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Neuro Exam/Tests
NPTE Neuromuscular
| Question | Answer |
|---|---|
| Myotatic reflex stimulus | muscle stretch |
| Myotatic reflex arc | Afferent Ia from muscle spindle to alpha MN and back to muscle |
| Myotatic reflex function | maintenance of muscle tone, support agonsist muscle contraction, provide feedback about muscle length |
| Myotatic reflex testing | DTR |
| Via an inhibitory IN the myotatic reflex inhibits the antagonist | Reciprocal inhibition |
| Myotatic reflex effect on synergistic muscles | facilitation |
| Inverse myotatic reflex stimulus | muscle contraction |
| Inverse myotatic reflex arc | Afferent Ib from GTO via inhibitory IN to muscle |
| Function of inverse myotatic reflex arc | provides agonist inhibition, decreases force of agonist, stretch protection reflex |
| Allows muscle tension to come under control of descending pathways | Gamma reflex loop |
| Gamma reflex loop path | excite gamma MN causing muscle spindle contraction then increased stretch sensitivity and increased firing from spindle afferents then conveyed to alpha MNs |
| Flexor withdrawal reflex stimulus | cutaneous sensory stimuli |
| Flexor withdrawal reflex arc | cutaneous receptors via Ins to flexor muscles |
| Flexor withdrawal reflex arc function | protective withdrawal mechanism |
| Crossed extension reflex stimulus and response | noxious stimuli – Flexors excited with extensor inhibition, opposite on CL side |
| Crossed extension reflex function | coordinates reciprocal limb activities such as gait |
| 3 elements of Glasgow Coma Scale | eye opening, motor response, verbal response |
| Scoring of GCS | 3-8 severe, 9-12 moderate, 13-15 minor |
| State defined by no eye opening even to pain, failure to obey commands, inability to speak | Coma |
| Return of sleep/wake cycles, normalization of basic functions, lack of cognitive responsiveness | Vegetative state |
| Central language DO with speech is awkward, restricted, interrupted, produced with effort | Expressive aphasia (Broca’s, nonfluent, motor) |
| Expressive aphasia result of | L hemisphere – Broca’s area |
| Impairment of volitional articulatory control 2/2 cortical dominant hemisphere lesion | Verbal apraxia |
| Impairment of speech production | Dysarthria |
| Central language DO where spontaneous speech preserved/smooth while auditory comprehension impaired | Receptive or Wernicke’s aphasa |
| Receptive aphasia is result of damage to | Posterior frist temporal gyrus of L hemisphere (Wernicke’s area) |
| Severe aphasia with impairments in comprehension & production of language | Global aphasia |
| Periods of apnea followed by gradually increasing depth/frequency of respirations | Cheyne Stokes respiration |
| Cheyne Stokes caused by | depression of frontal lobe and diencephalic dysfunction |
| Increased rate and depth of respirations | Hyperventilation |
| Hyperventilation can be caused by dysfunction of | lowere midbrain and pons |
| Abnormal respiration with prolonged inspiration | Apneustic breathing |
| Apneustic breathing is result of damage to | upper pons |
| Elevation of temperature may be damage to | hypothalamus or brainstem |
| Signs of meningeal irritation | Kernig’s sign, Brudinski’s sign, guarding in neck flexion, photophobia, disorientation, restlessness, persistent HA that increases with head down, altered vitals, weakness |
| Kernig’s sign | meningeal irritation. Supine with flexed hip/knee to chest then extend knee. |
| Brudzinski’s sign | meningeal irritation. Supine, flex neck. Causes flexion of hips/knees |
| Increased ICP leads to | restless, confused, decr LOC, incr BP, widening pulse P & slowed pulse, Cheyne-Stokes, elevated temp, HA, vomiting, unequal pupils, slowed PLRs, dilated pupils*, papilledema, weakness, hemiplegia, Babinski, decorticate or decerebrate rigidity, seizures |
| Joint position sense | test for ability to perceive joint position at rest in response to passive positioning |
| Kinesthesia | movement sense |
| Pallesthesia | vibration sense with tuning fork |
| Combined cortical sensation testing | discriminative sensory tests including Steriognosis, Tactile Localization, Two Point Discrimination, Bilateral Simultaneous Discrimination, Barognosis, Graphesthesia, Texture recognition |
| Stereognosis | ID familiar objects by touch |
| Two point discrimination | ability to recognize one or two blunt points applied to skin simultaneously |
| Barognosis | ability to differentiate weights |
| Graphesthesia | ability to ID numbers, letters or symbols traced on skin |
| Homonymous hemianopsia | loss of half of visual field in each eye contralateral to side of cerebral hemisphere lesion |
| Somatognosia | body scheme disorder – unable to ID body parts or relations to each other |
| Unilateral neglect | patient ignores one side of body and stimuli from that side |
| Anosognosia | severe neglect or denial of severity of condition |
| Figure ground discrimination | spatial relations syndrome with lack of ability to pick out object |
| Form constancy | pick out object from array of similar shapes but different sizes |
| Spatial relations | pt duplicates a pattern of 2-3 blocks |
| Topographical disorientation | navigation of a familiar route |
| Vertical disorientation | inability to accurately determine what is upright |
| Agnosia | inability to recognize familiar objects with one sensory modality |
| Apraxia | inability to perform voluntary learned movements in the absence of loss of sensation , strength, coordination, attention, or comprehension. Breakdown in conceptual or motor production system or both |
| Ideomotor apraxia | cannot perform task on command, but can do independently |
| Ideational apraxia | cannot perform the task at all, either on command or independently |
| Clasp-knife response | marked resistance to PROM suddenly gives way |
| Clonus | maintained stretch stimulus produces cyclical spasmodic contraction, usu plantar flexors or wrist flexors |
| Babinski | DF of great toe with fanning of other toes with stroke to lateral bottom of foot |
| Babinski indicates | corticospinal (pyramidal) tract disruption |
| Hyperreflexia | increased DTRs |
| Lead pipe Rigidity | uniform throughout range |
| Cogwheel rigidity | interrupted by series of jerks |
| Decerebrate posturing | increased tone in extension, seen in brainstem lesions between superior colliculus and vestibular nucleus |
| Decorticate posturing | UEs in flexion, LEs in extension, seen in brainstem lesions above superior colliculus |
| Opisthotonos | arching back of head back and heels with UEs rigidly flexed. Seen in severe meningitis, tetanus, epilepsy, strychnine poisoning |
| Plantar reflex | Normal is PF of toes in response to stroking lateral sole of foot from calcaneus to 5th met, S1-2, tibial nerve |
| Abdominal reflex | T6-L1, lateral to medial scratching of skin to umbilicus in each of 4 quadrants should cause deviation of umbilicus to stimulus |
| Cremasteric reflex | L1-L2, stroking of skin on inner thigh elevates testicle, lost in SCI and Corticospinal lesions |
| Sources of fatigue | CNS/central fatigue, neural/myoneural fatigue, muscle contractile failure |
| CNS/Central fatigue | in MS, ALS, CFS |
| Neural/myoneural junction fatigue | MS, Post Polio syndrome, GBS, myasthenia gravis |
| Muscle contractile failure fatigue | metabolic changes at muscle, muscular dystrophies |
| Extrapyramidal disorders (basal ganglia dysfunction) | Tics, Chorea, athetosis, tremors, myoclonus |
| Tics | spasmodic contractions of specific muscles |
| Chorea | relatively quick twitches or dancing movments |
| Athetosis | slow, irregular, twisting movements, esp in UEs |
| Tremor | continuous quivering mvmt, rhythmic, oscillatory observed at rest |
| Myoclonus | single, quick jerk |
| Cerebellar disorders cause | intention tremors |
| Cortical disorders cause | seizures, tonic/clonic convulsive mvmts |
| Dyssynergia | impaired ability to associate muscles together for complex mvmt |
| Dysmetria | impaired ability to judge distance or range of movement |
| Dysdiadochokinesia | impaired ability to perform rapid alternating movements |
Created by:
Jenwithonen
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