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History and Physical: Neurology Exam
Neuro exam questions
97
Medical
Graduate
04/04/2010

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Cards

Term
Causes of loss of sense of smell:
Definition
cocaine, smoking, aging, head trauma, sinus problems
Term
Testing CN II:
Definition
Snellen chart, confrontation, fundoscopy
Term
When might you see visual field defects?
Definition
glaucoma, retinal emboli, optic neuritis, pituitary tumor
Term
Testing CN III, IV, VI
Definition
Versions/ductions, corneal light reflex, check for ptosis
Term
What disorder may you find with checking the oculomotor/troch/abducens?
Definition
Binocular diplopia signalling MG, trauma, others
Term
What do pupils do in Horner's syndrome?
Definition
They constrict but one will not dilate subsequently
Term
When might you see ptosis?
Definition
Myasthenia gravis and horner's
Term
How do you test CN V?
Definition
Jaw muscle symmetry, light vs. sharp touch
Term
Absent blinking on corneal reflex + hearing loss (sensorineural) =
Definition
acoustic neuroma
Term
How do you test CN VII?
Definition
various different facial expressions
Term
Difference between facial paralysis in Bells palsy and stroke:
Definition
Bells palsy will more likely cause paralysis of entire side of face, upper and lower. CVA tends to only paralyze the lower part of one side of the face.
Term
How do you test CN VIII?
Definition
whispter test, weber, rinne, and otoscope
Term
Causes of conductive hearing loss:
Definition
cerumen, otosclerosis, otitis media
Term
Vertigo + hearing loss + nystagmus
Definition
menieres
Term
How do you test CN IX?
Definition
Gag reflex
Swallow
Term
How do you test CN X?
Definition
Uvula and palate symmetry
Term
With a unilateral lesion of CN X, uvula will deviate wehre?
Definition
toward the NORMAL side
Term
How do you test CN XI?
Definition
Shrug shoulders (trap), head to side (sternocleidos)
Term
How do you tst CN XII?
Definition
tounge against cheek, say ah lah pah
Term
Tongue atrophy + fasiculations =
Definition
ALS or polio
Term
Where does a tongue deviate when theres a cranial nerve XII lesion?
Definition
Away from the lesion
Term
Brachioradialis reflex tests:
Definition
C5 and C6
Term
Triceps reflex tests
Definition
C7
Term
Patella reflex tests
Definition
L2,3,4
Term
Achilles reflex tests
Definition
S1
Term
How do you document "clonus?"
Definition
4+ reflex
Term
What does shoulder extension strength test?
Definition
C5
Term
C6 can be assess with strength testing of what?
Definition
flexion of elbow
Term
C7 can be assessed via strength training with what?
Definition
elbow extension
Term
Wrist extension tests what nerve and what does weakness mean?
Definition
C8, MS/stroke
Term
Hand grasp tests what?
Definition
T1
Term
Test L2 by doing what? Strength
Definition
Hip flexion
Term
Test L3 by doing what (strength)
Definition
Extend knee
Term
Flexing knee tests what nerve
Definition
L4
Term
Dorsiflexion tests:
Definition
L5
Term
s1 strength testing:
Definition
plantar flex
Term
What does gross coordination?
Definition
vestibulocerebellum and spinocerebellum
Term
What does fine coordination?
Definition
cerebrocerebellum
Term
What is dysdiadochokinesis?
Definition
inability to follow an action quicklyby the opposite aciton; or it will be slow/clumsy. Seen in basal ganglia/umn/cerebellar dz
Term
How do u test rapid altering movements?
Definition
patting thighs, thumb to fingers, finer to nose, heel to shin, pronator drift, romberg test
Term
clumsy/unsteady/varying speed on finger to nose test:
Definition
cerebellar disease
Term
What does a + pronator drift mean?
Definition
cortical spinal tract lesion of contralateral hemisphere
Term
Romberg test will be + in those with:
Definition
loss of position sense/dorsal column disease
Term
Difficulty hopping in one place =
Definition
cerebellar disease, weakness or lack of position sense
Term
Unable to walk on toes/heels:
Definition
distal muscle weakness from corticospinal tract damage
Term
Why do you test someone with tandem walking?
Definition
To reveal a possible ataxia not previously noticed
Term
Spinothalamic tract does what?
Definition
senses pain/temperature
Term
DCML senses what?
Definition
vibration/position sense
Term
What are some discriminative sensations?
Definition
stereognosis, graphesthesia, two point discrimination, extinction,
Term
loss of vibratory sense =
Definition
first sign peripheral neuropathy (DM, alcoholism, B12 def.)
Term
anesthesia =
Definition
absense of touch sense
Term
Babinski sign positive in:
Definition
CNS lesion, drug/alcohol intox, post-ictal phase of seizure
Term
straight leg raise detects herniated disc at:
Definition
L5-S1
Term
What strengthens the diagnosis of herniated disc from straight leg?
Definition
ipsi. calf wasting, weak dorsiflexion
Term
Eyes of someone with a brain lesion: patient will:
Definition
LOOK at Lesion
Term
What is the corticospinal tract?
Definition
tract for voluntary movements and complicated/delicate movements. Allows for constant slight tension. Originates in motor cortex
Term
What is the basal ganglia's tract?
Definition
pathway between cortex, basal ganglia, brain stem, spinal cord maintianing tone, controls movements, gross automatic movements (walking)
Term
Decorticate position:
Definition
destructive lesion of corticospinal tract. Flexed elbows, internally rotated legs, plantar flex
Term
Decerebrate position =
Definition
lesion in diencephalon, pons, midbrain, or metabolic disroder. extension at elbows, clenched jaws, plantar flex, pronated arms
Term
Coma person with midposition fixed pupils =
Definition
structural damage to midbrain
Term
ONe large pupil =
Definition
herniation of temporal lobe on oculomotor nerve
Term
Small/pinpoint pupils
Definition
dmage to symp. nervous system, metabolic encephalopathy, pons hemorrhage, morphine/heroin/narcotics
Term
What aphasia has okay word and reading comprehension?
Definition
Broca's
Term
What causes upper and lower facial paralysis?
Definition
bells palsy
Term
SOmeone with spastic hemiparesis has what kind of gait abnormality?
Definition
circumduction
Term
Wide based gait, + romberg, watching ground for guidance when walking, etc.
Definition
sensory ataxia
Term
Changes in consciousness change after pupils change in =
Definition
toxic/metabolic coma
Term
Changes in consciousness occur before pupils change in
Definition
strucutral coma
Term
Anticholinergics cause pupils to:
Definition
be fixed/dilated and may be unreactive if in coma
Term
Respiratory pattern in toxic/met. coma:
Definition
normal or hyperventilation. if irregular, probably cheyne-stokes
Term
Respiratory pattern in structural coma:
Definition
cheyne stokes or ataxic.
Term
What cranial nerves effected when the PONS is disrupted?
Definition
CN 5,6,7,8
Term
What cranial nerves disrupted in those with medulla dysfunction?
Definition
9,10,11,12
Term
Cranial nerves effected in midbrain damage:
Definition
cn 3 and 4
Term
If you ignore one sid eof your body, you can assume there is a lesion in the:
Definition
nondominant parietal lobe
Term
hypersexuality, aggression, memory impairement seen in what kind of lobe damage?
Definition
temporal
Term
Apathy, inattention, uninhibited, labile affect seen in what lobe damage:
Definition
frontal
Term
inability to read/write/do math may have a lesion in what lobe?
Definition
dominant parietal
Term
Hemiballismus may be from a lesion in what part of brain?
Definition
subthalamic nuclei
Term
Glasgow coma scale parts
Definition
4 for eyes
5 verbal
6 motor
Term
What lobe does behavior/motivation/attention:
Definition
frontal
Term
Stupor vs. Obtunded
Definition
stupor is arousable only for a small period of time; obtunded requires painful stimuli
Term
bilateral proximal weakness =
Definition
myopathy
Term
bilateral distal weakness =
Definition
polyneuropathy
Term
when u examine comatose patient, you're really only assessing the:
Definition
brainstem
Term
What part of brain stem does oculocephalic reflex
Definition
pons
Term
Whats a reassuring sign in response to the caloric water test
Definition
eyes go toward irrigated ear if brainstem intact
Term
How many points if a person withdraws from pain?
Definition
4 points
Term
Decerebrate posture points:
Definition
2
Term
Eyes open to response to voice:
Definition
3 pionts
Term
Inappropriate words in verbal response:
Definition
3 points
Term
Confused verbal response points:
Definition
4 points
Term
Grade of 1 for reflexes means
Definition
decreased but present
Term
Full range of motion with gravity is what strength level
Definition
3
Term
Slight contraction with no movement in strength testing
Definition
1 point
Term
Amount of two point discrimination difference u should recognize on lips/fingertips
Definition
2-4 mm
Term
Distance you should be able to recognize between 2 points on their plams:
Definition
8-15 mm
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