Assessing the Neurological System and Mental Status Examination Flashcards
1
Q
2 main parts of Nervous System
A
Central Nervous System and Peripheral Nervous System
2
Q
carries messages to and from the CNS
A
Peripheral Nervous System
3
Q
Central Nervous System inlcudes:
A
brain and spinal cord
4
Q
connects brain and Peripheral Nervous System
A
spinal cord
5
Q
Peripheral Nervous System includes:
A
Somatic Nervous System and Autonomic Nervous System
6
Q
controls voluntary muscles and transmits sensory information to the CNS
A
Somatic Nervous System
7
Q
controls involuntary body functions
A
Autonomic Nervous System
8
Q
Autonomic Nervous System includes:
A
Sympathetic Nervous System and Parasympathetic Nervous System
9
Q
arouses body to expend energy
A
Sympathetic Nervous System
10
Q
calms body to conserve and maintain energy
A
Parasympathetic Nervous System
11
Q
Four lobes
A
Frontal
Parietal
Temporal
Occipital
12
Q
he cerebrum is divided into two halves:
A
the right and left hemispheres
13
Q
The the right and left cerebral hemispheres are joined by the
A
corpus callosum
14
Q
aggregation of neuronal cell bodies
A
Gray Matter
15
Q
mediates higher-level function (memory, perception,
communication, initiation of voluntary movements)
A
Gray Matter
16
Q
Regulate emotional expression, behavior, intellect;
influence personality; control voluntary movement
A
Frontal Lobe
17
Q
Perceives and interpret sensory inputs such as pain,
temperature, touch, texture, and proprioception
A
Parietal Lobe
18
Q
Influence hearing, smell, taste, and memory
A
Temporal Lobe
19
Q
Perceive and interpret visual stimuli, including spatial relationships; Influence the ability to read with
understanding
A
Occipital Lobe
20
Q
Clusters multiple stimuli into a coherent whole before sending it to the cerebral cortex for perception
A
Thalamus
21
Q
Regulates production of several hormones responsible for regulating water balance, appetite, vital signs, sleep cycles, pain perception, and emotional status; Stimulates visceral
responses such as heart rate, in response to emotions; Regulates temperature by prompting shivering and sweating
A
Hypothalamus
22
Q
Regulates visual, auditory, and other reflexes and controls eye movements, focusing, and pupil dilation
A
Midbrain
23
Q
Helps control respiratory function, facial movement and sensation, and eye movement
A
Pons
24
Q
Regulates heart and respiratory rate, BP, and protective reflexes such as swallowing, vomiting, sneezing, and coughing
A
Medulla Oblongata
25
parts of Brainstem
Midbrain
Pons
Medulla Oblongata
26
Coordination and smoothing of voluntary movements, maintaining equilibrium, and maintenance of muscle tone
Cerebellum
27
spinal cord is located in the
vertebral canal
28
Extends from the medulla oblongata to the first lumbar vertebra (L1)
spinal cord
29
Conducts sensory impulses up the ascending tracts to the brain
spinal cord
30
Conducts motor impulses down the descending tracts to neurons that stimulate glands and muscles throughout the body
spinal cord
31
Responsible for simple reflex activity
spinal cord
32
Conducting or conducted towards the brain
Afferent
33
Conducting or conducted away from the brain
Efferent
34
SAME DAVE
Sensory Afferent Motor Efferent
Dorsal Afferent Ventral Efferent
35
Sensations of pain, temperature, and crude an light touch
travel by the way of the
spinothalamic tract
36
Sensations of position, vibration and fine touch travel by way of the
posterior columns
37
Impulses from the afferent fibers of the peripheral nerves are carried through the
posterior root ganglion
38
Pyramidal Tracts
1. Motor neurons original in the motor cortex and travel down the medulla
2. Crosses over to the opposite side then travel down the spinal cord
3. Impulses are carried to muscles and produce voluntary movements
39
control voluntary skilled movement of the extremities and
fine movement of the fingers
Corticospinal tracts
40
voluntary control of face, head, and neck
Corticobulbar tract
41
Responsible for INVOLUNTARY control and modulation like
tone and balance
Extrapyramidal Tracts
42
Extrapyramidal Tracts originate in the
brainstem
43
Responsible for fine motor control
Rubrospinal tract (midbrain)
44
Reticulospinal tract includes
Pons and Medulla
45
facilitates contraction and increases tone
Pons
46
Pyramidal Tracts divides into the:
- Corticospinal tracts
- Corticobulbar tract
47
inhibits contraction, decreases tone, and automatic breathing
Medulla
48
Involved in balance and posture
Vestibulospinal tract
49
Involved in the coordinate head and eye coordination
Tectospinal (Colliculospinal) tract
50
Extrapyramidal Tracts
- Rubrospinal tract
- Reticulospinal tract
- Vestibulospinal tract\
- Tectospinal (Colliculospinal) tract
51
CRANIAL NERVES
Olfactory
Optic
Oculomotor
Trochlear
Trigeminal
Abducens
Facial
Vestibulocochlear (Acoustic)
Glossopharyngeal
Vagus
Spinal Accessory
Hypoglossal
52
Carries smell impulses from nasal mucous membrane to brain
I - Olfactory Nerve
53
Carries visual impulses from eye to brain
II - Optic Nerve
54
Contracts eye muscles to control eye movements (superolateral, superomedial, inferolateral, and medial), constricts pupils, and elevates eyelids
III - Oculomotor Nerve
55
Contracts superior oblique muscle to control inferomedial eye movement
IV - Trochlear Nerve
56
3 divisions of Trigeminal Nerve:
Ophthalmic, Maxillary, and Mandibular
57
Chewing and jaw opening and clenching
Trigeminal Nerve
58
Conveying sensory data from eyes (cornea), nose, mouth, teeth, jaw, forehead, scalp, and facial skin
Sensory
59
Controls lateral eye movements
VI - Abducens Nerve
60
LR6SO4
Lateral rectus, CN VI
Superior Oblique, CN IV
61
Closing eyes, closing mouth, moving lips and other muscles of facial expression, salivation and lacrimation
VII - Facial Nerve
62
Tasting on anterior tongue
VII - Facial Nerve
63
Branches of Facial Nerve
Temporal, Zygomatic, Buccal, Mandibular, Cervical
64
Contains sensory fibers for hearing and balance
VIII – Acoustic/Vestibulocochlear nerve
65
Hearing Pathways
Conductive phase
Sensorineural phase
66
from the external ear through the middle ear
Conductive phase
67
Hearing disorders of the external ear causes include
- cerumen impaction
- trauma
- tumor
- bony growths
68
Hearing disorders of the middle ear causes include
- otitis media
- congenital conditions,
- cholesteatomas and otosclerosis
- tumors
- perforation of the tympanic membrane
69
involves the cochlea and cochlear nerve
Sensorineural phase
70
Hearing disorders of the inner ear causes include
- congenital and hereditary conditions
- presbycusis
- viral infections
- Meniere disease
- noise exposure
- ototoxic drug exposure
- acoustic neuroma
71
Contains sensory fibers for taste on posterior third of tongue and sensory fibers of the pharynx that result in the gag reflex when stimulated
IX - Glossopharyngeal Nerve
72
Provides secretory fibers to the parotid salivary glands;
promotes swallowing movements
IX - Glossopharyngeal Nerve
73
Carries sensation from the throat, larynx, heart, lungs, bronchi, gastrointestinal tract, and abdominal viscera
X - Vagus Nerve
74
Promotes swallowing, talking, and production of digestive juices
X - Vagus Nerve
75
Innervates neck muscles (sternocleidomastoid and
trapezius) that promote movement of the shoulders and head rotation. Also promotes some movement of the larynx
XI – Spinal Accessory Nerve
76
Innervates tongue muscles that promote the movement of food and talking
XI – Hypoglossal Nerve
77
how many pairs of spinal nerves?
31 pairs (8 cervical, 12 thoracic, 5 sacral, 1 coccygeal)
78
The sensory root of each spinal nerve innervates an area of the skin called a
DERMATOME
79
Each spinal nerve is attached to the spinal cord by two nerve roots, the ________________________ that enters through the dorsal (posterior) root and the__________________________ that exits through the ventral (anterior) roots of the cord
sensory (afferent) fiber; motor (efferent) fiber
80
Impulses are carried by
both cranial and spinal nerves
81
activated during stress and elicits responses such as decreased gastric secretions, bronchiole dilatation, increased pulse rate, and pupil dilation; arise from the thoracolumbar level
Sympathetic nervous system
82
restore and maintain normal body functions like decreasing the heart rate; arise from the craniosacral regions
Parasympathetic nervous system:
83
Most common neurologic symptoms are
headache, memory loss, confusion, dizziness, loss of consciousness, numbness, sensory loss, and problems with any of the five senses
84
- Most common
- Mild or severe
- Acute or chronic
- Localized or generalized
- 90% are benign
- 10% have underlying pathology
Headache
85
pain at the temples, in front of the ears
Temporomandibular Joint (TMJ)
86
pain behind the brow bone and/or cheekbones
Sinusitis
87
pain in around one eye
cluster
88
pain is like a band squeezing the head
tension
89
pain (one sided), nausea and visual changes
migraine
90
pain is at the top and/or back of the head
Cervicogenic
91
dull constant pain, often worse in the morning
medication overuse-headache (MHO)
92
an auditory, visual, or motor sensation that forewarns the
client that a seizure is about to occur
Aura
93
May be caused by neurologic problems, fluid and electrolyte
imbalance, hypoxia, low perfusion states, nutritional deficiencies, infections, renal and liver disease, hyper- or hypothermia, trauma, medications, and drug and alcohol abuse
Mental Status Changes
94
“fainting” sensation
Dizziness
95
sensation that the surroundings are spinning around or that the person is spinning around; often accompanied by
nausea and vomiting, nystagmus, and tinnitus
Vertigo
96
temporary loss of consciousness
Syncope
97
numbness or tingling
Paresthesia
98
May be caused by diabetes and neurologic, metabolic,
cardiovascular, renal, and inflammatory diseases
Numbness or Loss of Sensation
99
what cranial nerve is affected when one has deficit in sense of smell?
CN I
100
what cranial nerve is affected when one has deficit in visual acuity, pupillary constriction, and extraocular movement?
CN II, III, IV, and VI
101
what cranial nerve is affected when one has deficit in taste?
CN VII and IX
102
what cranial nerve is affected when one has deficit in hearing?
CN VIII
103
what cranial nerve is affected when one has deficit in somatic sensations?
CN V and dermatomes
104
Disorders of Speech
- Aphonia
- Dysphonia
- Dysarthria
- Aphasia
105
loss of voice that accompanies disease affecting the
larynx or its nerve supply
Aphonia
106
less severe impairment in the volume, quality, or pitch
of the voice and may be caused by laryngitis, laryngeal tumors, and unilateral vocal cord paralysis (CN X)
Dysphonia
107
defect in the muscular control of speech apparatus
(lips, tongue, palate, or pharynx); words may be nasal, slurred, or indistinct
Dysarthria
108
disorder in producing or understanding language
Aphasia
109
a tumor that grows in the nasal cavity
Olfactory Neuroblastoma / Esthesioneuroblastoma
110
Defective formation of the olfactory bulb leads to defective migration of the GnRH cells to the hypothalamus. The deficit in the GnRH hormone production by the hypothalamus results in decreased levels of sex steroid responsible for sexual maturity and development of secondary sexual characteristics
Kallmann Syndrome
111
Kallmann Syndrome presents with
absence of secondary sex characteristics (enlarged breasts, widening of hips, facial hair, Adam’s apples, pubic hair) and hypo- or anosmia
112
Visual Field Defects
- Optic nerve lesion; Complete blindness in the left eye
- Left junctional scotoma with vision loss in the left eye coupled with a superotemporal defect in the left eye
- Bitemporal hemianopia
- Right homonymous hemianopia
- Right superior quadrant hemianopia
- Right inferior quadrant hemianopia
- Right homonymous hemianopia
- Hemianopia with macular sparing, posterior cerebral artery
infarction
113
swelling of the optic nerve
Papilledema
114
results in blurred optic disc margins and dilated, pulsating veins
Papilledema
115
occurs with increased intracranial pressure from intracranial hemorrhage or a brain tumor
Papilledema
116
occurs with brain tumors
Optic atrophy
117
drooping of the eyelid
Ptosis
118
is seen with weak eye muscles such as in myasthenia gravis
Ptosis
119
Some abnormal eye movements causes follow:
- Nystagmus
- Limited eye movement through the six cardinal fields of gaze
- Paralytic strabismus
120
rhythmic oscillation of the eyes
Nystagmus
121
paralysis of CN III, IV, or VI nerves
Paralytic strabismus
122
bilateral small pupils that reduce in size on a near object but do not constrict when exposed to bright light
Argyll-Robertson pupils
123
Described as the most excruciating pain known to humanity
Trigeminal Neuralgia (Tic Doloreux)
124
Intense, stabbing, electric shock-like pain in the forehead, cheek, and lower jaw
Trigeminal Neuralgia (Tic Doloreux)
125
Inability to close eyes, wrinkle forehead, or raise forehead along with paralysis of the lower part of the face on the affected side is seen with
Bell’s palsy
126
vibration heard equally well in both ears
Weber test
127
AC > BC (air conduction is twice as long as bone conduction).
Rinne test
128
- inability to wrinkle brow
- drooping eyelid: inability to close eye
- inability to puff cheek: asymmetrical smile
- dropping corner of mouth; dry mouth
Facial Nerve Palsy
129
Inability to identify correct flavor on anterior two-thirds of the tongue suggests impairment of
cranial nerve VII (facial)
130
If hearing loss is present, determine if the loss is conductive or sensorineural by conducting the
Weber and Rinne test
131
what branch of the vagus nerve innervates the vocal cords?
recurrent laryngeal nerve
132
what nerves innervate the hard and soft palate
greater palatine, nasopalatine nerve, and lesser palatine nerve, branches of the maxillary nerve
133
In _________________________, the soft palate fails to rise and the uvula deviates to the opposite side (points away from the lesion)
CN X paralysis
134
Derived from two Latin words, tortus = twisted, and collum = neck
Torticollis
135
Torticollis is derived from two Latin words ____________________ = ___________________ and ____________________ = ___________________
tortus = twisted, and collum = neck
136
Contraction or contracture of the muscles of the neck that causes the head to tilt to one side
Torticollis
137
may be caused by irritation to the cervical ligaments from a viral infection, injury, or vigorous movement
Acquired torticollis
138
may be caused by ischemia, trauma during childbirth and intrauterine malposition
Congenital torticollis
139
is associated with extremity weakness
Injury of the central spinal cord
140
Loss of motor function, pain and temperature seen in
anterior cord syndrome
141
Loss of proprioception seen in
posterior cord syndrome
142
A loss of strength, proprioception, pain and temperature is seen in
Brown-Séquard syndrome
143
continuous, rapid twitching of resting muscles
Fasciculations
144
involuntary contraction of opposing group of muscles
Tremors
145
tremors of the thumb and opposing finger seen in Parkinson’s disease
Pill-rolling
146
involuntary repetitive twitching movements seen in Tourette’s syndrome, habit psychogenic tics or tardive dyskinesias
Tics
147
sudden rapid, jerky voluntary and involuntary movements of limbs, trunk, or face seen in Huntington’s disease and Syndenham’s chorea
Chorea
148
twisting, writhing, slow continuous movements seen in cerebral palsy
Athetosis
149
- Wide-based, staggering, unsteady
- Romberg test result are positive
- Seen with cerebellar disease or alcohol or drug intoxication
Cerebellar Ataxia
150
- Shuffling gait, turns accomplished in very stiff manner
- Stooped-over posture with flexed hips and knees
- Typically seen in Parkinson’s disease and drug-induced
parkinsonian because of effects on the basal ganglia
Parkinsonian Gait
151
- Stiff, short gait; thighs overlap each other with each step
- Seen with partial paralysis of the legs
Scissors Gait
152
- Flexed arm held close to the body while client drags toe of leg or circles it stiffly outward and forward
- Seen with lesions of the upper motor neurons in the corticospinal tract, such as occurs in stroke
Spastic Hemiparesis
153
Swaying and moving feet apart to prevent fall is seen with disease of the posterior columns, vestibular dysfunction, or
cerebellar disorders.
Positive Romberg test
154
presence of abnormal, uncoordinated movements
Ataxia
155
3 sensory systems that regulate body posture
- Vision
- Proprioception
- Vestibular system
156
the inability to control the distance, speed, and range of motion necessary to perform smoothly coordinated
movements
Dysmetria
157
inability to perform rapid alternating movements
Dysdiadochokinesia
158
In Cerebellar damage, remember
DANISH
Dysdiadochokinesia/Dysmetria
Ataxia
Nystagmus
Intention tremor
Speech – slurred or scanning
Hypotonia
159
absence of touch sensation
Anesthesia
160
decreased sensitivity to touch
Hypesthesia
161
increased sensitivity to touch
Hyperesthesia
162
absence of pain sensation
Analgesia
163
decreased sensitivity to pain
Hypalgesia
164
increased sensitivity to pain
Hyperalgesia
165
Inability to correctly identify objects
astereognosis
166
deep tendon reflexes (rated 0) occur when a component of the lower motor neurons or reflex arc is impaired; this may be seen with spinal cord injuries.
Absent or markedly decreased (hyporeflexia)
167
deep tendon reflexes (rated 4+) may be seen with lesions of the upper motor neurons and when the higher cortical levels are impaired.
Markedly hyperactive (hyperreflexia)
168
are fibrous tissues that attach muscles to bones
Tendons
169
when the patient's neck is flexed (after ruling out cervical trauma or injury), flexion of the knees and hips is produced; when lower extremity of one side is passively flexed, a similar movement is seen in the opposite extremity
Brudzinki's sign
170
when the patient is lying with the thigh flexed on the abdomen, the leg cannot be completely extended
Kernig's sign
171
Five Components of Mental Status Examination
- Appearance and Behavior
- Speech and Language
- Mood
- Thoughts and Perceptions
- Cognitive Function
172
in which phrases or sentences are substituted for a word the person cannot think of, such as “what your write with” for “pen”
Circumlocutions
173
in which words are malformed (“I write with a den”),
wrong (“I write with a bar”), or invented (“I write with a dar”)
Paraphasias
174
Disorders of Thought Processes
- Circumstantiality
- Derailment (loosening of associations)
- Flight of Ideas
- Neologisms
- Incoherence
- Blocking
- Confabulation
- Perseveration
- Echolalia
- Clanging
175
The mildest though disorder, consisting of speech with
unnecessary detail, indirection, and delay in reaching the point
Circumstantiality
176
“Tangential” speech with shifting topics that are loosely connected or unrelated. This patient is unaware of the lack of association
Derailment (loosening of associations)
177
An almost continuous flow of accelerated speech with abrupt changes from one topic to the next. Changes are based on understandable associations, play on words, or distracting stimuli, but ideas are not well connected
Flight of Ideas
178
Invented or distorted words, or words with new and highly
idiosyncratic meanings
“I got so angry I picked up a dish and threw it at the geshinker”
Neologisms
179
Speech that is incomprehensible and illogical, with lack of
meaningful connections, abrupt changes in topic, or disordered grammar or word use.
Incoherence
180
Sudden interruption of speech in midsentence or before the
idea is completed, attributed to “losing the thought”
Blocking
181
Fabrication of facts or events even in response to questions, to fill in the gaps from impaired memory
Confabulation
182
Persistent repetition of words or ideas
Perseveration
183
Repetition of the words and phrases of others
Echolalia
184
Speech with choice of words based on sound, rather than meaning, as in rhyming and punning
Clanging
185
Abnormalities of Thought Content
- Compulsions
- Obsessions
- Phobias
- Anxieties
- Feelings of Unreality
- Feelings of Depersonalization
- Delusions
- Illusions
- Hallucinations
186
Repetitive behavior that the person feels driven to perform in response to an obsession, aimed at preventing or reducing anxiety or a dreaded event or situation
Compulsions
187
Recurrent persistent thoughts, images, or urges experienced as intrusive and unwanted that the person tries to ignore, suppress, or neutralize with other thoughts or actions
Obsessions
188
Persistent irrational fears, accompanied by a compelling desire to avoid the provoking stimulus
Phobias
189
Apprehensive anticipation of future danger or misfortune accompanied by feelings of worry, distress, and/or somatic symptoms of tension.
Anxieties
190
A sense that the environment is strange, unreal, or remote
Feelings of Unreality
191
A sense that one’s self or identity is different, changed,
unreal; lost or detached from one’s mind or body
Feelings of Depersonalization
192
False fixed personal beliefs that are not amenable to change in light of conflicting evidences. Examples are persecutory, grandiose, jealous, erotomatic, somatic, unspecified
Delusions
193
Misinterpretations of real external stimuli, such as mistaking rustling leaves for the sound of voices
May occur in grief reactions, delirium, acute and posttraumatic stress disorders, and schizophrenia
Illusions
194
Perception-like experiences that seem real but lack actual external stimulation. The person may or may not recognize
the experiences as false. Hallucinations may be auditory,
visual, olfactory, gustatory, tactile, or somatic. False perceptions associated with dreaming, falling asleep, and
awakening are not classified as hallucinations
Hallucinations
