Neurology
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| In order to test sensitivity of these divisions, you can use your finger, or an orange pin (medical clinic supply type). Name these areas (image). | Opthalmic, Maxillary, Mandible |
| The Corneal Reflex is which two nerves? | CN V and CN VII |
| When testing the corneal reflex with a cotton ball, do you test the cornea or the sclera?? | Cornea (coloured part) |
| CN V (motor) mainly affects which area: Ophthalmic, Mandible, Maxillary | Mandible (muscles of mastication) |
| True or false: Fifth-nerve palsies are very common in isolation. | False. They are typically rare in isolation. |
| True or False: When opening the jaw, palsy of the nerve causes deviation of the jaw AWAY from the side of the lesion | False. The jaw deviates TOWARDS the lesion side. |
| Describe the "Jaw jerk" test | Put your forefinger gently on the patient’s loosely opened jaw. Tap your finger gently with a tendon hammer. Explain the test to the patient or relaxation of his jaw will be impossible. Normally, the jaw will not jerk much, unless there is a lesion. |
| What is this image showing a weakness in (what muscle)? | Weak right pterygoid. Deviates towards the weak side. |
| CN V is often called the ________ nerve. | Trigeminal Nerve |
| What would someone's face look like if they had a Lower motor neuron lesion? | One half or one quadrant of their face would droop, due to muscle palsy. |
| What would someone's face look like if they had an Upper motor neuron lesion? | This would cause one lower quadrant (on the effected side) to droop. It's important to note that UPPER motor neuron lesions affect ONLY the LOWER face. This is because the part of the facial nucleus controlling the upper half of the face is bilaterally innervated. |
| When testing CN VII's taste capabilities, what are the 3 taste types used in the experiment? | Sweet, Salty, Sour |
| The Rinne Test is a test that uses bone conduction to test your hearing. What hearing apparatus is this mainly checking? | This test is checking the quality of hearing via the tiny hair follicles in our cochlea, that are part of our hearing apparatus. By comparing the two placements of the tuning fork, the practitioner can tell where the problem lies (drum or hairs). |
| What is the name of this test? | Rinne Test |
| In the Weber Test, the ringing pitch/tuning fork is placed on the top of the head, in the middle. What does this tell us about the patient's hearing? | This tests for which ear is poorer in hearing, and which hears better. |
| What is the name of this test? | Weber Test |
| What kind of deafness is this patient suffering from? | Conductive Deafness |
| What kind of deafness is this patient suffering from? | Sensorineural Deafness |
| This test asks you to look for nystagmus. What is the meaning of "nystagmus"? | Nystagmus is a vision condition in which the eyes make repetitive, uncontrolled movements. |
| Patients with IX Glossopharyngeal and X Vagus issues might have trouble with nerves relating to their mouths and many areas in the neck. You might get positive test results for dysarthria and dysphonia. What are dysarthria and dysphonia? | Dysarthria is a motor speech disorder in which the muscles that are used to produce speech are damaged, paralyzed, or weakened. Dysphonia refers to having an abnormal voice. It is also known as hoarseness. The voice can be described as hoarse, rough, raspy, strained, weak, breathy, or gravely (damage from cigarettes can cause this sound as well). |
| Which two cranial nerves are associated with the gag reflex? | IX Glossopharyngeal and X Vagus |
| What Cranial Nerve are these testing? | CN XI (Accessory) |
| What Cranial Nerve is this testing? The practitioner might ask the patient to say "yellow lorry" as well as checking their tongue. | CN XII Hypoglossal |
| What are the 5 parts of a muscle examination | Tone Reflexes Power (Strength) Coordination Palpation/Inspection |
| When we palpate a muscle in an examination, what's something SPECIFIC we're looking for? | Examine specifically for wasting or hypertrophy (thickening of muscle fibers from use; exercise.), fasciculation (twitch)/involuntary movements (like protective spasm). |
| Name a cause for muscle wasting. | Lower motor neurone lesions (between spine and muscle), longstanding or developmental upper motor neuron damage (between brain and spine). Muscle disorders; rheumatoid arthritis, cachexia (wasting due to chronic illness). |
| What causes hypertrophy, and is it always bad? | Hypertrophy is not usually a bad thing. Causes: certain occupations (such as those requiring frequent use of muscles; farming, construction), and sports. This causes the thickening of muscle fibers, thus creating larger (but not necessarily stronger) muscles. |
| What is Fasciculation, and is it always a bad thing? | Fasciculation is not usually the sign of a medical issue... but it can be the sign of a severe disorder or injury. Usually, fasciculation is caused by stress, trauma, injury, or fatigue (in healthy people). A fasciculation, or muscle twitch, is a spontaneous, involuntary muscle contraction and relaxation, involving fine muscle fibers. |
| What is a general reason for a, atypical muscle spasm (not related to stress, trauma, injury, or fatigue)? | Lower motor neuron diseases/lesions, non-pathological fasciculation (after vigorous exercise in healthy people). |
| What's a "Myoclonic Jerk," and what might cause someone to have one? | Myoclonic jerks - sudden shock-like contractions of one or more muscles which may be focal or diffuse. They may occur singly or repetitively. Causes - Healthy individuals: when falling asleep or surprised by a sudden noise or stimulus. Epilepsy, diffuse brain damage and dementias. |
| Which is true for a Parkinson's Tremor? a) Worse at rest, reduced during voluntary movement b) Worst during voluntary movement, reduced at rest.. | A) Worse at rest, reduced during voluntary movement |
| How did "Choreatic" (Chorea) movements earn their name? (Knowing this will help you understand more about the condition) | Choreatic movements, which are all involuntary, tend to almost seem "choreographed," in that the movements are rhythmic, and "DANCELIKE". See video in "alternative answers" |
| Athetosis is similar to Chorea, however, it is a little different. Describe the movements a person with Athetosis might have. If you can only "act out" the movements in your head, that is also fine. I understand many students are ESL. | Athetosis is a movement dysfunction. It's characterized by involuntary WRITHING (often called "snake like") movements. With athetosis, the same regions of the body are repeatedly affected. These typically include the hands, arms, and feet. See video for "snakelike" movements in Athetosis. |
| What is muscle spasticity? Is it associated with upper or lower motor neuron lesions? | Spasticity is a velocity-dependent resistance to passive movement (i.e. muscle resists being stretched). Most often associated with upper motor neuron lesions/issues. |
| In muscles that have spasticity issues, are the muscles more often kept in a shortened (contracted) or lengthened (stretched) position, when passive? | Shortened (contracted). This makes sense because spastic muscles resist passive stretching. |
| When stretching a muscle that is RESSISTANT to stretching, and then *suddenly* relaxes and stops resisting... do they have rigidity or spasticity? | Spasticity is muscle stiffness, but nearing the END of the ROM, it will RELEASE (stop resisting). See video in alternative answers to easily understand the different between the two! You'll never forget! |
| To reinforce UPPER limb reflex response (if reflex appears absent), what do you ask the patient to do? | To reinforce the upper limb reflexes ask the patient to clench their teeth. |
| To reinforce LOWER limb reflex response (if reflex appears absent), what do you ask the patient to do? | Ask the patient to interlock the fingers and pull one hand against the other. |
| True or false: you can test for lower motor neuron lesions in the cervical spine by checking the reflexes in the biceps, triceps AND supinator muscles? | True. More specifically, it checks C5 to C8. |
| True or False: Checking finger reflexes checks 3 cervical nerves. | FALSE. It checks 2 cervical nerves (C7 and C8) AND 1 thoracic (T1) |
| Does this ankle test check sacrum, lumbar or coccyx nerves | Sacrum. Specifically S1, S2 |
| What is this reflex test called? Lightly tap the lips. An abnormal response is protrusion of the mouth | Snout Reflex |
| What is isometric testing? | Isometric tests are via contractions of a particular muscle or group of muscles via resistance (maintenance of position, while increasing muscle's workload). |
| What is isotonic testing? | Isotonic testing is tests done on a joint where resistance is used to "prevent" a direct motion, such as flexing the leg (preventing a kinetic chain from moving; preventing flexion or retraction of a limb). |
| What is the MRC Scale, and what does MRC stand for? | The Medical Research Council (MRC) Scale is for grading muscle power ("strength"). |
| If a person's tested muscle functions completely normally, what do they score on the MRC scale? | 5; normal |
| What is paresis? | Partial paralysis. |
| What is plegia? | Complete Paralysis |
| What is monoplegia paralysis?? | Complete Paralysis involving a single limb |
| What is hemiplegia paralysis? | Complete Paralysis of one half of the body? |
| What is paraplegia paralysis? | Complete Paralysis of both legs. |
| What is tetraplegia paralysis? | Complete Paralysis of all 4 limbs. |
| What is Paraparesis? | PARTIAL paralysis of both legs. |
| What is Monoparesis? | PARTIAL paralysis of one limb... like what you might see in a stroke survivor. |
| What is more often the cause for paralysis: upper motor neuron issues or lower motor neuron issues? | Upper; in the brain. |
| In a myopathy, what is the cause of the dysfunction? | Damaged muscle fibers. |
| 1) The following image depicts the "rebound phenomenon" test. • Ask the patient to stretch his arms out in front and maintain this position. • Push the patient's wrist quickly downward and observe the returning movement. If the patient's arm overswings in its return to its original position, that.... (2 answers) 2) if the overswing is dramatic, what does it mean. | That there is either muscle weakness or cerebellar dysfunction present. If the "fly up" to the return position is dramatic, it's more indicative of cerebellar issues. |
| Describe the Finger-Nose coordination test. What is this test checking for? (2 things) | Have the patient put their finger on their nose, then touch your outstretched finger, then to their nose again. It checks for dyssynergia and dysmetria |
| What is dyssynergia? | Dyssynergia is any disturbance of muscular coordination, resulting in uncoordinated and abrupt movements. |
| What is dysmetria? | Dysmetria is caused when the cerebellum isn't functioning correctly, causing uncoordinated movements. |
| Demonstrate the act of repeatedly patting the palm of one hand with the palm and back of your opposite hand as quickly and regularly as possible. Ask the patient to copy your actions. This is testing for the impairment of rapid alternating movements, slowness, disorganization and irregularity of movement. To fail this test means they have.....? | Dysdiadochokinesis - the inability to execute rapidly alternating movements, particularly of the limbs. Note: It is cerebellar in nature. |
| What is Dyspraxia? | Is a neurological disorder that impacts an individual's ability to plan and process motor tasks. Also known as "developmental coordination disorder" (DCD). |
| What is Apraxia? | Apraxia is a neurological disorder characterized by the inability to perform learned (familiar) movements on command, (even though the command is understood and there is a willingness to perform the movement). (They would make poor mimes, because miming requires the ability to perform learned, common actions, without use of a prop.) |
| What ability does checking for stereognosis test? | The ability to perceive the form of solid objects by touch. |
| What ability does checking for graphaesthesia test? | Is the ability to recognize writing on the skin purely by the sensation of touch |
| In the instance of spinal cord trauma, and compressive lesions of the spinal cord, cause loss or impairment of sensation in a dermatomal distribution below the level of the lesion. Immediately above the area of desensitization, what might be notable about the area's ability to feel? | A zone of hyperaesthesia (excessive physical sensitivity, especially of the skin) may be found immediately above the level of sensory loss. |
| What is hyperaesthesia? | Excessive physical sensitivity, especially of the skin |
| What is Brown-Séquard syndrome? | Ipsilateral to injury: motor weakness and loss of vibration and joint position sense Contralateral to injury: loss of pain sense and temperature |
| Define "proprioception". | Proprioception refers to the body's ability to perceive its own position in a space. |