Neurological Exam Part I

Front 1

What are the 5 questions you MUST ASK?

Back 1

1. Functional/oranic

2. Level?

3. Focal or diffuse?

4. Mass or non-mass?

5. Cause?

Front 2

What is agnosia?

Back 2

1. Inability to interpret sensations and hence to recognize things

2. Occipitotemporal border

Front 3

What is apraxia?

Back 3

1. Inability to perform particular actions

2. Frontal and parietal lobes

Front 4

What is aphasia?

Back 4

1. Inability to understand or express speech

2. Frontal and temporal lobes

Front 5

What are the dominant hemisphere deficit signs?

Back 5

1. Dysphasia

2. Dysgraphia

3. Auditory agnosia

4. Word agnosia

Front 6

What is the non-dominant hemisphere in charge of?

Back 6

1. Emotion

2. Awareness of body schemes and spatial relationships

3. Nonsyntactic components of language

4. Prosody

Front 7

What are the findings of non-dominant hemisphere lesions?

Back 7

1. Extinction

2. inattention---blindness

3. Depression

Front 8

What is usually the first sign of Parkinson's?

Back 8

1. Loss of smell

Front 9

How do you test the optic nerve?

Back 9

1. Visual fields

2. Fundoscopy

Front 10

What is the function of CNs II, IV, and VI?

Back 10

1. Moves eyes

2. III constricts pupil

Front 11

What leads to bitemporal hemianopia?

Back 11

1. Pituitary enlargement

Front 12

What is the MCC of visual extinction?

Back 12

1. Contralateral parietal lesions

Front 13

What is amaurosis fugax?

Back 13

1. Blindness that comes and goes

2. Due to microemboli in ICA

3. "Cherry red spot" inside of fovea

Front 14

What is a scotoma?

Back 14

1. Blind spot

2. Black=retinal disease

3. Blank spot=optic nerve lesion

Front 15

What is the MCC of pailledema? How does it usually present?

Back 15

1. ICP

2. Impedes retinal venous return

3. Usually presents as a blind spot

Front 16

What are the ssx of acute anterior optic neuritis? What is the progression?

Back 16

1. Physician sees swollen disc, patient is blind

2. Usually unilateral

3. Sudden visual loss progresses over 1-2 weeks, recovery 4-6w later

Front 17

What is acute retrobulbar neuritis? Progression?

Back 17

1. Physician sees nothing

2. Patient sees nothing

3. Optic nerve issue

4. Visual loss is sudden, painless, and does not improve

Front 18

What is optic atrophy? Progression?

Back 18

1. Small, pale sharply marginated optic disc

2. Denotes old nerve injury

3. Blindness in one eye that resolves after 4-6 w

Front 19

With what diseases is optic atrophy associated?

Back 19

1. MS

2. Optic neuritis

3. Papilledema

Front 20

What controls construction of the pupil?

Back 20

1. Pretectal nucleus---> Edinger-Westphal nucleus---> ciliary ganglion---> iris

2. Parasympathetic

Front 21

What dilates the pupil?

Back 21

1. Sympathetic hypothalamic cervical cord pathway at T2

2. Superior cervical ganglion, postganglionic fibers along CIA to pupillary-dilator muscles

Front 22

What is anisocoria?

Back 22

1. Unequal pupils in low, ambient, and bright lights

2. Test with swinging flashlight test

3. Often disappears by 2nd exam

Front 23

What are the ssx of Horner's? Cause?

Back 23

1. Ptosis

2. Miosis

3. Anhydrosis

4. Medullary infarction, T1 root injury, Pancoast tumor, carotid atherosclerosis

Front 24

What is Wallenberg's syndrome?

Back 24

1. Infarction of lateral medullary tegmentum

2. Facial pain

3. Ataxia

4. Horner's syndrome

5. Dysphagia, dysarthria

Front 25

What is the MC form of brainstem stroke from a thrombosis of PICA?

Back 25

1. Wallenberg syndrome

Front 26

What are Argyll Robertson pupils?

Back 26

1. Accommodate but won't react

Front 27

What is iridoplegia? MCC?

Back 27

1. No reopens or accommodation in left eye

2. MCC: atropinic agents: scopolamine, eye drops

Front 28

What leads to complete CN III palsy?

Back 28

1. Compression (aneurysm)

2. Down and out eye

3. Ptosis of upper lid

4. Pupil dilated and unreactive to light

Front 29

What is the MCC of incomplete CN III palsy?

Back 29

1. DM---- central of nerve, not periphery

Front 30

What are the ssx of CN IV palsy?

Back 30

1. Reduced downward and inward gaze

2. Head tilt away from affected eye

Front 31

What are the ssx of CN VI palsy?

Back 31

1. Loss of lateral deviation of eye

Front 32

What is intranuclear ophthalmoplegia?

Back 32

1. Lesion of medial longitudianal fasciclus between C3 and C6

2. Eyes do not cross over

Front 33

What is Parinaud syndrome?

Back 33

1. Defective up and down gaze

2. Seen with pineal tumors, women in 20s/30s with MS, older pts. following stroke of upper brainstem

Front 34

What are saccades?

Back 34

1. Brain gets bored, eyes move

2. Helps track movements in space

Front 35

What is jerk nystagmus? What does it indicate?

Back 35

1. Phases of unequal velocity

2. Unidirectional

3. Indicates vestibular or brainstem abnormality

Front 36

What is pendular nystagmus? What does it indicate?

Back 36

1. Phases of equal velocity

2. Bidirectional

3. Indicates a brainstem abnormality

Front 37

Why should you test for optokinetic nystagmus?

Back 37

1. Temporal-parietal-occipital lesions

2. Visual acuity in infants beginning at 4-6 mos.

3. Visual function in patients with depresses consciousness

4. Provide a clue to presence of psychogenic visual loss (if present, patient not blind)

Front 38

When does afferent pupillary defect occur?

Back 38

1. When patient is blind and cannot sense light

2. Optic nerve issue

Front 39

What is Adie's Homes syndrome?

Back 39

1. Tonic pupil in presence of decreased DTRs in lower extremities

Front 40

When is ideomotor apraxia more complicated?

Back 40

1. In sequential activities