S1_L1-2: Approach to Diagnosis & Neuro Exam Flashcards
(130 cards)
1
Q
Signs/Symptoms of increased intracranial pressure (IICP) in NON-INFANTS
A
Headache, vomiting, papilledema, lateral rectus palsy (diplopia with internal squint), altered sensorium (deterioration in the level of consciousness), and Cushings Triad (↑ BP, ↓ Pulse, ↓ Respirations)
2
Q
Signs/Symptoms of meningeal irritation
A
Headache, nuchal (neck) rigidity, Brudzinski’s Sign, Kernig’s Sign
3
Q
Signs/Symptoms of increased intracranial pressure (IICP) in INFANTS
A
Bulging fontanel, separation of sutures, and rapid enlarging head size (Hydrocephalus)
4
Q
What is the Normal Respiratory Rate (Breaths per minute)?
A
12-20 breaths per minute
5
Q
Explain how to perform the Brudzinski’s Sign.
A
Patient is in supine and the examiner flexes the patient’s neck.
6
Q
What is the expected findings in a (+) Brudzinski’s Sign?
A
Patient will involuntarily flex hip and knee. (+) wincing pain
7
Q
Explain how to perform the Kernig’s Sign.
A
Patient is supine and the examiner flexes the patient’s hip, then extends the knee.
8
Q
What is the expected findings in (+) Kernig’s Sign?
A
Patient feels an excruciating pain.
9
Q
What is a secondary tumor of the brain?
A
A tumor that grows outside the CNS
10
Q
What is a primary tumor of the brain?
A
A tumor that grows within the CNS
11
Q
Type/Distribution of MASS LESION
A
Focal
12
Q
Type/Distribution of PERIPHERAL NEUROPATHY
A
Diffuse
13
Q
Type/Distribution of MULTIPLE SCLEROSIS
A
Multi-focal
14
Q
Type/Distribution of NUTRITIONAL ENCEPHALOPATHY
A
Diffuse
15
Q
A neurologic illness with a bulbar onset manifests with?
A
Swallowing and speech problems
16
Q
Diagnostic test that is MORE SENSITIVE to mass lesions, strokes, brain abscess, and demyelinating disease COMPARED TO A CT SCAN?
A
Magnetic Resonance Imaging (MRI)
17
Q
It is a cortical electrodiagnostic study
A
Electroencephalogram (EEG)
18
Q
It is used to detect myopathies
A
Muscle Biopsy
19
Q
Ancillary procedure for hypokalemic paralysis
A
Serum Potassium
20
Q
The GOLD STANDARD of Angiograms
A
Digital Subtraction Angiogram / Catheter Angiogram
21
Q
Angiogram that is NON-INVASIVE?
A
Magnetic Resonance Angiogram
22
Q
Angiogram that is the MOST ACCURATE BUT INVASIVE?
A
Catheter Angiogram / Digital Subtraction Angiogram
23
Q
Diagnostic test used to detect TB of the spine?
A
Spine X-ray
24
Q
Medical term for TB of the spine?
A
Pott’s Disease
25
What is the Transcranial Doppler Ultrasound (Ultrasonography) used for?
Stroke, Hydrocephalus
26
What is the purpose of the ancillary procedure: Serologic Test
It is used to identify the different types of bacteria or virus causing the infection
27
Diagnostic test for Myoneural Junction (Neuromuscular Junction) Disorders?
Nerve Stimulation Studies (NSS)
28
Components of the Cushings Triad?
↑ BP, ↓ Pulse (Bradycardia), and ↓ Respirations
29
What are the prominent bladder signs?
Bowel or bladder incontinence, constipation, dysuria, and no bowel movement.
30
A lesion that is bilateral and often presents with a symmetrical deficit is in the level of the _____?
Spinal cord
31
TRUE OR FALSE: The cerebrum is responsible for fine movements.
False
32
TRUE OR FALSE: Cerebellar affectation presents with incoordinated movements. It does not present with weakness.
Both statements are true.
33
Cause of Amyotrophic Lateral Sclerosis (ALS)
Degenerative
34
Cause of Alzheimer's Disease, Dementias
Degenerative
35
Cause of Myasthenia Gravis
Immunologic, autoimmune
36
Cause of Spina Bifida
Congenital / Developmental
37
Cause of subarachnoid hemorrhage
Trauma / neurotrauma
38
Cause of Hyponatremia
Toxic / metabolic
39
Cause of brain abscess
Infection
40
Cause of Stroke
Vascular / Circulatory problem
## Footnote
Source: Merritt's Neurology, 14th ed.
Due to cerebral ischemia or hemorrhage. It strikes “out of the blue” and manifests as hemiparesis or other focal brain signs
41
Cause of Arteriovenous Malformation (AVM)
Congenital / Developmental
42
Cause of B1, B6, B12 Defiency
Nutritional
43
What is the **most common** vascular / circulatory problem?
Stroke
44
Cause of Parkinson's Disease
Degenerative
45
Cause of Landry-Guillain-Barre Syndrome
Demyelinating and autoimmune
46
Cause of meningitis
Infection
47
Cause of intracerebral hemorrhage
Trauma / neurotrauma
48
Cause of aneurysm
Congenital / Developmental
49
TRUE OR FALSE: In a **spinal cord lesion**, there are normal findings **above** the level of the lesion.
True
50
TRUE OR FALSE: **Atrophy occurs with time** in a **peripheral nerve** lesion.
True
51
Other name for Bilateral Pyramidal Tract Signs
Pathologic Reflexes
52
Cause of Craniostenosis
Congenital / Developmental
53
Cause of hypercalcemia
Toxic / metabolic
54
Cause of Encephalitis
Infection
55
What is a tumor?
A tumor is an abnormal enlargement or proliferation of cells.
56
Cause of Multiple Sclerosis
Demyelinating and immune
57
Cause of epidural and subdural hematomas
Trauma / neurotrauma
58
Onset of trauma
Acute
59
Onset of degenerative disease (slowly progressive)
Chronic
60
Onset of intoxication
| Alcohol, exposure to poison or chemicals
Subacute
61
Onset of mass lesions
Chronic
62
Onset of infections
Subacute
63
Onset of vascular diseases
Acute
64
Onset of nutritional disorder/lesion
| E.g. lack of thiamine, lack of pyridoxine
Subacute
65
Onset of metabolic diseases
Subacute
66
Onset of acute demyelinating disease
Acute
67
Type/Distribution of VASCULAR DISEASE
Focal
68
Type/Distribution of Metastasis
| Multiple Tumors
Multi-focal
69
Type/Distribution of Metabolic Encephalopathy
Diffuse
70
What does a focal type/distribution of lesion mean?
The lesion is restricted to one area
71
What does a multi-focal type/distribution of lesion mean?
Lesion is present in multiple areas
72
Type/Distribution of a demyelinating disease
Multi-focal
73
Type/Distribution of Toxic Encephalopathy
Diffuse
74
Diagnostic Test for Fractures
Skull X-Ray
75
Diagnostic Test for Guillain-Barre's Syndrome
Nerve Stimulation Studies (NSS)
76
Diagnostic Test for Seizures
Electroencephalogram (EEG)
77
Diagnostic Test for Aneurysm
Angiogram
78
Diagnostic Test for Dermatomyositis
Total Creatine Phosphokinase (CPK)
79
Diagnostic Test for Subarachnoid Hemorrhage
Lumbar Puncture
80
Diagnostic Test for Myasthenia Gravis
Nerve Stimulation Studies (NSS)
81
Diagnostic Test for Arteriovenous Malformation (AVM)
Angiogram
82
Diagnostic Test for Polymyositis
Total Creatine Phosphokinase (CPK)
83
Diagnostic Test for Neuropathies
Nerve Stimulation Studies (NSS)
84
In performing Babinski sign, we use the (1) end of the key to strike the (2) aspect of the end of the foot going (3) towards the (4).
1. Pointed
2. Lateral
3. Upwards
4. Big toe/Great toe
85
Normal Response of Babinski Sign is -----. Abnormal Response of Babinski Sign is -----.
Normal: Plantarflexion (flexion) of all toes
Abnormal: Extension of big toe and flexion / fanning of small toes
86
TRUE OR FALSE: Babinski sign is present during the first year of life.
True. Reason: The corticospinal tract is not myelinated until the end of the first year of life. (Source: Snell)
87
A +++ grade in DTR / MSR indicates:
Increased reflex
88
Which segments are tested in the Brachioradialis reflex?
C5-C6
89
TRUE OR FALSE: Deep tendon reflex is more accurate than muscle stretch reflex.
False.
90
TRUE OR FALSE: In DTR, reflex muscle contraction mediated by the upper motor reflex arc.
False. It is mediated by the lower motor reflex arc.
91
Hyperreflexia is caused by a (1), while hyporeflexia is caused by a (2).
1. Upper motor neuron lesion
2. Lower motor neuron lesion
92
Cause of cerebral contusion / concussion
Trauma / Neurotrauma
93
Cause of Post-infectious and postvaccinal encephalomyelitis
Immunologic and demyelinating (neurologic or infectious in nature)
94
Arrange the components of a neurological examination (USUAL PRACTICE) in chronological order.
(1) Motor system
(2) Gait
(3) Cranial nerve exam
(4) Coordination / Cerebellar
(5) Sensory system
(6) Mental Status exam
(7) Reflexes
(6) Mental Status exam
(3) Cranial nerve exam
(1) Motor system
(4) Coordination / Cerebellar
(7) Reflexes
(5) Sensory system
(2) Gait
95
What is the tool used for sensory examination to check for equal sensations on the body?
Wartenberg Pin-Wheel
96
Name the sensory limb and the motor limb of the corneal reflex.
Sensory: Ophthalmic division of Trigeminal nerve
Motor: Facial nerve
97
Differentiate the affected areas of the face between stroke and bell's palsy.
Stroke: Lower half of face
Bell's Palsy: Whole half of face
98
TRUE OR FALSE: Air conduction is longer than bone conduction.
True.
99
Rinne's Test and Weber's Test are used to examine which cranial nerve?
Vestibulocochlear, Cranial nerve VIII
100
Shoulder shrug tests the (1) and head rotation tests the (2).
1. Trapezius muscle
2. Sternocleidomastoid muscle (Contralateral)
101
In a hypoglossal affectation, where is the tongue protruding/pushing?
Towards the weak / affected side
102
Fasciculations are (1) that are present in (2) and (3).
1. Muscle twitches
2-3. Amyotrophic Lateral Sclerosis & Lower Motor Neuron disease
103
Semipurposeful flowing movements that flit from one part of the body to another. Chaotic or unpredictable movements. Swift grimaces and sudden movements of the head or limbs are examples of this condition.
Present in Huntington's disease
Chorea
104
Wild, flinging/flailing movements that represent large amplitude proximal movements.
Rare form of involuntary movement confined to one side of the body.
Hemiballismus
105
Brief, sudden shock-life jerks, muscular contractions of a portion of a muscle, an entire muscle, or a group of muscles.
Patients with this condition can have seizures.
Myoclonus
106
Slow, sinuous, “snakelike”, writhing movements in distal limbs (fingers and toes).
Piano like movements in fingers & toes.
Athetosis
107
Alternating pronation-supination: Ask the patient to pronate and supinate the forearms rapidly.
This is a test for?
Dysdiadochokinesia
108
This test assesses unilateral hearing loss (conductive or sensorineural)
Weber’s Test
109
Eyebrow elevation, forehead wrinkling, eye closure, smiling, cheek puff, and whistling
can be used to examine which cranial nerve?
Facial nerve, cranial nerve VII
110
When testing this cranial nerve, the symmetry of nasolabial folds is examined at rest and at motion
Facial nerve, cranial nerve VII
111
We test the visual fields by -----.
Confrontation
112
Diagnostic test for muscle disease
Total Creatine Phosphokinase (CPK)
113
Diagnostic test for CNS infections (e.g. meningitis, encephalitis)
Lumbar puncture
114
TRUE OR FALSE: In papilledema, there's clear disk margins, visible blood vessels, and double vision.
True
115
Frequent, Maintained/Sustained contraction of both agonist & antagonist muscles, frequently causing twisting & repetitive movements/abnormal postures. May present like a mannerism.
Dystonia
116
TRUE OR FALSE: When mapping a region of sensory loss, move from the affected area into the normal region
True
116
Steady resistance through the entire movement of a joint. An example is Parkinson's disease
Rigidity
117
Diminished tone, suggests LMN disease
But may be observed acutely following UMN disease, such as stroke
Flaccidity
118
Clasp-knife reaction: When passive movement of a joint is attempted, ----produces resistance. The muscles, on stretching, suddenly give way due to neurotendinous organ-mediated inhibition.
Spasticity
Source: Snell
119
tone which is also velocity dependent but predictably increases with increased speed of movement and decreases at lower speeds
Paratonia
120
When asked to flex the neck, the whole body flexes except the neck
(+) neck rigidity
121
Segment/s of knee reflex
L2, L3, L4
122
Slow movements accompanied by tremors
Bradykinesia with tremors
123
Extremity tone indicative of UMN problem
Hypertonia
124
Assessing upper extremity strength and looking for pronator drift is part of which neuro exam?
Motor System
125
TRUE OR FALSE: CN VIII is affected in Bell's Palsy along with CN VII.
False
126
Test for perception/conduction of air or bone
Rinne's Test
127
TRUE OR FALSE: Distal sensorimotor deficit is present in a peripheral nerve problem.
True
128
TRUE OR FALSE: Examples of Inferior frontal lobe disease are meningioma/tumors that cause unilateral anosmia
True
129
TRUE OR FALSE: Gag reflex is checked by stimulating lateral pharyngeal wall on each side
FALSE. Posterior pharyngeal wall
