Neuro Std Exam Liza Flashcards
(116 cards)
0
Q
sensory processing is which lobe
A
Parietal lobe
1
Q
which lobe is behavior, judgmnt, mood, motor cortex, Broca’s motor language
A
Frontal love
2
Q
Auditory processing, memory, Wernicke’s lang comprehension, hearing, taste, smell
A
Temporal lobe
3
Q
Vision, visuospacial
A
Occipital lobe (back)
4
Q
Relays visual, auditory, sensation but NOT motor pathways
A
Thalamus
5
Q
precentral gyrus is
A
Motor
6
Q
postcentral gyrus is
A
sensory area
7
Q
What is included in examination
A
cognition language vision sensory processing movements and tone gait
8
Q
automated movements are
A
Basal ganglia
9
Q
Primary sensory relay
A
Thalamus
10
Q
Brainstem consists of
A
Midbrain, pons, medulla
11
Q
Cranial nerves, sleep wake centers, breathing, descending motor tracts, ascending sensory tacks are contained in
A
Brainstem
12
Q
Coordination, balance/equilibrium and smoothness movement is
A
Cerebellum: sends track to midbrain from spinal cord and pons
13
Q
Brainstem exam is made of
A
assess cranial nerves, gait and cerebellar fx (coordination and smoothness of movement)
14
Q
Where is cardio-respiratory center located in the brain?
A
Brainstem
15
Q
Where are cranial nerve nuclei are located
A
Brainstem
16
Q
Where are ascending and descending tracts located
A
brainstem
17
Q
Spinal cord starts at C1 and ends at
A
T12-L1
18
Q
Injury above which vertebra is not compatible with life?
A
above C5
19
Q
meylopathy definition
A
disease of spinal cord
20
Q
Which tracts transmit sensory info to the CNS/brain?
A
- Spinothalamic tract (spinal cord to thalamus)
- posterior columns
21
Q
transmission of motor into from CNS/brain is throug
A
Conticospinal tracts
extrapyramidal tracts
Cerebellar tracts
22
Q
Which tract carries voluntary motor movement?
A
Corticospinal tract
23
Q
Where does UMN (Upper Motor Neuron) cross to contralateral side?
A
at medulla, UMN dessicates and goes to contralateral side (sx manifests on opposite side)
24
Where does UMN (upper motor neuron) originate?
In Pre-Central gyrus (responsible for motor cortex)
25
If have a lesion in precentral gyrus on left side, it will manifest itself on opposite side
did I get this right?
26
??????????? So conticospinal tract dessicates at medulla and fibers cross to contra-lateral side but continue to descend IPSILATERALLY (to sypanse with anterior horn)
??????????? ask if that's correct and if lesion is on the left side above medulla, how will it manifest in real person?
27
tract that carries **light touch, pain, temp, pressure** is
** spinothalamic tract**
28
**tract that carries vibration, proprioception and discriminative touch** is
**Posterior Columns**
29
!!! what is characterised by increased tone (spascity), "stiff man" gait, elevated reflexes, proprioceptive changes (posterior column), positive Romberg sign and crossed findings (sensory and motor) and also by sensory levels?
Myeolopathies
30
Due to dessication at medulla
have sensory deficit on one side and motor on the other
31
Meylopathies are characterized by
!!! increased tone (spascity), "stiff man" gait, elevated reflexes, proprioceptive changes (posterior column), positive Romberg sign and crossed findings (sensory and motor) and also by sensory levels!!!!
32
Spinal Cord/Meylopathy exam includes
gain, Romberg, reflexes and tone
33
Optic nerve is
CNII
34
Hypoglossal nerve is and responsible for
CN XII: tongue movement
35
Trochlear
CNIV: eye movement of SO Superior Oblique
36
Facial
CNVII: facial motor and some taste
37
Glossopharyngeal
CN IX: soft palate
38
Spinal Accessory
CN XI: motor to trapezius
39
Trigeminal
CNV: sensation and taste
40
Abducens
CNVI: eye movement LR (lateral rectus)
41
Acoustic/Vestibulocochlear
CNVIII: hearing and balance
42
Vagus
CNX: soft palate, voice, swallowing
43
Oculomotor
CNIII: eye movement of IO, SR, IR, MR
44
Olfactory
CNI: smell
45
Optic
CNII: vision
46
Myopathy
disease of muscle
47
What has ***proximal distribution*** (what is that?)
muscle disease
| like in muscular dystrophy
48
What are the elements of the muscle/motor exam:
***bulk, strength, tone***
49
**Proximal weakness and fatigability that is improved with rest** is a characteristic of what disease?
dz affecting Neuro Muscular Junctions (NMJ)
50
Whats in NMJ exam?
*** check strength of certain muscles and for fatigability (e.g., ptosis)***
51
**peripheral neuropathy**
dz affecting peripheral nerves
52
Peripheral neuropathy/Nerve exam:
*** light touch, pin prick, vibration, proprioception and muscle strength***
53
Most important nerves in upper extremety
median, ulnar, radial, musculocutaneous, axiallary
54
Most impt nerves in lower extremity
femoral, obturator, sciatic, tibial and peroneal
55
Brachial plexus is at
**C5-C8**
| congregation of roots exiting at above
56
lumbarsacreal plexus
congregation of **L3-S1** roots
| in pelvis
57
What are plexopathies characterized by
*** loss of reflexes, widely distributed weakness and multifocal numbness with or without pain
58
what is the cause of most plexopathies?
*** compression or infiltration***
59
Plexopathy exam
** strength, motor, reflexes **
60
radiculopathy is
dz of the root
61
most rediculopathies are cause by
** complression or other mechanical causes **
62
*** which cervical root innervate upper extremities? ***
*** C5-C8 ***
| injury can cause pain, focal weakness, loss of reflexes, motor issues
63
*** which lumbarsacrial roots innervate lower extremeties? ***
L3-S1
64
31 pairs of spinal nerves
```
cervical 8,
thoracic 12
lumbar 5
sacral 5
coccygeal 1
```
65
what is frequently mistaken for neuropathy and how to distinguish?
radiculopathies (by careful exam)
66
Root/radiculopathy exam
strength, sensation, reflexes
67
lumbar radicular pain/ sciatica
look at slide!! memorize!
68
Mental Status exam
** behavior, oriented to person/place/time, level of consciousness **
-begins when you first meet the person
-formal MSE only when deficit:
score <24 is dementia
establish baseline and monitor progress
69
Brief Mental Status Exam
```
JOMAC
Judgement
Orientation
Memory
Affect
Cognition
```
70
Levels of consciousness
Alert, lethargic, stuporous, comatouse
| -responsive or not
71
Mental status exam of memory
Recent: check recall of 3 words after one minute
remote: ask about well known events, dates locations (name of president, capital of france)
72
CN exam Optic CN II
```
visual acuity (eye chart)
visual fields (H)
funduscopic exam (direct exam of CNII)
```
73
Exam of CNIII
Extra Ocular Movements: IO, SR, IR, MR
direct and consensual pupillary responses
Eyelid elevation: ptosis
EOMS: H for CN4 and 6: check for conjugate gaze and nystagmus
74
Trigeminal CN V (three)
1) Facial sensation/light touch (check frontal, maxillary, mandibular areas)
2) Corneal reflexes (cotton to cornea):
CNV - afferent (sensation TO brain)
CNVII - efferent (motor from brain)
3) Muscles of mastication:
Temporalis and masseter
75
Facial Nerve exam (CN VII)
- m of facial expression (raise eyebrows, frown?? smile, puff out cheeks, close eyes against resistance):
Central v peripheral VII lesion (what about it??)
- Taste
- efferent corneal reflex (motor from brain)
76
Acoustic N exam (CNVIII vestivulocochlear)
- hearing: whisper/rub fingers
| - Weber and rinne testing (test sensorineural v conductive hearing loss)
77
Glossopharyngeal exam CN IX (with Vagus X)
- say ah, palate elevation - check for symmetry (vagus)
- gag reflex
- swallowing ?
78
spinal accessory nerve (CNXI) exam
shrug your shoulders against resistance (and move head right to left?):
eval SternoCleidoMastoid and trapezius
79
Hypoglossal CN XII exam
Stick your tongue out and move side to side
80
?????? do we need to know all spinal root nerves for upper and lower extremities exams ??????
???? ask prof ?????
81
1) Pronator Drift tests
| 2) Romberg tests
1) Pronator - tests upper extremety motor fx
| 2) Romberg - test dorsal column fx and in some measures sensation in feet
82
Pronator drift test
- arms extended out/forward and palms up (supinated) for 20-30 secs with eyes CLOSED: watch for pronation of arm and drift down
- used to detect subtle contralateral upper motor neuron lesions (weakness due to CVA)
83
Robberg test
stand with feet together with eyes open and then closed for 20-30 sec.:
- tests position sense (dorsal column and some sens in feet)
- stand close in case they fall
- loss of balance = (+)
- *** check Romberg BEFORE GAIT to avoid fall ***
84
Sensory exam
- is done in RANDOM fashion on pts without specific sensory complaints
- all tests done with eyes closed
- check sharp vs dull, keep dermatomes in mind
85
Thumb, middle fingers, 5th digit
* Thumb C6
mid fingers C7
5th digit C8
86
Anterior thigh, anterior shin, top of foot, bottom of foot
Ant thigh - L3
Ant shin - L4
top of foot - L5
bottom of foot - S1
87
Nipple line
T4
88
Umbilicus
T10
89
Proprioreceptor exam
- move pt's thumb/toe up and down, ask which direction, eyes closed
- make sure to hold *SIDE* of digit
90
Corticosensory exam
2 pnt exam, hold like chopstick
91
Stereognosis
ask to id common object places in hand: key, coin
| cortical sensory
92
Graphesthesia
draw a number (0-9) on palm facing pt (eyes closed) and dorsum of foot
(cortical sensory specialized)
93
Tactile localization
aka "extinction" or "double simultaneous stimulation"
| - sim. touch 2 separate sites on Opposite sides and ask what is felt
94
1, 2 (S 1, 2)
Achilles reflex
95
3, 4 (L!!! 3, 4)
Patellar reflex
96
5, 6 ( C5, 6)
Biceps reflex
97
7,8 (C7, 8)
Triceps reflex
98
Clonus
seen with hyperactive reflexes, with UMN dz
- rhythmic oscillations between plantar and dorsiflexion
- 4+ on reflex scale
99
Brachioradialis
C5-C6 (like bicept) but tap lower arm: 1-2 inches above WRIST!!! (although the muscle is in upper arm)
100
reflex scale
```
0 no response
1+ diminished
2+ normal
3+ increased
4+ hyperactive, with CLONUS
```
101
Jendrassik's maneuver
reinforcement technique if difficulty getting reflexes:
UE - grit teeth
LE - isometric exercise
102
Babinski reflex
stroke lateral part of plantar foot upwards and then across the ball of the foot:
abnormal : dorsiflexion of great toe and fanning of other toes
(normal in babies)
103
Cerebellar exam
- test coordination of movement, balance and equilibrium
| - finger to nose
104
** Heel to Shin **
- cerebellar exam (bilateral)
| - slide heel of one foot down shin of other leg ***SLOWLY AND SMOOTHLY***; repeat; then switch legs
105
**Rapid Alternating Movements** (RAMs)
- rapid pronation supination of forearms
- touch fingertips to thumb
- tap feet
106
**Dysdiadochokinesia**
inability to do RAMs
107
if slow but regular RAMs, which part of brain is impaired?
Cerebral dysfx
108
if fast but irregular
cerebellar dysfx
109
Heel walk gait
L5 integrity
| Cerebellar test
110
Heel-to-toe (tandem gain)
avoid if (+) Romberg
111
Toe walk
S1 integrity
112
** Kernig's sign **
pt supine, flex hip and knee, then straighten the leg:
| LPB (low back pain)= (+) Kernig's
113
** Brudzinski's Sign **
pt supine, place your hands behidn the pt's neck and flex neck toward chest:
involuntary flexion of hips and knees = (+) meningitis irritation
114
10 minutes neuro exam
Must know?? check last few slides
115
Stiff man gait is a sign of
Myelopathy
Also increased tone and reflexes
