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health assessment - lecture > Assessing the Neurological System and Mental Status Examination > Flashcards

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

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2
Q

carries messages to and from the CNS

A

Peripheral Nervous System

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3
Q

Central Nervous System inlcudes:

A

brain and spinal cord

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4
Q

connects brain and Peripheral Nervous System

A

spinal cord

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5
Q

Peripheral Nervous System includes:

A

Somatic Nervous System and Autonomic Nervous System

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6
Q

controls voluntary muscles and transmits sensory information to the CNS

A

Somatic Nervous System

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7
Q

controls involuntary body functions

A

Autonomic Nervous System

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8
Q

Autonomic Nervous System includes:

A

Sympathetic Nervous System and Parasympathetic Nervous System

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9
Q

arouses body to expend energy

A

Sympathetic Nervous System

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10
Q

calms body to conserve and maintain energy

A

Parasympathetic Nervous System

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11
Q

Four lobes

A

Frontal
Parietal
Temporal
Occipital

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12
Q

he cerebrum is divided into two halves:

A

the right and left hemispheres

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13
Q

The the right and left cerebral hemispheres are joined by the

A

corpus callosum

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14
Q

aggregation of neuronal cell bodies

A

Gray Matter

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15
Q

mediates higher-level function (memory, perception,
communication, initiation of voluntary movements)

A

Gray Matter

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16
Q

Regulate emotional expression, behavior, intellect;
influence personality; control voluntary movement

A

Frontal Lobe

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17
Q

Perceives and interpret sensory inputs such as pain,
temperature, touch, texture, and proprioception

A

Parietal Lobe

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18
Q

Influence hearing, smell, taste, and memory

A

Temporal Lobe

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19
Q

Perceive and interpret visual stimuli, including spatial relationships; Influence the ability to read with
understanding

A

Occipital Lobe

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20
Q

Clusters multiple stimuli into a coherent whole before sending it to the cerebral cortex for perception

A

Thalamus

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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

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22
Q

Regulates visual, auditory, and other reflexes and controls eye movements, focusing, and pupil dilation

A

Midbrain

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23
Q

Helps control respiratory function, facial movement and sensation, and eye movement

A

Pons

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24
Q

Regulates heart and respiratory rate, BP, and protective reflexes such as swallowing, vomiting, sneezing, and coughing

A

Medulla Oblongata

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25
Q

parts of Brainstem

A

Midbrain
Pons
Medulla Oblongata

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26
Q

Coordination and smoothing of voluntary movements, maintaining equilibrium, and maintenance of muscle tone

A

Cerebellum

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27
Q

spinal cord is located in the

A

vertebral canal

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28
Q

Extends from the medulla oblongata to the first lumbar vertebra (L1)

A

spinal cord

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29
Q

Conducts sensory impulses up the ascending tracts to the brain

A

spinal cord

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30
Q

Conducts motor impulses down the descending tracts to neurons that stimulate glands and muscles throughout the body

A

spinal cord

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31
Q

Responsible for simple reflex activity

A

spinal cord

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32
Q

Conducting or conducted towards the brain

A

Afferent

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33
Q

Conducting or conducted away from the brain

A

Efferent

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34
Q

SAME DAVE

A

Sensory Afferent Motor Efferent
Dorsal Afferent Ventral Efferent

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35
Q

Sensations of pain, temperature, and crude an light touch
travel by the way of the

A

spinothalamic tract

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36
Q

Sensations of position, vibration and fine touch travel by way of the

A

posterior columns

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37
Q

Impulses from the afferent fibers of the peripheral nerves are carried through the

A

posterior root ganglion

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38
Q

Pyramidal Tracts

A
  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
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39
Q

control voluntary skilled movement of the extremities and
fine movement of the fingers

A

Corticospinal tracts

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40
Q

voluntary control of face, head, and neck

A

Corticobulbar tract

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41
Q

Responsible for INVOLUNTARY control and modulation like
tone and balance

A

Extrapyramidal Tracts

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42
Q

Extrapyramidal Tracts originate in the

A

brainstem

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43
Q

Responsible for fine motor control

A

Rubrospinal tract (midbrain)

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44
Q

Reticulospinal tract includes

A

Pons and Medulla

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45
Q

facilitates contraction and increases tone

A

Pons

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46
Q

Pyramidal Tracts divides into the:

A
  • Corticospinal tracts
  • Corticobulbar tract
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47
Q

inhibits contraction, decreases tone, and automatic breathing

A

Medulla

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48
Q

Involved in balance and posture

A

Vestibulospinal tract

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49
Q

Involved in the coordinate head and eye coordination

A

Tectospinal (Colliculospinal) tract

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50
Q

Extrapyramidal Tracts

A
  • Rubrospinal tract
  • Reticulospinal tract
  • Vestibulospinal tract\
  • Tectospinal (Colliculospinal) tract
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51
Q

CRANIAL NERVES

A

Olfactory
Optic
Oculomotor
Trochlear
Trigeminal
Abducens
Facial
Vestibulocochlear (Acoustic)
Glossopharyngeal
Vagus
Spinal Accessory
Hypoglossal

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52
Q

Carries smell impulses from nasal mucous membrane to brain

A

I - Olfactory Nerve

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53
Q

Carries visual impulses from eye to brain

A

II - Optic Nerve

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54
Q

Contracts eye muscles to control eye movements (superolateral, superomedial, inferolateral, and medial), constricts pupils, and elevates eyelids

A

III - Oculomotor Nerve

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55
Q

Contracts superior oblique muscle to control inferomedial eye movement

A

IV - Trochlear Nerve

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56
Q

3 divisions of Trigeminal Nerve:

A

Ophthalmic, Maxillary, and Mandibular

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57
Q

Chewing and jaw opening and clenching

A

Trigeminal Nerve

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58
Q

Conveying sensory data from eyes (cornea), nose, mouth, teeth, jaw, forehead, scalp, and facial skin

A

Sensory

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59
Q

Controls lateral eye movements

A

VI - Abducens Nerve

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60
Q

LR6SO4

A

Lateral rectus, CN VI
Superior Oblique, CN IV

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61
Q

Closing eyes, closing mouth, moving lips and other muscles of facial expression, salivation and lacrimation

A

VII - Facial Nerve

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62
Q

Tasting on anterior tongue

A

VII - Facial Nerve

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63
Q

Branches of Facial Nerve

A

Temporal, Zygomatic, Buccal, Mandibular, Cervical

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64
Q

Contains sensory fibers for hearing and balance

A

VIII – Acoustic/Vestibulocochlear nerve

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65
Q

Hearing Pathways

A

Conductive phase
Sensorineural phase

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66
Q

from the external ear through the middle ear

A

Conductive phase

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67
Q

Hearing disorders of the external ear causes include

A
  • cerumen impaction
  • trauma
  • tumor
  • bony growths
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68
Q

Hearing disorders of the middle ear causes include

A
  • otitis media
  • congenital conditions,
  • cholesteatomas and otosclerosis
  • tumors
  • perforation of the tympanic membrane
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69
Q

involves the cochlea and cochlear nerve

A

Sensorineural phase

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70
Q

Hearing disorders of the inner ear causes include

A
  • congenital and hereditary conditions
  • presbycusis
  • viral infections
  • Meniere disease
  • noise exposure
  • ototoxic drug exposure
  • acoustic neuroma
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71
Q

Contains sensory fibers for taste on posterior third of tongue and sensory fibers of the pharynx that result in the gag reflex when stimulated

A

IX - Glossopharyngeal Nerve

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72
Q

Provides secretory fibers to the parotid salivary glands;
promotes swallowing movements

A

IX - Glossopharyngeal Nerve

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73
Q

Carries sensation from the throat, larynx, heart, lungs, bronchi, gastrointestinal tract, and abdominal viscera

A

X - Vagus Nerve

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74
Q

Promotes swallowing, talking, and production of digestive juices

A

X - Vagus Nerve

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75
Q

Innervates neck muscles (sternocleidomastoid and
trapezius) that promote movement of the shoulders and head rotation. Also promotes some movement of the larynx

A

XI – Spinal Accessory Nerve

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76
Q

Innervates tongue muscles that promote the movement of food and talking

A

XI – Hypoglossal Nerve

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77
Q

how many pairs of spinal nerves?

A

31 pairs (8 cervical, 12 thoracic, 5 sacral, 1 coccygeal)

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78
Q

The sensory root of each spinal nerve innervates an area of the skin called a

A

DERMATOME

79
Q

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

A

sensory (afferent) fiber; motor (efferent) fiber

80
Q

Impulses are carried by

A

both cranial and spinal nerves

81
Q

activated during stress and elicits responses such as decreased gastric secretions, bronchiole dilatation, increased pulse rate, and pupil dilation; arise from the thoracolumbar level

A

Sympathetic nervous system

82
Q

restore and maintain normal body functions like decreasing the heart rate; arise from the craniosacral regions

A

Parasympathetic nervous system:

83
Q

Most common neurologic symptoms are

A

headache, memory loss, confusion, dizziness, loss of consciousness, numbness, sensory loss, and problems with any of the five senses

84
Q
  • Most common
  • Mild or severe
  • Acute or chronic
  • Localized or generalized
  • 90% are benign
  • 10% have underlying pathology
A

Headache

85
Q

pain at the temples, in front of the ears

A

Temporomandibular Joint (TMJ)

86
Q

pain behind the brow bone and/or cheekbones

A

Sinusitis

87
Q

pain in around one eye

A

cluster

88
Q

pain is like a band squeezing the head

A

tension

89
Q

pain (one sided), nausea and visual changes

A

migraine

90
Q

pain is at the top and/or back of the head

A

Cervicogenic

91
Q

dull constant pain, often worse in the morning

A

medication overuse-headache (MHO)

92
Q

an auditory, visual, or motor sensation that forewarns the
client that a seizure is about to occur

A

Aura

93
Q

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

A

Mental Status Changes

94
Q

“fainting” sensation

A

Dizziness

95
Q

sensation that the surroundings are spinning around or that the person is spinning around; often accompanied by
nausea and vomiting, nystagmus, and tinnitus

A

Vertigo

96
Q

temporary loss of consciousness

A

Syncope

97
Q

numbness or tingling

A

Paresthesia

98
Q

May be caused by diabetes and neurologic, metabolic,
cardiovascular, renal, and inflammatory diseases

A

Numbness or Loss of Sensation

99
Q

what cranial nerve is affected when one has deficit in sense of smell?

A

CN I

100
Q

what cranial nerve is affected when one has deficit in visual acuity, pupillary constriction, and extraocular movement?

A

CN II, III, IV, and VI

101
Q

what cranial nerve is affected when one has deficit in taste?

A

CN VII and IX

102
Q

what cranial nerve is affected when one has deficit in hearing?

A

CN VIII

103
Q

what cranial nerve is affected when one has deficit in somatic sensations?

A

CN V and dermatomes

104
Q

Disorders of Speech

A
  • Aphonia
  • Dysphonia
  • Dysarthria
  • Aphasia
105
Q

loss of voice that accompanies disease affecting the
larynx or its nerve supply

A

Aphonia

106
Q

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)

A

Dysphonia

107
Q

defect in the muscular control of speech apparatus
(lips, tongue, palate, or pharynx); words may be nasal, slurred, or indistinct

A

Dysarthria

108
Q

disorder in producing or understanding language

A

Aphasia

109
Q

a tumor that grows in the nasal cavity

A

Olfactory Neuroblastoma / Esthesioneuroblastoma

110
Q

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

A

Kallmann Syndrome

111
Q

Kallmann Syndrome presents with

A

absence of secondary sex characteristics (enlarged breasts, widening of hips, facial hair, Adam’s apples, pubic hair) and hypo- or anosmia

112
Q

Visual Field Defects

A
  • 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
Q

swelling of the optic nerve

A

Papilledema

114
Q

results in blurred optic disc margins and dilated, pulsating veins

A

Papilledema

115
Q

occurs with increased intracranial pressure from intracranial hemorrhage or a brain tumor

A

Papilledema

116
Q

occurs with brain tumors

A

Optic atrophy

117
Q

drooping of the eyelid

A

Ptosis

118
Q

is seen with weak eye muscles such as in myasthenia gravis

A

Ptosis

119
Q

Some abnormal eye movements causes follow:

A
  • Nystagmus
  • Limited eye movement through the six cardinal fields of gaze
  • Paralytic strabismus
120
Q

rhythmic oscillation of the eyes

A

Nystagmus

121
Q

paralysis of CN III, IV, or VI nerves

A

Paralytic strabismus

122
Q

bilateral small pupils that reduce in size on a near object but do not constrict when exposed to bright light

A

Argyll-Robertson pupils

123
Q

Described as the most excruciating pain known to humanity

A

Trigeminal Neuralgia (Tic Doloreux)

124
Q

Intense, stabbing, electric shock-like pain in the forehead, cheek, and lower jaw

A

Trigeminal Neuralgia (Tic Doloreux)

125
Q

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

A

Bell’s palsy

126
Q

vibration heard equally well in both ears

A

Weber test

127
Q

AC > BC (air conduction is twice as long as bone conduction).

A

Rinne test

128
Q
  • inability to wrinkle brow
  • drooping eyelid: inability to close eye
  • inability to puff cheek: asymmetrical smile
  • dropping corner of mouth; dry mouth
A

Facial Nerve Palsy

129
Q

Inability to identify correct flavor on anterior two-thirds of the tongue suggests impairment of

A

cranial nerve VII (facial)

130
Q

If hearing loss is present, determine if the loss is conductive or sensorineural by conducting the

A

Weber and Rinne test

131
Q

what branch of the vagus nerve innervates the vocal cords?

A

recurrent laryngeal nerve

132
Q

what nerves innervate the hard and soft palate

A

greater palatine, nasopalatine nerve, and lesser palatine nerve, branches of the maxillary nerve

133
Q

In _________________________, the soft palate fails to rise and the uvula deviates to the opposite side (points away from the lesion)

A

CN X paralysis

134
Q

Derived from two Latin words, tortus = twisted, and collum = neck

A

Torticollis

135
Q

Torticollis is derived from two Latin words ____________________ = ___________________ and ____________________ = ___________________

A

tortus = twisted, and collum = neck

136
Q

Contraction or contracture of the muscles of the neck that causes the head to tilt to one side

A

Torticollis

137
Q

may be caused by irritation to the cervical ligaments from a viral infection, injury, or vigorous movement

A

Acquired torticollis

138
Q

may be caused by ischemia, trauma during childbirth and intrauterine malposition

A

Congenital torticollis

139
Q

is associated with extremity weakness

A

Injury of the central spinal cord

140
Q

Loss of motor function, pain and temperature seen in

A

anterior cord syndrome

141
Q

Loss of proprioception seen in

A

posterior cord syndrome

142
Q

A loss of strength, proprioception, pain and temperature is seen in

A

Brown-Séquard syndrome

143
Q

continuous, rapid twitching of resting muscles

A

Fasciculations

144
Q

involuntary contraction of opposing group of muscles

A

Tremors

145
Q

tremors of the thumb and opposing finger seen in Parkinson’s disease

A

Pill-rolling

146
Q

involuntary repetitive twitching movements seen in Tourette’s syndrome, habit psychogenic tics or tardive dyskinesias

A

Tics

147
Q

sudden rapid, jerky voluntary and involuntary movements of limbs, trunk, or face seen in Huntington’s disease and Syndenham’s chorea

A

Chorea

148
Q

twisting, writhing, slow continuous movements seen in cerebral palsy

A

Athetosis

149
Q
  • Wide-based, staggering, unsteady
  • Romberg test result are positive
  • Seen with cerebellar disease or alcohol or drug intoxication
A

Cerebellar Ataxia

150
Q
  • 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
A

Parkinsonian Gait

151
Q
  • Stiff, short gait; thighs overlap each other with each step
  • Seen with partial paralysis of the legs
A

Scissors Gait

152
Q
  • 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
A

Spastic Hemiparesis

153
Q

Swaying and moving feet apart to prevent fall is seen with disease of the posterior columns, vestibular dysfunction, or
cerebellar disorders.

A

Positive Romberg test

154
Q

presence of abnormal, uncoordinated movements

A

Ataxia

155
Q

3 sensory systems that regulate body posture

A
  • Vision
  • Proprioception
  • Vestibular system
156
Q

the inability to control the distance, speed, and range of motion necessary to perform smoothly coordinated
movements

A

Dysmetria

157
Q

inability to perform rapid alternating movements

A

Dysdiadochokinesia

158
Q

In Cerebellar damage, remember

A

DANISH
Dysdiadochokinesia/Dysmetria
Ataxia
Nystagmus
Intention tremor
Speech – slurred or scanning
Hypotonia

159
Q

absence of touch sensation

A

Anesthesia

160
Q

decreased sensitivity to touch

A

Hypesthesia

161
Q

increased sensitivity to touch

A

Hyperesthesia

162
Q

absence of pain sensation

A

Analgesia

163
Q

decreased sensitivity to pain

A

Hypalgesia

164
Q

increased sensitivity to pain

A

Hyperalgesia

165
Q

Inability to correctly identify objects

A

astereognosis

166
Q

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.

A

Absent or markedly decreased (hyporeflexia)

167
Q

deep tendon reflexes (rated 4+) may be seen with lesions of the upper motor neurons and when the higher cortical levels are impaired.

A

Markedly hyperactive (hyperreflexia)

168
Q

are fibrous tissues that attach muscles to bones

A

Tendons

169
Q

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

A

Brudzinki’s sign

170
Q

when the patient is lying with the thigh flexed on the abdomen, the leg cannot be completely extended

A

Kernig’s sign

171
Q

Five Components of Mental Status Examination

A
  • Appearance and Behavior
  • Speech and Language
  • Mood
  • Thoughts and Perceptions
  • Cognitive Function
172
Q

in which phrases or sentences are substituted for a word the person cannot think of, such as “what your write with” for “pen”

A

Circumlocutions

173
Q

in which words are malformed (“I write with a den”),
wrong (“I write with a bar”), or invented (“I write with a dar”)

A

Paraphasias

174
Q

Disorders of Thought Processes

A
  • Circumstantiality
  • Derailment (loosening of associations)
  • Flight of Ideas
  • Neologisms
  • Incoherence
  • Blocking
  • Confabulation
  • Perseveration
  • Echolalia
  • Clanging
175
Q

The mildest though disorder, consisting of speech with
unnecessary detail, indirection, and delay in reaching the point

A

Circumstantiality

176
Q

“Tangential” speech with shifting topics that are loosely connected or unrelated. This patient is unaware of the lack of association

A

Derailment (loosening of associations)

177
Q

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

A

Flight of Ideas

178
Q

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”

A

Neologisms

179
Q

Speech that is incomprehensible and illogical, with lack of
meaningful connections, abrupt changes in topic, or disordered grammar or word use.

A

Incoherence

180
Q

Sudden interruption of speech in midsentence or before the
idea is completed, attributed to “losing the thought”

A

Blocking

181
Q

Fabrication of facts or events even in response to questions, to fill in the gaps from impaired memory

A

Confabulation

182
Q

Persistent repetition of words or ideas

A

Perseveration

183
Q

Repetition of the words and phrases of others

A

Echolalia

184
Q

Speech with choice of words based on sound, rather than meaning, as in rhyming and punning

A

Clanging

185
Q

Abnormalities of Thought Content

A
  • Compulsions
  • Obsessions
  • Phobias
  • Anxieties
  • Feelings of Unreality
  • Feelings of Depersonalization
  • Delusions
  • Illusions
  • Hallucinations
186
Q

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

A

Compulsions

187
Q

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

A

Obsessions

188
Q

Persistent irrational fears, accompanied by a compelling desire to avoid the provoking stimulus

A

Phobias

189
Q

Apprehensive anticipation of future danger or misfortune accompanied by feelings of worry, distress, and/or somatic symptoms of tension.

A

Anxieties

190
Q

A sense that the environment is strange, unreal, or remote

A

Feelings of Unreality

191
Q

A sense that one’s self or identity is different, changed,
unreal; lost or detached from one’s mind or body

A

Feelings of Depersonalization

192
Q

False fixed personal beliefs that are not amenable to change in light of conflicting evidences. Examples are persecutory, grandiose, jealous, erotomatic, somatic, unspecified

A

Delusions

193
Q

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

A

Illusions

194
Q

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

A

Hallucinations

health assessment - lecture (17 decks)

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