Clinical Neurology Final Review

  1. What is a mnemonic to remember the which nerves are sensory, motor, or both?
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  2. What CN's control which muscles of the eye?
    Image Upload 1
    • CN III - Inferior oblique, Superior / Medial / Inferior Rectus
    • CN IV - Superior Oblique
    • CN VI - Lateral Rectus
  3. If a patient has Medial Strabismus, what CN / muscle is affected?
    CN VI / Lateral Rectus problem
  4. If a patient has Lateral Strabismus, what CN / muscle is affected?
    CN III & IV / Medial Rectus problem
  5. What CN innervates the skin of the face? muscles of the face?
    CN V - skin of faceCN VII - muscles of face
  6. What can you tell me about Bell's Palsy?
    • 1. CN VII problem
    • 2. Lower motor neuron lesion
    • 3. Cause weakness of all facial muscles
    • 4. Angle / Corner of the mouth droops
    • 5. Weakness of frontalis muscle
    • 6. Eye closure is weak
  7. What can you tell me about the Stroke / Cerebro Vascular Accident (CVA)?
    • 1. Upper Motor Neuron lesion
    • 2. Frontalis is spared
    • 3. Eye closure & blinking are not affected
    • *severe CVA may lead to Bell's Palsy
  8. What is the formula for the Rinne Test?
    • ACf (Rinne Test + ACi) ≥ 2 x BC (Rinne Test)
    • Example:
    • Weber test indicates lateralization
    • Rinne Test is performed and time is 20 secs
    • Air Conduction (ACi) is 20 secs, therefore ACf = 40 secs
  9. In performing the CN IX test, the uvula deviates in which direcion?
    Awasy from the lesion
  10. In performing the CN XII test, the tongue deviates in which direction?
    To the side of the lesion
  11. Please describe the Soto Hall test
    • 1. Place patient supine
    • 2. Put on hand on sternum & the other hand under occiput flexing patient's head
    • (+) is pain anywhere in the body
  12. Please describe Forestier's Bowstring Sign
    • 1. Patient stands with the back of gown open to properly visualize it and laterally flexes to each side
    • (+) contracture of ipsilateral musculature
  13. Please describe the Lewin's Supine Test
    • 1. Patient is supine & examiner holds legs down & patient tries to sit up without using arms
    • (+) inability to sit up
  14. Please describe the Chest Expansion Test
    • 1. Difference between chest circumference upon Expiration vs. Inspiration is measured at the nipple line or 4th intercostal space
    • 2. Normal differene between inspiratoray and expiratory measurements - 5.75-7.5 cm
    • (+) if less than 3 cm difference
  15. What are the symptoms of Meningitis?
    • Fever & Chills
    • Mental status change (patient may not be able to communicate to you)
    • Nausea & vomiting
    • Severe Headache
    • Stiff Neck
    • Sensitivity to ligh (photophobia)
  16. Please describe the Brudzinski's Test
    • Soto Hall + (+) for involuntary knee flexing with diffuse pain
    • Image Upload 2
  17. Please describe L'Hermitte's Sign
    Soto Hall + (+) shock like dyesthesia (electric shock) down the spine or into extremities
  18. What type of Diabetes is lacking of insulin / insulin dependent?
    Type I DM
  19. What type of Diabetes is resistant to insulin?
    Type II DM
  20. What type of Diabetes is characterized by excessive thirst and excretion of large amoutns of severely diluted urine, with reduction of fluid intake having no effect on the latter.
    • Diabetes Insipidus
    • *Urine is not sweet as it does not contain glucose and there is no hyperglycemia (elevated blood glucose)
  21. What is the image study for MS?
  22. What can trigger / worsen MS?
    • Fever
    • Hot Baths
    • Sun Exposure
    • Stress
  23. Carries signals for voluntary movement of skeletal muscle. It controls movement of the torso, upper, and lower limbs
    Corticospinal / Pyramidal tract
  24. Controls the muscles of the face, head, and neck.
    Corticobulbar tract
  25. It is the sensory pathway responsible for transmitting fine touch and consious proprioceptive information from the body to the cerebral cortex.
    Posterior column (dorsal column) pathway
  26. It is a sensory pathway orginating in the spinal cord that transmits information about pain, temperature, itch and crude touch to the thalamus.
    Spinothalmic tract
  27. Provides feedback on the position of the body in space (proprioception).
    Spinocerebellar tract
  28. An object such as fat / blood clot / cholesterol forms in a vessel but moves to another part of the body
  29. An object such as fat / blood clot / cholesterol form in a vessel but does not move to another area. It forms at the blockage point within blood vessels.
  30. When clot migrates from one part of the body through circulation. It causes blockage of blood vessels in another part of the body.
  31. Formation of a clot inside of a blood vessel obstructing the flow of blood through the circulatory system.
  32. What is the term for Increased Muscle Tone (spasms)?
    Muscular Hypertonia
  33. What is the name of the UMNL test where the appendage will shake constantly with tremors?
  34. What is the name of the UMNL test where there is excessive reflex / contraction?
  35. What is the name of the UMNL test where there will be resistance initially & then easier movement follows?
    Clasp Knife Rigidity
  36. Please describe the Gordon's Finger Test (UMNL - Pathological Reflex (Upper Limb))
    • Squeeze pisiform
    • (+) finger extend
    • (-) fingers flex or stay neutral
  37. Please describe Rossolimo's Hand Sign (UMNL - Pathological Reflex (Upper Limb))
    • Tap base of 3rd MCP joint on the palmar side
    • (+) fingers flex
    • (-) fingers stay neutral
  38. Please describe Hoffman's test (UMNL - Pathological Reflex (Upper Limb))
    • Hand Prone
    • Flick 3rd digit into flexion
    • (+) thumb & 1st finger make "OK" sign
    • (-) finger doesn't move
  39. Please describe the Snout Reflex (UMNL - Pathological Reflex (Head))
    • Tap patients on side of face
    • (+) patient grimaces on ipsilateral side
  40. Please describe the Babinski sign (UMNL - Pathological Reflex (Lower Limb))
    • Stimulate plantar surface
    • Image Upload 3
    • Image Upload 4
  41. Please describe Gordon's (UMNL - Pathological Reflex (Lower Limb))
    • Squeeze Calf
    • (+) Babinski's Sign
    • Image Upload 5
  42. Please describe Chaddock's (UMNL - Pathological Reflex (Lower Limb))
    • Image Upload 6
    • (+) Babinski's Sign
  43. Please describe Schaefer's (UMNL - Pathological Reflex (Lower Limb))
    • Pinch Achilles Firmly (KI-3 & BL-60)
    • (+) Babinski's Sign
  44. In the Abdominal Superficial Reflex, which nerve root innervates upper quadrants?
  45. In the Abdominal Superficial Reflex, which nerve root innervates lower quadrant?
  46. What is the difference between Upper and Lower Motor Neuron Lesion?
    • UMNL - muscle weakness, increased reflexes, increased muscle tone (spasm)
    • LMNL - muscle weakness, muscle atrophy, fasciculations (twitching), decreased reflexes, decreased muscle tone
  47. When performing Dorsal Column Pathway tests, how should each test be performed?
    With eyes closed
  48. Please describe the test for Apallesthesia (Lack of Vibration - Dorsal Column Dysfunction)
    • Using 128 Hz tuning fork on any bony area
    • Patient should feel vibration
    • Practitioner will stop for mid-vibration
    • Patient should feel the stopping of vibration
  49. Please describe the tests for Akinesthesia (Lack of Proprioception - Dorsal Column Dysfunction)
    • Romberg's - Jesus-like pose, head up, eyes closed
    • Positional Change Digits - pinching sides of 2 different fingers and patient will tell you what position it is going
    • *These are Bi-lateral tests
    • *Eyes closed
  50. Please describe the tests for Absence of Deep Pressure (Dorsal Column Dysfunction)
    • Abadie's Achilles - like Schaefer's but patient should feel pressure
    • (+) they don't feel pressure
    • (-) feeling of discomfort
    • Biernacki's - push up ulnar nerve (SI-8)
    • (+) they don't feel pressure
    • (-) feeling of discomfort
  51. Please describe the tests for Multi Modal Sensation (Fine Touch - Dorsal Column Dysfunction)
    • Stereognosis - identify different objects
    • Graphesthesia - writing numbers on palmar aspect of hand
    • Graphognosis - writing letters on palmer aspect of hand
    • *These are Bi-lateral tests
    • *Eyes Closed
  52. What make Cerebellar Dysfunction Assessment different from UMNL & Dorsal Column Dysfunction?
    There is no cross over
  53. Please describe the tests for Muscular Hypertonia (decreased muscle tone - Cerebellar Dysfunction Assessment)
    • Rag doll posture - patient has a sloppy and dragged posture
    • Pendular Deep Tendon Reflex - when reflex is hit, the appendage continues to swing many times
  54. What is the term for presence of near normal coordination when the movement is visually observed by the patient?
    Cerebellar Ataxia
  55. What is the term for loss of sensory input to conrol movement?
    Sensory Ataxia
  56. Mittlemerye March
    Swivel Test
    These are all examples of what type of Ataxia?
    Vestibular Ataxia
  57. Please describe the tests for Ataxia (Cerebellar Dysfunction Assessment)
    • Romberg's - Jesus-like pose, head up, eyes open
    • Heel-to-Toe / Tandem Gait (DWI Test)
    • (+) Patient is unable to do test without staggering
  58. Please describe the tests for Dysdiadochokinesia (problem with alternating movement - Cerebellar Dysfunction Assessment)
    • Finger Tapping - fingers to thumb
    • Hand Patting - alt. patting on thighs
    • Foot Patting - alt. foot tappping
    • Pronation/Supination - palms up / palms down
  59. Please describe the tests for Dysmetria (lack of coordination of movement - Cerebellar Dysfunction Assessment)
    • Finger-to-Nose
    • Finger-to-Finger
    • Heel-to-Knee
    • Toe-to-Finger
  60. Please describe the test for Rebound Phenomenon (Cerebellar Dysfunction Assessment)
    • Holmes - face punch test
    • Andre Thomas - hand above head, should drop freely
    • Rebound Checking - hand out, slap down, should stabilze
  61. Please describe the tests for Accessory Movements
    • Intention Tremors - patient reaching for object
    • Dysarthria - checking for speech problems
    • Nystagmus - shaking of eyes at extremities in "H in the sky" test
  62. Intention Tremors denote condition of what part of the brain?
  63. Resting Tremors denote condition of what part of the brain?
    Pyramidal (Parkinson's)
  64. A diminished Substantia Nigra, is indicative of what condition?
    • Parkinson's (dopamine deficiency)
    • Image Upload 7
  65. Neurotransmitters that help transmit messages to the stratum that both initiate and control your movements and balance; it makes sure the muscles work smoothly under precise control and unwanted movements.
  66. Excites skeletal muscle but decreases contraction in cardiac muscles
  67. What are the signs of Parkinsonism (Dopamine Deficiency - Extrapyramidal Evaluation)?
    • Shuffling Gait - dragging of feet cause a sound (shuffling)
    • Festinating Gait - progressively faster and faster gait, often ending in a fall
    • Resting Tremors
    • Rigidity
    • Mask faces - lack of expression
    • Soque's Test - patient falls over is support for back is taken away
  68. What are the signs of Dyskinesia (abnormal movement - Extrapyramidal Evaluation)?
    • Choreas - jerky quick movements in extremiteis mostly
    • Athetosis - involunatary movement of fingers / toes
    • Hemiballism - jerky movements on one half of the body only
    • Dystonias - abnormal trunk movements & postures
    • Myoclonus - tick-like movements & twitches
Card Set
Clinical Neurology Final Review
Clinical Neurology