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PE skills Neuro exam 1
PE skills exam 1 neuro
78
Anatomy
Graduate
09/19/2010

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Term
confusion:
Definition
inability to think with usual speed and clarity -  attention span & trouble remembering(memory), decreased speed of thought and thoughts less clear
Term
lethargy:
Definition
Drowsy, falls asleep – but rouses & responds – it’s confusion plus sluggishness, don’t say if someone is just tired, someone reading the chart will think very sick, pt may fall asleep when talking to you
Term
delirium:
Definition
Disordered perception, attention , anxiety, inappropriate reaction-temporary state, goes away, temporary, altered perceptions, hallucinations, confused, lethartgic and may have hallucinations
Term
stupor:
Definition
Aroused by rigorous repeated painful stimuli, only simple motor activity, moaning, pt will only rouse in response to pain
Term
coma:
Definition
unresponsive even with painful stimuli-state of unconsciousnes
Term
Decorticate means there is abnormal ___ and the lesion is above the ____.
Definition
- flexion
- brainstem
Term
Decerebrate is abnormal ___ meaning the lesion is in the ____, this is worse than decorticate, it is a deeper coma, brain just trying to keep most basic function alive.
Definition
- extension
- brainstem
Term
The Glasgow Coma scale is a ___ test of consciousness. It looks at ___, ___, and ___ responses. There are versions for adults, children, and infants.
Definition
- quantitative
- eye, verbal, and motor responses
Term
what are the max and min scores on the glasgow coma scale?
Definition
- max 15, each category gets a max of 5
- min 3, each category gets a min of 1
Term
Hemiplegia:
Definition
(corticospinal tract above brainstem)
Unilateral brain damage
Paralysis with flaccidity early on, then spasticity= tightness
No spontaneous movement
Term
decorticate is damage to the ___ tract. Explain.
Definition
- corticospinal tract
Abnormal flexor response- arms curled up
Arms tight to sides, with flexion of elbows, wrist, fingers
Extended legs
Term
decerebrate:
Definition
(damage to brainstem)-worst, may need respirator
Abnormal extensor response
Arms and legs extended
Jaws clenched
May have back rigidly arched
Term
With decorticate the corticospinal tract is damaged. The ___ spinal tract gets disinhibited, so motor neurons in the cervical cord supplying the flexor muscles of upper extremities are overly active. The __ ___ tract gets disrupted so the flexors of lower extremity are not supplied so the legs are extended.
Definition
- rubrospinal
- lateral corticospinal
Term
The corticospinal tract is concerned specifically with discrete voluntary skilled movements, especially of the distal parts of the limbs. As a lesion that results in hemiplegia occurs in the brain or spinal cord, hemiplegic muscles display features of the Upper Motor Neuron Syndrome. Features other than weakness include decreased movement control, clonus (a series of involuntary rapid muscle contractions), spasticity, exaggerated deep tendon reflexes and decreased endurance.
Definition
Term
If corticospinal tract is damaged above the brainstem, then the ___ side will be damaged. If the corticospinal tract is damaged below the brainsttem then the damage will be on the ___ side.
Definition
- contralateral
- ipsilateral
Term
delirium:
Definition
Sudden onset of acute confusional state with disordered perceptions
Sundowning
Term
dementia
Definition
Clinical syndrome of failing memory,
 intelligence, behavioral abnormalities
- also can exhibit sundowning
Term
delirium is acute onset. dementia happens over a period of time
Definition
Term
for remote memory what should you ask patient?
Definition
presidents
Term
disarthria:
Definition
difficulty speaking, lack of facial sensation, trouble moving tongue
Term
disphonia:
Definition
bad voice quality
Term
circumlocution:
Definition
- describe something simple with lots of words
Term
Broca's aphasia:
Definition
- can understand written and spoken language
- cannot physically speak
- motor problem
Term
Wernicke's aphasia:
Definition
- aka receptive aphasia
- can't understand and can't make sense of written or oral language
- can physically speak but it won't make sense
Term
Global aphasia:
Definition
broca's + wernicke's aphasia
Term
Folstein's mini mental status exam:
Definition
Orientation (10 points)
What is the; year, season, date, day, month?
Where are we; state, county, town, clinic, floor?
Registration (3 points)
Name 3 objects
Attention & Calculation (5 points)
Serial 7’s
OR
WORLD backwards
Recall (3 points)
Repeat 3 previously named objects after 10 minutes
Language (9 points)
Identify 2 objects
Repeat “no ifs, ands or buts”
Follow 3 stage command
Read and obey written command
Write a sentence
Copy intersecting pentagons
Term
what is max score on Folstein's mini mental exam?
Definition
30
Term
cognitive impairment test may help detect ___ ___ earlier. The maximum score is a ___. Is a lower or higher score better?
Definition
- mild dementia
- 28
- lower score is better
Term
what test may help diagnose early dementia?
Definition
- cognitive impairement test
Term
what test is least sensitive and specific to dementia?
Definition
SET test
Term
SET test:
Definition
Easiest of the 3 to administer

Least sensitive & specific for dementia

“FACT”

Patient names 5 fruits, animals, colors, towns
Term
confrontation tests what CN?
Definition
cranial nerve II optic
Term
lesion to CN III oculomotor?
Definition
- ptosis
- downward and lateral gaze
- mydriasis (pupil dilation)
- double vision
- accomodation diffiuclties due to ciliary paralysis
Term
trochlear nerve innervates the ___ __ _muscle which moves the eye __ and ___.
Definition
- superior oblique
- down and out
Term
what nerve innervates lateral rectus?
Definition
abducens cnVI
Term
explain accomadation:
Definition
if looking at something in distance, pupils will dilate
- then if look at something close up, the pupils will constrict and lens changes shape
Term
EOMI
Definition
extracolar muscles in tact
Term
Weber tests for conductive hearing loss.
Definition
Term
with Rinne's test a positive test is ___.
Definition
normal
Term
If air conductance is not longer than bone conductance with Rinne's test then there is ____ hearing loss meaning there is ___ damage in the ___ ear.
Definition
- sensoryneural
- nerve
- ipsilateral
Term
which cranial nerve is responsible for sour and bitter tastes?
Definition
glossopharyngeal CN IX
Term
tests for glossopharyngeal nerve?
Definition
- gag
- swallow
- sour/bitter taste
Term
tests for vagus nerve:
Definition
- gag
- swallow
- uvula deviation to opposite side of lesion
- palate symmetry
Term
past pointing is a symptom of ____ ___.
Definition
cerebellar disease
Term
Romberg, rapid alternating movements, and fine motor skills all test for ___ lesions.
Definition
UMN
Term
walking on tip toes tests?
Definition
S1
Term
walking on heels tests?
Definition
L4, L5
Term
ataxia:
Definition
lack of coordinated muscle movements
Term
cerebellar ataxia:
Definition
- wide base
- staggering and lurching side to side with swaying of trunk
Term
sensory ataxia:
Definition
- wide base
- feet thrown foward and outward, high stepping gait, often slap foot down
Term
If patient is ataxic, do Rhomberg test. If rhomberg is positive you have ____ ataxia. If Rhomberg is negative you have ___ ataxia.
Definition
- ataxic with positive rhomberg= sensory ataxia
- ataxic with negative rhomber= cerebellar ataxia
Term
dystonia:
Definition
Jerking, dancing movements that appear nondirectional
Term
spastic hemiparesis:
Definition
Affected leg stiff & difficult to move – extended w/ plantar flexion of foot
Foot moved by tilting pelvis & dragging/circling outward & forward
Term
foot drop:
Definition
Slapping gait of affected foot due to weakness of dorsiflexors of the foot
Term
what tests for LMN lesion?
Definition
Superficial (light) touch
Superficial pain (sharp/dull)
Temperature and deep pressure
Vibratory
Position in space
Term
dorsal column controls proprioception and 2 point discrimination
Definition
Term
spinothalamic tracts control light touch, pressure, pain, and temperature
Definition
Term
dorsolateral column comtrols vibratory sense
Definition
Term
peripheral sensation:
Definition
Supraclavicular: cervical plexus (C4)
Axillary: posterior deltoid (C6)
Radial: back of 2/3 of arm, forearm, hand and of 1st-3rd fingers, proximal portion (C7)
Median: thenar eminence, tips of 1st thru 3 to 4th fingers (C6)
Ulnar: hypothenar eminence, 5th finger, ½ of 4th, back of 5th finger (C8)
Saphenous: medial thigh & lower leg to arch of foot (L2, 3)
Sural: gastrocnemius, posterolateral aspect of ankle and posterolateral foot (S1, S2)
Superficial peroneal: lateral leg (L5)
Deep Peroneal: anterior leg to top of foot (L4,5)
Term
cremasteric reflex:
Definition
T12, L1, L2
Term
Plantar reflex:
Definition
L5, S1, S2
Term
biceps reflex:
Definition
C5, C6
Term
Brachioradialis reflex:
Definition
C5, C6
Term
Triceps reflex:
Definition
C6, C7, C8
Term
Patellar reflex;
Definition
L2, L3, L4
Term
Achilles reflex:
Definition
S1, S2
Term
scoring of deep tendon reflexes:
Definition
0 : no response
1+ : sluggish or diminished
2+ : active or expected response
3+ : more brisk than expected, slightly hyperactive
4+ : brisk, hyperactive, with intermittent clonus
Term
Nuchal rigidity:
Definition
- associated with meningitis or intracranial hemorrhage
Term
Brudzinski'a:
Definition
patient supine> flex neck> positive sign if patient flexes at hip or knee
Term
Kerning's sign:
Definition
patient supine> flex leg at knee and hip> attempt to straightn LE> positive if resistance to straightening
Term
Infant reflexes:
Definition
Palmar
Sucking
Rooting
Plantar
Moro
Placing
Stepping
Fencing or asymmetric tonic neck
Term
Palmar reflex and when it disappears?
Definition
- touch palm and baby's hand curls around object
- disappears around 6 months
Term
Sucking:
Definition
touch lips and patient starts sucking
- disappears around 4 months
Term
rooting:
Definition
touch corner of mouth and baby will turn that way
- disappears around 4 months
Term
Babinski sign, when does it disappear?
Definition
1 year
Term
Moro reflex:
Definition
- startle reflex
- drop head and upper body and arms reach out
- disappears at 3 months
Term
stepping reflex:
Definition
place feet on hard surface and baby will move feet like walking
- disappears around 6 weeks
Term
fencing aka asymmetric tonic neck reflex:
Definition
lay baby flat and turn head one way
- ipsilateral arm and leg will extend
- contralateral arm and leg will flex
- occurs from 2-6 months
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