Neuro Physical Exam
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
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| Language expression | Inferior frontal lobe, anterior motor strip, dominant hemisphere
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| Impaired memory | Bilateral mesial temporal lobe lesions or bilateral medial thalamic lesions
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| Impaired attentiveness | Diffuse mild cortical dysfunction, right parietal lesion
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| Homonymous hemianopsia | Lesion to the contralateral visual pathway posterior to optic chiasm
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| Ptotic lid + larger pupil (poorly responsive to light) | Third nerve lesion
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| Ptotic lid + smaller pupil (responsive to light) | Horner's syndrome
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| Diplopia keys (2) | 1. Diplopia worsens in the gaze direction of the action of the paretic muscle 2. The outer image is always the false image
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| Corneal reflex | CN V-VII polysynaptic reflex
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| Most common cause of progressive unilateral hearing loss | Acoustic neuroma
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| Slowed speech | Spastic (upper motor neuron) process
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| Irregular speech rates | Ataxic (cerebellar) process
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| Deltoid muscle | C5 > C6, axillary nerve
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| Triceps muscle | C7 > C6 & C8, radial nerve
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| Interossei muscles | C8 & T1, ulnar nerve (also requires C7 & C8 radial nerve finer extensors to have normal strength)
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| Iliopsoas muscle | L2 & L3 > L4, femoral nerve
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| Dorsiflexor muscles | L4 & L5, peroneal nerve
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| Biceps reflex | C5 > C6, musculocutaneous nerve
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| Triceps reflex | C7 > C6 & C8, radial nerve
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| Quadriceps reflex | L2, L3 & L4, femoral nerve
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| Achilles reflex | S1 > S2, tibial nerve
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| Slowing of rapid alternating movements | Upper motor lesions
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| Positive Babinski response | Injury to the corticospinal tract
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| Triple flexion: 1. Extension of the great toe & dorsiflexion of the ankle 2. Flexion of the knee 3. Hip flexion | The BIG BABINSKI, signifies major upper motor neuron injuries
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| Dysmetria | Ipsilateral cerebellar (hemispheres) dysfunction
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| Fiber type: Vibration, joint position sense, light touch | Large myelinated fibers
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| Fiber type: Pain and temperature | Small myelinated and small unmyelinated fibers
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| Tract type: Pain and temperature | Spinothalamic tract
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| Tract type: Vibration and joint position sense | Posterior columns
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| Joint position sense, stereognosis, graphesthesia, touch localization, two-point discrimination | Cortical sensations; the contralateral parietal cortex is essential for their perception
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| Spastic gait muscle imbalances | Increased plantar flexor, knee extensor and hip extensor tone with inability to flex hip, knee and ankle (stiff leg with toes dragging and some circumduction)
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| Parkinsonian gait characteristics | 1. Flexion of the neck, trunk and arms 2. Short steps 3. Poor arm swing 4. Difficulty turning
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| Ataxic gait characteristics | Inability to perform tandem gait is the first manifestation then irregularity of stride rate and length with imprecise foot placement and leg control
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