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Pt Assess II Final > Chapter 18 - Nervous System > Flashcards

Chapter 18 - Nervous System Flashcards

1
Q

Cerebrovascular disease is ___ leading cause of death in US

A

3rd

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2
Q

Mental status exam evaluates:

A
  • Level of consciousness
  • Speech
  • Orientation
  • Knowledge of current events
  • Judgment
  • Abstraction
  • Vocab
  • Emotional responses
  • Memory
  • Calculation ability
  • Object recognition
  • Praxis
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3
Q

Describe patients in a coma

A
  • Completely unconscious

- Cannot be roused even by painful stimuli

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4
Q

How to assess level of consciousness

A

Awake? Alert? Responsive?

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5
Q

How to evaluate a patient’s speech

A

Recite a short phrase like “no ifs, ands, or buts”

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6
Q

Define dysarthria

A

Difficulty in articulation

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7
Q

Define dysphonia

A

Difficulty in phonation (resulting in alteration in volume and tone of voice)

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8
Q

Lesions of the ____ are responsible for dysarthria

A

Tongue and palate

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9
Q

Lesions of the ____ are responsible for dysphonia

A

Palate and vocal cords

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10
Q

Define dysphasia

A

Difficulty comprehending or speaking

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11
Q

What causes dysphasia?

A

Cerebral dysfunction

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12
Q

Define aphasia

A

Total loss of speech

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13
Q

How to evaluate orientation

A

Patient’s awareness of self in relation to person, place, time

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14
Q

An abnormality in recent memory may be caused by a lesion where?

A

Temporal lobe

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15
Q

The ability to calculate depends on the integrity of what?

A

Dominant cerebral hemisphere AND patient’s intelligence

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16
Q

Define agnosia

A

Failure to recognize a sensory stimulus despite normal primary sensation

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17
Q

Define visual agnosia

A

Patient has normal vision and fails to recognize an object

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18
Q

Define tactile agnosia

A

Inability to recognize an object by palpation (w/o a sensory defect)

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19
Q

A lesion located in the ___ can cause tactile agnosia

A

Non-dominant parietal lobe

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20
Q

Define autotopagnosia

A

Patient’s inability to recognize his or her own body part

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21
Q

Define praxis

A

Ability to perform a motor activity

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22
Q

Define apraxia

A

Inability to perform a voluntary movement (w/o deficits in motor strength, sensation, or coordination)

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23
Q

Define dyspraxia

A

Decreased ability to perform a motor activity

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24
Q

Define constructional apraxia

A

Patient is unable to construct or draw simple designs (e.g. face of a clock)

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25
Q

A lesion in the ____ causes dyspraxia

A

Deep frontal lobe

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26
Q

A lesion in the ___ causes constructional apraxia

A

Posterior parietal lobe

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27
Q

CN 1 name and function

A

Olfactory - Smell

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28
Q

CN 2 name and function

A

Optic - Vision

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29
Q

CN 3 name and function

A

Oculomotor - eye movements, pupillary constriction, accommodation

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30
Q

CN 4 name and function

A

Trochlear - eye movements

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31
Q

CN 5 name and function

A

Trigeminal - general sensation of face/scalp/teeth, chewing movements

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32
Q

CN 6 name and function

A

Abducens - eye movements

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33
Q

CN 7 name and function

A

Facial - expressions, taste, general sensation of palate/external ear, salivary gland secretion

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34
Q

CN 8 name and function

A

Vestibulocochlear - hearing and equilibrium

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35
Q

CN 9 name and function

A

Glossopharyngeal - taste, elevation of palate, parotid gland secretion, general sensation of pharynx and ear

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36
Q

CN 10 name and function

A

Vagus - taste, swallowing, phonation, parasympathetic innervation of heart and abdominal viscera, general sensation of pharynx, larynx, ear

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37
Q

CN 11 name and function

A

Spinal accessory - phonation, head/neck/shoulder movements

38
Q

CN 12 name and function

A

Hypoglossal - tongue movements

39
Q

When should CN 1 be tested?

A

Suspected frontal lobe disorder

40
Q

Divisions of trigeminal nerve

A

Ophthalmic
Maxillary
Mandibular

41
Q

Unilateral weakness of CN 5 (motor) causes what to happen when patient chews?

A

Jaw deviates TOWARD side of lesion

42
Q

How do upper motor neuron lesions affect the face?

A

Contralateral weakness of lower face but SPARES forehead (e.g. stroke)

43
Q

How do lower motor neuron lesions affect the face?

A

Total paralysis of ipsilateral face, does NOT spare forehead

e.g. Bells palsy

44
Q

Fasciculations are indicative of a ___ lower motor neuron lesion

A

Hypoglossal

45
Q

The motor system is evaluated for:

A

Muscle bulk, strength, tone

46
Q

Proximal muscle weakness is related to:

A

Muscle disease

47
Q

Distal muscle weakness is related to:

A

Neurologic disease

48
Q

Define muscle tone

A

Slight residual tension in a voluntarily relaxed muscle

49
Q

How is muscle tone assessed?

A

Resistance to passive movement

50
Q

What clinical features do upper motor neuron lesions produce?

A

Hyperreflexia
Babinski’s sign
Clonus
Spasticity

51
Q

What clinical features do lower motor neuron lesions produce?

A

Hyporeflexia
Fasciculations
Atrophy
Decreased tone

52
Q

How can you make fasciculations more apparent?

A

Gently tap muscle with reflex hammer

53
Q

Define cogwheeling

A

Ratchety jerkiness to motion

54
Q

Hyperactive reflexes are characteristic of what type of disease?

A

Pyramidal tract

electrolyte abnormalities, hyperthyroid

55
Q

Diminished reflexes are characteristic of what type of disease?

A

Anterior horn cell disorders and myopathies

56
Q

What is a hung reflex?

A
  • Decreased relaxation after a DTR

- Occurs with hypothyroidism pts

57
Q

Describe reinforcement with DTRs

A
  • When someone has decreased DTRs, try reinforcement

- Isometric contraction of other muscles (clenching teeth, push down on bed with thighs)

58
Q

What is Jendrassik’s maneuver?

A
  • A form of reinforcement to try to elicit LE DTRs

- Patient locks fingers and tries to pull them apart

59
Q

What DTRs are routinely tested?

A 
Biceps
Triceps
Brachioradialis
Patellar
Achilles
60
Q

What are the superficial reflexes?

A
  • Abdominal (umbilicus moves toward stimulus)

- Cremasteric (men only, ipsilateral testicle raises)

61
Q

The superficial abdominal reflex is frequently NOT seen in which patients?

A

Obese

62
Q

What is the clinical significance of superficial reflexes?

A

LITTLE significance

63
Q

What is Chaddock’s sign?

A
  • Abnormal reflex a/w pyramidal disease

- Lateral aspect of foot is stroked and big toe dorsiflexes

64
Q

What is Oppenheim’s sign?

A
  • Abnormal reflex a/w pyramidal disease

- Downward pressure along the shin causes big toe to dorsiflex

65
Q

What is Hoffmann’s sign?

A
  • Abnormal reflex a/w pyramidal disease
  • Flick fingernail of middle finger
  • Positive response is adduction and flexion of thumb (the ok symbol)
66
Q

Sensory exam consists of:

A
  • Light touch
  • Pain sensation
  • Vibration sense
  • Proprioception
  • Tactile localization
  • Discriminative sensations (2 point, stereognosis, graphesthesia)
67
Q

Vibration sense is tested using what?

A

128-Hz tuning fork

68
Q

How is proprioception tested?

A

Moving distal phalanx subtly (hold the sides of the digit)

69
Q

Stereognosis is the integrative function of which lobes?

A

Parietal and occipital

70
Q

How is cerebellar function tested?

A 
FNF (finger nose finger)
HKS (heel knee shin)
Rapid alternating movement
Romberg
Gait
71
Q

Define past pointing

A

Patients with cerebellar disease persistently overshoot the target in FNF testing

72
Q

Define diadochokinesia

A

Ability to perform rapid alternating movements

73
Q

Pronator drift is seen in patients with:

A

Mild hemiparesis

74
Q

What is the Romberg test examining?

A

Posterior columns (rather than actual cerebellar function)

75
Q

A patient with ____ tends to drag or circumduct a weak and spastic leg

A

Hemiplegia

76
Q

A patient with ____ tends to shuffle with short, hurried steps

A

Parkinson’s

77
Q

A patient with ____ walks with a wide based gait

A

Cerebellar ataxia

78
Q

A patient with ____ has a slapping gait resulting from weakness of the ankle dorsiflexors

A

Footdrop

79
Q

A patient with ____ has a high stepping gait in which the feet are slapped down firmly

A

Sensory ataxia

80
Q

Decorticate posture - which abnormalities/lesions?

A

Cerebral hemispheric dysfunction OR destructive lesion of pyramidal tracts

81
Q

Decerebrate posture - which abnormalities/lesions?

A

Midbrain or pons lesion

82
Q

What does decorticate posture look like?

A

Arms adducted
Elbows/wrists/fingers flexed
Legs internally rotated
Feet plantarflexed

83
Q

What does decerebrate posture look like?

A

Arms adducted
Elbows extended, forearms pronated
Wrists/fingers flexed
Feet plantarflexed

84
Q

Central neurogenic hyperventilation is see in lesions of:

A

Midbrain or pons

85
Q

Describe Cheyne-Stokes breathing

A

Rapid breathing separated by apnea episodes

A/w brainstem compression or bilateral cerebral dysfunction

86
Q

Brainstem lesion and doll’s eyes reflex

A

Doll’s eyes reflex is ABSENT with a brainstem lesion

87
Q

Doll’s eye reflex

A
  • Turning a comatose pt’s head rapidly to one side while eyelids are held open
  • Eyes SHOULD move conjugately to the other side
88
Q

Why can doll’s eyes reflex only be elicited in a comatose patient?

A

Alert individuals will fixate on an object and override the reflex

89
Q

What is caloric stimulation and what is it used for?

A
  • Head flexed at 30 degrees, syringe of ice water is squeezed into one of the external auditory canals
  • NORMAL response is nystagmus away from irrigation (warm water would cause nystagmus toward irrigation)
  • Used to enhance doll’s eyes reflex or to test movements in a person with fractured cervical spine
90
Q

How to remember caloric stimulation?

A

COWS - Cold Opposite, Warm Same

  • Cold water causes nystagmus to other side of irrigation
  • Warm water causes nystagmus to same side of irrigation
91
Q

Extrapyramidal system is composed of:

A

Basal ganglia
Nuclei of midbrain and reticular formation
Cerebellum

Pt Assess II Final (17 decks)

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