Chapter 17 Neuro

Question 1

5 categories of Neurological Exam

Answer 1

Mental status (speech & language), cranial nerves, motor system, sensory system, and reflexes

Question 2

LOC

Answer 2

Alertness (responds fully), lethargy (appears drowsy), obtundation (responds slowly/confused), stupor (minimal awareness), coma (no evident awareness)

Question 3

Speech

Answer 3

Look for underlying abnormalites; is there evidence of dysarthria, aphasia, or other psychological problems?

Question 4

Thought processes

Answer 4

Logical, Relevant, Organized, Coherent

Question 5

CN I

Answer 5

Olfactory: smell

Question 6

CN II

Answer 6

Optic: Visual acuity, visual fields, ocular fundi, and pupillary reactions

Question 7

CN III

Answer 7

Oculomotor: Pupillary reactions, extraocular movements

Question 8

CN IV, VI

Answer 8

Trochlear (IV) Abducens (VI): Extraocular movements

Question 9

CN V

Answer 9

Trigeminal: Corneal reflexes, facial sensation, voice and speech, and jaw movements

Question 10

CN VII

Answer 10

Facial: facial movements and voice and speech

Question 11

CN VIII

Answer 11

Acoustic: Hearing

Question 12

CN IX & X

Answer 12

Glossopharyngeal: swallowing and rise of the palate, gag reflex
voice and speech (X)

Question 13

CN XI

Answer 13

Spinal Accessory nerve: shoulder and neck movements

Question 14

CNXII

Answer 14

Hypoglossal: Tongue symmetry and position, and voice and speech

Question 16

Muscular atrophy

Answer 16

fasciculations, hyporeflexia (lower motor nerver lesion)wasting away/ loss of muscle bulk. Seen in diabetic neuropathy and flattening of thenar and hypothenar eminences

Question 17

Muscle tone

Answer 17

look for hyperreflexia, clonus, spasticity, and barbinski’s sign (upper motor neuron lesion) versus atrophy

Question 18

Muscle strength

Answer 18

impaired strength (paresis), absence of strength (plegia),

Question 19

Weakness of extension at elblow

Answer 19

CNS disease producing hemiplegia- stroke, MS

Question 20

Weak grip

Answer 20

de Quervain’s tenosynovitis, CTS, arthritis

Question 21

Rapid alternating movements

Answer 21

Dysdiadochokinesis: one movement cannot be followed quickly by its opposite and movement are slow

Question 22

Positive Romberg sign

Answer 22

Ataxia from dorsal column disease and loss of position sense

Patient stands fairly well with eyes open but loses balance when they are closed.

Question 23

Pronator drift test

Answer 23

A sideward or upward drift, sometimes with searching, writhing movements of hand suggest loss of position sense.

Cerebellar incoordination- arms returns to original positiion but overshoots and bounces

Question 24

Gait

Answer 24

Ataxia (cerebellar disease) lacks coordination with reeling and instability

Question 25

Muscle atrophy

Answer 25

loss of muscle bulk wasting; results from diseases such as diabetic neuropathy

Question 26

Hypertrophy

Answer 26

increase in bulk with proportionate strength;

Question 27

Pseudohypertrophy

Answer 27

Increase in bulk with diminished strength (seen in the Duchenne form of muscular dystrophy)

Question 28

flaccidity

Answer 28

marked floppines that indicates hypotonia

Question 29

Spasticity

Answer 29

increased resistance that worsens at the extreme range (seen in central corticospinal tract diseases

Question 30

Rigidity

Answer 30

increased resistance throughout rangle of movement in both directions

Question 31

upper motor neuron lesion

Answer 31

hyperreflexia, clonus, spasticity, and barbinski's sign

Question 32

Clonus

Answer 32

a hyperactive response required for assigning a reflex grade of 4, usually elicited at the ankle. The ankle plantar flexes and dorsiflexes repetitively and rhythmically caused by CNS disease

Question 33

lower motor neuron lesion

Answer 33

atrophy, fasciculation, hyporeflexia

Question 34

hyperthesia

Answer 34

decrease sensitivity

Question 35

Anesthesia

Answer 35

absence of touch sensitivity

Question 36

Loss of position sense

Answer 36

tabes dorsalis, MS, B12 deficiency

Question 37

Astereognosis

Answer 37

inability to recognize objects place in hand

Question 38

Lesion in sensory cortex

Answer 38

inability to recognize numbers

Question 39

Graphesthesia

Answer 39

tests the individual's ability to use sensory input to identify a number or letter drawn onto his/her hand while visually occluded.

Question 40

Positive Barbinski's reflex

Answer 40

dorsiflexion of big toe

Question 41

0 (grading reflexes 0-4 scale)

Answer 41

no reponse

Question 42

1+ (grading reflexes 0-4 scale)

Answer 42

somewhat diminished; low normal

Question 43

2+ (grading reflexes 0-4 scale)

Answer 43

Average; normal

Question 44

3+ (grading reflexes 0-4 scale)

Answer 44

Brisker than average; possible not necessarily indicative of disease

Question 45

MMSE

Answer 45

Date, Place, Object, Serial sevens, Naming, Recall, Repeat, Verbal commands, written command, writing, drawing

Question 46

4+ (grading flexes 0-4 scale)

Answer 46

very brisk; hyperactive, with clonus (rhythmic oscillations between flexion and extension)

Question 47

Symmetric weakness of proximal muscles suggests:

Answer 47

a myopathy or muscle disorder

Question 48

Symmetric weakness of distal muscles suggests:

Answer 48

polyneuropathy or disorder of peripheral nerves

Question 49

Dysdiadochokinesis

Answer 49

In cerebellar disease, when one movement cannot be followed quickly by its opposite movement

Question 50

Cerebellar Ataxia

Answer 50

patient has difficulty standing with feet together whether they eyes are open or closed.

Question 51

First sensation to be lost in a peripheral neuropathy

Answer 51

vibration sense

Question 52

Causes of peripheral neuropathy:

Answer 52

Diabetes, alcoholism, vit. B12 deficiency, and tertiary syphilis

Question 53

Causes of loss of position sense:

Answer 53

tabes dorsalis, MS, B12 deficiency, diabetes

Question 54

Astereognosis and the inability to recognize numbers both suggest a lesion of:

Answer 54

the sensory cortex

Question 55

Causes of hyperreflexia

Answer 55

CNS lesions along the descending corticospinal tract Associated findings of weakness, spasticity, or positive Babinski's sign.

Question 56

Causes of hyporeflexia

Answer 56

Diseases of spinal nerve roots, spinal nerves, plexuses, or peripheral nerves. Associated findings of weakness, atrophy and fasciculations

Question 57

Kernig's Sign

Answer 57

Pain and increased resistance to extending the knee Suggests meningeal irritation