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Neuro > Approach to the Neuro Pt - Exam 3 > Flashcards

Approach to the Neuro Pt - Exam 3 Flashcards

1
Q

The name of the game in neuro is _____. Even subtle _____ requires action

A

change

change

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2
Q

What are the 2 categories of the nervous system?

A

Central Nervous System (CNS): brain and spinal cord

Peripheral Nervous System (PNS): autonomic and somatic nervous system

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3
Q

______ comprises the majority of the brain. What are the 4 lobes of the brain?

A

cerebrum

frontal
parietal
occipital
temporal

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4
Q

_____ hemispheres which control activities on the _____ side of body from that hemisphere

A

Two

opposite

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5
Q

What are each of the lobes of the brain responsible for?

A

Frontal - consciousness

Parietal - movement and stimulation perception

Occipital - vision

Temporal - speech recognition

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6
Q

Personality, behavior, emotions
Judgment, planning, problem solving
Speech: speaking and writing (Broca’s area)

A

frontal lobe

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7
Q

Where is Broca’s area located?

A

frontal lobe

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8
Q

Short term memory
Body movement (motor strip)
Intelligence, concentration, self awareness

A

frontal lobe

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9
Q

Interprets language, words
Sense of touch, pain, temperature (sensory strip)

A

parietal lobe

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10
Q

Interprets signals from vision, hearing, motor, sensory and memory
Spatial and visual perception

A

parietal lobe

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11
Q

interprets other sensations like what we are seeing and hearing
walking down stairs
the part of the brain that is responsible for why kids lack depth perception

A

parietal lobe

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12
Q

Understanding language (Wernicke’s area) aka make words make sense
Memory (short and long term)
Hearing aka ability to hear sound

A

temporal lobe

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13
Q

Sequencing and organization aka ordering of events
Processing affect/emotions

A

temporal lobe

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14
Q

Interprets vision (color, light, movement)

A

occipital lobe

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15
Q

What two parts make up the diencephalon?

A

thalamus and hypothalamus

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16
Q

what part of the diencephalon relays motor and sensory signals between the CNS and the PNS?

A

thalamus

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17
Q

what part of the diencephalon helps to regulate sleep, alertness and wakefulness?

A

thalamus

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18
Q

what part of the diencephalon releases hormones associated with the endocrine and sexual system?

A

hypothalamus

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19
Q

what part of the diencephalon controls hunger and body temperature?

A

hypothalamus

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20
Q

What part of the brain is responsible for muscle coordination and equilibrium?

A

cerebellum

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21
Q

What part of the brain stem is responsible for vision, hearing, motor control, sleep/wake, arousal and temperature regulation?

A

midbrain

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22
Q

What part of the brainstem transmits signals to and from cerebrum, cerebellum and spinal cord?

A

Pons

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23
Q

What part of the brainstem is responsible for breathing, heartbeat and vomiting?

A

Medulla Oblongata

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24
Q

What are 3 parts to the brainstem?

A

midbrain, pons, medulla oblongata

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25
Q

What are the 2 types of matter? What is the difference between the 2?

A

white matter and grey matter

White: has myelin sheath protection cover so appear white due to fat

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26
Q

What is the role of the white matter?

A

Contains nerve fibers (axons) that carry information to and from the Grey Matter

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27
Q

What is the role of grey matter?

A

Contains the cell bodies of the nerves and works to receive and store impulses

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28
Q

How many segments does the spinal cord have? each segment has _____ and _____ nerves. What is the end of the spinal cord called?

A

31 segments

Each segment has both motor and sensory nerves

cauda equina: “tale” of nerves

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29
Q

What are the 3 layers of membranes that cover the brain and spinal cord? Where are blood vessels found?

A

Dura Mater - Outermost layer
Arachnoid - Middle layer
Pia Mater - Innermost layer

blood vessels are found in the pia mater

(said between arachnoid and pia mater during lecture)

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30
Q

Where is CSF made? What is the function?

A

choroid plexus, the inner lining of the ventricles

Protects and nourishes the brain/spinal cord

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31
Q

How many ventricles does the brain have? What two ventricles does the cerebral aqueduct connect?

A

4 ventricles: 2 lateral, 3rd and 4th

cerebral aqueduct connects the 3rd and 4th ventricle

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32
Q

What are the 2 components of the peripheral nervous system?

A

autonomic and somatic

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33
Q

the autonomic nerve system is responsible for innervating the ?????

A

the smooth involuntary muscles of the (internal organs) and glands

think: HR, BP, RR, temp, digestion, metabolism etc etc

aka things we do not control

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34
Q

What are the 2 components of the autonomic nervous system?

A

sympathetic or parasympathetic

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35
Q

What are the 2 different types of somatic nerve fibers? what are the responsibilities of each?

A

sensory and motor

Sensory nerve fibers that transmit sensory information from the peripheral or distant structures to the central nervous system

Motor nerve fibers transmit impulses for movement from the brain to the skeletal muscles

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36
Q

Where do UPPER motor neurons originate? What do they do?

A

motor region of the cerebral cortex or in the brain stem

carry information down to the lower motor neurons

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37
Q

What does a UPPER motor neuron impulse stimulate?

A

stimulation of LMN - muscle “contraction”

inhibition of LMN - muscle “relaxation”

results in both an excitatory and inhibitory response

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38
Q

**What will an UPPER motor neuron lesions present like?

A

a block in the inhibitory motor pathway leading to SPASTICITY

contraction will always dominate so spasticity will occur

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39
Q

Where does the LOWER motor neurons orginiate? Where does their signals go?

A

anterior grey column, anterior nerve roots or cranial nerves of the brainstem

signals go to the skeletal muscles

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40
Q

UMN sends signal to ______, which receive the stimulation and transmit it to the ______ leading to ________

A

LOWER motor neurons

muscle cells

contraction of muscle

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41
Q

watch the khan academy video about motor neurons. link is in the answer

A

https://www.youtube.com/watch?v=LwA00uqniiU

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42
Q

How will an upper motor neuron lesions present? What are 2 causes?

A

weakness paralysis with increased muscle tone, increased reflex strength and + babinski sign. Muscle mass will be maintained

stroke or cord section

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43
Q

How will a lower motor neuron lesion present?

A

as weakness paralysis with decreased/absent muscle tone, decrease/absent reflex strength with rapid muscle wasting

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44
Q

What is important to remember about the neuro assessement? What are the 5 different aspects of the neurological exam?

A

exam needs to be symmetric!! done in a distal to proximal fashion

change is important!

mental status
cranial nerves
motor
reflexes
sensory

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45
Q

What is the first thing you should assess about the pt? What are the 5 categories?

A

their level of consciousness

alert
lethargy
obtundation
stupor
coma

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46
Q

LOC: _______ awakens to verbal or light physical stimulation, slowly follows commands.

A

lethargy

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47
Q

LOC: _______ difficult to arouse and needs constant stimulation in order to follow simple commands

A

obtundation

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48
Q

LOC: ______ arouses to vigorous and continuous stimulation, typically, a painful stimulus is required. May moan, but does not follow commands. May withdraw from painful stimuli

A

stupor

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49
Q

LOC: ______ No response to continuous or painful stimulation. No movement - except, possible, reflexively. No verbal sound

A

coma

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50
Q

_____ is assessing the execution of learned motor movement - in the absence of motor or spatial deficits

A

praxis

mimic using scissors, brushing hair/teeth

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51
Q

How would you assess executive functioning as part of the mental status exam?

A

ask the pt what they would do if their oven catches on fire

assessing insight and judgement

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52
Q

**What are all the cranial nerves 1-12 names and functions?

A
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53
Q

CN: shoulder movement, head rotation

A

XI: Spinal accessory

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54
Q

CN: tongue movement, speech

A

XII: Hypoglossal

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55
Q

CN: smell

A

I: Olfactory

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56
Q

CN: Gaggings, swallowing, speech phonation

A

X: Vagus

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57
Q

CN: Swallowing, taste of posterior 1/3 of tongue

A

IX: Glossopharyngeal

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58
Q

CN: visual acuity and visual fields

A

II: Optic

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59
Q

CN: Hearing, equilibrium

A

VIII: Acoustic

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60
Q

CN: eyelid elevation, pupil reactivity, EOM: up, down, peripheral

A

III: Oculomotor

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61
Q

CN: facial expression- motor control of the facial muscles

A

VII: Facial

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62
Q

CN: EOM- Turns eyes laterally outward

A

VI: Abducens

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63
Q

CN: Chewing/biting, facial/mouth sensation, corneal reflex

A

V: Trigeminal

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64
Q

CN: EOM: centrally downward movement-> towards the nose

A

IV: Trochlear

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65
Q

How do you evaluate CN II?

A

optic: Visual fields by confrontation
Visual acuity with Snellen chart
Fundoscopic exam

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66
Q

How do you evaluate CN III?

A

Oculomotor:

Extraocular movements
Pupillary reaction to light

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67
Q

How do you evaluate CN IV and VI?

A

Trochlear- IV and Abducens - VI

Extraocular movements

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68
Q

How do you evaluate CN V?

A

trigeminal:

sharp vs dull along all 3 branches

muscles of mastication

corneal reflex with a cotton wisp

69
Q

How do you evaluate CN VII?

A

facial

facial muscle movements

raise both eyebrows
frown
close both eyes tight- against resistance
show teeth
smile
puff out cheeks- against resistance

70
Q

How do you assess CN VIII?

A

Vestibulocochlear/auditory

assess hearing:
Whisper
Webber
Renne

71
Q

How do you assess CN IX and X?

A

Glossopharyngeal / Vagus

palatal movement: say “ahhh”
gag reflex
articulation errors in speech

72
Q

How do you asses CN XI?

A

Spinal Accessory

Shrug shoulders against resistance
Turn head against resistance

73
Q

How do you assess CN XII?

A

hypoglossal

tongue movement: stick out tongue and move side to side

74
Q

When assessing pupils what 4 things do you need to note?

A

size
shape
reactivity to light
comparison of one pupil to the other

75
Q

What is the normal pupil size? What is the name for unequal pupils without pathology?

A

pupils should be the same size between 2-6mm

physiologic anisocoria: up to 20% of people have normal unequal pupils

76
Q

When are pinpoint pupils commonly seen?

A

seen with opiate overdose and pontine hemorrhage

77
Q

When is mid position and nonreactive pupil commonly seen?

A

cause is midbrain damage

78
Q

What type of pupils are always abnormal? When are they seen?

A

dilated

bilateral, fixed and dilated pupils are seen in the terminal stage of severe anoxia-ischemia or at death or anticholingergic drugs can dilate pupils

79
Q

What type of pupil is this? What does it represent? What are the causes?

A

ovoid pupil

usually represents the intermediate phase between normal and fully dilated-fixed pupil

acute neurologic injury, complication of cataract surgery

80
Q

Name? What does it represent? What are the causes?

A

keyhole

reacts sluggish to light

coloboma, iridectomy with cataract surgery

81
Q

What is an coloboma?

A

a genetic defect resulting in missing part of the eye

82
Q

Name? What causes it?

A

irregular

traumatic orbital injury

83
Q

What does a sluggish or nonreactive or fixed pupil make you think?

A

some sort of condition or compression of the 3rd cranial nerve

84
Q

What is hippus phenomenon? What condition?

A

Alternating dilation and contraction of the pupil

Often associated with early signs of brain herniation or seizure activity

85
Q

What does it make you think if there is weakness in specific line of gaze?

A

compression or damage with the associated nerve or muscle

86
Q

When assesses motor skills, what 6 things do you need to note? Which one is most important?

A

muscle size, tone, strength, presence of voluntary movements, posture/gait, symmetry!

symmetry!!

87
Q

gait: _______ involuntary tendency for steps to accelerate and shorten

A

shuffling

88
Q

gait: ______ limp associated with pain

A

antalgic

89
Q

gait: ______ unsteady, uncoordinated walk, with a wide base and the feet thrown out

A

staggering (aka ataxic)

90
Q

gait: ______ lifting of the leg in an attempt to combat drop foot

A

steppage

91
Q

gait: ______ involuntarily moves with short, accelerating steps, often on tiptoe

A

festinating

92
Q

gait: ______ spasticity leads to adduction of hip with knee flexion and plantar flexion.

A

scissor gait

93
Q

gait: _______ muscles on one side are contracted preventing the natural knee flexion - the affected leg

A

spastic hemiparesis

94
Q

gait: _______ legs are spread in an attempt to maintain balance

A

wide base

95
Q

go back to the lecture and watch videos associated with each gait pattern

A

do it!!

96
Q

coordination is also referred to as _______. What tests do you do to check? What does abnormal findings indicate?

A

cerebellar testing

Rapid alternating movements (RAM’s)
Finger to Nose testing (F→N)
Heel To Shin testing (H→S)

Abnormal findings indicate damage to the cerebellum but may also be seen in motor weakness affecting extremity

97
Q

involuntary movements: _________ unintentional trembling or shaking movement

A

Tremor

98
Q

involuntary movements: _________ rapid, shock like muscle jerks

A

myoclonus

99
Q

involuntary movements: _________ rapid, jerky twitches, similar to myoclonus but more random in location

A

chorea

100
Q

involuntary movements: _________ slow movements of the limbs

A

athetosis

101
Q

involuntary movements: _________ large amplitude flinging of the limbs

A

ballismus

102
Q

involuntary movements: _________ abrupt, stereotyped, coordinated movements or vocalizations

A

tics

103
Q

involuntary movements: _________ maintenance of an abnormal posture or repetitive twisting movements

A

dystonia

104
Q

Describe the Romberg test. What does it assess? What is a negative test result?

A

Stand with feet together and arms at their sides. Close his/her eyes and maintain this position for 10 seconds. If the patient begins to sway, have them open their eyes.

position sense

negative: no loss of balance with eyes closed

105
Q

during the romberg test, if the patient sways, but stops when the eyes are opened. What is the problem?

A

sensory ataxia

106
Q

during the romberg test, if the swaying continues occurs and persists once eyes are open. What is the problem?

A

cerebellum ataxia

107
Q

Describe the pronator drift test. If the pt is conscious, what will the weak side do?

A

Have patient stretch out the arms so they are level and fully extended with the palms facing straight up, and then close the eyes. Watch 5-10 seconds to see if either arm tends to pronate and a slight drift DOWNWARD

“drifting” downward will occur in the one side that is weak

108
Q

What does a drifting downward during pronator drift suggest?

A

Unilateral pronator drift suggest UMN lesion affecting the arm

weakness of the extensor muscles more than the flexor muscles

109
Q

What is the motor skills strength scale? What is normal? give numbers with explanations

A

5 - active ROM, full strength against resistance

4 - active ROM against gravity and some resistance

3 - active ROM against gravity only

2 - weak contraction insufficient to overcome gravity

1 - minimal movement/muscle contraction

0 - no movement/muscle contraction

110
Q

______ is a slight residual tension present in voluntarily relaxed muscle

A

tone

111
Q

_____ is resistance to pass movement- found in ____ lesion

A

hypertonia

UMN

112
Q

____ is decreased tone that is found in ____ lesions

A

hypotonia

LMN lesions

but normal in newborns

113
Q

types of hypertonia: ______ the limb moves freely for a short distance then “catches” requiring more force to move.

A

spasticity

114
Q

types of hypertonia: _____ increased resistance throughout the movement

A

rigidity

115
Q

types of hypertonia: ______ a rhythmic and involuntary muscle contraction that can be provoked by stretching a group of muscles

A

clonus

116
Q

______ increased resistance that becomes less prominent when the patient is distracted - associated with both cognitive impairment and mental disorders

A

paratonia

117
Q

What is another test that need to be done when assessing muscle tone?

A

assessing tone will asking the pt to let their leg ‘go floppy’

Then lift the knee off the bed with one of your hands. If the ankle raises off the bed as well, this is indicative of increased tone

118
Q

How do you test for ankle clonus?

A

Flex the patient’s knee, resting the ankle on the bed.

Dorsiflex the foot quickly and keep the pressure applied.

You will be able to see the foot moving up and down if clonus is present

119
Q

What is happening during a DTR?

A

This activates SENSORY FIBERS in the muscle triggering a sensory impulse that travels to the spinal cord via a peripheral nerve

This sensory fiber then directly synapses with the ANTERIOR HORN INNERVATING THAT MUSCLE and causing the muscle to contract

120
Q

What is the scale of rating DTR? What is normal?

A

increased DTR think UMN lesions

decreased DTR think LMN lesion

121
Q

What are the coresponding nerve roots for each of the following DTR locations:

Biceps
Brachioradialis
Triceps
Patellar
Achilles

A

Biceps Tendon - C5,C6

Brachioradialis Tendon - C6

Triceps Tendon - C7

Patellar Tendon - L2 - L4

Achilles Tendon - S1

122
Q

What is the Babinski test? What is a positive test and negative test? What does a positive test indicate? What nerve roots?

A

positive test: indicates a central nervous system disorder - upper motor neuron lesion

L5-S1

123
Q

When can a positive Babinski test be seen briefly? What age range is a positive test normal?

A

Can be seen temporarily in unconscious alcohol/drug intoxication and postictal periods following a seizure

Positive reflex is normal in children up to 2 years of age and disappears as the child gets older

124
Q

How is the sensory exam performed?

A

eye CLOSED

start distal and work peripherally

need to compare sides

125
Q

What are the components of the sensory exam?

A

light touch

pain/temp

Proprioception (position sense)

Vibration

discriminative sensation: stereognosis, graphesthesia, 2-point discrimination, point localization

dermatomes

126
Q

Write the dermatome chart from lecture

A
127
Q

Describe the Glasgow Coma Scale

A
128
Q

______ inability to interpret sensations and and hence recognize things, despite intact sensations

A

Agnosia

aka you feel something but cannot tell what it feels like

129
Q

**agnosia results from damage to the _______ or _____ lobes of the brain

A

occipital or parietal

130
Q

______ is inability to recognize faces.

A

prosopagnosia

131
Q

______ is inability to recognize own body

A

autotopagnosia

132
Q

______ is inability to localize tactile sensation

A

topognosia

133
Q

_____ is inability to express speech both verbally and written

A

aphasia

134
Q

Types of aphasia: _________ speech is labored, effortful and nonfluent - comprehension is intact - due to lesion in ______ region

A

Broca’s/Expressive

posterior inferior frontal

aka can think of what words they want to say, but words do not come easily

135
Q

Types of aphasia: _________ similar to Broca’s except patient is limited to being able to say one word or phrase

A

monophasia

136
Q

Types of aphasia: _________ words are fluent, but devoid of meaningful content - due to a lesion in the _______ region.

A

Wernicke’s

posterior superior temporal

aka string of words make no sense but can speak easily

137
Q

Types of aphasia: _________ Unable to repeat statements which worsens with length of statement. due to lesion in ______ in the region of the ______

A

conduction

deep white matter

supramarginal gyrus

138
Q

Types of aphasia: _________ patients who can produce few recognizable words and understand little or no spoken language

A

global

139
Q

______ is MODERATE loss of language impairment - comprehension is intact. When is it commonly used to describe?

A

dysphasia

Sometimes used to describe language delays in children

aka not as significant as aphasia

140
Q

_______ Inability to write not resulting from weakness, incoordination, or other neurologic dysfunction of the arm or hand. What is the milder form called?

A

Agraphia

dysgraphia

141
Q

type of agraphia: ______ due to impaired visuospatial ability.
letters and words can be written correctly, but not arranged appropriately on a writing surface

A

constructional

142
Q

type of agraphia: ______ distorted, slow, effortful, incomplete, and/or imprecise letter formation

A

apraxic

143
Q

______ is defined as the inability to perform learned (familiar) movements on COMMAND, in the absence of weakness, sensory loss, or other deficit. What are the 3 MC affected areas?

A

Apraxia

eyes, walking and talking

aka were once able to perform the activity but stops suddenly, pauses then starts again

144
Q

What is hypertrophy a result of?

A

Result from excessive use of the muscles (physiologic hypertrophy) or occur on a pathologic basis. Often associated with persistent abnormal muscle contraction

145
Q

______ is defined as having difficulty articulating sounds or words. Associated with the motor function of speech as opposed with language as you see with aphasia

A

dysarthria

146
Q

_____ is defined as difficulty swallowing. What is it usually caused by?

A

dysphagia

lower brain dysfunction

147
Q

_____ is defined as a change in quality, volume, or pitch of voice

A

dysphonia

148
Q

______ spasms of the vocal cords causing high pitch, strained, or squeaky voice

A

Spasmodic dysphonia

149
Q

What type of dysphonia is commonly see in Parkinson’s disease?

A

hypophonia: low volume of voice

150
Q

_____ is impaired balance or coordination. What are the 2 different types?

A

ataxia

cerebellar and sensory

151
Q

Type of ataxia: ______ can involve any of the limbs and/or gait. Can be found by examining coordination and gait

A

cerebellar

think tremor

152
Q

Type of ataxia: ______ lack of proprioception which can cause gait imbalance or poor coordination that occurs or worsens with eyes closed

A

sensory

think worse when eyes are closed

153
Q

______ a condition of muscular weakness caused by nerve damage or disease. What are the 4 types? Give brief description of each

A

paresis

Hemiparesis - weakness on one side

Hemiplegia - paralysis of one side

Paraplegia - paralysis of both legs from usually damage to the spinal cord or degenerative muscle disease

Quadriplegia - paralysis of all four limbs due to spinal cord damage

154
Q

______ is the loss or impairment of the power of voluntary movement

A

Akinesia

155
Q

____ is defined as slow movement. What type of pt? Where is the problem coming from?

A

bradykinesia

parkinson’s pt and pts with extrapyramidal symptoms

problem arises from the basal ganglia

156
Q

______ is the abnormal involuntary movement that is similar to being figety or restless

A

Hyperkinesia / Dyskinesia

157
Q

_____ is defined as inability to sustain a stable posture. How do you test it? What 2 conditions is it associated with?

A

asterixis

Can be detected when patient’s arms are outstretched with wrists extended. The hands will flop down and then quickly recover making an odd “flapping” motion

Usually associated with hepatic encephalopathy, cirrhosis

aka flapping clonus when you try and hold body part in the same position

158
Q

_____ is increased sensitivity to sensory stimulus

A

hyperesthesia

159
Q

________ a sensation of pain from a stimulus that doesn’t cause pain. What conditions are good examples of this? What is a synonym?

A

allodynia -> light touch elicits painful sensation

think shingles or gout

hyperalgesia

160
Q

_____ is loss of sensation, used interchangeably with ______.

_____ is decreased sensation

_____ is tingling, burning, and needles sensation in the skin

A

anesthesia

numbness

hypoesthesia

paresthesia

161
Q

_____ - lack of pain sensation

______ - decrease in pain sensation

_______- exaggerated response to painful stimulus

A

Analgesia

Hypalgesia

hyperalgesia

162
Q

______ ability to recognize writing on the skin without seeing it visually. Used to look for disorders associated with what 5 areas?

A

Graphesthesia

parietal lobe, brainstem, spinal cord, thalamus, and sensory cortex

163
Q

______ is the inability to recognize an object by touch alone. What 2 places is usually the source of the problem?

A

Astereognosis

parietal lobe of the brain
or
dorsal column of the spinal cord

164
Q

_______ is difficulty with judging distance, speed and power. How is it assessed?

A

dysmetria

assessed by finger-to-nose

165
Q

________ inability to perform repetitive movements or rapid alternating movements

A

Dysdiadochokinesia

aka not fluid or consistent when doing rapid alternating movements

166
Q

______ is involuntary resistance to passive movement. What is the key different between spasticity?

A

rigidity

aka same regardless of the speed

Key difference from spasticity is the that the degree of resistance remains the same regardless the speed of movement.

Spasticity is more noticeable with fast and slow passive movement

167
Q

What can hyperreflexia indicate? Is it always abnormal?

A

Can be indicative of myopathic process, hyperthyroidism, serotonin syndrome

NO! can be normal if the finding is symmetric

168
Q

What can hyporeflexia indicate?

A

Can be associated with lower motor neuron disorder (i.e. peripheral neuropathy) or hypothyroidism

but also can be normal

169
Q
A

Neuro (13 decks)

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