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Neuro exam PNS Flashcards

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1
Q

If a patient comes in with motor signs what are the 4 main pathologies?

A

UMN lesion (pyramidal tract and spinal chord)
LMN lesion (spinal chord nerves)
Cerebellar pathology
Basal ganglia pathology (ie Parkinsons)

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2
Q

Damage to which nerve causes carpal tunnel?

A

Median

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3
Q

What position should the patient be in for a upper limb exam?

A

45 degrees on couch or sitting with their legs off the couch

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4
Q

What position should the patient be in for a lower limb exam?

A

Lying on the couch 45 degrees

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5
Q

What may you see on general inspection for an upper limb exam?

A 
Wheelchair
Catheter (could be due to neurological cause)
Muscle wasting
Neurofibromas
Ptosis
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6
Q

What acronym is used to remember how should should inspect a patient for an upper limb exam and what does it mean?

A

SWIFT
Scars
Wasting of muscles
Involuntary movements (chorea, myoclonus, tardive dyskinesia)
Fasciculations
Tremor (resting, intention tremor, postural tremor)

Also look for specific signs eg neurofibromas
Look at the face for hypomimia, ptosis, ophthalmoplegia

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7
Q

What is hypomimia and when is it seen?

A

Reduced facial expression often seen in Parkinson’s

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8
Q

How do you test for pronator drift?

A

Ask the patient to put their arm out in front of you with the palm up, close their eyes and get them to hold it there for 30 secs/ as long as they can

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9
Q

If a patients arm goes down slightly and pronates when testing for pronator drift where may their lesion be?

A

Right side (UMN lesion causing pronator drift)

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10
Q

What happens to upper limb and lower limb flexors and extensors in UMN lesion?

A

Upper limb: flexors are stronger than extensors (resulting in pronation of the arm)
Lower limb: extensors are stronger than flexors

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11
Q

What does pronator drift test for?

A

Upper motor neurone lesion

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12
Q

Where do you test for tone in the upper limb? How?

A

Shoulder
Elbow
Wrist

Ask them to be floppy, circumduction of shoulder, flexion/extension of elbow and flexion/extension of the wrist

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13
Q

What is the difference between spasticity and rigidity?

A

Spasticity is velocity dependant ie if you do the movement faster the hypertonia will reduce but rigidity is not velocity dependant so the hypertonia will remain

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14
Q

What type of rigidity is seen in the upper limb in Parkinsonism? Describe what it means

A

Cogwheel rigidity= everytime you attempt a movement it doesn’t work/ gets stuck

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15
Q

What are the ways to test for power in the upper limb?

A 
Shoulder abduction
Shoulder adduction
Elbow flexion
Elbow extension
Wrist flexion
Wrist extension
Finger abduction
Thumb abduction
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16
Q

How should you apply resistance when testing for power in the upper limb?

A

Use the same part of the arm the patient is using eg when testing for shoulder abduction use your whole arm as they are too but when testing for finger abduction only use your fingers as thats what they will use

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17
Q

How is power reported?

A

MRC= muscle power scale

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18
Q

Describe the MRC and what trick can be used to remember it?

A 
0= no movement
1= flicker of movement 
2= active movement (not against gravity)
3= active movement against gravity 
4= active movement against gravity and resistance
5= normal power

If you remember that 3 is movement against gravity then you can work up and down to figure out the rest

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19
Q

What reflexes do you test for in the upper limb?

A

Biceps
Triceps
Supinator

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20
Q

How do you test for the biceps reflex?

A

Find the biceps tendon

Strike the tendon hammer onto YOUR finger

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21
Q

How do you test for the triceps reflex?

A

Find the triceps tendon

Strike the tendon hammer on the patients skin directly

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22
Q

How do you test for the patient’s supinator reflex?

A

Find the tendon and strike the tendon hammer onto YOUR finger
Observe the brachioradialis muscle

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23
Q

What track is responsible for light touch?

A

Mainly dorsal column

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24
Q

What track is responsible for pin prick/ pain?

A

Spinothalamic tract

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25
What track is responsible for vibration?
Dorsal column
26
What track is responsible for proprioception?
Dorsal column
27
What signs are seen in Brown sequard syndrome and explain them? What is it?
Damage to half the spinal chord You will see ipsilateral motor weakness and loss of vibration and proprioception Contralateral loss of pain and temp This is because the spinothalamic tract crosses at the level of the vertebra (so lesion in the spinal cord causes contralateral signs) but the dorsal column crosses at the level of the medulla (so lesion in the spinal cord has ipsilateral effects)
28
What is mononeuropathy?
Loss of sensation in the area a nerve applies eg radial nerve
29
What is radiculopathy?
Sensory loss in area supplied by the nerve root eg C5 dermatome
30
What sensory loss will occur when there is spinal cord damage?
Sensory loss at and below the level of involvement
31
What type of sensory loss will occur if there is a thalamic lesion?
Contralateral sensory loss
32
What type of sensory loss will occur if there is peripheral neuroapthy?
Symmetrical sensory loss ie glove and stocking
33
What typically gives glove and stocking sensory loss?
Diabetic neuropathy | Chronic alcohol use
34
How do you test for sensation in the upper limb?
Close their eyes and say yes when they can feel something Touch C5, C6, C7, C8 and TI alternating between sharp end and blunt end or cotton wool
35
How do you test for vibration in the upper limb?
Use a 128 Hz tuning fork and vibrate it Place it on the most distal bony prominence ie interphalangeal joint of the thumb and ask the patient to close their eyes Stop the fork vibrating by touching it and ask the patient to tell you when it stops vibrating
36
What do you do if a patient is unable to identify when vibrations stop when testing for vibration in the upper limb?
Move the tuning fork up their arm and repeat ie from IPJ of thumb to wrist to elbow and see if they can tell at those joints
37
How do you test for proprioception in the upper limb?
First show the patient how you will move their thumb up and down with their eyes open and ask them to close their eyes and say when you move it up and down When moving their thumb hold it on the SIDES
38
What should you do if a patient fails the test for proprioception?
Move up their limb ie go from thumb to wrist to elbow and see if they can identify proprioception there
39
What 2 tests are done for coordination in the upper limb?
Rapid alternating movement test | Finger nose test
40
What does the rapid alternating movement test look for when examining the upper limb?
Cerebellar pathology Dysdiadokokinesia Also seen in MS
41
How do you ask he patient to do the rapid alternating movement test?
Ask them to hold out their left hand palm up and then slap their right hand onto it, then turn the right hand over and slap it on and keep going as fast as they can Then ask them to repeat with the hands the other way around
42
How do you do the finger nose test?
Ask the patient to touch their nose with their finger and then hold out your finger and ask them to touch their finger to yours. Get them to do this multiple times and move your finger around
43
What does the finger nose test look for? Explain it
Intention tremor- this is a tremor that gets worse as the patient approaches the object
44
How may a patient fail a finger nose test?
Intention tremor | Pass pointing- where they overshoot when trying to point to your finger
45
What pathology is a failed finger nose test suggestive of?
Ipsilateral cerebellar pathology (if tremor is only present on one hand) Bilateral cerebellar pathology (if tremor is present on both hands)
46
What acronym is used to remember clinical signs a patient with cerebellar pathology may have?
``` DANISH Dysdiadochokinesia Ataxia Nystagmus Intention tremor Slurred speech (dysarthria) Hypotonia (heel/shin test) ```
47
What is nystagmus?
Flickering eye movements in one eye
48
What additional tests might you want to do for the PNS aside from upper and lower limb exam?
Mini mental state exam | Assess gait and balance
49
What are some common gait abnormalities?
``` Ataxic Parkinsonian High stepping Waddling Hemiparetic Spastic paraparesis ```
50
What does cerebellar ataxia look like?
Legs far apart as they can't tell where they are/ poor balance
51
What does sensory ataxia look like?
Stomping on the ground as they can't really feel their feet
52
What does a Parkinsonian gait look like?
Shuffling and festinating gait (where they appear to shuffle in a rushed way) They may also freeze and get stuck
53
What is a hemiparetic gait?
One leg is stiff and so the other one swings around it in an arc
54
What usually causes a hemiparetic gait?
UMN lesion
55
What does spastic paraparesis look like? What might cause it?
Both legs are stiff so they have to swing around in arcs when walking Caused by a problem that affects both sides of the brain eg cerebral palsy
56
What senses are needed to maintain balance?
2/3: Proprioception Vision Vestibular function
57
How do you do Rombergs test?
Ask the patient to stand still and spot them by their sides with your arms and ask them to close their eyes and observe them
58
What is Romberg's test used to identify and how does it identify it?
It is used to identify if a patient has cerebellar or sensory ataxia Sensory ataxia= the patient will become wobbly when they close their eyes as they don't have proprioception so when vision is knocked out they are left only with vestibular function which is not enough to maintain balance Cerebellar ataxia= the patient will already be wobbly and will not get worse after their eye shuts as they do not have a sensory priblem
59
What may causes sensory ataxia?
Peripheral neuropathy B12 deficiency Diabetes Menieres
60
Where do you test for tone in the lower limb?
Hip Knee Ankle
61
How do you test for tone in the legs
Tell them to let their leg go floppy Flap their leg Lift their leg and the knee and let it drop Circumduct their ankle and then push it back for clonus
62
Where do you test for power in the lower limb?
``` Hip flexion Hip extension Hip abduction Hip adduction Knee flexion Knee extension Ankle dorsiflexion Ankle plantar flexion Big toe extension Big toe flexion ```
63
What reflexes do you test for in the lower limb?
Knee Ankle Plantar
64
How do you do the plantar reflex test on the lower limb?
Using a blunt object drag it from the ankle end to their toes on the lateral aspect of the foot
65
What is the normal and abnormal response to the plantar reflex?
``` Normal= toes move down Abnormal= big toe moves up and other toes fan out ``` Remember in babies the opposite is normal
66
What will you see on inspection of limbs in UMN lesion?
No fasciculations or wasting
67
What will you see on inspection of limbs in LMN lesion?
Fasciculations and wasting
68
What will happen to tone in UMN lesion?
Hypertonia
69
What will happen to tone in LMN lesion?
Hypotonia
70
What will happen to power in UMN lesion?
Reduced- usually pyramidal weakness
71
What will happen to power in LMN lesion?
Reduced
72
What will the plantar reflex be in UMN lesion?
Up going plantars (babinski +ve)
73
What will the plantar reflex be in LMN lesion?
Normal plantars
74
How do you test for sensation in the lower limb?
Fine touch with cotton wool in dermatomes | Pin prick test (alternate sharp and blunt)
75
How you test for vibration in the lower limb?
128 Hz tuning fork in IPJ of big toe and stop and ask them to tell you when it stops
76
How you test for proprioception in the lower limb?
Get them to close their eyes and hold their big toe on the sides with your fingers, move it up and down and tell them to tell you when you do so
77
How do you test for coordination in the lower limb?
Heel shin test, ask them to bend their leg at the knee and bring their right heel on their left knee and then run it down their left shin and back up to the knee etc and repeat the other way around
78
Why may a patient fail the heel shin test?
``` Cerebellar pathology (more likely if their power was normal) Weakness in legs ```

Year 3 (104 decks)

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