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Neurophysiology > Clinical Neuro Exam > Flashcards

Clinical Neuro Exam Flashcards

1
Q

what is an Upper Motor Neuron (UMN)?

A

descending axons from cortex to brainstem

OR

from brainstem to spinal cord

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2
Q

what is a Lower Motor Neuron (LMN)?

A

axons exiting the CNS and innervating peripheral nerves

motor divisions of cranial nerves

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3
Q

is weakness a sign of an UMN or LMN Lesion?

A

Both

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4
Q

is atrophy a sign of an UMN or a LMN lesion?

A

LMN lesion

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5
Q

are fasiculations a sign of an UMN or LMN lesion?

A

LMN

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6
Q

are increased reflexes a sign of an UMN or a LMN lesion?

A

UMN lesion

(LMN have decreased reflexes)

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7
Q

is decreased tone a sign of an UMN or a LMN lesion?

A

LMN lesion

(increased tone = UMN lesion)

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8
Q

What are the 6 components of the whole clinical neurological exam?

A
  1. Mental Status
  2. Cranial Nerves
  3. Motor Exam
  4. Sensory Exam
  5. Reflexes
  6. Coordination/Gait
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9
Q

Which cranial nerves are pure sensory nerves?

A
  1. Olfactory (CN 1)
  2. Optic (CN 2)
  3. Auditory (CN 8)
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10
Q

which cranial nerves are pure motor nerves?

A
  1. Trochlear (CN 4)
  2. Abducent (CN 6)
  3. Accessory (CN 11)
  4. Hypoglossal (CN 12)
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11
Q

which cranial nerves are mixed nerves (both motor and sensory)?

A
  1. Trigeminal (CN 5)
  2. Facial (CN 7)
  3. Glossopharyngeal (CN 9)
  4. Vagus (CN 10)
  5. Occulomotor (CN 3)
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12
Q

Th test for olfaction (CN 1) includes what 2 tests?

A
  1. Tests for discrimination (contrast odors)
  2. Tests for arousal (noxious stimulant)
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13
Q

T/F: the CN 1 test is not often included in the cranial nerve screen

A

TRUE

this nerve tends to be spared from a lot of issues unless there is a specific pathology that impacts this sense

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14
Q

If a patient presents with unilateral or bilateral loss of smell but can still distinguish the smell what is the differential diagnosis?

A

a local nasal disease rather than a neural condition

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15
Q

When testing CN 1, what would suggest to you that there might be a neural pathology invovled?

A

if the pt has a distorted sense of smell for a neutral scent

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16
Q

List some possible mechanisms of injury to the olfactory nerve

A
  1. Parkinson’s disease
  2. chronic meningeal inflammation
  3. tumors in sub frontal region
  4. head injuries
  5. heavy smoking
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17
Q

What tests are included in the CN 2 exam?

A
  1. Visual acuity
  2. Color discrimination
  3. Field Cuts
  4. Pupillary response to light accommodation
  5. Visual Extinction
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18
Q

What is visual acuity? How do we test it?

A

ability to see clearly

Snellin chart

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19
Q

What is a visual field cut?

A

blindness in one of the 4 quadrants of the eye

this is due to damage to the optic nerve and is NOT the same as visual neglect

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20
Q

What is the visual extinction test?

A

a visual neglect test

helpful to include in testing the optic nerve and ruling out visual neglect over a visual field cut

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21
Q

what cranial nerves are responsible for innervating the extraoccular muscles?

A

CN III
CN IV

CN VI

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22
Q

CN III innervates extraoccular muscles that perform what movements?

A

elevation

depression

ADDuction

(PSNS: pupil constriction - efferent limb of pupillary reflex)

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23
Q

CN IV innervates extraoccular muscles that perform what movements?

A

Depression/intorsion

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24
Q

CN VI innervates extraoccular muscles that perform what movements?

A

ABDuction

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25
Q

what test is performing the examination of CN 3, 4, and 6?

A

Big H test

26
Q

if a patient presents with a gaze palsy in which both eyes are skewed in the same direction, what type of lesion are you suspecting?

A

UMN Lesion

(both eyes have dysconjugate gaze)

27
Q

if a pt presents with a gaze palsy in which both eyes are dysconjugate but are skewed in different directions, what lesion do you suspect?

A

LMN lesion

28
Q

if a pt presents with a gaze palsy in which only one eye has a dysconjugate gaze in a specific direction, what type of lesion are you suspecting?

A

LMN lesion

29
Q

The trigeminal nerve is a mixed sensory and motor nerve. What afferent/efferent info does it carry?

A

Afferent:

  1. pain
  2. temperature
  3. joint position
  4. vibration
  5. anterior 2/3 tongue (somatosensory)
  6. nasal sinuses

Efferent

  1. muscles of mastication
  2. tensor tympani
30
Q

How would you test the trigeminal nerve?

A
  1. Light tough to face
    • for all branches (V1, 2, 3)
  2. Bite strength
    • for muscles of mastication
  3. Corneal reflex
    • tests both V and VII
31
Q

when is the corneal reflex test most often performed?

A

if a pt is obtunded

not commonly performed if a pt is alert

32
Q

the facial nerve is a mixed sensory and motor nerve. What are it’s afferent and efferent branches?

A

afferent

  1. taste afferents for anterior 2/3 of tongue
  2. somatosensory for proprioception of facial muscles
  3. somatosensory for skin sensation of posterior ear and external auditory meatus
  4. motor for facial expression muscles
  5. autonomic motor to lacrimal and salivary glands
33
Q

What is/are the methods for testnig CN VII?

A
  1. Observation
  2. Motor
    1. smile, raise eyebrows, puff out cheeks, purse lips, close eyes tightly
  3. Sensory
    1. taste (not typically done)
    2. secretomotor function
  4. Reflexes
    1. corneal reflex (CN V and VII)
    2. nasopalpebral reflex
34
Q

why is taste not typically tested specifically?

A

pts wil often complain about it and will let you know if they have lose some taste

35
Q

what is the formal way to test the salivary glands?

A

give the pt something spicy and then compare the either side of the inside of their mouth.

look for saliva secretion either side

36
Q

When testing CN 7 how can you distinguish between an UMN and a LMN lesion?

A

look at the forehead

UMN = intact forehead muscle function

LMN = entire side of face will lose motor function

37
Q

how is CN IX assessed/tested?

A

Palatal activation

inspect for symmetry → with a lesion, one side will deviate to uninvolved side

Gag reflex (sensory limb)

38
Q

The gag reflex tests which cranial nerves?

A

CN IX (sensory afferent limb)

CN X (motor efferent limb)

39
Q

how would you expect a pt with CN 9 and 10 dysfunction to sound?

A

hoarse

difficulty with speech production

40
Q

how is CN 11 assessed?

A

Shoulder Shrug (UTrap)

Side bend and rotate (SCM)

41
Q

how would an UMN lesion impact CN 11?

A

pt will present with trapezius weakness

BUT the SCM will be spared

42
Q

how would a LMN lesion impact CN 11?

A

both the trapezius and SCM would be impacted

43
Q

how is CN 12 assessed?

A

Stick out tongue (tongue protrusion)

direction may indicate UMN vs LMN

44
Q

how will a pt present with an UMN lesion of CN 12?

A

tongue will deviate away from the side of the lesion

(picture on the right)

45
Q

how will a pt present with a LMN lesion of CN 12?

A

tongue will deviate toward the side of the lesion

atrophy and fasciculations will also be observed

(left picture)

46
Q

T/F: you can performm the motor exam part of the clincial neurological exam without even toughing the pt?

A

TRUE

47
Q

what are the components of the Motor Exam?

A
  1. Inspection at rest
  2. Task Based observation
  3. Tone assessment
  4. MMT
48
Q

what are you looking for during the inspection at rest portion of the Motor Exam?

A
  1. Muscle atrophy
  2. Fasiculation
  3. Hypertrophy
  4. Tremors
  5. Involuntary movements
  6. posturing
49
Q

What is posturing?

A

occurs when a pt picks up a very specific position of their UE and LE base don where their inujury was

50
Q

What are the 2 main kinds of posturing?

A
  1. Decorticate posture
  2. Decerebrate posture
51
Q

Describe decorticate posture

A

pt has full flexion of the UE and they hold it there

full extension of LE

52
Q

What type of damage would result in decorticate posturing?

A

damage to brainstemm above the red nucleus

53
Q

Describe decerebrate posture

A

pt has full extension of UE and LE

might still have some finger flexion

54
Q

What type of damage would result in decerebrate posture?

A

damage underneath/lower than the red nucleus in the brainstem

ex: pontine lesion

55
Q

T/F: posturing has no prognostic value

A

FALSE

it is an indicator that the pt might not progress/get that much better

56
Q

What is the distinction between the tone assessment and MMT?

A

tone assessment = resitance against passive movement

MMT = greater resistance, helps ID patterns of weakness

57
Q

What is assessed during the Sensory Exam?

A
  1. Pain
  2. Temperature
  3. Vibration
  4. Proprioception
  5. Light touch/2 pt discrimination
58
Q

How are reflexes graded?

A

0-5

0 = absent

1 = trace

2 = normal

3= brisk

4 = non-sustained clonus

5 = sustained clonus

59
Q

If reflexes are abnormally increased this is indicative of what?

A

UMN lesion

60
Q

if reflexes are abnormally decreased, this is indicative of what?

A

LMN lesion

but could be muscle, nerve fiber and NMJ

Neurophysiology (9 decks)

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