Lecture 3: Neurologic Exam

Question 1

What is dysarthria?

Answer 1

Defective articulation

-Usually caused by defect in motor control of speech apparatus

Question 2

What is aphasia?

Answer 2

Disorder in producing or understanding language

-Normally due to lesions in left hemisphere

Question 3

What are the four things checked in AxO?

What is x1, x2, x3, x4?

Answer 3

Alert and Oriented:
Person
Person and Place
Person, Place, and Time
Person, Place, Time, and Event

Question 4

What is anhedonia?

Answer 4

Inability to feel pleasure

Question 5

What is delirium?

Answer 5

Confused thinking and reduced awareness of the environment

Question 6

Is delirium reversible?

Answer 6

Yes

Question 7

Is dementia reversible?

Answer 7

No

Question 8

What is ptosis?

Answer 8

Drooping of eyelid

-Due to levator palpebrae weakness

Question 9

What does CN IV lesions lead to?

Answer 9

Exotropia: Eyes drift laterally
Weakness of Downward Gaze
Vertical Diplopia: Worsens when looking down (e.g. walking down the stairs)
Head tilts to side opposite of lesion

Question 10

What does CN VI lesions lead to?

Answer 10

Esotropia: Cannot abduct eye

Horizontal Diplopia

Question 11

What is nystagmus?

Answer 11

Rhythmic oscillation of the eyes

Question 12

What are possible causes of nystagmus?

Answer 12

Vision Impairment
Disorder of Labyrinth or Cerebellar Systems
Drug Toxicity

Question 13

What does CN V lesions lead to?

Answer 13

Decreased sensation to face
Loss of Corneal Reflex
Weakness of mastication muscles
Jaw deviation toward weak side

Question 14

What is Trigeminal Neuralgia?

Answer 14

Brief episodes of unilateral shock-like pains along trigeminal nerves

Question 15

What does CN VII lesions lead to?

Answer 15

Bell’s Palsy
Loss of Corneal Reflex
Hyperacusis: increased sensitivity to sound
Crocodile Tears Syndrome: Patient sheds tears when chewing

Question 16

How can bilateral facial palsies occurs?

Answer 16

variant of Guillain-Barre Syndrome

Question 17

What is supranuclear (central) facial palsy?

Answer 17

Weakness to one side of body (spares upper face)

Question 18

What are two tests to test for CN VIII?

Answer 18

Whisper Test

Finger Rub Test

Question 19

What does CN VIII vestibular lesions lead to?

Answer 19

Dysequilibrium: imbalance

Nystagmus

Question 20

What does CN VIII cochlear lesions lead to?

Answer 20

Sensorineural Hearing Loss

Tinnitus: ringing in the ear

Question 21

How can you test CN IX and X?

Answer 21

Listen for hoarseness and nasal tone
Check gag reflex and difficulty of swallowing
Check symmetric elevation of soft palate and uvula

Question 22

What specific symptoms indicate a lesion of CN IX?

Answer 22

Loss of gag reflex
Loss of sensation and tase in posterior ⅓ of tongue
Slight dysphagia (difficulty swallowing)

Question 23

What specific symptoms indicate a lesion of CN X?

Answer 23

Dysphonia
Dysphagia
Dyspnea
Loss of cough or gag reflex

Question 24

What symptoms would you see if a patient had a CN XI lesion?

Answer 24

Difficulty turning head to opposite direction

Weakness and unilateral shoulder drop

Question 25

What symptoms would you see if a patient had a CN XII lesion?

Answer 25

Tongue will deviate to side of lesion and cannot push tongue to opposite side

Question 26

What sensations are you testing for when testing the sensory system?

Answer 26

Pain Temperature Vibration Proprioception (position)

Question 27

What is stereognosis?

Answer 27

Ability to identify shapes of objects or recognize objects placed in hand

Question 28

What is graphesthesia?

Answer 28

Ability to identify numbers written on the palm

Question 29

How would sensory loss occur is there was a lesion to the brainstem?

Answer 29

Crossed findings with ipsilateral in the face and contralateral in the body

Question 30

How would sensory loss occur is there was a lesion to the thalamus?

Answer 30

Hemisensory loss of all modalities

Question 31

How would sensory loss occur is there was a lesion to the cortex?

Answer 31

Intact primary sensations but loss of cortical sensations

Question 32

What are some cerebellar and coordination tests?

Answer 32

``` Rapid Alternative Movements Finger to Nose Heel to Shin Gait Stance ```

Question 33

What specific test can test stance?

Answer 33

Romberg Test | Pronator Drift

Question 34

What do you observe for when testing the motor system?

Answer 34

``` Gait Body Position Involuntary Movements Muscle bulk: Hypertrophy/atrophy Muscle tone ```

Question 35

What is cerebral ataxia?

Answer 35

Staggering, unsteady, feet wide apart

Question 36

What is sensory ataxia?

Answer 36

Unsteady, feet wide apart, feet thrown forward and slapped down first on heels then forefoot Patients watch ground when walking

Question 37

Describe the Parkinsonian Gate

Answer 37

Stooped forward with short steps (shuffling gait) | Festination: involuntary hesitation

Question 38

What is a Babinski sign?

Answer 38

Fanning of toes to a stimulus at the bottom of the foot

Question 39

What is the main symptom of meningitis?

Answer 39

Nuchal Rigidity: neck stiffness with resistance to flexion

Question 40

What two signs are positive for meningitis?

Answer 40

Brudzinksi Sign | Kernig Sign