Neuro Exam

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