Nervous Flashcards
Where do motor nerves exit?
anterior nerve root
Where do sensory nerves exit?
posterior nerve root
How many pairs of spinal nerves do we have?
31
What is a pyramidal or corticospinal pathway also called?
motor pathway
What happens with damage in the corticospinal tract?
weakness
What can damage to the basal ganglia cause?
rigidity, slowness, involuntary movements, posture/gait disturbances
What does damage to the cerebellar system cause?
impaired coordination, gait, equilibrium, decrease muscle tone
Which tract does pain, temperature, crude touch reach the brain?
spinothalamic tract
Which tract does vibration, proprioception, kinesthesia, pressure, fine touch do to reach the brain?
posterior column system
What should you ask about numbness?
pattern of sensory loss == stocking-glove distribution, patchy or non-dermatomal, occuring on one limb?
What does mental status include?
- alertness
- language function
- memory
- calculation
- visuospatial processing
- abstract reasoning
What should you watch for in involuntary movements?
- tics
- chorea
- fasciculations
What is pronator drift?
checking for corticospinal tract lesion
What is normal muscle strength on the 0 to 5 scale?
5
What nerves test shoulder abduction?
C5, C6
What nerves supply elbow flexion?
C5, C6
What nerves supply elbow extension?
C6, C7, C8
What nerves supply wrist extension?
C6, C7, radial nerve
What nerves supply finger extension?
C7, C8, radial nerve
What nerves supply finger abduction?
C8, T1, ulnar nerve
What nerves supply thumb abduction?
C8, T1, median nerve
What nerves supply hip flexion?
L2, L3, L4, iliopsoas
What nerves supply hip adduction?
L2, L3, L4
What nerves supply hip abduction?
L4, L5, S1
What nerves supply hip extension?
S1
What nerves supply knee extension?
L2, L3, L4
What nerves supply flexion at knee?
L4, L5, S1, S2
What nerves supply ankle dorsiflexion?
L4, L5
What nerves supply plantarflexion?
S1
What four areas need to function for coordination?
- motor system
- vestibular system
- sensory system
- cerebellar system
How do you assess coordination?
- rapid alternating movements
- point to point movements
- gait stance
What’s the Romberg test?
Standing without support and ability to maintain an upright posture
What should you do when detecting sensory loss?
map out boundaries in detail
What should you do for pain, temperature and touch sensation?
compare distal to proximal areas:
* both shoulders (C5)
* inner and outer forearms (C6 and T1)
* thumbs and fingers (C6 and C8)
* fronts of both thighs (L3)
* ankle at medial malleous (L4)
* dorsum of foot (L5)
* fifth toes (S1)
* medial aspect of buttock (S3)
What is stereognosis?
identifying object by feeling it
What is graphesthesia?
identify number drawn in hand
What does two point discrimination test?
how finely innervated the skin is
What should you test for if hyperactive reflex?
clonus
How do you grade reflexes?
0-4; 2 = normal
What is nuchal rigidity?
laying down, flex patient’s neck forward until chin touches chest
normally is easy — if difficult could be sign of meningitis
What is the Brudzinski sign?
when the neck is flexed, the knees come up to compensate too
What’s the Kernig sign?
flex the hips and knees –> slowly extend and watch for pain
What’s the straight leg raise?
patient is supine, and raise the relaxed and strained leg – assess degree of elevation where pain occurs
What is pain in the ipsilateral leg positive for?
lumbosacral radiculopathy
What is pain in the contralateral leg positive for?
Cross straight leg raising sign
What is asterixis?
metabolic encephaopathy with mental function impairment
test with patients in stop sign and sudden movement = positive
What puts someone at risk of asterixis?
alcohol, liver disease, uremia, hypercapnia
What are two things to never do with comatose patients?
- don’t dilate the pupils
- don’t flex the neck
What are five ways to check the level of consciousness?
- alertness (normal)
- lethargy (speak loud)
- obtundation (shake)
- stupor (pinch tendon)
- coma (painful stimuli)
What’s the glasgow coma scale?
higher number = best level of consciouness with
eyes open spontaneously - 4
obeys orders - 6
oriented, conversant - 5
What do doll’s eyes movement indicate?
intact brainstem
In a healthy patient, what is COWS?
Cold goes opposite with warm going to the same
In a comatose patient how are COWS different?
cold stays same and warm goes opposite
CSWO
