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ICM 1 > Neuro Exam > Flashcards

Neuro Exam Flashcards

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1
Q

What can cause a person to feel anxious out of proportion to their circumstances?

A

Drugs, low vitamin levels, psychiatric issues, endocrine problems

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2
Q

What can cause a person to have mood problems or feel excessively sad?

A

Physiologic issues, exposure to chronic pain or illness, endocrine problems, social isolation, poor nutrition, inadequate sleep

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3
Q

What can cause a person to have problems with memory?

A

Physiological decline, dementia, trauma, psychiatric issues, drug reactions, ischemia, tumors, infection

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4
Q

What can cause isomnia?

A

Secondary to multiple physical or psychiatric problems, poor sleeping environment, daytime napping, early bedtimes, excessive time spent awake in bed

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5
Q

What can cause problems with staying awake (hypersomnia)?

A

Sleep apnea, narcolepsy

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6
Q

What can cause sleep disruption disorders?

A

Often occurs when traveling between time zones and with shift workers on rotating schedules, particularly nighttime workers

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7
Q

What are sleep disruptive behaviors?

A

Sleep terror disorder, sleep walking

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8
Q

What can cause sleepwalking in adults?

A

An organic brain syndrome, reactions to drugs, psychological disorders, and certain medical conditions

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9
Q

Feelings of going to pass out (syncope) are typically caused by what?

A

A malfunction from any number of causes to the brainstem or bilateral cerebral hemispheres

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10
Q

Feelings of movement (vertigo) are typically caused by what?

A

A malfunction of the vestibular apparatus (ear or brainstem)

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11
Q

Feelings of imbalance (ataxia) are typically caused by what?

A

A malfunction of the cerebellum, eyes, ears, or proprioceptors

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12
Q

Muscular weakness or paralysis could be caused by what?

A

A neuro problem (like a problem with cortex, basal ganglia, brainstem, cord, or peripheral nerve) or a muscle/tendon problem

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13
Q

What could cause abnormal sensations?

A

Pressure or injury to a nerve, ischemia, neuropathy, electrolyte imbalance, vitamin deficiencies, or medication reactions

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14
Q

What components make up the mental status examination?

A

Appearance and behavior, speech and language, mood, thoughts and perceptions, and cognitive function

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15
Q

What things should you look for when examining the appearance and behavior component of the mental status examination?

A

Facial expression, relationship to people and things, manner and affect, dress, grooming, and personal hygiene, posture and motor behavior, and level of consciousness

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16
Q

When observing manner and affect, what might you observe?

A

Anger, hostility, suspiciousness, or evasiveness in patients with paranoia; flat affect in schizophrenia or dementia; elation and euphoria of mania

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17
Q

How would you determine a patient’s level of consciousness is “lethargic?”

A

Speak to the patient in a loud voice. A lethargic patient appears drowsy but opens the eyes and looks at you, responds to questions, and then falls asleep

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18
Q

How would you determine a patient is “obtunded?”

A

Shake the patient gently as if awakening a sleeper. An obtunded patient opens the eyes and looks at you but responds slowly and is somewhat confused.

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19
Q

How would you determine if a patient is “stuporous?”

A

Apply a painful stimulus. A stuporous patient arouses from sleep only after painful stimuli, but verbal responses are slow or absent

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20
Q

How would you determine if a patient is “comatose?”

A

Apply a repeated painful stimuli. A comatose patient remains unarousable with eyes closed.

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21
Q

What should you look for when observing the speech and language component of the mental status examination?

A

Quantity, quality, rate and volume

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22
Q

When examining the quality of a person’s speech, what are you observing?

A

Their articulation of words and fluency/variability/clarity

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23
Q

What are circumlocutions?

A

Phrases or sentences are substituted for a word the person can’t think of

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24
Q

What is paraphasias?

A

Words are malformed, wrong, or invented

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25
What are different things you might observe when looking at the rate and volume of a person's speech?
Slow speech associated with depression, accelerated, loud speech associated with mania
26
A defect in Broca's area could cause what?
Non-fluent aphasia
27
A defect in Wernicke's area could cause what?
Fluent aphasia
28
What should you look for when observing the mood component of the mental status examination?
Assess mood by exploring the patient's perceptions of their mood, and if you suspect depression, assess its depth and any associated risk of suicide
29
What is circumstantiality
Speech characterized by indirection and delay in reaching the point because of unnecessary detail, although components of the description have a meaningful connection
30
What is derailment?
Speech in which a person shifts from one subject to others that are unrelated or related only obliquely without realizing that the subjects are not meaningfully connected
31
What is flight of ideas?
An almost continuous flow of accelerated speech in which a person changes abruptly from topic to topic
32
What are neologisms?
Invented or distorted words, or words with new and highly idiosyncratic meanings
33
What is incoherence?
Speech that is largely incomprehensible because of illogic, lack of meaningful connections, abrupt changes in topic, or disordered grammar or word use
34
What is blocking?
Sudden interruption of speech midsentence or before the completion of an idea
35
What is confabulation?
Fabrication of facts or events in response to questions, to fill in the gaps in an impaired memory
36
What is perseveration?
Persistent repetition of words or ideas
37
What is echolalia?
Repetition of the words or phrases of others
38
What is clanging?
Speech in which a person chooses a word on the basis of sound rather than meaning
39
What are compulsions?
Repetitive behaviors or mental acts that a person feels driven to perform in order to produce or prevent some future state of affairs
40
What are obsessions?
Recurrent, uncontrollable thoughts, images, or impulses that a person considers unacceptable and alien
41
What are phobias?
Persistent, irrational fears, accompanied by a compelling desire to avoid the stimulus
42
What are anxieties?
Apprehensions, fears, tensions, or uneasiness that may be focused or free-floatin
43
What are feelings of unreality?
A sense that things in the environment are strange, unreal, or remote
44
What are feelings of depersonalization?
A sense that one's self is different, changed, or unreal, or has lost identity or become detached from one's mind or body
45
What are delusions?
False, fixed, personal beliefs that are not shared by other members of the person's culture
46
What are you looking for when you examine the thoughts and perceptions component of the mental status exam?
Variations or abnormalities in thought process, abnormalities of thought content, insight and judgement, and abstract thinking
47
How can you usually assess judgement?
By noting the patient's responses to family situations, jobs, use of money, and interpersonal conflicts
48
A concrete response when asking a patient what people mean when they use a proverb can be a sign of what?
Mental disability, delirium, dementia, or just a function of limited education
49
What are you looking for when you examine the cognitive functions component of the mental status exam?
Orientation, attention, memory, calculating ability, and constructional ability
50
What does orientation include?
Time, place, person
51
How can you test attention?
Recite a series of digits and ask the patient to repeat the numbers back to you
52
If vision and motor ability are intact, what does poor constructional ability suggest?
Dementia or parietal lobe damage
53
According to the Glasgow Coma Scale, patients with what scores are considered to be in a coma?
Scores between 3-8
54
What are the two cardinal DON'Ts when examining comatose or stuporous patients?
Don't dilate the pupils and don't flex the neck
55
What is the pathophysiology of a toxic-metabolic coma?
Arousal centers are poisoned or critical substrates are depleted
56
What is the pathophysiology of a structural coma?
A lesion destroys or compresses brainstem arousal areas, either directly or secondary to more distant expanding mass lesions
57
What would you expect to see in pupil examination of a patient in a toxic-metabolic coma?
Equal size, reactive to light. If they are pinpoint from opiates or cholinergics, you may need a magnifying glass to see the reaction
58
What would you expect to see in pupil examination of a patient in a structural coma?
Unequal or unreactive to light (fixed)
59
What do midposition, fixed pupils suggest?
Midbrain compression
60
What is the difference in level of consciousness in a toxic-metabolic vs structural coma?
In toxic-metabolic, level of consciousness changes after pupils change, but it changes before pupils change in a structural coma
61
What are examples of causes of toxic-metabolic comas?
Uremia, hyperglycemia, alcohol, drugs, liver failure, hypothyroidism, hypoglycemia, anoxia, ischemia, meningitis, encephalitis, hyperthermia, hypothermia
62
What are examples of causes of a structural coma?
Epidural, subdural, or intracerebral hemorrhage; cerebral infarct or embolus; tumor, abscess; brainstem infarct, tumor, or hemorrhage; cerebellar infarct, hemorrhage, tumor, or abscess
63
Bilaterally fixed and dilated pupils may be caused by what?
Severe anoxia
64
One fixed and dilated pupil suggests what?
Herniation of the temporal lobe
65
What does decerebrate posture result from?
Damage to the upper brain stem
66
What does decerebrate posture look like?
Arms are adducted and extended with wrists pronated and fingers flexed. Legs are stiffly extended and feet are plantarflexed
67
What does decorticate posture result from?
Damage to one or both corticospinal tracts
68
What does decorticate posture look like?
Arms are adducted and flexed with wrists and fingers flexed on the chest. Legs are stiffly extended and internally rotated with feet plantarflexed
69
How would you test CN I?
Test the sense of smell by presenting the patient with familiar nonirritating odors
70
Loss of smell occurs with what conditions?
Sinus conditions, smoking, aging, and cocaine use
71
What is anisocoria?
A difference of more than 0.4mm in the diameter of one pupil compared to the other, seen in up to 38% of healthy individuals
72
What should you look for when testing CN II and III?
Inspect size and shape of the pupils, identify any nystagmus, look for ptosis, and test pupillary reactions to light
73
What is Horner's syndrome?
Results when cervical sympathetic pathway from hypothalamus is interrupted, lesion may be central, preganglionic, or postganglionic and may be primary or secondary to another disorder. Symptoms include ptosis, miosis, anhydrosis, and/or hyperemia
74
What is nystagmus?
An involuntary jerking movement of the eye, named for the direction of the quick component
75
What is nystagmus seen in?
Cerebellar disease (increases with retinal fixation), vestibular disorders (decreases with retinal fixation), and internuclear ophthalmoplegia (often from stroke or MS)
76
What is ptosis?
Drooping of the upper eyelids
77
How would you test CN III, IV, and VI?
Test the extraocular movements in the six cardinal directions of gaze, look for loss of conjugate movements in any of the six directions (causes diplopia), and check near response
78
How would you test CN V?
Test motor function by palpating temporal and masseter muscles while the patient bites down, test sensory by having the patient close their eyes and test the forehead, cheeks, and jaw on each side for sensation, and test corneal reflex
79
How would you test CN VII?
Have the patient raise their eyebrows, from, and smile with their teeth
80
How would you test CN VIII?
Assess hearing with the whispered voice test
81
If hearing loss is present in a patient, what should you determine about the hearing loss?
Whether it is conductive (from impaired "air through ear" transmission) or sensorineural (from damage to cochlear branch of CN VIII)
82
How would you test CN IX and X?
Listen to the patient's voice, ask the patient to say "ah" or yawn as you watch the soft palate, and test gag reflex
83
What could cause hoarseness?
Vocal cord paralysis
84
What could cause a nasal voice?
Paralysis of the palate
85
What would unilateral absence of the gag reflex suggest?
Either a lesion of CN IX (afferent) or CN X (efferent)
86
How would you test CN XI?
Test the trapezius by having the patient shrug against restriction, test the SCM by having the patient turn into your hand (against restriction)
87
How would you test CN XII?
Listen to the articulation of the patient's words, inspect the patient's tongue, then, with the tongue protruded, look for asymmetry, atrophy, or deviation from the midline
88
What are tremors?
Rhythmic oscillatory movements, which can be roughly subdivided into three groups: resting (static), postural, and intention
89
What are resting (static) tremors?
Tremors that are most prominent at rest and may disappear with voluntary movement, as seen in parkinsonism
90
What are postural tremors?
Appear when the affected part is actively maintaining a posture, as those cause by hyperthyroidism or anxiety and fatigue
91
What are intention tremors?
Appear with movement and often get worse as the target gets closer, as those caused by diseases of the cerebellum
92
What are tics?
Brief, repetitive, stereotyped, coordinated movements occurring at irregular intervals, such as those caused by Tourette's or drugs
93
What is chorea?
Brief, rapid, jerky, irregular, and unpredictable movements that seldom repeat themselves, such as those caused by Syndenham's chorea (with rheumatic fever) and Huntington's disease
94
What are athetoid movements?
Slower movements that are more twisting and writhing than choreiform movements and have a larger amplitude, most commonly involving the face and distal extremities. Causes include cerebral palsy
95
What are dystonic movements?
Similar to athetoid movements, but often involve larger portions of the body, including the trunk. Causes include drugs like phenothiazines
96
What are oral-facial dyskinesias?
Rhythmic, repetitive, bizarre movements that chiefly involve the face, mouth, jaw, and tongue, such as those caused by a late complication of psychotropic drugs like phenothiazines
97
What is muscular atrophy?
Refers to a loss of muscle bulk, or wasting
98
What do fasciculations with atrophy and muscle weakness suggest?
Disease of the peripheral motor unit
99
What is hypertrophy?
An increase in bulk with proportionate strength
100
What is pseudohypertrophy?
An increase in bulk with diminished strength, which can be seen in Duchenne Muscular Dystrophy
101
What is muscle tone?
The slight residual tension of a normal muscle with an intact nerve supply when it is relaxed voluntarily
102
How can you best assess muscle tone?
By feeling the muscle's resistance to passive stretch
103
What is muscle tone spasticity?
Velocity-dependent increased tone that worsens at the extremes of range
104
What is muscle tone rigidity?
Increased resistance throughout the range of movement in both directions, not rate-dependent
105
What does decreased resistance when testing muscle tone suggest?
Disease of the peripheral nervous system or the acute stages of spinal cord injury
106
What is paresis?
Impaired strength
107
What is paralysis or plegia?
Absence of strength
108
What is muscle weakness observed in?
Peripheral nerve disease, CNS disease, muscular abnormalities, and other things like malnutrition
109
What would you tell a patient to do if you were testing for pronator drift?
Stand for 20-30 seconds with both arms straight forward, palms up, and with eyes closed
110
What is pronator drift indicative of?
It is both sensitive and specific for a corticospinal tract lesion originating in the contralateral hemisphere
111
Coordination of muscle movements requires integration of what?
The motor system, the cerebellar system, the vestibular system, and the sensory system
112
What is dysdiadochokinesis?
The inability to follow a movement quickly by its opposite, and movements are slow, irregular, and clumsy. Occurs in cerebellar disease
113
What is an ataxic gait?
A gait that lacks coordination, with reeling and instability
114
What could ataxia be caused by?
Cerebellar disease, loss of position sense, or intoxication
115
What is tandem walking?
Walking heel-to-toe in a straight line, which can show an ataxia that was not previously obvious
116
When observing gait, what should you look for?
Posture, balance, swinging of the arms, and movement of the legs
117
What is a positive Romberg sign?
If, when told to stand with feet together and eyes open and then close both eyes for 30-60 seconds without support, the patient stands fairly well with eyes open but loses balance when the eyes are closed
118
Would a patient with cerebellar ataxia have a positive Romberg sign?
No, because they have difficulty standing with feet together whether the eyes are open or closed
119
What is hyperreflexia seen in?
CNS lesions along the descending corticospinal tract
120
What is hyporeflexia seen in?
Diseases of spinal nerve roots, spinal nerves, plexuses, or peripheral nerves
121
What is reinforcement?
A technique involving isometric contraction of other muscles for up to 10 seconds that may increase reflex activity, used when a patient's reflexes are symmetrically diminished or absent
122
What can cause a positive Babinski response?
A CNS lesion in the corticospinal tract. It can also be seen in unconscious states from drug or alcohol intoxication or in the postictal period following a seizure
123
What is asterixis seen in?
Liver disease, hypercapnia, and metabolic encephalopathy
124
What types of sensation should you test to evaluate the sensory system?
Pain and temperature (spinothalamic tracts), position and vibration (posterior columns), light touch, and discriminative sensations
125
What is analgesia?
Absence of pain sensation
126
What is hypalgesia?
Decreased sensitivity to pain
127
What is hyperalgesia?
Increased sensitivity to pain

ICM 1 (8 decks)

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