Exam I Flashcards
What are the 5 cognitive domains that are tested in a mental status exam?
- social function/behavior
- executive function
- memory
- language
- visual-perceptual-spatial/attention
What is the anatomical loction of memory?
mesial temporal lobe, basal forebrain
What is the anatomical loction of executive function?
frontal, temporal lobes, subcortical
What is the anatomical loction of social cognition/behavior?
frontal, temporal lobes, subcortical
What is the anatomical loction of language?
dominant frontotemporaoparietal (usually left)
What is the anatomical loction of visuospatial function?
non-dominant parietal (usually right)
Which hemisphere is usually dominant?
left hemisphere
95% right handed people
70% left handed people
What are the four avenues of communication? What is the term for a deficit in each?
- Speech - dysphagia/aphasia
- Writing - dysgraphia
- Listening - auditory agnosia
- Reading - word agnosia
Depression is frequently seen in stroke of what hemisphere?
left
What is dyslexia?
developmental agnosia
What is alexia?
word blindness
What is the difference in how the 2 hemispheres attend to spatial stimuli?
right - stimuli on both sides of space
left - stimuli on right side
Deficits in the right hemisphere can lead to what problems?
- extinction
- inattention
- spatial neglect
- emotionla indifference/euphoria
What is the function of the dorsolateral frontal lobe?
What does dysfunction here look like?
- Function
- judgement, abstract thinking, problem solving
- Dysfunction
- impaired planning, perseveration, retrieval deficit, decreased verbal/design fluency
What is the function of the medial frontal lobe?
What does dysfunction here look like?
- Function
- motivation, initiation
- Dysfunction
- mutism, emotional/cognitive/motor apathy, urinary incontinence
What is the function of the orbital frontal lobe?
What does dysfunction here look like?
- Function - emotional / social / sexual restraint
- Dystunction - disinhibition, witzelsucht, emotionla lability, echopraxia, utilization behavior, impulsiveness, distractibility
Inappropriate hyperactivity of the orbital frontal lobe leads to what condition?
OCD
What are you looking for upon clinical presentation when you are assessing frontal lobe function?
Affect (passive vs. engaged), look for disinhibition, witzelsucht, confabulation, utilization behavior, perserverance
What tests can you perform to assess frontal lobe status?
- attention
- word generation
- abstract
- reasoning
- frontal release signs- glabellar tap, grasp, palmomental sign, rooting, snout
The pathological signs in the provided image are indicative of what dysfunction?
frontal lobe dysfunction
What are the functions of the temporal lobe?
memory
- short term / working memory
- long term
- declarative
- episodic
- semantic
- non-declarative
- procedural memory
- declarative
Which hemisphere & lobe mediates verbal memory?
Spatial memory?
- verbal memory
- left temporal lobe
- spatial memory
- right temporal lobe
Describe the general pathway of the circuit of papez
- Circuit of Papez
- mamillary bodies
- anterior thymus
- cingulate gyrus
- enterorhinal cortex
- hippocampi & parahippocampi
Mamillary bodies are infarcted in what vitamin deficiency?
thiamine
vitamin B1
How are the roles in memory different fro the hippocampus & frontal lobe?
- Hippocampus
- encoding episodic information
- Frontal lobe
- episodic recollection
Where is Wernicke’s area?
Function?
Dysfunction?
- posterior superior temporal gyrus
- auditory associate cortex
- memory for word sounds
- dystunction - sensory aphasia
Where is Broca’s area?
Function?
Dysfunction?
- inferior frontal gyrus
- word programming
- needed for word production
- dysfunction - motor aphasia
What is the function of the angular gyrus?
Dysfunction?
- memory for how words look
- dysfunction - dyslexia
Identify the type of aphasia:
Fluent - N
Comprehend - N
Repeats - N
Global aphasia
Identifythe type of aphasia:
Fluent - N
Comprehend - Y
Repeats - N
Broca’s aphasia
Identify the type of aphasia:
Fluent - Y
Comprehend - N
Repeats - N
Wernicke’s aphasia
Motor aprosodia is cause by dysfunction where in the brain?
non-dominant posterior / inferior frontal gyrus
Sensory aprosodia is cause by dysfunction where in the brain?
(auditory affective agnosia - impaired emotional perception of speech)
non-dominant posterior / superior temporal gyrus
What are the functions of the parietal lobe?
- Spatial attention & awareness
- Movement programs
Damage to which parietal lobe is more commonly produces deficits in spatial attention & awareness?
This causes?
How do you test for this?
Right > left
neglect
draw a clock, bisect a line, test for sensory extinction
Damage to which parietal lobe is more commonly produces deficits in movement programs?
This causes?
left > right
apraxia
Identify the type of apraxia that fit with the following definitions:
loss of tool knowledge; not able to pick correct object to use in performing a task
inability to follow particular step / sequence
inability to peform a task when cued
inabilty to imitate a gesture
constructional apraxia
inabiltiy to dress
- Conceptual: loss of tool knowledge; not able to pick correct object to use in performing a task
- Ideational: inability to follow particular step / sequence
- Ideomotor: inability to peform a task when cued
- Conduction: inabilty to imitate a gesture
- Constructional apraxia: constructional apraxia (righ)
- Dressing apraxia: inability to dress (right)
Gerstmann Syndrom is due to a problem where in the brain?
left inferior parietal lobe
What are the 4 components of Gerstmann Syndrome?
What function is preserved
- Agraphia: inability to write
- Acalculia: difficulty in learning or comprehending mathematics
- Left-right disorientation
- Finger agnosia: inabilty to distinguish the fingers on the hand
Reading is preserved
How do you test the primary somatosensory cortex?
- two point discrimination
- simultaneous discriminatin
- stereognosis
- graphesthesia
- touch
- vibration
- proprioception
How do you test the secondary somatosensory cortex?
pain & temperature
What is the “where” pathway?
It does what?
occipital / parietal dorsal pathway
analysis of motion & space
Occipital lesions can cause what?
Bilateral occiptal lesions?
- Occipital lesions
- inferior quadrantanopia
- Bilatera
- Balint Syndrome
- (optic ataxia, oculomotor apraxia, stimultanagnosia)
- Balint Syndrome
What is the “what” pathway?
It does what?
occipital / temporal ventral pathway
analysis of form/color/face/letters
What problems could occur with a lesion in the temporal ventral pathway?
- visual agnosia
- achromatopsia
- prosopagnosia
- “Alice in Wonderland” Syndrome
- micropsia / macropsia
- metamorphosia
- Superior quadrantanopia
What stroke causes alexia without agraphia?
left PCA stroke
What symptoms do you see in alexia without agraphia?
- right homonymous hemianopia
- disconnection syndrome
What is the cause & symptoms of Foster-Kennedy Syndrome?
ipsilateral anosmia (d/t mass) & optic atrophy
contralateral papilledema
What are the basic test you should perform when assessing CNII?
- Visual Fields
- Funduscopy
- Papillary reflex
Altitudinal scotoma is a what type of defect?
Cause?
- Prechiamal Field Defect
- d/t retinal branch artery occlusion
What type of lesion causes “pie in the sky”?
temporal lobe lesion
homonymous superior quadrantanopia
What type of lesion causes “pie in the floor”?
parietal lobe lesion
contralateral homonymous inferior quadrantanopia
What type of lesion causes macular sparing?
pituitary tumors
bitemporal hemianopia
Identify the indicated lesions
A female, >70 with sudden severe painful vision loss w/ headache, jaw claudication, anorexia, ESR > 50, CRP >2.45, thrombocytopenia- what is your thought?
Arteritic ischemic optic neuropathy
(temporal arteritis & polymyalgia rheumatica)
What is a cause of a transient, paninless, monocular blindness?
internal carotid artery
