Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

YL1: Neuroscience > Module 3 > Flashcards

Module 3 Flashcards

1
Q
  • tubular stalk-like part of the brain made up of midbrain, pons and medulla oblongata from above down
A

BRAINSTEM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

MIDBRAIN

A
  • CN III oculomotor

- CN IV trochlear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

PONS

A
  • CN V trigeminal
  • CN VI abducens
  • CN VII facial
  • CN VIII vestibulocochlear
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

MEDULLA

A
  • CN IX glossopharyngeal
  • CN X vagus
  • CN XI accessory nerve
  • CN XII hypoglossal
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q
  • carries information from olfactory bulb to the olfactory areas of the cerebral cortex
  • does not go through the thalamus
  • go through amygdala (center for memory and emotion)
A
  • CN I olfactory nerve
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q
  • special somatic afferent pathway concerned with reception and transmission of visual impulse and perception of vision or sight
  • rods (black and white)
  • cones (colored)
  • made up of ganglionic cells
A
  • CN II optic nerve
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q
  • carry nasal field
A
  • TEMPORAL FIBER
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q
  • carry the temporal field
A
  • NASAL FIBER
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q
  • loss of half field of vision
A
  • HEMIANOPIA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q
  • same half of field of vision is lost in both eyes
A
  • HOMONYMOUS HEMIANOPIA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q
  • lesion before the optic chiasm
A
  • MONOCULAR VISUAL PROBLEM
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q
  • lesion after the optic chasm
A
  • BINOCULAR VISUAL LOSS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q
  • supplies majority of the extrinsic as well as the intrinsic muscles of the eyeball
A
  • CN III ocolumotor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q
  • EXTRINSIC
A
  • superior rectus (looking up, down and out eye)
  • inferior rectus (looking down)
  • medial rectus (moves the eye towards nose)
  • inferior oblique (elevates the eyeball)
  • levator palpebrae superioris (elevate the eyelid)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q
  • INTRINSIC
A
  • sphincter pupillae (constrict pupils)

- ciliary muscles or ciliaris (for accommodation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q
  • drooping of eyelid due to elevator palpebrae superiors
A
  • PTOSIS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q
  • due to unopposed action of lateral rectus because of paralysis of medial rectus
A
  • LATERAL STRABISMUS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q
  • due to paralysis of sphincter pupillae; loss of light reflex
A
  • MIDRIASIS (dilation of pupil)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q
  • due to paralysis of extrinsic muscle
A
  • DIPLOPIA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q
  • contralateral hemiplegia due to damage of crus cerebri
A
  • WEBER SYNDROME
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q
  • located in the tegmentum of the midbrain
  • supplies the superior oblique - depresses the eyeball (downward gaze)
  • only cranial nerve that emerges from the dorsal aspect of the brainstem
A
  • CN IV TROCHLEAR NERVE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q
  • thickest and largest sensory nerve
A
  • CRANIAL NERVE V TRIGEMINAL NERVE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q
  • corneal reflex

- sensation in the uppercase up to the forehead including the conjunctiva

A
  • V1: ophthalmic nerve
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q
  • sensation from maxillary teeth and gums
A
  • V2: maxillary nerve
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q
  • sensory from mandibular teeth and gums
A
  • V3: mandibular
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q
  • not the area of the trigeminal nerve
A
  • angle of jaw
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q
  • for the angle of the jaw
A
  • cervical spinal cord
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q
  • innervation of the muscles of mastication (masseter, temporalis, medial and lateral pterygoid)
A
  • motor function of trigeminal nerve
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q
  • supplies the lateral rectus (move eye laterally away from the midline)
A
  • CN VI ABDUCENS NERVE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q
  • areas affected by the cavernous sinus
A
  • CN III, IV, V, VI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q
  • due to nonfiction of the lateral rectus leading to unopposed action of the medial rectus
A
  • MEDIAL STRABISMUS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q
  • mixed nerve with multiple motor and sensory component
  • supplies muscles developed from mesoderm of 2nd brachial arch
    a. muscles of the scalp, auricle and facial expressions with platysma
    b. stapedius muscle of the middle ear
    c. posterior belly of digastric and stylohyoid
A

CN VII FACIAL NERVE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q
  • supplies secretomotor fibers to submandibular and sublingual salivary glands
  • carries taste sensation from anterior two thirds of tongue and form plate
  • carries proprioceptive sensation from muscles of facial expression
A

CN VII FACIAL NERVE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Clinical testing to judge the function of Facial Nerve

A
  1. Frowning
  2. Tight closure of eyelids
  3. Smiling
  4. Blowing of mouth
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q
  • characterized grossly by contralateral hemiplegia and ipsilateral total facial paralysis
A

MILLARD GUBLER SYNDROME

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q
  • compression of the nerve within the stylomastoid foramen
A

Bell’s Paralysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q
  • lesion above the origin of nerve to stapedius

- loss of damping down effect in conduction of sound wave through stapes of the chain of the middle ear ossicles

A

HEMIHYPERACUSIS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q
  • purely sensory nerve made up of two components vestibular and cochlear
  • VESTIBULAR - impulses required for maintenance of equilibrium or balance of the body
  • COCHLEAR - for the perception of hearing
A

CN VIII VESTIBULOCOCHLEAR NERVE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Vestibulocochlear nerve as well as facial nerve are relates to ___

A

Cerebellopontine Angle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q
  • due to increase edolymphatic volume in membranous labyrinth
  • complains of recurrent attacks of vertigo and tinnitus
A

Meniere’s Syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q
  • mixed cranial nerve
  • supply muscle developed from third branchial arch (stylopharyngeus muscle)
  • provides general sensation from posterior 1/3 of the tongue, tonsils, skin of the external ear, internal surface of tympanic membrane and the pharynx
  • stimulates the parotid gland
A

CN IX GLOSSOPHARYNGEAL NERVE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q
  • characterized by severe, sharp, lancing pain in the region of the tonsil, radiating to the ear
A

GLOSSOPHARYNGEAL NEURALGIA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q
  • latin word means “wandering”
  • sensation from posterior meninges, concha, skin at the back of the ear and in the acoustic meatus, part of external surface of the tympanic membrane, the pharynx, and larynx
  • supplies smooth muscles of whole tracheaobronchial tree, and foregut and midgut
  • testing the GAG REFLEX
A

CN X VAGUS NERVE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q
  • head turning and shoulder elevation

- purely motor nerve to supply muscles developed from 6th branchial arch along with sternocleidomastoid and trapezius

A

CN XI ACCESSORY NERVE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Central lesion of accessory nerve may occur due to __

A

Lateral Medullary Syndrome and Jugular Foramen Syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q
  • purely motor nerve supplying muscles of tongue

- consists of all extrinsic and intrinsic muscle of tongue except palatoglossus

A

CN XII HYPOGLOSSAL NERVE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

If Left hypoglossal nerve is paralyzed, tongue will deviate to the __ because the muscle is unopposed.

A

Left

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

The Clinical Method

A
  1. The symptoms and signs are secured by history and physical examination
  2. The symptoms and physical signs considered relevant to the problem at hand are interpreted in terms of physiology and anatomy
  3. These analyses permit the physician to localize the disease process - This step is called anatomic, or topographic, diagnosis
  4. From the anatomic diagnosis and other medical data
  5. Physician should assess the degree of disability and determine whether it is temporary or permanent (functional diagnosis)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q
  • Often one recognizes a characteristic clustering of symptoms and signs, constituting a syndrome of anatomic, physiologic, or temporal type. The formulation of symptoms and signs in syndromic terms is particularly helpful in ascertaining the locus and nature of the disease
A

anatomic, or topographic, diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q
  • Special care must be taken to avoid suggesting to the patient the symptoms that one seeks
  • The setting in which the illness occurred, its mode of onset and evolution, and its course are of paramount importance.
A

History

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

2 main components:
Psychiatric aspects - incorporate affect, mood, and normality of thought processes and content

Neurologic aspects - include the level of consciousness, awareness (attention), language, memory, and visuospatial abilities.

A

Testing of Higher Cortical Functions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

The function of the cranial nerves must generally be investigated more fully in patients who have neurologic symptoms than in those who do not.

A

Testing of Cranial Nerves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

It should be kept in mind that observation of the speed and strength of movements and of muscle bulk, tone, and coordination are most informative and are considered in the context of the state of tendon reflexes.

A

Testing of Motor Function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Testing of the biceps, triceps, supinator-brachioradialis, patellar, Achilles, and cutaneous abdominal and plantar reflexes permits an adequate sampling of reflex activity of the spinal cord.

A

Testing of Reflexes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Attainable only through the subjective responses of the patient, it requires great patient cooperation.
 It is not necessary to examine all areas of the skin surface.

A quick survey of the face, neck, arms, trunk, and legs with a pin takes only a few seconds.

A

Testing of Sensory Function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

An abnormality of stance or gait may be the most prominent or only neurologic abnormality,

Having the patient walk tandem or on the sides of the soles may bring out a lack of balance or dystonic postures in the hands and trunk.

A

Testing of Gait and Stance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Parts of the Neurologic Examination

A
  1. Mental Status Examination
  2. Cranial Nerves
  3. Motor System
  4. Deep Tendon Reflexes
  5. Cerebellar System
  6. Sensory System
  7. Meningeals
  8. Autonomics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

INITIAL INSPECTION

A
  • Motor examination begins the moment the patient walks into your clinic
  • Have the patient undress
  • Determine the patient’s gestalt, somatotype or body build
- Inspect the size and contour of muscles
Look for atrophy vs hypertrophy
Body asymmetry
Joint malalignment
Fasciculations
Tremors
Involuntary movements
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

STATION AND GAIT TESTING

A
  • Observe the Pt’s station, the steadiness and verticality of the standing posture.
  • Test the gait by asking the Pt to walk freely across the room.
  • Look for unsteadiness, a broad-based gait, and lack of arm swinging.
  • Ask the Pt to walk on the toes, heels, and in tandem (from heel to toe along a straight line).
  • Request a deep knee bend. Ask a child to hop on each foot and to run.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

(Strength Testing)

PRINCIPLES

A
  • The Matching Principle
  • The Length-Strength Principle
  • The antigravity muscle principle
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Select those movements that just about match your arm and hand strength.

To gauge strength accurately, select movements that are neither too strong for you to possibly overcome nor too weak for you to judge their resistance.

A

The Matching Principle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

muscles are strongest when tested from the shortest position

A

The Length-Strength Principle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

muscles which support the standing posture against collapse by pull of gravity

A

The antigravity muscle principle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

STRENGTH SCALE

A

0 - No contraction
1 - A flicker or trace of contraction
2 - Active movement with gravity eliminated
3 - Active movement against gravity
4 - Active movement against gravity and moderate resistance
5 - Normal power

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Techniques in Testing for Muscle Weakness

A
  • Be systematic: Rostrocaudal Sequence
  • Test the neck flexors and extensors
  • Test the shoulder girdle muscles
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Command px to hold out the arms at the sides. Press down.

A

Arm elevation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

With arms extended, patient resists your effort to elevate them

A

Arm adduction downward

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

With arms extended in front with wrists crossed, examiner tries to pull them apart

A

Arm adduction across the chest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

With hands on the hips patient forces elbows back against your resistance

A

Scapular adduction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Have the patient try to do a push up or push against the wall

A

Scapular winging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

The average Pt’s back is far too strong for the Ex to test by manual opposition. Two tests can be done:

  1. With the Pt prone, ask the Pt to arch the back and rock on the stomach. Inspect and palpate the paraspinal muscles.
  2. Have the Pt bend forward at the waist and straighten up. If you try to oppose the Pt’s straightening up from a bent waist, you may cause a back sprain or herniation of an intervertebral disc.
A

Testing for weakness of the large back muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q
  1. Elbow flexors: The Pt tightly flexes the forearm. Brace one hand against the Pt’s shoulder. With the other hand, grasp the Pt’s wrist and attempt to straighten the Pt’s forearm.
  2. Elbow extensors: If you give the matter no thought, you might try to test the triceps with the elbow locked in extension. But the triceps, an antigravity muscle, is tremendously strong, and with an average person against another average person, the locked-out elbow wins easily.
A

Testing for weakness of upper arm muscles: flexion and extension of the elbow

73
Q

Testing for weakness of forearm muscles: wrist flexion and extension

A
  1. Wrist flexors: The Pt makes a fist and holds the wrist flexed against your efforts to extend it. By hooking your fingers around the Pt’s fist and flexing your own wrist, you can pit your own wrist flexion against the Pt’s. Brace the Pt’s wrist with your other hand.
  2. Wrist extensors: For support, rest the Pt’s forearm flat on his thigh or a tabletop. The Pt then holds the wrist forcefully cocked-up (dorsiflexed) as you try to press it down with the butt of your palm on the Pt’s knuckles.
74
Q

Testing for weakness of finger muscles

A

Abduction-adduction of the fingers: Test by carefully figuring out how to match your strength against the Pt’s.

75
Q

Testing for abdominal muscle weakness

A

Position:With the Pt supine (face up), ask for a sit-up or for the Pt to elevate the legs or the head. At the same time, watch the umbilicus as the abdominal muscles contract.

76
Q

Testing for weakness of the hip girdle

A
  1. Hip flexion:With the patient sitting, ask the Pt to lift a knee off of the table surface and to hold the thigh in a flexed position. With the butt of your palm, try to push the knee back down.
  2. Thigh abduction and adduction: With the Pt sitting, have the Pt hold the legs abducted as you try to press them together with your hands on the lateral sides of the knees. Then have the Pt try to hold the legs adducted (squeezed together) as you place your hands on the medial sides of the knees to try to pull the knees apart.
77
Q

Knee extensors: With the Pt prone, have the Pt try to touch the heel to the buttock to induce extreme flexion of the knee.Grasp the Pt’s ankle and oppose extension. Compare the extensor strength of the two legs.

Knee flexors (hamstrings): The Pt holds the knee at an angle of 90 degrees, while you try to straighten it by grasping the Pt’s ankle.

A

Testing for weakness of the thigh muscles

78
Q
  1. Have the Pt dorsiflex, invert, and evert the feet. Inspect, palpate the leg, and check for the strength of these movements by manual opposition.
  2. Plantar flexion of the foot is ordinarily too strong to test by manual opposition. Because the Pt walked on the balls of the feet during the gait examination, you already know that the plantar flexors can lift the entire body weight of the Pt.
  3. The Pt holds the toes flexed or extended as the Ex attempts to press them back to the neutral position.
A

Testing for weakness of ankle and toe movements

79
Q

Muscular resistance apart from gravity or joint disease the examiner feels when manipulating a patient’s resting joint

is due to:
Elasticity of the muscle
Number and rate of motor discharges

A

Muscle tone

80
Q

(Muscle Tone: Hypertonia)

  • Initial catch or resistance and then a yielding when the examiner manipulates the patient’s resting extremity
  • Clasp knife spasticity
A

SPASTICITY

81
Q

(Muscle Tone: Hypertonia)

  • Increased muscular resistance felt throughout the entire range of movement when the examiner slowly manipulates a patient’s resting joint
  • Lead-pipe rigidity
A

RIGIDITY

82
Q

(Muscle Tone: Hypertonia)

Resistance equal in degree and range that the patient presents to the examiner as he tries to move a part in any direction

A

PARATONIA

83
Q

(Muscle Tone: Hypotonia)

  • Decreased resistance
  • Increased range of motion of the joint movement i.e. hyperextensible knees or flaccid heel cords
A

FLACCIDITY

84
Q

Technique for Eliciting Muscle Stretch Reflexes

A
  1. Holding the percussion hammer and delivering the blow

2. Eliciting the MSRs in the Neurologic Examination

85
Q

With the patient’s jaw sagging loosely open, the examiner rests a finger across the tip and strikes it a crisp blow.

A

Jaw reflex

86
Q

The examiner’s thumb places slight tension on the patient’s biceps tendon and the bicipital aponeurosis.The examiner strikes his thumbnail a crisp blow

A

Biceps reflex

87
Q

(A) Dangle the patient’s forearm over your hand and strike the triceps tendon.
(B) Cradle the patient’s forearm in your hand and strike the triceps tendon.

A

Triceps reflex

88
Q

Cradle the patient’s forearm in one hand, placing the thumb on top of the radius.
(A) The hammer strikes the examiner’s thumbnail rather than the patient’s radius.
(B) Don’t whack away on the patient’s unprotected bone. The examiner may cradle both forearms side by side for accurate comparison of the responses of the two arms.

A

Brachioradialis reflex

89
Q

The examiner supports the patient’s completely relaxed hand and briskly flips the patient’s distal phalanx upward, as though to flip a handful of water high into the air. The patient’s fingers and thumb flex in response to the stretch of the finger flexor muscles.

A

Finger flexion reflex (Tromner’s method)

90
Q

The examiner depresses the distal phalanx and allows it to flip up.The extension of the phalanx stretches the flexor muscles, causing the fingers and thumb to flex. This method is effective only with very brisk muscle stretch reflexes.

A

Finger flexion reflex (Hoffman’s method)

91
Q

The examiner strikes the patellar tendon a crisp blow. By placing a hand on the patient’s knee, the examiner feels and sees the magnitude of the response

A

Quadriceps femoris reflex, with the patient sitting

92
Q

The examiner bends the patient’s legs to place slight tension on the patellar tendon.The blow then will deform the tendon and transmit a stretch to the muscle.

A

Quadriceps femoris reflex, with the patient supine

93
Q

With the patient’s knee bent and relaxed, the examiner dorsiflexes the patient’s foot to place slight tension on the triceps surae muscle

A

Triceps surae reflex,with the patient supine.

94
Q

a muscle stretch reflex. The maneuver is identical with the finger flexion method. Tapping the ball of the foot also elicits toe flexion.

A

Toe flexion reflex (Rossolimo’s sign)

95
Q

After interruption of the UMNs to the lumbosacral cord, the great toe extends instead of flexing, a result called an __

A

extensor plantar response, extensor toe sign,or Babinski sign

96
Q

MSR Grading

A

0 - Areflexia
1 - Hyporeflexia
2 and 3 - Normal
4 and 4+ - Hypereflexia

97
Q

Stroking the skin of the abdominal quadrants or inner thighs elicits the superficial abdominal and cremasteric reflexes

A

Abdominal Reflex

98
Q

Pricking the skin around the anus causes a quick, twitch-like constriction of the anal sphincter, the so-called __

A

anal wink

99
Q
  • Paralyzes movements in hemiplegic, quadriplegic distribution, not individual muscles
  • Atrophy of disuse
  • Hyperactive MSRs
  • (+) Clonus, Clasp-knife spasticity
  • (+) Extensor Toe Sign
A

Upper Motor Neuron Lesions

100
Q
  • Paralyzes individual muscles or sets of muscles in root or peripheral nerve distribution
  • Atrophy of denervation
  • (+) Fasciculations and Fibrillations
  • Hypoactive MSRs
  • Hypotonia
A

Lower Motor Neuron Lesions

101
Q

Move an object along the lateral side of the foot

A

Chaddock

102
Q

Squeeze hard on the Achilles tendon.

A

Achilles-toe reflex/Schaeffer

103
Q

Press your knuckles on the patient’s shin and move them down.

A

Shin-toe reflex or Oppenheim

104
Q

Squeeze the calf muscles momentarily.

A

Calf-toe reflex or Gordon

105
Q

Make multiple light pinpricks on the dorsolateral surface of the foot

A

Pinprick toe reflex or Bing

106
Q

Pull on the 4th toe outward and downward for a brief time and release suddenly

A

Toe-pull reflex or Gonda, Stransky

107
Q
  • Are sensorimotor functions that are lost after a neurologic lesion
  • i.e. loss of movement, loss of vision
A

Deficit Phenomenon

108
Q
  • Are sensorimotor functions that become increased or first emerge after a neurologic lesion
  • i.e. hyperactive MSRs, Babinski sign
  • The lesion has interrupted inhibitory connections
A

Release Phenomenon

109
Q

rhythmic oscillations of a body part

A

Tremors

110
Q

incessant, random, quick movement

A

Chorea

111
Q

slow, writhing movement of fingers and extremities

A

Athetosis

112
Q

prolonged slow, alternating contraction and relaxation of agonist and antagonist muscles

A

Dystonia

113
Q

violent flinging movements of one half of the body

A

Hemiballismus

114
Q

quick, lightning-fast movements of face and upper extremties

A

Tics

115
Q

Three membranes that surround the brain

A
  1. Dura Mater or Pachymeninx - Most external; Dense connective tissue
  2. Arachnoid - Delicate layer of reticular fibers forming a weblike membrane
  3. Pia Mater - Thin, translucent membrane
    - Adherent to the surface of the brain and spinal cord
    - Accurately follows every contour
116
Q

Pia Mater + Arachnoid

A

Leptomeninges

117
Q

Cranial Dura

Periosteal layer: outer most layer; blood vessels and nerves
Meningeal Layer: flat cells, gives rise to several septa

A

CRANIAL DURA MATER

118
Q

(Septa)

  • Crista galli to internal occipital protuberance
  • b/n cerebral hemispheres
A

Falx Cerebri

119
Q

(Septa)

between posterior fossa and cortex

A

Tentorium Cerebelli

120
Q

(Septa)

small midsagittal septum below the tentorium which partially separates the cerebellar hemispheres

A

Falx Cerebelli

121
Q

(Septa)

an extension of the dura mater that roofs over the pituitary fossa, perforated by the infundibulum

A

Diaphragma Sellae

122
Q

opening b/n compartments

A

Tentorial Incisure (Notch)

123
Q
  • Branch of maxillary artery
  • Enters skull via foramen spinosum
  • Major blood supply of the dura
A

Middle meningeal artery

124
Q

The ophthalmic artery gives rise to __

A

anterior meningeal branches

125
Q

occipital and vertebral arteries provide __

A

posterior meningeal branches

126
Q

Skull fractures lacerating branches of the meningeal artery produce epidural hemorrhages that separate the periosteal layer of the dura from the inner table of the skull

A

epidural hematoma

127
Q
  • From the foramen magnum to S2
  • Caudal termination invests the filum terminal to form the coccygeal ligament
  • Spinal Cord: ends at L1
  • Paired dural root sleeves: extensions of dura passing laterally around the spinal nerve rootlets
A

SPINAL DURA MATER

128
Q

extends to the coccyx and becomes continuous with the periosteum

A

Coccygeal Ligament

129
Q
  • Delicate non vascular membrane
  • Between dura and pia mater
  • Passes over the sulci without following their contours
A

ARACHNOID

130
Q

The space between the arachnoid and pia is filled with CSF

A

subarachnoid space

131
Q
  • Largest cistern

- b/n medulla and cerebellum

A

cerebellomedullary cistern (cisterna magna)

132
Q
  • surround posterior, superior and lateral surfaces of midbrain
  • contains the great vein of Galen and PCA and SCA
A

cisterna amaines or superior cistern

133
Q

from conus medullaris to S2, contains the filum terminale and nerve roots of the cauda equina, where CSF is commonly withdrawn

A

Lumbar cistern

134
Q
  • Avascular, nutrients from CSF and underlying neural tissue
  • 2 components:
    Epipial Layer: meshwork of collagenous fiber bundles
    Intima Pia: fine reticular and elastic fibers
  • Epipial layer is absent over the convex surface of the cortex
  • Cerebral blood vessels lie on the intima pia anchored by arachnoid trabeculae
A

CORTICAL PIA MATER

135
Q
  • formed by intima pia

- where blood vessels enter and leave the CNS

A

Perivascular space

136
Q
  • Spinal cord blood vessels lie within the epipial layer
  • Denticulate ligaments:
    > epipial tissue that attach the spinal cord to the dural tube
    > Bases arise in the pia and apices are attached to the arachnoid and inner surface of the dura
    > Present throughout the length of the spinal cord
  • Intima pia is firmly attached to the spinal cord by the superficial glial membrane
A

SPINAL CORD PIA MATER

137
Q

is a set of four structures, the ventricles, containing cerebrospinal fluid (CSF) in the brain. It is continuous with the central canal of the spinal cord

A

ventricular system

138
Q

LOCATION OF CSF

A

Subarachnoid space and the ventricular system (ventricles, cistern, sulci of the brain, central canal)

139
Q

CSF PRODUCTION

A

Choroid Plexus: within ventricles (lateral ventricles and roof of the third and fourth ventricles) of the brain

Rate of production: 500 mL/day (0.3-0.4 mL/ min)

140
Q

FUNCTION OF THE CSF

A
  1. Mechanical protection by bouyancy
    - Low specific gravity of CSF (1.007)
    - Reduces the effective weight of the brain from 1.4 kg to 47g (Archimede’s principle) reduces brain inertia protects it against deformation
  2. Removes waste products of metabolism, drugs and other substances that diffuse into the brain from blood.
  3. Integrate brain and peripheral endocrine functions
  4. Influence microenvironment of neurons and glial cells
141
Q

CSF COMPOSITION

A

Protein - 60% of plasma
Glucose - 1% of plasma
RBC - 0 cells
WBC - 0-3 cells

142
Q

THE CSF PATHWAY

A

lateral ventricle&raquo_space;> foramina of monroe&raquo_space;
3rd ventricle&raquo_space; cerebral aqueduct&raquo_space;
4th ventricle&raquo_space; central canal of the spinal cord or into the cisterns of the subarachnoid space via three small foramina (central foramen of Magendie and the two lateral foramina of Luschka)

143
Q
  • Separates blood from brain extracellular fluid
  • Formed by endothelial cells
  • Allow passage of water, some gases and lipid soluble molecules by passive diffusion and selective transport of glucose and amino acids
  • Prevent the entry of lipophilic neurotoxins
A

BLOOD-BRAIN BARRIER

144
Q
  • is a pair of barriers that separates peripheral and cerebral blood flow from the CSF
  • composed of epithelial cells of the choroid plexus at the peripheral blood–CSF boundary and the arachnoid membrane at the cerebral blood–CSF boundary
  • serves the same purpose as the BBB but facilitates the transport of different substances into the brain due to the distinct structural characteristics between the two barrier systems
A

blood–cerebrospinal fluid barrier

145
Q

WBC: >50/mm3
PROTEIN: 100-250
GLUCOSE: 20-250 mg%
OTHER FEATURES: inc. pressure; (+) organism on GS

A

BACTERIAL

146
Q

WBC - 10-100/mm3
PROTEIN: 50-200
GLUCOSE: Normal or slightly decreased
OTHER FEATURES: N or sl. increase ICP; special culture

A

VIRAL, FUNGAL, SIPROCHETAL

147
Q

WBC: >25/mm3
PROTEIN: 100-1000
GLUCOSE:

A

TUBERCULOSIS

148
Q

RBC: >500/mm3
PROTEIN: 60-150
GLUCOSE: Normal
OTHER FEATURES: Xanthochromic; inc pressure

A

SAH

149
Q

RBC: 50-200/mm3
PROTEIN: 50-150
GLUCOSE: Normal
OTHER FEATURES: Inc Pressure

A

ICH, TRAUMA

150
Q

Normal or few WBC
PROTEIN: Normal
GLUCOSE: Normal
OTHER FEATURES: Normal unless with edema

A

ISCHEMIC STROKE

151
Q

Normal or few WBC
PROTEIN: Normal or slight increase
GLUCOSE: Normal
OTHER FEATURES: increase IgG fraction and oligoclonal bands

A

MULTIPLE SCLEROSIS

152
Q

WBC 10-100/mm3
PROTEIN: usually increase
GLUCOSE: Normal or slightly decreased
OTHER FEATURES: Neoplastic cells in CSF

A

MENINGEAL CANCER

153
Q

RAISED INTRACRANIAL PRESSURE

A
  • Obstructed to CSF flow and/or absorption
  • Increase CSF production/CSF volume expansion
  • Generalized Cerebral Edema (Cytotoxic, Vasogenic or Interstitial)
  • Cerebral or Extracerebral mass
  • Increase in Venous pressure
154
Q
  • Obstruction of the basal cisterns
  • Extensive meningeal disease
  • At absorptive sites adjacent to cerebral convexities and SSS: ventricles are normal in size
A

OBSTRUCTED CSF ABSORPTION

155
Q
  • Establish symmetry and distribution of deficits for the following modalities:
    Light touch
    Pain and temperature
    Vibration and position sense
A

Sensory System

156
Q

General Principles in Examination of Somatosensory System

A
  1. Have the patient close their eyes to avoid visual clues and place full reliance on the skin stimuli
  2. Compare homologous areas of the right and left sides and compare normal and suspected abnormal areas
  3. The skin areas differ greatly in sensitivity to stimuli
  4. Sensory lesions can have either positive phenomenon (too much sensation) or negative phenomenon (deficit/too little sensation)
157
Q

The skin areas differ greatly in sensitivity to stimuli

A
  • Skin over the face and armpits» horny skin of palms and soles
  • Hairy skin» glabrous skin
  • Forehead sensitive area for temperature discrimination
158
Q

Terminology

A

Esthesia = touch or feeling

Therm = heat

Algesia = pain

159
Q
  • Loss of all modalities in the limbs (depending on the extent of the lesion)
  • Loss of pain and temperature of the face with or without “muzzle” area sparing and a lateral gaze palsy towards that side
A

Contralateral Pontine Lesion

160
Q
  • Loss of all modalities in the limbs (depending on the extent of the lesion)
  • Loss of pain and temperature of the face with or without “muzzle” area sparing and normal gaze
  • weakness of palate and tongue on side opposite to the limb sensory deficit
A

Contralateral Medullary Lesion

161
Q
  • Loss of pain, temperature and light tough below a specific dermatome level (may spare sacral sensation)
A

Contralateral Spinothalamic Tract

162
Q
  • Loss of all modalities at one or several dermatome levels
  • Loss of pain and temperature below a specific dermatome level
  • Loss of proprioception ‘discriminatory’ touch up to the similar level and limb weakness
A

Brown-Sequard Syndrome

163
Q
  • Bilateral loss of all modalities

- Bilateral leg weakness

A

Complete Cord Lesion

164
Q
  • Bilateral loss of pain and temperature

- Preservation of proprioception and discriminatory sensation

A

Central Cord Lesion

165
Q
  • discriminatory sensory deficit
  • sensory inattention (perceptual rivalry)
  • only minimal pain and temperature loss
A

Lesion of Contralateral Parietal Cortex

166
Q
  • selective deficit in face, arm, trunk or leg
A

Selective Cortical Lesion

167
Q
  • Loss of all sensory modalities including pain and temperature in the face, arm, trunk and leg
A

Contralateral Thalamic Lesion

168
Q
  • Initially, the area of total sensory loss is defined
  • Test object e.g. pin, should be moved from anaesthetic to
    normal area: it is more accurate to state when an object is felt rather when it disappears.
  • Examination of gait is important; with joint position impairment, sensory ataxia is evident. Romberg’s test is positive. Neuropathic burns/ ulcers or joins may be present
A

Testing for Pain and Temperature

169
Q

For screening purposes test only the dorsum of the hands and feet (DeMyer)

Test each area as required by the history (DeMyer)

A

Testing touch sensation

170
Q
  • Use the tuning fork versus finger or hot and cold tubes (DeMyer)
  • Remember you are testing temperature discrimination, not how much heat/cold the patient can tolerate! (DeMyer)
A

Testing temperature sensation

171
Q
  • Use of a pin, with both blunt and sharp ends (DeMyer).
  • Alternate blunt and sharp ends.
  • Make 3 successive pricks.
  • Ask the patient to respond “dull” or “sharp.”
  • Have the patient close his eyes.
  • Start with a normal area.
  • Avoid the thick skin of the palms and the soles.
A

Testing pain sensation

172
Q
  • Grasp the 4th digit by its side and wiggle it up and down
  • Show the patient which way is up and which way is down
  • Do not use different pressures or force or use a different tone of voice on the up or down movement
  • If position sense is normal distally it will be normal proximally
A

Testing for Position Sense

173
Q
  • Start with the patient’s eyes open.
  • Strike the tuning fork and apply to the patient’s finger- and/or toenails.
  • If the patient cannot feel the vibration at the nails for as long as you can, apply the fork to proximal bony prominences.
A

Testing for loss of vibration sense

174
Q

Romberg Test

A
  • Test for position of the body in space (proprioception)
  • Instruct the patient to stand,feet together, look straight
    the place yourself on the side to the patient then
    instruct the patient that if you feel dizzy, don’t worry
    i got your back
175
Q

Result of Romberg Test

A

Normal: minimal swaying with eyes closed but not fall.

Unilateral Vestibular Disease: sways to the side of the
lesion, but the nervous system compensate. Many patients
with the disease perform well on the Romberg Test.

Dorsal Column Lesions (tabesdorsalis): sways much more
with eyes closed and may fall unless supported. They do not compensate with time.

Hysteria: causes the most difficulty in interpreting the
swaying test. Patients are often gyrate wildly but usually do
not fall, thus proving that they have intact balance.

176
Q
  • Just like the other test (AGAIN) close eyes, test left and right and compare it.
  • Use any object and place it on the palm and have the pt to identify what object it is. When testing the other palm use a different object
A

Stereognosis

177
Q
  • ability to discern the letter or number written to the
    skin.
  • Using a pointy object, write any letter or number to the skin of the patient and have the pt to identify what it is.
A

Graphesthesia

178
Q
  • ability to discern of identify body parts

- Ask the patient what is the name of a particular body part.

A

Autotopagnosia

179
Q

There are 2 screening patterns:

A
  1. side to side (usually compares the major dermatomes and peripheral nerve distributions)
  2. distal to proximal (when peripheral neuropathy is a differential)

YL1: Neuroscience (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions