Neuro Exam 1: Neruo Exam

Front 1

name the 5 components of the neurological exam, in the order they are generally performed

Back 1

mental status, cranial nerves, motor/deep tendon reflexes, sensory, gait/coordination

Front 2

what is the most neurologically relevant component of the mental status exam?

Back 2

testing speech --> look for fluency, repetition, naming, and comprehension

Front 3

in anomic aphasia, which of the following are intact: naming ability, fluency, comprehension, repetition

Back 3

all but naming ability

Front 4

in broca's aphasia, which of the following are intact: naming ability, fluency, comprehension, repetition? what's it's "cousin" deficit?

Back 4

comprehension only. it's cousin is transcortical motor aphasia (repetition is spared, fluency is not)

Front 5

in wernicke's aphasia, which of the following are intact: naming ability, fluency, comprehension, repetition? what's it's "cousin" deficit?

Back 5

fluency is the only thing spared. it's cousin is transcortical sensory aphasia (repetition is spared, comprehension is not)

Front 6

in conduction aphasia, which of the following are intact: naming ability, fluency, comprehension, repetition? what's it's "cousin" deficit?

Back 6

fluency and comprehension are spared. it's cousin is anomic aphasia (all are spared except for naming)

Front 7

which cranial nerves are tested with visual acuity and fields? pupillary responses? fundascopic exam? extraocular movements?

Back 7

visual acuity: CN2, pupillary responses: CN2, CN3, fundascopic exam: CN2, extraocular movements: CN 3, CN4, CN6

Front 8

which cranial nerves are tested by facial sensation? corneal reflex? muscles of facial expression? hearing and vestibular sense?

Back 8

facial sensation: CN5, corneal reflex: CN5 (afferent), CN7 (efferent), muscles of facial expression: CN7, hearing/vestib: CN8

Front 9

which cranial nerves are tested by palate elevation and gag reflex? tongue muscles? SCM and trapezius strength?

Back 9

palate elevation/gag: CN9, CN10, tongue muscles: CN12, SCM and trapezius: CN11

Front 10

lesions in front of the ___ cause visual deficits in ___, while lesions behind the ___ cause visual deficits that are ___.

Back 10

lesions in front of the OPTIC CHIASM cause visual deficits in ONE EYE, while lesions behind the optic chiasm cause SIMILAR DEFICITS IN BOTH EYES

Front 11

where is the lesion? monocular scotoma on the R

Back 11

R retina, in opposite quadrant of deficit

Front 12

where is the lesion? monocular visual loss on the R

Back 12

optic nerve on the R

Front 13

where is the lesion? bitemproal hemianopia (can't see R visual field in R eye, can't see L visual field in L eye)

Back 13

optic chiasm

Front 14

where is the lesion? quadrantanopia in upper L visual field

Back 14

R Meyer's loop (anterior portion) or lower bank of R calcarine fissure

Front 15

where is the lesion? quadrantanopia in lower L visual field

Back 15

R Meyer's loop (posterior portion) or upper bank of R calcarine fissure

Front 16

where is the lesion? homonymous hemianopia on the L visual field

Back 16

R optic tract or R optic radiation or R calcarine fissure upper + lower banks

Front 17

in pupillary reflex testing, the direct response is impaired in lesions of what 4 areas?

Back 17

ipsilateral optic nerve, pretectal area, ipsilateral parasympathetics (in CN3), pupillary constrictor muscle of the iris

Front 18

in pupillary reflex testing, the consensual response is impaired in lesions of what 4 areas?

Back 18

contralateral optic nerve, pretectal area, ipsilateral parasympathetics (CN3), pupillary constrictor muscle

Front 19

the pupillary reflex is impaired in accommodation testing with which 4 lesions? accommodations is spared in lesions of ___.

Back 19

accommodation is impaired w/lesions of the ipsilateral optic nerve, ipsilateral parasymptahtetics (in CN3), pupillary constrictor muscle, bilateral lesions of optic tract pathways to cortex. accommodation is SPARED in PRETECTAL lesions.

Front 20

Horner's syndrome is caused by ___, and is characterized by ___, ___, and ___.

Back 20

caused by lesions of the CERVICAL SYMPATHETIC TRUNK, and characterized by PUPILLARY CONSTRICTION, ANHYDROSIS, and PTOSIS.

Front 21

relative afferent pupillary defect (RAPD) is caused by ___ of cranial nerve ___. IIt can be detected only ___. When light is shone in the unaffected eye, ___ constrict(s). When light is shone in the affected eye, ___ constrict(s).

Back 21

RAPD is caused by an ASYMMETRIC lesion of CN2. It can only be detected IN THE DARK. When light is shone in the unaffected eye, BOTH EYES constrict. When light is shone in the affected eye, the eyes only SLIGHTLY CONSTRICT.

Front 22

what are 4 causes of anisocoria?

Back 22

benign essential anisocoria (most common), oculomotor nerve lesion, Horner's syndrome, Adie's pupil

Front 23

in terms of the pupillary light reflex, how could you differentiate between a L oculomotor nerve lesion and L horner's syndrome?

Back 23

in L OCULOMOTOR nerve lesion, the L eye will not constrict in response to light directly shone in L eye (DIRECT response affected). in L HORNER'S, the L eye will not constrict in response to light shone in the R eye (consentual response affected).

Front 24

horner's is more obvious in a ___ (dark/light) room. oculomotor lesions are more obvious in a __ room.

Back 24

horner's is more obvious in a dark room (impaired pupillary dilation), oculomotor lesions are more obvious in a light room (impaired pupillary constriction).

Front 25

name 3 causes of light near-dissociation

Back 25

Argyll Robertson Pupil (neurospyhilis), Parinaud's syndrome (dorsal midbrain syndrome, also associated w/paralysis of up gaze), Adie's pupil (lesion in ciliary ganglion)

Front 26

name all the players on team rightward gaze

Back 26

Right PPRF, Right 6th nerve nucleus (R pons); Left frontal eye field; Right 6th nerve, Left MLF, Left 3rd nerve nucleus, Left 3rd nerve

Front 27

name all the players on team leftward gaze

Back 27

Left PPRF, Left 6th nerve nucleus (L pons); right frontal eye field; left 6th nerve, right MLF, right 3rd nerve nucleus, right 3rd nerve

Front 28

describe the defect associated w/right abducens nerve lesion

Back 28

right eye cannot look right

Front 29

describe the defect associated w/right abducens nucleus lesion

Back 29

right lateral gaze palsy (both eyes can't look right) - note: same as right abducens nucleus lesion

Front 30

describe the defect associated with right PPRF lesion

Back 30

right lateral gaze palsy (both eyes can't look right) - note: same as right abducens nucleus lesion

Front 31

describe the defect associated w/left MLF lesion

Back 31

left INO (left eye cannot look right, right eye has nystagmus on rightward gaze)

Front 32

describe the defect associated w/lesion in the left MLF and the left abducens nucleus

Back 32

1 1/2 syndrome --> both eyes can't look left, left eye can't look right, right eye has nystagmus on rightward gaze

Front 33

describe the characteristic appearance of a patient w/3rd nerve palsy. describe 4th nerve palsy.

Back 33

3rd nerve palsy: affected eye is down and out and the pupil is too big. 4th nerve palsy: head tilts so that forehead is away from the affected eye, correcting the "up and out" rotation that lesion to CN4 causes.

Front 34

usually, when a cortical lesion affects the frontal eye fields on the left, the eyes look ___.

Back 34

LEFT (towards the lesion, away from the paralyzed side). recall that this is caused b/c the rightward gaze center loses tonic input.

Front 35

what can cause "wrong-way eyes"?

Back 35

lesion in the pons --> would affect corticospinal tract on opposite side, so the patient would look away from the lesion.

Front 36

facial sensation can be impaired by lesions of the __ nerve, the ___ nuclei in the ___, or the ascending sensory pathways to the ___ and ___ in the ___.

Back 36

facial sensation can be impaired by lesions of the TRIGEMINAL nerve, the TRIGEMINAL SENSORY NUCLEI in the BRAINSTEM, or ascending sensory pathways to the THALAMUS and SOMATOSENSORY CORTEX in the POSTCENTRAL GYRUS.

Front 37

the corneal blink reflex is mediated by postsynaptic connections in the brainstem between the __ and __ nerves, and can be impaired by lesions anywhere in this ciruit

Back 37

trigeminal and facial (CN5 and CN7)

Front 38

what can cause facial weakness (3 things)?

Back 38

lesions of upper motor neurons in contralateral motor cortex, descending central nervous system pathways, lower motor neurons in ipsilateral facial nerve nucleus (CN7). note: upper motor neurons to upper face will spare the forehead, lower motor neurons cause bells palsy type lesions

Front 39

weber test: normally sound is = in both ears. in conduction loss, it is louder in the ___ ear. in sensorineural loss, the sound is louder in the __ ear.

Back 39

in conduction loss, sound is louder in ear with decreased hearing. in sensorineural loss, sound is louder in the good ear.

Front 40

rinne: the sound is normally louder ___ (over the mastoid/in front of the ear) in CONDUCTION hearing loss. and the sounds is normally louder ___ in SENSORINEURAL loss.

Back 40

in conduction loss, sound is louder over the mastoid. in sensorineural loss, sound is louder in front of the ear.

Front 41

clinically significant unilateral hearing loss is ___ caused by ____ lesions.

Back 41

clinically significant unilateral hearing loss is INVARIABLY caused by PERIPHERAL NEURAL or MECHANICAL lesions. (after the hearing pathways enter the brainstem, they cross over at multiple levels and ascend bilaterally to the thalamus and auditory cortex.)

Front 42

explain the COWS mnemonic

Back 42

cold opposite warm the same - in HEALTHY AWAKE PEOPLE, cold water in one ear will cause nystagmus w/the fast portion to the opposite side.

Front 43

in a patient that is not braindead, but is in a coma with damage to the vestibular nuclei, then what will happen when you squirt cold water in their left ear?

Back 43

eyes will deviate to the left. (recall that it would cause nystagmus to the right in a healthy awake person, so with this lesion, only the slow component remains).

Front 44

palate elevation and the gag reflex are impaired in lesions involving CN _, CN _, the ___, or the ___ muscles. if the palate elevates to the left (uvula deviated left), it is b/c of weakness in the __.

Back 44

palate elevation and the gag reflex are impaired in lesions involving CN9, CN10, the neuromuscular junction, or the pharyngeal muscles. if the palate elevates to the left, it is because of weakness in the right (not pulling uvula midline)

Front 45

fasciculations and atrophy are signs of ___ lesions. unilateral tongue weakness causes the tongue to deviate towards the __ (strong/weak) side. tongue weakness can result from lesions of the ___, the ___, the ___, or the ___.

Back 45

fasciculations and atrophy are signs of LOWER MOTOR NEURON lesions. unilateral tongue weakness causes the tongue to deviate towards the WEAK side. tongue weakness can result from lesions of the TONGUE MUSCLES, NEUROMUSCULAR JUNCTION, LOWER MOTOR NEURONS of the HYPOGLOSSAL NERVE (12), or UPPER MOTOR NEURONS in the CONTRALATERAL MOTOR CORTEX

Front 46

explain the corticospinal tract

Back 46

precentral gyrus (primary motor cortex) --> posterior limb of internal capsuls --> pyramidal decussation in midbrain --> lateral corticospinal tract in spinal cord --> anterior horn, where it synapses on lower motor neuron --> skeletal muscle

Front 47

involuntary movements and tremors are commonly associated with lesions of the __ or __.

Back 47

basal ganglia or cerebellum

Front 48

characteristics of upper motor neuron lesions

Back 48

weakness, hyperreflexia, increased tone (although acute UMN lesions can be associated w/flaccid paralysis and the increased tone and reflexes develop later on. similarly, atrophy may develop in an UMN lesion over time due to disuse.)

Front 49

characteristics of lower motor neuron lesions

Back 49

weakness, atrophy, fasciculatios, hyporeflexia

Front 50

strength testing: 0/5, 1/5, 2/5, 3/5, 4/5, 5/5

Back 50

0/5: no contraction. 1/5: muscle flicke, no movement. 2/5: movement possible, but not against gravity. 3/5: can move against gravity but not resistance. 4/5: mvt possible against some resistance, but not normal. 5/5: normal strength.

Front 51

what are normal reflexes? what is abnormal?

Back 51

normal is 1-3 (2 being normal, 3 being brisk, 1 being diminished. abnormal is 0 (absent reflex) or 4 (clonus)

Front 52

name 6 new born infant feflexes

Back 52

rooting, sucking, moro, grasp, babinski, tonic neck

Front 53

rooting and sucking reflexes are present ___ and assist in ___. these disappear at around ___.

Back 53

present at birth, assist in breastfeeding, disappear ~4 mo.s

Front 54

palmer grasp reflex is present __. persists until __.

Back 54

present at birth, persiss until 5-6 months of age

Front 55

the babinski reflex is positive __. fades around __.

Back 55

positive at birth. fades around 1yr.

Front 56

the moro reflex is also known as the ___. present __, peaks at ___, and disappears around ___.

Back 56

moro reflex is the startle reaction (arms spread wide apart when you pull your hands away). present at birth, peaks at 1 month, disappears ~2 months.

Front 57

the tonic neck reflex, also called ___ is present at ___ and disappears around __.

Back 57

also called fencing posture (reach arm out to same direction as you turn the head in), the tonic neck reflex is present at 1 month of age and disappears ~4 months (as infants start to learn to sit)

Front 58

posterior columns are tested by __.

Back 58

vibration and position sense.

Front 59

spinothalamic tracts are tested by __.

Back 59

pain and temperature testing

Front 60

cortical sensation is tested by __

Back 60

extinction, 2-point discrimination, graphesthesia, stereognosis.

Front 61

spinal cord ascending pathways: what tract is at the top (dorsal side) in the center? how about the bottom (ventral side) near the side? how about the very edges?

Back 61

top: posterior columns (vibration and position). anterolateral tract/spinothalamic tract is front and toward the side. at the very edge is the spinocerebellar tract (dorsal and ventral)

Front 62

explain the posterior columns pathway

Back 62

primary somatosensory cortex --> synapse in thalamus: ventral posterior lateral nucleus --> secondary sensory neuron decussates at medulla --> posterior (dorsal) columns

Front 63

explain the anterolateral (spinothalamic pathway)

Back 63

primary somatosensory cortex --> synapse in thalamus: ventral posterior lateral nucleus --> secondary sensory neuron ravels through anterolateral pathway (spinothalamic tract) and decussates just before leaving the spinal cord --> exits through dorsal root ganglion

Front 64

what does the romberg test for? how do you do it?

Back 64

patient stands together with eyes closed. used to check for sensory ataxia. vision, proprioception, and vestibular function all contribute to the cerebellum. so what happens when you take one out? generally, it's good for detecting problems w/proprioception in particular (vision will be tested w/eye fields etc., vestibular dysfcn is usually accompanied by vertigo)

Front 65

appendicular coordination cerebellar testing. finger-nose-finger and heel-knee-shin assess __ and rapid alternating movements assess ___

Back 65

finger-nose-finger assesses DYSMETRIA (decreased ability to aim), and alternating movements assesses DYSDIADOKINESIA (decreased ability to flip b/w muscle groups)

Front 66

appendicular ataxia is usually caused by lesions of the ___ and associated pathways, while truncal ataxia (Romberg test, gait problems) are usually caused by damage to the __ and associated pathways.

Back 66

appendicular ataxia usually caused by lesions of the cerebellar HEMISPHERES, truncal ataxia usually caused by damage to the MIDLINE CEREBELLAR VERMIS.

Front 67

cerebellar dysfunction is always ___.

Back 67

IPSILATERAL. (same side affected as lesion)