Neuro

Question 1

What are the 6 sections of the Neuro eval?

Answer 1

1. Mental status 2. Cranial Nerves 3. Motor Nerves 4. Reflexes 5. Sensory 6. Coordination/Cerebellar Testing

Question 2

With mental status changes what should you always ask about/review?

Answer 2

The pt’s prescriptions!

Question 3

With mental status changes (especially in the younger population) what do you always have to rule out?

Answer 3

illegal drugs or alcohol

Question 4

With mental status or behavior changes which ROS are important to include besides neuro and psych?

Answer 4

Gen, HEENT, Pulm, C/V, M/S, and Endo

Question 5

If someone is elderly and has hypothyroidism, what could they present with?

Answer 5

mental status changes, slows their thinking way down

Question 6

Tools necessary for advanced neuro exam?

Answer 6

MMSE, Ophthalmoscope, Reflex hammer, penlight, tongue blade, sterile needles, tuning forks, familiar objects, cotton wisp, 5.07 Monofilament, vials of aromatic substances

Question 7

What is the 3 step approach to the PE in neuro?

Answer 7

Is the mental status intact?
Are right sided and left sided findings symmetric?
If the findings are asymmetric or otherwise abnormal, does the causative lesion lie in the CNS or PNS?

Question 8

What is important in the HEENT PE for neuro?

Answer 8

Facial expression, eyes—including fundoscopic, speech—quantity/quality, rate/volume, articulation/fluency

Question 9

PE neck for neuro?

Answer 9

Lymphadenopathy?, ROM, thyroid exam

Question 10

A score of less than what on the MMSE may suggest dementia and requires further testing?

Answer 10

<24

Question 11

Three easy ways to test if someone is having a stroke?

Answer 11

1. speech, can they speak normally?
2. Arms, can they keep both arms extended?
3. Face, ask them to smile, do both sides look equal?

Question 12

What is constructional praxis?

Answer 12

part of the MMSE, tests 3D manipulation

Question 13

What do you have to keep in mind when testing the corneal reflex?

Answer 13

contacts may obliterate this reflex

Question 14

What is abnormal result when testing the jaw reflex?

Answer 14

The jaw will jerk

Question 15

What does a positive Glabellar reflex indicate?

Answer 15

PD

Question 16

Which CN is responsible for taste from the anterior 2/3rds of the tongue?

Answer 16

CN VII

Question 17

Which CN is responsible for taste from the posterior 1/3rd of the tongue?

Answer 17

CN IX

Question 18

What is the “gold std” for testing CN VIII?

Answer 18

Audiometry

Question 19

Dysphonia, dysarthria, and dysphagia could all be a result of damage to which CN?

Answer 19

X, Vagus

Question 20

Normal DTRs = ?

Answer 20

+2/4

Question 21

Reflexes tested with biceps?

Answer 21

C5 and C6

Question 22

Reflexes tested with triceps?

Answer 22

C6 and C7

Question 23

Reflexes tested with brachioradialis?

Answer 23

C5 and C6

Question 24

Reflexes tested with patellar?

Answer 24

L2, L3, and L4

Question 25

Reflexes tested with Achilles?

Answer 25

Primarily S1

Question 26

Reflexes tested with Plantar?

Answer 26

L5-S1

Question 27

What could an abnormal Babinski’s reflex indicate?

Answer 27

a CNS lesion in the corticospinal tract

Question 28

Indications for a LP?

Answer 28

suspected CNS infection, suspected SA hemorrhage, pseudotumor cerebri (therapeutic), normal pressure hydrocephalus (diagnostic), Guillain Barre syndrome (protein), MS (IgG level elevated with oligoclonal banding), spinal analgesia, systemic lupus erythematous, acute demyelinating disorders, dementia, meningeal carcinomatosis, unexplained neurological disorders, intrathecal antibiotics, myelography/cisternography

Question 29

Contraindications to a LP?

Answer 29

Local skin infection, Raised intracranial pressure (unless suspected NPH, pseudotumor cerebri), supratentorial mass lesions, severe bleeding diastheis, coagulopathy, or anticoagulation, plt count <50,000/mm3