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Neurology > Clinical Skills > Flashcards

Clinical Skills Flashcards

1
Q

What are the six cognitive domains?

A

memory, language, perception, praxis, executive function, speed of processing

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2
Q

Define the memory cognitive domain?

A

Ability to recall information; involves multiple brain regions (including temporal lobes & hippocampus

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3
Q

Define the executive functions cognitive domain?

A

A range of skills that allow a person to establish new ways of thinking and behaviour patterns; and to introspect. Associated with frontal brain regions.

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4
Q

Describe what area will be affected in a CNS problem?

A

hemiplegia, paraplegia or a whole limb

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5
Q

Describe what area will be affected in a PNS problem?

A

May be peripheral or localised area or can be whole limb if a plexus is involved

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6
Q

Describe what area will be affected in a NMJ problem?

A

Ocular (eyes) / bulbar (palsy of cranial nerves 7-12) / proximal limb

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7
Q

Describe what area will be affected in a muscle problem?

A

Proximal muscles and will be symmetrical

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8
Q

Describe the description of a weakness due to problem in CNS?

A

Heaviness

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9
Q

Describe a description of a weakness due to problem in PNS?

A

positional may get worse in sleep (e.g. carpal tunnel syndrome) or foot goes to sleep sitting in certain position
ascending- starts in the feet and moves uo

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10
Q

Describe a description of a weakness due to a problem in NMJ?

A 
fatiguable (worse after use of the muscles)
Diurnal variation (worse towards end of day)
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11
Q

Describe a description of a weakness due to a problem in muscle?

A

may also have aching, may be insidious in onset

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12
Q

Describe additional features in a CNS problem?

A

spasm or jerks

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13
Q

Describe additional features in a PNS problem?

A

cramp and twitching (aka fasciculation)

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14
Q

Describe additional features in a NMJ problem?

A

bulbar: issues with swallowing and speaking
ocular issues with diplopia and ptosis
respiratory: orthopnoea, sob on exertion

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15
Q

Describe additional features in a muscle problem?

A

myalgia and cramp

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16
Q

Are sensory symptoms possible in a CNS or PNS problem causing weakness?

A

Yes

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17
Q

Are sensory symptoms possible in a NMJ or muscle problem causing weakness?

A

No (at this point only motor fibres are present)

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18
Q

In a CNS problem causing weakness what additional difficulties are possible?

A 
Cognitive 
sphincter involvement (changes to urinary frequency)
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19
Q

In a PNS problem causing weakness what additional difficulties are possible?

A

Loss of grip
Tripping up
Unsteady with eyes closed

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20
Q

In a NMJ problem causing weakness what additional difficulties are possible?

A

lots of chewing

Difficulties speaking or holding a prolonged gaze (may be apparent when trying to read or on prolonged drives)

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21
Q

In a muscle problem causing weakness what additional difficulties are possible?

A

Getting up from low chairs
Hanging up washing
(things that involve big proximal muscles)

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22
Q

In a CNS problem causing weakness what may you see on inspection?

A

changed posture

23
Q

In a PNS problem causing weakness what may you see on inspection?

A

wasting of muscles
twitching / fasciculation
pes cavus

24
Q

In a NMJ problem causing weakness what may you see on inspection?

A

ptosis

ophthalmoplegia

25
Q

In a muscle problem causing weakness what may you see on inspection?

A

proximal wasting

26
Q

In a CNS problem causing weakness describe tone?

A

increased

there is spasticity and clonus

27
Q

In a PNS problem causing weakness describe tone?

A

decreased tone

28
Q

In a NMJ problem causing weakness describe tone?

A

no change (or slight decrease shouldn’t see increase)

29
Q

In a muscle problem causing weakness describe tone?

A

no change (or slight decrease shouldn’t see increase)

30
Q

In a CNS problem what would pattern of weakness be?

A

pyramidal pattern
in the arms the extensors are weaker than flexors
in the legs the flexors are weaker than extensors

31
Q

In a PNS problem what would pattern of weakness be?

A

distal weakness
specific pattern depends on whether it is a root problem (small area), plexus (arms or legs), mononeuropathy (in distribution of one nerve) or a polyneuropathy (commonly has a glove and stocking distribution)

32
Q

In a NMJ problem what would pattern of weakness be? How is it assessed?

A

fatiguability

bulbar: counting out loud
ocular: fixed gaze - do they develop double vision
ptosis: fixed up gaze
limb: repetitive movement

33
Q

In a muscle problem what would pattern of weakness be?

A

proximal symmetrical weakness

34
Q

In a CNS problem causing weakness reflexes will be _____

A

increased

35
Q

In a PNS problem causing weakness reflexes will be _____

A

decreased

36
Q

In a NMJ problem causing weakness reflexes will be _____

A

normal (maybe decreased but not increased)

37
Q

In a muscle problem causing weakness reflexes will be _____

A

normal (maybe decreased but not increased)

38
Q

In a CNS problem causing weakness the plantar response will be _______

A

extensor

39
Q

In a PNS problem causing weakness the plantar response will be _______

A

flexor (sometimes mute)

40
Q

In a NMJ problem causing weakness the plantar response will be _______

A

flexor

41
Q

In a muscle problem causing weakness the plantar response will be _______

A

flexor

42
Q

In a CNS problem causing weakness the associated sensory symptoms will occur in what pattern?

A

with brain it will be one side

with the spinal cord there will be sensory level

43
Q

Where is the lesion likely located?

Increased tone and reflexes, weakness in a pyramidal pattern, extensor plantar response, associated sensory symptoms on same side of body?

A

CNS lesion (brain)

44
Q

Where is the lesion likely located?

Increased tone and reflexes, weakness in a pyramidal pattern, extensor plantar response, there is a sensory level?

A

CNS (spinal Cord)

45
Q

Where is the lesion likely located?

Decreased tone and reflexes, distal weakness, flexor plantar response, glove and stocking distribution?

A

PNS

46
Q

Where is the lesion likely located?

Decreased tone and reflexes, fatiguability, flexor plantar response, no associated sensory symptoms?

A

NMJ

47
Q

Where is the lesion likely located?

Proximal muscle wasting, decreased tone and reflexes, proximal weakness, flexor plantar response, no associated sensory symptoms?

A

muscle

48
Q

Where is the lesion likely located?

hemiplegia or paraplegia, described as heaviness, spasms and jerks, sensory symptoms, sphincter involvement and or cognitive involvement?

A

CNS

49
Q

Where is the lesion likely located?

localised area, worse after sleep, cramping, twitching, sensory symptoms, loss of grip?

A

PNS

50
Q

Where is the lesion likely located?

worse after use of muscles, diplopia, no sensory symptoms, finds prolonged gaze difficult?

A

NMJ

51
Q

Where is the lesion likely located?

proximal symmetrical muscles affected, aching pains, cramps, no sensory symptoms, finds getting up from chairs and hanging washing difficult

A

muscle

52
Q

Define agnosia and how you would test for it? what pathology does this suggest?

A

inability to process sensory information
can you identify what you are holding if you close your eyes?
parietal lesion

53
Q

Define apraxia? What pathology does this suggest?

A

inability to perform learned (familiar) movements on command, even though the command is understood and there is a willingness to perform the movement
parietal lesion

Neurology (22 decks)

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