system?

i. Difficult to conventionally assess large muscle groups or exceptionally powerful individuals
ii. Subjectivity between 4/5 and 5/5

79

What muscles have deep tendon reflexes?

i. biceps C5-6
ii. triceps C 6-7
iii. brachioradialis C5-6
iv. knee (patellar) L3-4
v. ankle (gastrocsoleus
or Achilles) S1
vi. hamstrings L5

80

What is clonus?

rhythmic series of contractions elicited by stretching the tendon

81

What is the DTR grading system positive tests?

Asymmetry and sustained clonus ; the most important positives

82

On the DTR grading system what is a 0/4?

0 or 0/4 = absent

83

On the DTR grading system what is a 1/4?

1/4 = reduced (hypoactive)

84

On the DTR grading system what is a 2/4?

2/4 = normal DTR

85

On the DTR grading system what is a 3/4?

3/4= hyperactive

86

On the DTR grading system what is a 4/4?

4/4= clonus (sustained or several beats)

87

What cervical nerve goes to the thumb?

C6

88

What cervical nerve goes to the pinky?

C8

89

What lumbar nerve goes to the large toe and lateral thigh?

L5

90

What sacral nerve goes to the small toe and sole?

S1

91

What is Dysmetria?

inibility to perform point to point movements

92

What is Dysdiadochokinesis?

an inability to perform rapid alternating movements slow or irregular: movement disorder

93

What test do you do to check cerebellar/coordination?

-Evaluate by testing patient’s ability to perform:
-Rapid alternating movements (hands on thighs and rapidly supinate- pronate hands for 10 seconds).
-Heel down Shin- slide down from knee to top of foot.

94

What is the Romberg test?

1. Patient stands still, feet together, then ask patient to close eyes
2. Positive test-If significant and immediate loss of balance

95

What are false positives for cerebrovascular brutus?

Anemia, hypermetabolic state or pressing too hard with stethoscope

96

What are the false negatives for cerebrovascular bruits?

Total occlusions

97

What is the grading system for Cerebrovascular bruits?

1/4 low grade, 2/4 more, 3/4 more, 4/4; if there’s an associated diastolic component