Ch. 1 - Neuro assessment and exam

Question 1

Confabulation

Answer 1

Severe disorientation and memory disturbance causing pt to make up stories to provide a convincing answer to questions; seen in alcoholism (Korsakoff’s psychosis) or anterior hypothalamic lesions

Question 2

Mutism

Answer 2

Pt is alert but makes NO ATTEMPT to speak; lesions to medial aspects of both frontal lobes (e.g. vasospasm s/p SAH)

Question 3

Phalilalia

Answer 3

repetition of a particular syllable; can be seen in Parkinson’s

Question 4

Brain death exam

Answer 4

lack of pupillary response to light
lack of corneal reflex to stimulation
lack of oculocephalic reflex
failure of vestibulo-ocular testing
failure of gag or cough reflex
no motor response in face or muscles or CN in response to pain stimuli
failure of respiratory movements off ventilator and after PaCO2 has risen to 50 mmHg
tests need to be repeated after 30 min and by at least 2 doctors

Question 5

What is the most important neurological sign indicating major intracranial pathology?

Answer 5

DROWSINESS

Question 6

4 main speech disorders

Answer 6

Mutism, Aphonia, Dysarthria, Dysphasia

Question 7

Aphonia

Answer 7

Pt able to speak but UNABLE TO PRODUCE any volume of sound 2/2 disturbance of vocal cords or larynx; if pt can cough then it is hysterical

Question 8

Dysarthria

Answer 8

Impaired coordination of lips, palate, tongue, larynx 2/2 extrapyramidal, brainstem, or cerebellar lesions

Question 9

Spastic vs. ataxic dysarthria

Answer 9

Spastic - 2/2 bilateral UMN dx (pseudobulbar palsy, motor neuron dx, or brainstem tumors)
Ataxic - incoordination of muscles of speech (staccato or scanning speech) 2/2 cerebellopontine angle tumors, cerebellar lesions, MS, and phenytoin toxicity

Question 10

Expressive dysphasia

Answer 10

Pt can understand speech but cannot FORMULATE their own speech; 2/2 lesion in Broca’s area or left posterior temporoparietal region

Question 11

Receptive dysphasia

Answer 11

Cannot UNDERSTAND spoken or written speech; 2/2 lesion in Wernicke’s area

Question 12

Alexia

Answer 12

Inability to understand written speech; alexia with agraphia (inability to write) is 2/2 lesion in let angular gyrus

Question 13

‘Clasp knife’ spasticity

Answer 13

Resistance is most pronounced when movement is first made; sign of UMN lesion

Question 14

‘Lead pipe’ rigidity

Answer 14

Equal resistance to all movements; characteristic of lesion in extrapyramidal system

Question 15

‘Cog wheel’ rigidity

Answer 15

Alternating jerky resistance to movement; degenerative lesions of extrapyramidal system (esp. Parkinson’s dx)