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2.3 Neuro exam lecture Flashcards

1
Q

what dzs are associated with abrupt onset neurological sxs

A

cerebral hemorrhage
vascular dz
infection
head trauma

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2
Q

what dzs are associated with progressive neurological sxs

A

neoplasm

degenerative dz

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3
Q

what dzs are associated with intermittent neurological sxs

A

demyelinating dz

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4
Q

what must be eliminated before dementia can be dx

A

depression and delerium

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5
Q

what do you have to do before testing CN I

A

make sure nasal passages are clear

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6
Q

what is evaluated by the near response

A
  • pupillary constriction
  • medial rectus (convergence)
  • ciliary m (lens accomodation)
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7
Q

what is presbyopia

A

farsightedness AKA impaired NEAR vision

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8
Q

what is the progression of CN III sxs from space occupying masses

A

first pupil dilation and fixation

THEN down and out position

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9
Q

what CN is responsible for inward rotation, downward and lateral movement

A

CN IV

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10
Q

what CN is responsible for only lateral movement

A

CN VI

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11
Q

what CN lesion is assoc w/ vertical diplopia and how might this present

A

CN IV, difficulty reading for walking down stairs

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12
Q

in CN IV which way does the head tilt

A

opposite to the lesion

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13
Q

what is the most common isolated nerve palsy

A

VI

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14
Q

what CN lesion is associated with convergent strabisus or esotropia (inability to abduct eye)?

A

CN VI

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15
Q

what CN lesion is assoc w/ horizontal diplopia

A

CN VI

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16
Q

when is physiologic nystagmus seen? which direction is the beat?

A

seen in extreme deviation of gaze

eye beats in opposite direction of gaze

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17
Q

what CNs are evaluated by the corneal reflex

A

V and VII

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18
Q

which way does the jaw deviate in a trigeminal lesion

A

toward the weak side

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19
Q

what CN is responsible for saliva and tear secretion

A

VII

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20
Q

what CN lesion causes hyperacusis (inc sensitivity to sound)

A

VII

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21
Q

aberrant regeneration of what CN causes crying w/ chewing

A

VII

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22
Q

supranuclear or central facial palsy spares what part of the face

A

upper and usually associated with hemiplegia (weakness to one side of body)
-important in determining if weakness is central or peripheral

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23
Q

what CN lesion is associated w/ disequilibrium and nystagmus

A

vestibular division of CN VIII

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24
Q

what CN lesion is assoc with sensorineural hearing loss and tinnitus

A

cochlear div of CN VIII

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25
if the pt can swallow, what CN lesions can be ruled out
IX and X
26
how does CN XII lesion present on exam
tongue deviates ipsi | cannot push tongue into CONTRA cheek
27
what muscle and spinal level are responsible for plantarflexion
gastrocnemius, S1
28
what muscle and spinal level are responsible for dorsiflexion
tibialis anterior (L4, L5)
29
what is a pattern of weak EXTENSION of the arms and weak FLEXION of the legs called and what lesion is it assoc w/
pyramidal pattern of weakness | UMN lesion
30
what is a pattern of weak FLEXION of the arms and weak EXTENSION of the legs called and what lesion is it assoc w/
peripheral pattern of weakness | LMN dz
31
heel walking and pronator drift test for lesions of what tract
CST
32
in what dzs is a scissoring gait seen
cerebral palsy and MS
33
what is a gait with high stepping and a broad base called and when is it seen
sensory ataxia, seen in posterior column damage and peripheral neuropathy
34
in what dzs is a magnetic gait seen
frontal lobe processes | hydrocephalus
35
what is indicated by a waddling pelvis
myopathy
36
how is a positive babinski sign recorded
toe up going
37
is clonus associated with UMN or LMN lesion
UMN
38
what dermatomes are evaluated by the abd reflex
T10-12
39
what is kernigs sign
pt has neck pain with hip flexion | + meningitis
40
what is brudzinski's sign
pts knees raise when you lift their head | + meningitis
41
Dysarthria
defect in speech, usually from defect in motor control of speech apparatus
42
Aphasia
disorder in producing or understanding language, usually lesion to dominant hemisphere (usually left)
43
Nystagmus
rhythmic oscillation of eyes
44
potential causes for nystagmus
1. vision impairment at early age 2. disorders of labyrinth or cerebellar systems 3. drug toxicity
45
Hyperacusis
increased sensitivity to sound
46
What does it mean when you chart, "CN are grossly intact"
you have spent enough time talking with the patient that you haven't seen anything that warrants an actual CN test, meaning you haven't noticed drooling, ptosis, facial droop, difficulty with articulation, etc
47
What does it mean when you chart, "CN II-XII are intact to testing"?
you went through the actual confrontation of each nerve bilaterally
48
What sensory dermatome is on the auricle?
C2
49
What sensory dermatome is on the earlobe, posterior/ant neck?
C3
50
What sensory dermatome is on the shoulder top?
C4
51
What sensory dermatome is on the Radial aspect of forearm?
C6
52
What sensory dermatome is on the long finger?
C7
53
What sensory dermatome is on the little finger?
C8
54
What sensory dermatome is on the Nipple?
T4
55
What sensory dermatome is on the umbilicus?
T10
56
What sensory dermatome is on the inguinal?
L1
57
What sensory dermatome is on the Patella, medial calf?
L4
58
What sensory dermatome is on the Anterolateral calf, great toe?
L5
59
What sensory dermatome is on the posterolateral calf/little toe?
S1
60
Sterognosis
ability to id shapes of objects or recognize objects placed in hand
61
Graphesthesia
ability to id numbers written on palm
62
2 pt discrimination
ability to distinguish being touched by 1 or 2 pts
63
double simultaneous stimulation (extinction)
ability to feel 2 locations being touched simultaneously
64
thalamic patterns of sensory loss
hemisensory loss of all modalities
65
cortical sensory loss
intact primary sensations but loss of cortical sensations
66
functional sensory loss
non-anatomical distribution
67
Cerebellar ataxia gait
staggering, unsteady, feet wide apart, other cerebellar sigs usually present
68
sensory ataxia gait
unsteady, feet wide apart, feet thrown forward and slapped down 1st on heels then forefoot, pt watch ground when walking
69
parkinsonian gait
stooped forward, short steps commonly called "shuffling gait"
70
What CN is most vulnerable to head trauma? What deficit would you see with damage to this?
CN IV- exotropia (lateral eye drift) and weakness of downward gaze, vertical diplopia, and head tilt to side opposite lesion
71
What is the most common isolated CN and why? What patients do you see damage in? What deficit would you see with damage to this?
- CN VI, long peripheral course - subarachnoid hemorrhage, late syphilis, trauma - convergent strabismus (estropia): inability to abduct eye and horizontal diplopia
72
potential causes of nystagmus
1. vision impairment at early age 2. disorder of labyrinth or cerebella systems 3. drug toxicity
73
how do you test for pain and what is this testing?
pt eye are closed and use a broken tongue depressor on skin, testing spinothalamic tract
74
how do you test for temp of the sensory system?
pt eyes are closed and used test tubes filled with hot and cold water- spinothalamic
75
how to you test vibration sense and what is it testing?
use a 128 hz tuning fork on bony prominence- PCMLS
76
how to you test proprioception sense and what is it testing?
1. grab pt's big toe b/t thumb and index finger and move through an arc 2. when pt's eyes are closed, ask them if the toe is up or down - testing PCMLS
77
what are the 4 discriminative (cortical) sensations?
1. stereognosis: ID shape of object or recognize if in hand 2. graphesthesia: ID number written on palm 3. 2 pt discrimination 4. double simultaneous stimulation (extinction): ability to feel 2 locations being touch simultaneously
78
pattern of single nerve loss
limited to distribution of single nerve
79
pattern of root loss
loss in different nerve distributions with common root
80
pattern of sensory loss for thalamic path
hemisensory loss of all modalities
81
pattern of sensory loss for cortical path
intact primary sensation but loss of cortical sensation
82
what nerve does the brudzinski's sign stretch?
femoral
83
what nerve does the kernig's sign stretch?
sciatic

PCMI (15 decks)

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