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Neurology > Bates Ch 17- The Nervous System > Flashcards

Bates Ch 17- The Nervous System Flashcards

1
Q

Which cranial nerve(s) is(are) involved in . . . smell?

A

CNI - olfactory

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2
Q

Which cranial nerve(s) is(are) involved in . . .visual acuity, visual fields, and ocular fundi?

A

CN2 - optic nerve

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3
Q

Which cranial nerve(s) is(are) involved in . . . pupillary reactions?

A

CN2 (optic nerve) & CN3 (oculomotor)

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4
Q

Which cranial nerve(s) is(are) involved in . . . extraocular movements?

A

CN3 (oculomotor), CN4 (trochlear), CN6 (abducens)

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5
Q

Which cranial nerve(s) is(are) involved in . . . corneal reflexes, facial sensation, and jaw movements?

A

CNV (trigeminal)

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6
Q

Which cranial nerve(s) is(are) involved in . . . facial movements?

A

CNVII (facial)

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7
Q

Which cranial nerve(s) is(are) involved in . . . hearing?

A

CNVIII (vestibulocochlear)

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8
Q

Which cranial nerve(s) is(are) involved in . . . swallowing and rise of the palate, gag reflex?

A

CNIX (Glossopharyngeal) & CNX (Vagus)

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9
Q

Which cranial nerve(s) is(are) involved in . . . voice and speech?

A

CNV (trigeminal) VII (facial), X (vagus), XII (hypoglossal)

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10
Q

Which cranial nerve(s) is(are) involved in . . . shoulder and neck movements?

A

CNXI (accessory/spinal accessory)

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11
Q

Which cranial nerve(s) is(are) involved in . . . tongue symmetry and position?

A

CNXII (hypoglossal)

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12
Q

What conditions might be associated with loss of smell?

A
  • sinus conditions
  • head trauma
  • smoking
  • aging
  • use of cocaine
  • Parkinson’s disease
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13
Q

What diseases are associated with prechiasmal or anterior defects in visual field/acuity?

A
  • glaucoma
  • retinal emboli
  • optic neuritis (visual acuity poor)
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14
Q

Hemianopsia or hemianopia

A

is visual field loss that respects the vertical midline, and usually affects both eyes, but can involve one eye only

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15
Q

Homonymous hemianopsia, or homonymous hemianopia

A

occurs when there is hemianopic visual field loss on the same side of both eyes

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16
Q

Anisocoria

A

difference of >0.4mm in diameter of 1 pupil compared to other (seen in up to 38% of healthy individuals)

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17
Q

diplopia

A

double vision

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18
Q

monocular diplopia can occur with . . .

A
  • local problems with glasses or contact lenses
  • cataracts
  • astigmatism
  • ptosis (drooping or falling of the upper or lower eyelid)
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19
Q

binocular diplopia can occur with . . .

A
  • CN III (oculomotor), IV (trochlear), VI (abducens) neuropathy (40% of pts)
  • eye muscle disease from myasthenia gravis
  • trauma
  • thyroid ophthalmopathy
  • internuclear ophthalmoplegia
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20
Q

nystagmus

A
  • involuntary jerking movement of the eyes with quick and slow components (“Dancing Eyes”)
  • should note direction of gaze, plane (horizontal, vertical, rotary, or mixed), direction of quick and slow components (name based on direction of quick component)
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21
Q

ptosis can occur with

A

3rd nerve palsy (oculomotor nerve), Horner’s syndrome, myasthenia gravis

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22
Q

Horner’s syndrome symptoms

A

ptosis, miosis (constriction of the pupil), anhidrosis (decreased sweating of face on same side as prob)

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23
Q

spinothalamic tract involved in sensation of

A

pain & temperature

24
Q

posterior columns involved in sensation of

A

position & vibration

25
Q

What tuning fork should be used for vibration sense?

A

128 Hz (relatively low pitched)

26
Q

Where do you test vibration sense?

A

on bony prominences (start with distal toe bone or finger and then move more proximally if vibration sense impaired

27
Q

Common causes of loss of vibration sense

A
  • diabetes
  • alcoholism
  • posterior column disease
  • tertiary syphilis
  • vitamin B12 deficiency
28
Q

Some causes of loss of position sense

A

[- tabes dorsalis

  • multiple sclerosis
  • B12 deficiency] from posterior column disease
  • in peripheral neuropathy from diabetes
29
Q

When are discriminative sensation test useful?

A

when touch and position sensation are intact (or only slightly impaired) b/c discrim sens test depend on this

30
Q

What does it mean if touch and position sensation intact or only sightly impaired, but there is a disproportionately decrease or loss of discrimination sensation?

A

sensory cortex problem

31
Q

stereogenesis

A

ability to id an object by feeling it

32
Q

What are three tests of discrimination sensation?

A
  • stereogenesis
  • # identification
  • 2 point discrimination
  • pt localization
  • extinction
33
Q

with lesion in sensory cortex . . .

A
  • astereogenesis - inability to recognize objects placed in hand
  • inability to recognize #s traced into hand
  • incr distance btw 2 recognizable points
  • impaired ability to localize points accurately
  • may see extinction on contralateral side of damage
34
Q

dermatome

A

band of SKIN innervated by SENSORY root of SINGLE spinal nerve

35
Q

caveat about dermatomes

A

more variable than diagrams suggest

36
Q

scale for grading reflexes

A 
4+ very brisk, hyperactive, with clonus
3+ brisker than average; possibly but not necessarily indicative of disease
2+ average; normal 
1+ somewhat diminished; low normal
0 No response
37
Q

hyperactive reflexes may indicate

A

CNS lesion along the descending corticospinal tract

38
Q

hypoactive reflexes may indicate

A

disease of spinal nerve roots, spinal nerves, plexuses, or peripheral nerves

39
Q

what to do if patient’s reflexes are symmetrically diminished or absent?

A

use reinforcement

40
Q

which two reflexes should you do on your finger and not directly on the patient’s tendon?

A

biceps and brachioradialis (according to dr. kendall) but the bates book says pointed or flat edge of reflex hammer fo rthe brachioradialis/supinator reflex

41
Q

When might a patient have a Babinski response?

A
  • CNS lesion in the corticospinal tract
  • seen in unconscious states from drug or alcohol intox
  • postictal period following a seizure
  • babies!!
42
Q

What does loss of anal reflex suggest?

A

lesion in S2-3-4 reflex arc as in a cauda equina lesion

43
Q

positive Brudzinski’s sign

A

flexion of hips and knees when the neck is flexed

- suggests meningeal inflammation

44
Q

positive Kernig’s sign

A

pain and increased resistance to extending the knee

  • when bilateral, suggests meningeal irritation
  • compression of lumbosacral root can also cause pos Kernig’s sign (usu 1 leg + pain in low back and posterior thigh
45
Q

asterixis

A
  • helps id metabolic encephalopathy in patients w/ impaired mental fxn
  • ask pt to stop traffic –> sudden brief, nonrhytmic flexion of hands and fingers
  • seen in liver disease, uremia, and hypercapnia
46
Q

winging of scapula suggests

A

weakness of serratus anterior muscle

- seen in muscular dystrophy or injury to long thoracic nerve

47
Q

aphonia

A

loss of voice

48
Q

dysphonia

A

impairment in volume, quality, or pitch of voice

49
Q

dysarthria

A

defect in muscular control of speech apparatus; words may be nasal, slurred, or indistinct

50
Q

some causes of dysarthria

A

motor lesions of CNS or PNS, parkinsonism, cerebellar disease

51
Q

aphasia

A

disorder in producing or understanding language

- often caused by lesions in dominant cerebral hemisphere

52
Q

Wernicke’s aphasia

A

fluent/receptive aphasia

  • often rapid, voluble, effortless
  • inflection and articulation good
  • sentences lack meaning, words malformed (paraphasias) or invented (neologisms)
  • speech may be totally incomprehensible
  • impaired word comprehension, repetition, naming, reading comp, writing
53
Q

Broca’s aphasia

A

nonfluent/expressive aphasia

  • slow, with few words and laborious effort
  • inflection and articulation impaired but words meaningful, with nouns, transitive verbs, and important adjective
  • word and reading comprehension fair to good
  • repetition and writing impaired
  • naming impaired though pt recognizes objects
54
Q

location of lesion in Wernicke’s aphasia

A

posterior superior temporal lobe

55
Q

location of lesion in Broca’s aphasia

A

posterior inferior temporal lobe

Neurology (10 decks)

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