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PCM II: Test 2 > CNS > Flashcards

CNS Flashcards

1
Q

what will we be able to evaluate mental status through in the exam?

A 
Cortex
Basal ganglion
Brain stem
Cerebellum
Cranial nerves
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2
Q

what are the 5 major categories in mental health exam?

A 
Appearance
Affect
Language
Thought Process/perception 
Cognitive function/Executive fx
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3
Q

what can change awareness? what are different descriptions of awareness?

A
  • State of awareness of self and environment. Impaired by disease of the brainstem reticular activating system, or damage in parts of both hemispheres

Alert→ awake, not sleepy or tired, responding appropriately to environment
Lethargic→ (sleepy): awake, but tending to fall asleep if not gently stimulated
Stuporous → falling asleep unless vigorously stimulated
Comatose→ a sleep-like state from which the patient cannot be awakened

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4
Q

what should clinical exam of language include?

A 
Spontaneous speech
Naming
Comprehension 
Repetition 
Reading 
Writing
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5
Q

aphasia

A

Disorder in producing or understanding language

aphasia may be the only sign of a new neurological disease, such as stroke, tumor or head trauma, or recent seizure

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6
Q

paraphasia

A

substituting similar sounding syllables or words

- “paraphasis errors”: pen for pencil or plentil for pencil

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7
Q

prosody

A

the melody or variable tone of speech

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8
Q

aphasia

A

disorder in understanding or producing language: spoken or written

  • testing for aphasia: naming, comprehension, repetition and reading/writing
  • due to localized lesion of dominant hemisphere (70% are left hemisphere dominant)
  • can be caused by damage to either Broca’s or Wernicke’s area
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9
Q

dysphasia

A

impairment in USE of speech that is clear

i.e. failure to arrange properly in sentence

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10
Q

dysarthria

A

imperfect articulation due to lack of motor coordination; damaging event CNS or PNS, language comprehension and use may be fine.

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11
Q

Wernicke’s area

A

transforms sensory input –> neural word : giving words meaning

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12
Q

Broca’s area:

A

transforms neural word representations to spoken word

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13
Q

Broca’s aphasia

A

“expressive aphasia” - have understanding of spoken language, but can’t articulate

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14
Q

Wernicke’s aphasia:

A

have ability to produce “fluent speech” but it makes no sense

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15
Q

apraxia

A

inability to turn verbal request into motor performance
(often seen with aphasic patients)

patients have difficulty with complex yet familiar activities, such as dressing or taking a shower, writing with a pen or pencil, using a comb or toothbrush, mimicking an examiner

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16
Q

Orientation testing?

A
  1. PERSON (name): seldom lost unless the patient has aphasia or schizophrenia
  2. PLACE (location): often lost in some hospitalized patients, or delirious/extremely demented outpatients
  3. TIME: most commonly lost of these three; include time of day, day of week, month, year if possible
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17
Q

recent vs. remote memory

A

RECENT Memory: the ability to store new information, up to a few days

REMOTE Memory: more distant memories. Includes autobiographical (dates of graduation, marriage, etc.) or historical (date of wars, elections, sports, etc.)

Alzheimer’s dementia almost always begins as a progressive loss of memory; first recent, and then distant memory

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18
Q

how can insight be evaluated?

A
  • explain a proverb
  • explain a situational choice
  • compare similarities/difference betwen objects
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19
Q

delerium

A

acute confusion episode, may be due to infection, uremia, alcohol withdrawal. Disoriented, poor judgment, delusions common, attention poor, mood fluctuates
“Everything’s an Emergency!”

  • if they have poor attention, think delerium
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20
Q

Dementia

A

: insidious, slowly progressive, affect often flat, maintains orientation and attention until late in process. Altzheimer’s, B12 deficiency, hypothyroid, head trauma. Can have acute angry, delusional episodes later in the course of disease.

21
Q

constructional ability

A

tests executive function

- ability to copy a figure or draw something simple

22
Q

apraxia

A

inability to perform the command

23
Q

what does cerebellum do?

A

receives sensory and motor input to coordinate motor activity, maintain equilibrium and control posture

24
Q

rhomberg tests?

A

tests ataxia specific to posterior column function. While positioned and eyes open, balance is maintained. Closing eyes removes visual input and ataxia (falling over) occurs. Direction of the fall may indicate where the lesion is.

Cerebellar ataxia is present with eyes open or closed, ie, not a function of proprioceptive input.

25
Q

Pronator drift

A

in same stance as for Romberg, if the arm pronates and drifts downward (and occasionally lateral) when eyes are closed it is specific for a contralateral corticospinal tract lesion/disease

26
Q

dysmetria

A

movment that is clumsy, varied in speed/force, past the destination point
- can be tested with finger-to-nose eyes opened or with eyes closed

27
Q

dysdiadochokinesis

A

one movement cannot be abruptly stopped and followed by the opposite movement: slow, irregular and clumsy

28
Q

why is cranial nerve important?

A

Localizes pathologic processes specific to individual cranial nerves and can indicate where pathology is involved. This assists in diagnostic accuracy of neurologic disorders.

Headache:  new onset or change in character
Dysarthria
Asymmetric facial features
Dysphagia
Hearing complaints
Visual disturbance
Ataxia/Asymmetric motor use
29
Q

CN I

A

Olfactory is seldom tested, unless the patient complains of a loss of smell, or there is a frontal injury or possible frontal lobe tumor

Abnormalities seen with concussion(mild traumatic brain injury or TBI)

30
Q

CN II/III testing

A

Acuity

Pupillary Reflex:Afferent is CN II, it senses the light.

Efferent: CN III (Oculomotor)
Visual field exam
Ophthalmoscopic (fundoscopic) examination is direct visualization of retina including optic disc and vessels. Optic nerve exam is primarily functional

31
Q

CN III, IV, VI

A

Look at eyes in the primary position:
esotropia (medial deviation)
exotropia (lateral deviation)

Occulomotor:
Efferent pupillary response to light (III Oculomotor: levator palpebrae, sup/inf rectus, inf oblique, medial rectus) Extraocular movements: Six cardinal directions

Trochlear (IV Superior Oblique):
moves the eye downward and out.

Abducens (VI Lateral Rectus) move laterally

Remember the cover/uncover test to check bilateral central focus; looking for strabismus

32
Q

Right fourth nerve palsy

A

Globe in right eye goes up and in, when it cannot go down and out (superior oblique)

33
Q

Right Sixth nerve palsy

A
  • cannot pull eye lateraly without lateral rectus innervation, results in on eye going in
34
Q

horizontal diplopia

A
  • Mild or total loss of lateral rectus function
  • due to loss of CN VI
  • often due to increased intracranial pressure b/c of its location in main sinus
35
Q

how do you test the trigeminal nerve? corneal reflex?

A

Sensory: for the face, 3 divisions
Test sensation to each bilaterally: soft or temperature, and/or pinpick

Motor: masseter and pterygoid: clench teeth, move jaw side to side

Corneal Reflex: Gently touch lateral cornea w/ cotton or gauze
Afferent: CN V senses the stimulus
Efferent: CN VII motor to blink
Both eyes should blink together

36
Q

central vs. peripheral effect of CN VII

A

central: cortex or brainstem: muscles of lower face only affected on one side
(lesion on opposite side)

peripheral: distal to brainstem, muscles of unilateral same side upper and lower face are affected. (lesion on same side)

37
Q

Facial nerve?

A

Other things facial nerve does:

  • Muscles of facial expression
  • Upper face: closing the eyes, raising the eyebrows
  • Lower face: smiling
  • Taste of anterior 2/3 tongue
  • Lacrimation
  • Salivation
  • Stapedius muscle of middle ear (dampens sound)
38
Q

2 types of central lesions?

A
  1. Cerebral hemisphere lesion: signal must cross before it is manifested
    - Lower facial weakness of the opposite side.
    - Extremities on opposite side
  2. Brainstem lesion:
    - Lower facial weakness of the same side.
39
Q

causes of peripheral lesion of CN VII?

A

Commonly compressed as it goes through the internal or external auditory canal by unknown, likely auto-immune processes (Bell’s palsy) or tumors, lacerations, infections (Lyme, etc.)

In a PERIPHERAL CN VII lesion, the entire seventh nerve is likely damaged, so there is weakness of the upper AND lower facial muscles on that same side

40
Q

CN VIII

A

Vestibulocochlear
Hearing and Balance: The auditory portion of CN VIII is tested by the physician directly; most disorders of the vestibular portion are assumed from a history of positional vertigo

Hearing can be determined subjectively by how well the patient seems to understand the physician’s words, or by the examiner rubbing her index and thumb together one inch lateral to each ear of the patient, or the patient’s hair can be rubbed about one inch lateral to each ear

41
Q

which nn. most commonly seen in TBI?

A

Injured in concussion (TBI): CN I, VII, VIII can be seen

42
Q

CN IX and X testing?

A

gag reflex tests them both

CN IX is sensory to the soft palate, and CN X helps to raise the palate, so the Gag Reflex tests them both:

GAG REFLEX:
Afferent: CN IX
Efferent: CN X

Glossopharyngeal (IX) provides taste on the posterior 1/3 of tongue

43
Q

CN XI testing?

A

Innervation of the sternocleidomastoid and trapezius muscles

Resist the patient shrug both shoulders simultaneously

Resist a head tilting to each side

44
Q

CN XII testing?

A

Purely motor to only the tongue

Ask patient to stick out tongue (note if midline) and move side to side

Look also for atrophy or fasiculations of the tongue

In case of a CN XII peripheral lesion, the tongue deviates to the SAME SIDE

45
Q

how can insight be evaluated?

A
  • explain a proverb
  • explain a situational choice
  • compare similarities/difference betwen objects
46
Q

delerium

A

acute confusion episode, may be due to infection, uremia, alcohol withdrawal. Disoriented, poor judgment, delusions common, attention poor, mood fluctuates
“Everything’s an Emergency!”

  • if they have poor attention, think delerium
47
Q

Dementia

A

: insidious, slowly progressive, affect often flat, maintains orientation and attention until late in process. Altzheimer’s, B12 deficiency, hypothyroid, head trauma. Can have acute angry, delusional episodes later in the course of disease.

48
Q

constructional ability

A

tests executive function

- ability to copy a figure or draw something simple

49
Q

apraxia

A

inability to perform the command

PCM II: Test 2 (5 decks)

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