104 Questions
Which nerve is responsible for wrist flexion?
Median nerve
What is the motor function of the radial nerve?
Wrist extension and finger extension
Which nerve provides sensation to the palmar cutaneous branch?
Median nerve
Which nerve is responsible for the sensation in the anterior thigh and medial leg?
Femoral
Which muscle is NOT responsible for hip flexion and knee extension?
Gastrocnemius
Which nerve is responsible for the sensation in the posterolateral leg and lateral foot?
Tibial
Which nerve is responsible for the motor function of knee adduction?
Obturator
Which muscle is responsible for dorsiflexion of the foot?
Anterior tibialis
Which nerve is responsible for the sensation in the anterior and lateral thigh down to the knee?
Lateral femoral cutaneous
What is the primary function of the CN V Trigeminal nerve?
Face sensation and mastication
What is the function of the CN III Oculomotor nerve?
Control of eye movement
What is the primary purpose of the Mental Status examination?
To assess the patient's cognitive function
What is the function of the CN VIII Vestibular cochlear nerve?
Regulation of hearing and balance
What is the primary purpose of the Modified Glasgow Coma Scale?
To assess the patient's level of consciousness
What is the function of the CN IX Glossopharyngeal nerve?
Control of swallowing and phonation
What is the primary purpose of taking a good history during a neurological assessment?
To gather information about the patient's symptoms and medical history
What is the function of the CN X Vagus nerve?
Movement, sensation, and parasympathetic functions
What is the primary purpose of the elements of the Mental Status examination?
To assess the patient's cognitive function
What is the primary function evaluated by the Romberg Test?
Vestibular function
What is characterized by a lack of voluntary coordination of muscle movements and a wide, uncoordinated gait?
Cerebellar ataxia
What is the term for an involuntary shaking movement with an associated rhythm?
Tremor
What is Benign Paroxysmal Positional Vertigo (BPPV) an example of?
A vestibular cause of vertigo
What is the term for a loss of proprioception characterized by a stomping, heel-striking gait?
Sensory ataxia
What does the Tandem Walk exam evaluate?
Balance, proprioception, and sensation
What is the primary characteristic of upper motor neuron lesions in terms of muscle tone?
Increased/spastic
A patient exhibits fasciculations and profound muscle atrophy. Which type of motor neuron lesion is most likely present?
Lower motor neuron lesion
What is the term for the ability to identify objects by feel?
Stereognosia
A reflex arc with a single synapse between afferent and efferent neurons is classified as a?
Monosynaptic reflex
What is the primary goal of the finger to nose to finger test?
To reduce higher function processing compensation to identify subtle motor dysfunctions
Which of the following is NOT a component of gait evaluation?
Cognitive processing
A patient exhibits pins and needles, decreased sensation, and anesthetic skin. What aspect of sensory function is likely involved?
Light touch discrimination
What is the term for the ability to identify two or more places being touched simultaneously?
Extinction
What element(s) contribute to taking a good history?
All of the above
What tests are used to assess cognitive status?
Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), 6 item cognitive impairment test
What does the Glasgow Coma Scale (GCS) measure in human physiology?
Level of consciousness
What are evaluated in assessing motor function?
Trophic state, tone, and strength
In what motor lesions does hypotonia manifest?
Lower motor neuron lesions
Strength is graded 0-5. Which score indicates full strength?
5
Weakness is present in both lower motor and upper motor lesions
True
Fasciculations are present in upper motor lesions
False
Upper motor lesions present with increased/spastic muscle tone and increased muscle stretch reflexes
True
Atrophy and reduced muscle stretch reflexes are profound in lower motor lesions
True
What modalities should be evaluated when performing a neurologic assessment on the upper extremities?
All of the above
Which part of the CNS does light touch discrimination run through?
Posterior tract of the spinal cord
What type of sensation is conveyed through the lateral spinothalamic tract?
Sharp and dull pain
Which type of information is conveyed through the lateral spinothalamic tract?
Temperature
Which part of the spinal cord is responsible for conveying vibration sense?
Posterior aspects
Through which aspects of the spinal column does proprioceptive information travel?
Posterior aspects
What is graphesthesia?
The ability to write words or numbers on one's skin and recognize them
What is a polysynaptic reflex?
A reflex that involves multiple neurons and at least one interneuron
How is the corneal reflex tested?
By gently touching the cornea with a cotton swab
How is the pupillary reflex tested?
By shining a bright light into the eyes
What is the difference between autonomic reflexes and superficial reflexes?
Autonomic reflexes control involuntary movements, while superficial reflexes control voluntary movements.
Which of the following are examples of deep tendon reflexes?
All of the above
Deep tendon reflexes are monosynaptic reflexes
True
What would a normal reflex response be graded as?
2+
What would a hyperreactive reflex with clonus be graded as?
4+
Which are examples of lower extremity deep tendon reflexes?
Achilles (ankle) and Patellar (knee)
Which is an example of a lower extremity superficial reflex?
Plantar reflex
Superficial reflexes are polysynaptic & are the result of direct stimulation of a body part.
True
What is indicated by a positive Babinski sign in adults?
Abnormal reflexes in the brain or spinal cord
The plantar reflex is also known as
Babinski reflex
Which nerve roots are involved in the patellar reflex?
L2-L4
Which nerve roots are involved in the Achilles and plantar reflex?
S1, S2
What nerve roots are involved in the biceps reflex?
C5-C6
What nerve roots are involved in the triceps reflex?
C6-C7
What nerve roots are involved in the brachioradialis reflex?
C6-C8
What is ankle clonus?
A reflex characterized by rhythmic, involuntary muscle contractions that is a symptom of spasticy
What does simultaneous toe tapping evaluate?
Cerebellar function - fine motor coordination
What does the heel to shin maneuver evaluate?
Lower extremity ataxia
What is ataxia?
A lack of coordination or balance
What does rapid alternating hand movements evaluate?
Loss of fine motor function
What are the two elements of gait?
Balance and motor coordination
What are aspects of balance in a neuro assessment?
Vestibular, visual, lower extremity proprioception
How is the Romberg test performed?
The patient is asked to stand with their feet shoulder-width apart and eyes open, then closed.
What does an antalgic gait indicate?
Hip abductor weakness
What is a characteristic of a spastic gait?
Stiffness of the muscles
What is a characteristic of a steppage gait?
Stomping to ensure feet are planted
What is a Parkinsonian gait characterized by?
Shuffling steps with a narrow base
What type of gait is present in cerebellar ataxia?
Wide-based gait
What is characteristic of an ataxic gait?
A wide, unsteady base of support
Symptoms worsen when eyes are closed in which type of ataxia?
Sensory ataxia
Which type of ataxia may be the result of spinal cord pathology?
Sensory ataxia
Sensory ataxia is seen in which disease processes?
MS and severe diabetes
What is vertigo?
A symptom of illusory movement
Vertigo is caused by asymmetry of the vestibular system
True
Which of the following are causes of vertigo?
All of the above
Vertigo can have cardiac etiologies
True
What are the 4 sources of tremors?
mechanic oscillations of the limbs, reflex oscillations, natural central oscillators, pathologic central oscillations
What do reflex oscillations result from?
Inherent instability of negative muscle feedback loops in the sensory muscle pathways
What causes natural central oscillations in the nervous system?
Intrinsic oscillatory properties of neurons in thalamus, basal ganglia, inferior olive
What causes pathologic central oscillations?
Disease processes in cerebellum, thalamus, basal ganglia, and inferior olive
What is peripheral neuropathy?
A problem with nerve damage or dysfunction outside the central nervous system
Peripheral neuropathy may be sensory, motor, or autonomic
True
Peripheral neuropathy may be caused by traumatic injuries, infection, metabolic problems (diabetes), alcohol exposure, and environmental toxins
True
What are x-ray films useful for?
Identifying spine instability, degenerative changes, and deformities
CT has poor tissue differentiating capabilities
False
X-ray exposure is less in CT
False
MRI images are less detailed than CT
True
What are the signs of a Parkinsonian gait?
Shuffling steps, decreased arm swing, and forward flexion
Deep tendon reflexes are also which type of reflexes?
Monosynaptic
The corneal and gag reflexes are examples of what type of reflex?
Superficial
The pupillary light reflex is an example of what type of reflex?
Autonomic reflex
What are the 3 components of the Glasgow Coma Scale (GCS)?
Eye, Verbal, and Motor
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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