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Emma - Physical Diagnosis > PD - Neuro Exam > Flashcards

PD - Neuro Exam Flashcards

1
Q

CN I

A

Smell cinnamon/vanilla; ask if smell has changed lately.

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2
Q

CN II

A

Test visual acuity; pupillary light reflex/accommodation (CN II (aff) + CN III(eff) ).

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3
Q

CN III

A

Open eye and look up; pupillary light reflex (carries parasympathetics).

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4
Q

CN IV

A

Look inward and downward (superior oblique).

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5
Q

CN V

A

Motor (chewing; clench teeth), Sensory (test dermatomal distributions of V1-3)

Corneal reflex: CN V (aff) + CN VII (eff)

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6
Q

CN VI

A

Look laterally (lateral rectus).

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7
Q

CN VII

A

Motor (Bare teeth, puff cheeks, close eyes tight)

Sensory (Taste anterior ⅔ tongue)

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8
Q

CN VIII

A

Hearing: auditory and bone and air conduction tests (Weber and Rinne)

Vestibular: test for Romberg’s Sign; (close eyes on one foot).

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9
Q

CN IX

A

Motor (stylopharyngeus + parotid gland; say “ahh” and watch for symmetric palate elevation)

Sensory (Taste posterior ⅓ of tongue; pharynx sensation tested with gag reflex [CN IX (aff) + CN X (eff)])

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10
Q

CN X

A

listen to pt speak

have pt swallow

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11
Q

CN XI

A

elevate shoulders against resistance (SCM + trapezius)

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12
Q

CN XII

A

Test by sticking tongue out (lesion to CN XII = tongue deviates toward lesioned side).

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13
Q

General order of neuro exam

A
  1. mental status examination
  2. CN examination
  3. motor function
  4. sensory function
  5. reflex testing
  6. coordination testing
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14
Q

steps to examine motor function during neuro exam

A
  • Inspect for atrophy, fasiculations, clonus, etc.
  • Palpate for muscle tone (decreased, normal, elevated).
  • Test major muscle groups and grade 0-5.
  • Assess gait: Walk normally, on tiptoes/heels and feet aligned (heel-to-toe).
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15
Q

In the neuro exam, when is gait testing usually performed?

A

last, after coordination testing

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16
Q

In a patient without any signs or symptoms of neurologic disease, you can quickly screen for sensation how?

A

using the proximal and distal portion of the upper and lower extremities.

normal examination findings using light touch and pain is probably sufficient to document intact sensation.

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17
Q

Light touch

A

With patient’s eyes closed, touch various dermatomes and ask them to note feeling it.

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18
Q

Pain

A

Touch with safety pin (sharp/blunt ends) with eyes closed; ask to tell which side is used.

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19
Q

Vibration

A

Strike tuning fork and place it on any bony prominence and ask when the vibration ceases.
(then immediately put it on your own extremity to verify vibe ceased)

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20
Q

Proprioception

A

Move distal phalanx up/down, ask close-eyed pt to say if it is “up” or “down”.

21
Q

Tactile localization

A

Double-simultaneous touching in two places with eyes closed; pt reports where you touched them.

22
Q

Point localization

A

Patient eyes closed; ask patient to identify where they were touched.

23
Q

Discrimination

A

Two-point discrimination:
Hold two pins, touching one or two heads and
ask patient to report if they felt one or two heads.
Fingertip 2-5mm; Palm 10-12mm; Back 40-60mm

24
Q

Stereognosis

A

Identify an object placed in the hand with eyes closed.

25
Q

Graphesthesia

A

Identify a character written on the hand with eyes closed.

26
Q

steps to examine sensory function during neuro exam

A 
light touch
pain
vibration
proprioception
tactile localization
discrimination
stereognosis
graphesthesia
point localization
27
Q

reflexes grading scale

A 
0 - no response
1 - diminished
2 - normal 
3 - increased
4 - hyperactive

*should be equal on both sides

28
Q

Biceps reflex

A

C5

29
Q

Brachioradialis reflex

A

C6

30
Q

triceps reflex

A

C7

31
Q

patellar reflex

A

L2-L4

32
Q

achilles

A

S1-S2

33
Q

Babinski’s sign

A

L5-S2

34
Q

maintaining balance and posture requires

A
  1. Positional sense input (examines visual input, vestibular input, proprioception)
  2. Sensorimotor Integration (examines cerebellar function)
  3. Motor Output (examines basal ganglia, corticospinal and pyramidal tracts)
35
Q

Tests for coordination

A
  • Finger-to-Nose
  • Heel-to-Knee
  • Rapid alternating movement
  • Romberg sign
  • Pronator drift
36
Q

Finger-to-Nose

A
  • Cerebellar test (sensorimotor integration)
  • Hold finger out, have patient touch own nose then your finger alternately and quickly.
  • Look for intention tremor, overshooting.
37
Q

Heel-to-Knee

A
  • Cerebellar test.
  • With patient lying or sitting, ask them to slide one heel to the knee of the other leg then up and down the shin smoothly.
38
Q

Rapid alternating movement

A
  • Cerebellar test

- Test in both upper/lower extremity (pronation/supination alternation or pinky to thumb as rapidly as possible)

39
Q

Romberg Sign

A
  • Tests for sensory ataxia (loss of proprioception);
  • ask pt to stand upright, eyes open, arms at side. Then closed eyes. Observe 60 seconds.

+ if pt sways/falls after closing eyes

40
Q

if pt sways/falls w/ eyes open, is this a + Romberg sign?

A

No.

if sway/fall with eyes open = cerebellar ataxia, NOT a positive Romberg sign.

41
Q

Appearance of vestibular imbalance on Romberg examination

A

may sway more than normal, but still will not fall.

42
Q

Pronator drift

A

Tests for position sense, contralateral corticospinal lesions.

-With eyes closed, hold arms extended at shoulder and fully supinated for 30 seconds (should remain stable; if one arm drifts downward and/or pronates = present pronator drift).

Pronator drift can assess for subtle motor weakness from UMN lesion (may be undetectable in routine strength testing)

43
Q

facial paralysis common causes

A

stroke

peripheral nerve paralysis

44
Q

gait disorder common causes

A

Stroke

Foot drop (peripheral nerve dysfunction)

Ataxia

Parkinson’s

Aging (musculoskeletal disease)

45
Q

resting tremor common causes

A

Parkinson’s

46
Q

Intention tremor common causes

A

cerebellar stroke

multiple sclerosis

47
Q

postural tremor common causes

A

hyperthyroidism

48
Q

asterixis common causes

A

liver failure

tremor of the hand when the wrist is extended, sometimes said to resemble a bird flapping its wings

Emma - Physical Diagnosis (12 decks)

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