Term
| know the components of the neurolgoic mental status exam |
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Definition
"1. Level of alertness
2. Language fluency and content
3. Orientation to person, place and time
4. Registration: ask patient to repeat a 3 item list
5. Repetition: repeat a phrase
6. Comprehension: ask patient to follow a 3 step command
7. Reading: ask patient to follow a written command
8. Writing: ask patient to write a sentence
9. Naming: ask patient to name 3 objects
10. Visual special construction: ask patient to copy a figure or draw a clock
11. Immediate memory: digit span (repeat up to 7 digits), serial 7’s, spell world forward and backwards
12. Short term memory: give patient 3 items to remember, then ask for them 5 minutes later
13. Recent long term memory: ask about recent current events, who is president, how they got here, what they had for dinner
14. Remote long term memory: past presidents, birthdate, names and birthdays of children
15. Abstract thought: interpret a proverb or give similarities and differences between objects
16. Calculation: straightforward computation (how many nickels in $1.35) |
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Term
| know the motor and sensory functions of cranial nerves I-XII |
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Definition
"Olfactory (CN I): Sensory – smell
Optic (CN II): Sensory – sight. Exam- Visual accuity using near card w corrective lenses, visual fields
Oculomotor (CN III): Motor - eye movement (SR, IR, MR, IO), pupillary constriction, accommodation, eyelid opening. Exam- pupillary light response, swinging flashlight test, eye lid position (ptosis), eye movement
Trochlear (CN IV): Motor - eye movement (SO) Exam- eye movement
Trigeminal (CN V): Motor – mastication; Sensory – facial sensation. Exam- light tough sensation on forehead, cheeks, and jaw; muscles of mastication (jaw opening and closing)
Abducens (CN VI): Motor - eye movement (LR). Exam- eye movement
Facial (CN VII): Motor - facial movement, eye lid closing, stapedius muscle in ear, lacrimation, salivation; Sensory - taste to anterior 2/3 of tongue. Exam- muscles of facial expression (smile, eye closure, brow wrinkling), arthria
Vestibulocochlear (CN VIII): Sensory - hearing and balance. Exam- hearing to finger rub or tuning fork
Glossopharyngeal (CN IX): Motor - swallowing, salivation (parotid), stylopharyngeus (elevates pharynx/larynx); Sensory – taste from posterior 1/3 of tongue, carotid body and sinus chemo/baroreceptors. Exam- Palatal movement, arthria
Vagus (CN X): Motor - Swallowing, palate elevation, midline uvula, talking, coughing, diaphragm; Sensory – taste from epiglottic region, aortic arch chemo/baroreceptors. Exam- palatal movement, arthria
Accessory (CN XI): Motor – head turning, shoulder shrugging. Exam- strength of head rotation in each direciton
Hypoglossal (CN XII): Motor – tongue movement. Exam- arthria, tongue movements (side to side and protrustion) |
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Term
| know the function and pathways of spinothalamic and corticospinal tracts |
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Definition
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Term
| know the grading scale for motor strength |
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Definition
"Grade:
0/5- no muscle movement
1/5- visible muscle movement, but no movement at the joint
2/5- movement at the joint, but not against gravity
3/5- movement against gravity, but not against added resistance
4/5- movement against resistance, but less than expected
5/5- full strength |
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Term
| know the definition of muscular tone |
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Definition
| The amount of tension or resistance to passive movement in a muscle. Tested at biceps, triceps, brachioradialis, patellar and achilles bilaterally. |
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Term
| know the definitions of athetosis, ballismus, chorea, dystonia, myoclonus, and tic |
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Definition
"athetosis – slow writhing or twisting involuntary movements; commonly associated with spasticity and involving the face and distal extremities; often caused by cerebral palsy and accompanied by other symptoms of cerebral palsy
ballismus – involuntary movements involving proximal limb musculature; often manifest as rapid jerking or flinging movements of the arms or legs
chorea – brief, rapid, jerky irregular, unpredictable movements; can occur at rest OR interrupt normal coordinated movements; common causes include sydenham’s chorea and huntington’s disease
dystonia – similar to athetoid movements, only involving larger portions of the body; result in grotesque, twisted postures; common causes include drug-induced dystonia, primary torsion dystonia, and spasmodic torticollis
myoclonus – seizure disorder characterized bysudden, brief, rapid jerks involving the trunk and limbs; variable postictal state
tics – brief, repetitive, stereotyped, coordinated movements occurring at irregular intervals; common causes involve Tourette’s syndrome and drug-induced tics" |
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Term
| know the definitions of atrophy, hypertonicity, rigidity, and spasticity |
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Definition
"atrophy – decrease in the mass of a muscle; can be partial or complete; can be caused by disuse or starvation or occur as a comorbidity of several common diseases
hypertonicity – chronic contraction resulting in a tight, shortened muscle
rigidity – increase in muscle tone causing resistance to externally imposed joint movments
spasticity – velocity dependent increased resistance to passive stretch; lack of inhibition that results from a lack of CNS inhibition or “upper motor neuron syndrome”" |
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Term
| know the correct techniques to elicit deep tendon reflexes |
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Definition
| To elicit a deep tendon reflex, persuade the patient to relax, position the limbs properly and symmetrically, and briskly tap the tendon of the partially stretched muscle using a rapid wrist movement. Hold the reflex hammer between your thumb and index finger so that it swings freely within the limits set by your palm and other fingers. Use no more force than you need to provoke a definite response. Note the speed, force, and amplitude of the reflex response. Always compare one side with the other. |
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Term
| know the physioogy and signifiance of abnormal deep tendon reflexes |
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Definition
"For the reflex to fire, all components of the reflex arc must be intact: sensory nerve fibers, spinal cord synapse, motor nerve fibers, neuromuscular junction, and muscle fibers. Tapping the tendon activates special sensory fibers in the partially stretched muscle, triggering a sensory impulse that travels to the spinal cord via a peripheral nerve. The stimulated sensory fiber synapses directly with the anterior horn cell innervating the same muscle. When the impulse crosses the neuromuscular junction, the muscle suddenly contracts, completing the reflex arc.
Increased deep tendon reflexes are the result of lack on CNS inhibition. This can result from a lesion in the cerebral cortex, brainstem, or spinal cord.
*When upper motor neurons are damaged above the crossover of its tracts in the medulla, motor impairment develops on the opposite or contralateral side. In damage below the crossover, motor impairment occurs on the same or ipsilateral side of the body.
Decreased deep tendon reflexes are the result of deficits in the spinal reflex arc. This can result from a lesion in the anterior horn cell, spinal root, spinal nerve, or peripheral nerve. Lesions in the muscle or NMJ can also cause decreased deep tendon reflexes." |
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Term
| know the terminology used to describe findings during the nuerologic sensory exam |
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Definition
"Terms used to describe the findings of the sensory exam include: light touch, temperature, vibration sense, joint position sense, two-point discrimination.
*I’m not sure what this objective is actually getting at. I listed the names of the main tests, because the only other terms I can think of are pretty simple ones like numbness, lost or diminished sensation, tingling, etc. Some other possible terms to include may be allodynia and hyperalgesia, although more specifically related to pain." |
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Term
| know the definitions of anosognosia and alexia |
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Definition
Agnosognosia: unawareness of a condition
Alexia: loss of the ability to read
Unlike denial, anosognosia is rooted in physiology and is commonly seen after brain injury (although it can occur in conjunction with any neurological disorder). Alexia typically occurs following injury to the hemisphere of the brain that is dominant for language (usually the left). PCA occlusion in the dominant hemisphere can lead to alexia without agraphia—these patients can write, but can’t read (even things they just wrote themselves). |
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Term
| know the definitions of diadochokinesia, graphesthesia, stereognosis |
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Definition
Diadochokinesia: ability to do rapid alternating movements
Graphesthesia: being able to identify numbers written onto one's hand (oriented toward the patient) with the blunt end of a pencil
Stereognosis: describes the integration of parietal and occipital functions - test by asking patient to close their eyes and then placing an object (ex: paperclip) in their hand and asking them to identify it (test bilaterally)
graphesthesia = ability to recognize writing on skin purely by sensation of touch |
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Term
| know the physical exam findings in patients with median, radial and ulnar neuropathies |
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Definition
Radial neuropathy: can't extend forearm against examiner's resistance (C6-C8), can't extend wrist while making fist against resistance (C6-C8); abnormal sensation on the back of the hand.
Median Neuropathy: Can't flex wrist while making fist against resistance (C6-C7); can't adduct fingers adequately (tested by asking patient to squeeze your index and middle fingers) (C7-T1); can't adequately touch thumb to base of pinkie finger against resistance (thumb adduction) (C8 -T1); test sensation at palmar surface of the tip of the index finger.
Ulnar neuropathy: inadequate finger abduction (can't resist keeping fingers spread open against resistance) (C8-T1); test sensation on palmar surface at tip of pinkie
Median neuropathy can manifest as median claw hand or "hand of benediction", with the 2nd and 3rd fingers extended when the patient attempts to make a fist. These fingers are unable to flex due to loss of lateral lumbrical function and remain extended due to unopposed radial nerve action on finger extensors. Ulnar neuropathy can manifest as claw hand, with the 4th and 5th fingers unable to flex due to loss of function of ulnar-supplied dorsal interossei (secondary to medial epicondyle fracture or Guyon Canal entrapment). |
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Term
| know the physical exam findings in patients with homomymous and temporal hemianosias |
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Definition
"*homonymous hemianopsia - will not be able to see one half (either left or right) of the visual field with either eye individually or with both eyes open
-this is caused by a lesion in the optic tract, posterior to the chiasm
*bitemporal hemianopsia - ""tunnel vision"" with one eye closed, patient will have reduced or absent vision in the ipsilateral (temporal) field. (right eye with left eye closed - loss of right visual field)
-this is caused by a lesion in the optic chiasm" |
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Term
| know the physical exam findigns and significance in patients with scotomas |
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Definition
| Scotoma: partial visual field defect with area of preserved vision around it. Exam: Can be detected by confrontation testing (patient will not be able to see some areas of normal visual field). Amsler Grid: ask patient to color in grid where the lines disappear. Scotomas are caused by any lesion from the eye to the brain. Ex: central, cecocentral, arcuate (often glaucoma) and temporal scotomas (optic nerve lesion), bitemporal hemianopsia (optic chiasm lesion - can be pituitary tumor), homonymous hemianopsia (after optic chiasm) |
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Term
| know the physical exam findings in patients with spinal cord injuries |
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Definition
| Hemicord Lesion: Loss of vibration/position/fine touch on the opposite side and weakness/paralysis on same side of lesion. Whole lesion: everything is gone. |
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Term
| know the physical exam findings in patients with tibial, peroneal, femoral, sciatic, superior gluteal, sacral, and diabetic neuropathies |
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Definition
| Tibial splits into the (1) Medial plantar nerve (abductor hallucis, the flexor digitorum brevis, the flexor hallucis brevis and the first lumbrical. Cutaneous distribution of the medial plantar nerve is to the medial sole and medial three and one half toes, including the nail beds on the dorsum. Mnemonic LAFF muscles (L-first Lumbrical, A- Abductor Hallucis, F- Flexor digitorum brevis, F- flexor hallucis brevis) (2) Lateral plantar nerve: quadratus plantae, flexor digiti minimi, adductor hallucis, the interossei, three lumbricals. and abductor digiti minimi. Cutaneous innervation is to the lateral sole and lateral one and one half toes. Peroneal Nerve: foot drop. Femoral Nerve: does something in the leg, Sciatic Nerve: butt pain, Superial gluteal: trendelenburg gait (lurch to opp side of lesion), Sacral: peripheral nerve lesion: neuropathic (severe, shooting, burning or stabbing) pains, tingling, numbness of certain skin areas or, conversely, areas that are very hypersensitive to the touch, and weakness and wasting of certain muscles in the thigh, buttock and leg region. Usually, when a lesion is acute, pain will be a marked symptom, followed by weakness and wasting. Diabetic Neuropathies: nerve damage anywhere, usually ends of extremities, i think. |
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