Neuro Exam Lecture Flashcards
1
Q
what are the components of the neuro exam?
A
mental status, cranial n., motor system, sensory, reflexes
2
Q
what neuro dz presents episodically?
A
MS
3
Q
what are the components of a mental status exam?
A
level of alertness, appropriateness of response, orientation
4
Q
what cranial n. exits at telencephalon?
A
CN I
5
Q
what cranial n. exits at the diencephalon?
A
CN II
6
Q
what cranial n. exits at the mesencephalon?
A
CN III and IV
7
Q
what cranial n. exits at the metencphalon?
A
CN V
8
Q
what cranial n. exits at the myelencephalon?
A
CN IX-XII
9
Q
what part of the brain is the midbrain?
A
mesencephalon
10
Q
what part of the brain is the pons?
A
metencephalon
11
Q
what part of the brain is the medulla?
A
myelencephalon
12
Q
what cranial nerves exit at the pontomedullary junction?
A
CN VI, VII, VIII
13
Q
what kinds of things can cause loss of smell?
A
smoking, chronic sinus dz, head trauma, aging, PD, use of cocaine
14
Q
CN I lesion is what side?
A
ipsilateral
15
Q
lesions to the optic n. anterior to chasm cause what sided blindness?
A
ipsilateral
16
Q
What are the nerves (afferent and efferent) involved in the pupillary light reflex?
A
CN II and (efferent) CN III
17
Q
what nerve is responsible for the consensual light reflex?
A
CN III (efferent to opposite eye)
18
Q
What is opticokinetic nystagmus?
A
normal physiologic response to fixating on a moving target
19
Q
what can asymmetric loss of opticokinetic nystagmus be due to?
A
frontal or parietal lesion on side to which target is moving to
20
Q
If there is a lesion of CN III what can present?
A
ptosis, pupillar dilation or asymmetry, position change of eye “down and out”
21
Q
what is involved in a near reaction?
A
pupils constrict, eyes converge, and accommodation occur (thickens lens)
22
Q
what kinds of things can lead to compressive brainstem lesions effecting CN III?
A
hematomas, large strokes, abscesses, tumors, space occupying or expanding masses, aneurysms
23
Q
diabetes mellitus can present with in regards to eye?
A
extraocular m. weakness but often spares the pupilloconstrictor fibers
24
Q
why is CN IV particularly susceptible to trauma?
A
long course around brainstem
25
what can lesions of CN IV result in?
extorsion (eye drifts laterally), weakness of downward gaze, VERTICAL diplopia (increases when looking down), ** Head tilting** to side opposite of lesion (can be misdiagnosed as idiopathic torticollis
26
what CN is the most common isolated CN palsy? due to?
CN VI, due to its long peripheral course
27
what pts often have a CN VI lesion?
subarachnoid hemorrhage, late syphilis and trauma
28
what do pts with CN VI lesion present with?
convergent (medial) strabismus (estropia)- inability to ABDUCT eye
HORIZONTAL diplopia
29
pts with CN V lesions present with?
decreased sensation of face and mucus membranes, loss of corneal reflex, weakness of m. of mastication, jaw deviation (toward weak side- due to unopposed action of the opposite lateral pterygoid m.)
30
What nerves are involved in corneal reflex?
afferent- CN V
| efferent- CN VII
31
what is CN VII involved in?
motor- face expression
sensory- taste to anterior 2/3 of tongue
parasympathetic- secretion of saliva and tears
general sensation- external ear
32
what do lesions of CN VII result in?
paralysis of the m. of facial expression= Bell's palsy
loss of corneal reflex
hyperacusis
crocodile tears syndrome- tears with chewing
33
What can cause bilateral facial palsies?
miller-fisher variant of Guillian-Barre Syndrome
34
how does supra nuclear (central) facial palsy? why important?
upper face spared and lower face palsy, associated with hemiplegia; important in determining weakness is central or peripheral
35
what are the 2 tests for the hearing division of CN VIII?
Weber and Rinne tests
36
what can lesions in the vestibular division of CN VIII result in?
dysequilibrium and -nystagmus
37
What can destructive lesions of the cochlear division of CNVIII lead to? example?
sensorineural hearing loss; acoustic neuroma
38
what can irritative lesions cause? example?
tinnitus; medications (aspirin, some antibiotics, etc.)
39
what does weber test for?
lateralization
| (this is more for knowledge outside this lecture but it
40
how does Weber result if there is conductive hearing loss?
sound lateralizes to impaired ear; seen with occlusion of ear
41
how does Weber result if there is sensorineural hearing loss?
sound lateralizes to good ear
42
what is the Rinne test used to compare? what is normal?
air to bone conduction; AC>BC
43
how is the Rinne test done?
virbrating fork put on mastoid and then near ear canal (with U facing forward)
44
what is the result of the Rinne test in conductive hearing loss?
BC>AC, negative test
45
what is the result of the Rinne test in sensorineural hearing loss?
AC>BC; positive test
| -- because both AC and BC are diminished keeping ratios the same
46
What does CN IX do?
motor- stylopharyngeus m.
sensory- taste to posterior 1/3 of tongue, sensation to palate and pharynx, skin of ext. ear & afferent of gag reflex
47
what does the gag reflex?
CN IX and X
48
lesions of CN IX present as?
loss of gag reflex, sensation in pharynx and posterior 1/3 of tongue, slight dysphagia
49
what does the lesions of CN X present as?
dysphonia, dysphagia, dyspnea, loss of gag or cough reflex
50
what does the cranial division of CN XI innervate?
innervation of the m. of larynx except the Cricothyroid m.
51
what does the spinal division of CN XI innervate?
innervates trapezius (with contributions from C2) and sternocleidomastoid (with contribution from C3 and C4)
52
what direction does the left SCM turn the head?
right
53
what does a CN XI lesion result in?
ipsilateral shoulder droop
54
what does hypoglossal n innervate?
all intrinsic and extrinsic tongue muscles except palatoglossus (CN X)
55
how do you test the hypoglossal n?
have pt protrude tongue into opposite cheek.
56
what does a CN XII lesion result in?
deviation to the weak side "lick your wounds"
57
what is dysarthria?
slurred speech
58
what is dysphagia?
partial or complete impairment of ability to communicate
59
what is aphasia?
inability to get words out or understand what is being said
60
what do you do to assess the motor system?
inspetion, m. tone, involuntary movement, m. power, body position
61
what does a m. strength grade of 0/5 mean?
no m. contraction detected
62
what does a m. strength grade of 1/5 mean?
evidence of contraction, no joint movement
63
what does a m. strength grade of 2/5 mean?
active movement with gravity eliminated
64
what does a m. strength grade of 3/5 mean?
complete ROM against gravity
65
what does a m. strength grade of 4/5 mean?
complete ROM against gravity with some resistance
66
what does a m. strength grade of 5/5 mean?
complete ROM against gravity with full resistance
67
what m. and n. control shoulder abduction, flexion, and extension?
deltoid-C5
68
what nerves control elbow flexion? and extension?
flex- C5, C6
| extension-C6, C7, C8
69
what nerves control wrist flexion and extension?
C6 and C7
70
what n. do hand grip?
C7, C8, T1
71
what n. are involved in finger abduction?
C8, T1
72
what n. are involved in opposition of the thumb?
C8, T1
73
what m. and n control hip flexion?
psoas and iliacus- L2, 3, 4
74
what m. and n. control hip extension?
gluteus maximus- S1
75
what n. control hip adduction?
L2, 3, 4
76
what n. control hip abduction
L4, 5, S1
77
what m. and n. control knee flexion?
hamstrings- L4, L5, S1, S2
78
what m. and n. control knee extension?
quadriceps- L2, L3, L4
79
what m. and n. control plantar flexion of the ankle?
gastrocnemius- S1
80
what m. and n. control dorsiflexion of the ankle?
primarily tibialis anterior- L4, L5
81
sensory dermatome for the shoulder?
C4
82
sensory dermatome for the radial aspect forearm and thumb?
C6
83
sensory dermatome for the little finger?
C8
84
sensory dermatome for the little toe?
S1
85
sensory dermatome for the hallucis?
L5
86
sensory dermatome for the nipple?
T4
87
sensory dermatome for the umbilicus?
T10
88
what kinds of changes in m. tone and reflexes occurs when there is UMN injury? what is the pattern of weakness?
hypertonia, hyperreflexia;
| pyramidal pattern of weakness-weak extensors in arms and weak flexors in legs
89
how do you test for an UMN injury?
pronator drift- arms held extended for up to 2 mins, arms drift down and supinate
90
what kinds of changes in m. tone and reflexes occurs when there is LMN injury? what is the pattern of weakness?
hypotonia, hyporeflexia;
| peripheral pattern of weakness- weak flexors in arms, weak extensors in legs
91
what happens at NMJ in LMN injury?
fatigable weakness
92
what 4 things can be tested for the sensory system?
pinprick and temp
proprioception, 2pt tactile discrimination and vibratory
light touch
discriminative sensations
93
what tract does pain and temp travel in?
spinothalamic tract
94
what tract does proprioception, 2 pt tactile discrimination and vibratory travel in?
posterior columns
95
what are the 4 discriminative (cortical) sensations?
sterognosis, graphesthesia, 2 pt discrimination, double simultaneous stimulation (extension)
96
what is sterognosis?
ability to ID objects or recognize objects placed in the hand
97
what is graphesthesia?
ability to ID numbers written on the palm
98
what is the scale that DTRs are rated on?
0-4
99
what is a normal DTR?
2/4
100
what does a DTR of 4/4 mean?
hyperactive with clonus
101
what does a hyperactive reflex indicate?
lesion of CNS
102
what does a hypoactive reflexes indicate?
lesion of PNS
103
what does a DTR of 3/4 mean?
brisk, spread to involve movement across more than one joint
104
what n. is tested with DTR of biceps?
C5*, (6)
105
what n. is tested with DTR of triceps?
(C6,) 7*
106
what n. is tested with DTR of brachioradialis?
(C5,) C6*
107
what n. is tested with DTR of patella?
(L2, 3) L4*
108
what n. is tested with DTR of achilles?
S1*
109
what does a Babinski's sign indicate?
critical sign of UMN dysfxn
110
how do you test for a Babinski's sign?
scratch foot from heel to toe and across transverse arch
111
what is a positive Babinski's?
great toe extends and remainder spread
112
what does clonus indicate? what is it?
UMN sign, abnormal pattern of NM activity characterized by rapidly alternating involuntary contraction and relaxation of skeletal m.
113
what kind of reflexes are frontal lobe release reflexes?
rooting, grasping, glabellar, and palmo-mental
114
what 3 reflexes are superficial tendon reflexes? describe?
abdominal reflex- test for all 4 quadrants, stroking abdomen, umbilicus moves toward area of stimulation
cremasteric reflex- afferent L1, efferent L2, scrotum rises on side of stroking
anal wink reflex- cauda equina or sacral lesions
115
what 4 systems are involved in coordination?
motor, vestibular, sensory, and cerebellar***
116
what kinds of tests can be done for cerebellar testing?
finger to nose, heel to shin, rapid alternating movement, saccades
117
what is heel walking sensitive for testing?
corticospinal tract lesions or distal m. weakness
118
romberg test tests for what?
proprioception (sensory test)
119
how is the romberg test performed?
pt stands in front of examiner with back, pt feet together and arms outstretched, pt closes eyes, pt should maintain balance
120
what part of walking is pathognomic for parkinson's dz?
en bloc turns: taking 5-6+ steps to turn around
121
what kind of gait is scissoring? often seen with?
not Liz or Kenna's, but with feet crossing and toes dragged over; CP or MS
122
sensory ataxia can indicate what? what does it look like?
posterior column damage and peripheral neuropathy; high stoppage, broad based gait
123
magnetic gait looks like? indicative of?
small steps, feet on ground; frontal lobe processes and hydrocephalus
124
Astasia-abasia gait is what?
psychogenic
125
what kinds of abnormal gaits are asymmetrical?
hemiplegic, waddling pelvis, foot drop
126
what does does a resting (pill rolling) tremor indicate?
basal ganglia disease (parkinson's)
127
what are the 2 meningitic signs and how do you do them?
Kernig's- flex thigh then straighten leg, pt will experience pain in neck
Brudzinski's- doc lifts pt head, pt lifts knees in response
128
what are the 2 coma postures and what do they look like?
Decorticate- arms flexed and legs extended
| Decerebrate- arms and legs extended
