Neuro Flashcards
(121 cards)
1
Q
Sx that prompt a neuro exam
A
Headache
Dizziness/ Vertigo
Weakness
Loss of sensation
Seizures
Stroke like sx
Confusion
Altered mental status
Intoxication
2
Q
Components of Neurological exam
A
Mental status exam
Cranial nerve evaluation
Motor function evaluation
Sensory function evaluation
Reflexes
3
Q
What does mental status exam look for?
A
Level of alertness
Appropriateness of responses
Orientation to date and place
4
Q
A patient is ALERT if they …. (3 things)
A
Speak to you in normal tone of voice
Are awake
Respond to their surroundings
5
Q
What does A&O x3 indicate?
A
Patient alert and oriented to person, place and time
6
Q
Mini-Mental Status Exam is used to screen for……
A
Cognitive impairment and dementia
7
Q
The MMSE has questions regarding:
A
Level of consciousness (arousal)
Attention and concentration
Memory (immediate, recent, remote)
Language
Visual spatial perception
Executive functioning
Mood and thought content
Calculations
8
Q
Cranial Nerves (I-XII) names
A
I- Olfactory
II- Optic
III- Occulomotor
IV- Trochlear
V- Trigeminal
VI- Abducens
VII- facial
VIII- acoustic
IX- Glassopharyngeal
X- Vagus
XI- Accessory
XII- Hypoglossal
9
Q
Function of CN I
A
Sense of smell
10
Q
Function of CN II
A
Vision
11
Q
What CN’s are responsible for medial deviation, medial upward deviation, lateral upward and lateral downward devaition of the eyeball
A
CN III
12
Q
What CN is responsible for medial downward deviation of the eye (SO4LR6)
A
CN IV (superior oblique)
13
Q
What CN is responsible for lateral deviation of the eye (SO4LR6)
A
CN VI
14
Q
Function of CN III
A
Pupillary constriction
Lid elevation
Most Extraocular movements
15
Q
Function of CN IV
A
Trochlear
Downward, internal rotation of the eye
16
Q
Function of CN V
A
Trigeminal
Motor—> temporal and mass enter muscles (jaw clenching), lateral pterygoids (lateral jaw movment)
Sensory—> facial (1)opthalmic, (2) maxillary, (3) mandibular
17
Q
Function of CN VI
A
Abducens
Lateral deviation of the eye
18
Q
Function CN VII
A
Facial
Motor- facial movements
- facial expression
- closing eye
- closing mouth
Sensory- taste for salty, sweet, sour bitter substances on ANTERIOR 2/3 TONGUE
- sear sensation
19
Q
Function CN VIII
A
Acoustic
Hearing— cochlear division
Balance— vestibular division
20
Q
Function CN IX
A
Glassopharyngeal
Motor- pharynx
Sensory- POSTERIOR eardrum and ear canal, pharynx, POSTERIOR TONGUE (including taste)
21
Q
Function CN X
A
Vagus
Motor- palate, phayrnx, larynx
Sensory- pharynx, larynx
22
Q
Function CN XI
A
Accessory
Motor- sternocleoidmastoid and upper traps
23
Q
CN XII
A
Hypoglossal
Motor to tongue
24
Q
Order of testing for neuro exam
A
I
II, III, IV, VI
II
V
VII
VIII
IX
X
XI
XII
25
Order for CN testing in real live
VIII
II, III, IV, VI
IX, X, XII
XI
VII, V, XII
26
Rapid, shock-like jerks
Myoclonus
27
Rapid, jerky twitches similar to myoclonus but MORE RANDOM in location and more likely to blend into one another
Chorea
28
Slow, writhing movements of limbs
Athetosis
29
Abrupt, stereotyped, coordinated movements OR VOCALIZATIONS
Tics
30
maintenance of an abnormal posture or receptive twisting motion
Dystonia
31
Muscle tone
Qualitatively assessed by asking the patient to relax and let you manipulate limbs passively
32
Increased resistance
Hypertonic
33
Decreased resistance (flaccid)
Hypotonia
34
What spinal nerve roots are responsible for elbow flexion
Biceps: C5-6
35
What spinal nerve roots are responsible for elbow extension?
Triceps: C6-8
36
What spinal nerve roots extend the wrist?
C6-8
37
What spinal nerve roots flex the wrist
C6-7
38
What spinal nerves are responsible for grip strength?
C7-8, T1
39
What spinal nerves are responsible for finger abd?
C8, T1, ulnar N
40
What spinal nerves are responsible for thumb opposition?
C8, T1, median n
41
Spinal nerves responsible for hip flexion
L2-4
42
Spinal nerves responsible for hip add.
L2-4
43
Spinal nerves responsible for hip abd?
L4-5, S1
44
Spinal nerves responsible for hip extension?
S1
45
Spinal nerves responsible for knee extension?
L2-L4
46
Spinal nerves responsible for knee flexion?
L4-5, S1-2
47
Spinal nerves responsible for dorsiflexion?
L4-5
48
Spinal nerves responsible for plantarflexion?
S1
49
Coordination requires what 4 areas of the nervous system?
Motor
Cerebellar
Vestibular
Sensory
50
Romberg
Position sense
51
Positive Romberg test
Loss of balance
52
What does a positive Romberg test indicate?
Possible dorsal column disease (proprioception) or Cerebellar disease (issue standing with eyes open or closed)
53
Positive pronator drift
Drops of the arms or pronation
Arms don’t return SMOOTHLY to horizontal when tapped
54
What does a positive pronator drift test indicate?
Corticospinal tract lesion
55
Reinforcement
Isometric contraction of other muscles for up to 10 seconds that may increase reflex activity
56
You need to reinforce the arm reflexes. What would you instruct the patient to do?
Ask the patient to clench his or her teeth or to squeeze both knees together
57
You need to reinforce the leg reflexes. What would you instruct your patient to do?
Ask the patient to lock fingers and pull one hand away from other
58
Testing biceps reflex (walk me through it)
Biceps reflex C5-6
Partially flex elbow, arm pronated
Identify biceps tendon and place finger over it
Strike OUR FINGER
59
Testing brachioradialis reflex
Brachioradialis C5-6
Rest the patients hand on their lap, 50% pronated
Strike radius 1-2” above the wrist WITH FLAT SIDE
60
Testing the patellar reflex
Patellar L2-4
Perform with patient seated, knee flexed
Legs “dangling”
Locate and tap patellar tendon just below knee cap
61
Testing the Achilles reflex
Achilles- S1
Partially dorsiflexion foot at the ankle and support it with our hand
Strike the Achilles with flat portion—> feel for plantar flexion
62
A defect in muscular control of the speech apparatus (lips, tongue, palate or pharynx).
Dysarthria
63
How will a patient with dysarthria present?
Words may sound nasally, slurred, or indistinct, but central symbolic aspect of language remains intact
64
Disorder in producing or understanding language
Aphasia
65
Causes of Dysarthria
Motor lesions of CNS or PNS
Parkinsonism
Cerebellar disease
66
Cause of Aphasia
Lesion in dominant cerebellar hemisphere
67
What are the 2 types of dysphagia?
Wernike’s (fluent- receptive)
Brocas (non fluent- expressive)
68
Wernicke aphasia
Fluent (receptive) aphasia
Wordy and wrong
69
Broca aphasia
Non fluent or expressive aphasia
Broken but befitting
70
Pain and temperature are sensed by what?
Spinothalamic tracts
71
Position and Vibration are sensed by what?
Dorsal/posterior columns
72
Light touch is sensed by which: spinothalamic tracts or dorsal columns?
Both
73
Correctly distinguishing sharp sensation indicates normal function of __________________
Spinothalamic pathway
74
In a patient without any signs or symptoms of neurological disease, how can we quickly assess for neurologic disease?
Check normal sensation of distal fingers and toes (stocking glove distribution)
75
What is often the 1st sensation lost in peripheral neuropathy?
Vibration
76
What are the causes of peripheral neuropathy
Diabetes
Alcoholism
Posterior Column disease
- tertiary syphilis
- vit B12 deficiency
77
If you are performing proprioception position sense on a patient and they cannot feel you squeezing the IP. What do you do next?
Go to the next proximal jt
78
Discriminative sensations
Graphesthesia
Stereognosis
2-point discrimination
Point localization
Extinction
79
A descriminative exam where the provider draws a number on the patients hand and the patient is asked to identify the number
Graphesthesia
80
Discrimination sensation test where the patient is asked to identify an object in their palm
Stereognosis
81
If the patient is able to unable to object in stereognosis with normal cutaneous sensation, that clues the provider in about a lesion where?
In the sensory cortex
82
Discrimination test where you find the smallest distance at which a patient can discriminate one from 2 points
2 point discrimination
83
Typical variance of 2 point discrimination of the finger tips
<5mm often ~2mm
84
Palms of the hands 2 point discrimination norm
8-12mm
85
Back norm for 2 point discrimination
40-60mm
86
A lesion to the ___________ lobe impairs 2 point discrimination
Parietal
87
Examination where patients eyes are closed and the examiner touches the patient and then the patient must point to the area where the practitioner touched
Point localization
88
Inability to perform point localization indicates lesions to where?
Sensory cortex
89
Patient closes eye and the examiner touches their body in 2 separate places
Extinction
90
A patient with a lesion to the parietal lobe may feel individual touches but may ‘extinguish’ the sensation on the side ________________ to the side of the lesion
Contralateral
91
Upper motor neuron lesions will be found where
Spinal cord
Brain stem
Motor cortex
92
Upper motor lesions are characterized by
Increased muscle tone (spasticity)
Weakness
Exaggerated reflexes
Up-going plantar reflex response and sustained clonus
Positive babinski
Diffuse atrophy
93
Lower motor neuron lesions are found where?
Anterior horn cell
Root
Plexus
Peripheral nerve
94
Lower motor lesions are characterized by:
Decreased muscle tone
Weakness and wasting (atrophy) of muscles innervated by that nerve
Hyporeflexia or a reflexia
Muscle fasiculations
95
What would you grade an absent reflex?
0
96
Grading for a reflex that is diminished or below normal
1+
97
Grading of a reflex that is average or normal
2+
98
Grading of a reflex that is brisker than average
3+
99
Grading of reflex that is very brisk, hyperactive W/ CLONUS
4+
100
Abnormal babinski reflex
Extension of the great toe with fanning of the other toes
101
Reflex exam where the abdomen is stroked lightly on each side above T8-T10 and elbow T10-T12 patinet supine
Superficial abdominal reflex
102
What is a normal superficial abdominal reflex
Local abdominal muscles contract cause the umbilicus to move towards the quadrant stimulated
103
What type of lesions will cause the superficial abdominal reflex to be absent
Central and peripheral
104
Cremasteric reflex
Reflex center at L1-L2
Stroke inner thigh from the inguinal crease downward
105
Normal cremasteric reflex
Cremeaster contracts—> prompt elevation of the testes on that side
106
What can cause loss of the cremasteric reflex?
Testicular torsion
107
Rhythmic series of muscular contractions induced by stretching a tendon
Clonus
108
When is clonus most commonly found
At the ankle, elicited by sudden dorsiflexion of the patients foot and maintenance of light upward pressure result in a beat downwards into the providers hand (a few beats may be normal if the patient is tense or just exercised
109
Reflex that uses the end of an applicator stick to scratch both sides of the anus looking for contraction
Anal reflex
110
Loss of the anal reflex may be indicative of….
Lesion in L2-3-4 (like in cauda equina)
111
Occulocephalic reflex is done on what type patients and is used to asses what?
Performed on comatose/ unresponsive pateints
Used to assess brainstem function
112
If the eyes in the occulocephalic reflex go in the opposite direction of the head when moved, what type of response is that?
Normal
113
If the eyes move in the same direction as the head when performing the occulocephalic reflex, what does that indicate?
Lesion to brainstem or upper spine
114
Oculovestibular reflex
Done ONLY when the occulocephalic reflex is absent
Irrigate the ear canal with cold water—> if eyes drift towards side of irrigation= brainstem intact
115
Your patient comes in with their upper extremities in a flexed position and their lower extremities in an extended position. What is this called and where does this suggest the lesion is?
Decorticate position
Suggests injury in the midbrain
116
Your patient does with their arms and elbow extended, internal rotation and extension of the lower extremities. What is this called and where does this suggest the injury may be?
Decerebrate posturing
Caudal (lower) injury
117
Kerning Sign
Hip and knee flexed at R ankle and knee is slowly extended by examiner
118
What is positive kerning sign and what is it indicative of?
Positive kerning sign= pain or resistance during knee and hip extension
Indicative of meningeal irritation
119
Brudzinski Sign
Provider flexes patient’s neck forward—> involuntary flexion of the hips and knees= +
120
Positive straight leg raise
Pain at 45 degrees
Pain should be radiating on the Same leg being examined
121
Crossed straight leg raise sign
Increased pain on SLR with contralateral leg
