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DCCJP Final Prep > Module 6 & 7, Year 1 - Functional Neurology > Flashcards

Module 6 & 7, Year 1 - Functional Neurology Flashcards

1
Q

Name the area the primary motor cortex is found and its function

A

Frontal lobe

Conscious contralateral motor control; motor homunculus

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2
Q

Name the area the premotor cortex is found and its function

A

Frontal lobe

Integration of sensory and motor information for the performance of action.

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3
Q

Name the area the frontal eye fields are in and their function

A

Frontal lobe

Saccadic eye movement or visual searching; controls contralateral field

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4
Q

Name the area the dorsolateral prefrontal cortex is in and its function

A

Frontal lobe

Executive function

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5
Q

Name the area the orbitofrontal cortex is in and its function

A

Frontal lobe

Modulation of affective and social behavior, smell discrimination

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6
Q

Name the area the cingulate cortex is in and its function

A

Frontal lobe

Drive, motivation, environmental exploration

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7
Q

Name the area the Broca’s Area is in and its function

A

Frontal lobe

Motor control of speech

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8
Q

Name the area the primary somatosensory cortex is in and its function

A

Parietal lobe

Conscious sensation of touch, pain, temperature, vibration, proprioception; sensory homunculus

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9
Q

Name the area the parieo-insular vestibular cortex is in and its function

A

Parietal lobe

Perception of vertical upright and body schema

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10
Q

Name the area the primary auditory cortex is in and its function

A

Temporal lobe

Hearing

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11
Q

Name the area Wernick’s Area is in and its function

A

Temporal lobe

Perception of speech

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12
Q

Name the area the primary olfactory cortex & limbic association cortex are in and their function

A

Smell and emotion

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13
Q

Name the area the primary & secondary visual cortices are in and their function

A

Vision, depth, and visual association; dorsal pathway tells “where” and ventral pathway tells “what”

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14
Q

What is the function of the thalamus?

A

Relay center for all sensory input (minus smell)

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15
Q

T or F: The thalamus is the relay center for all sensory input.

A

False, MINUS SMELL, it is the relay center for all sensory input

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16
Q

What is the function of the basal ganglia?

A

General motor control, eye movements, cognitive function, emotional functions

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17
Q

What is the function of the caudate nucleus?

A

Learning, storing and processing memories

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18
Q

What is the function of the putamen?

A

Regulate movement and influence learning

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19
Q

What is the function of the globus pallidus?

A

Regulation of voluntary movement

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20
Q

What is the function of the subthalamic nucleus?

A

Inhibition and movement control (indirect pathway)

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21
Q

What is the function of the substantia nigra?

A

DA and GABA production

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22
Q

What is the function of the nucleus accumbens?

A

Reward circuit

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23
Q

What is the function of the ventral pallidum?

A

Reward and motivation

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24
Q

What is the function of the limbic system?

A

Emotions, olfactory, memory, homeostatic functions

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25
Q

What is the function of the midbrain (mesencephalon)?

A

Vertical eye movements, contains CN V, VI, VII, and VIII; pontine reticular formation (or cardiovascular control and pontine reticulospinal tracts), origin of the medial and lateral vestibulospinal tracts

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26
Q

What is the function of the medulla?

A

Contains CN IX, X, XI, and XIII; medullary reticular formation (or cardiorespiratory centers, medullary reticulospinal tracts), contains the pyramidal decussation of the corticospinal tract

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27
Q

What is the function of the cerebellum?

A

Planning and refinement of motor movement

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28
Q

What is the function of the vermis and flocculonudular lobe?

A

Motor control of midline structures; nucleus: fastigual nucleus; relay with vestibular nuclei

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29
Q

What is the function of the intermediate hemisphere of the cerebellum?

A

Motor control of the girdle muscles to distal joints (shoulders and hips to wrists and ankles)
Nucleus: Interposed nucleus (eboliform n. and globus n.)

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30
Q

What the function of the lateral hemisphere of the cerebellum?

A

Fine motor control of distal joints (hands and feet)

Motor planning and learning

Nucleus: dentate nucleus

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31
Q

What is the function of the vestibular system?

A

Balance (via CN VIII)

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32
Q

What is the function of the semicircular canals?

A

Info about angular/rotation velocity of the head

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33
Q

What is the function of the ampulla?

A

Info about angular/rotation velocity of the head

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34
Q

What is the function of the saccule?

A

Vertical translation velocity (gravity)

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35
Q

What is the function of the utricle?

A

Linear translation velocity (gravity)

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36
Q

What are the blood suppliers to the brain?

A

Internal carotid artery provides anterior blood supply.
Vertebrobasilar system provides posterior blood supply.

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37
Q

What removes metabolic waste from the CNS?

A

Both the venous system and cerebrospinal fluid.

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38
Q

What is the area called where the motor neuron meets the muscle fiber?

A

Neuromuscular junction

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39
Q

Functional unit of the nervous system

A

Neuron cellular level

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40
Q

What tests and treatment would serve a practice member recovering from a stroke? What area is this rebuilding?

A

L-test, UPDRS, and MRI

Mirror exercises will help build the primary motor cortex

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41
Q

Practice member states he has a hard time following along with mass, particularly doing the actions. Luria sequencing shows problems with mirroring actions. What is the problem and what is a good treatment?

A

Practice member shows signs of apraxia, a compromised premotor cortex, integrating sensory and motor information.

Continue with Luria sequencing, but add duel tasking to it as well (stimulates frontal lobe)

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42
Q

A practice member walks in with makeup on one half of her face. Visual eye test shows a loss of saccadic eye movement to the left side. What is the problem and what is a potential solution?

A

This is evidence of hemineglect, ignoring a partial side of the eye field due to a lesion in opposite side of the brain.

The hemistim app stimulates the lost visual field, encouraging rebuilding of the frontal lobe eye fields.

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43
Q

A practice member states he is having trouble remembering what his wife told him to do, like things at the grocery store or chores around the house. What would be a good test to do

A

Luria alternating figures test would confirm a problem with preservation in the dorsolateral prefrontal cortex, where executive function happens.

A treatment to help rebuild this area would be puzzles and alternate sequencing training.

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44
Q

If a practice member had a difficult time with refraining from talking and also noticed having decreased sensitivity to smell, what kind of problem are you suspecting? Is there an exercise that would help rebuild this deficiency?

A

A lesion to the orbitofrontal cortex could lead to social behavioral disinhibition and anosmia.

Testing for this could be go-no-go test. Treatment that would help is stroop exercises.

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45
Q

A practice member has been coming into the office, but showing signs of depression, talking about grim subjects and not acknowledging your inquiries. What should be done? What underlining brain issue could be considered?

A

Continuing to observe and record history. It is okay to try to motivate the practice member, but additional help, such as counselor or psychological help, is needed.

A lesion to the cingulate cortex, the frontal lobe region responsible for drive, motivation, and exploration, is a possibility.

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46
Q

Over the last several visits, a practice member has had difficulty expressing his pain in words; it is clearly aggravating him. What area of the brain could be affected? What steps could you start taking?

A

Broca’s area could potentially be involved.

Continue observing and see if an MRI has been ordered. Stimulating the fascial and tongue areas could help, as well as recommending 5g/day creatine.

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47
Q

“Speech”, “Aphasia”

A

Broca’s area

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48
Q

“Drive”, “Motivation”

A

Cingulate Cortex

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49
Q

“Social Behavior”, “Smell discrimination”

A

Orbitofrontal cortex

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50
Q

“Executive function”

A

Dorsolateral prefrontal cortex

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51
Q

“Saccadic movements”

A

Frontal eye fields

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52
Q

“Motor and Sensory integration”

A

Premotor cortex

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53
Q

“Motor homunculus”

A

Primary motor cortex

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54
Q

What is the function of the primary somatosensory cortex?

A

Conscious sensation of touch, pain, temperature, vibration, proprioception

aka “Sensory Homunculus”

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55
Q

What is the function of the parieo-insular vestibular cortex?

A

Perceiving being vertically upright and body schema

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56
Q

A practice member is unable to perceive objects with his fingers. Additionally, his signature is illegible. What tests would you want to run? What area of the brain is in question? What treatment can be done?

A

Point localization test and a MRI would be helpful for ruling out Gertsmann’s Syndrome.

The primary somatosensory cortex of the parietal lobe is in question.

Mirror therapy or graphethesia exercises to remap the body part would be helpful.

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57
Q

A practice member with a history of stroke comes in with a laterally bend spine walks heavy footed on the left and pushes himself up with his left arm when getting off of the table. What are these manifestations/syndromes called? What region of the brain does it involved? What is the best course of action?

A

The loss of vertical uprightness are manifested through Pusher’s syndrome and Pisa’s syndrome. This is associated with the parieo-insular vestibular cortex, which was affected by the blood buildup on the brain from the stroke.

Continue to monitor, record history, seeing the original MRI (and maybe a follow up) would be helpful. Treatment will involved feedback training of subjective visual vertical and stroke treatment.

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58
Q

“Upright”, “Pusher’s, “Pisa’s”

A

Parieo-insular vestibular cortex

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59
Q

“Conscious”, “Sensory homunculus”

A

Primary somatosensory cortex

60
Q

What is the function of the primary auditory cortex?

A

Hearing

61
Q

What is the function of Wernick’s area?

A

Perception of speech

62
Q

What is the function of the primary olfactory cortex?

A

Smell

63
Q

What is the function of the limbic association cortex?

A

Emotion

64
Q

A practice member has had a hard time understanding what you tell them during a check. She hears you, but describes it as “not being able to distinguish your voice from talk in the other room.” What tests would be appropriate? What region of the brain is involved? What treatment could benefit?

A

Sound localization test and a MRI analyzing the frontal and temporal lobes for atrophy would confirm suspected frontotemporal dementia.

The area in question is the primary auditory cortex.

Treatment would focus on superior field hemistim with sound in contralateral ear and increased dose of omega 3’s.

65
Q

A practice member keeps asking you to repeat what you are saying while looking straight at you. What area is in question? What is the appropriate continuation?

A

Wernick’s Area

Continue to observe. A MRI to evaluate the area would be beneficial.

66
Q

A practice member comes in panicked and insists had Covid-19. She did not run a fever nor had any head pressure, but she did lose her sense of smell. Her husband reports she has been unusually uptight over the last several weeks after she “bumped her head.” What area of the brain is suspect? How could you further investigate?

A

Primary olfactory cortex and limbic association cortex is in question. Continue to observe. MRI would confirm damage to the region.

67
Q

What is the function of the primary & secondary visual pathways?

A

Vision, depth and visual association; the dorsal pathway tells you “where” and the ventral pathway tells you “what”

68
Q

A practice member appears to have trouble seeing things - walking partly into walls and having to get on the table with a lot of feeling around. CN II & III tests appears normal. He is offended by the question and exclaims, “Of course, I can see, doc. You’re blind!” What condition do you suspect? What further testing would confirm your suspicion? How would you start treating it?

A

Cortical blindness is suspect, but you could make a case for Anton’s Syndrome (denial of cortical blindness). A lesion to the occipital lobe would be suspect.

Blind spot mapping and visual evoked potential testing would both confirm, but MRI would definitively show a lesion to the occipital region.

Treatment, if practice member can see some, should include visual motor and sensory inputs.

69
Q

“Vision”, “Depth”

A

Primary and sensory visual cortices

70
Q

“Relay center”

A

Thalamus

71
Q

A practice member who had a stroke a few months back has restarted care. One of the problems she states that has not improved is she cannot see out of her right eye and everything smells burnt. CN II & III tests appear normal. How would you explain these symptoms? What would confirm your diagnosis? What treatment could begin today?

A

Stroke could cause a number of brain issues including dysfunction of the thalamogeniculate artery, causing Dejerine-Roussy Syndrome as described.

MRI would confirm this diagnosis.

Mirror therapy would be an active step following a stroke. Psychological counseling may also be needed if practice member is stressed by these changes.

72
Q

________ is to Parkinson’s as subthalamic nucleus is to _______.

A

Substantia nigra is to Parkinson’s as subthalamic nucleus is to Huntington’s or Dystonia.

73
Q

What is the midbrain’s function?

A

Vertical eye movements, contains the substania nigra and periaquaductal grey area (pain reguation), origin of the tectospinal tract and rubrospinal tract

74
Q

What area of the brainstem would you expect to have dysfunction for a practice member with anxiety? How would you test it? What treatments may help?

A

Midbrain

Vertical plane smooth pursuit

Breathing exercises, vertical sinusoidal VOR movements

75
Q

“Homeostasis”, “Psychogenic”

A

Limbic system

76
Q

What area of the brainstem would you suspect dysfunction for someone with POTS? What tests would confirm? What exercises could you start?

A

Pons

Modified tilt table test and horizontal eye movements.

Horizontal sinusoidal VOR movements, lateral gaze holding, breathing exercises.

77
Q

“Mesencephalon”, “substania nigra”

A

Midbrain

78
Q

“Pontine reticular formation”, “Vestibulospinal tracts”

A

Pons

79
Q

Contains CN V, VI, VII, VIII

A

Pons

80
Q

Contains CN IX, X, XI, XII

A

Medulla

81
Q

“Medullary reticular formation”, “Wallenburg Syndrome”

A

Medulla

82
Q

What is dolichoectasis? How does it apply to the upper cervical region? What would be the best way to confirm this?

A

It is elongating, distending, and tortuous changes of an artery.

It is notable in the vertebrobasilar artery especially because it can compress the medulla, affecting the entire ANS.

MRI is the gold standard confirmation of this test. A sensory exam of the nucleus ambiguus (dysphagia, dysphonia, and dysarthria) is recommended.

This is a 911 emergency as stroke may be imminent.

83
Q

A practice member has exceptional shaking when reaching out with his arm. Finger-nose-finger test is all over the place. What is your suspicion? What would confirm this diagnosis? What interventions could you start with?

A

Ataxia is suspect of a cerebellar lesion, which would be confirmed with a MRI w/o contrast.

Adjust and finger-nose-finger exercises would benefit to rebuild neural pathways.

84
Q

“Refine movements”, “Ataxia”

A

Cerebellum

85
Q

“Fastigual nucleus”, “Midline movement”

A

Vermis and flocculonudular lobe

86
Q

“Girdle muscle control”, “Eboliform & globus nuclei”

A

Intermediate hemisphere

87
Q

“Hands & feet”, “Fine motor control”

A

Lateral hemisphere

88
Q

A practice member tells you she had to pull her car over to the side of the road due to a sudden hit of vertigo that lasted about 15 minutes. This has occurred several times over the last few months. What do you suspect is going on? How would you confirm? How would you treat?

A

Benign paroxysmal positional vertigo could be caused by labyrinthitis peripherally (using dix-hallpike test) or centrally (rhombergs test) by vestibular neuronitis, pressure on CN VIII. MRI would confirm either. Normal hearing test and videonystagmography can be used as well.

Treatment for a peripheral problem would by Eply’s maneuver and centrally mondified senor interaction balance exercises.

89
Q

Explain the function of the semicircular canals.

A

Superior canal manages balance with nodding, posterior canal manages head tilt balance, and the horizontal canal manages head rotation balance

90
Q

Explain the function of the saccule.

A

Orientation and balance with vertical head movement

91
Q

Explain the function of the utricle

A

Orientation and balance with horizontal head movement

92
Q

“Classic Migraine”, “Red desaturation”

A

Arterial problem

93
Q

Anterior blood supply to brain

A

Internal carotid artery

94
Q

Posterior blood supply to brain

A

Vertebrobasilar system

95
Q

“Idiopathic intracranial hypotension”, “CNS waste removal”

A

Venous system and CSF

96
Q

What test would you do if IIH was suspect?

A

Fundoscopic exam (normal cup:disc ratio 1:2, vein:artery 2:1), MRI w/o contrast, lumbar puncture

97
Q

Supplementation for myasthenia gravis

A

Omega 3, trisomal glutathione, tumeric, vitamin D

98
Q

Supplementation for multiple sclerosis

A

Omega-3, trisomal glutathione, tumeric, vitamin D, magnesium threonate

99
Q

Which embryological developmental region is most pertinent to chiropractors?

A

Ectoderm

100
Q

Gives rise to digestive tract, kidneys, and lungs

A

Endoderm

101
Q

Gives rise to circulatory system, skeletal muscle, bone, connective tissue, and genitourinary system

A

Mesoderm

102
Q

Gives rise to the epidermis, hair, nails, cornea, brain, spinal cord, retina, nerves, adrenal medulla

A

Ectoderm

103
Q

Notochord forms from the ________ after gastrulation is complete.

A

Mesoderm

104
Q

What is the notochords role in formation of the neural tube?

A

The notochord causes the ectoderms inward folding at the neural plate, which will fuse and give rise to the autonomous neural tube.

105
Q

What is the role of the notochord following the formation of the neural tube?

A

It will become the nucleus pulposus of the intervertebral discs.

106
Q

What happens to the mesoderm following the formation of the notochord?

A

It will differentiate into somites, the precursors of the axial skeleton and skeletal muscles.

107
Q

Region of dopamine production

A

Substantia nigra and ventral tegmental area

108
Q

Region of serotonin production

A

Raphe nuclei

109
Q

The forebrain gives rise to the…

A

Telencephalon (which gives rise to the cerebral hemispheres and olfactory lobes)

Diencephalon (which gives rise to the Thalamus and Hypothalamus)

110
Q

The midbrain gives rise to the…

A

Mesencephalon (which gives rise to the midbrain)

111
Q

The hindbrain gives rise to the…

A

Metencephalon (which gives rise to the pons and cerebellum)

Myelencephalon (which gives rise to the Medulla)

112
Q

Which glial cells support the CNS? What is the function of each?

A

Astrocyte - maintain extracellular environment, remove excess neurotransmitters, direct neural growth, induce blood-brain barrier

Oligodendrocyte - creates myelin

Microglia - immune surveillance and phagocytosis

Ependymal cell - create and circulate cerebrospinal fluid (CSF)

113
Q

Which glial cells support the PNS? What is the function of each?

A

Satellite cell - maintain extracellular environment, remove excess neurotransmitters, direct neural growth

Schwann cell - create myelin

114
Q

Connects the two brain hemispheres…

A

Corpus callosum

115
Q

Region that give conscious awareness…

A

Cerebral cortex

116
Q

Brodmann area 4 is associated with what region of the brain?

A

Primary motor cortex

117
Q

Brodmann area 6 is associated with what region of the brain?

A

Premotor cortex

118
Q

Brodmann area 8 is associated with what region of the brain?

A

Frontal eye fields

119
Q

Brodmann area 45-49 is associated with what region of the brain?

A

Dorsolateral prefrontal cortex and orbitofrontal cortex

120
Q

Brodmann areas 24 and 32 are associated with what region of the brain?

A

Cingulate cortex

121
Q

Brodmann’s area 44 is associated with what region of the brain?

A

Broca’s area

122
Q

Broadmann’s area 1, 2, & 3 are assocaited with what region of the brain?

A

Primary somatosensory cortex

123
Q

Brodmann’s areas 19, 37, 39, and 40 are associated with what region of the brain?

A

Parieto-insular vestibular cortex

124
Q

Brodmann’s area 41 is associated with what region of the brain?

A

Primary auditory cortex

125
Q

Brodmann’s areas 28, 34, 35, 35, and 38 are associated with what region of the brain?

A

Primary olfactory cortex and limbic association cortex

126
Q

Brodmann’s areas 17, 18, 19 are associated with what region of the brain?

A

Primary and secondary visual cortex

127
Q

CN I

A

Olfactory nerve - sense of smell

128
Q

CN II

A

Optic nerve - sense of sight

129
Q

CN III

A

Oculomotor nerve

Motor control of extra-ocular muscles superior, inferior, and medial rectus

Parasympathetic to sphincter pupillae and ciliary muscles

130
Q

CN IV

A

Trochlear nerve - motor control of superior oblique muscle

131
Q

CN V

A

Trigeminal nerve

V1 - ophthalmic (sensory)

V2 - maxillary (sensory)

V3 - mandibular (sensory and motor - muscles of mastication)

132
Q

CN VI

A

Abducens nerve - motor control to lateral rectus muscle

133
Q

CN VII

A

Facia nerve

Sense of taste for anterior 2/3rds of tongue

Motor to the muscles of facial expression

Parasympathetic to lacrimal, nasal, palatine, submandibular, and sublingual glands

134
Q

CN VIII

A

Vestibulocochlear nerve - balance and hearing control

135
Q

CN IX

A

Glossopharyngeal nerve

Sense of taste for posterior 1/3rds of tongue

Sensory to nasopharynx, oropharynx and to the adenoid, palatine tonsil, auditory tube, and middle ear

Parasympathetic to parotid salivary gland

136
Q

CN X

A

Sensory to laryngopharynx and larynx

Motor to muscles of soft palate, pharynx and larynx

Parasympathetic to chest organs and to GI tract and associated organs from oesophagus to mid-transverse colon

137
Q

CN XI

A

Spinal accessory nerve - motor to SCM and upper trapezius

138
Q

CN XII

A

Hypoglossal nerve - motor to muscles of the tongue

139
Q

Describe a trochlear nerve palsy manifested

A

Head tilt away from affected eye to correct extorsion
Chin tuck corrected with looking up to correct hypertropia

140
Q

Motor system of the reticular formation that controls locomotion and posture

A

Reticulospinal

141
Q

Motor system of the reticular formation that controls postural response to vestibular input

A

Vestibulospinal

142
Q

Motor system of the reticular formation that controls head and eye movements

A

Tectospinal

143
Q

Motor system of the reticular formation that controls postural and voluntary control of flexor muscles

A

Rubrospinal

144
Q

Part of the vestibulospinal tract that supports head and neck position…

A

Medial vestibulospinal tract

145
Q

Sensory system that controls proprioception, vibration, fine touch, discriminative touch

A

Posterior column-medial lemniscal tract

DCCJP Final Prep (9 decks)

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