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.
2
Q
define anosagnosia
A
inability to recognize own neurological deficit.
3
Q
define apraxia
A
inability to perform learned actions despite intact motor functions
4
Q
define receptive aphasia
A
inability to understand. characteristic of Wernicke’s
5
Q
define expressive aphasia
A
inability to express via speech. characteristic of Broca’s
6
Q
define global aphasia
A
inability to comprehend, produce, repeat speech.
7
Q
define alexia
A
visual agnosia. inability to read.
8
Q
define agraphia
A
inability to write. Akin to expressive aphasia
9
Q
define disinhibition
A
frontal lobe lesion accompanied by inappropriateness, etc
10
Q
define dysnomia
A
anomia, difficulty naming items
11
Q
define paraphasia
A
well-articulated but incorrect words. includes neologisms, semantic paraphasia, phonemic paraphasia
12
Q
Language: bilateral or unilateral?
A
uni.
13
Q
attention to the non-dominant world: bilateral or unilateral?
A
uni
14
Q
somatic sensation: bilateral or unilateral?
A
uni
15
Q
vision: bilateral or unilateral?
A
uni
16
Q
voluntary motor function: bilateral or unilateral?
A
uni
17
Q
hearing: bilateral or unilateral?
A
bi (Heschel’s gyrus)
18
Q
short term memory: bilateral or unilateral?
A
bi (medial temopral lobe)
19
Q
frontal lobe functions (mood, behavior, emotional control, motivation, exec function): bilateral or unilateral?
A
bi
20
Q
long-term memory: bilateral or unilateral?
A
diffuse (both)
21
Q
visuospatial function: bilateral or unilateral?
A
bi. parietal lobe
22
Q
aphasia is lateralized where?
A
to the dominant hemisphere
23
Q
patients with Broca’s, Wernicke’s, global and conductive aphasias will be unable to do what?
A
repeat complex phrases
24
Q
Broca’s area infarction results in what?
A
very reduced speech, repetition and naming. intact aud and visual language comprehension (reading). frustration.
25
Wernicke's area infarction results in what?
output that is active but nonsensical, inability to comprehend language. inability to repeat and name things. not frustrated.
26
conduction aphasia is due to a lesion where?
arcuate fasciculus.
27
define conduction aphasia
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.
28
damage to the dominant occipital lobe and splenium of the corpus callosum yields what?
alexia without agraphia. can write but can't read what they're written
29
immediate recall occurs where?
frontal lobe
30
short term memory occurs where?
hippocampus
31
long term memory occurs where?
diffusely. only lost if large and diffuse areas are damaged
32
the non-dominant parietal lobe does what?
attention to the contralateral world
33
lesion of the non-dominant parietal lobe yields what?
hemi-inattention/neglect of the non-dominant world. impaired recognition of self, inability to learn that deficits exist in non-dominant motor/sensory functions.
34
what does the frontal lobe do?
exec functions like initiative, sequencing, planning, problem solving.
35
lesion to the frontal lobe yields what?
personality change, failure of executive function, difficulty with activities of daily living
36
orbitofrontal injury can lead to what/
disinhibition, aggression
37
what can a corpus callosum transection yield?
split brain: information not transferred from side to side, R hand not knowing what L hand is doing.
38
what does the neurological exam include?
mental status, cranial nerves, motor systems, reflexes, sensory systems, coordination, gait
39
when to do the mental status exam?
known brain lesion, suspected brain lesion, psychiatric disease, behavioral complaints
40
what is included in the mental status exam?
LOC, attention, concentration, cognitive functions, thought processes, thought content, affect
41
define dementia
a generalized deterioration of intellectual or cognitive function, particularly memory, without altered alertness or perception
42
define confusion
acute thinking disorder. expected to improve.
43
define delirium
acute thinking disorder plus altered consciousness, hyperactivity, irritability etc
44
define encephalopathy
Broadly, diffuse alteration in brain function generally including disordered thinking. Static.
45
define amnesia/retrograde/anterograde
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
define aphasia
language impairment
47
4 levels of consciousness?
awake
somnolent
stuporous
coma
48
how to test attention/concentration?
digit span, spell world/backwards
49
define aprosody
loss or impairment of the use and understanding of inflection
50
semantic paraphasia
substitute wrong word
51
phonemic paraphasia
substitute wrong sound
52
neologism
use of non-existent word
53
why is Broca's often seen with R hemipareisis?
lesion usually on L side because of L sided language dominance
54
what are 4 tests of language?
- 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
where is Broca's aphasia lesion?
inferior precentral gyrus
56
where is Wernicke's aphasia lesion?
upper posterior temporal
57
where is conduction aphasia lesion?
inferior parietal
58
where is global aphasia lesion?
large area in parietal and frontotemporal
59
where is music localized?
R hemisphere
60
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?
L posterior temporal
61
what are the parts of memory that we test?
episodic, short term/working
62
where does episodic memory reside?
medial temporal (bil), hippocampus, mammillary body
63
where does short term memory reside?
frontoparietal regions
64
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?
medial temporal (bil), hippocampus, mammillary body
65
acalculia results from a lesion where?
dominant parietal lobe
66
how to test calculation?
serial 7s, adding
67
prospagnosia
inability to recog faces
68
astereognosia
inability to recognize items by touch
69
visual agnosia
Inability to recognize objects despite normal vision.
70
visual agnosia: location?
Lesion is usually bilateral parieto-occipital cortex.
71
prospagnosia: location?
Lesions usually in bilateral occipital lobes.
72
simultagnosia
Can see objects but cannot sort them out from one another.
| Cannot see forest for trees
73
alexia: location?
Lesion in L temp-parieto-occipital region
74
Alexia: be sure to rule out what?
```
Visual impairment
Diplopia
Field defect - L
Simultanagnosia
Illiteracy
```
75
Agraphesthesia
inability to recognize numbers traced on hand
76
auditory agnosia
inability to recognize and identify specific sounds despite normal hearing
77
auditory agnosia: location?
Lesion usually in non-dominant temporal lobe. non-dom because that's the side we process music on.
78
anosognosia: location
non-dominant parietal lobe
79
neglect: location
Lesion usually contralateral parietal lobe, esp R
Ventral thalamic lesions can produce neglect too
Visual neglect - parieto-occip lesions
80
Neglect syndrome testing?
cross all the lines in half, circle all the As: pt will only do task in right side of visual field
81
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?
R parietal
82
agraphia: location?
dominant posterior frontal cortex
83
Gerstmann's Syndrome: symptoms?
agraphia
finger agnosia
L/R disorientation
acalculia
84
Gerstmann's Syndrome: location?
dominant angular gyrus, corpus callosum
85
constructional apraxia: definition
inability to copy or construct figures. disturbance in visuo-spatial abilities rather than pure apraxia
86
constructional apraxia: lesion?
non-dominant parietal cortex
87
tests of constructional ability?
clock drawing, overlapping pentagons, cube
88
```
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
```
all of these
89
ideomotor apraxia
inability to perform a specific task when asked. ie, unable to show how to use a comb, use a key
90
ideomotor apraxia: location
usually non-localizable, but can be due to disconnection (callosal lesion preventing opp side from receiving command from Wernicke's)
91
gait apraxia: location
bil frontal lobes
92
gait: wide based, unable to tandem
ataxia
93
gait: stooped, smalls steps, turns en bloc
Parkinsonian
94
gait: high knee-lift, foot slapping
foot drop
95
gait: stiff, short steps, scissoring
spastic paresis
96
gait: slow and unsteady, magnetic
apractic
97
social inappropriateness, disinhibition, euphoria, abnl sexual beh: where is lesion?
orbitofrontal
98
apathy, akinesis, abulia: where is lesion?
medial frontal
99
irritability, inflexibility, reduced sex interest, loss of exec function: where is lesion?
dorsolateral
100
frontal lobe testing: observe what, and ask what?
```
observe for perseveration, slowness/abulia, apathy
judgment: pose a scenario
proverbs: ask to interpret
planning: how would you...
working memory
```
101
types of perceptual disturbances?
illusions - misinterpretation
hallucinations - sensory
depersonalization
derealization
