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Pt Assess II Final > Neuro Lecture > Flashcards

Flashcards in Neuro Lecture Deck (75)
1

Elements of complete neuro exam

Mental status
CNs
Motor and sensory
DTRs
Cerebellar
Gait
Special tests

2

What must first be established in neuro exam?

Patient's dominant hand

3

R handed people are ___ brain for speech

Left

4

75% of L handed people are ___ brain for speech

Left

5

Mental status exam consists of:

-Level of consciousness
-Appearance (dress, affect, hygiene)
-Orientation (to person, date, place)
-Language (quality, comprehension)
-Concentration (serial 7s, WORLD backwards)
-Calculation (17+12)
-Recall (3 objects in 3 mins)
-Current events

6

What tool can be used for the mental status exam? What does it test?

Folstein MMSE
-Orientation
-Registration
-Calculation
-Recall
-Language

7

CN I testing:

-Patency of each nostril
-Odor test

8

CN II testing:

-VA then VF
-Funduscopic exam
-PERRLA

9

CN III, IV, VI testing:

EOMs with the H test

10

CN V testing:

-Pin and light touch on ophthalmic, maxillary and mandiublar divisions
-Motor test (jaw jerk should be absent, ask patient to chew to test masseter and temporalis muscles)

11

CN VII testing:

-Show teeth
-Squeeze eyes shut
-Wrinkle forehead

12

What is Bells phenomena?

Patient closes eyes and the eye on the SAME side as the peripheral facial weakness will NOT close (but eye rolls superiorly)

13

Central facial weakness occurs with what disorder?

Stroke

14

Peripheral facial weakness occurs with what disorder?

Bell's palsy, acoustic neuromas

15

Central facial weakness spares:

Forehead and eye closing

16

CN VIII testing:

Hearing, Weber and Rinne

17

CN IX and X testing:

-Say ahh watch uvula (deviates to strong side)
-Test gag reflex

18

CN XI testing:

-Shrug shoulders (trap)
-Turn head against resistance (SCM)

19

CN XII testing:

Stick out tongue (deviates to weak side)

20

What is upper motor neuron weakness characterized by?

-Increased tone/spasticity
-Increased reflexes
-Minimal or no atrophy
-No fasciculations
-Positive Babinski

21

What is lower motor neuron weakness characterized by?

-Decreased tone
-Flaccidity
-Absent or hyporeflexia
-Atrophy and fasciculations
-Absent Babinski

22

What is upper motor neuron disease often a result of?

Stroke or brain injury

23

What does lower motor neuron disease involve?

Can involve spinal cord, peripheral nerve, or muscle

24

UE motor testing:

-Pronator drift
-Deltoids (C5)
-Biceps (C5, C6)
-Triceps (C6, C7)
-Wrist extensors (C6, C7 stop traffic)
-Wrist flexors (C6, C7)

25

LE motor testing:

-Hip flexion (L2, 3)
-Adduction (L2-4)
-Abduction (L4, 5)
-Knee extension (L3, 4)
-Knee flexion (L5, S1)
-Dorsiflex foot (L4, 5)
-Plantar flex (S1)
-Extension of great toe (L5)
-Extension of remaining toes (L5, S1)

26

Strength grading system of motor exam

0 = no movement
1 = trace/flicker of movement
2 = able to move when gravity is eliminated
3 = able to move against gravity
4 = some weakness against resistance
5 = normal strength (able to move against resistance)

27

What strength grades are considered functional movement?

Above 3/5
(so 4/5 is weakness but some function preserved)

28

Sensory exam consists of which tracts?

-Spinothalamic tract (pain and temperature)
-Dorsal (posterior) column (position sense and vibration)

29

L5 sensory =

Lateral portion of lower leg and great toe

30

S1 sensory =

Lateral portion of top and sole of foot

31

Dermatome of the shoulders

C5, C6
T1

32

Dermatome of inner upper arms

T1

33

Dermatome of nipple level

T4

34

Dermatome of umbilicus

T10

35

Dermatome of groin

L1, L2

36

Dermatome of knee

L4

37

Dermatome of posterolateral thigh

S1

38

Dermatome of upper anterior thigh

L3

39

Dermatome of lateral thigh crossing to anterior lower leg

L5

40

Dermatome of great toe

L5

41

Dermatome of little toe

S1

42

Dermatome of posteromedial thigh

S2

43

Describe position (proprioception) test

-Test distal most portion of an extremity (finger or toe)
-Move up and down with lateral contact points

44

How to test vibration sense?

-Use 128 tuning fork
-Test over bony prominences

45

Define graphesthesia

-Test of discriminatory sense
-Draw number in patient's palm and have them identify

46

Define stereognosis

-Ability to identify touch alone
-Put an item in palm of pt's hand and ask them to identify (e.g. key, coin, paper clip)

47

Define 2 point discrimination

-Ability to identify 2 separate stimuli that are close together
-Use EKG calipers
-Ask pt if 1 or 2 pins

48

Define extinction and what may cause it

-Patient "extinguishes" 1 of 2 simultaneous contralateral stimuli
-Lesions in sensory cortex

49

What does the Romberg test assess?

Position sense NOT cerebellar function

50

Define ataxia

Loss of coordination

51

What 3 senses are required to keep us upright and balanced?

-Vision
-Equilibrium (semicircular canals)
-Proprioception (position sense)

52

How many of the 3 senses required for balance do you need to maintain balance?

2 of the 3 need to work
(remove 2 of the 3 and you will fall over - vision, equilibrium, proprioception)

53

What symptom will patients with disequilibrium complain of?

Vertigo/dizziness

54

If a patient "passes" the Romberg test, what is it called?

ABSENT Romberg (NOT negative)

55

What do the deep tendon reflexes test?

Simple spinal reflex (even deeply comatose pts may have preserved DTRs)

56

Grading of DTRs

0 = no reflex
1 = hyporeflexia
2 = normoreflexia
3 = hyperreflexia
4 = marked hyperreflexia (clonus)

57

Reinforcement techniques of DTRs

-Used to "coax" diminished reflexes
-For LE, pt curls fingertips together in front of themselves and pulls in oppo directions
-For UE, pt clenches jaw

58

How to use reflex hammer for DTRs?

-UE use pointy portion (smaller tendon target)
-LE use wider portion (wider tendon target)

59

UE DTRs

-Biceps
-Triceps
-Brachioradialis

60

LE DTRs

-Patellar
-Achilles

61

What else do we check when doing LE DTRs?

Babinski
-Stroke along lateral aspect of sole and then across
-POSITIVE (abnormal) is if great toe moves upward
-ABSENT (normal) is if great toe moves down

62

What are the superficial reflexes?

-Superficial abdominal
-Cremasteric (men only)

63

Describe superficial abdominal reflexes

Stroke 4 quadrants lightly and umbilicus will move toward the stimulus

64

Describe cremasteric reflex

-Men only
-Stroke inner upper thigh and ipsilateral testicle will move rostrally (superiorly)

65

What does cerebellar testing assess and what does it consist of?

-Tests coordination
-Rapid alternating movements (RAMs)
-Finger nose finger (FNF)
-Heel knee shin (HKS)

66

How to assess gait?

-Normal walking
-Heels (brings out AT)
-Toes (brings out gastroc)
-Tandem

67

Glabellar sign

-Tap between eyebrows
-Pt eyes blink rhythmically (abnormal)

68

Grasp reflex

Just like babies reflex but is pathological in adults

69

Palmomental reflex

Scratch palm and patient will purse lips (may be very subtle)

70

Snout reflex

Tap mouth and pt will purse lips

71

Asterixis

Flapping tremor of the hands seen in liver disease

72

Kernig's sign

-Flex hip and knee
-Straighten knee
-Pt will resist and note pain behind knee
-Pain is the telling sign

73

Brudzinski sign

Flex neck and patient will draw up hips and knees

74

Describe Babinski reflex

-Briskly stroke lateral surface of sole and go across MT heads
-Absent (normal) is great toe to flex (move down)
-Positive (abnormal) is great toe to extend (move up)

75

What are you looking at to assess Babinski reflex?

Only the FIRST motion of the big toe determines absent or positive Babinski