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Neuroanatomy and Physiology > Lecture 10 > Flashcards

Lecture 10 Flashcards

1
Q

Where is the clinical neuro exam most helpful?

A

helpful in distinguishing between Upper Motor Neuron (UMN) lesion or Lower Motor Neuron (LMN) lesion.

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2
Q

What are we looking at when talking about UMN?

A
  • descending axons from cortex to brainstem or brainstem to spinal cord
  • brain, spinal cord
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3
Q

What are we looking at when talking about LMN?

A
  • axons exiting the CNS and innervating peripheral targets
  • motor divisions of cranial nerves
  • exiting brain stem and spinal cord
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4
Q

Will UMN lesions cause weakness?

Will LMN lesions cause weakness?

A
  • yes

- yes

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5
Q

Will UMN lesions cause atrophy?

Will LMN lesions cause atrophy?

A
  • no

- yes

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6
Q

Will UMN lesions cause fasciculations?

Will LMN lesions cause fasciculations?

A
  • no

- yes

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7
Q
  • Will UMN lesions cause increased or decreased reflexes?

- Will LMN lesions cause increased or decreased reflexes?

A
  • increased

- decreased

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8
Q

Will UMN lesions cause increased or decreased tone?

Will LMN lesions cause increased or decreased tone?

A
  • increased

- decreased

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9
Q

What are the 6 main components of the clinical neurological exam?

A
  • Mental Status
  • Cranial Nerves
  • Motor Exam
  • Sensory Exam
  • Reflexes
  • Coordination/Gait
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10
Q

What are the main components of the Mental Status Exam?

A
  • Alertness/Arousal
  • Orientation
  • Memory
  • Spatial Relations
  • Apraxia
  • Neglect and Constructions
  • Sequencing tasks and frontal release signs
  • Logic and abstraction
  • Delusions and hallucinations
  • Mood
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11
Q

Mnemonic to remember cranial nerves.

A 
Oh          /     Some
Oh          /     Say
Oh          /     Marry
To           /     Money
Touch     /     But
And        /     My
Feel        /     Brother
Very        /     Says
Good      /     Big
Velvet     /     Brains
Ah           /     Matter
Heaven   /     More
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12
Q

Our cranial nerves stem off of our ___________. What this means is that our CN can give us insight to any brain stem activity that is abnormal that may have not produced other symptoms.

A

brain stem

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13
Q

Our cranial nerve exam is considered a ______ and can help to rule in/out any more serious pathologies that may have been missed.

A

screen

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14
Q

What is CN1?

A

olfactory nerve

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15
Q

Is the olfactory nerve often included in the cranial nerve screen? Why or why not?

A

-No, unless specific pathologies such as a subfrontal tumor are present the olfactory bulb and tract are sparred.

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16
Q

With a CN1 test, we are testing for _________ and ___________.

A
  • discrimination

- arousal

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17
Q

When during our testing of CN1 would we be concerned about the olfactory nerve as opposed to a nasal disease?
This is when we would look further into CN1.

A

If the patient smells something that should be neutral (such as chocolate) and it is unpleasant or distorted.

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18
Q

What is anosmia?

A

The loss of smell, either partial or total.

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19
Q

What are some things that could cause impairements with the olfactory nerve?

A
  • Parkinson’s
  • Chronic meningeal inflammation
  • Tumor in subfrontal region
  • Heavy smoking
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20
Q

What is CN2?

A

optic nerve

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21
Q

The optic nerve has multiple roles in the vision system and therefore has multiple tests such as what?

A
  • Visual Acuity
  • Color Discrimination
  • Field Cuts
  • Pupillary Response to Light Accommodation
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22
Q

What is visual acuity?

How do we test for visual acuity?

A
  • how clear is patients vision

- Snellen chart (eye doctor chart)

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23
Q

What is color discrimination?

A

example is color blindness

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24
Q
  • What are field cuts?

- How do we test field cuts?

A
  • loss of vision
  • patient sits in front of you and looks at your nose, using a color cap of a marker move slowly through each of the 4 quadrants from posterior to anterior and have them note when they can see the marker, repeat with other eye
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25
Q

What needs to be ruled out before ruling in visual field cuts.

A

neglect

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26
Q

Is visual neglect a result of damage to the optic nerve?

A

No, it is a result of damage to the parietal lobe

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27
Q

1

A

1

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28
Q

1

A

1

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29
Q

What is pupillary response to light accommmodation?

A

how well our eyes adjust in response to light (shining light into someones eyes should cause constriction)

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30
Q
  • The pupillary response to light accommodation hits on _ cranial nerves, what are they?
  • The ______ side of pupillary response is CN2, whereas the ________ side comes from CN3 (pupil constriction).
A
  • 2, optic nerve (II) and occulomotor nerve (III)

- afferent, efferent

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31
Q

CN3, 4, and 6 are all ______ nerves that innervate what muscles?

A
  • motor

- extraoccular muscles (EOMs)

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32
Q
  • What nerve is CN3?
  • What nerve is CN4?
  • What nerve is CN6?
A
  • 3 = occulomotor
  • 4 = trochlear
  • 6 = abducens
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33
Q

CN3 is important in pupil _________ (efferent limb), but is also important in what movements of the eyes?

A
  • constriction

- elevation, depression, adduction

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34
Q

CN4 is important in what movements of the eyes?

A
  • depression
  • intorsion

(down and in)

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35
Q

CN6 is important in what movements of the eyes?

A

abduction

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36
Q

The extraoccular muscles can all be tested with one test, which is called what?

A

BIG H test

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37
Q

What can be important to do before jumping into a BIG H test?

A

looking at the eyes at rest for dysfunction (if abducens nerve isn’t firing properly, at rest the patient’s eye can go into adduction because the muscles arent holding the eye in place).

38
Q

With any of the 3 EOM nerves and a palsy associated with them, we will see a complaint of __________ from the patient.

A

double vision

39
Q

Why do patients with palsies associated to CN3,4 or 6 present with double vision?

A

our eyes normally move in harmony with one another, in these patients they don’t

40
Q

If an individual has dysconjugate gaze in both eyes AND the same direction, is this indicative of a UMN or LMN lesion?

A

UMN

41
Q

If an individual a dysconjugate gaze in both eyes BUT in different directions, is this indicative of a UMN or LMN lesion?

A

LMN

42
Q

If an individual a dysconjugate gaze in one eye in a specific direction, is this indicative of a UMN or LMN lesion?

A

LMN

43
Q

What nerve is CN5?

A

trigeminal nerve

44
Q

CN5 is a _______ nerve, but is more known for its __________ signaling.

A
  • mixed

- sensory (afferent)

45
Q

What are the 3 subdivisions of the trigeminal nerve?

A
  • opthalmic (forehead and nose bridge)
  • maxillary (cheeks and upper lip)
  • mandibular (jaw and anterior part of tongue, also towards ears)
46
Q

What are 3 tests performed to test for the trigeminal nerve function?

A
  • light touch to face (sensory to V1, V2, and V3)
  • bite strength
  • corneal reflex
47
Q

When is the corneal reflex test used?

A

With more unalert patients that can’t participate in the first two tests (obtunded patients)

48
Q

How is the corneal reflex test performed and what nerves are involved?

A
  • touch a cotton ball to the white of the eyes (do they feel the swab, do they blink)
  • CN5 and CN7
49
Q

If a patient has total loss of sensory to the face, where may the lesion be occuring?

A

-ganglion or sensory root

50
Q

Lesions in the _____ will result in a loss of light touch to the face, but pain and temperature are preserved.

A

pons

51
Q

Pain and temperature loss, but light touch retainment is much more _________. What is this called?

A
  • uncommon

- associative anasthesia

52
Q

What nerve is CN7?

A

facial nerve

53
Q

CN7 is a ____ nerve most known for its motor innervation to muscles of ________________.

A
  • mixed

- facial expression

54
Q

CN7 also has a sensory aspect and innervates the taste _________ for the anterior / of our tongue.

A
  • afferents (sensory)

- 2/3

55
Q

CN7 also has a function in the innervation of our secretomotor glands, including our _________ and __________ glands.

A
  • lacrimal

- salivatory

56
Q

What are the methods to testing CN7?

A
  • Observation
  • Motor (smile, raise eyebrows, puff out cheeks, purse lips, close eyes tightly)
  • Sensory (taste (typically don’t test), secretomotor function)
  • Reflexes (corneal reflex (w/CN5), nasopalpebral reflex)
57
Q
  • What is a complaint seen with the lacrimal gland?

- How could we test this?

A
  • dry eyes

- have them inhale ammonia

58
Q

-What is the way to test the salivatory gland?

A

-give them something spicy

59
Q

How do we differentiate between a UMN vs a LMN lesion of CN7?

A

-forehead gets bilateral innervation, therefore patient with a UMN lesion will be forehead sparing, but a LMN lesion will result in full contralateral facial weakness.

60
Q

What nerve is CN8?

A

vestibulocochlear

61
Q

Our vestibulocochlear nerve innervates both structures involved in our _________ and ____________ systems.

A
  • auditory

- vestibular

62
Q

What are the 2 tests used to test the auditory portion of CN8?

A
  • Auditory

- Weber and Rinne Tests

63
Q

What is the vestibulo-ocular reflex (VOR)?

A

vestibular reflex that allows you to keep your eyes on target while your head is moving, without distorting the visual input along the way

64
Q

What nerve is CN9?

What nerve is CN10?

A
  • glossopharyngeal

- vagus

65
Q

How do we test for CN9?

A

Palatine Activation

-look for symmetry when patient has mouth open, uvula will deviate to uninvolved side

66
Q

What test can we perform that involves both CN9 and CN10?

A

Gag reflex

  • sensory = CN9
  • motor (gag) = CN10
67
Q

Patients with CN9 and 10 dysfunctions will also present with what that causes difficulty in speech production?

A

voice hoarseness

68
Q

What nerve is CN11?

A

spinal accessory nerve

69
Q

What muscles does CN11 innervate?

A

SCM and trapezius

70
Q

How do we test for CN11 dysfunction?

A

MMTs

  • shoulder shrug for upper trap
  • bend and rotate for SCM
71
Q

Patients with a CN11 UMN lesion will present with weakness where?

A

trapezius, SCM is spared

72
Q

Patients with a CN11 LMN lesion will present with weakness where?

A

both SCM and trapezius

73
Q

What nerve is CN12?

A

hypoglossal nerve

74
Q

What does CN12 innervate?

A

tongue musculature

75
Q

How do we test for CN12 dysfunction?

A

-ask patient to stick tongue out, look for tongue deviation

76
Q

How do we determine CN12 UMN vs LMN lesions?

A

UMN lesion- tongue will deviate away

LMN lesion- tongue will deviate towards

77
Q

With CN12 LMN lesions we will also see what?

A

atrophy and fasciculations

78
Q

THE MOTOR EXAM

A

THE MOTOR EXAM

79
Q

What are the parts of the motor exam?

A
  • Inspection at Rest
  • Task Based Observation
  • Tone Assessment
  • MMT
80
Q

What are we looking for when inspecting a patient at rest?

A
  • Muscle Atrophy
  • Fasciculations
  • Hypertrophy
  • Tremors
  • Involuntary Movements
  • Posturing
81
Q

Patients with damage above/below the _____________ of the midbrain has significance to not only patient presentation (posturing) but also overall prognosis.

A

Red Nucleus

82
Q

Patients with damage above the red nucleus will take on a _________ resting posture where they have full flexion of their UE and LE.

A

decorticate

83
Q

Patients with damage below the red nucleus will take on a _________ resting posture where they have full extension of UE and LE.

A

decerebrate

84
Q

When we see posturing, what is this a prognostic indicator of?

A

severe injury to NS, will probably not get better

85
Q

What are the primary sensory pathways of the sensory exam?

A
  • pain
  • temperature
  • vibration
  • proprioception
  • light touch/2pt discrimination
86
Q

What is the scale for reflex testing?

A 
0 = absent
1+ = trace
2+ = normal
3+ = brisk
4+ = non-sustained clonus
5+ = sustained clonus
87
Q
  • Abnormally increased reflexes are a result of _____ lesions.
  • Abnormally decreased reflexes are a result of _____ lesions.
A
  • UMN

- LMN

88
Q

________ is also a part of the neuro exam.

A

coordination

89
Q

Deficits in any components of the neuro exam will inevitably lead to _____ disturbances.

A

gait

90
Q

UMN and LMN lesions will present very _________ during functional tasks

A

differently

Neuroanatomy and Physiology (19 decks)

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