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What are the 6 categories for neuro exam?
mental status and speech, cranial nerves, motor function, sensory function, reflexes, cerebellar function
What is the primary motor cortex?
precentral gyrus
What is the primary sensory cortex?
Post central gyrus
What is the primary visual cortex?
Calcarine fissure
What is the primary auditory cortex?
Transverse temporal gyrus
What is the responsibility for cerebellum?
Spatial orientation and to halt or check motions
What are the halves of the spinal cord?
Anterior medial fissure and posterior medial sulcus
What job does corticospinal (pyramidal) tract have?
Helps maintain motor tone, voluntary skilled movements of extremities
What job does the basal ganglia system have?
Regulates coarse control for voluntary muscles, it selects or inhibits motor tone to produce an action
What job does the cerebellar system have?
Receives sensory and motor input to coordinate motor activity, posture and equilibrium
What job does the ventral spinothalamic tract have?
Pressure and crude touch
What job does the lateral spinothalamic tract have?
Pain and temperature
What job does the dorsal/ posterior columns have?
Vibration sense, passive motion, joint position sense and two- point discrimination
What is the cervical spinal nerve group?
C1-C8
What does the spinal reflex involve?
Afferent neuron and efferent neuron at same level in SC
What does the spinal reflex require?
Intact sensory limb, functional synapses in SC, intact motor limb, and muscle capable of responding
What is difficulty in articulation?
Dysarthria (lesions of tongue and palate)
What is difficulty in phonation?
Dysphonia (lesions of palate and vocal cords)
What is difficulty in comprehending or speaking?
Dysphasia (cerebral dysfunction)
What is a partial or total loss of ability to communicate verbally or written word?
Aphasia
What refers to the person’s awareness of self in relation to other persons, places and time?
Orientation
What 3 questions should a patient be asked?
What is today’s date?, What is the day of the week?, What is the name of this hospital or building? (Do you know where you are?)
For judgement what do you do?
Ask the patient to interpret a simple problem such as what would you do if you were in a crowded movie theater and a fire started
What is abstraction?
Higher cerebral function that requires comprehension and judgement (people who live in glass houses shouldn’t throw stones)
How do you assess vocabulary?
Ask patient to define words or use them in a sentence. (increasing order of difficulty)
What do you ask a patient for emotional responses?
If they have noticed any sudden mood change
How can you test immediate memory?
Name 3 objects and have patient repeat them back
How can you test recent memory?
Have patient recall the 3 items after 5 minutes
How can you test remote memory?
Ask patient regarding well known events in past, be sure information asked is verifiable
How can you test calculation ability?
Have patient count backwards from 100 by 7 or 3
What is the failure to recognize sensory stimulus despite normal primary sensation?
Agnosia
How do you test object recognition?
Show the patient a series of well-known objects and ask patient to name ( pen, ruler)
What is it if vision is intact, but fails to recognize objects?
Visual agnosia
What is the ability to perform a motor activity?
Praxis
What is the inability to perform voluntary movement in absence of deficits?
Apraxia
What is the decreased ability to perform activity?
Dyspraxia
What supplies nerve endings to superior nasal concha and upper 1/3 of nasal septum?
Olfactory
What nerve is checked with visual acuity, fundoscopic exam, visual fields by confrontation?
Optic
What is subtle impairment that suggests a lesion in the parietal cortex?
Visual extinction
What is a visual abnormality seen in stroke patients, having impaired vision in corresponding halves of each eye, lesion is posterior to optic chiasm?
Homonymous hemianopsia
What supplies medial, superior, and inferior rectus muscles?
Oculomotor
What is responsible for movement of superior oblique muscle?
Trochlear (SO4)
What is responsible for movement of lateral rectus muscle of the eye?
Abducens (LR6)
Which is the mixed nerve that has sensation to face, nasal and buccal mucosa and teeth; motor division with 3 subdivision?
Trigeminal (V)
What is tested with a wisp of cotton and seen normal if the patient blinks in response to contact?
CN V- corneal reflex
What is increased auditory volume because it innervates the stapedius in the middle ear which dampens ossicle movements which decreases volume?
Hyperacusis
What is tested with whisper/finger rub test; weber; rinne; balance tests?
Vestibulocochlear (VIII)
Which auditory test compares BC to determine if hearing impairment is neural or conductive?
Weber
Which auditory test compares AC to BC?
Rinne
What results is seen if BC>AC>
Conductive hearing loss
What results is seen if AC>BC BUT may be difficult to determine?
Sensorineural
What is ipsilateral hearing loss due to?
LMN lesion
Where is sensation to pharynx, posterior 1/3 of tongue and tympanic membrane?
Glossopharyngeal CN IX
Will the uvula deviate away or from paralyzed side when raised?
AWAY
The vagus nerve is motor to what?
Pharynx and larynx
The vagus nerve is sensory to what?
External ear canal, meninges of posterior cranial fossa, pharynx, larynx and viscera
When testing CN XII will the tongue deviate towards or away from paralyzed side?
TOWARDS
Which nerves are sensory?
I,II, VIII
Which nerves are motor?
III, IV, VI, XI, XII
Which nerves are mixed?
V,VII,IX,X
Which motor neurons transmit impulses from cortical nerve bodies to motor nuclei in brainstem, synapse in brainstem, anterior horn cells of spinal cord for peripheral nerves?
Upper motor neurons
Which motor neurons transmit impulses from anterior horn cells through anterior root into peripheral nerves, terminating at the neuromuscular junction?
Lower motor neurons
What do you look for when noticing muscle bulk?
Size and contour; flat or concave; unilateral or bilateral; proximal or distal
What do you look for when examining muscle tone?
slight residual tension in normal relaxed muscle, feel muscle’s resistance to passive stretch, resistance increased or decreased, varies or persists throughout movement
What does wide variance mean for muscle strength?
Wide variance
What do you do if muscles are too weak?
test against gravity only or eliminate gravity
What do you do if the patient fails to move?
Watch or feel for weak contraction
What nerves make up the brachial plexus?
C5-T1
What is the function for wrist extensor and what innvervates it?
Wrist extension; Radial N (C6-C8)
What is the function for wrist flexion and what innvervates it?
Wrist flexion; Medial N (C6-C7)
What is the function for hand grip and what innervates it?
Grasp fingers; C7-T1
What is the function for deltoid and what innervates it?
Shoulder aBduction; Axillary N (C5-6)
What is the function for biceps and what innervates it?
Elbow flexion; Musculocutaneous N (C5-6)
What is the function for triceps and what innervates it?
Elbow extension; Radial N (C6-8)
What is the function and innervation for Extensor digits communis?
finger extension; Radial N (C7)
What is the function and innervation for Flex sig. sup and flex dig prof?
finger flexion; Median N (FDS and ½ FDP) (C8)
What is the function and innervation for Palmar interossei + lumbricals?
finger aDuction; Median N (C8,T1)
What is the function and innervation for Dorsal interossei + lumbricals?
finger aBduction; Ulnar N (C8,T T1)
What is the function and innervation for Opponens pollicis?
opposition of thumb; Median N (C8,T1)
What is the function and innervation for Iliopsoas?
hip flexion; Femoral N (L1-L4)
What is the function and innervation for adductor brevis, longus, magnus, gracilis ?
Hip aDduction; Obturator N (L2-L4)
What is the function and innervation for gluteus medius and minimus?
Hip aBduction; Superior gluteal N (L4-S1)
What is the function and innervation for gluteus maximus?
Hip extension; Inferior gluteal N (S1)
What is the function and innervation for Quadriceps (vastus lateralis, medialis, intermedius, and rectus femoris)?
Knee extension; Femoral N (L2-L4)
What is the function and innervation for Hamstrings (biceps femoris, semimebranosus, semitendinosus)?
Knee flexion; Sciatic and tibial N (L4-S2)
What is the function and innervation for tibialis anterior, EDL, EHL?
Ankle dorsiflexion; Deep peroneal N (L4-5)
What is the function and innervation for gastrocnemius, soleus, FDL, FHL, tibilias posterior?
Ankle plantar flexion; Tibial N (S1)
What is the function and innervation for Tibialias anterior?
Foot inversion; Deep Peroneal N (L4,L5)
What is the function and innervation for peroneus longus and brevis?
Foot eversion; Superficial peroneal N (S1)
What is the function and innervation for extensor hallicus longus?
Extension of great toe; Deep peroneal N (L5)
How is sensory function evaluated by?
Pain and temperature; proprioception and vibration; light touch; tactile localization; discriminative sensations
What is the absence of pain sensation?
Analgesia
What is decreased sensitivity to pain?
Hypoalgesia
What is increased sensitivity to pain?
Hyperalgesia
What is the absence of touch sensation?
Anesthesia
What is decreased sensitivity to touch sensation?
Hypoesthesia
What is increased sensitivity to touch sensation?
Hyperesthesia
What is the band of skin innervated by sensory root of single spinal nerve?
Dermatomes
What is the location for dermatome C5?
Lateral upper arm
What is the location for dermatome C6?
Lateral Forearm, thumb and index finger