Midterm

Question 1

How do we rate muscle strength?

Answer 1

scale of 0-5

0: no muscle contraction, joint movement
5: normal strength, active movement against full resistance wo fatigue

Question 2

neuro exam organized into what 6 sections?

Answer 2

Mental
CN
Motor
Sensory
DTRs
Coordination

Question 3

How do you assess mental status?

Answer 3

“Never Omit”

O: orientation (Ox3) - what’s your name? where are you? what day is it? - person, place, time

M: memory - recent & remote - who’s the president? who was the last president?

I: intelligence - do math or compare apple/orange

T: talk - speech rate, quantity, fluency, articulation

Question 4

CN 1

Answer 4

olfactory - smell

• smell this lavender
• should not be painful substance - otherwise, trigem V

Question 5

CN ll

Answer 5

optic

• snellen for far
• rosenbaum for near
• ophthalmascopic exam - optic disc, and ratio, atrophy, papilledema, venous impulses (should be present)

Question 6

CN lll

Answer 6

oculomotor

• PERRLA
• ptosis
• extraocular movements “H in space”

Question 7

CN lV

Answer 7

Trochlear

• extraocular movements, “X in space” (down and in - assists w down and out)

Question 8

CN Vl

Answer 8

Abducens

• lateral movement of eye, “H in space”

Question 9

horizontal nystagmus in extreme lateral gaze is normal. on the other hand, Vertical Nystagmus suggests…

Answer 9

brainstem lesion

Question 10

Diploplia occurs when…

True diplopia when…

Answer 10

• there is weakness or imbalance of EOM
• when one eye is closed
  ddx: lens or cornea probs

Question 11

CN V

Answer 11

Trigeminal

• motor to masseter, temporal M - clench jaw
• sensory to face - so use cotton ball to ophthalmic, maxillary and mandibular areas … if deficit, Corneal Reflex

Question 12

CN Vll

Answer 12

Facial

• motor to face, taste on anterior 2/3 of tongue
• so, raise eyebrows, close eyes tightly, frown, smile, real smile, puff cheeks

Question 13

Lesions in cerebral cortex cause _____ weakness of the mouth.

Lesions of the periphery cause _____ facial paralysis.

Answer 13

• contralateral

- ipsilateral

Question 14

CN Vlll

Answer 14

Acoustic

• auditory and balance
• gross hearing test … if deficit, weber and rinne
• Romberg test

Question 15

loss of balance w eyes open suggests…

Answer 15

cerebellar ataxia

Question 16

CN lX

Answer 16

Glossopharyngeal

• sensory to pharynx, taste on posterior 1/3 of tongue
• cotton swab for gag reflex - symmetrical?

Question 17

CN X

Answer 17

Vagus

• motor to pharynx
• swallow - symmetry? ; say “ahhh” - see palate and uvula

Question 18

CN Xl

Answer 18

Spinal Accessory

• trap, SCM
• shrug against resistance … if abN, test SCM

Question 19

CN Xll

Answer 19

Hypoglossal

• motor to tongue
• protrude tongue

Question 20

dysdiadochokinesis - what is it? what dysfx manifest it?

Answer 20

• inability to perform rapid alernating movments

- cerebellar dysfx

Question 21

The posterior column is tested by….

Answer 21

vibration and proprioception

Question 22

The anterior spinothalamic tract is tested by…

Answer 22

light tough

Question 23

The lateral spinothalamic tract is tested by…

Answer 23

temp and pain

• hot vs cold
• sharp vs dull

Question 24

The normal cortical fxs are tested via sensory by…

Answer 24

Discriminative Sensations:

• stereognosis - can recognize common objects “what is this?”
• graphesthesia - ability to identify # or letter - write on pts hand
• 2 point discrimination (3cm for hand/foot, 6mm for fingertips)

Question 25

hyperactive reflexes suggest what dz?

Answer 25

upper motor neuron dz

Question 26

How do you grade DTRs? what is normal? what is 4/4?

Answer 26

0-4 2/4 - normal 4/4 - extremely brisk hyperreflexia w clonus

Question 27

+ Babinski Sign indicates

Answer 27

UMN dz

Question 28

Tests for meningeal irritation are...

Answer 28

- Brudzinski's (pt lays down, flexion of neck) | - Kernig's (pt lays down, doc flex's hip and knee, then extends knee)

Question 29

Adson's Test

Answer 29

+ when diminished pulse or paresthesias - compression of subclavian artery - thoracic outlet syndrome (peripheral neuropathy)

Question 30

Best tests to rule in CTS? rule out?

Answer 30

- IN: Katz hand diagram, weak thumb abduction | - hypalgesia

Question 31

Rule in CTS: | Rule out CTS:

Answer 31

- IN w Hypalgesia, Hand Sx Diagram | - OUT w weak thumb abduction

Question 32

Findings in tennis elbow?

Answer 32

T distal to lateral epicondyle

Question 33

Tests for malingering back pain?

Answer 33

- Flip test - SLR pt can sit up wo pain - Hoover Test - legs lifted off table by doc by ankles - pt asked to lift one leg (if wo difficult, +)... if wo pressure of contralateral leg going down, +

Question 34

Bragard's Test

Answer 34

for LUMBAR | - SLR until painful, lower a bit, dorsiflex foot, pain?

Question 35

Kemp's Test

Answer 35

for LUMBAR - rotate, extend, lateral bend - pain? - indicates facet dz or lumbar disc herniation

Question 36

Which test is most sensitive for an ACL tear?

Answer 36

Lachman's Sign

Question 37

test for ligamentous stability of knee: - apley's - mcmurray's - lachman's - patellar entrapment - valgus and varus - anterior/posterior drawer sign - Thessaly

Answer 37

- apley's compression/distraction - tests meniscus and collateral ligaments - pull leg up, push leg down - mcmurray's* - meniscus tears - ex. valgus stress to flexed knee while externally rotating leg - lachman's - try pop out the tibia - ACL - patellar entrapment - chondromalacia patella - valgus and varus - MCL, LCL - anterior/posterior drawer sign - ACL, PCL - Thessaly* - meniscal - stands - one leg flexed, dance

Question 38

Patrick-Fabere Test

Answer 38

- figure 4 - tests HIP - hip or sacroiliac dz

Question 39

Gaenslen's Test

Answer 39

- HIP - one leg off table, other leg to chest, push in knees

Question 40

Low back pain tests:

Answer 40

- straight leg raise//crossed SLR - Bragard's - SLR until painful then dorsiflex - Valsalva - Kemp's

Question 41

size of normal prostate

Answer 41

2.5cm