Neurological diagnosis

Question 1

direct light reflex, indirect light reflex

Answer 1

tests cranial nerves II and III
when the light is shined in one eye, CN II sends the signal to the brain and CN III sends the signal to constrict the pupil
CN III on the other side also sends the signal to constrict the other pupil

Question 2

L -< (o) (O) R
L (o) (o) >- R
Describe what is happening.

Answer 2

since the light is being shown in the left eye, we can say that CN II and CN III is working in the left eye.
since the pupil on the other side did not constrict when the light was on the left but did on the right, we can say that CN III is not working properly.

Question 3

L -< (o) (o) R

L (o) (O) >- R

Answer 3

when the light is shown in the left eye, both pupils constrict, which means that CN II and III are working on the left and CN III is working on the right
when the light is shown in the right eye, the right eye doesn’t constrict, but the left one does, which means CN II isn’t working on the right side.

Question 4

Six cardinal fields of gaze

Answer 4

in reference to the right eye: lateral rectus moves the eye laterally, which is innervated by CN VI, superior oblique moves the eye down and medial, which is innervated by CN IV, and the rest are innervated by CN III which are: the inferior oblique moves the eye upward and medial, the inferior rectus brings the eye down and lateral, the superior rectus brings the eye up and lateral, the medial rectus brings the eye medially, and the levator palpebrae lifts the eyelid

Question 5

sensory test for CN V (face)

Answer 5

have patient close their eyes, touch forehead, cheekbone and chin with cotton wisp and ask the patient to say yes when they can feel you touch their face
general sensation to the anterior 2/3 of the tongue

Question 6

corneal reflex

Answer 6

touch cornea with cotton wisp, eye will blink or tear

problem with CN V or CN X if this is not achieved

Question 7

oculocardiac reflex

Answer 7

press on closed eye and heart rate decreases

problem with CN V or CN X if this is not achieved

Question 8

tic douloureaux

Answer 8

extreme, sporadic, sudden burning or shock-like face pain that lasts anywhere from a few seconds to as long as 2 minutes per episode. lightening like, excruciating pain is repetitive, occurring several times per day. pain is typically felt on one side of the jaw or cheek
usually a result of dental work

Question 9

jaw jerk reflex

Answer 9

the mandible is tapped with hammer and masseter draws the jaw upward

Question 10

muscles of mastication

Answer 10

TIME
masseter
external pterygoid
internal pterygoid
temporalis

Question 11

sensory for CN VII

Answer 11

taste to anterior 2/3 of tongue (sweet, sour, salty)

Question 12

motor for CN VII

Answer 12

muscles of facial expression

Question 13

Bell’s palsy

Answer 13

unilateral facial paralysis caused by trauma, virus or immune mediated response and is not permanent. initial pain behind the ipsilateral ear, twitching, weakness or paralysis, drooping eyelid, drooping corner of mouth, drooling, dry eye, and impairment of taste

Question 14

bell’s palsy vs stroke

Answer 14

bell’s: LMNL of CN VII, ipsilateral motor loss of entire face, forehead does not wrinkle
stroke: UMNL of CN VII, contralateral motor loss below eye, forehead does wrinkle

Question 15

CN VIII sensory

Answer 15

vestibular: balance, mittelemeyer and romber’s. barany caloric test
cochlear: hearing, weber and rinne

Question 16

endolymphatic hydrops/central vertigo

Answer 16

meniere’s disease
cause is unknown, but probably results from an abnormality in the fluids of the inner ear. symptoms are episodic rotational vertigo, hearing loss, tinnitus, and fullness in the ear

Question 17

sensory CN IX

Answer 17

gag reflex and uvula reflex (CN IX afferent, CN X efferent (stroke uvula)
carotid reflex (CN IX afferent, CN X efferent) massage carotids and heart rate drops
taste to posterior 1/3 of tongue (bitter)

Question 18

motor CN IX

Answer 18

stylopharyngeus muscle elevates pharynx and larynx, dilates pharynx to permit swallowing

Question 19

sensory CN X

Answer 19

epiglottis and laryngeal muscles of swallowing (palate, pharynx, contracting muscles

Question 20

motor CN X

Answer 20

gag reflex and carotid reflex

uvular reflex: palate and uvula deviate to opposite side of lesion when patient says Ahhh

Question 21

CN IX

Answer 21

trapezius and SCM muscles: shoulder shrug (traps) and lateral flexion with head rotation (SCM)

Question 22

wry neck

Answer 22

torticollis

spasm of SCM muscle

Question 23

CN XII

Answer 23

tongue muscles: stick out tongue. deviation to side of lesion

Question 24

graphesthesia

Answer 24

with patient’s eyes closed the doctor draws a letter in the patient’s open palm and asks them to identify the letter. repeat on the other side

Question 25

sterognosis

Answer 25

with the patient's eyes closed the doctor places a familiar object into the patient's open palm and asks them to identify it. repeat on other side

Question 26

how do you tests reflexes (generally)?

Answer 26

bilaterally, starting with normal side first

Question 27

bicep nerve and nerve root

Answer 27

C5

Question 28

brachioradialis nerve and nerve root

Answer 28

C6

Question 29

triceps nerve and nerve root

Answer 29

C7

Question 30

patellar nerve and nerve root

Answer 30

L4

Question 31

medial hamstring nerve and nerve root

Answer 31

L5

Question 32

Achilles nerve and nerve root

Answer 32

S1

Question 33

``` UMNL: definition paralysis DTR path reflex clonus tone reaction of degeneration atrophy fasciculation superficial reflexes ```

Answer 33

``` lesion of the brain and spinal cord not including the anterior horn cells spastic hyperactive present present hypertonic absent absent absent absent ```

Question 34

``` LMNL: definition paralysis DTR path reflex clonus tone reaction of degeneration atrophy fasciculation superficial reflexes ```

Answer 34

``` lesion of the anterior horn cells out to the myoneural junction flaccid hypoactive/absent absent absent hypotonic present present present present ```

Question 35

ciliospinal reflex

Answer 35

pinch neck wile noting dilation of the eyes sensory from neck cervical sympathetics

Question 36

oculocardiac reflex

Answer 36

press on eye, note slowing of the heart by 10BPM CN V CN X

Question 37

carotid sinus reflex

Answer 37

press on carotid sinus note slowing of heart and decreased pressure CN IX CN X

Question 38

conditions of UMNL

Answer 38

``` meningitis MULTPLE SCLEROSIS cerebral palsy CVA BRAIN TUMOR ALS (lower extremity) ```

Question 39

conditions of LMNL

Answer 39

``` SUBLUXATION MYASTHENIA GRAVIS DISC PROTRUSION polio bell's palsy ALS (upper extremity) ```

Question 40

babinski

Answer 40

stroke up lateral aspect of foot to great toe | dorsiflexion of great toe with slaying of other toes

Question 41

chaddock

Answer 41

stroke down lateral malleolus to 5th toe | dorsiflexion of great toe with slaying of other toes

Question 42

oppenheim

Answer 42

stroke down tibial crest to ankle | dorsiflexion of great toe with slaying of other toes

Question 43

Gordon's calf

Answer 43

squeeze calf below knee | dorsiflexion of great toe with slaying of other toes

Question 44

schaefer

Answer 44

squeeze Achilles tendon | dorsiflexion of great toe with slaying of other toes

Question 45

rossolimo

Answer 45

tap ball of foot | plantar flexion of great toe with curling of the other toes

Question 46

hoffman

Answer 46

examiner extends middle phalanx and flicks distal phalanx inferior flexion and adduction of the thumb and flexion of the fingers

Question 47

tromner

Answer 47

examiner sharply taps the tips of the middle 3 fingers | flexion and adduction of the thumb and flexion of the fingers

Question 48

Gordon's finger

Answer 48

examiner strokes the pisiform of the patient | flexion of wrist and fingers or thumb and index finger

Question 49

chaddock's wrist

Answer 49

examiner strokes the distal ulnar side of the forearm near the wrist flexion of wrist with extension and fanning of fingers