Oct3 A2-Neurological Exam Flashcards Preview

Bloc J - Neuro > Oct3 A2-Neurological Exam > Flashcards

Flashcards in Oct3 A2-Neurological Exam Deck (23)
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1
Q

weakness, spasticity and increased reflexes in right arm and leg (UMN lesion) + LMN facial weakness (anywhere from VII nucleus to the nerve before it branches) + normal mental status and language: where is the lesion

A

if look at neuro map, the UMNs, after get through cortex and brain, pass through the brainstem, which is also where VII nucleus is
*answer = brainstem

2
Q

parts of the neuro exam and very imp part

A
  • observation
  • mental status
  • language
  • CNs
  • motor (bulk, tone, power, arms, legs)
  • reflexes
  • coordination
  • sensation
  • gait
3
Q

first thing to test in the neuro exam ** have to do it first

A

test the digit span (for mental status): say 5 to 7 digits and they have to repeat them
IT TESTS ATTENTION

4
Q

mental status testing in neuro exam vs psychiatric exam

A
  • neuro = emphasize cognitive functions (memory, judgement, visuaspatial ability)
  • psychiatry = emphasize mood and content of patient’s thoughts (their affect, the flow of their ideas)
  • *neuro doesn’t always exam mental status**
5
Q

pyramid of the hierarchy of basic cognitive functions

A
  1. awake
  2. alert
  3. appropriate
  4. attention
    * just describe what you see*
6
Q

delirium def

A

acute fluctuating mental status usually caused by a systemic toxic or metabolic problem. attention is impaired***

7
Q

dementia def

A

chronic progressive impairment in mental status caused by a focal abnormality in the brain. attnetion is usually preserved*** (until late)

8
Q

pt with difficulties in the digit span test: meaning

A
  • more likely delirium

- can’t do complicated cognitive things like calculation

9
Q

language vs speech

A
  • language = higher COGNITIVE fct = decode or encode written or spoken symbols of communication
  • speech = ability to produce sounds of spoken language (it is a MOTOR function)
10
Q

name for problems of language

A

aphasias

11
Q

imp thing about CN testing in neuro exam

A

test them in order

12
Q

imp things in motor exam part of neuro exam

A
  • test muscle tone (decreased tone is less worrysome in adults. problem in babies) (increased tone = prob in adults): will test resist to passive movement, spasticity = UMN, rigidity = basal ganglia problems. focus on checking if increased tone
  • bulk (look and feel + check fasciculations)
  • power
13
Q

how to check for muscle bulk

A
  • normal convex shape = bulking out
  • abnormal concave shape = caving in
  • deltoid, forearm, first dorsal interosseus, edge of tibia (more prominent when tibialis anterior shrinked bc of decreased bulk*
14
Q

spasticity charact

A
  • velocity dependent**
  • felt with a fast movement
  • feel a sudden increase in resistance, spastic catch
15
Q

rigidity charact

A
  • not velocity dependent
  • can be ct, described as wheel pipe
  • described as cog-wheel (engrenage)
16
Q

5 point scale of motor power

A
5 = normal
5- = can't overcome
4+ = just overcome
4 = moderate resist
4- = just resist
3 = no resist
2 = not vs gravity
1 = glicker
17
Q

UMN lesion charact

A
  • weakness (decreased muscle power)
  • increased reflexes and tone
  • positive Babinski
18
Q

LMN lesion charact

A
  • weakness (decreased muscle power)
  • decreased reflexes and normal tone
  • decreased bulk
  • fasciculations
  • negative Babinski
19
Q

cerebellum anatomy and fct

A
  • midline of cerebellum (the vermis) coordinates axial movements
  • each cerebellar hemisphere coordinates the ipsilateral limb movement
  • axial movements = eye movement, speech, gait
  • limb movement = hand movement, heel to shin test, etc.
20
Q

how to test for axial limb coordination

A

finger (of examiner) to nose (of patient) test

21
Q

how to test for sensation in neuro exam + imp principles of sensory testing

A

test pinprick sensation

  • is the most sensitive
  • sensory testing is subjective
  • you need to have a specific question in mind
22
Q

how to test gait

A

ask pt to walk

  • can check things like circumduction
  • swinging of the arms
  • balance
  • etc
23
Q

main things of neuro exam (for this lecture)

A
  • observation
  • test digit span before any cognitive test
  • language and speech are not the same thing
  • test CNs in order
  • know how to test muscle tone (is the resistance to passive movement at a joint)
  • know UMN vs LMN
  • axial vs limb movements
  • test pinprick sensation
  • watch the person walk

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