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86 Cards in this Set
- Front
- Back
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What are the 6 primary domains evaluated in a neurologic exam?
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1) Mental Status
2) Cranial Nerves 3) Motor Systems/Exam 4) Reflexes 5) Sensation/Sensory Exam 6) Cerebellar System/Coordiantion and Gait (Blumenfeld, Chapter 3) |
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What are the 4 symptoms of Gerstmann's syndrome?
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1) acalculia
2) right-left confusion/disorientation 3) finger agnosia 4) agraphia (Blumenfeld, Chapter 3) |
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Gerstmann's syndrome is associated with damage to the ______ _____ lobe.
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dominant parietal
(Blumenfeld, Chapter 3) |
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When one is unaware of their deficits following an injury (e.g., hemiplegia), they are said to have _______.
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anosagnosia
(Blumenfeld, Chapter 3) |
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Name the 10 cranial nerves.
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I Ofactory
II Optic III Oculomotor IV Trochlear v Trigeminal VI Abducens VII Facial VIII Acoustic IX Glossopharyngeal X Vagus XI Spinal Accessory XII Hypoglossal |
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Signs of a lower motor neuron lesion include _____, _____, and _____.
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weakness, atrophy, fasciculations, and hyporeflexia (reduced reflexes)
(Blumenfeld, Chapter 3) |
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Upper motor neuron lesions may result in _____, ____, and _____.
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weakness, hyperreflexia, and increased tone
(Blumenfeld, Chapter 3) |
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You just scraped an object across an adult patient's foot. If the patient has not sustained any neurologic damage, you would expect the big toe to go upward and the other toes to "fan" out. True or False?
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False. The described response is an abnormal response known as the "Babinski sign." It is also abnormal if the patient shows a "silent" responses (i.e., doesn't move his/her toes); NOTE: the Babinski sign is normal in infants up to about age one
(Blumenfeld, Chapter 3) |
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When a patient is unable to perform alternating movements, it is called ____.
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dysdiadochokinesia
(Blumenfeld, Chapter 3) |
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Name the four primary reflexes observed in infants.
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grasp, snout, root, suck
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What are the 11 key components evaluated in the mental status examination?
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1) Level of alertness, attention, cooperation
2) Orientation 3) Memory 4) Language 5) Gerstmann's syndrome symptoms 6) Apraxia 7) Neglect & Constructions 8) Sequencing and Frontal Release Signs 9) Logic and Abstraction 10) Delusions/Hallucinations 11) Mood (see Blumenfeld, p. 51 for more detailed outline) |
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Severe impairments in consciousness may be observed in a patient as the result of what insults?
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damage to reticular formation or bilateral lesions of thalami or cerebral hemispheres
(Blumenfeld, Chapter 3) |
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You might expect to see mild alterations in consciousness with what type of lesions?
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unilateral cortical or thalamic lesions; toxic or metabolic factors (due to effects on the structures mentioned)
(Blumenfeld, Chapter 3) |
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Why is it important to document the patients exact responses during the mental status exam?
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this allows one to make direct comparisons in a particular patients mental status over time
(Blumenfeld, Chapter 3) |
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What are the 3 main questions you should ask a patient to assess their orientation?
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1) full name
2) date 3) location (e.g., person, place, and time) |
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What type of tasks might a physician ask a patient to accomplish to assess memory as part of a mental status exam?
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Recent Memory - ask patient to recall 3 items or a brief story after 3-5 minute delay (provide distractions during the delay to prevent rehearsal)
Remote Memory - ask patient hisotrical or verifiable personal events (Blumenfeld, Chapter 3) |
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During a mental status exam, if a patient fails items assessing immediate memory, it is most likely due to difficulties with _____; whereas, if they fail delayed items there may be damage to _____ structures and _____ ______.
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During a mental status exam, if a patient fails items assessing immediate memory, it is most likely due to difficulties with ATTENTION; whereas, if they fail delayed items there may be damage to LIMBIC structures and MEDIAL DIENCEPHALON.
(Blumenfeld, Chapter 3) |
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During a mental status exam, what should you listen for to evaluate spontaneous speech?
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fluency, phrase length, abundance of spontaneous speech, tonal modulation, paraphasic errors, neologisms, grammatical errors
(Blumenfeld, Chapter 3) |
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When assessing language as part of the mental status exam, what are the main areas you should assess?
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1) spontaneous speech
2) comprehension 3) naming 4) repetition 5) reading 6) writing (Blumenfeld, Chapter 3) |
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An easy way to test for right-left confusion and finger agnosia quickly is to ask the patient what question?
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"Touch your right ear with your left thumb."
(Blumenfeld, Chapter 3) |
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Define apraxia.
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Apraxia is the inability to follow a motor command, but is not due to a primary motor deficit or language impairment
(Blumenfeld, Chapter 3) |
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Apraxia can be caused by lesions in many different brain regions; but the primary area of damage is usually where?
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language areas and adjacent structures of the dominant hemisphere
(Blumenfeld, Chapter 3) |
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Hemineglect is an abnormality in ____ to one side of space that is not due to a primary ____ or ____ disturbance.
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Hemineglect is an abnormality in ATTENTION to one side of space that is not due to a primary sensory or MOTOR disturbance.
(Blumenfeld, Chapter 3) |
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What is the best way to test for hemineglect?
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determine if there is extinction on dobule simultaneous stimulation (i.e., patient can detect stimulus affected side when presented alone, but when stimuli are presented simultaneously on both sides, on the stimulus on the unaffected side may be detected); line bisection or other construction tasks can also be used to assess neglect
(Blumenfeld, Chapter 3) |
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You just determined that your patient has right-sided hemineglect. Where you would expect the lesion to be?
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Hemineglect is most common in lesions of the nondominant parietal lobe (with patients neglecting the right side); left sided neglct can also bee seen with right frontal lesions, right thalamic or basal ganglia lesions, and, rarely, in lesions of the right midbrain
(Blumenfeld, Chapter 3) |
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Name some behavioral signs commonly observed with frontal lobe damage.
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1) perseveration
2) motor impersistence 3) auditory go-no-go 4) frontal release signs (e.g., grasp reflect) 5) abulia 6) changes in personality and/or judgment (Blumenfeld, Chapter 3) |
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Logic and abstraction can be assessed during a mental status exam by asking patients to _______ ______, interpret _______, or complete _______.
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Logic and abstraction can be assessed during a mental status exam by asking patients to SOLVE PROBLEMS, interpret PROVERBS, or complete SERIES.
(Blumenfeld, Chapter 3) |
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Under what circumstances might a patient experience hallucinations or delusions?
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toxic or metabolic abnormalities or other causes of diffuse brain function; primary psychiatric disorders; focal lesions or seizures in visual, somatosensory, or auditory cortex
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Thought disorders can be caused by lesions in the _____ cortex and the _____ _____.
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Thought disorders can be caused by lesions in the ASSOCIATION cortex and the LIMBIC SYSTEM.
(Blumenfeld, Chapter 3) |
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When assessing cranial nerve function, it is recommended that one not use noxious odors because.....
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One should not use noxious odors because they may stimulate pain fivers from cranial nerve V.
(Blumenfeld, Chapter 3) |
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The function of cranial nerve I is not often assessed unless...
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unless there is reason to believe specific pathology may be present (e.g., subfrontal brain tumor)
(Blumenfeld, Chapter 3) |
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What are some reasons why a patient may not perform normally when olfaction is assessed?
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1) nasal obstruction
2) damage to olfactory nerves in nasal mucosa 2) damage to nerve as they pass the cribriform plate 3) intracranial lesions affecting the olfactory bulbs (Blumenfeld, Chapter 3) |
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Use of an opthalmoscope to assess function of cranial nerve II allows the clinician to visualize what potential abnormalities?
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1) damage to retina or retinal vessels
2) optic nerve atrophic changes 3) papilledema (Blumenfeld, Chapter 3) |
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An examination of cranial nerve II should assess what 4 primary functions?
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1) visual acuity
2) color vision 3) visual fields 4) visual extinction (Blumenfeld, Chapter 3) |
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Lesions in front of the optic chiasm cause visual deficits in ___ eye(s), while lesions behind the optic chiasm cause visual deficits in ___ eye(s).
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Lesions in front of the optic chiasm cause visual deficits in ONE eye, while lesions behind the optic chiasm cause visual deficits in BOTH eyes.
(Blumenfeld, Chapter 3) |
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Visual hemineglect is often caused by lesions to what areas of the brain?
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Visual hemineglect is usually caused by contralateral pareital lesions. It may also, albeit less frequently, result from lesions of the frontal lobe or thalamus.
(Blumenfeld, Chapter 3) |
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Neglect is most robust with lesions to which hemisphere of the brain?
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the right hemisphere
(Blumenfeld, Chapter 3) |
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Whaty is the purpose of the swinging flashlight test?
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This test moves light back and forth between the eyes to assess for an afferent pupillary defect; the affected pupil will dilate in response to light (see page 59 of Blumenfeld for more info)
(Blumenfeld, Chapter 3) |
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True or False? The pupils typically constrict when fixated on an object being moved away from the eyes?
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False. The pupils typically constrict when fixated on an object being moved TOWARD the eyes (accommodation)
(Blumenfeld, Chapter 3) |
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How do you assess extraocular movements?
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Ask the patient to move their eyes (in all directions) without moving their head
(Blumenfeld, Chapter 3) |
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What are some methods for testing extraocular movements?
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1) test smooth pursuit
2) test convergence movements 3) test eyes at rest 4) look at saccades 5) check for optokinetic nystagmus (Blumenfeld, Chapter 3) |
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A patient is asked to visually follow a moving object. What is being assessed?
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smooth pursuit
(Blumenfeld, Chapter 3) |
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What abnormalities might one observed when a pateitns eyes are examined at rest?
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1) spontaneous nystagmus
2) dysconjugate gaze (both eyes not fixated on same point) 3) diplopia (double vision) (Blumenfeld, Chapter 3) |
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Define saccades.
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Saccades are eye movements that assist one to rapidly refixate their gaze from one object to another.
(Blumenfeld, Chapter 3) |
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Facial sensations and muscles of mastication are evaluated to determine if there is damage to cranial nerve ____.
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cranial nerve V
(Blumenfeld, Chapter 3) |
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Facial sensation can be impaired by lesions to what nerves/brain regions?
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1) trigeminal nerve (V)
2) trigeminal sensory nuclei in brain stem 3) ascending senosry pathways to the thalamus and somatosensory cortex in the postcentral gyrus (Blumenfeld, Chapter 3) |
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The corneal reflex is mediated by polysynaptic connections in the brainstem between the ____ and ____ nerves.
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The corneal reflex is mediated by polysynaptic connections in the brainstem between the TRIGEMINAL (V) and FACIAL (VII) nerves. NOTE: The corneal relfect can be impaired by lesions anywhere in this circuit.
(Blumenfeld, Chapter 3) |
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Muscles of facial expression and taste are evaluated to determine if there is damage to cranial nerve ____ .
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cranial nerve VII
(Blumenfeld, Chapter 3) |
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What are some potential reasons one might observe spontaneous nystagmus in a patient?
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toxic or metabolic conditions (e.g., drug overdose, alcohol intoxication), or peripheral or central vestibular dysfunction
(Blumenfeld, Chapter 3) |
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Facial weakness can result from a number of different lesions, including...
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1) upper motor neuron lesions in the contralateral motor cortex or descending CNS pathways
2) lower motor neuron lesions in the ipsilateral facial nerve nucleus or exiting nerve fibers 3) lesions in the neuromuscular junction 4) lesions of the face muscles (Blumenfeld, Chapter 3) |
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_____ motor neuron lesions cause contralateral face wekness sparing the forehead, while _____ motor neuron lesions cause weakness involving the whole ipsilateral face.
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UPPER motor neuron lesions cause contralateral face wekness sparing the forehead, while LOWER motor neuron lesions cause weakness involving the whole ipsilateral face.
(Blumenfeld, Chapter 3) |
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Hearing and vestibular sense (cranial nerve VIII) is usually not specifically tested except under what circumstances?
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1) in patients with vertigo
2) in patients with limitations of horizontal or vertical gaze 3) in patients in coma (Blumenfeld, Chapter 3) |
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What can cause abnormal articulation of speech?
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1) lesions in muscles of articulation
2) lesions of neuromuscular junction lesions in periperhal or central portions of cranial nervs V, VII, IX, X, or XII (Blumenfeld, Chapter 3) |
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Abnormal speech production can result from lesions to....
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1) motor cortex
2) cerebellum 3) basal ganglia 4) descending pathways to the brainstem (Blumenfeld, Chapter 3) |
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Your patient just demonstrated nonsymmetrical palate elevation or an impaired gag reflex. You anticipate that there may be a lesion where?
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1) cranial nerves IX or X
2) the neuromuscular junction 3) the pharyngeal muscles (Blumenfeld, Chapter 3) |
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What are fasciculations?
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spontanous quivering movements
(Blumenfeld, Chapter 3) |
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Tongue atrophy and fasciculations are signs of ____ _____ _____ lesions.
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Tongue atrophy and fasciculations are signs of LOWER MOTOR NEURON lesions.
(Blumenfeld, Chapter 3) |
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What are the 6 steps of the motor exam?
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1) Observation
2) Inspections 3) Palpation 4) Muscle tone testing 5) Functional testing 6) Strength testing of individual muscle groups (Blumenfeld, Chapter 3) |
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In the Observation stage of the motor exam, what should you be looking for?
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look for involuntary movements, such as twitches or tremors, as well as limitations in movement
(Blumenfeld, Chapter 3) |
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Tremors and involuntary movements often result from lesions to the ______ or ____, although they can also result from lesions to _____.
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Tremors and involuntary movements often result from lesions to the basal ganglia or cerebellum, although they can also result from lesions to peripheral nerves.
(Blumenfeld, Chapter 3) |
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What is involved in the "inspection" stage of the motor exam?
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You should look at several individual muscles to makes ure there is no wasting, hypertrophy, or fasciculations
(Blumenfeld, Chapter 3) |
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Palpation is done to look for muscle ____.
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tenderness
(Blumenfeld, Chapter 3) |
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What is muscle tone testing and what is its purpose?
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evaluates for resistance or regidity by asking patient to relax and then passively move each limb; helps distinguish between upper and lower motor neuron lesions
(Blumenfeld, Chapter 3) |
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What are the pojections of the motor neurons?
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Upper motor neurons project via the corticspinal tract to the lower motor neurons located in the anterior horn of the spinal cord
(Blumenfeld, Chapter 3) |
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What is typically observed with acute upper motor neuron lesions?
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flaccid paralysis with dcreased tone and reflexes; over time, incrased tone and hyperreflexia usually occur
(Blumenfeld, Chapter 3) |
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Increased tone can occur with ___ motor neuron lesions as well as in dysfunction in the ____.
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Increased tone can occur with UPPER motor neuron lesions as well as in dysfunction in the BASAL GANGLIA.
(Blumenfeld, Chapter 3) |
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If a patient demonstrates slow or awkward finger movements or toe taps but does not have any signs of wekness, this can signify abnormality in the _____, but may also reflect lesions of the ____ or ____.
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If a patient demonstrates slow or awkward finger movements or toe taps but does not have any signs of wekness, this can signify abnormality in the CORTICOSPINAL PATHWAYS, but may also reflect lesions of the BASAL GANGLIA or CEREBELLUM.
(Blumenfeld, Chapter 3) |
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What are some signs of hyperreflexia?
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1) spreading of reflexes (to other muscles not being tested)
2) crossed adduction (opposite leg responds to knee tap) 3) Hoffmann's sign (flick patients middle finger downward - if thumb flexes, Hoffmann's sign is present) (Blumenfeld, Chapter 3) |
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What abnormal reflex responses in adults are considered to be "frontal release signs?"
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grasp, snouth, root, suck
(Blumenfeld, Chapter 3) |
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What is the difference between appendicular ataxia and truncal ataxia?
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Appendicular ataxia affects movements of extremeities and is usually caused by lesions of the cerebellar hemispheres and the assocaited pathways. Truncal ataxia affects the proximal musculature, especially that are involved in gait stbility and is caused by midline damage to the cerebellar vermis and its pathways
(Blumenfeld, Chapter 3) |
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How can you test for appendicular ataxia?
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Have patient do rapid alternating movements, finger-nose-finger test, or hell to shin test
(Blumenfeld, Chapter 3) |
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What is the Romberg Test?
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You ask the patient to stand with feet close together and eyes closed; if they sway or lose balance it may suggest imapirment in the proprioceptive or vestibular systems; the Romberg test can also be abnormal if there are lesions in the midline cerebellar region; may also result from lesions in other parts of the nervous system (e.g., motor neurons, basal ganglia)
(Blumenfeld, Chapter 3) |
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What is tandem gait?
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A patient is aked to walk a straight line heel to to.
(Blumenfeld, Chapter 3) |
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True or False. Tandem gait is typically impaired in a patient with truncal ataxia.
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True. Patients with truncal ataxia oftendemonstrate impairments in tandem gait. They typically have a wide-based, unsteady gait, and become more unsteady when attempting to keep their feet close together.
(Blumenfeld, Chapter 3) |
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What is gait apraxia?
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Gait apraxia is a rare disorder in which a person can demonstrate all the movements required for normal gait when lying down, but cannot walk when in a standing position
(Blumenfeld, Chapter 3) |
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What causes gait apraxia?
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Gait apraxia has been observed in patients with frontal lobe dysfunction or normal pressure hydrocephalus
(Blumenfeld, Chapter 3) |
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What sensations are typically evaluated in a sensory examination?
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1) light touch
2) pain 3) temperature 4) vibration sense 5) joint position sense 6) two-point discrimination (Blumenfeld, Chapter 3) |
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In what ways do you assess cortical sensation?
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1) test for graphesthesia (can pt identify letter or numbers traced in their palm?)
2) test stereognosis (ask pt to identify objects by touch with eyes closed) 3) test for tactile extinction on double simultaneous stimulation NOTE: primary sensation must be intact to test for cortical sensation (Blumenfeld, Chapter 3) |
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What types of lesions can result in somatosenosry deficits?
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peripheral nerves, nerve roots, posterior columns or anterolateral sensory systems in the spinal cord or brainstem, thalamus, or sensory cortex
(Blumenfeld, Chapter 3) |
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Describe the pathway for position and vibration sense.
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Position and vibration sense ascend in the poterior column pathway and cross over in the medulla
(Blumenfeld, Chapter 3) |
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Describe the pathway for pain and temperature.
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Pain and temperature sense cross over shortly after entering the spinal cord and then ascend in the anterolateral pathway
(Blumenfeld, Chapter 3) |
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If a patient's primary sensations are all intact, but they demonstrate agraphestehsia or astereognosis, where would you expect the lesion to be?
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the lesion is likely to be in the contralateral sensory cortex.
(Blumenfeld, Chapter 3) |
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Where is the lesion when primary sensation is intact, but the patient shows tactile extinction?
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this is a type of hemineglect usually associated with damage to the right parietal lobe, but may also occur with right frontal or subcortical lesions
(Blumenfeld, Chapter 3) |
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What are some conditions that may be mistaken for coma?
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1) akinesia or abulia caused by frontal lobe lesions (patient is minimally responsive and has decreased initiative)
2) catatonia (decreased resonsiveness due to psychiatric illness) 3) Locked-in syndrome (patient unable to move because of lesion in brinstem motor pathways or peripheral neuromusclar blockade (Blumenfeld, Chapter 3) |
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What is the difference between decorticate and decerebrate posturing?
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Decorticate posturing is flexor posturing and decerebrate posturing is extensor posturing; decorticate posturing tends to accompany lesions higher in the enuraxis at the midbrain or above, whereas decerebrate posturing tends to occur with more severe lesions extending lower down the brainstem. NOTE: in decorticate, lesion is higher and arems point up toward cortex; in decerebrate, lesion is lower and extended arms point down
(Blumenfeld, Chapter 3) |
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What is meant by the term "brain death?"
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this refers to an irreversible lack of brain function
(Blumenfeld, Chapter 3) |
