Fundamentals Of Human Neuropsychology. Kolb.- Neurological Exam

Front 1

How to check patient's history? (4)

Back 1

Blood, urine, CBF, genetics

Front 2

What is Lumbar puncture?

Back 2

Lumbar puncture: drawing fluid out of the spine (typically clear – may have blood or is cloudy(infection))

Front 3

What's the olfactory nerve for?

Back 3

Smell

Front 4

How do you test the olfactory nerve?

Back 4

clear vial, unlabeled with a distinguishable smell → must have them identify the smell

Front 5

What's the optic nerve for?

Back 5

carries visual info

Front 6

How do you test the optic nerve?

Back 6

eye exams, test boundaries of your vision

Front 7

What's the Oculomotor nerve for?

Back 7

control eye movement

Front 8

What's the test for oculomotor nerve?

Back 8

shines light in eyes and must follow with your eyes

Front 9

What's the Trochlear nerve for?

Back 9

control eye movement

Front 10

What's the test for Trochlear nerve?

Back 10

• Test: shines light in eyes and must follow with your eyes

Front 11

What's the Trigeminal nerve for?

Back 11

controls touch for the face

Front 12

What's a good test for Trigeminal nerve?

Back 12

patient closes eyes, touch them on their face and ask where they are being touched

Front 13

What's the Abducens nerve for?

Back 13

control eye movement

Front 14

How is abducens nerve tested?

Back 14

Test: shines light in eyes and must follow with your eyes

Front 15

What's the Facial nerve for?

Back 15

controls movement for the face

Front 16

How do you test the facial nerve?

Back 16

ask them to smile, to pucker up (something that requires facial symmetry)

Front 17

What's the Vestibulocochlear nerve for?

Back 17

* transmits info for balance and hearing
* Damage could result in deafness and/or vertigo like symptoms

Front 18

What's the Glossopharyngeal nerve for?

Back 18

throat, important for the ability to speak

Front 19

What's a test for glossopharyngeal nerve?

Back 19

asked to swallow and go ”ahhhhh”

Front 20

What's the Vagus nerve for?

Back 20

* controls redistribution of blood pressure
* breathing, bronchial system,
* gastrointestinal tract,
* stomach

Front 21

What's the Accessory nerve for?

Back 21

head and neck muscles

Front 22

What's a test for the accessory nerve?

Back 22

asked to shrug shoulders, test neck strength with hands as resistance

Front 23

What's the Hypoglossal nerve for?

Back 23

tongue

Front 24

What's a test for hypoglossal nerve?

Back 24

stick out your tongue (lesion – tongue may drift to one side

Front 25

What is Papilledema?

Back 25

looking into the back of the eye, see swelling in the back of the eye

Front 26

What is Strabismus?

Back 26

cross eyed, have a lesion to cranial nerves that control eye movement

Front 27

What is Amblyopia?

Back 27

*lazy eye
* doesn’t get visual info in very well,
* brain stops responding to that eye (not useful info, causing lots of problems)
* can be rendered functionally weak/useless

Front 28

What is Herpes Simplex Encephalitis?

Back 28

interfaces in temporal lobe (on trigeminal nerve) and attacks the brain (destroys the brain quickly)
* Very rare but deadly

Front 29

What's Bell’s palsy?

Back 29

damage to facial nerve on one side, cannot control the face

Front 30

What is the Corticospinal tract important for?

Back 30

important for movement,
* runs from the motor cortex to the spine and the effectors

Front 31

Somatosensory pathways test

Back 31

Close eyes (eliminate vision), touch on different areas of body and person must respond with where they are touching

Front 32

What does damage to parietal lobe do?

Back 32

Damage to parietal lobe: problem identifying objects using touch (without vision) → astereognosis (disconnect b/w touch and memory)

Front 33

What is astereognosis?

Back 33

Damage to parietal lobe: problem identifying objects using touch (without vision) → astereognosis (disconnection between touch and memory)

Front 34

What is Agraphesthesia?

Back 34

unable to integrate sensory information to identify letters/shapes/numbers, problem in the parietal lobe
* Ex. Drawing words on someone’s back and asking them to identify it

Front 35

What are Dermatomes

Back 35

* Different parts of the bodies corresponding to different parts of the spinal cord

Front 36

What's the process of reflex?

Back 36

Touch receptor → spine → motor neuron → effector → movement

Front 37

If patient shows positive sign to Babinski or Snout reflex test, which brain lobe is damaged?

Back 37

frontal lobe

Front 38

What does damage to cerebellum do?

Back 38

problem w/ coordination of movement (not smooth movements)

Front 39

Finger to nose test. What is a damaged result like?

Back 39

shaky and/or endpoint is not correct

Front 40

Simple and complex finger movement test. What is a damaged result like?

Back 40

slow, miss fingers

Front 41

Heel to toe walking
 test. What is a damaged result like?

Back 41

may venture of to one side, may not even be able to walk

Front 42

Romberg test. What is a damaged result like?

Back 42

when eyes are closed they will immediately fall → cerebellum problem

Front 43

What is the romberg test?

Back 43

Ask person to have arms spread standing and then close eyes

Front 44

Name four cerebellum tests?

Back 44

* Finger to nose/heel to shin testing
* Simple and complex finger movements
* Heel to toe walking

* Romberg test

Front 45

Coma score 13 or 14, what kind of injury?

Back 45

Mild traumatic brain injury (concussion)

Front 46

Moderate traumatic injury, what's the score range for it?

Back 46

Moderate traumatic brain injury: 9-12

Front 47

Coma scale <8, what's the brain injury?

Back 47

Severe traumatic brain injury

Front 48

What does a mental status exam do?

Back 48

Assess cortical and sub-cortical functioning related to cognition

Front 49

What are categories of mental status exam?

Back 49

Categories (order matters)
o Attention: always tested first, if you cannot pay attention you cannot do these other tests
o Language

o Memory
o Visuospatial/perceptual
o Executive functions

Front 50

What's the first thing to test in a mental status exam?

Back 50

Attention - always tested first, if you cannot pay attention you cannot do these other tests

Front 51

How to do mental status exam for attention? (4)

Back 51

* Observe the patient
(if person follows you with their eyes and responds to you, they are paying attention)
* Count backwards from 20 (attention problem → will lose track)
* Months forward, backward
* Sustained attention: holding attention for a duration of time

Front 52

focal brain injury

Back 52

Focal: cortical or subcortical

Front 53

diffuse brain injury

Back 53

Diffuse: metabolic, toxin, infection

Front 54

Mental status exam, Test for language (5):

Back 54

o Fluency: ability to produce language (mute, stutter)
o Naming common objects
o Repetition (being able to repeat speech)
o Prosody: tone in which you speak (damage to right side – prosody flattens out)
o Comprehension: understanding (can indicate w/ words, actions → if cannot talk)
o Reading
o Writing
o Praxis: ability to follow verbal commands into actions (tested by tool use – left hemisphere damage confuse body with object)

Front 55

What is Anomia?

Back 55

inability to name things due to a brain injury

Front 56

What is Praxis?

Back 56

ability to follow verbal commands into actions (tested by tool use – left hemisphere damage confuse body with object)

Front 57

What is Prosody?

Back 57

tone in which you speak (damage to right side – prosody flattens out)

Front 58

In mental status exam, how do you check for memory?

Back 58

o Digit span, pointing span → does not require language
• average people can remember 5-9, if they cannot there is a problem
o Verbal, visual object learning
o Past public/personal events (must have a family member present)
o Factual knowledge

Front 59

Where is language mostly located?

Back 59

Left hemisphere

Front 60

Where is memory located(4)?

Back 60

Medial temporal lobes, thalamus, basal forebrain, frontal lobes

Front 61

How is Visuospatial/perceptual checked in a mental status exam?

Back 61

o Copy of geometric designs (if cannot – brains ability to interpret images is compromised)
o Judgment of line orientation
o Object/face/color recognition

Front 62

Where is Visuospatial/perceptual located?

Back 62

Right hemisphere

Front 63

how are executive functions checked in mental status exam?

Back 63

o Judgment: making simple decisions
o Verbal fluency: people with impairments do not categorize, are slower, produce less info
o Luria 3-step: continuously doing the same steps over and over, gets stuck, understands what they are supposed to do
o Coin switch task

o Drawing loops, alternating patterns: get stuck on a letter or number
o Oral trail making test: alternate between letters and numbers (A1B2, etc)
o Perseveration: continue to do the same thing over and over again when it is no longer appropriate

Front 64

Where are executive functions located?

Back 64

o Frontal lobes