11/13/13 Flashcards
Which part of the brain is responsible for the motor cortex & executive functions?
The frontal lobe
Which part of the brain is responsible for sensory data, tactile sensations, visual, gustatory, olfactory, auditory, & proprioception?
The parietal lobe
Where is the primary vision center of the brain?
The occipital lobe
Which part of the brain is primarily responsible for sounds & the integration of tastes, smell, & balance?
The temporal lobe
What part of the brain refines motor movements?
Basal ganglia
Which part of the brain integrates multiple inputs, esp voluntary movements, balance, posture, & precise movements?
Cerebellum
Which part of the brain is responsible for controlling involuntary functions? What does it contain?
Brainstem
12 cranial nerves
What is your cranial nerves mnemonic?
Oprah Ought Order Tasty Treats And Finally Value Growing Voluptuous And Happy
What is Cranial Nerve 1?
Olfactory
What is Cranial Nerve 2?
Optic
What is Cranial Nerve 3?
Oculomotor
What is Cranial Nerve 4?
Trochlear
What is Cranial Nerve 5?
Trigeminal
What is Cranial Nerve 6?
Abducens
What is Cranial Nerve 7?
Facial
What is Cranial Nerve 8?
Vestibulocochlear/ Acoustic
What is Cranial Nerve 9?
Glossopharyngeal
What is Cranial Nerve 10?
Vagus
What is Cranial Nerve 11?
Accessory (Spinal)
What is Cranial Nerve 12?
Hypoglossal
Where does the spinal cord begin & end?
Begins exiting the skull @ the foramen magnum & ends @ L1 or L2.
What does the butterfly shape of the spinal cord contain? What is it called?
Gray matter
contains cell bodies of autonomic & sensory neurons.
What does the white matter of the spinal cord contain?
Ascending & Descending Nerve Tracts
What are the 3 main tracts of the white matter in the spinal cord? Which are ascending & which are descending?
Dorsal Column: ascending
Spinothalamic Tracts: ascending
Corticospinal Tracts: descending
What are the 2 specific names of the dorsal column & what information do they transmit?
Fasiculis Gracilis (from the leg) Fasiculis Cuneatus (from the arm) **transmit touch, vibration, proprioception
What information does the spinothalamic tract transmit?
Pain & temperature
What information does the corticospinal tract transmit?
signals of skilled, delicate, & purposeful movements.
Where does the rubrospinal tract come from?
Red nucleus in the midbrain
What are some extra associated symptoms that you have to question w/ a headache?
aura (visual, auditory changes–sorta a hallucination); photophobia (intolerance to light); tearing of eyes; phonophobia
What are some extra questions you need to ask if someone has had a seizure?
aura
preceding event
loss of consciousness
fall
If a patient complains of disorientation or confusion…what are some extra questions you need to ask?
Hallucinations?
Trauma?
Fever?
Infection?
If somebody has a tremor…what are some possible differential diagnoses?
Hyperthyroidism
Alcohol Consumption
Multiple Sclerosis
Familial Tremor
With a neurologic exam…aside form CHADS…what are conditions you want to ask the patient if they have a history of?
Meningitis Encephalitis Aneurysm Neurologic Disorder Anxiety Depression
In the family Hx of a neurologic exam what are some hereditary disorders you want to ask about?
Neurofibromatosis
Huntington’s Disease
Muscular Dystrophy
Tay-Sachs Disease
Aside from CHADS & the possible hereditary disorders…what are some other diseases you want to ask about in the family Hx of a neurologic exam?
Alzheimer’s
Mental Retardation
Problems w/ Gait
Thyroid Disease
What are some environmental/occupational hazards that you want to check in on w/ a person in the social Hx of a neurological exam?
lead
arsenic
insecticides
organic solvents
What are 2 things you are thinking of in a neurological exam when you ask about sexual history?
The possibility of neurosyphilis
The possibility of HIV related dementia
What is one REALLY important thing to ask a patient about in social history of a neurological exam?
Their ability to support themselves at home…their support system.
What is the MMSE? What does it test for? What is one complicating factor w/ this test?
Folstein Mini Mental Status Exam
- *screening tool for dementia, looks @ orientation, registration, attention, calculation, language
- *could be obscured by level of education & language skills
What is the max number of points you can get on the MMSE? What does a score over 25 mean? 21-24? 10-20? Less than 9?
Out of 30. over 25 mean? Normal 21-24? Mild Cognitive Impairment 10-20? Moderate Cognitive Impairment Less than 9? Severe Cognitive Impairment
What is cranial nerve 1? How do you test it?
Olfactory
Close eyes. Occlude one nare.
Test familiar odors.
What is Cranial nerve 2? How do you test it?
Optic
Viscual Acuity Test
Pupils reactive to light
Confrontation of visual fields
What is the cranial nerve 3? how do you test it? When you test this one—which nerves do you also test?
Oculomotor
Movement thru 6 cardinal motions
pupil size, reactive, shape, accomodations
**also tests trochlear & abducens
What is cranial nerve 4? How do you test it?
Same test as for the oculomotor.
What is cranial nerve 5? What are the 4 divisions of how you test it?
Trigeminal: facial sensation Inspection Palpation Sensation Cornea Reflex
What do you inspect in the trigeminal nerve examination?
Look for atrophy, deviations, or fasciculations (muscle twitch) of the face
What do you inspect in the trigeminal nerve examination?
Look for atrophy, deviations, or fasciculations (muscle twitch) of the face
What do you palpate in the trigeminal nerve examination?
You palpate the muscles of the jaw when the pt has their teeth clenched. Look for fasciculations.
What do you palpate in the trigeminal nerve examination?
You palpate the muscles of the jaw when the pt has their teeth clenched. Look for fasciculations.
What are the 3 divisions of the sensation portion of the trigeminal nerve examination? What are the other portions of this exam?
V1: opthalmic V2: maxillary V3: mandibular **look for light, dull, & sharp sensation **patient has eyes closed. **test temp sensation
What are the 3 divisions of the sensation portion of the trigeminal nerve examination? What are the other portions of this exam?
V1: opthalmic V2: maxillary V3: mandibular **look for light, dull, & sharp sensation **patient has eyes closed. **test temp sensation
What is the corneal reflex portion of the trigeminal nerve examination?
When the patient looks up & away, you lightly touch the cornea w/ a cotton wisp…You should see the patient equally blink.
Contact wearers won’t blink.
What is the corneal reflex portion of the trigeminal nerve examination?
When the patient looks up & away, you lightly touch the cornea w/ a cotton wisp…You should see the patient equally blink.
Contact wearers won’t blink.
What is the first cranial nerve to go w/ an increase in intracranial pressure? How do you test for this?
Abducens
Same as for oculomotor.
superior oblique works w/ which cranial nerve?
4 trochlear
moves in
lateral rectis works w/ which cranial nerve?
6 abducens
moves out
What do you inspect for the 7th cranial nerve? What do you test?
Facial
Inspect: Facial Expressions, blowing cheeks out
Taste 4 solutions
How do you test cranial nerve 8?
Auditory Tests.
How do you test cranial nerve 9?
Glossopharyngeal
test posterior 1/3 of tongue
Gag reflex
How do you test cranial nerve 10?
Vagus Gag reflex--watch uvula movement Say ah & watch symmetry of soft palate Sip & swallow water--make sure it doesn't get up your nose Listen to patient speech.
How do you test cranial nerve 11? What 2 muscles does this test?
Accessory Spinal
Shrug
trapezius & sternocleidomastoid.
How do you test cranial nerve 12?
Hypoglossal
mess w/ the tongue
In the Rinne & Weber Test: if the tuning fork lateralizes to the good ear…what type of loss is this?
Sensorineural loss
If the Rinne & Weber Test: if the tuning fork materializes to the bad ear…what type of loss is this?
Conductive loss
What qualifies as primary sensory fcn?
superficial touch, pain, pressure, vibration
What qualified as cortical sensory fcn?
Stereognosis
2 point discrimination
Graphesthesia
Point location
What is stereognosis?
ability to identify an object by touching it w/ your hand.
Negative stereognosis is called what? What does this indicate?
Tactile Agnosia
indicates a parietal lobe lesion
What is graphethesia?
You draw on a pt w/ a cotton swab & ask them to identify what you drew.
What are the 3 superficial reflexes?
Abdominal Reflex
Cremasteric Reflex
Plantar Reflex
What is the cremasteric reflex?
stroke the inner thigh of the male & look for elevation of the scrotum.
What is a normal reaction to the plantar reflex? What is an abnormal reaction called?
Stroke bottom of the foot.
Normal: Flexion of toes
Abnormal: Flaring of toes; called the Babinski sign
At what age is the Babinski sign considered normal?
Considered normal up to 2 years of age.
What are the 5 places you look for deep tendon reflexes?
Brachioradialis Biceps Triceps Patellar Achilles
What is the grading of deep tendon reflexes?
Scale 0-4
0: no reflex
1: hyporeflex
2: Normal
3: hyperreflex
4: Clonus–>repetitive shortening after single stimulation.
What are the 3 categories of cerebellar function tests?
Rapid rhythmic alternation movements
accuracy of movements
Balance
What is the test for rapid rhythmic alternation movements?
switching hands from palm down to up while on your lap really fast. Do w/ both hands & w/ only one hand.
What are the 2 tests you can do w/ accuracy of movements?
Nose to doc’s finger touch.
Heel to shin test.
What are the 2 things that you are looking for w/ testing balance?
Equilibrium
Gait
What are 3 ways to test equilibrium?
Romberg Test: close eyes & don’t fall
Stand on one foot
Hop on one foot
What is spastic hemiparesis? Related to gait
Weakness on one side of the body
What is spastic diplegia? Related to gait
a form of Cerebral Palsy…tightness in the lower limbs
What is steppage gait?
foot drop due to loss of dorsiflexion…person has to raise their feet higher than normal when they walk.
What is cerebellar ataxia? Related to Gait.
A form of ataxia: lack of ability to control voluntary movements…that originates from problem in the cerebellum
What is sensory ataxia? Related to gait.
difficulty controlling voluntary movements b/c of a lack of sensory info
What is the Wernicke area? Broca’s Area?
Wernicke: interpretation of speech
Broca: voluntary speech
Does injury to upper motor neurons or lower motor neurons cause permanent paralysis?
lower motor neurons.
What is anosmia? What could cause this?
loss of sense of smell
trauma to cribriform plate or olfactory tract lesion
How many spinal nerves are there?
31
How long is the spinal cord?
40-50 cm long.
Which reflexes are present at birth?
patellar tendon reflexes
Which reflexes appear at 6 months of age?
Achilles
Brachioradial tendon reflexes
What is sustained clonus associated w/?
upper motor neuron disease
When does the major portion of brain growth occur?
the first year of life
