NEURO Exam Flashcards
(129 cards)
1
Q
Sense that does not go to THALAMUS
A
SMELL
2
Q
• Spinothalamic Tracts
________order _________, then _________to ______
@thalamus, synapse to ______
A
- Pain/Temp/Light Touch/Crude Touch
- 2nd orders cross to opposite side, then ascend to Thalamus
- @ Thalamus, synapse to 3rd order
3
Q
Posterior Dorsal Columns
1st order enter ______and ______on which sidee?
@ Medullla, synapse to _______then cross over and ascend to ________
@ thalamus, synapse to 3rd order
ascend to cortex
A
• Proprioception/Vibration/2 pt discrim/Stereognosis
• 1st orders enter SC and ascend same side
• @ medulla, synapse to 2nd order then cross over
and ascend to Thalamus
• @ Thalamus, synapse to 3rd order
• Ascend to cortex
4
Q
OUTSIDE
A
LOWR MOTOR NEURON
5
Q
Inside
A
UPPER MOTOR NEURON (Stroke)
6
Q
Dermatome have
A
1/3 OVERLAP
7
Q
To get dermatome numbing
A
both dermatomes above and below
8
Q
• 4 types of Reflexes:
•
A
DTR
Superficial
Visceral
Pathologic
9
Q
• Deep Tendon (DTR)
A
• ex. Patellar
10
Q
• Superficial
A
• ex. Corneal (blink), abdominal
11
Q
• Visceral
A
• ex. Pupillary response to light
12
Q
Pathologic
A
• ex. Babinski’s sign
13
Q
Example of Lower MN disease
A
- SC lesions
- Polio
- ALS
14
Q
Examples of Upper MN disease
A
- CVA
- CP
- MS
15
Q
Extrapyramidal Tracts
• Gross automatic movement
A
(ie. Walking)
16
Q
Only test in anosmia pt.s with:
A
- Head trauma
- Abnormal mental status
- Suspected intracranial lesion
17
Q
Ophthalmoscope – fundoscopy
• Optic disc LOOK FOR
A
- Papilledema
* Optic atrophy
18
Q
Optic disc is
A
most prominent landmark (nasal side)
19
Q
Pallor indicated
A
CN 2 atrophy
20
Q
Hyperemia indicates
A
methanol poisoning
21
Q
Irregular shape indicates
A
Glaucoma
22
Q
Margins Blurred =_________ = _________
A
Blurred margins = papilledema = ↑ ICP
23
Q
CN III is the
A
OCULOMOTOR NERVE
24
Q
• Asymmetric response indicated
A
CN 3 damage
25
Asymmetry in Corneal Light REFLEX
| What to do next?
Asymmetry indicates deviation 2o to muscle weakness or paralysis – if present, do Cover Test
26
• Phoria =
mild weakness when fusion is blocked
27
• Tropia =
severe weakness that is constant
28
Ptosis occurs with:
• Myasthenia Gravis
29
MG is a ________
* Autoimmune cause
| * One or both eyes affected
30
Horner’s Syndrome (PIAC)
* Pupil constriction
* Ipsilateral sympathetic n. paresis
* anhydrosis
* CN III damage
31
CN IV is the
TROCHLEAR NERVE
32
CN V is the
Abducens
33
Uneven eye movement, Strabismus or failure to follow =
EOM weakness or CN dysfunction
34
EOM weakness or CN dysfunction
Uneven eye movement, Strabismus or failure to follow =
35
• Nystagmus indicates (2) SPM
semicircular canal ds.
paretic eye m.,
MS or brain lesion
36
Lid lag =
hyperthyroidism
37
CN V is the
Trigeminal nerve
38
EOM testing
Hold finger ~12” back, Move through the 6 cardinal positions of gaze, “H” pattern
39
Motor function of Nerve V trigeminal
Mastication
| Note: WAP weakness, asymmetry, pain
40
Sensory testing of CN V trigeminal
• Forehead (ophthalmic branch)
• Cheeks (maxillary branch)
• Chin (mandibular branch)
Test light touch with cotton wisp or brush
41
Sensory testing of CN V trigeminal (FO)
| • Forehead
(ophthalmic branch)
42
Sensory testing of CN V trigeminal (CheekMax)
| • Cheeks
(maxillary branch)
43
Sensory testing of CN V trigeminal (TRIMAN)
| • Chin
(mandibular branch)
44
If there's no Blink means
damaged CN V and/or CN 7
45
2 typs
Circular (sympathetic)
| radial (
46
Facial Nerve
motor test CN 7
47
CN 7 dseases
CVA
| • Bell’s Palsy
48
MG looking up makes eyelid
droop
49
CN 8 is the___________
| •
Vestibulocochlear N.
50
Vestibulocochlear
Test Hearing acuity w/
• normal conversation & whispered voice
• Weber & Rinne tuning fork tests
51
Weber test
normal, both ears hear equally
52
weber test sound lateralizes to POORER with
conductive loss
53
weber test sound lateralizes to BETTER with
SENSONEURINAL loss
54
Normal Rinne test
AC>BC
55
Conductive loss in Rinne Test
AC =BC
| AC < BC
56
Sensorineural loss is
AC> BC BUT POOR EAR IN BOTH OVERALL REDUCED
57
CN IX IS
Glossopharyngeal N.
58
CN X IS
Vagus N.
59
MOTOR Function tests IX and X (AATU)
```
• Note :
absence
asymmetry of soft palate
tonsil pillar movement,
uvula deviation
```
60
• Hoarse/brassy voice =
vocal cord dysfunction (CN X)
61
Spinal Accessory N is CN
XI
62
Test motor function
* Instruct pt. to rotate head against resistance
| * Shrug shoulders against resistance
63
CN XII is
• Hypoglossal N.
64
Inspect tongue for (FAT)
* Fasciculations
* Atrophy
* Tongue deviates toward paralyzed side
65
When do you use atrophy? (DIL PD)
Disuse
injury
LMN ds. (Polio, Diabetic neuropathy)
66
Paresis means
diminished strength
67
Paralysis/plegia =
absence of strength
68
Decorticate rigidity where is the lesions (decorCORTEX)
Lesion in Cerebral Cortex
69
DECEBRATE RIGIDITY where is the lesion
Lesion in brain stem @ midbrain or pons
70
in Decorticate there is
FLEXION
71
Decerebrate there is
EXTENDED
72
Staggering, loss of balance =
| Seen UMN lesion such as
Ataxia
| ie. MS
73
FLACCID
Lower
74
Romberg test
Sways/falls/widens feet
75
• (+) Romberg sign (CEM)
* Cerebellar ataxia
* MS
* Etoh intoxication
76
(+) Romberg sign (CEM)
* Cerebellar ataxia
* MS
* Etoh intoxication
77
Slow, clumsy, lack of coord. indicates______For _______
dysdiadochokinesia; cerebellar ds.
78
There is dysymmetry means
cerebellar disorder
79
Finger to nose test multiple misses
Cerebellar ds.
80
Heel to shin test : lack of coordination
= cerebellar ds.
81
For pt.s with neurologic symptoms
pain, numbness, tingling, motor deficits
| full work up s/b done (all sensory modalities, most dermatomes)
82
For pt.s without neurologic symptoms, screening includes:
| SLVS
* Superficial pain (sharp/dull discrimination)
* Light touch
* Vibration
* Stereognosis
83
Spinothalamic Tract Testing
PAIN (SHARP/DULL)
84
Temp Test
May omit since fibers follow same path as pain, or use side of metal tuning fork (cold)
85
Spinothalamic Tract Testing: Light touch
Test w/ hammer brush
• Brush over skin in random order of sites at irreg. intervals
• Ask pt. eyes closed; say “now” or “yes” when they feel it
86
Vibration Test
• Vibration sense usually first lost in______
In 2 conditions_______
Peripheral Neuropathy
| (DM, Etoh abuse
87
Posterior column tract testing
Position (Kinesthesia) Test
| • Tests ability to perceive passive movement of extremities
88
Posterior Column Tract Testing
| 2 tests
• Position (Kinesthesia) Test
| - Tactile Discrimination (Fine Touch)
89
Posterior Column tract testing (GSTEP)
* Graphesthesia
* Stereognosis
* Two-point discrimination
* Extinction
* Point location
90
Stereognosis Test
Tests ability to recognize object by feel, size, shape
91
Stereognosis test steps
* Pt. eyes closed
* Place a familiar object in one hand, ask them to identify it
* Left hand assess Right parietal lobe function; Right hand assess Left lobe
92
Graphesthesia –
tests ability to “read” a number traced on skin
93
Graphestesia Steps
* Pt. eyes closed
* Using blunt instrument trace a single digit or letter on palm
* Useful test for pt.s with limited hand ROM (ie. Arthritis)
94
Failure of either test GRAPHESTESA/ STEREOGNOSIS indicates
sensory cortex lesion (ie. CVA)
95
Two-point Discrimination
* Pt. eyes closed
* Lightly touch two points of opened paper clip to skin in ever-closing distances.
* Note distance pt. no longer perceives two separate points.
* Level of perception varies with region tested)
96
Two-point Discrimination• Most sensitive =
Fingertips (2 – 8 mm)
97
Two-point Discrimination• Least sensitive =
Back, Thigh, Upper Arms (40 – 75 mm
98
Extinction Failure one side indicates
a contralateral sensory cortex lesion
99
Point Location TEST
| • Failure indicates___________
sensory cortex lesion
100
DTRs
| Clonus ____________ indicates
repeated jerking contractions; UMN lesion (MS)
101
DTRs Hyperreflexia indicates
UMN lesion (CVA)
102
Hyporeflexia indicates
LMN or Cord damage S
103
Biceps Reflex
| • Tests_______
C5 – C6
104
Normal for biceps reflex is
flexion
105
Triceps Reflex
| • Tests
C7 – C8
106
Normal for Triceps is
extension
107
Brachioradialis Reflex
| • Tests_______
C5 – C6
108
Brachioradialis Reflex
Gently strike 2 to 3 cm above radial styloid process
109
Normal Brachioradialis refex
Flexion & supination of forearm
110
Quadriceps Reflex
| • Tests_______
L2 – L4
111
Quadriceps normal
extension
112
Achilles
| • Tests______
L5 – S2
113
AChilles is Normal =
plantar flexion
114
Clonus is
Jerky Repeated muscle contractions
115
Clonus is seen in
UMN
116
Clonus normal test is
no movement
117
Superficial reflex
Abdominal
• Upper _______
Upper T8-T10
118
Superficial reflex
Abdominal
Lower________
T10 – T12
119
Plantar Reflex test is
Babinski Sign
120
Babinski plantar test
• Test L4 – S2
121
Abnormal in babinski is dorsiflexion and it is
Indicates Lesion in corticospinal (“pyramidal”) tract
122
Babinski is normal up to
18 months
123
Neurologic recheck
These pts. need close monitoring to chk. for improvement/deterioration/ ↑ICP
124
______can push brain stem down (uncal herniation)
↑ICP
125
Pressure on CN III causes
pupil dilation
126
Cushing reflex can indicates
↑ICP
127
Pain and temp monitor
LaTeral SPINOTHALAMIC tract
128
• Light/Crude Touch monitor
ANTERIOR spino-thalamic tract
129
Space spinothalamic tract testing
2 seconds apart
