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X Physical Diagnosis Final > Neuro Assessment > Flashcards

Neuro Assessment Flashcards

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1
Q

What is a gait that lacks coordination and stability?

A

Ataxic- due to cerebellar disease, loss of position sense or intoxication

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2
Q

What is steppage gait?

A

“Foot drop”
Pt drags foot/ft or lifts them high, then foot slaps floor
Unilateral or bilateral

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3
Q

What causes steppage gait?

A

Tibialis anterior and toe extensor weakness

Lower motor neuron/peripheral nerve injury (L4/L5)

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4
Q

What is spastic hemiparesis?

A

When pt drags toe, circle leg stiffly outward and forward (circumduction) or lean trunk to contralateral side to clear affected leg during walking
Affected leg extensors are spastic, ankles are plantar-flexed and inverted

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5
Q

What occurs in the UE during spastic hemiparesis?

A

Affected arm is flexed, immobile and held close to side, with elbow, wrists and interphalangeal joints flexed

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6
Q

What causes spastic hemiparesis?

A

Corticospinal tract lesions (stroke)

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7
Q

What is scissors gait?

A

Pts advance each leg slowly and thighs tend to cross
Stiff gait and short steps
Look like they’re “walking through water”

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8
Q

What causes scissors gait?

A

Spinal cord disease and spasticity disorders (cerebral palsey)

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9
Q

What is sensory ataxia?

A

Unsteady gait and wide based stance
Throw feet forward and outward, first bring down heel then toes with double tap
They watch the ground (probably walk assist device)

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10
Q

What causes sensory ataxia?

A

Loss of proprioception (polyneuropathy or posterior column damage)

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11
Q

What is a Parkinsonian gait?

A

Stooped posture with head, arm, hip and knee flexion
Shuffling, short steps, slow to start
Decreased arm swing and stiff turns
Pill rolling tremor

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12
Q

What causes Parkinsonian gait?

A

Basal ganglia abnormalities (Parkinson disease)

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13
Q

What does coordination require?

A

Integration of the nervous system (motor, cerebellar-control, vestibular-balance, sensory)

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14
Q

Romberg test

A

Position sense

Stand with feet together, eyes closed

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15
Q

What is an abnormal Romberg test?

A 
Unable to maintain upright posture
Dorsal column disease causing loss of position sense
Cerebellar ataxia (can't balance eyes open or closed)
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16
Q

When do you see an abnormal pronator drift test?

A

Upper motor neuron lesion due to possible stroke

Can’t keep arms at shoulder height or arm pronates/drifts downward

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17
Q

What causes an abnormal heel to shin test?

A

Cerebellar disease: heel overshoots knee and foot oscillates side to side
Position sense absent: heel lifts too high

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18
Q

What causes an abnormal finger-to-nose test?

A

Intentional tremor-multiple sclerosis

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19
Q

When do you see an abnormal rapid alternating movements test?

A

Cerebellar disease: slow, clumsy, irregular movement (dydiadochokinesis)

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20
Q

A and O x 4

A

Alert and oriented to person, place, time and situation

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21
Q

Abnormal CN I

A

Anosmia

Head trauma, Parkinsons

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22
Q

Abnormal CN II

A

Visual field defect, 2 degree retinal emboli, optic neuritis, pituitary tumor, stroke

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23
Q

Abnormal CN III

A

Vertical and horizontal diplopia

Ptosis=CN III palsy

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24
Q

Abnormal CN IV

A

Vertical diplopia (might have trouble going down stairs)

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25
Abnormal CN V
Trigeminal neuralgia
26
Abnormal CN VI
Horizontal diplopia, esotropia
27
Abnormal CN VII
Peripheral- Bell's palsy | Central- cerebral infarct
28
Abnormal CN VIII
Disequilibrium, vertigo, nystagmus
29
Abnormal CN IX
No gag reflex, loss of taste posterior 1/3 of tongue
30
Abnormal CN X
Hoarseness, dyspnea, dysarthria, loss of gag reflex
31
Abnormal CN XI
Trap weakness, atrophy and fasiculations=scapular winging
32
Abnormal CN XII
Central lesion= tongue deviates away | Peripheral lesion= tongue deviates to weak side
33
Upper extremity dermatomes
``` Lateral upper arms (C5) Radial forearm and thumb (C6) Middle finger (C7) Ring and little finger (C8) Ulnar forearm (T1) ```
34
Abdomen dermatomes
Nipple (T4) Umbilicus (T10) Inguinal region (L1)
35
Lower extremity dermatomes
Anterior/proximal thigh (L3) Knee/medial shin (L4) Lateral shin, dorsal foot to great toe (L5) Lateral and plantar foot (S1)
36
Streognosis
Ask patient to recognize a familiar object
37
Graphesthesia
Number identification
38
Two point discrimination
Alternate double and single stimulus | Normal <5 mm on finger pads
39
Extinction
Touch pt in same place on both sides of body
40
Abnormal body position
Mono or hemiparesis (stroke)
41
Static tremor
``` Seen at rest Parkinson disease (pill rolling tremor) ```
42
Postural tremor
Seen when affected areas maintains posture | Hyperthyroid, anxiety, fatigue, benign essential
43
Intention tremor
Absent at rest, appear with movement | Multiple sclerosis
44
Tics
Brief, repetitive, twitching | Tourette syndrome, medications
45
Dystonia
Twisted posture of large body parts | Medications, spasmodic torticollis
46
Dyskinesias
Bizarre, rhythmic, repetitive movements | Parkinsons, psychoses, medications
47
Akathisia
Inability to sit still | Meds (antipsychotics, Compazine)
48
Chorea
Brief, jerky, unpredictable movements | Huntingtons, rheumatic fever
49
Athetosis
Slow, twisting, writhing movements | Cerebral palsy
50
When do you see muscle bulk?
Lower peripheral nerve problem
51
What causes hypotonia/flaccidity?
Central and peripheral causes
52
What causes spasticity?
Central corticospinal tract disease | Increased muscle tone, velocity dependent
53
What causes rigidity?
Cog-wheel rigidity (Parkinsons) | Increased resistance throughout ROM
54
Nerve root and peripheral nerve shoulder abduction
C5- axillary
55
Nerve root and peripheral nerve elbow flexion
C5, C6- musculocutaneous
56
Nerve root and peripheral nerve elbow extension
C6, C7- radial
57
Nerve root and peripheral nerve wrist extension
C6, C7- radial
58
Nerve root and peripheral nerve wrist flexion
C7, C8- median
59
Nerve root and peripheral nerve finger abduction
C8, T1- ulnar
60
Nerve root and peripheral nerve thumb opposition
C8, T1- median
61
Nerve root and peripheral nerve hip flexion
L2, L3- femoral
62
Nerve root and peripheral nerve hip extension
L4, L5- gluteal
63
Nerve root and peripheral nerve knee extension
L3, L4- femoral
64
Nerve root and peripheral nerve knee flexion
L5, S1- sciatic
65
Nerve root and peripheral nerve ankle dorsiflexion
L4, L5- peroneal
66
Nerve root and peripheral nerve ankle plantar flexion
S1- plantar
67
How to rate DTRs
``` 0- no response +1- diminished +2- normal +3- increased +4- hyperactive, associated with clonus ```
68
Hypoactive DTRs
Diminished or absent Diseases of spinal nerve roots or peripheral nerves Additional findings in LMN disease (weakness, atrophy, fasciculations)
69
Hyperactive DTRs
Brisk and can be associated with clonus CNS lesions along descending corticospinal tract Additional findings in UMN disease (weakness, spasticity, positive babinski)
70
What DTRs do you test?
Biceps, brachioradialis, triceps, patella, achilles
71
How do you test for clonus?
Alternate dorsi and plantar flexing pts ankle, then briskly dorsiflex ankle-evaluate rhythmic oscillation Can be normal bilaterally (if abnormal check wrist)
72
When do you see abnormal clonus?
Upper motor neuron disease (4+)
73
What does Babinski test?
L5, S1- normal for toes to flex
74
When do you see an abnormal Babinski response?
CNS lesion affecting corticospinal tract (great toe extends and other toes fan out)
75
When do you see an abnormal superficial abdominal reflex?
Central and peripheral pathologies
76
When do you see an abnormal cremasteric reflex?
UMN, LMN or L1, L2 nerve injury | Ilioinguinal injury s/p hernia repair
77
What is Brudzinski sign?
Normal- pts remains relaxed | Abnormal- hip and knee flexion
78
What is nuchal rigidity?
Place hands behind pts head and flex toward chest Normal- easy motion Abnormal- pain and resistance indicating potential meningeal irritation
79
What is Kernig sign?
Flex pts hip and knee, then straighten knee Normal- may have tightness in hamstring Abnormal- back pain and resistance indicating meningeal irritation

X Physical Diagnosis Final (4 decks)

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