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SUMPHYS2 > MOD3-Neuro > Flashcards

MOD3-Neuro Flashcards

1
Q

 Cranial Nerves

A

– 12 pairs emerging from (mainly brainstem) within the skull
– Motor, sensory or specialized functions
– Symptoms specific to area and function of nerve
– CN deficits: nerve or brain lesions

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2
Q

 Spinal Cord

A

– Extends from medulla (brainstem) to L1-2
– Becomes cauda equina below L2
– Contains motor and sensory nerve pathways
– Mediates reflex activity of deep tendon reflexes

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3
Q

 Spinal nerves

A

– Connect spinal cord with muscles and peripheral sensory receptors
– Nerve roots exit vertebral (spinal) column through neural foramina
– Each spinal nerve has an anterior (motor) and a posterior (sensory) root
– 31 pairs of spinal nerves attach to the spinal cord – 8 cervical, 12 thoracic, 5 lumbar and 5 sacral, 1 coccygeal

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4
Q

 Neural Pathways

A

 Three Main “Super-Highways” of brain and spinal cord
– Corticospinal Tract Motor
– Spinothalamic Tract-Sensory
– Posterior Column-Sensory
 Primarily located in brainstem and spinal cord

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5
Q

 Corticospinal tract: motor pathway

A

– White matter connection between cerebral cortex and lower medulla into the anterior horn cells of the spinal cord
– Decussates- nerve crossing over spinal cord.
– Upper motor neuron
– Lesion on C7- ipsilateral weakness
– Lesion in brain- crosses thus opposite side from brain lesion
– Responsible for muscle tone and skilled, voluntary movements

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6
Q

 Locating source of motor deficits

A

– If corticospinal tract is damaged, motor function is affected below the level of injury
– If neurons are damaged above crossover tracts in medulla, motor impairment is on opposite (contralateral)
– If lesion is in spinal cord motor impairment is on the same(ipsilateral)

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7
Q

 Upper motor neuron problem (CNS to cord); IE: stroke (Peripheral just going no control)

A

– Affected extremity is spastic
– Increased muscular tone
– Increased reflexes
– Positive Babinski

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8
Q

 Lower motor neuron problem (anterior horn to peripheral nerve)IE: herniated disc. NO signal.

A

– Affected extremity is flaccid
– Decreased muscular tone
– Decreased/absent reflexes
– Atrophy and fasciculations

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9
Q

 Spinothalamic tract(sensory tract)

A

– AFFERENT
Transmits pain, temperature, and crude touch sensation from spinal cord to thalamus
– Fibers cross to contralateral side at the posterior horn SPINAL CORD and travel up
– Lesions IN CNS cause contralateral anesthesia
– Loss of pain- Sharp/dull – evaluating pain
– Loss of temperature
– Unmyelinated- fast
– Same level of cross over of spinal cord
–

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10
Q

 Posterior column(sensory tract)

A

– Transmit fine touch, pressure, vibration, and proprioception from posterior column to thalamus
– Fibers cross to contralateral side in the medulla

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11
Q

 Peripheral neuro: the motor exam

A

 Motor exam (corticospinal tract) – combined with musculoskeletal system
– Myotomes (peripheral nerves to muscles)
– Corticospinal tracts
– Body position at movement and rest
– Involuntary movements: tremors, tics, fasciculation
– Muscle bulk: atrophy LMN
– Muscle tone: rigidity to passive ROM, spasticity, cog wheeling
– Muscle strength: resistive ROM. Compare for symmetry, OBJ

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12
Q

 Peripheral neuro: the sensory exam

A

– Dermatomes (spinal nerves)
– Deep tendon reflexes (spinal reflexes) (use reinforcement somewhere else, strenthers, hand clasp, clinch jow, or squeeze knees. Finger on tendon, then wider edge. If no finger, then smaller end. Look for muscle twitch. Take to length on tendon.
– Sensory modalities (spinothalamic tract, posterior columns)
 Cerebellum exam-balance & coordination

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13
Q

 Myotomes UPPER- test in middle ROM, break test

A

– Elbow flexion-C5, C6;
– Elbow and wrist extension- C6, C7, C8;
– Grip-C7, C8, T1;
– Finger abduction(ulnar nerve): C8, T1.
– Opposition of thumb: C8, T1(median nerve)

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14
Q

 Myotomes LOWER test in middle ROM, break test

A 
–	Flex at hip - L2,L3, L4; 
         Extend hip- S1
–	ADDuct hip - L2, L3, L4; 
–	ABD hip-L4, L5, S1; 
–	Extend knee - L2, L3, L4; 
–	Flex knee - L4, L5, S1
–	Dorsiflex-L4, L5; 
–	Plantarflex-S1
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15
Q

Sensory receptors found in:

A 
–	Skin
–	Mucous membranes
–	Muscles, tendons
–	Viscera
GSA
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16
Q

 Sensory Function

A

Skin receptors for different kinds of sensation send afferent impulses to spinal cord via peripheral and spinal nerves
– Impulses travel via spinothalamic tract or posterior columns to thalamus
– Impulses then travel to cortex for fine interpretation

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17
Q

 Tips for sensory testing

A

– Compare for symmetry
– For pain, temperature and touch sensation compare distal to proximal areas
– If detect an area of sensory loss map out its boundaries
– Ask yourself questions of central vs peripheral. Bilateral vs unilateral. Pattern of sensory loss suggest dermatomal distribution, polyneuropathy or spinal cord syndrome
– MD- marker will help determine what nerve and where

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18
Q

 Dermatomes

A

– A dermatome is a band of skin innervated by the sensory root of a single spinal nerve
– abnormal sensation w/in dermatome identifies location of injury
– Can be variable

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19
Q

 Nerve root or cutaneous(peripheral nerve)?

A

– Important to due sharp or dull (control)-to determine peripheral or cutaneous.
– Cutaneous- mixed spinal nerves large patches, many
– Dermatomes-linear lines

20
Q

 Spinal Reflexes: Deep Tendon Response

A

– Involuntary reflex arc between afferent and efferent nerves in spinal cord
Sensory impulse directly stimulates motor fiber
– Reflex – involuntary stereotypical response
– Hyperactive- UMN

21
Q

 Stereotypical – oversimplified

A

– Weakness and sensation changes can be tricky.
– *Reflexes are the most important test when determining a central vs peripheral process
– Damage to the corresponding spinal nerve, damaged peripheral nerves or disease of the muscle can all cause a LMN(peripheral nerve issue)
– Each reflex involves specific spinal segment
– abnormal finding will be helpful in location of problem

22
Q

 Deep Tendon Reflexes

A

– Specific to nerve root(dermatome) Stretch the muscle
– Increased or decreased?
– hyperactive reflex think UMN (CNS).
– Absent/diminished think LMN (PNS)

23
Q

Grading scale-DTR; Look for muscle contraction, no necessary the movement

A

– 0 = no response; always abnormal
– 1+ = a slight but definitely present response; may or may not be normal
– 2+ = normal
– 3+ = a very brisk response; may or may not be normal
– 4+ = a tap elicits a repeating reflex (clonus); always abnormal
– Clonus-fasciculations with DTR. MRI STAT

24
Q

Reflexes tested-Consider reinforcement if necessary to increase reflex activity; jaw clinch, knee squeeze, or hand clasp

A 
	Biceps – C5, C6
	Triceps – C6, C7
	Brachioradialis – C5, C6
	Patella – L2, L3, L4
	Achilles – S1
	Abdominal – T8-12- Abdominal reflex should show contraction of abdominal wall muscles and deviation of the umbilicus toward the stimuli
	Plantar – L5, S1
25
Q

Babinski response

A

Plantar Reflex (L5, S1):

Positive Babinski: upgoing/Ext of toes
- abnormal, indicating a UMN central nervous system lesion in the corticospinal tract

26
Q

Components of Sensory Exam

A 
	Light touch (both pathways)
	Pain (spinothalamic)
	Position and vibration (posterior columns)
	Discriminative sensations (cortex or posterior columns) – must have intact touch and proprioception
	Stereognosis
	Graphesthesia
	2 point discrimination
	Point localization
	Extinction
27
Q

Sensory Exam: Light Touch

A

 Eyes closed and have patient tell you when they feel the cotton ball
 Compare bilaterally, “do they feel the same?”
 Compare distal to proximal on each extremity, “do they feel the same?”
 Is the sensory loss dermatomal? Is it bilateral or unilateral? Does the pattern suggest central or peripheral issue?

28
Q

Sensory Exam: Spinothalamic tract

A

 Compare BIL
 Pain (sharp or dull)
 Eyes closed: Each time you feel me touch you, tell me if it is sharp or dull (control to make sure pt telling the truth)
 Once you touch one side (R) then the other (L) ask the patient, “do they feel the same?”
 Use dull (cotton Qtip) as control. Avoid Callus areas
 Compare distal to proximal on each extremity; “do they feel the same?”
 Performed on face, UE, LE

29
Q

 Sensory Abnormalities Findings for Doc.

A

 Hemisensory loss: lesion in spinal cord or higher
 Symmetrical distal loss: polyneuropathy, “stocking glove” in DM
 Anesthesia: absence of touch sensation

30
Q

 Sensory Abnormalities Findings for Doc.

A

 Hypoesthesia: decreased touch sensitivity
 Hyperesthesia: increased touch sensitivity. Zosters
 Analgesia: absence of pain sensation
 Hypoalgesia: decrease of pain sensation
 Hyperalgesia: increase of pain sensation

31
Q

 Sensory Exam: Vibration

A

 128 Hz tuning fork
 Eyes closed
 IP of thumb and great toe – bilaterally (or bony part of wrist. Distal to proximal
 Instruct the patient, “tell me what you feel”
 Then instruct, “Tell me when it stops”
 If impaired move proximally apply to bony prominences
 Vibration loss is typically the first sensation lost in peripheral neuropathy from diabetes, alcoholism, can be posterior column disease like syphilis and vitamin B12 deficiency. 16-fold increase in likelihood (diabetes mellitus, alcoholism). Can also help to identify what level the spinal cord lesion is

32
Q

 Sensory Exam: Proprioception

A

 Eyes closed
 DIP joint of index finger – isolate this joint by stabilizing the PIP joint on the side
 IP joint of great toe – stabilize MP joint
 Hold digit by the sides
 “Tell me which position I stopped in, up or down”
 Compare bilaterally
 Seen in DM peripheral neuropathy, posterior column diseases such as B12 deficiency and MS

33
Q

 Sensory Exam: Cortex & Posterior Columns.

A

Discriminative Sensations:
EYES CLOSED FIRST. Evaluates sensory cortex. Touch and proprioception must be intact or only slightly impaired to test for discriminative sensations. If these are intact and decreased or absent DS then lesion in the sensory cortex

34
Q

 Sensory Exam: Cortex Posterior Columns.

A
  1. Stereognosis- describe what is placed in hands
  2. Graphesthesia- describe what is drawn on hand
  3. 2 point discrimination- normally less than 5 mm on the finger pads. “AM I TOUCHING YOU WITH TWO OR ONE. COMMON TEST
  4. Point localization -Eyes closed, touch patient; have them open their eyes and touch themselves where you touched them
  5. Extinction- Eyes closed, touch patient with simultaneous stimulation; ask where patient felt touch (should be both). if only one side is felt then lesion of the sensory cortex is opposite side of stimuli
35
Q

 Balance and Coordination

A

Tests motor system, cerebellar system, vestibular system and sensory system
Balance and coordination require four areas of function: motor system(strength), cerebellar system which is part of the motor system for steady posture and rhythmic movement, vestibular system(balance and coordination), sensory system(position sense).

36
Q

 Rapid Alternating Movements

A

 Flip hands back and forth on thighs- normal is smooth
 Tap index finger on thumb
 Tap foot quickly
These test for dysdiadochokinesis (cerebellar disease)

37
Q

 Point-to-point movements

A

 Ask pt to touch your index finger and then his/her nose alternately; watch for smooth movements
 Hold your finger in one place and have patient raise their arm, then lower their arm to touch your finger
 Dysmetria
 Heel-to-shin, note smoothness and accuracy

38
Q

 Gait

A

 Ask patient to walk across room to observe balance
 Walk heel-to-toe or Tandem walking
 Walk on the toes, then on the heels; Heel walk sensitive for corticospinal tract damage
 Hop in one place on one foot at a time; Proximal and distal muscle strength, cerebellar function and position sense
 Shallow knee bend and Rise from sitting to standing position; Proximal muscle strength

39
Q

 Stance

A

 Romberg test: Ask pt to stand with feet together then have patient close eyes. Positive Romberg test is loss of balance. Test of position sense.
 Romberg test is NOT a test of the cerebellum but one of proprioception or dorsal column disease.

40
Q

Pronator Drift

A

: Stand with both arms stretched out forward with palms up (supination), then close eyes. Positive Pronator Drift when one arm drifts down and starts to pronate. Supinator not strong enough to lift up. Able to lift but not maintain. (Radial nerve-weak UMN lesion) MRI STAT
 Pronator drift indicative of an UMN issue – supination weaker than pronation

41
Q

 Ankle Clonus-special test

A

 Next step if patient’s reflexes are hyperactive. UMN
 Support knee in partially flexed position
 Gently dorsiflex and plantarflex foot to relax it
 Sharply dorsiflex foot and hold
 Look and feel for rhythmic oscillations
Fasciculation muscle twitch
 Sustained clonus indicates CNS disease

42
Q

 Anal Reflex

A

– Stroke of four quadrants of anus with dull object
– Normally contraction of anal musculature occurs
– S2-4

43
Q

 Terms: sensory problems

A

– Analgesia: absence of pain sensation
– Anesthesia: absence of touch sensation
– Astereognosis: inability to recognize objects placed in the hand

44
Q

 Terms: motor problems

–

A

 Terms: motor problems
– Hypotonia: decreased muscle tone
– Hypertonia: increased muscle tone
– Spasticity: increased resistance that is rate dependent and worsens with certain movements
– Rigidity: hypertonia that is not direction or rate dependent
– Paresis: weakness (impaired strength)

45
Q

 Terms: motor problems cont.

A

– Plegia: paralysis
– Ataxia: gait that lacks coordination
– Clonus: rhythmic jerking from flexion to extension in response to muscle stimulation
– Dysarthria: impaired speech due to uncoordination of speech muscles
– Dysdiadochokinesis: when one movement cannot be followed quickly by its opposite- movements are slow, irregular or clumsy
– Dysmetria: a lack of coordination of movement illustrated by the undershoot or overshoot of intended position

SUMPHYS2 (27 decks)

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