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Exam II Mental and Neuro Flashcards

1
Q

2 types of mental disorders

A

Organic and Psychiatric

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2
Q

What is an organic mental disorder?

A

Related to a medical disorder like dementia or a psychological disorder.

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3
Q

What are 2 psychiatric mental disorders?

A

Depression, schizophrenia

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4
Q

What is mental status?

A

A person’s emotional (feelings) and cognitive (knowing) functioning.

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5
Q

With a mental disorder what signs do patient’s have?

A

Significant behavorial or psychological patter of distress, disability, impaired functioning that can lead to suicide.

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6
Q

Causes of mental dysfunction

A
  • Traumatic life events
  • Organic disorder (delirium, dementia, alcohol and drugs withdrawal)
  • Psychiatric mental illnesses (anxiety, schizophrenia).
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7
Q

What does Lewy Body dementia cause?

A

Depression and hallucinations

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8
Q

How is consciousness assessed for mental status?

A

Awake, alert and oriented x3

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9
Q

When should you perform a mental status examination?

A

When see:
- Behavioral changes
- Brain lesions
- Aphasia
- Psychiatric illness

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10
Q

Define delirium

A

Acute confused change or less of consciousness and perceptual disturbance that may accompany acute illness; usually resolved when underlying cause is treated.

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11
Q

Define dementia

A

gradual progressive process causing decreased cognitive function even though the person is fully conscious and awake; not reversible.

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12
Q

What’s the difference between dementia and delirium?

A

Dementia is gradual, not reversible
Delirium is usually resolved when the underlying cause is treated; is acute.

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13
Q

Four main components of mental status examination.

A

A B C T’s
Appearance
Behavior
Cognition
Thought processes

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14
Q

Objective assessment of mental status examination looks at what 5 categories?

A

Appearance
Behavior
Orientation
Cognitive funcitons
Thought processes and perceptions

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15
Q

In a mental health assessment, what do nurses evaluate when assessing the appearance of a person?

A

Posture
Body movements
Dress
Grooming and hygiene

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16
Q

In a mental health assessment, what do nurses evaluate when assessing the behavior of a person?

A
  • Alert
  • Lethargic - not fully awake, drifts off to sleep
  • Obtunded - Sleeps most of the time, difficult to arouse
  • Stupor - Spontaneously unconscious
  • Coma - completely unconscious
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17
Q

What to ask a patient to determine orientation in a mental status assessment?

A

Today’s date
Where live
Address, phone, building
City, state
Name, age, employment

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18
Q

Recent vs remote memory in a mental status evaluation

A

Recent: “What did you have for breakfast this morning?”
Remote: “Where did you go to elementary school?”

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19
Q

What is the Mini Mental Status Examination (MMSE)?

A

11 questions about time, repeating words and recall, naming, reading, copying, writing, max score 30. Good screening tool, useful for initial and serial measurements.

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20
Q

What is the Mini Mental State Examination (MMSE) good for?

A

Initial and serial measurements.

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21
Q

What is the Mini-Cog

A

A mental status examination where you ask the patient to repeat three words and draw the face of a clock and the time you select.

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22
Q

Why is the Mini-Cog a great mental status exam tool?

A

It takes all four lobes of the brain to tell time analog.

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23
Q

What is Dysphonia?

Know this

A

Trouble speaking due to physical problem, inability to produce voice sounds (hoarse)

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24
Q

What is aphasia?

Know this

A

Disorder of language comprehension and production

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25
Two types of aphasia
- Expressive: difficulty producing language - Receptive: difficulty understanding what is said
26
What is Broca's aphasia?
Left frontal lobe voluntary speech center is damaged; non-fluent staccato speech.
27
About what percentage of strokes present with some type of aphasia?
20%
28
What is Wernike's aphasia?
Superior temporal gyrus; Cranial nerve VIII; fluent speech but don't make sense (guy on YouTube)
29
Screening test for mental status for infants and children is
Denver II screening test: birth to 6 years
30
Screening test for mental status for school-age children?
Behavioral checklist for 7-11 year olds
31
What mental status screening do you use for adolescents?
The same as for adults: A B C T: Appearance Behavior Cognition Thought processes
32
What to check first for screening for mental health status in older adults
Sensory status, vision, hearing.
33
In older adults, what is commonly misdiagnosed as mental status change?
Confusion
34
When screening for suicidal thoughts, how do you question a patient?
Ask general and then specific questions
35
How would you asses abstract reasoning in an adult patient?
Proverbs: "How are a car, a plane and a boat alike? Transportation."
36
Subjective data for a mental status exam?
A B C T's - Appearance - posture erect, no involuntary movements, dress and grooming are appropriate. - Behavior - Alert, appropriate facial expression, understandable speech, appropriate responses. - Cognitive functions - Oriented to time, person, place, cooperates with examiner, recent and remote memory intact, recall four unrelated words at 5, 10 and 30 minutes, future plans. - Thought processes - perception and thought processes are logical and coherent, no suicidal ideation.
37
What is normal score on Min Mental Health Examination?
25 or > Perfect is 30
38
What is the most common type of dementia?
Alzheimer's
39
2 parts to the nervous system
CNS and peripheral
40
What does afferent nerve transmission do?
Carry sensory information to the CNS.
41
What does efferent nerve transmission do?
Carries motor messages from CNS to muscles and glands.
42
What is the cerebral cortex?
Cerebrum's outer layer
43
What are the four lobes of the cerebral cortex?
4 lobes: frontal, parietal, temporal and occipital.
44
In a stroke of the pre-central gyrus of the frontal lobe of the cerebral cortex, what is affect?
Voluntary movement
45
The parietal lobe's post-central gyrus is responsible for what?
Primary center for sensation (touch, pressure, vibration and proprioception)
46
What sense does the occipital lobe of the cerebral cortex handle?
Sight
47
What sense does the temporal lobe of the cerebral cortex handle?
Auditory, taste, smell, memory, visual recognition
48
Where is Wernike's area?
In the temporal lobe of the cerebral cortex.
49
When Wernike's area is damaged, what happens to the patient?
Hears sounds but have no meaning.
50
When Broca's area of the frontal lobe is damaged, what happens?
Expressive aphasia results: person cannot can understand and knows what they want to say but can't say it.
51
What is the frontal lobe responsible for?
Personality Behavior Emotion Intellectual functions
52
Where is Broca's area and what does it handle?
In frontal lobe; motor speech
53
What does the pre-central gyrus of the frontal lobe handle?
Motor skills
54
What does the post-central gyrus of the parietal lobe handle?
Sensory (touch, pressure, vibration and proprioception)
55
What does Wernike's area do and where is it?
In the temporal lobe; speech comprehension
56
What does the temporal lobe handle?
Hearing Taste Smell Memory Visual recognition
57
What does the occipital lobe handle?
Vision
58
What neurotransmitter controls the frontal lobe?
GABA
59
What lobe comprises 1/3rd of your brain?
The frontal lobe
60
What does the frontal lobe do as influenced by GABA?
Inhibitory when mature at about 22 years.
61
At what age does the frontal lobe mature?
17-22
62
What is different about the frontal lobe in infants and children vs. adults?
The frontal lobe is not matured.
63
Where is Broca's Center?
Left inferior frontal gyrus
64
What condition is associated with Broca's center?
Broca's aphasia
65
What signs occur with Broca's aphasia?
Telegraphic, staccato speech
66
What part of the brain is responsible for abstract thought: "What does don't cry over spilled milk mean?"
Frontal lobe
67
The neurons located in the pre-central gyrus are called what?
Upper motor neurons.
68
What happens when UMN send signal thorugh the medulla?
Crossover. The left side of the brain controls the right and vice versa.
69
What side of the body does the left pre-central gyrus control?
The right.
70
What side of the body does the right pre-central gyrus control?
The left
71
Corticospinal tract is what type of pathway?
Motor
72
What type of movements does the corticospinal tract have?
Voluntary
73
What type of movement is the pre-central gyrus responsible for?
Voluntary movement
74
What percentage of strokes present with hemiparesis?
70%
75
What is hemiparesis?
Paralysis on one side of the body
76
What does damage to the UMN/CS tract result in?
- Contralateral - Hemiparesis - Pronator drive - Positive Babinski sign
77
With UMN/CS tract damage, what is an abnormal/+ Babinski sign?
Fanning of all toes when running an object down the length of the bottom of a patient's foot.
78
What do baby's have that is comparable to UMN/CS Tract damage?
Positive Babinski sign until they start to walk.
79
What is a negative Babinski sign?
Dorsiflexion
80
What reflex does the Babinski sign test?
The plantar reflex
81
What type of memory is the first to go?
Recent memory
82
Where is Wernike's area located?
Left temporal lobe
83
What is associated with loss of recent memory?
Loss of hippocampal cell function
84
What tests are used with parietal lobe testing?
Two-point test - touch two areas at the same time Superficial pain, light touch and vibration in a few distal locations Stereognosis and graphesthesia.
85
Who can you not test with the two-point test for the parietal lobe?
Kids under 6 because kids recognize touch on the face.
86
What is Stereognosis?
Recognizing a 3-dimensional shape with eyes closed.
87
What is graphesthesia?
Recognize symbols when they're traced on the skin.
88
What CN and lobe are involved in sight?
See with CN II and interpreted by occipital lobe
89
What does cerebellum do?
- Coordinates and smooths muscle movements - Synergy - Balance - Equilibrium - Muscle tone
90
Some tests to test the cerebellum
Observe walking Tandem walking Close eyes and touch fingers to nose Heel to shin test Rapid alternating movements
91
At what alcoholic level do you lose cerebellum function
0.08
92
In what is the cerebellum not well developed?
Babies
93
What three structures are in the brainstem?
- Midbrain - most anterior part; motor neurons and tracts - Pons - Medulla - all fibers connecting brain to spinal cord
94
Damage to pons results in what?
Coma
95
What function does the brainstem support?
Cardiorespiratory function
96
What is the hangman's fracture and what part of the brain does it affect?
C2, C3, the brainstem
97
Oh, oh, oh, to touch and feel very good vagina. Such heaven?
O: olfactory nerve (CN I) O: optic nerve (CN II) O: oculomotor nerve (CN III) T: trochlear nerve (CN IV) T: trigeminal nerve (CN V) A: abducens nerve (CN VI) F: facial nerve (CN VII) A: vestibulocochlear) nerve (CN VIII) G: glossopharyngeal nerve (CN IX) V: vagus nerve (CN X) S: spinal accessory nerve (CN XI) H: hypoglossal nerve (CN XII)
98
CN I function
Olfactory (smell)
99
CN II
Optic nerve (Visual accuity)
100
PERRLA
CN II (Optic) and III (Oculomotor)
101
CN III, IV, VI test what?
Extraocular movements - "Follow my finger"
102
Argyll Robertson pupil
Will accommodate but not react to light "Prostitute's pupil"
103
Argyll Roberson puli affects which cranial nerves?
CN II and CN III
104
CN V
Trigeminal - Huge nerve Cornel reflex (light touch to cornea, both eyes blink)
105
CN VII
Facial nerve Smile, puff cheeks, frown, close eyes tightly, life eyebrows, show teeth
106
What is biggest concern with trigeminal neuralgia
Pain
107
Three places on skull innervated by CN V
Opthalmic Mandible Maxillary
108
What disorder affect CN VII?
Facial nerve - Bell's Palsy
109
CN IX
Glossopharyngeal
110
What two CNs are responsible for the gag reflex and the uvula?
IX and X
111
What do you do with someone with no gag reflex.
Don't put anything in mouth
112
Impaired functioning of the XI and X CNs put the patient at risk for?
Choking
113
CN XII
Hypoglossal; tongue movement and strength, L, R, midline.
114
CN I test
Olfactory: close one nostril and smell familiar scent
115
CN II
Optic, check visual acuity and peripheral vision
116
CN III, IV and VI
Oculomotor, Trochlear and Abducens Check pupils for size, equality, accommodation, consensual to light. Cardinal gaze (IV and VI) Nystagmus
117
CN V test
Trigeminal Motor: Palpate muscles of mastication as patient clenches teeth Sensory: light touch on forehead, cheeks, chin, corneal reflex,
118
CN VII test
Facial nerve Motor: facial symmetry with smile, frown, close eyes tightly, left eyebrows, show teeth, puff cheeks Sensory: Test only when suspect facial nerve injury
119
CN VIII
Vestibulocochlear Hearing
120
CN IX and X
Glossopharyngeal and vagal nerves Watch uvula as say "Ah." Gag reflex
121
How many spinal nerves?
31 pairs
122
How many of each section of spinal nerves?
8 cervical 12 thoracic 5 lumber 5 sacral 1 coccygeal
123
What are dermatomes?
Areas of skin that send their sensory info into specific spinal cord segments
124
Levels of dermatomes
C4 C4 shoulder and referred pain T1 axilla T4 nipple (know when checking reflexes) T10 umbilicus L1 bikini (know when checking reflexes) L3 L4 knees S1 S2 back of leg S3-S5 perineum
125
What levels are the reflexes found? (Know)
C5-C6 biceps C7-C8 triceps L2-L4 Patellar (knee jerk) L5-S2 Achilles (ankle jerk)
126
How does a reflex arch work?
Sensory info goes into spinal cord (afferent) Synapses in same spinal cord segment Sent out via lower motor neuron to peripheral motor nerve.
127
How to collect objective data from reflexes
Limb should be relaxed Compare right to left 4 point scale: - +2 normal - 0 absent - +4 hyper

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