79 Questions
What is the primary purpose of the neurological examination described in the text?
To localize the lesion
What is highlighted as the key to performing an efficient neurological examination?
Observation of the patient
Why does the text caution against performing an overly detailed neurological examination?
To prevent unnecessary incidental findings
What aspect of a patient can help in localizing a lesion during a neurological examination?
Their way of speaking and moving
What is considered unnecessary when performing a neurological examination according to the text?
Performing formalized testing
What is an important aspect to consider when interpreting the results of a neurological examination?
Relating observations to neuroanatomy
What is the primary location of lesions that can cause apraxias?
Frontal lobes
Which type of apraxia is characterized by an inability to plan a series of complex tasks?
Ideational apraxia
How is memory typically assessed in a cognitive evaluation?
Testing immediate recall and recent memory
Which component of cognition can be tested by asking the patient to interpret a simple proverb?
Abstraction
What is the key aspect assessed when judging a patient's cognitive abilities by presenting an ambiguous situation?
Judgment
Which abnormal thought content could indicate schizophrenia or delirium?
Paranoid behavior
What may be indicative of a basilar skull fracture when inspecting a patient's skull?
"Raccoon eyes"
"Bruits" heard over certain areas of the skull may suggest which condition?
"Arteriovenous malformations"
"Meningismus" may reflect inflammation of which structures when examining the spine?
"Meninges"
"Paratonic muscle rigidity" may cause limitations in which range-of-motion when assessing the spine?
"Both cervical and lumbar range-of-motion"
What structures are required for consciousness?
Brain stem reticular activating system and one cerebral hemisphere
Which of the following is a type of expressive aphasia?
Broca's aphasia
What is agnosia?
Defect in recognizing a complex sensory stimulus
Which area is involved in receptive aphasia?
Temporal lobe (Wernicke's area)
What is the hallmark of expressive aphasia?
Significant difficulty producing language, but with preserved understanding
In aphasia testing, what does repetition assess?
Ability to repeat a spoken phrase
Which of the following is an example of agnosia?
"Inability to recognize faces"
"Anosognosia" is associated with:
"Denial of illness"
"Apraxia" is a defect in:
"Performing a complex motor task"
Which lobe is primarily involved in recognizing faces?
Temporal lobe
What is the main reason why family members are often asked to provide historical details for patients with dementia?
Because patients with dementia may have difficulty providing a cogent history.
Why is summarizing the history important in making a tentative diagnosis?
To help the physician fill in historical gaps that were missed.
Which of the following is an example of a component of neurologic history besides past medical history?
Occupation
Why is obtaining a detailed medication history important in neurologic assessments?
Many medications can affect the nervous system.
What type of questions are typically included in the Neurologic Review of Systems component of the history?
Questions about dysfunction affecting various parts of the nervous system.
Which term refers to a patient's unawareness of their own disease?
Anosognosia
'Entrapment of the median nerve across the carpal tunnel at the wrist' is associated with which occupational activity?
Factory assembly line work
'Cranial Nerves: Abnormalities in vision, hearing, smell, taste, speech or swallowing' is part of which component of neurologic history?
'Cranial Nerves'
'Difficulty maintaining balance' would be considered an abnormality in which component of neurologic examination?
'Gait and Station'
'Repetitive hand motion leading to carpal tunnel syndrome' is associated with which type of occupation?
'Assembly line worker'
Which eye movement fixates the image on the retina with respect to head and neck motion?
Vestibulo-Ocular Reflex
How is image motion sensed in the Visual Pursuit reflex?
By the occipital cortex
Which structure receives electrical impulses converted from angular acceleration?
Vestibular Nuclei
Which neural pathway is responsible for maintaining a stable visual field despite head motion?
MLF to CNs III, IV, and VI
Which reflex redirects the line of sight?
Visual Saccade
What is the role of the lateral gaze center in ocular movements?
Relaying information about image motion
What is the significance of abnormal findings in a neurological examination?
They are crucial for diagnosing neurological conditions
What is the purpose of including short cases in a handout about neurological examinations?
To demonstrate how to efficiently conduct a neurological examination
When should lower cranial nerves (IX-XII) be tested during a neurological examination?
Only if dysphagia and dysarthria are present
Which part of the neurological exam is a test of proprioception?
Touching nose with eyes closed
In a neurologic diagnosis, what does an anatomic diagnosis aim to do?
Locate the lesion within a specific area of the nervous system
Why are confirmatory laboratory data and imaging techniques considered secondary in neurologic diagnosis?
The history and physical exam are more important
What is the purpose of focusing sensory testing on a patient's symptoms?
To ensure accurate diagnosis based on specific complaints
Why is gait considered one of the most important parts of a neurological exam?
'It evaluates overall coordination and motor function
What technique is used to assess the visual field in each quadrant of the eye?
Bilateral simultaneous stimuli
What is considered the only purely objective part of the neurological exam?
Reflexes
How is visual neglect often related to brain lesions?
Parietal lobe lesions
Which cranial nerve is responsible for pupillary constriction in response to light?
CN III (Oculomotor nerve)
What is the term for a dilated pupil that does not respond to direct or consensual light?
Hutchinson pupil
Which part of the brain is responsible for shifting pupils from far to near gaze?
Optic pretectum
Which of the following can be visualized during a funduscopic examination?
Cornea and lens
What results from an impaired light response and slow constriction to near vision?
Adie's tonic pupil
Which area coordinates voluntary and reflex eye movements?
Frontal eye fields
'Convergence' is a normal dysconjugate eye movement associated with which type of response?
'Far to near' response
What does a positive straight leg-raising test indicate?
Herniated lumbar disks
What maneuver stretches the sciatic nerve during the straight leg-raising test?
Thigh flexion at the hip and leg extension at the knee
Which sign is indicative of meningeal inflammation and involves spontaneous leg flexion following neck flexion?
Brudzinski sign
How are cranial nerves III through XII evaluated?
By examining the brain stem
Which nerve is tested by occluding one nostril and presenting a non-volatile stimulus to the other nostril?
Olfactory nerve
What is the most common cause of loss of smell?
Inflammation of the nasal mucosa
How are visual fields typically evaluated during an eye exam?
Using the Snellen chart
What does visual acuity evaluate?
Refractile components of the eye
What is an important distinction to make regarding neck stiffness due to meningeal inflammation?
It is primarily limited to flexion only
During the straight leg-raising test, what increases the amount of stretch on the sciatic nerve?
Dorsiflexion of the foot while thigh is flexed and lower leg extended
What type of lesions are typically due to expanding mass lesions, such as a tumor or abscess?
Slowly progressive lesions
Which type of lesions are typically due to vascular accidents, such as stroke?
Lesions of sudden onset
What do symptoms that have a waxing and waning course with exacerbations and remissions suggest in terms of etiology?
Demyelinating etiology
Which component of neurologic diagnosis is the most important according to the text?
Neurologic history
What plays a major role in various neurologic disorders such as carpal tunnel syndrome and peripheral neuropathy?
Occupation
What should a good rule of thumb be when listening to the patient initially for important information according to the text?
>5 minutes without interruption
What do chronic and progressive symptoms suggest in terms of etiology?
Degenerative disorder
What type of illnesses may have normal or non-focal findings on neurologic examination and often require relying heavily on neurologic history for diagnosis?
"Most types of dementia"
"Abnormalities on laboratory studies may be incidental to the patient’s primary problem or may simply represent" what according to the text?
"Coincidental process irrelevant to the patient’s concerns"
This quiz covers the assessment of visual fields in each quadrant using a target, testing each eye individually, and evaluating visual neglect by presenting bilateral stimuli. Visual neglect often indicates parietal lobe lesions.
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