Part 4 Boards - Neuro DX

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  1. What are you looking for with the 6 Cardinal Fields Of Gaze?
    • "I'm looking for symmetrical movements & no nystagmus."
    • *Lesion of IV (Sup Obl.): cannot go down & in.
    • *Lesion of VI (Lat Rect.): cannot go laterally. 
    • *Make sure you are at the same eye level as the pt. 
    • *Pause for 1-2 seconds at each end range. 
  2. Testing the muscles of mastication is associated with which CN?
    • V (Trigeminal): Temporalis, Int Ptyergoid, Masseter, Ext Ptyergoid.
    • *Not tested: Jaw Jerk Reflex. 
  3. What are the 3 locations for sensory testing of CN V?
    • 1. Forehead. 
    • 2. Cheekbones.
    • 3. Chin. 
    • "Say yes when you can feel me touch your face."
    • *Use cotton wisp, stay midline & do 6 points.
    • *Not tested: Corneal reflex, oculocardiac reflex, general sensation to the ant 2/3 tongue.  
  4. _________: extreme, sporadic, sudden burning/shock-like face pain that lasts anywhere from a few seconds to 2 min/episode, is associated with which CN?
    • Tic Douloureaux: Trigeminal Neuralgia = extreme, sporadic, sudden burning/shock-like face pain that lasts anywhere from a few seconds to 2 min/episode.
    • *Typically felt on the L side of the face. 
    • *Made worse by moving the TMJ. 
    • *Refer/co-treat w/ neurologist. 
  5. The muscles of facial expression are associated with which CN?
    • VII Facial: show your patieint what you want them to do (raise your eyebrows, close your eyes, puff out your cheeks, etc). 
    • *Also taste to the ant. 2/3 of tongue. 
  6. Bell's Palsy is associated with which CN?
    • CN VII = Bell's Palsy: complete unilateral paralysis. 
    • *D/T trauma, virus or BC pills.
    • *They give a pt HX of female 20-35 YO. 
    • *Ipsilateral ear, twitching, weakness/paralysis, drooping/eyelid, drooping of the corner of the mouth, drooling, dry eyes, decreased taste. 
    • *CN VII shuts the eye = NO corneal reflex. 
    • *Bell's Palsy is an inflammation problem = self-resolving. 
  7. LMNL's affect ______ of the face.
    • LMNL's affect ALL of the face. 
    • *Bell's Palsy = LMNL of CN 7.
    • *Forehead does not wrinkle. 
  8. _________: vertigo, hearing loss, tinnitius & fullness in the ear.
    Meiniere's DX / Endolypmhatic Hydrops / Central Vertigo.
  9. Which CN is associated with shoulder shrugging & head rotation?
    • XI Spinal Accessory.
    • *Traps: shoulder shrug. 
    • *SCM: LF & rotation. 
    • *Torticollis (Wry Neck): spasm of the SCM.
    • *TX: transfriction massage, spray & stretch. 
  10. How do you test CN XII?
    • Have the pt stick out their tongue. 
    • *Deviates to side of lesion. 
  11. Know UMNL vs LMNL.
    • UMNL: MS, CVA, brain tumor, Parkinson's.
    • LMNL: Subluxation, Myasthenia Gravis, NRC, disc protrusion, Polio, Bell's Palsy, ALS.
    • *DX subluxation by ruling out everything else.  
    • *Pt is acting & will fake babinski response. 
  12. Pt HX for a CVA?
    Female on BCP's, @ air show looking up or @ hair dresser before SX started.
  13. MG SX's are ______ in the morning.
    • MG SX's are better in the morning (worse at night). 
    • *Bilateral ptosis. 
  14. Describe a (+) Babinski's...
    • Dorsiflexion of the great toe w/ splaying of the other toes. 
    • *If pt jerks foot away = plantar reflex. 
  15. Reflexes:
    • Test ALL reflexes bilaterally, w/ normal side first.
    • *If you do not get a response pretend like you did & move on! 
    • *Normal: 2+. 
  16. What is the pt positioning for the Knee Jerk reflex?
    • Pt seated, with your fist under their leg to support it from touching the table. 
    • *C5: Biceps.
    • *C6: Brachioradialis. 
    • *C7: Triceps.
    • *L4: Patellar (Knee jerk).
    • *L5: Medial hamstring... do prone, bend knee to 30 degrees. 
    • *S1: Achille's (Ankle jerk). 
  17. How many mm's do you test for NR evlauations?
    • Just one!!
    • C5: Arm abduction. 
    • C6: Wrist extension. 
    • C7: Wrist flexion.
    • C8: Make an 8. 
    • T1: Finger fun. 
    • L4: Up & in (dorsiflexion & inversion). 
    • L5: Big toe extension. 
    • S1: Down & out (plantar flexion & eversion). 
    • *Do L4-S1 mm tests w/ pt supine. 
  18. What 2 ways do you test dermatomes for boards?
    • 1. Using a cotton ball; touch the dermatomes you are testing, asking the pt "does this feel like this?"
    • 2. Using the cotton swab & tooth pick; alternate sharp dull sharp dull 3 x's per dermatome. 
    • *No sharp/dull for T1-12 dermatomes. 
    • *Call out what you are doing "I'm testing the C5 dermatome... Does this feel like this?
    • *Do cotton swab first. 
  19. Which 2 dermatomes are different for boards?
    • 1. No big toe... just med aspect of the leg. 
    • 2. No post calf... just lat aspect of the foot & little toe.
    • *Do bilaterally!
    • *Anesthesia, hypoesthesia & hyperesthesia. 
  20. Verbal instructions for the pt w/ graphesthesia...
    • "I am drawing a capital letter in your hand, so LMK what you feel."
    • *Draw an A or a C. 
  21. What is sterognosis?
    Put a familiar object in the pt's hand & ask them to identify it.
  22. A (+) graphesthesia or sterognosis indicates a problem with...
    "Inability to do this means a lesion of the dorsal columns."
  23. Which 2 conditions are associated with a Median N lesion? Which fingers are affected?
    • 1. CTS: lat 3 fingers. 
    • 2. Pronator Teres Syndrome: lat 3 fingers.
  24. The use of a cock up splint is helpful for which condition?
  25. Which 2 locations are associated with Ulnar N compression? Which fingers are affected?
    • 1. Tunnel of Guyon (Pisi/Hook of Hamate): medial 2 digits. 
    • 2. Cubital Tunnel: medial 2 digits.
    • *Claw hand deformity D/T hypothenar atrophy... "I'm going to CLAW yoU!" 
  26. What condition of the hand is associated with a Radial N entrapment?
    • Wrist drop: inability to extend the elbow & wrist. 
    • *Decreased triceps reflex & sensation to the post arm. 
  27. Where does the pain present in a sciatic pt?
    • The post. butt, thigh & leg down to the floor.
    • *Weak knee flexion & decreased achille's reflex. 
    • *Allowed to adjust this pt! 
  28. TTS needs to be DDXed from which DX?
    • Diabetes. 
    • *TTS = med plantar N entrapment behind the med malleolus = burning @ the bottom of the foot. 
  29. Where is the MC location for weakness associated w/ Syringomyelia?
    • C5/6. 
    • *Loss of sensation of pain & temp over the shoulders in a cape-like distribution. 
    • *Pt is a nurse, cleft palate repair when younger. 
  30. __________: diploplia, scotomas, transient blindness, optic neuritis, pain, vertigo & UMNL in the legs ([+] Babinski) causing dital weakness.
    • MS. 
    • *Heat exacerbates SX... remissions. 
    • *(+) Lhermitte's... "Where do you feel the pain?"
    • *It's a SIN to have MS
    • *Charcot's Triad: Scanning speech, Intention tremors, Nystagmus. 
    • *DX via MRI, or CSF tap.
  31. You walk into the room & notice that the pt is blinking excessively... what is your initial impression?
    • MG.
    • "I noticed that you're blinking a lot. Anything going on with that?"
    • *Affects the motor CN's first, then the prox mm's. 
    • *Early signs = ptosis, diplopia, dysarthria, weakness @ the end of the day & fatigue after exercise. 
    • *Females 20-40 YO. 
    • *DX via ACHr, TX w/ cholinesterase inhibiting drugs. 
    • *Eyes weak @ the end of the day = refer to neurologist. 
  32. Where does ALS usually begin?
    • The hands or feet.
    • *Males >40 YO. 
    • *Short life expectancy. 
    • *Fasiculations, spasticity & increased DTR's. 
    • *LMNL's in the arms, UMNL's in the legs.
    • *DDX lat canal stenosis. 
  33. A/K/A for Extrapyramidal Tract Disorder?
    • Parkinson's DX (Paralysis Agitans). 
    • *Female pt whispering, w/ finger rolling tremor & weakness. 
    • *Resting tremors, mask like face, festinating (propulsive/shuffle) gait, cogwheel/lead pipe rigidity, forward stooped posture, bradykinesia.
    • *D/T loss of dopamine in the substantia nigra. 
    • "I see that your fingers are moving, can you tell me more about this?" 
  34. What does a pt w/ Guillain- Barre Syndrome present with?
    • Weakness... send to ER!
    • *Demyelnating polyneuropathy of the PNS D/T immunizations or recent illness.
    • *Ascending paralysis & sensory SX. 
  35. What is the classic gait presentation for a pt with Paralysis Agitans?
    • Propulsion/Festinating/Shuffling. 
    • *Steppage = ACS, L4 lesion or TA problems.
    • *Circumduction = stroke.
    • *Wide based (drunken) = cerebellum. 
  36. What are the 3 a/k/a's for the common migraine?
    • 1. Sick
    • 2. Vascular
    • 3. Hormonal
    • *Photophobia, throbbing, worse behind one eye, nausea/vomiting, bright lights, red wine, menstural cycle, hypoglycemia.
    • *Adjust, dietary log, massage, avoid triggers. 
  37. What type of HA presents with a prodrome?
    Classic migraine = aura (prodrome).
  38. Which type of headache is gone by noon?
  39. 2 A/K/A's for Cluster headache?
    • 1. Autonomic Nervous System Distrubance.
    • 2. Vasomotor headache. 
    • *HA lasting 15 min - hours w/ rhinorrhea, unilateral facial sweating, red eye, miosis. 
    • *R/O intracranial pathology.
    • *Do CN CT scan & exam.
    • *Allergy testing.
  40. Which type of HA has a band-like presentation?
  41. 2 A/K/A's for Polymyalgia Rheumatica?
    • 1. Temporal Arteritis.
    • 2. Giant Cell Tumor. 
    • *Over 50 years old.
    • *Unilateral, temporal. 
    • *Pain w/ combing hair. 
    • *DX via ^ ESR and biopsy. 
  42. A/K/A for Vertebrogenic headache?
    • Cervicogenic. 
    • *Occipital/upper cervical region. 
    • *May occur daily.
    • *Pt has decreased ROM & pain in neck. 
    • *F/E views to R/O congenital anomaly. 
  43. Which brian bleed has an abrupt onset?
    • Subarachnoid hemorrhage. 
    • *Basilar area. 
    • *Stiff neck, excruciating pain like never before. 
    • *ER!!
  44. Which brain bleed has SX & SX's weeks post injury?
    • Subdural hematoma. 
    • *ER!!
  45. Meningial irritation is worse in which position?
    • Flexion.
    • *(+) Kernig & Brudzinski Tests.
    • *CSF tap: decreased sugar = bacterial, increased protein = viral. 
  46. Who do you refer to with hypoglycemic headaches?
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Part 4 Boards - Neuro DX
2013-11-04 00:32:48

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