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NEURO OSCE Tests 1 Flashcards

1
Q

Level of Consciousness

A
  • Test steps
  • Consciousness: brainstem, hemispheres, thalamus

Causes:
-toxic metabolic, focal lesion, dementia, encephalitis, behavioural or mood

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2
Q

Glascow Coma Scale

A

-Test

Decorcitate:

  • cerebral hemispheres, internal capsule, thalamus
  • corticospinals cut, rubrospinals unaposed = dystonia

Decerebrate:
-brainstem, more serious

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3
Q

Memory

A

Recent n Remote
-Lymbic system damage: anterograde amnesia n short retrograde just prior accident

Declarative
-Medial temporaal lobes n diencephalon

Info -> Brainstem n Diencephalon -> Frontal association cortex (working memory) -> Temporal lobe n Diencephalon (consolidated) -> various cortical areas

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4
Q

Attention n Orientation

A

Attention: 5 tests
-focal lesion, dementia, encephalitis, behavioural, mood

Orientation: person, place, time

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5
Q

Language

A

Spontaneous speech
-fluency, rate, errors, abundance, invented words

Comprehension: 3 tasks

Left hemisphere:

  • frontal , temporal, parietal lobes
  • Wernicke’s, Broca’s
  • thalamus, caudate nucleus

Abnormal speeches

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6
Q

Gerstmann’s Syndrome

A
  • Acalculia
  • R-L confusion
  • Finger agnosia
  • Agrapghia
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7
Q

Apraxia

A

-Miming task

  • Test
  • Theory
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8
Q

Neglect n Construct

A
  • Visual neglect
  • Tactile neglect
  • Sensorimotor neglect
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9
Q

Sequencing n Frontal Release

A
  • Manual alternating sequence
  • Grasp reflex
  • Sucking reflex
  • Snout reflex
  • Palmomental
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10
Q

Logic n Abstract

A
  • Proverbs

- Analogies

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11
Q

Abnormal Thought Process

A
  • compulsions
  • obsessions
  • phobias
  • anxiety
  • delusions (of persecution, grandeur, jelousy)
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12
Q

Mood

A
  • Facial expression
  • Body language
  • Voice

Euthymic : normal
Dysthymic : depressed
Manic : elated

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13
Q

Olfactory Nerve Test

A

Object smelling

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14
Q

Optic Nerve Testing

A
  • Ophthallmoscopy
  • Pupillary light reflex
  • Convergence n Acomodation
  • Visual acuity
  • Visual field
  • Colour vision
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15
Q

Extraocular Muscles

A
  • Eye movements
  • Smooth pursuit
  • Saccades
  • Optokinetic nystagmus
  • Oculocephalic testing
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16
Q

Tests for Trigeminal nerve

A
  • Facial sensation
  • Corneal reflex
  • Mastication muscles
  • Jaw jerk reflex
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17
Q

Facial expression n taste

A
  • Facial muscles

- Taste

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18
Q

Hearing n Vestibular

A
  • General hearing

- Otoscopy

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19
Q

Passive Neck Flexion

A

-protocol

  • Brudzinski - meningitis -flex neck = reflex flex knees
  • Lhermitte’s sign -electric shock from neck flexion
  • Indication: spinal symptoms
  • Normal: pulling sensation
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20
Q

Straight Leg Raise

A

-OG

  • Tibial
  • Sural
  • Peroneal
  • Well leg

-pain post thigh, knee, calf
—-straightening of neural slack—|30|—dural sleeves L4-S2 roots mechanically loaded—|70|—hamstrings, Gmax, hip, lumbar, SIJ

Kernig’s sign: flex hip n knee to 90 90, then try to extend knee
-resistance or pain is ++

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21
Q

Prone Knee Bend

A

OG
-quad pain, tight is normal

  • Femoral
  • Lateral femoral cutaneous (meralgia paresthetica, passes under inginal lig, obesity, pregnancy, tool belt)
  • Saphoneous (adductor/hunter cana, medial knee n leg pain on walking, standing)

Indications: kneeling issues, knee, ant thtigh, hip, lumbar symptoms

+ : U/L lumbar pain, buttock, post thigh pain

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22
Q

Slump

A
  • OG
  • Obturator (supplies adductors)

-Hands behind -slump -neck -push -leg -dorsiflex -desensitize

  • nerve roots, dural sheath
  • pain T8/9, hamstring, post knee pain
  • Indication: spinal symptoms, pain getting in car or kicking
23
Q

Median Nerve

A
  • pistol grip thumb, index, middle fing
  • depress shoulder - abduct - supinate - extend wrist n fingers - extend elbow - sensitizing neck
  • Indicated if any arm, neck, thoracic symptoms

Positive if:

  • reproduce pain symptoms
  • reproduce neuro symp
  • diff to normal side
  • in your experince abnormal

Loads all brachial plexus

24
Q

Radial Nerve

A

Depress shoulder - extend elbow - abduct - pronate - flex wrist n fingers - ulnar deviate - abduct more - sensitize w neck

Positive if:

  • reproduce pain symptoms
  • reproduce neuro symp
  • diff to normal side
  • in your experince abnormal
25
Ulnar Nerve
- Tunnel of Guyon - scap on table Depress shoulder - wrist n fing - pronate - flex elbow - abduct - externaly rotate - sensitize neck Positive if: - reproduce pain symptoms - reproduce neuro symp - diff to normal side - in your experince abnormal
26
Opthalmoscopy
- dark room - large scope light n 0 lens setting - ask pt to focus on one point ahead - scope against my orbit - 30cm n 15 degrees from midline - Find RED LIGHT REFLEX, follow it in - Find DISC n refocus - my Thumb on their eyebrow - REPORT disc: sharp outline, white-yellow cup, cup-disc ration 0.3 - Trace arteries n veins. Report: A- bright red, small; V-dark red, big - refocus to 10 n observe ant. chamber opacities - pt look into the light - report fovea n macula
27
Pathway of the pupillary light reflex
Optic N. -> Chiasm -> Optic Tract -> most* Thalamus LGN * But also -> Superior Colliculus Brachium -> Pretectal area -> Edinger Westphal Nuclei -> Parasympathetic Preganglionics - Oculomotos N. -> Ciliary Ganglion -> Postganglionics -> Pupil Constrictor Muscles
28
What does convergence? And accommodation?
Convergence: Oculomotor GSE Accomomdation: Oculomotor GVE
29
Visual acuity
- Snellen eye chart - pt distance / number assigned to line they can read Bad eye first
30
Colour vision
A) Red desaturation - optic neuritis if acute change - red will look faded if optic n. Damage - compare L n R B) Ishihara Charts
31
Visual Fields
- block opposite eye to pt. - stare into each others eyes - finger EQUIDISTANT pt n Dr - come from 4 directions - « tell me when you see my finger » - I am the baseline -can do other way without me as baseline
32
Eye movements
- oculomotor n - trace H, passing by middle each time - one eye - other eye - both at once
33
Smooth pursuit
- trace X - passing by middle each time - one eye - other eye - both at once
34
Saccades
- hold 2 separate fingers - have pt alternate (keep head still) - horizontal - then vertical
35
Oculocephalic testing
Brainstem injury = doll’s eyes
36
Facial sensation
GSA of trigeminal N.
37
Corneal reflex
Tigeminal is sensory Facial is motor - warm pt of what will happen - note asymmetry
38
Mastication
- SVE trigeminal N. | - jaw deviates to week side
39
Causes of Jaw Jerk reflex
- abnormal is hyper-refexia | - UMN lesion
40
Facial Expression
-Facial SVE - Smile -> zygomatic n lavator ang ori - Wrinkle forehead -> frontalis - Squeeze eyes n resist -> orbic oculi - Whistle -> buccinator, orbic ori - Blow cheeks -> buccinators - Show teeth -> orbic oris - Platysma muscles UMNL: C/L week except for forehead (bc B/L bulbar innervation) LMNL: I/L whole face week
41
Taste
Facial SVA
42
Otoscopy
TECHNIQUE: - hold like a pen - R ear R hand R eye - Pinky out on temple - AT, not IN canal STEPS: - warn pt of cough, tickle - attach speculum - good ear 1st - pt on corner couch - adjust table height - pt C/L at flex n ext slight - pull pinna up n back, rest on mastoid - Report canal inflam, excess wax n hair - Report eardrum: shiny, pearl gray, translucent, bulldge or retracted - Report annulus - no fluid, bubbles, perforations
43
Abnormal thought processes
- compulsions, obsessions, phobias, anxiety - delusions of persecutions, grandeur, or jelousy Caused by: - toxic metabolic - psychiatric - focal lesion, seizure
44
Manual Alternating Sequencing
Draw tiangles n squares: perseveration Luria Manual Sequence Task: abulia (slow)
45
Neglect
R lobe lesion -> neglect left arm L lobe lesion -> minimal effect
46
Gerstmann’s Syndrome
- Left parietal angular gyrus lesion | - might also have aphasia, language, praxis, construction, logic, abstraction issues
47
Abnormal Speaches
- hesitancy - monotone - circumduction - paraphasias - brocas aphasia - wenickes aphasia - incoherence - blocking - confabulation - perseveration - echolalia - clanging - circumstantiality - derailment - flight of ideas - neologisms
48
Hesitancy
Stroke , brocas aphaia
49
Circumlocutions
Substitute forgotten word with its definition
50
Paraphaia
Malformed, wrong or invented words
51
Brocas aphasia vs wenickes aphasia
Broca: cant express Wernicke: talks easy but wrong sense n words
52
Well leg raise
-nerve root on C/L side is pulled toward midline -> medial disc protrusion -> pain on C/L leg
53
Prone knee bend - Saphenous nerve bias
-prone extend n abduct hip - >externaly rotate hip - >dorsiflex n evert

Neuromusculoskeletal Diagnosis (4 decks)

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