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Bates Reviews > Chapter 17: The Nervous System > Flashcards

Chapter 17: The Nervous System Flashcards

1
Q

Central nervous system

A

brain and spinal cord

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2
Q

peripheral nervous system

A

12 pairs of cranial nerves, spinal and peripheral nerves

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3
Q

frontal lobe

A

The frontal lobes are considered our emotional control center and home to our personality. There is no other part of the brain where lesions can cause such a wide variety of symptoms (Kolb & Wishaw, 1990). The frontal lobes are involved in motor function, problem solving, spontaneity, memory, language, initiation, judgement, impulse control, and social and sexual behavior. The frontal lobes are extremely vulnerable to injury due to their location at the front of the cranium, proximity to the sphenoid wing and their large size.

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4
Q

parietal lobe

A

The parietal lobes can be divided into two functional regions. One involves sensation and perception and the other is concerned with integrating sensory input, primarily with the visual system. The first function integrates sensory information to form a single perception (cognition). The second function constructs a spatial coordinate system to represent the world around us. Individuals with damage to the parietal lobes often show striking deficits, such as abnormalities in body image and spatial relations (Kandel, Schwartz & Jessel, 1991).

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5
Q

occipital lobe

A

The occipital lobes are the center of our visual perception system. They are not particularly vulnerable to injury because of their location at the back of the brain, although any significant trauma to the brain could produce subtle changes to our visual-perceptual system, such as visual field defects and scotomas.

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6
Q

cerebellum

A

The cerebellum is involved in the coordination of voluntary motor movement, balance and equilibrium and muscle tone. It is located just above the brain stem and toward the back of the brain

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7
Q

brainstem

A

The brain stem plays a vital role in basic attention, arousal, and consciousness. All information to and from our body passes through the brain stem on the way to or from the brain. Like the frontal and temporal lobes, the brain stem is located in an area near bony protrusions making it vulnerable to damage during trauma.

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8
Q

midbrain

A

The midbrain or mesencephalon (from the Greek mesos - middle, and enkephalos - brain[1]) is a portion of the central nervous system associated with vision, hearing, motor control, sleep/wake, arousal (alertness), and temperature regulation

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9
Q

pons

A

The pons is a structure located on the brain stem, named after the Latin word for “bridge” or the 16th-century Italian anatomist and surgeon Costanzo Varolio (pons Varolii).[1] It is cranial to the medulla oblongata, caudal to the midbrain, and ventral to the cerebellum. In humans and other bipeds, this means it is above the medulla, below the midbrain, and anterior to the cerebellum. This white matter includes tracts that conduct signals from the cerebrum down to the cerebellum and medulla, and tracts that carry the sensory signals up into the thalamus.[2]
The pons in humans measures about 2.5 cm in length. Most of it appears as a broad anterior bulge rostral to the medulla. Posteriorly, it consists mainly of two pairs of thick stalks called cerebellar peduncles[disambiguation needed]. They connect the cerebellum to the pons and midbrain.[3]
The pons contains nuclei that relay signals from the forebrain to the cerebellum, along with nuclei that deal primarily with sleep, respiration, swallowing, bladder control, hearing, equilibrium, taste, eye movement, facial expressions, facial sensation, and posture

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10
Q

medulla

A

The medulla oblongata is a portion of the hindbrain that controls autonomic functions such as breathing, digestion, heart and blood vessel function, swallowing and sneezing.

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11
Q

Spinal cord

A

C1-7
T1-12
L1-5
S1-5

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12
Q

CN1

A

(S)olfactory-smell

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13
Q

CN2

A

(S)optic: vision

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14
Q

CN3

A

(M)occulomotor: pupil constriction, opening eye(lid elevation), most EOM

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15
Q

CN4

A

(M)Trochlear: downward, inward rotation of eye

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16
Q

CN5

A

(B)Trigeminal: motor: jaw clenching; lateral jaw movement

sensory: facial. nerve has 3 divisions-opthalmic, maxillary, mandibular

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17
Q

CN6

A

(M)Abducens:lateral deviation of eye

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18
Q

CN7

A

(B)-facial:
motor: facial movements, expression, closing eye, closing mouth

sensory: taste for salty, sweet, sour, bitter (anterior 2/3 tongue)

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19
Q

CN8

A

(S)-acoustic: hearing-cochlear division; balance-vestibular division

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20
Q

CN9

A

(B) Glossopharyngeal

motor: pharynx
sensory: posterior portions of eardrum, ear canal, posterior tongue taste

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21
Q

CN10

A

(B) Vagus

motor: palate, pharynx, larynx
sensory: pharynx, larynx

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22
Q

CN11

A

(M): spinal accessory-sternomastoid and upper portion of trapezius

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23
Q

CN12

A

(M)-hypoglossal-tongue

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24
Q

DTR physiology

A

over both CNS and PNS. Involuntary stereotypical response that may involve as little as 2 neurons (1 afferent sensory, 1 efferent motor) across a single synapse. tapping the tendon activates special sensory fibers in the partially stretched muscle, triggering a sensory impulse that travels to the spinal cord via a peripheral nerve. the stimulated sensory fiber synapses directly with the anterior horn cell innervating the same muscle. when the impulse crosses the neuromuscular junction, the muscle suddenly contracts, completing reflex arc

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25
Q

grading muscle strength

A

0-no muscular strength
1-a barely detectable flicker or trace of contraction
2-active movement of body part with gravity eliminated
3-active movement against gravity
4- active movement against gravity with some resistance
5-active movement against full resistance without evident fatigue-normal

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26
Q

coordination requirements

A

4 areas: muscle strength/system; cerebellar system (rhythmic movement and steady posture; vestibular system (balance and coordinating eye, head, body movements); sensory system for position sense

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27
Q

Rapid Alternating Movements (RAM)-arms

A
  1. Hand to thigh-palmar/dorsum
  2. Thumb tapping to index finger fast

cerebellar disease will impair movements

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28
Q

Rapid Alternating Movements (RAM)-legs

A

patient taps ball of foot to your hand

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29
Q

Point-to-point movements:arms

A

finger-to nose
In cerebellar disease movements are clumsy, unsteady, inappropriately varying of speed, force, and direction. finger may overshoot its mark and finally reach it-dysmetria

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30
Q

Point-to-point movements:legs

A

heel-to-shin. place heel to opposite knee and run down shin

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31
Q

gait

A

walk across room, her-to-toe, walk on toes then heels

32
Q

stance: romberg

A

romberg: position sense-patient stand feet together and with eyes open and then close both eyes for 30-60 seconds w/o support. . In ataxia from dorsal column disease and loss of position sense, vision compensates for the sensory loss. the patient stands fairly well with eyes open but loses balance when they are closed=positive romberg.
cerebellar ataxia: difficulty standing with feet together eyes open or closed

33
Q

stance pronator drift

A

patient stands for 20-30 seconds with both arms straight forward palms up, and with eyes closed. normal-person holds arms well. now instruct patient to maintain arm position and tap arms briskly downward-arms normally return to horizontal position. pronation of one forearm=corticospinal tract lesion in contralateral hemisphere

34
Q

Sensory system: pain

A

spinothalmic tracts:

sharp or dull: cotton swab versus paperclip tip

35
Q

sensory system: temp

A

spinothalmic: hot versus cold (test tubes w hot and cold water)

36
Q

sensory system: light touch

A

spinothalmic and posterior

wisp of cotton-ask when pt feels something

37
Q

sensory system: vibration

A

tuning fork to joint locations-ask what patient feels

38
Q

sensory system:proprioception (position)

A

start with big toe and pt eyes closed. ask when up or down then move proximal with ankle, fingers, wrist, elbow

39
Q

discriminative sensations:for?

A

test ability of the sensory cortex to correlate, analyze, and interpret sensations. They depend on touch and position sense. If diminished-disease of sensory cortex

40
Q

stereognosis

A

ability to identify an object by feeling. familiar object in hand: coin, paperclip, key, pencil. Distinguishing heads from tails is a sensitive test
**astereognosis: inability to recognize objects in hand

41
Q

number identification

A

if patient unable to handle objects in hand draw a number using blunt object in the patients palm

Graphesthesia

42
Q

2-point discrimination

A

using the 2 ends of a paperclip touch a finger pad in 2 places simultaneously. alternate with one point touch. Record the minimal distance at which the patient can discriminate one from 2 points, normally less than 5mm in finger pads. lesions of the sensory cortex will increase the distance between recognizable points

43
Q

point localization

A

briefly touch a point on the patients skin with eyes closed. have patient open eyes and point to place touched

44
Q

extinction

A

touch corresponding areas on both sides of the body. normally patient can feel both at same time

45
Q

dermatomes

A

areas of skin innervated by single nerve root

46
Q

Grading reflexes

A 
0-none
1+ somewhat diminished low normal
2+ average normal
3+ brisker than average; possibly indicative of disease
4+very brisk hyper reactive; clonic
47
Q

anal reflex

A

last reflex to die

48
Q

meningeal signs

A

neck mobility: normally neck is supple and pt able to flex chin to chest w/o difficulty

49
Q

brudzinski’s sign

A

as flexing neck watch the hips and knees in response-normally relaxed; flexion of hips and knees=positive sugest irritation

50
Q

Kernig’s sign

A

flex pt leg at both the hip and knee and then straighten the knee. normally should not produce pain (discomfort upon full extension behind knee may be normal)
=pain and increased resistance to extending the knee =positive sign (bilateral)

51
Q

asterixis

A

helps identify metabolic encephalopathy. ask patient to “stop traffic” by extending both arms with hands cocked up and fingers spread. watch for 1-2 minutes. sudden brief nonrhythmic flexion of the hands and fingers indicative of liver disease, uremia, and hypercapnia

52
Q

resting (static) tremors

A

most present at rest-decrease or disappear with voluntary movement-pill-rolling tremors of parkinsons

53
Q

postural (action) tremors

A

during maintenance of posture; hyperthyroid, anxiety, fatigue

54
Q

intention tremors

A

absent at rest and appear with activity worse as gets near target-disorders of cerebellar pathways such as MS

55
Q

oral-facial dyskinesias

A

rhythmic, repetitive, bizarre movements that invlove the face, mouth, jaw, and tongue-tardive dyskinesia.
psychoses

56
Q

tics

A

brief repetitive stereotyped coordinated movements occuring at irregular interval. tourettes and drugs such as phenothiazines and amphetamines

57
Q

nystagmus

A

defined by its fast phase: example if the eyes jerk quickly to the patients left and drift back slowly to the right, the patient is said to have left-beating nystagmus

58
Q

discriminative sensations:for?

A

test ability of the sensory cortex to correlate, analyze, and interpret sensations. They depend on touch and position sense. If diminished-disease of sensory cortex

59
Q

stereognosis

A

ability to identify an object by feeling. familiar object in hand: coin, paperclip, key, pencil. Distinguishing heads from tails is a sensitive test
**astereognosis: inability to recognize objects in hand

60
Q

number identification

A

if patient unable to handle objects in hand draw a number using blunt object in the patients palm

61
Q

2-point discrimination

A

using the 2 ends of a paperclip touch a finger pad in 2 places simultaneously. alternate with one point touch. find the minimal distance at which the patient can discriminate one from 2 points, normally less than 5mm in finger pads. lesions of the sensory cortex will increase the distance between recognizable points

62
Q

point localization

A

briefly touch a point on the patients skin with eyes closed. have patient open eyes and point to place touched

63
Q

extinction

A

touch corresponding areas on both sides of the body. normally patient can feel both at same time

64
Q

dermatomes

A

areas of skin innervated by single nerve root

65
Q

Grading reflexes

A 
0-none
1+ somewhat diminished low normal
2+ average normal
3+ brisker than average; possibly indicative of disease
4+very brisk hyper reactive; clonic
66
Q

anal reflex

A

last reflex to die

67
Q

meningeal signs

A

neck mobility: normally neck is supple and pt able to flex chin to chest w/o difficulty

68
Q

brudzinski’s sign

A

as flexing neck watch the hips and knees in response-normally relaxed; flexion of hips and knees=positive sugest irritation

69
Q

Kernig’s sign

A

flex pt leg at both the hip and knee and then straighten the knee. normally should not produce pain (discomfort upon full extension behind knee may be normal)
=pain and increased resistance to extending the knee =positive sign (bilateral)

70
Q

asterixis

A

helps identify metabolic encephalopathy. ask patient to “stop traffic” by extending both arms with hands cocked up and fingers spread. watch for 1-2 minutes. sudden brief nonrhythmic flexion of the hands and fingers indicative of liver disease, uremia, and hypercapnia

71
Q

resting (static) tremors

A

most present at rest-decrease or disappear with voluntary movement-pill-rolling tremors of parkinsons

72
Q

postural (action) tremors

A

during maintenance of posture; hyperthyroid, anxiety, fatigue

73
Q

intention tremors

A

absent at rest and appear with activity worse as gets near target-disorders of cerebellar pathways such as MS

74
Q

oral-facial dyskinesias

A

rhythmic, repetitive, bizarre movements that invlove the face, mouth, jaw, and tongue-tardive dyskinesia.
psychoses

75
Q

tics

A

brief repetitive stereotyped coordinated movements occuring at irregular interval. tourettes and drugs such as phenothiazines and amphetamines

76
Q

nystagmus

A

defined by its fast phase: example if the eyes jerk quickly to the patients left and drift back slowly to the right, the patient is said to have left-beating nystagmus

77
Q

Cranial nerves sensory/motor acronym

A

Some Say Marilyn Monroe, But My Brother Says Bridgette Bardot Mmmmmm Mmmmm

Bates Reviews (22 decks)

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