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PCMII Final > (2) Basic Neuro Exam > Flashcards

(2) Basic Neuro Exam Flashcards

1
Q

What type of onset is typical for cerebral hemorrhages, vascular diseases, and infections, and head trauma?

A
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2
Q

What type of onset is typical for demyelinating diseases such as multiple sclerosis?

A

Intermittent, relapsing episodes

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3
Q

Dysarthria is usually caused by what?

A

Defect in motor control of speech aparatus

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4
Q

Aphasia is usually caused by what?

A

Lesion in dominant hemisphere (usually left)

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5
Q

What is A/Ox4? Where is it documented?

A

Oriented to person, place, time, and event

Documented in objective

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6
Q

What is anhedonia?

A

When the things that used to give you pleasure no longer work

(occurs w/ depression)

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7
Q

Associated sx to ask about for a patient presenting with neuro findings (there’s a few…)

A

Headache

Dizziness/vertigo

Weakness (generalized, proximal)

Numbness/abnormal/absent sensation

Syncope

Seizures

Tremors

Loss of bowel or bladder control

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8
Q

What type of response would you expect from a pt who is alert?

A

Pt opens eyes, looks at you, fully responds appropriately to stimuli

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9
Q

What type of response would you expect from a lethargic pt?

A

Pt appear drowsy but opens eyes to look at you, responds to questions, then falls asleep

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10
Q

What type of response would you expect from an obtunded pt?

A

Obtunded pt opens eyes and looks at you but responds slowly and is somewhat confused

Alertness and interest in the environment are decreased

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11
Q

What type of response would you expect from a pt in a stupor?

A

Arouses from sleep only after painful stimuli

Verbal responses slow/absent

Pt lapses into an unresponsive state when the stimulus ceases

Minimal awareness of self or the environment

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12
Q

What mental status finding is common for older adults during hospitalization?

A

Delirium

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13
Q

What diagnoses must be eliminated before diagnosing dementia?

A

Depression

Delirium

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14
Q

What is the difference bw “Cranial nerves intact” and “Cranial nerves grossly intact”?

A

“Cranial nerves intact” means that all of the cranial nerves were actually tested instead of observed (‘grossly”)

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15
Q

Pt with history of smoking and use of cocaine presents with loss of smell. This can indicate what type of lesion?

A

Ipsilateral lesion

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16
Q

What is myopia? What cranial nerve is involved?

A

Impaired distance vision (near sighted)

CN II

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17
Q

What is presbyopia? What cranial nerve is involved?

A

Impaired near vision (farsighted)

CN II

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18
Q

Lesion to the optic nerve anterior to the chiasm cause what kind of blindness?

A

Ipsilateral

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19
Q

What cranial nerves are being tested in the pupillary light reflex?

A

CN II and III

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20
Q

What muscles are involved in pupillary convergence?

A

Medial rectus muscles

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21
Q

What muscles are involved in accomodation of the lens?

A

Ciliary muscle

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22
Q

Pt presenting with ptosis, asymmetrical pupils, and a “down and out” eye may have a lesion in what cranial nerve?

A

CN III (oculomotor)

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23
Q

Pupil dilation or asymmetry is due to what?

A

Disruption of parasympathetic fibers

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24
Q

Space-occupying or expanding masses compressing on the brainstem can affect what cranial nerve? What is the second effect?

A

CN III

No output via somatic efferents => external strabismus

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25
A lesion in CN IV results in what symptoms?
Extorsion of the eye Weakness of downward gaze (due to weak SO M.) Vertical diplopia Head tilting away from lesion
26
What is the most common isolated CN palsy?
CN VI palsy
27
Pt has history of subarachnoid hemorrhage and syphilis presnts with medial strabismus and horizontal diplopia. Where is the lesion?
CN VI
28
What planes can nystagmus occur?
All of them (vertical, horizontal, and rotatory)
29
How is nystagmus lateralized?
Based on the direction of the fast beat
30
What are some common causes of nystagmus?
Early vision impairment Disorders of labyrinth and cerebellum Drug toxicity
31
What are the 3 components of testing CN V?
Facial sensation - pinprick/light touch, hot/cold to forehead, cheek, and chin Motor fxn - lateral jaw movement and jaw clenching Corneal reflex - tests orbicularis oculi m.
32
Pt presents with decreased sensation to the face. Upon examination, his jaw deviates to one side and there is loss of the corneal reflex. Where is his lesion?
CN V
33
What are the afferent and efferent limbs of the corneal reflex?
Afferent - CN V Efferent - CN VII
34
What is the parasympathetic function of CN VII?
Secrete saliva and tears
35
What is the sensory function of CN VII?
Taste for salty, sweet, bitter substances to anterior 2/3 of tongue
36
What is crocodile tears syndrome?
Abberent regeneration of CN VII nerve after trauma =\> pt sheds tears when chewing
37
What are the main sx of a CN VII lesion?
Bell's palsy Loss of corneal reflex Hyper acusis (increased sensitivity to sound) Crocodile tears
38
Supranuclear facial palsy is important in determining what type of lesion?
Central facial nerve palsy (upper face spared but still associated with hemiplegia)
39
When would the Weber-Rinne test be indicated in testing CN VIII?
If there is loss of hearing found when performing whisper test or finger rub
40
What kind of lesion to CN VIII can cause tinnitis?
Irritative (cochlear division)
41
What kind of lesion to CN VIII can cause sensorineural hearing loss?
Destructive (cochlear division)
42
Lesion to the vestibular division of CN VIII can result in what sx?
Dysequilibrium (imbalance) Nystagmus
43
What is the motor function of CN IX?
Innervates stylopharyngeus muscle =\> elevates and widens pharynx on swallowing
44
What is the sensory fxn of CN IX?
Taste to posterior 1/3 of tongue, sensation to palate and pharynx, skin of external ear
45
What are the efferent and afferent limbs of the gag reflex?
Afferent - CN IX Efferent - CN X (lesions usually present on ipsilateral side)
46
What CN innervates muscles of the pharynx (except stylopharyngeus) and larynx?
CN X
47
What division of the CN XI innervates muscles of the larynx (except cricothyroid m.)?
Cranial division
48
What does the spinal division of CN XI innervate?
Trapezius M. and SCM
49
How is CN XII tested?
Test by having pt protrude tongue and push tongue into opposite cheek
50
Complete range of motion against gravity, but not resistance would be graded as what muscle strength?
3/5 (review this)
51
What motor dermatomes are tested in shoulder abduction, flexion, extension?
C5
52
What motor dermatomes are tested in elbow flexion?
C5, C6
53
What motor dermatomes are tested in elbow extension?
C6, C7, C8
54
What motor dermatomes are tested in wrist flexion and extension?
C6, C7
55
What motor dermatomes are tested in hand grip?
C7, C8, T1
56
What motor dermatomes are tested in finger abduction and opposition of the thumb?
C8, T1
57
What motor dermatomes are tested with hip extension?
S1
58
What motor dermatomes are tested with action of gastrocnemius?
S1 (gastrocnemius)
59
What motor dermatomes are tested with hip flexion?
L2, L3, L4
60
What motor dermatomes are tested with hip abduction?
L4, L5, S1
61
What pattern of weakness is seen with upper motor neuron lesion?
Pyramidal - weak **extensors in arms,** weak **flexors in legs**
62
Wasting, fasciculations, hypotonia/hyporeflexia is classic of what kind of lesion?
LMN lesion
63
What pattern of weakness is seen in a LMN lesion?
Peripheral pattern of weakness **Weak flexors in arms** **Weak extensors in legs** (will have give-away weakness, sudden loss of strength)
64
Coordination of muscle movement requires input from what systems?
Motor Cerebellar Vestibular Sensory
65
Romburg test is testing what?
Proprioception (is a sensory test)
66
A pt with anteroflexed posture, festinating (difficult start/stop), small steps, and en block turns has what kind of gait?
Parkinsonian - symmetrical
67
What type of gait is seen in cerebral palsy or multiple sclerosis?
Scissoring - symmetrical
68
What type of gait has high steppage and a broad base?
Sensory ataxia - symmetrical
69
Pt has a hx of hydrocephalus, walks with small steps where the feet don't leave the ground. How is this gait described?
Magnetic - symmetrical
70
What is Astasia-abasia?
Gait is all over the place as if the pt is falling but they don't fall bc cause is usually psychogenic
71
What asymmetrical gait is usually due to UMN such as stroke? Will see circumducted gait and decreased arm swing ipsilateral to affected leg.
Hemiplegic
72
What is waddling pelvis gait?
Asymmetrical gait indicating myopthic disease Hips sway or waddle side to side
73
What is foot drop gait?
Asymmetrical gait where pt is unable to keep foot up during heel walk LMN or UMN lesion
74
What is stereognosis?
Ability to identify shapes of objects, recognizing objects placed in the hand
75
How do you test for spinothalamic tract function?
Pinprick pain and temperature Light touch
76
How do you test for posterior column function?
Proprioception, 2 point tactile discrimination and vibratory Light touch
77
What is the C4 dermatome?
Shoulder top
78
Where is the C8 dermatome?
Pinky finger
79
How is proprioception tested?
Grasp sides of pts big toe b/w thumb and index finger and move it through arc Ask pt if toe is pointed up or down
80
What is double simultaneous stimulation/Extinction?
Ability to feel 2 locations being touched simultaneously
81
Hyperactive reflexes indicate lesion in the \_\_\_
CNS
82
\_\_\_\_ reflexes indicate a lesion in the PNS
Hypoactive
83
What pathological reflexes are UMN signs?
Babinski Clonus
84
What is the abdominal reflex?
Stroking abdomen causes umbilicus to move towards area of stimulation (T10-L2)
85
What are the superficial tendon reflexes?
Abdominal reflex (T10-L2) Cremasteric reflex (Afferent L1, efferent L2) Anal wink reflex (S4, S5) - test cauda equina
86
What disease is pill rolling tremor usually seen in? What does this indicate?
Parkinson's Basal ganglia disease
87
What is Brudzinski's sign?
Pt supine, lift head, knees will come up too
88
If pt experiences neck pain when you flex their thigh and straighten their leg, what sign is this?
Kernig's sign
89
What is postural or kinetic tremor?
Tremor with intention Usually due to essential tremor
90
What is the difference b/w decorticate and decerebrate posturing?
Decerebrate posturing - everything extended Decorticate posturing - body extended, arms flexed

PCMII Final (9 decks)

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