Clin Assess -- this could be a blood bath.

Question 1

When testing the cranial nerves, which two nerves only have sensory function?

Answer 1

I and II

Question 2

What 5 cranial nerves only have motor function?

Answer 2

III (pupil constriction, opening of eye, lid elevation, most extra-ocular movements)

IV (downward, internal rotation of the eye)

VI (lateral deviation of the eye)

XI (sternocleidomastoid and upper portion of the trapezius)

XII (tongue)

Question 3

If you have anisocoria (unequal pupils), intracranial hemorrhage, transtentorial herniation, or Horner’s syndrome, what cranial nerves might be affected?

Answer 3

II, III

Question 4

A patient with Bell’s Palsy is having an issue with what cranial nerve?

Answer 4

VII

Question 5

Cerumen impaction, otitis media, and Meniere’s disease will cause problems with what cranial nerve?

Answer 5

VIII

Question 6

Pharyngeal weakness would be associated with a lesion on what cranial nerves?

Answer 6

IX, X

Question 7

Sinusitis, smoking, aging, and cocaine use may cause problems with what cranial nerve?

Answer 7

I

Question 8

Aphonia due to vocal cord paralysis, dysarthria (poor articulation) due to cerebellar disease, aphasia (disorder in producing or understanding language) such as Wernicke’s aphasia or Broca’s aphasia would be associated with what cranial nerves?

Answer 8

V, VII, X, XII

Question 9

Trapezius weakness could be associated with a lesion on what cranial nerve?

Answer 9

XI

Question 10

Cortical lesion, amyotrophic lateral sclerosis, or polio would be associated with what cranial nerve?

Answer 10

XII

Question 11

Nystagmus, ptosis, diplopia, astigmatism, Grave’s disease are all issues that would be associated with lesions on what cranial nerves?

Answer 11

III, IV, VI

Question 12

Papilloedema, glaucoma, stroke, retinal emboli, and optic neuritis are issues associated with what cranial nerve?

Answer 12

II

Question 13

True or False

A patient with a lesion within the cerebral cortex, brainstem, or spinal cord will present with increased deep tendon reflexes.

Answer 13

True

Question 14

Lesions within what part of the brain would present with either normal or decreased deep tendon reflexes?

Answer 14

Subcortical gray matter (basal ganglia) or Cerebellum

Question 15

True or False

A peripheral nervous system disorder will always present with increased deep tendon reflexes?

Answer 15

False

Peripheral nervous system lesions will either present with normal or decreased deep tendon reflexes

Question 16

What could be the cause of a lesion in the neuromuscular junction?

Answer 16

Myasthenia Gravis

Question 17

What could be the cause of a lesion in the muscle?

Answer 17

Muscular dystrophy

Question 18

What test do we do to test for metabolic encephalopathy?

Answer 18

Asterixis

Question 19

What does a positive Babinski sign look like?

Answer 19

Dorsiflexion of the big toe is a positive sign from a CNS lesion in the corticospinal tract

Also seen in unconscious states from drug or alcohol intoxication or in the post-ictal period following a seizure

Question 20

What test should we do if DTRs seem hyperactive (4+)?

Answer 20

Clonus – dorsiflex and plantar flex foot then sharply dorsiflex foot and hold

If clonus present, may indicated CNS disease

Question 21

What are the two meningeal signs?

Answer 21

Brudzinski’s sign and Kernig’s sign

Question 22

What is the Brudzinski’s sign? And what nerve is this affecting?

Answer 22

Flex the neck and watch the knees and hips; flexion of both the hips and knees is a positive sign

Femoral nerve

Question 23

What is the Kernig’s sign? And what nerve is this affecting?

Answer 23

Flex the patient’s leg at both the hip and knee, and the straighten the knee. Positive test is increased pai and increased resistance to extending the knee

Sciatic nerve

Question 24

What is the pronator drift test? What does a positive test look like?

Answer 24

Pt should stand for 20-30 seconds with both arm straight forward, palms up, eyes closed. Tap the arms briskly downward – arms normally return smoothly to horizontal position.

Positive test = sensitive and specific for corticospinal tract lesion originating in the contralateral hemisphere. Downward drift of the arm with flexion of fingers and elbows may also occur.

Question 25

What test is described as follows: have patient stand with feet together, eyes open and then close both eyes for 30-60 seconds without support. Note patients ability to maintain upright posture.

Answer 25

Romberg test.

Question 26

What is cerebellar ataxia?

Answer 26

Pt has difficulty standing with feet together with eyes opened or closed.

Question 27

Why might someone have a positive Romberg test?

Answer 27

Dorsal column disease.

Question 28

If your patient demonstrates "winging of the scapula", what does this suggest?

Answer 28

Serratus anterior muscles.

Question 29

In what diseases might you see winging of the scapula?

Answer 29

Muscular dystrophy

Question 30

When performing the Weber test on your patient, you find that the sounds lateralizes to the impaired ear -- does your patient have conductive or sensorineural hearing loss?

Answer 30

Conductive

Question 31

When perform the Rinne test, if air conduction lasts longer than bone conduction, what type of hearing loss does your patient have?

Answer 31

Sensorineural hearing loss

Question 32

If your patient has a Glasgow coma scale score between 3 and 8, what does that mean?

Answer 32

They're in a coma

Question 33

If you speak to your patient in a normal tone of voice and they open their eyes, look at you, and respond fully and appropriately to stimuli, how would do you document this?

Answer 33

Your patient is ALERT

Question 34

If your patient remains unarousable with eyes closed and there is no response to inner need or external stimuli, they are....

Answer 34

Comatose

Question 35

If your patient appears drowsy but opens eyes and looks at you, responds to questions, and then falls back asleep, they are....

Answer 35

Lethargic.

Question 36

If you have to shake your patient to awake them, and they respond slowly and seem somewhat confused, your patient is...

Answer 36

Obtunded.

Question 37

If your patient can only be aroused from sleep with a painful stimulus, they are?

Answer 37

Stuporous

Question 38

Heroin and other narcotics will cause large or small pupils.

Answer 38

Small, pinpoint pupils.

Question 39

Cocaine and amphetamine will cause large or small pupils?

Answer 39

Large

Question 40

A pupil that is ______ and _______ warns of herniation of the temporal lobe, causing compression of the oculomotor and midbrain.

Answer 40

Fixed, dilated

Question 41

When is a single large pupil most commonly seen?

Answer 41

Diabetics with infarction of CN III.

Question 42

What type of gait is described as staggering, unsteady, wide-based, with exaggerated difficulty on turns.

Answer 42

Cerebellar ataxia -- seen with diseases of cerebellum or associated tracts

Question 43

What type of gait is seen in loss of position sense in the legs. Their gait will be unsteady and wide based -- throw their feet forward and outward and bring them down first on heels and then toes with double-tapping sound.

Answer 43

Sensory ataxia -- seen in polyneuropathy or posterior column change

Question 44

Posture is stooped with flexion of head, arms, hip, and knees. Patient will be slow to get started. Steps are short and shuffling with involuntary hastening (festination). What type of gait is this?

Answer 44

Parkinsonian gait -- seen in basal ganglia defects of Parkinson's disease

Question 45

What type of gait will have bilateral lower extremity spasticity including adductor spasm and abnormal proprioception? Furthermore, their giat will be stiff, with thighs crossing forward on each other.

Answer 45

Scissors gait -- spinal cord disease

Question 46

This type of gait is seen in foot drop, usually secondary to peripheral motor unit disease. Patients either drag the foot or lift it high.

Answer 46

Steppage gait.

Question 47

Slower and more twisting/writhing than choreiform movements and have a large amplitude. Most commonly involves the face and distal extremities; often associated with spasticity. Causes include cerebral palsy. What is being described?

Answer 47

Athetosis

Question 48

Brief, rapid, jerky, irregular and unpredictable movements

Answer 48

Chorea

Question 49

What is similar to athetoid movements but often involves larger portions of the body (i.e. trunk)?

Answer 49

Dystonia

Question 50

What kind of tremor is absent at rest, appears with movement, and gets worse as the target gets close?

Answer 50

Intention tremor

Question 51

Rhythmic, repetitive, bizarre movements that chiefly involve the face, mouth, jaw, and tongue.

Answer 51

Oral-face dyskinesias

Question 52

What type of tremor appears when the affected part is actively maintaining a posture?

Answer 52

Postural tremor

Question 53

What type of tremor is most prominent at rest and may decrease or disappear with voluntary movement.

Answer 53

Resting tremor

Question 54

Brief, repetitive, stereotyped coordinated movements occurring at irregular intervals.

Answer 54

Tics

Question 55

head -- dermatomes

Answer 55

C1-C2

Question 56

diaphragm, breathing -- dermatomes

Answer 56

C3-C4

Question 57

deltoid, biceps (shoulder abduction and elbow flexion) -- dermatome

Answer 57

C5

Question 58

biceps flexion and wrist extensors -- dermatome

Answer 58

C6

Question 59

triceps, wrist flexors, and fingers extensors -- dermatome

Answer 59

C7

Question 60

finger flexors and muscles --- dermatome

Answer 60

C8

Question 61

interossei muscles only -- dermatome

Answer 61

T1

Question 62

hip flexion -- dermatome

Answer 62

L2

Question 63

knee extension -- dermatome

Answer 63

L3

Question 64

Ankle dorsi flexion -- dermatome

Answer 64

L4

Question 65

Great toe extension -- dermatome

Answer 65

L5

Question 66

Ankle plantar flexion, ankle eversion, hip extension -- dermatome

Answer 66

S1

Question 67

knee flexion-- dermatome

Answer 67

S2

Question 68

How do we rate a normal, average reflex?

Answer 68

2+

Question 69

How would we document a hyperactive w/ clonus reflex?

Answer 69

4+ This is as high as the reflex scale goes!

Question 70

Loss of the anal wink reflex may indicate what?

Answer 70

Cauda equina

Question 71

How do you document normal muscle strength?

Answer 71

5/5

Question 72

What would a 3/5 muscle strength look like?

Answer 72

Active movement against gravity

Question 73

What tests do we do to test for coordination?

Answer 73

Rapid alternating movements, point to point movements, gait and related movements

Question 74

What tests do we do for sensory testing?

Answer 74

Pain: sharp or dull testing Temperature: usually only tested if pain testing reveals deficit Position (proprioception): grasp big toe on sides, move up and down, asking patient to identify position Vibration: Use 128Hz fork over distal interphalangeal joint of patient's finger and great toe Light touch: light wisp of cotton

Question 75

What test might we do to diagnose a brain/spinal cord tumor, eye disease, inflammation, infection, and vascular irregularities that lead to stroke?

Answer 75

Brain MRI

Question 76

What test might we do to diagnose a stroke, determine location and size of tumor, aneurysm, or vascular formation? For this test dye is injected via capsule placed (catheter), serial x-rays taken.

Answer 76

Cerebral angiogram

Question 77

When do we use cisternography and what does the procedure look like?

Answer 77

To detect problems with spine and spinal nerve roots. Allows for clear image of spinal canal and nerve root. Procedure: lumbar puncture --> fluid mixed with contrast dye and injected into spinal sac.

Question 78

What test involves injecting small amounts of dye via x-ray guidance into spinal disc?

Answer 78

Discography

Question 79

What test monitors brain activity through the skull?

Answer 79

EEG (electroencephalography)

Question 80

What test is used to diagnose nerve/muscle dysfunction and spinal cord disease? It measures electrical activity from brain/spinal cord to peripheral nerve root.

Answer 80

EMG (electromyography)

Question 81

What group of tests is used to diagnose d/o such as involuntary eye movement, dizziness, balance issues?

Answer 81

ENG (electronystagmography)

Question 82

What test measures electrical signals to brain generated by hearing, sight, and touch?

Answer 82

Evoked potentials.

Question 83

What test do we do to diagnose muscular dystrophy?

Answer 83

Muscle/tissue biopsy

Question 84

What test is done by injection water or oil-based contrast into spinal cord to enhance x-ray imaging?

Answer 84

Myelography

Question 85

When might we use myelography?

Answer 85

Spinal nerve injury, herniated discs, fractures, back or leg pain, spinal tumors

Question 86

What test is an ultrasound of the brain and spinal cord to enhance x-ray imaging of spine?

Answer 86

Neurosonography

Question 87

What test measures brain and body activity during sleep?

Answer 87

Polysomnogram

Question 88

What test provides 2 and 3 dimensional images of brain activity by measuring radioactive isotopes that are injected into the bloodstream?

Answer 88

Positron Emission Tomography (PET scan)

Question 89

What test evaluates blood flow to tissues, a follow-up test to MRI to diagnose tumors, infections, degenerative spinal d/o, and stress fractures?

Answer 89

Single Photon Emission CT (SPECT scan)

Question 90

What test uses infrared sensing device to measure small temperature changes between two sides of the body or within a certain organ?

Answer 90

Thermography (infrared thermal imaging)

Question 91

Complete basilar artery occlusion causes?

Answer 91

"locked in syndrome" -- w/ intact consciousness but with inability to speak and quadriplegia