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Clinical Assessment II > CNS Part 1 > Flashcards

CNS Part 1 Flashcards

1
Q

What are some potential reasonings for the following:

Dec brain weight
Dec cerebral blood flow
alterations in CNS NTs

A

Drug toxicities
Altered mental status
Parkinsons

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2
Q

What are some potential reasonings for the following:

Dec Memory

Dec Reation time

Dec sleep/Inc waking

Dec Vibratory senses

Dec Righting reflec/postural instability, altered gait

A

Benign senile forgetfulness, MCI, dementia

Dec IQ score

Inc Sleep disturbances

Altered gait

Falls/accidnets/ syncope

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3
Q

What are some expected age related changes in the BRAIN

A

Dec NT (GABA, seratonin, dopamine, choline o acetyltransferase)

Compensatory mechanisms reduce clinical effects age related changes
- redundancy minimizes age related effects of neuron loss

 - plasticity nerve cell offsets loss and deterioration 
- non dominant hemisphere or other motor systems
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4
Q

What are some age related changes to spinal cord

A

loss of cells, but not assoc w loss functional capacity, most changes 2ndary to sacropenia, osteoporosis

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5
Q

What are some age related changes to peripheral nerves

A

conduction slows w age but functional change not evident

re innervation -not as effective

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6
Q

Stoke prevention:

what are RFs

A

weight/obesity, diet/nutrition, sedentary lifestyle, nicotine and ETOH

dyslipidemia, atherosclerosis, DM, metabolic syndrome, HTN, carotid art dz, a fib

OSA

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7
Q

Herpes zoster:

What is the recommended age for vaccination

A

> 60 y/o

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8
Q

Behavioral Health

ID pt for co existent mental health issues

A

physical symptoms w/o medical explination

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9
Q

CAGE Assesment

A

Cutdown, Annoy, Guilt, Eye-opener

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10
Q

Suicide rfs (warrants screening)

A
  • idiopathic physical symptoms
  • high symptom count
  • chronic pain >6 weeks
  • difficult encounters
  • high severity for somatic complaint
  • hx recent stressor
  • pt self rates poor health
  • substance abuse
  • abuse
  • grief
  • financial issues
  • BH disorders
  • hx of selfharm
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11
Q

Suicide Impedning

A

sudden happiness

  • flat affect
  • giving away possesions
  • plan/note
  • abuse
  • selfharm
  • depressive social media posts
  • no plans/care for the future
  • catasrophizing
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12
Q

How do we assess Mental status (CNS exam)

A

LOC

Posture/motor activity,
grooming/dress/hygiene

facial expression

affect

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13
Q

How do we asess speech?

A 
Quantity 
rate 
volume 
articulation
Fluency
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14
Q

Speech disorders:

Dysarthria?

Fluency absence?

A

Disarthria is physical inabilty to form words d/t issue with BULBAR MUSCLES

Language issue, impaired ability to understand or use spoken words
affects reading, writing, abonromal spont speech

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15
Q

Fluency abnormalities:

Hesitancy
Disturbed inflections?
Circumlocutions?
Paraphasia?

A

monotone
describe object instead of word
malformed word or wrong word (snoop instead of spoon, cut food with a saw)

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16
Q

APHASIA types?

A

Receptive and Expressive

17
Q

what is receptive aphasia?

aka?

A

WERNICKES APHASIA

language with normal rhythm and articulation but meaningless content d/t difficulty in comprehension

18
Q

Expressive Aphasia?

A

BROCAS APHASIA

preserved comprehension with slow speech

19
Q

describe wernickes aphasia ?

A

rapid, effortless and spont speech, good articulation, impaired word comp, repetition, naming, reading /writing

paraphasa, neologims, or incomprehensible

fluent w/out content: person seldom understands whats being said or controls what they are saying

20
Q

Describe brocas aphasia

A

Laborius speech effort
words/content meaningful but articulation impaired

Know what they are saying just cant get words out

21
Q

How do we screen for aphasia (aphasia testing CNS exam)

A

Word comp: 3 stage command

repetition: repeat a phrase or one syllable words

Naming: ask pt to name familiar objects

reading comp: silently read a written request

Writing ability: write sinple sentence

22
Q

Thought process and content:

Abnormalities:

Circumstantiality? 
Blocking? 
Perservation? 
Neologisms?
Derailment? 
Flight of ideas? 
Incoherence?
Confabulation?
Echolalia? 
Clanging? 
Obsessions? 
Compulsions? 
Phobias?
A

Delay getting to point of convo

stop mid sentence before thought is completed

persistent repitition of word or idea

invented words

Little to no meaningful connection when shifting topics of convo

continous flow of accelerated speech w poorly connected ideas

incomp and illogical convo w/out meaningful connections

Fabricate facts to compensate for mem gaps
korsakoff syndrome-
alchis
Repeat word or phrase of another person

like the sound of a word to rhyme or pun (nose froze, tips of toes)

Intrusive reccurent uncontrollable thoughts, images, or impulses

repetetive bx or mental acts to produce or prevent some future state of affairs in response to obsesion

persistent irrational fears

23
Q

Perception disorders:
Derealization?

Depersonalization?

Delusions?

Illusions?

A

exp objects, people, surroundings as unreal

feel detached from self, numb from emotions or exp

false, fixed personal beliefs that are not substantiated & not altered by evidence to the contrary

Misinterpretation of real external stimuli

perceptions seem real but absence of actual ext stimuli

24
Q

How do we assess pt judgement?

A

pt ability to compare and eval alt course of action

25
Q

How do we test cognitive function (CNS TEST)

A 
Orientation: AXO status 
Attention: subract from 100 
Memory: appt time 
New learning ability: give pt 
   3 words have him repeat 
   now and after 3 min
Higher Functions: can pt speak on familiar topic
26
Q

CN 1

A

olfaction

test with pt eye closed

27
Q

CN II

A

Optic

Confrontation
VA

28
Q

CN II & III

A

II- perception light stim
III- pupillary constriction

PERRL

29
Q

CN III, IV, VI

A

EOM
Convergence
Ptosis: occulomotor

30
Q

CN V

A

trigeminal:

sensory: test forehead,
cheek, jaw d/l

 sharp dull/ light touch 

  corneal reflex
31
Q

CN VII

A

Facial

raise eyebrow, frown, open/closed smile

strenght close both eyes tighly, attempt to raise lids against resistance

32
Q

CN VIII

A

vestibular cochlear

auditory acuity
nystagmus

33
Q

CN IX

A

motor: swallow/gag response
sensory: taste

34
Q

CN X

A

Motor: uvula deviation
sensory: articulation and phonation

35
Q

CN XI

A

SCM, TRAP

36
Q

CN XII

A

inspect tounge at rest and protruded

fasciculation/atrophy = LMN lesion

Clinical Assessment II (3 decks)

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