Neurological Exam Ii

Front 1

What is the normal blink reflex?

Back 1

1. Touching either eye at outer limbus causes lid closure of both eyes

Front 2

Where is the blink reflex coordinated?

Back 2

1. Pons

2. Sensation=nasociliary branch of V1

3. Motor= orbicularis oculi--- CN VII

Front 3

What happens to the blink reflex in a trigeminal lesion?

Back 3

1. Absent on affected side--- afferent deficit

2. Unaffected side yields bilateral wink

Front 4

What happens to the blink reflex in a facial nerve lesion?

Back 4

1. Normal corneal sensation

2. Full closure on unaffected side only

Front 5

What happens to the blink reflex in a supra nuclear lesion?

Back 5

1. Behaves like a trigeminal lesion

Front 6

What are the ssx of a trigeminal lesion?

Back 6

1. Deviation of jaw away from unopposed pterygoid

2. Wasting of temporalis on affected side

Front 7

What is the age of onset of trigeminal neuralgia?

Back 7

1. 50 y/o

Front 8

What are the trigger points of trigeminal neuralgia?

Back 8

1. Touching face, chewing, smiling, talking, blowing nose, brushing teeth

Front 9

What branch is MC involved in trigeminal neuralgia?

Back 9

1. V2

Front 10

What are the ssx of trigeminal neuralgia?

Back 10

1. Paroxysms of stabbing, turing, lancinating pain

2. Persistent for weeks or longer

3. No sensory or motor loss

Front 11

How do you tx trigeminal neuralgia?

Back 11

1. Carbamazepine

2. Cure=surgery

Front 12

What is the urgency of HZ opthalmicus? How do you tx?

Back 12

1. Relative urgency

2. Tx with acyclovir immediately

Front 13

What are the ssx of Sturge Weber Dimitri syndrome?

Back 13

1. Phakomatosis

2. Port wine nevi

Front 14

With what is Sturge Wber Dimitri associated?

Back 14

1. Ispsilateal elptomeningeal angiomas

2. Intracortical calcifications

3. Cerebral atrophy

4. Focal seizures

Front 15

What are the disorder associated with CN VII palsy?

Back 15

1. Bell's palsy

2. Ramsey Hunt sydnrome

3. Facial hemispasm

Front 16

What do you test for in CN VII?

Back 16

1. LMN/UMN palsy

2. Chvostek's sign

3. Bell phenomena

Front 17

What will a UMN CN VII issue cause?

Back 17

1. Lower facial muscle weakness

Front 18

What will a LMN CN VII issue cause?

Back 18

1. All facial muscle involvement

Front 19

What is facial synkinesis?

Back 19

1. Involuntary muscular movements accompanying voluntary movements

2. Due to mis-wiring of nerves after injury

Front 20

What is the outlook of facial synkinesis?

Back 20

1. Permanent

2. No tx

Front 21

What is Ramsey Hunt syndrome? SSx?

Back 21

1. HZ oticus+Bells palsy

2. Patient will complain of pain behind the ear, later complain of ipsilateral facial paralysis

3. Pain more severe than Bells palsy

4. Loss/decrease of hearing

Front 22

What are the ssx of facial hemispasm?

Back 22

1. Involuntary contraction of muscles supplied by CN VII

Front 23

What is the MCC of facial hemispasm?

Back 23

1. Compression or irritation of CN VII--- tumors, aberrant artery

Front 24

How do you tx facial hemispasm?

Back 24

1. Botulinum toxin

2. Microvascular decompression

Front 25

What are the ssx of central facial palsy?

Back 25

1. Pt. always able to close eye

2. Corneal reflex is absent

3. Bell's phenomenon present

Front 26

What is subjective tinnitus?

Back 26

1. Not from real sounds

2. Caused by auditory system disorder or drugs

Front 27

What is objective tinnitus?

Back 27

1. Caused by a real sound, audible to you as well

2. Can be caused by AV malformation, anemia, or hyperthyroidism

3. Has a pulse or hum

Front 28

What is peripheral vertigo?

Back 28

1. Labyrinthine or peripheral nerve ir origin

2. Jerk nystagmus present with increased ssx on head movement

Front 29

What is central vertigo?

Back 29

1. Origin in CNS
2. Has pendular nystagmus associated with dysequilibirum

3. No nausea or fear of movement with head movement

Front 30

Facial palsy and hearing loss in the elderly?

Back 30

1. Acoustic neuroma

2. Bell' palsy--- causes hyperacusis

Front 31

What is the use of the Dix-Hallpike maneuver?

Back 31

1. Induce nystagmus moving head rotationally and in extension/flexion

2. Labyrinthine nystagmus**

Front 32

What is the caloric test?

Back 32

1. Checks integrity of brainstem and MLF

2. Validates dx of asymmetric dysfunction in peripheral vestibular system

3. COWS

Front 33

What is the MC peripheral vertigo? Tx?

Back 33

1. Benign paroxysmal positional vertigo

2. Tx: Epley maneuver

Front 34

What are the ssx of peripheral vertigo?

Back 34

1. Intermittent severe ssx

2. Affected by head position and movement

3. N/V

4. Motor, gait, and coordination intact

Front 35

What are the ssx of central vertigo?

Back 35

1. More mild than peripheral

2. Unaffected by head position and movement

3. Gait instability and loss of coordination frequent

4. Labyrinthine/cerebellar in origin

Front 36

What are the ssx of glossopharyngeal neuralgia?

Back 36

1. lancinating pain on side of throat or tonsillar region

2. Radiates along course of eustachian tube to tympanic membrane

Front 37

What are the trigger zones for glossopharyngeal neuralgia?

Back 37

1. Pharyngeal wall, tonsillar regions, base of tongue

2. Talking, eating, swallowing, coughing

Front 38

With what is CN IX related?

Back 38

1. Neoplasms

2. Basilar skull frature

3. Motor neuron disease

4. MS

Front 39

What nerves are involved in the gag reflex?

Back 39

1. IX- afferent

2. X- efferent

Front 40

How do you test for CN X palsy?

Back 40

1. Uvula deviates away from weak side

Front 41

What is the MCC of CN XI palsy?

Back 41

1. Trauma

Front 42

What are the ssx of CN XI palsy?

Back 42

1. Wasting of left SCM/trap

2. Trouble turning head away

3. Bilateral: can't nod head down

Front 43

What are the ssx of CN XII injury?

Back 43

1. Deviation towards lesion

2. LMN**

Front 44

What do you lose in sensory ataxia?

Back 44

1. Posterior colummn

Front 45

What do you lose in motor ataxia?

Back 45

1. Cerebellum

Front 46

What causes labyrinthine ataxia?

Back 46

1. Head position--- jerk nystagmus

Front 47

What are the ssx of cerebellar hemisphere syndrome? MCC?

Back 47

1. Lateralized cerebellar signs in 1/2 of the body

2. MCC: focal process in one cerebellar hemisphere

Front 48

What are the ssx of rostral vermis syndrome? MCC?

Back 48

1. Ataxia in legs, sparing cranial nerve musculature

2. MCC: toxic/metabolic--- alcohol/nutrition

Front 49

What are the ssx of caudal vermis syndrome? MCC?

Back 49

1. Ataxia of stance and gait

2. Little or no limb ataxia

3. MCC: midline cerebellar lesion--- tumor

Front 50

What are the ssx of pancerebellar syndrome? MCC?

Back 50

1. Cerebellar signs bilaterally in all musculature, cranial, axial, and extremities

2. MCC: toxic, metabolic, or degenerative