Neuro Assessment
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Questions and Answers

Which nerve is responsible for wrist flexion?

  • Radial nerve
  • Musculocutaneous nerve
  • Median nerve (correct)
  • Ulnar nerve

    • What is the motor function of the radial nerve?

  • Arm abduction and elbow flexion
  • Elbow flexion and forearm sensation
  • Finger flexion and wrist flexion
  • Wrist extension and finger extension (correct)

    • Which nerve provides sensation to the palmar cutaneous branch?

  • Musculocutaneous nerve
  • Radial nerve
  • Ulnar nerve
  • Median nerve (correct)

    • Which nerve is responsible for the sensation in the anterior thigh and medial leg?

    <p>Femoral</p> Signup and view all the answers

    Which muscle is NOT responsible for hip flexion and knee extension?

    <p>Gastrocnemius</p> Signup and view all the answers

    Which nerve is responsible for the sensation in the posterolateral leg and lateral foot?

    <p>Tibial</p> Signup and view all the answers

    Which nerve is responsible for the motor function of knee adduction?

    <p>Obturator</p> Signup and view all the answers

    Which muscle is responsible for dorsiflexion of the foot?

    <p>Anterior tibialis</p> Signup and view all the answers

    Which nerve is responsible for the sensation in the anterior and lateral thigh down to the knee?

    <p>Lateral femoral cutaneous</p> Signup and view all the answers

    What is the primary function of the CN V Trigeminal nerve?

    <p>Face sensation and mastication</p> Signup and view all the answers

    What is the function of the CN III Oculomotor nerve?

    <p>Control of eye movement</p> Signup and view all the answers

    What is the primary purpose of the Mental Status examination?

    <p>To assess the patient's cognitive function</p> Signup and view all the answers

    What is the function of the CN VIII Vestibular cochlear nerve?

    <p>Regulation of hearing and balance</p> Signup and view all the answers

    What is the primary purpose of the Modified Glasgow Coma Scale?

    <p>To assess the patient's level of consciousness</p> Signup and view all the answers

    What is the function of the CN IX Glossopharyngeal nerve?

    <p>Control of swallowing and phonation</p> Signup and view all the answers

    What is the primary purpose of taking a good history during a neurological assessment?

    <p>To gather information about the patient's symptoms and medical history</p> Signup and view all the answers

    What is the function of the CN X Vagus nerve?

    <p>Movement, sensation, and parasympathetic functions</p> Signup and view all the answers

    What is the primary purpose of the elements of the Mental Status examination?

    <p>To assess the patient's cognitive function</p> Signup and view all the answers

    What is the primary function evaluated by the Romberg Test?

    <p>Vestibular function</p> Signup and view all the answers

    What is characterized by a lack of voluntary coordination of muscle movements and a wide, uncoordinated gait?

    <p>Cerebellar ataxia</p> Signup and view all the answers

    What is the term for an involuntary shaking movement with an associated rhythm?

    <p>Tremor</p> Signup and view all the answers

    What is Benign Paroxysmal Positional Vertigo (BPPV) an example of?

    <p>A vestibular cause of vertigo</p> Signup and view all the answers

    What is the term for a loss of proprioception characterized by a stomping, heel-striking gait?

    <p>Sensory ataxia</p> Signup and view all the answers

    What does the Tandem Walk exam evaluate?

    <p>Balance, proprioception, and sensation</p> Signup and view all the answers

    What is the primary characteristic of upper motor neuron lesions in terms of muscle tone?

    <p>Increased/spastic</p> Signup and view all the answers

    A patient exhibits fasciculations and profound muscle atrophy. Which type of motor neuron lesion is most likely present?

    <p>Lower motor neuron lesion</p> Signup and view all the answers

    What is the term for the ability to identify objects by feel?

    <p>Stereognosia</p> Signup and view all the answers

    A reflex arc with a single synapse between afferent and efferent neurons is classified as a?

    <p>Monosynaptic reflex</p> Signup and view all the answers

    What is the primary goal of the finger to nose to finger test?

    <p>To reduce higher function processing compensation to identify subtle motor dysfunctions</p> Signup and view all the answers

    Which of the following is NOT a component of gait evaluation?

    <p>Cognitive processing</p> Signup and view all the answers

    A patient exhibits pins and needles, decreased sensation, and anesthetic skin. What aspect of sensory function is likely involved?

    <p>Light touch discrimination</p> Signup and view all the answers

    What is the term for the ability to identify two or more places being touched simultaneously?

    <p>Extinction</p> Signup and view all the answers

    What element(s) contribute to taking a good history?

    <p>All of the above</p> Signup and view all the answers

    What tests are used to assess cognitive status?

    <p>Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), 6 item cognitive impairment test</p> Signup and view all the answers

    What does the Glasgow Coma Scale (GCS) measure in human physiology?

    <p>Level of consciousness</p> Signup and view all the answers

    What are evaluated in assessing motor function?

    <p>Trophic state, tone, and strength</p> Signup and view all the answers

    In what motor lesions does hypotonia manifest?

    <p>Lower motor neuron lesions</p> Signup and view all the answers

    Strength is graded 0-5. Which score indicates full strength?

    <p>5</p> Signup and view all the answers

    Weakness is present in both lower motor and upper motor lesions

    <p>True</p> Signup and view all the answers

    Fasciculations are present in upper motor lesions

    <p>False</p> Signup and view all the answers

    Upper motor lesions present with increased/spastic muscle tone and increased muscle stretch reflexes

    <p>True</p> Signup and view all the answers

    Atrophy and reduced muscle stretch reflexes are profound in lower motor lesions

    <p>True</p> Signup and view all the answers

    What modalities should be evaluated when performing a neurologic assessment on the upper extremities?

    <p>All of the above</p> Signup and view all the answers

    Which part of the CNS does light touch discrimination run through?

    <p>Posterior tract of the spinal cord</p> Signup and view all the answers

    What type of sensation is conveyed through the lateral spinothalamic tract?

    <p>Sharp and dull pain</p> Signup and view all the answers

    Which type of information is conveyed through the lateral spinothalamic tract?

    <p>Temperature</p> Signup and view all the answers

    Which part of the spinal cord is responsible for conveying vibration sense?

    <p>Posterior aspects</p> Signup and view all the answers

    Through which aspects of the spinal column does proprioceptive information travel?

    <p>Posterior aspects</p> Signup and view all the answers

    What is graphesthesia?

    <p>The ability to write words or numbers on one's skin and recognize them</p> Signup and view all the answers

    What is a polysynaptic reflex?

    <p>A reflex that involves multiple neurons and at least one interneuron</p> Signup and view all the answers

    How is the corneal reflex tested?

    <p>By gently touching the cornea with a cotton swab</p> Signup and view all the answers

    How is the pupillary reflex tested?

    <p>By shining a bright light into the eyes</p> Signup and view all the answers

    What is the difference between autonomic reflexes and superficial reflexes?

    <p>Autonomic reflexes control involuntary movements, while superficial reflexes control voluntary movements.</p> Signup and view all the answers

    Which of the following are examples of deep tendon reflexes?

    <p>All of the above</p> Signup and view all the answers

    Deep tendon reflexes are monosynaptic reflexes

    <p>True</p> Signup and view all the answers

    What would a normal reflex response be graded as?

    <p>2+</p> Signup and view all the answers

    What would a hyperreactive reflex with clonus be graded as?

    <p>4+</p> Signup and view all the answers

    Which are examples of lower extremity deep tendon reflexes?

    <p>Achilles (ankle) and Patellar (knee)</p> Signup and view all the answers

    Which is an example of a lower extremity superficial reflex?

    <p>Plantar reflex</p> Signup and view all the answers

    Superficial reflexes are polysynaptic & are the result of direct stimulation of a body part.

    <p>True</p> Signup and view all the answers

    What is indicated by a positive Babinski sign in adults?

    <p>Abnormal reflexes in the brain or spinal cord</p> Signup and view all the answers

    The plantar reflex is also known as

    <p>Babinski reflex</p> Signup and view all the answers

    Which nerve roots are involved in the patellar reflex?

    <p>L2-L4</p> Signup and view all the answers

    Which nerve roots are involved in the Achilles and plantar reflex?

    <p>S1, S2</p> Signup and view all the answers

    What nerve roots are involved in the biceps reflex?

    <p>C5-C6</p> Signup and view all the answers

    What nerve roots are involved in the triceps reflex?

    <p>C6-C7</p> Signup and view all the answers

    What nerve roots are involved in the brachioradialis reflex?

    <p>C6-C8</p> Signup and view all the answers

    What is ankle clonus?

    <p>A reflex characterized by rhythmic, involuntary muscle contractions that is a symptom of spasticy</p> Signup and view all the answers

    What does simultaneous toe tapping evaluate?

    <p>Cerebellar function - fine motor coordination</p> Signup and view all the answers

    What does the heel to shin maneuver evaluate?

    <p>Lower extremity ataxia</p> Signup and view all the answers

    What is ataxia?

    <p>A lack of coordination or balance</p> Signup and view all the answers

    What does rapid alternating hand movements evaluate?

    <p>Loss of fine motor function</p> Signup and view all the answers

    What are the two elements of gait?

    <p>Balance and motor coordination</p> Signup and view all the answers

    What are aspects of balance in a neuro assessment?

    <p>Vestibular, visual, lower extremity proprioception</p> Signup and view all the answers

    How is the Romberg test performed?

    <p>The patient is asked to stand with their feet shoulder-width apart and eyes open, then closed.</p> Signup and view all the answers

    What does an antalgic gait indicate?

    <p>Hip abductor weakness</p> Signup and view all the answers

    What is a characteristic of a spastic gait?

    <p>Stiffness of the muscles</p> Signup and view all the answers

    What is a characteristic of a steppage gait?

    <p>Stomping to ensure feet are planted</p> Signup and view all the answers

    What is a Parkinsonian gait characterized by?

    <p>Shuffling steps with a narrow base</p> Signup and view all the answers

    What type of gait is present in cerebellar ataxia?

    <p>Wide-based gait</p> Signup and view all the answers

    What is characteristic of an ataxic gait?

    <p>A wide, unsteady base of support</p> Signup and view all the answers

    Symptoms worsen when eyes are closed in which type of ataxia?

    <p>Sensory ataxia</p> Signup and view all the answers

    Which type of ataxia may be the result of spinal cord pathology?

    <p>Sensory ataxia</p> Signup and view all the answers

    Sensory ataxia is seen in which disease processes?

    <p>MS and severe diabetes</p> Signup and view all the answers

    What is vertigo?

    <p>A symptom of illusory movement</p> Signup and view all the answers

    Vertigo is caused by asymmetry of the vestibular system

    <p>True</p> Signup and view all the answers

    Which of the following are causes of vertigo?

    <p>All of the above</p> Signup and view all the answers

    Vertigo can have cardiac etiologies

    <p>True</p> Signup and view all the answers

    What are the 4 sources of tremors?

    <p>mechanic oscillations of the limbs, reflex oscillations, natural central oscillators, pathologic central oscillations</p> Signup and view all the answers

    What do reflex oscillations result from?

    <p>Inherent instability of negative muscle feedback loops in the sensory muscle pathways</p> Signup and view all the answers

    What causes natural central oscillations in the nervous system?

    <p>Intrinsic oscillatory properties of neurons in thalamus, basal ganglia, inferior olive</p> Signup and view all the answers

    What causes pathologic central oscillations?

    <p>Disease processes in cerebellum, thalamus, basal ganglia, and inferior olive</p> Signup and view all the answers

    What is peripheral neuropathy?

    <p>A problem with nerve damage or dysfunction outside the central nervous system</p> Signup and view all the answers

    Peripheral neuropathy may be sensory, motor, or autonomic

    <p>True</p> Signup and view all the answers

    Peripheral neuropathy may be caused by traumatic injuries, infection, metabolic problems (diabetes), alcohol exposure, and environmental toxins

    <p>True</p> Signup and view all the answers

    What are x-ray films useful for?

    <p>Identifying spine instability, degenerative changes, and deformities</p> Signup and view all the answers

    CT has poor tissue differentiating capabilities

    <p>False</p> Signup and view all the answers

    X-ray exposure is less in CT

    <p>False</p> Signup and view all the answers

    MRI images are less detailed than CT

    <p>True</p> Signup and view all the answers

    What are the signs of a Parkinsonian gait?

    <p>Shuffling steps, decreased arm swing, and forward flexion</p> Signup and view all the answers

    Deep tendon reflexes are also which type of reflexes?

    <p>Monosynaptic</p> Signup and view all the answers

    The corneal and gag reflexes are examples of what type of reflex?

    <p>Superficial</p> Signup and view all the answers

    The pupillary light reflex is an example of what type of reflex?

    <p>Autonomic reflex</p> Signup and view all the answers

    What are the 3 components of the Glasgow Coma Scale (GCS)?

    <p>Eye, Verbal, and Motor</p> Signup and view all the answers

    Study Notes

    Neurological Assessment

    • A good history should include:
      • Chief complaint
      • Onset and precipitating event
      • Associated symptoms
      • Aggravating and relieving factors
      • Past medical and surgical history (including anesthetic history)
      • Occupational, family, and social history

    Mental Status Examination

    • Elements of a Mental Status examination:
      • Memory
      • Orientation (person, place, time)
      • Intelligence
      • Affect
      • Insight and Judgment
      • General health

    Modified Glasgow Coma Scale

    • Elements of the Modified Glasgow Coma Scale:
      • Eye opening
      • Verbal response
      • Motor response

    Cranial Nerves

    • The 12 cranial nerves and their functions:
      • CN I (Olfactory): Olfaction/smell
      • CN II (Optic): Vision (fields and acuity)
      • CN III (Oculomotor): Eye movement (superior rectus, medial rectus, inferior rectus, and inferior oblique) and pupil reflex
      • CN IV (Trochlear): Eye movement (superior oblique)
      • CN V (Trigeminal): Motor - Face sensation and chewing; Sensory - V1 (ophthalmic), V2 (maxillary), and V3 (mandibular)
      • CN VI (Abducens): Eye movement (lateral rectus)
      • CN VII (Facial): Motor - Face movement (most facial muscles), salivary glands; Sensory - Taste from anterior 2/3 of tongue, hard and soft palate
      • CN VIII (Vestibular/Cochlear): Hearing and balance
      • CN IX (Glossopharyngeal): Motor - Swallowing, phonation; Sensory - Taste from back 1/3 of tongue, sensory component of gag reflex
      • CN X (Vagus): Motor - Movement, sensation, parasympathetic functions
      • CN XI (Spinal Accessory): Neck movement (SCM and upper traps)
      • CN XII (Hypoglossal): Tongue movement

    Motor Function

    • Elements of motor function:
      • Trophic state (size, shape, symmetry)
      • Tone (hypertonic, hypotonic)
      • Strength on a 0-5 scale

    Nerves of the Brachial Plexus

    • Sensory and motor functions of the nerves of the brachial plexus:
      • Axillary (C5): Superior lateral cutaneous nerve - inferior region of deltoid; Arm abduction - deltoid
      • Musculocutaneous (C5, C6): Lateral cutaneous branch of forearm - lateral half of anterior forearm, tiny lateral portion of posterior forearm; Elbow flexion - biceps and brachioradialis
      • Radial (C7): Posterior aspect of arm and forearm, posterolateral aspect of hand; Elbow, wrist, and finger extension - triceps, extensor digitorum
      • Median (C8): Palmar cutaneous branch - lateral part of hand and digital cutaneous branch - lateral 3.5 fingers on palmar surface of hand; Wrist flexion - flexor carpi ulnaris, and finger flexion - flexor digitorum superficialis, profundus
      • Ulnar (C8, T1): Anterior and posterior surfaces of medial 1.5 fingers (pinky and half of ring) and palm; Finger abduction - interossei muscles

    Nerves of the Lumbar Plexus

    • Sensory and motor functions of the nerves of the lumbar plexus:
      • Femoral: Anterior thigh and medial leg; Hip flexion and knee extension
      • Lateral femoral cutaneous: Anterior and lateral thigh down to knee; None
      • Obturator: Medial thigh; Knee adduction
      • Sciatic: None directly but sensory info through terminal branches; Inversion/eversion of foot, dorsiflexion/plantarflexion, flexion/extension of toes, knee flexion, hip adduction
      • Tibial (branch of sciatic): Posterolateral leg, lateral foot, sole of foot; Posterior compartment of leg, intrinsic foot muscles
      • Peroneal/Common fibular (branch of sciatic): Anteriorolateral leg, dorsum of foot; Dorsiflexion - anterior tibialis

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