Lecture/Lab 2: Basic Neuro Exam

Question 1

What are the 4 components of a Mini-Mental Status Exam?

Answer 1

1) Level of alertness
2) Appropriateness of responses
3) Orientation to person, place, time
4) Congruency of modod

Question 2

Visual acuity is tested using?

Legally blind at?

Answer 2

• Snellen eye chart - position pt 20ft from chart
• 20/200 = legally blind

Question 3

Bell’s palsy affects?

Central lesion affects?

What CN?

Answer 3

• Affects both upper and lower face, loss of taste
• Affects mainly lower face
• CN VII

Question 4

What does 0-5 stand for in terms of muscle strength testing?

Answer 4

0 = no muscle contraction

1 = barely detectable flicker or trace of contraction

2 = active movement w/ gravity eliminated

3 = active movement against gravity

4 = active movement against gravity and some resistance

5 = active movement against full resistance w/o fatigue

Question 5

Nerve roots tested for flexion at elbow?

Extension at elbow?

Answer 5

Flexion = C5, C6

Extension = C6, C7, C8

Question 6

Nerve roots tested for flexion and extension at wrist?

Answer 6

C6, 7

Question 7

Nerve roots tested for Hand Grip?

Answer 7

C7, 8, T1

Question 8

Nerve roots tested for Opposition of thumb, Finger Abduction?

Answer 8

C8, T1

Question 9

Nerve roots tested for Hip Flexion?

Extension?

Adduction?

Abduction?

Answer 9

• L2, 3, 4 (flexion)
• S1 (extension)
• L2, 3, 4 (adduction)
• L4, 5, S1 (abduction)

Question 10

Nerve roots tested for Knee Flexion?

Extension?

Answer 10

• L4, 5, S1, 2
• L2, 3, 4

Question 11

Nerve roots tested for Ankle Plantarflexion?

Dorsiflexion?

Answer 11

• S1 (plantarflexion)
• L4, 5 (dorsiflexion)

Question 12

Inability to heel-walk is sensitive test for?

Answer 12

CST damage

Question 13

Abnormal results during Rapid Alternative Movements test may indicate?

Answer 13

Dysdiadochokinesis

Question 14

Dermatomes of C4

C6

C8

T4

T10

L5

S1

Answer 14

C4 = shoulder top

C6 = Radial aspect forearm

C8 = Little finger

T10 = Umbilicus

L5 = Great Toe (5 (big toe) is > 1 = little toe)

S1 = Posteriolateral calf/little toe

Question 15

What is the Romberg Test?

Answer 15

• Test of position sense/proprioception (posterior columns).
• Pt stands w/ feet together and eyes open - then close both eyes for 30-60 secs w/o support
• Note pt ability to maintain upright posture
• Normally only minimal swaying occurs

Question 16

What is the Babinski test?

Abnormal test suggestive of?

Answer 16

• W/ an object stroke to lateral aspect of sole from heel to the ball of the foot.
• Normal response should be plantar
• Dorsiflexion of big toe and fanning of toes is positive and suggestive of UMN dysfunction

Question 17

Inflammation in the subarachnoid space causes resistance to movement that stretches nerves, which for nuchal rigidity?

Brudzinski’s sign?

Kernig’s sign?

Answer 17

• Nuchal rigidity = spinal nerves
• Brudzinski’s sign = femoral nerve
• Kernig’s sign = sciatic nerve

Question 18

What is a positive Brudzinski’s Sign?

Answer 18

Hips and knees flex as pt’s neck is flexed

Question 19

What is a positive Kernig’s Sign?

Answer 19

Pain and increases resistance to extending the knee

Question 20

Shoulder abduction with the deltoid is what nerve root?

Answer 20

C5

Question 21

Dorsiflexion of the ankle is primarily what muscle and nerve root?

Answer 21

• Tibialis anterior
• L4, L5

Question 22

Hypertonia and hyperreflexia are seen in what type of nerve damage?

Answer 22

UMN

Question 23

A pyramidal pattern of weakness (weak extensors in arms and weak flexors in legs) seen in what kind of damage?

Test for this kind of damage?

Answer 23

• UMN
• Pronator drift: arms held extended for up to 2 minutes, arm drifts down and supinates

Question 24

Sensory dermatome of the shoulder?

Answer 24

C4

Question 25

Sterognosis

Answer 25

Ability to identify shapes of objects, or recognizing objects placed in the hand

Question 26

Graphesthesia

Answer 26

Ability to identify numbers written on the palm

Question 27

Clonus is a abnormal sign indicating?

Answer 27

UMN sign

Question 28

Anal wink reflex is what nerve roots and is useful in testing for?

Answer 28

S2-S4 Cauda Equina or lesions that affect sacral region

Question 29

The cremasteric reflex tests what afferent and efferent component?

Answer 29

Afferent: **L1** Efferent: **L2**

Question 30

Nystagmus, vertigo, vomiting, postural impairment, disequilibrium are all part of what system?

Answer 30

Vestibular

Question 31

Dysmetria, dydiadichokinesia, ataxia, intention tremor, slurred speech, asthenia are due to what system?

Answer 31

Cerebellar

Question 32

Spastic paralysis/paresis, hyperreflexia, hypertonia, babinksi are all signs of what system?

Answer 32

Pyramidal

Question 33

Dyskinesia and resting tremor are signs of what system?

Answer 33

Extrapyramidal

Question 34

Hemi-dysasthesia, hemiplegia, hemiparesis, apraxia, aphasia, cognitive/behavioral are all part of what system?

Answer 34

Cortical

Question 35

Finger-to-nose tests for?

Answer 35

Dysmetria/dysataxia of voluntary movements (cerebellar)

Question 36

Scissoring gate is often seen in?

Answer 36

Cerebral palsy or MS

Question 37

Sensory ataxia is what type of gait? Seen in?

Answer 37

- High steppage, broad based - Seen with posterior column damage and peripheral neuropathy

Question 38

Magnetic gait seen in what diseases?

Answer 38

Frontal lobe processes and hydrocephalus

Question 39

Hemiplegic gait is usually due to?

Answer 39

UMN such as stroke

Question 40

Waddling pelvis usually indicates?

Answer 40

Myopathic disease (myopathy) - hips sway or "waddle" in a side to side type fashion