ECR 11.12.12 Neurological Exam Flashcards Preview

ECR 2012 > ECR 11.12.12 Neurological Exam > Flashcards

Flashcards in ECR 11.12.12 Neurological Exam Deck (68):
1

Guiding principle for Neuro Exam (3)

1. IS mental status intact (able to answer questions)

2. IS my patient able to partner with me to complete an accurate and reliable exam?

3. Deficients may be transient/fluctuating (frustrating b/c answers may be different later in time)

2

Framework

Are findings symmetric

Is process generalized or focal (localized)

Is lesion in PNS or CNS (where are the lesion? what are the lesions?)

What is the nature of the lesion/process (infectious? sudden?)

3

Common presentations for neuro

Headach
Dizziness, vertigo, imbalance, clumsiness
Weakness
Sensory complaints
Loss of consciousness, syncope, near-syncope
Seizures
Tremors, involuntary movements, gait distrubance
Memory Changes, confusion

4

What are common neurological illnesses?

Strokes
Seizures
Headaches
eoplams
Neuromuscular disorders
Nerve disorders
Movement disorders
Neurodegenerative disorders

5

What else could cuase headache

hypetension

6

Dizziness

inner ear infection

7

confusion-

dementia, por oxygenation, pneumonia, pulmonary embolism

8

loss of consciousness

hypokalemia
arrhthymia

9

What are the components of a the Neuro Exam (7)

Mental Status
Cranial Nerves
Motor Exam
Sensory Exam
Reflexes
Coordination
Gait and Stance

10

What do you look for doring Motor Exam (4)

Involuntary movements
Bulk
Tone
Power/Strength

11

What type of involuntary movements are you looking for

Tremor
Tics
Dystonia
Athetosis
Chorea


note location, quality, rate, rhythm, amplitude, relation to posture

12

Tremor

can happen at rest (Parkinsons)

when trying to grab soething you might be able to see it

13

Dystonia

twisted posture

14

Athetosis

writhing movements;greater amplitude with movement

15

Chorea

quick movement; often not purposeful but
may try to cover it up with a seemignly purposeful gesture

Chorea happens then pat pretnes like tried to make hand out gout like that

16

Bulk

mass of bulk- is it waht you expect

INspect and palpate
-shape/size/mass
-symmetry
-hypertrophy

17

Pseudohypertropphy

muscle tissue is degenerating
show false enalrgement

Muscle dystrophy (boy on swing with hugeeee calves b/c muscle infiltrated with iprprer tissue)

18

Atrophy

lower motor neuron- wasting disease

19

Tone

tension detected in muslce

normally slight residual maintained even at rest

palpate resitsnce ith movmeent through ROM

20

What are different tone

normal
hypertonic- inc tone
hypotonic- dec dtone
flaccid- complete absence of toen

21

Spasticity vs rigidity

Spastic- resistance at extremems/end of motion

Rigidity- same resistance ENTIRE motion

22

What is grading scale for Strength?

0-5

0- no muscle contrction
1- barely detectable flicker/trace of contraction
2- movement with gravity eliminated
3. movement with gravity, no resisitance
4. movement with gravity, with resistance
5. Normal muscle strenght**** active

23

What is the grade for NORMAL Strength

5

24

What is paresis

IMPAIRED strength/weakness

25

What is plegia

ABSENCE of strength/paralysis

26

what are the different types of plegias?

hemiparesis
hemiplegia
paraplegia
quadriplegia

27

what is a parapleegia? Quadirplegia?

paraplegia- both legs paralyzed

Quadriplegia- all four limbs paralyzed (often spinal cord injury)

28

What are the primary modalities that you check for sensory exam?

pain (spinal)
Temp (spinal)
Proprioception (position) (Dorsal)
vibration (Dorsal)
light touch
*Distcriminateive sensation

29

How do you assess pain

sharp object

30

how do you assess temp

cool side of tunign fork

31

Howdo ou assess postion/proprioception

moving digit

32

How d oyu assess vibration

128 Hz tunign fork

33

How do you assess light touch

cotton swab or fingers

34

What dermatone is T10

umbilicas

35

dermatome for T4

Nipple

36

Dermatome for C7

middle finger

37

Dermatome for L5

big toe

38

what is a dermatome

band of skin innervated by sensory root of a single spinal nerve

39

What is a reflex?

involuntary stereoteypical repsonse

Predictable reaction to standardized stimulus

40

What are the three types of reflexes

DTR- deep tendon reflex

Cutaneious stimulous reflexes

Primitive reflexes (beydong tis class)

41

Describe DTR

Deep Tendon Reflex

simplest of relfexes- monosynaptic, strike tendon with reflex hammer
Strike tendo

42

What are the DTR (5)

S1- Achilles
L 2,3,4- Patellar
C5,6- Brachioradialis
C5,6- Biceps
C7- Triceps

43

What is the grading for DTR

0-4+

0 = no response
1+ somewhat diminished, low normal
2+ average; noraml
3+ Brisker than avg (possibly, but not necessarily indicative of disease)
4+ Very brisk, hyperactive with Clonus

44

What is normal grading for DTR

2+

45

What is clonus

sustained rhythmic beating between flexion and extension

46

What are the superficial Cutaneous reflexes (4)

Abdominal Reflexes (T8-T12)
Cremasteric Reflex (L1-L2)
Babinski Reflex/ extensor plantar response (L5, S1)
Anal REflex (S2-S4)

47

Abdominal Reflex

T8-T12

polysynaptic, more complicated

Strok outer quadrant, umbilicus mucles pulltoward stimulated area
May not respond (pregnant, surgery),

48

Cremasteric Reflex

L1-L2

stroke inner thigh and testes raises

49

Babsinki Response

L5,S1

Extensor platnar reposne

Normal: great toe plantarflex
Abnormal" Great toe dorsiflex, toes fan
Upper motor neuron defet! Stroke lateral aspect of foot; then cross-
babies hav+ Babinski till 6 months

50

Superficial Cutaneous Grading

Not graded!

Either present or absent!

Asymmetry is important to note

UMN or LMN lesion

51

What does Coordination require integration of fucntion of

1. Cerebellarsystem (rhythmic, smooth, sequential movment)
2. Motor System
3 Vestibular System: balance and coordinating eye
4. Sensory system : position sense

52

How do you test Coordination

1 Rapid Alternating Movements (RAM)
2. Point to point movements
3. Gait
4. Stance

53

Cerebellar system

rhtymic, smooth, sequential movment and steady psoture

54

Motor system

strength

55

Vestibular system

balance and coordinating eye, head, body movements

56

sensory system

position sense

57

How do you test RAM coordination

Rapid Alternating Motion

Upper Extremity- Hands alternate palm and dorsum of hand on the thigh rapidly

Lower extremity- Tap foot against examiners hand

Dysdidiadochokinesis

58

What is Dysdiadochokinesis

slow, irregular, slumspy movements in response to attempt to alternately contract and relax agonist and antagonist muscles or muscle groups
Slow, irregular; lack of coordination

Can't do RAM

59

Coordination : Point to Point

Finger-to-nose (F--> N)

Heel to shin (H-->S)

Dymetria

60

What is Dysmetria

difficulty with F-->N and H-->S (Point to Point)

inability to control muscle action required to move a body part smothly in a specific direaction or along aaprticular course

61

What is ataxia

lack of muscle coordinatino during voluntary movement


usually gait; but any voluntary movmvent

62

What is gait

process of recruiting and coordinating activity of various mucle groups of LE, UE, andn trunk to rpoduce at of walking

63

How do you test gait?

Normal gait across room

Tandem gait (drunk test)

Walk on toes; walk on heels

64

How do you test stance/station

measure of postural control

observe patietn standing

Romberg tst

Pronatory drift

65

What is romberg test

tests mainly for posiition sese

take aw ay vision, stay in one place with eyes closed

66

Pronator drift

detects subtle weakness (cerebellar disease)

arms out with eyes closed

if weakness in one arm, might drop/ pronate

67

What is the neurologic ROS

chagnes in mood, attention, or speech; changes in orientation, memory, insight, or judgemnt;

headache, dizziness, vergito; fainting, balckouts, seizures, weakness, paralysis, numbess of loss of snestiano, tingling or pins and needles' termors or othe ronvlntary movments seizsures

68

What is the neurologic ROS

chagnes in mood, attention, or speech; changes in orientation, memory, insight, or judgemnt;

headache, dizziness, vergito; fainting, balckouts, seizures, weakness, paralysis, numbess of loss of snestiano, tingling or pins and needles' termors or othe ronvlntary movments seizsures