The abnormal neuro exam

Question 1

Components of a neuro exam

Answer 1

1. Mental Status Exam
2. Cranial Nerves
3. Cerebellum
4. Strengths
5. Deep tendon reflexes
6. Sensory testing
7. Gait

Question 2

Components of the mental Status Exam

Answer 2

LOL AMEN

Level of consciousness
Orientation
Language

Attention
Memory
Executive/intellectual function
non-dominant hemisphere

Question 3

Alert definition

Answer 3

Fully awake without stimulation, and able to cooperate in a history and physical exam

Question 4

Lethargic definition

Answer 4

Patient prefers to sleep, but will stay awake with minimal verbal or physical stimualtion

Question 5

Stuporous definition

Answer 5

Patient requires repeated physical stimulation to stay awake

Question 6

Comatose definition

Answer 6

A sleep like state in which the patient CANNOT be awakened. No further mental status testing is possible

Question 7

Causes of abnormal level of consciousness

Answer 7

1. The pt has a new problems such as a decline in function of an organ system
2. A new medication has produced an adverse effect
3. Bacterial infection has spread to the blood
4. Pts hematocrit, glucose, or partial pressure of oxygen has declined or the partial pressure of CO2 has risen

Question 8

How to test for orientation

Answer 8

Person, place, and date

Question 9

Aphasia means _____ is damaged

Answer 9

A patient’s dominant hemisphere

Question 10

Broca’s aphasia

Answer 10

Frontal lobe

Usually accompanied by hemiplegia, retained understanding, brief ‘telegraphic’ output

Question 11

Wernicke’s aphasia

Answer 11

Superior temporal lobe

- fluent, poor understanding

Question 12

Anomia

Answer 12

Inability to name objects

Question 13

Agraphia

Answer 13

Limitations in writing

Question 14

Dysarthria

Answer 14

Slurred or thick speach

Question 15

Apraxia

Answer 15

Loss of skilled movements and gestures
- Partial damage to the dominant lobe, resulting in the loss of complex, multi-step actions- pts cannot carry out these tasks, even though they have sufficient motor and sensory function

Likely due to damage to connections b/w different sites in the cerebral cortex

Question 16

Gestmann syndrome

Answer 16

Damage to the angular gyrus of the dominant parietal lobe

1. Acalcula
2. Agraphia
3. Inability to distinguish the left and right sides of the pt
4. Inability to distinguish the individual fingers

Question 17

How is attention evaluated?

Answer 17

1. Do the months (or the days of the week) forward and then backwards
2. Serial sevens, subtracting seven starting from 100
3. Read a series of letters, asking the patient to raise his hand when he hears the letter “A”
4. Have the patient spell “WORLD” forwards and backwards

Question 18

Delirium

Answer 18

Acute confusional state

• Suggests a diffuse systemic problem is affecting large sections of the brain
• Presents either as a hyper-reactivity to environmental stimulation or extreme sleepiness

Question 19

Delirium causes

Answer 19

• Sepsis
• New medications
• Alcohol withdrawal

Question 20

Who is more prone to delirium?

Answer 20

Demented patients

Question 21

Where does memory localize to?

Answer 21

B/L medial temporal lobe damage –> hippocampus

Question 22

Anterograde

Answer 22

Recent memory, or the ability to store new information up to a few days

Question 23

Retrograde

Answer 23

More distant memories including autobiographical or historical

Question 24

Executive function

Answer 24

Includes the important functions of insight, judgment, and making important decisions

• Verbal fluency- ask the pt to name as many members of a category as they can
• Healthy pts can name 20 or more in a minute, demented elderly pts wil name less than 12

Question 25

The loss of executive function is diagnostic of?

Answer 25

Dementia

Question 26

Parietal lobe functions

Answer 26

- Visual-spatial skills - Constructions - Awareness of one's own body or the environment, especially to the left visual field

Question 27

Temporal lobe damage results in?

Answer 27

Loss of musical abilities and a tendency to psychiatric disturbances such as psychosis, depression, bipolar disorder, and anxiety

Question 28

Occipital lobe damage results in?

Answer 28

Left homonymous hemianopia and prosopagnosia | - Inability to recognize faces

Question 29

Hemispatial neglect

Answer 29

not appreciating that there are people or objects in the left side of the room or on the left side of a drawing or photograph, in spite of preserved vision

Question 30

Anosognosia

Answer 30

the inability to recognize hemiparesis in a patient’s left arm or left leg; very common immediately after a stroke

Question 31

Dressing agnosia

Answer 31

inability to button clothes or put an arm in a sleeve on the left side, or to shave or put on make up on the left side of the face

Question 32

Prosopagnosia

Answer 32

Inability to recognize familiar faces, congenital or acquired

Question 33

Cranial nerves

Answer 33

1. Olfactory 2. Optic 3. Oculomotor 4. Trochlear 5. Trigeminal 6. Abducens 7. Facial 8. Acoustic (Now called Vestibulo-Cochlear) 9. Glossopharyngeal 10. Vagus 11. Accessory 12. Hypoglossal

Question 34

Abnormal pupil reactions results from?

Answer 34

Problem with afferent CN II and efferent CN III

Question 35

What does lack of constructional skills indicate?

Answer 35

A problem in the nondominant (right) parietal lobe - Can be tested by having the pt draw a clock - May also reveal hemispatial neglect