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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
What tuning fork should be used for vibration sense?
128 Hz (relatively low pitched)
26
Where do you test vibration sense?
on bony prominences (start with distal toe bone or finger and then move more proximally if vibration sense impaired
27
Common causes of loss of vibration sense
- diabetes - alcoholism - posterior column disease - tertiary syphilis - vitamin B12 deficiency
28
Some causes of loss of position sense
[- tabes dorsalis - multiple sclerosis - B12 deficiency] from posterior column disease - in peripheral neuropathy from diabetes
29
When are discriminative sensation test useful?
when touch and position sensation are intact (or only slightly impaired) b/c discrim sens test depend on this
30
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?
sensory cortex problem
31
stereogenesis
ability to id an object by feeling it
32
What are three tests of discrimination sensation?
- stereogenesis - # identification - 2 point discrimination - pt localization - extinction
33
with lesion in sensory cortex . . .
- 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
dermatome
band of SKIN innervated by SENSORY root of SINGLE spinal nerve
35
caveat about dermatomes
more variable than diagrams suggest
36
scale for grading reflexes
``` 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
hyperactive reflexes may indicate
CNS lesion along the descending corticospinal tract
38
hypoactive reflexes may indicate
disease of spinal nerve roots, spinal nerves, plexuses, or peripheral nerves
39
what to do if patient's reflexes are symmetrically diminished or absent?
use reinforcement
40
which two reflexes should you do on your finger and not directly on the patient's tendon?
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
When might a patient have a Babinski response?
- CNS lesion in the corticospinal tract - seen in unconscious states from drug or alcohol intox - postictal period following a seizure - babies!!
42
What does loss of anal reflex suggest?
lesion in S2-3-4 reflex arc as in a cauda equina lesion
43
positive Brudzinski's sign
flexion of hips and knees when the neck is flexed | - suggests meningeal inflammation
44
positive Kernig's sign
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
asterixis
- 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
winging of scapula suggests
weakness of serratus anterior muscle | - seen in muscular dystrophy or injury to long thoracic nerve
47
aphonia
loss of voice
48
dysphonia
impairment in volume, quality, or pitch of voice
49
dysarthria
defect in muscular control of speech apparatus; words may be nasal, slurred, or indistinct
50
some causes of dysarthria
motor lesions of CNS or PNS, parkinsonism, cerebellar disease
51
aphasia
disorder in producing or understanding language | - often caused by lesions in dominant cerebral hemisphere
52
Wernicke's aphasia
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
Broca's aphasia
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
location of lesion in Wernicke's aphasia
posterior superior temporal lobe
55
location of lesion in Broca's aphasia
posterior inferior temporal lobe

Neurology (10 decks)

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