27.2e | Neurologic, Motor, and Sensory System Examination

Are the findings symmetrical or unilateral?

first vital question when conducting a neurological exam

if unilateral, is the site of origin the CNS or the PNS?

second vital question when conducting a neurological exam

head trauma, nasal stuffiness, smoking, cocaine use, or congenital defect

bilateral loss of smell suggests …

frontal lobe lesion

unilateral loss of smell w/o nasal disease suggests a …

medications, drug abuse, glaucoma, and neurlogic disease

constricted or dilated pupils can result from …

direct reaction to light

pupillary constriction in the same eye

consenual reaction to light

pupillary constrict in the opposite eye

strabismus

deviation in pupil movement

cranial nerve or ocular muscle, or an eye orbit that can be fractured and impinging on the muscle or nerve

inability to move pupils in any direction can be the result of a problem with a …

CN-III palsy or myasthenia gravis

ptosis can be the result of …

trigeminal nerve lesion

unilateral loss of sensation suggests a …

Bell's palsy

an inflammation of CN-VII, pt presents w/ unilateral facial dropping due to nerve paralysis

vocal cord problem

hoarseness suggests a …

palate problem

nasal quality to the voice suggests a …

vagus nerve paralysis

soft palate and uvula deviating toward the side of a lesion suggests …

lesion in CN-IX or CN-X

absence of a gag reflex suggests a …

trouble lifting their head

a supine pt w/ bilateral weakness of the sternocleidomastoids will have …

CN-XII lesion

a … makes the tongue deviate from the affected side

below the level of the injury

when the motor system is damaged, function is lost …

weak or paralyzed

when the motor system is damaged, movements become …

muscle tone is increased + deep tendon reflexes are exaggerated

when the motor system is damaged, inhibition is lost, so …

contralteral side of the body

if the damage occurs above the crossover point in the brainstem, the effects will be seen on the …

ipsilateral side of the body

if the damage is below the crossover point, the damage will be on the …

abnormal changes in gait, coordination, and equilibrium

cerebellar damage causes …

fasciculation

twitches, spontaneous muscle contraction and relaxation

postural tremor

if the pt's hand begins to shake only when you ask them to perform a task with it, this suggests a …

Parkinson's disease

a tremor at rest that could disappear w/ voluntary mocement suggests

atrophy

decrease in muscle bulk and strength

hypertrophy

increase in muscle bulk and strength

pseudohypertrophy

an increase in muscle bulk and decrease in strength

lower motor neuron disease

flatted or concave contours, esp. w/ fasciculations, could result from …

median or ulnar nerve paralysis

unilateral muscle atrophy in the hands suggests …

spasticity

a disruption in muscle movement patterns that causes certain muscles to contract all at once when you try to move or even at rest

ataxic

uncoordinated, reeling, or unstable gate

cerebellar disease, loss of position sense, or intoxication

an ataxic gate suggests …

leg muscle weakness, lack of position sense, or cerebellar dysfunction

difficulty hopping can result from …

muscle weakness in the pelvic girdle and legs

difficulty doing a shallow knee bend suggests …

flaccidity

loss of muscle tone causing limb to be loose

paratonia

sudden changes in tone with passive movement

mild hemiparesis

if one forearm pronates, suspect a …

loss of position sense

during a pronator drift test, if one forearm drifts sideways or upwards, suspect a …

no response

a score of 0 on the reflex scale represents …

diminished, below normal response

a score of + on the reflex scale represents a …

average, normal response

a score of ++ on the reflex scale represents a …

brisker than normal response

a score of +++ on the reflex scale represents a …

hyperactive response

a score of ++++ on the reflex scale represents a …

upper motor neuron disease

a hyperactive reflex response suggests …

damage to lower motor neurons or spinal cord

a diminished reflex response or no response suggests …

Babinski's response

big toe dorsiflexing while other toes fan out

CNS lesion

Babinski's response indicates a …

CNS or PNS disorder

absence of abdominal reflexes can suggest …