WVSOM -- Tips for Success Neurology
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| What is function of frontal lobe? | Primary motor cortex. Personality, intellect, executive function and impulse control.
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| What will a lesion in the frontal lobe result in? | seizures, change in consciousness, paresis and paralysis
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| What is the function of the parietal lobe? | sensory data
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| What will a lesion of the parietal lobe result in? | impairment in skin sensation on contralateral side of the body
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| What is the function of the occipital lobe? | primary visual cortex
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| What is the function of teh temporal lobe? | primary auditory cortex. Hearing, language, taste, smell, balance, behavior and emotions
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| What is the primary function of the limbic system? | Feeding fighting, feeling, fleeing and fucking.. (5Fs)
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| What is the function of the cerebellum? | controls muscle tone, equilibrium and posture
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| What will a lesion in teh cerebellum result in? | ataxia, postural abnormality, wide stance gait, imbalance, intention tremor, abnormal rapid alternating-movements, impaired muscle tone and speech
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| What is the function of the lateral spinothalamic tract? | pain and temperature
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| What is teh functino of teh Anterior spinothalamic tract? | superficial touch and deep pressure
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| What is the function of the posterior columns? | conscious proprioception, vibration and light touch
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| What is the function of the spinocerebellar tracts? | unconscious proprioception
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| What are the 5 key areas to the neurologic exam? | mental status
cranial nerves
Motor-coordination -- cerebellar
sensory
reflexes
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| What is assessed with mental status? | oriented x 3
Mini mental status exam
geriatric depression scale
consciousness
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| What is the mini mental status exam? | MMSE is normally a standardized 30 question form filled out with the patient
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| What is a bad score in the geriatric depression scale | Greater than 5
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| What is assessed with conscousness? | if tehre is:
confusion
lethargy
delirium
stupor
coma
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| what is confusion? | inappropriate response to questions, decreased attention span
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| What is lethargy | drowsy when awakened -- responds appropriately
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| What is delirium | Confusion with disordered perceptions or anxiety with inappropriate reason or stimuli
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| What is stupor? | arousable for short poeriods after visual, verbal or painful stimuli
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| Waht is coma | not awake and not aware
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| What is glasgow coma scale | used in cases of head trauma or hypoxia. Lower the score more severe teh impairment in consciousness. Less than 8, INTUBATE
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| What is apraxia | patient has no motor deficits but is unable to perform an activity
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| What is construct apraxia? | unable to construct or draw simple designs (clock face). Lesion of the parietal lobe
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| What is dyspraxia | incompletely performs the activity. Leasion in the deep frontal lobe
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| Pneumonic for function of cranial nerves | Some Say marry Money But My Browther Says Big Brains
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| How do you test oflaction? | test using a strong odor
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| How do test the optic nerve | visual acuity using charts. Ophthalmoscopic exam
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| How do you test occulomotor/trochlear adn abducens? | assess size, shape, and symmetry
6 cardinal fields of gaze
confrontation or peripheral vision test
Accomodation
direct and consensual reflex
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| How do you test trigeminal motor function? | Observe and say "I am looking for any muscle atrophy, deviation of the jaw, or fascicualtions"
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| How do you test trigeminal sensory function? | Ask patient to close eyes.
assess patient's ability to feel light touch on forehead, cheeks, and jaw bilaterally.
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| What does the corneal reflex test? | Sensory limb of CN V
Motor Limb of CN VII
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| What happens with an upper motor neuron lesion to CN VII | stroke
normal function to upper face
contralateral weakness of lower face
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| What happens with lower motor neuron lesion to CN VII? | Bell's Palsy
Total involement of ipsilateral face paralized
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| What is muscle tone with upper motor neuron leason? | increased
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| What is muscle atrophy with upper motor neuron? | little to none
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| What is sensation to upper motor neuron? | may affect entire limb
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| What are reflexes with an upper motor neuron? | hyperactive
POSTIVE babinski
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| Is there faasciculation with upper motor neuron lesions? | no
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| What is motor effect with upper motor neuron lesion? | paralysis of voluntary movements
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| Where is location of insult with upper motor neuron lesion? | damage above level of brainstem affects CONTRALTERAL side
Damage below level of brainstem affects the IPSILATERAL side
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| What is muscle tone with lwer motor neuron lesion? | decreased
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| Waht is muscle atrophy with lower motor neuron leasion? | may follow dermatones or peripheral nerves
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| What are reflexes like with lower motor neuron lesion? | weak to absent
absent babinski
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| Is there fasciculation with lower motor neuron loss? | yes
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| where is location of insult in a lower motor neuron lesion? | damage affects muscle on the ipsilateral side of the body
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| How do you test CN VIII? | assess hearing using fingertips moving
Weber-Rinne Test
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| How do you test the sensory function of the glossopharyngeal nerve? | taste to posterior 1/3 of tongue
Sensory portion of the gag reflex
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| How do you test the motor function of the glossophryngeal nerve? | swallowing
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| How do you test the vagus nerve? | ability to swallow
quality of speech
inspect the palate and uvula
lesion = uvula deviating away from side of lesion
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| How do you test spinal accessory nerve? | shoulder shrug and head turn
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| How do you test the hypoglossal nerve | tongue movement and proturusion
lesion = tongue devation toward the side of lesion
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| How do you test cerebellar function? | finger-nose-finger
finger-finger
heel-shin
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| What does finger-nose-finger test for? | tandem gait
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| What does finger-finger test for? | rapid alternating movements
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| What does heel-shin test for? | Romberg Test
evaluates mainly balance
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| What is a dermatone? | band of skin innervated by the sensory nerve root of a single spinal segment
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| What is carpel tunnel? | median nerve palsy
use tinnel's and phalen's tests
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| How do you test sensory loss? | perform with touch, pain, deep ressure adn vibration.
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| What is peripheral neuropathology? | disorder of the PNS that results in motor and sensory loss in the distribution of 1 or more nerves, most commonly the hands and feet.
Sensation of numbness, tingling, burning and cramping.
Associated with diabetes
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| How do you rate reflexes? | 0-4
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| What is normal reflex? | 2+
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| What do deep tendon reflexes that are hyperactive mean? | Upper motor neuron disorder
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| What if deep tendon reflexes are absent? | neuropathy or LOWER motor neuron disorder
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| Where do you check deep tendon reflexes? | Bicepts and brachioradial
triceps
patellar
achilles
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| What are you tsting with biceps and brachioradial reflexes? | c5-c6
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| What are you testing with tricep reflexes? | c6-c8
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| What are you testing with patellar reflexes? | L2-L4
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| What are you testing with achilles reflex? | S1-S2
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| What is babinski? | stroke lateral sole of the foot and move in and upside down J fasion to sole of forefoot
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| What is Chaddock sign? | stroke teh lateral foot
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| What is schaeffer sign? | squeeze the achilles tendon
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| What is oppenheim sign? | press knuckles on skin and move distal
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| What is gordon sign? | squeeze calf briefly
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| Waht is bing sign? | multiple light pinpricks on the dorslolateral foot surface
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| What is gonda/stransky sign? | pull the 4th toe outward and downward briefly and quickly release
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| What is a bad toe sign? | up going toes or sustained ankle clonus
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| What is gait like in a stroke? | spastic hemiparesis
affected leg is stiff and extended with plantar flexion of foot. foot is dragged with scraping of the toe.
affected arm is flexed adn adducted and does not swing
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| What is gait like with Parkinsons? | shuffling
posture is stopped and body is rigid. Steps are short with heistaion on starting and stopping
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| What is gait like with cerebellar infarct? | WIDE STANCED, STAGGER ADN LURCHING FROM SIDE TO SIDE. ACCOMPANIED BY SWAYING OF TEH TRUNK
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| What is gait like with tabes? | foot slapping
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| What is gate like with sensory deficit | wide stance, with foot being brought down on heal then toe.
Postitive romberg
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| What is romberg test? | stand with feet together and eyes closed.
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| What is brudzinski sign? | flex teh neck forward
Positive sign -- involuntary flexion of hips and knees when flexing the neck
INDICATES MENINGEAL IRRITATION
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| What is Kernig's sign? | flex the leg at the knee and hip when the patient is supine and then attempt to straighten the legs.
Positive sign -- pain in the lower back adn resistance to straightening the leg at the knee.
Indicates -- Meningeal Irritation
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