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M2 Neurology > 2. Cognitive Exam > Flashcards

2. Cognitive Exam Flashcards

1
Q

Define agnosia

A

inability to perceive/understand the import of sensory stimuli despite intact sensory mechanisms. perception devoid of meaning.

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2
Q

define anosagnosia

A

inability to recognize own neurological deficit.

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3
Q

define apraxia

A

inability to perform learned actions despite intact motor functions

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4
Q

define receptive aphasia

A

inability to understand. characteristic of Wernicke’s

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5
Q

define expressive aphasia

A

inability to express via speech. characteristic of Broca’s

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6
Q

define global aphasia

A

inability to comprehend, produce, repeat speech.

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7
Q

define alexia

A

visual agnosia. inability to read.

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8
Q

define agraphia

A

inability to write. Akin to expressive aphasia

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9
Q

define disinhibition

A

frontal lobe lesion accompanied by inappropriateness, etc

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10
Q

define dysnomia

A

anomia, difficulty naming items

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11
Q

define paraphasia

A

well-articulated but incorrect words. includes neologisms, semantic paraphasia, phonemic paraphasia

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12
Q

Language: bilateral or unilateral?

A

uni.

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13
Q

attention to the non-dominant world: bilateral or unilateral?

A

uni

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14
Q

somatic sensation: bilateral or unilateral?

A

uni

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15
Q

vision: bilateral or unilateral?

A

uni

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16
Q

voluntary motor function: bilateral or unilateral?

A

uni

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17
Q

hearing: bilateral or unilateral?

A

bi (Heschel’s gyrus)

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18
Q

short term memory: bilateral or unilateral?

A

bi (medial temopral lobe)

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19
Q

frontal lobe functions (mood, behavior, emotional control, motivation, exec function): bilateral or unilateral?

A

bi

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20
Q

long-term memory: bilateral or unilateral?

A

diffuse (both)

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21
Q

visuospatial function: bilateral or unilateral?

A

bi. parietal lobe

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22
Q

aphasia is lateralized where?

A

to the dominant hemisphere

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23
Q

patients with Broca’s, Wernicke’s, global and conductive aphasias will be unable to do what?

A

repeat complex phrases

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24
Q

Broca’s area infarction results in what?

A

very reduced speech, repetition and naming. intact aud and visual language comprehension (reading). frustration.

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25
Q

Wernicke’s area infarction results in what?

A

output that is active but nonsensical, inability to comprehend language. inability to repeat and name things. not frustrated.

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26
Q

conduction aphasia is due to a lesion where?

A

arcuate fasciculus.

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27
Q

define conduction aphasia

A

reasonably normal expression and comprehension, but impaired repetition of simple and complex phrases.
Inability to repeat due to interruption of the arcuate fasciculus. Fluent, but with paraphasias. Comprehension may be OK.

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28
Q

damage to the dominant occipital lobe and splenium of the corpus callosum yields what?

A

alexia without agraphia. can write but can’t read what they’re written

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29
Q

immediate recall occurs where?

A

frontal lobe

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30
Q

short term memory occurs where?

A

hippocampus

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31
Q

long term memory occurs where?

A

diffusely. only lost if large and diffuse areas are damaged

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32
Q

the non-dominant parietal lobe does what?

A

attention to the contralateral world

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33
Q

lesion of the non-dominant parietal lobe yields what?

A

hemi-inattention/neglect of the non-dominant world. impaired recognition of self, inability to learn that deficits exist in non-dominant motor/sensory functions.

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34
Q

what does the frontal lobe do?

A

exec functions like initiative, sequencing, planning, problem solving.

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35
Q

lesion to the frontal lobe yields what?

A

personality change, failure of executive function, difficulty with activities of daily living

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36
Q

orbitofrontal injury can lead to what/

A

disinhibition, aggression

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37
Q

what can a corpus callosum transection yield?

A

split brain: information not transferred from side to side, R hand not knowing what L hand is doing.

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38
Q

what does the neurological exam include?

A

mental status, cranial nerves, motor systems, reflexes, sensory systems, coordination, gait

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39
Q

when to do the mental status exam?

A

known brain lesion, suspected brain lesion, psychiatric disease, behavioral complaints

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40
Q

what is included in the mental status exam?

A

LOC, attention, concentration, cognitive functions, thought processes, thought content, affect

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41
Q

define dementia

A

a generalized deterioration of intellectual or cognitive function, particularly memory, without altered alertness or perception

42
Q

define confusion

A

acute thinking disorder. expected to improve.

43
Q

define delirium

A

acute thinking disorder plus altered consciousness, hyperactivity, irritability etc

44
Q

define encephalopathy

A

Broadly, diffuse alteration in brain function generally including disordered thinking. Static.

45
Q

define amnesia/retrograde/anterograde

A

pure loss of memory without other cognitive loss
Retrograde amnesia – loss of memory prior to a specific time
Anterograde amnesia – loss of memory after a specific time

46
Q

define aphasia

A

language impairment

47
Q

4 levels of consciousness?

A

awake
somnolent
stuporous
coma

48
Q

how to test attention/concentration?

A

digit span, spell world/backwards

49
Q

define aprosody

A

loss or impairment of the use and understanding of inflection

50
Q

semantic paraphasia

A

substitute wrong word

51
Q

phonemic paraphasia

A

substitute wrong sound

52
Q

neologism

A

use of non-existent word

53
Q

why is Broca’s often seen with R hemipareisis?

A

lesion usually on L side because of L sided language dominance

54
Q

what are 4 tests of language?

A
  • pace of speech (should be 12-50 words per minute)
  • naming items and parts of items
  • comprehension (paper, fold, put on floor)
  • repetition of phrases
  • reading
  • writing
55
Q

where is Broca’s aphasia lesion?

A

inferior precentral gyrus

56
Q

where is Wernicke’s aphasia lesion?

A

upper posterior temporal

57
Q

where is conduction aphasia lesion?

A

inferior parietal

58
Q

where is global aphasia lesion?

A

large area in parietal and frontotemporal

59
Q

where is music localized?

A

R hemisphere

60
Q

72 year old left-handed man was noted by his wife to be confused this morning. On exam he has some difficulty naming items as well as trouble following complex commands. He is noted to have atrial fibrillation on ECG. He is otherwise intact. Where might you expect a lesion?

A

L posterior temporal

61
Q

what are the parts of memory that we test?

A

episodic, short term/working

62
Q

where does episodic memory reside?

A

medial temporal (bil), hippocampus, mammillary body

63
Q

where does short term memory reside?

A

frontoparietal regions

64
Q

62 year old man was seen in the ED because of “altered mental status”. On exam he has some difficulty remembering events, and in fact seemed to make up some details to mask this problem. He was not well-oriented. Language was good. Where might you expect a lesion?

A

medial temporal (bil), hippocampus, mammillary body

65
Q

acalculia results from a lesion where?

A

dominant parietal lobe

66
Q

how to test calculation?

A

serial 7s, adding

67
Q

prospagnosia

A

inability to recog faces

68
Q

astereognosia

A

inability to recognize items by touch

69
Q

visual agnosia

A

Inability to recognize objects despite normal vision.

70
Q

visual agnosia: location?

A

Lesion is usually bilateral parieto-occipital cortex.

71
Q

prospagnosia: location?

A

Lesions usually in bilateral occipital lobes.

72
Q

simultagnosia

A

Can see objects but cannot sort them out from one another.

Cannot see forest for trees

73
Q

alexia: location?

A

Lesion in L temp-parieto-occipital region

74
Q

Alexia: be sure to rule out what?

A 
Visual impairment
Diplopia
Field defect - L
Simultanagnosia
Illiteracy
75
Q

Agraphesthesia

A

inability to recognize numbers traced on hand

76
Q

auditory agnosia

A

inability to recognize and identify specific sounds despite normal hearing

77
Q

auditory agnosia: location?

A

Lesion usually in non-dominant temporal lobe. non-dom because that’s the side we process music on.

78
Q

anosognosia: location

A

non-dominant parietal lobe

79
Q

neglect: location

A

Lesion usually contralateral parietal lobe, esp R
Ventral thalamic lesions can produce neglect too
Visual neglect - parieto-occip lesions

80
Q

Neglect syndrome testing?

A

cross all the lines in half, circle all the As: pt will only do task in right side of visual field

81
Q

83 year old woman is brought to the ER from for retirement home because of confusion
On exam she is awake and neurologically intact but she seems to ignore you and does not move her left side unless coaxed. MRI reveals a stroke.
Where?

A

R parietal

82
Q

agraphia: location?

A

dominant posterior frontal cortex

83
Q

Gerstmann’s Syndrome: symptoms?

A

agraphia
finger agnosia
L/R disorientation
acalculia

84
Q

Gerstmann’s Syndrome: location?

A

dominant angular gyrus, corpus callosum

85
Q

constructional apraxia: definition

A

inability to copy or construct figures. disturbance in visuo-spatial abilities rather than pure apraxia

86
Q

constructional apraxia: lesion?

A

non-dominant parietal cortex

87
Q

tests of constructional ability?

A

clock drawing, overlapping pentagons, cube

88
Q 
A 57 year old man with Parkinson’s disease has a great deal of trouble performing simple actions like combing his hair.  
What is a likely cause of this?
-Bradykinesia (slowness of movement)
-Dementia
-Procedural memory deficit
-Apraxia
-Depression
A

all of these

89
Q

ideomotor apraxia

A

inability to perform a specific task when asked. ie, unable to show how to use a comb, use a key

90
Q

ideomotor apraxia: location

A

usually non-localizable, but can be due to disconnection (callosal lesion preventing opp side from receiving command from Wernicke’s)

91
Q

gait apraxia: location

A

bil frontal lobes

92
Q

gait: wide based, unable to tandem

A

ataxia

93
Q

gait: stooped, smalls steps, turns en bloc

A

Parkinsonian

94
Q

gait: high knee-lift, foot slapping

A

foot drop

95
Q

gait: stiff, short steps, scissoring

A

spastic paresis

96
Q

gait: slow and unsteady, magnetic

A

apractic

97
Q

social inappropriateness, disinhibition, euphoria, abnl sexual beh: where is lesion?

A

orbitofrontal

98
Q

apathy, akinesis, abulia: where is lesion?

A

medial frontal

99
Q

irritability, inflexibility, reduced sex interest, loss of exec function: where is lesion?

A

dorsolateral

100
Q

frontal lobe testing: observe what, and ask what?

A 
observe for perseveration, slowness/abulia, apathy
judgment: pose a scenario
proverbs: ask to interpret
planning: how would you...
working memory
101
Q

types of perceptual disturbances?

A

illusions - misinterpretation
hallucinations - sensory
depersonalization
derealization

M2 Neurology (20 decks)

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