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Flashcards in Basic Neuro Exam Deck (34):
1

5 components of basic neuro exam

1. General assessment (mental status)
2. Cranial nerves (II-XII)
3. Motor systems
4. Sensory systems
5. Reflexes

2

4 things you are testing in your general assessment during basic neuro exam

1. Level of alertness
2. Appropriateness of responses
3. Orientation to person, place, and time
4. Congruency of mood

3

Location of cranial nerves

Telencephalon = 1

Diencephalon = 2

Midbrain = 3-4

Pons = 5

Pontomedullary junction = 6-8

Medulla = 9-12

4

Olfactory n. testing

Use familiar/non-irritating odors, have pt occlude one nostril and identify odor on each side

5

Conditions that cause loss of sense of smell

Sinus conditions
Head trauma
Smoking
Aging
Cocaine use
Parkinson’s disease

6

Optic n. testing

Visual acuity w/ snellen chart

Visual fields by confrontation (wiggling fingers at edge of VF)

Light reaction (check for direct and consensual reaction)

7

Visual acuity result indicating pt is legally blind

20/200

8

Light reaction actually checks what 2 CNs?

CN II sensory
CN III constriction

9

CN III, IV, and VI testing

Cardinal signs of gaze

Near reaction (accommodation)

Also checking for nystagmus and/or ptosis

10

Trigeminal n. testing

Sensory: test forehead, cheeks, and jaw bilaterally with pinprick and cotton wisp. If pain sensation not intact, check temperature using hot/cold test tube

Motor: test temporalis+masseter with teeth clenching, lateral pterygoid with jaw movement side to side

11

Unilateral weakness of jaw musculature indicates what type of lesion

CNS pontine lesion

12

Bilateral weakness of jaw musculature indicates what type of lesion?

Cerebral hemispheric disease d/t bilateral cortical innervation

13

CNS patterns of stroke

Facial and body sensory loss on same side but from contralateral cortical or thalamic lesion

Ipsilateral face but contralateral body sensory loss in brainstem

14

Isolated facial sensory loss may indicate what condition

Trigeminal neuralgia

15

Facial n. testing

Motor: mm. of facial expression: raise eyebrows, frown, close both eyes tight, show upper and lower teeth, smile, puff out both cheeks

Sensory: taste for salty, sweet, sour, and bitter substances on anterior 2/3 tongue

Parasympathetic: secretion of saliva and tears

16

During facial n. testing, a widened ____ ____ and _____ ____ are indicative of weakness

Palpebral fissure; nasolabial fold

17

What condition affects both upper and lower face, loss of taste, hyperacusis, and increased/decreased tearing as a result of facial n. damage?

Bell’s palsy

18

A central lesion affecting the facial n. typically affects which part of the face?

Lower face

19

Vestibulocochlear n. testing

Whisper test

Weber/Rinne test

Balance testing (typically done with cerebellar testing)

20

Glossopharyngeal n. testing

Motor: voluntary m. for swallowing+phonation

Sensory: sensation of nasopharynx, gag reflex and taste for posterior 1/3 tongue

Parasympathetic: secretion of salivary glands and carotid reflex

21

Vagus n. testing

Inspect palate+uvula for symmetry
Observe for difficulties swallowing (water test)
Test for gag reflex
Check for hoarseness of voice

22

Spinal accessory n. testing

Shoulder shrug
Head turn against resistance

23

General observations for motor system

Body position and gait
Involuntary movement - tremors, tics, or fasciculations
Muscle bulk - wasting, atrophy
Muscle tone - muscle resistance to passive stretch

24

Testing major muscle groups of upper extremity

Shoulder shrug - CN XI
Elbow flexion (C5,6) and extension (C6-8)
Wrist flexion and extension (C6,7)
Hand grip (C7,8, T1)
Finger abduction (C8, T1)
Thumb opposition (C8, T1)

25

Testing major muscle groups of lower extremity

Hip flexion (L2-4) and extension (S1)
Hip adduction (L2-4) and abduction (L4-S1)
Knee flexion (L4-S2) and extension (L2-4)
Ankle plantarflexion (S1) and dorsiflexion (L4-5)

26

Gait observation

Casual -observe posture, balance, arm swinging, leg movement, look for ataxia

Tandem - heel-to-toe in straight line

Toe walk/heel walk - may reveal distal weakness in legs

27

Inability to heel-walk is a sensitive test for damage to what tract?

CST damage

28

Cerebellar tests and what abnormal test is

Rapid alternating movements (abnormal=dysdiadokinesia)

Finger-to-nose (abnormal=tremor)

Heel-to-shin (tests position sense)

29

Sensory testing utilizes dermatomes and what 3 methods of testing for spinothalamic tract, posterior columns, and both pathways at once?

Spinothalamic testing = pain and temp of dermatomes

Posterior columns = proprioception and vibration

Both pathways = light touch

30

What is the romberg test

Test of position sense/proprioception (posterior columns)

Pt stands with feet together and eyes open, pt closes eyes for 30-60 seconds without support, doc notes pt ability to maintain upright posture without excessive swaying

31

Cutaneous reflexes

Abdominal reflexes (T10-12) - contraction of abdominal muscles w/ deviation toward stimulus

Cremasteric reflex (afferent L1, efferent L2) - scrotum raises on ipsilateral side

Plantar response (babinski)

Anal reflex (S2-4) - note contraction of anal muscles (cauda equina)

32

Babinski sign

Use object to stroke lateral aspect of sole from heel to ball of foot. Normal response should be plantarflexion. Dorsiflexion of big toe and fanning of toes is + and suggests UMN dysfunction

33

Clonus

Abnormal pattern of neuromuscular activity, characterized by rapidly alternating involuntary contraction+relaxation of skeletal m.

34

Meningeal signs

Nuchal rigidity (stretching of spinal nn)

Brudzinskis sign (stretching of femoral n)

Kernigs sign (stretching of sciatic n)