Nervous System Flashcards by Dylan Null

Motor Pathway (also known as Corticospinal or Pyramidal Pathway) have what kind of effect on lower motor neurons?

Inhibitory

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Damage to the Corticospinal Tract System would cause what?

Weakness

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Damage to this system could cause: rigidity, slowness of movement (bradykinesia), involuntary movements, and or disturbances in balance and gait.

Basal Ganglia System

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Damage to this system could cause: impaired coordination (ataxia) gait equilibrium, and decreased muscle tone. Nystagmus and dysarthria (difficulty of speech) may also be present.

Cerebellar System

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Damage of what neurons would cause INCREASED muscle tone and HYPER-reflexia.

Upper Motor Neuron damage

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Damage of what neurons would case DECREASED muscle tone, HYPO-reflexia, atrophy, and fasciculations (involuntary twitches in a small area).

Lower Motor Neuron damage

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Sensory pathway that detects pain, temperature and crude touch.

Spinothalamic Tract

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Sensory pathway that detects proprioception (sense of body movement), vibration, kinesthesia, pressure, and fine touch. (Dorsal Root Ganglion)

Posterior Column System

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Two important questions to consider when taking a health history of the nervous system.

Localization of the responsible lesion
Underlying Pathophysiology
- Pattern of Symptoms
- Time course of Symptoms

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Type of headache WITHOUT an identified underlying disease
- Migraine
- Tension Headache
- Cluster Headache
- Trigeminal Autonomic Cephalgias
- Chronic Daily Headache

Primary Headache

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Type of headache WITH an identified underlying disease (Sudden and Severe)
- Meningits
- Subarachnoid Hemorrhage
- “Worst headache of my life”
- Thunderclap

Secondary Headache

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Dizziness or lightheadedness may be a sign of what three things?

Vestibular Disease
Vertebrobasilar TIA
Stroke

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Feeling faint or like you are about to pass out.

Pre-syncope

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Unsteady or off balance.

Ataxia
Disequilibrium

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Spinning sensation within patient or of their surroundings.

Vertigo

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An actual loss of strength.

Weakness

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What are some pathologies that may cause weakness?

TIA
Stroke
Guillan-Barre
Myopathies
Myasthenia Gravis
Polyneuropathy

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What are some pathologies that may cause numbness, or sensations that are abnormal or absent?

Herniated Disc
Stroke
Multiple Sclerosis
Diabetes

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Pins and needles sensation.

Paresthesia

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Distorted sensations

Dysesthesia

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Reduced or complete loss of sensation

Hypoesthesia (reduced)
Anesthesia (complete)

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What is the most common cause of syncope?

Vasovagal Syncope

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A sudden, but temporary loss of consciousness and postural tone from transient hypo perfusion of the brain.

True Syncope

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A sudden excessive electrical discharge from cortical neurons.

Seizure

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2+ seizures that are not provoked by other illnesses or circumstances.

Epilepsy

What pathologies may cause tremors or involuntary movements?

Parkinson's Disease Essential Tremor Restless Leg Syndrome

Smell Test

CN I - Olfactory

Visual acuity test. Ishihara. Snellen/Rosenbaum. Direct pupillary light reflex. Near test, near far test. Static Wiggle. Ocular Fundi.

CN II - Optic

Big H. Consensual Pupillary Light Reflex. Hirshberg's Corneal light reflex (cover, uncover).

CN III - Oculomotor (AO3)

Moves eyes towards nose. Big H. Possible contralateral head tilt.

CN IV - Trochlear (SO4)

Sharp and dull x3. Corneal Reflex. Clench Teeth and feel temporal and masseter muscle.

CN V - Trigeminal

Moves eyes away from nose. Big H

CN VI - Abducens (LR6)

Squeeze eyes with resistance, raise your eyebrows. Show teeth. Smile, frown. Puff cheeks.

CN VII - Facial

Whisper Test. Weber and Rinne. Finger Rub. Coma --> Caloric & dolls eye test.

CN VIII - Vestibulocochlear

Taste and Gag Reflex

CN IX - Glossopharyngeal

Gag reflex and movement of soft palate. Activates parasympathetic nervous system. Responsible for VasoVAGAL syncope.

CN X - Vagus

Turn head and shrug shoulders against resistance.

CN XI - Spinal Accessory

Stick out tongue and move it side to side.

CN XII - Hypoglossal

Test used to check for corticospinal tract lesion in the contralateral hemisphere. Both arms are held up with the palms supinated.

Pronator Drift (Abnormal = Hands Drift Down or Pronates)

Active movement against full resistance without evident fatigue.

Grade 5 (Normal Muscle Strength)

Active movement against gravity and some resistance.

Grade 4

Active movement against gravity.

Grade 3

Active movement of the body part with gravity eliminated (planar motion).

Grade 2

A barely detectable flicker or trace of contraction.

Grade 1

No muscular contraction detected.

Grade 0

Inability to perform rapid and coordinated successive movements.

Rapid Alternating Movements (Dysdiadochokinesia) - Rapid Alternating Arm Movements - Rapid Finger Tapping - Tapping balls of foot

Lack of coordination of movement typified by the undershoot or overshot of intended position.

Point-to-Point Movements - Finger to Nose Test - Heel to Shin Test

Shoulder Abduction

C5 C6

Elbow Flexion

C5 C6

Elbow Extension

C6 C7 C8

Finger Extension

C7 C8 Radial Nerve

Wrist Extension

C6 C7 C8 Radial Nerve

Finger Abduction

C8 T1 Ulnar Nerve

Thumb Abduction

C8 T1 Median Nerve

Hip Flexion

L2 L3 L4

Hip Adduction

L2 L3 L4

Hip Abduction

L4 L5 S1

Hip Extension

Knee Extension

L2 L3 L4

Knee Flexion

L5 S1 S2

Foot Dorsiflexion

L4 L5

Foot Plantar Flexion

Biceps Flexion

C5 C6

Brachioradalis

C5 C6

Triceps

C6 C7

Knee Extension

L2 L3 L4

Grab big toe and move it up and down. First with eyes open and next with eyes closed.

Proprioception - Syphilis - Multiple Sclerosis

Identify an object held in the hand

Stereognosis (Diabetic Neuropathy)

Identify number drawn in hand

Graphesthesia (Diabetic Neuropathy)

Smallest distance between 2 points with perception of both distinct stimuli.

Two-Point Discrimination

Tuning fork (128 Hz) tap on hand and place the tuning fork on DIP joint in the finger and Big Toe IP Joint.

Vibration - Peripheral Neuropathy - Posterior Column Disease

Difficulty standing with feet together with the eyes either opened or closed would indicate what?

Cerebellar Ataxia

Patient should first stand with feet together and eyes open and then close both eyes for about 30 seconds without support. Used to test their sense of position.

Romberg Test

Walk heel-to-toe (sobriety test)

Ataxia

Walk on heels and toes

Distal Leg Weakness

Casual walk

Ataxia

Rise from sitting position without pushing up.

Proximal Weakness (Hip Extensors) Quadriceps (Knee Extensors)

Very brisk reflex, with clonus (rhymes oscillations between flexion and extension)

Reflex Grade: 4

Brisker than average reflex; possibly but not necessarily indicative of disease.

Reflex Grade: 3

Average or normal reflex.

Reflex Grade: 2

Somewhat diminished reflex, or requires reinforcement.

Reflex Grade: 1

Absent reflex.

Reflex Grade: 0

Hyperactive (hyperreflexia) may indicated what kind of lesion?

CNS Lesion

Hypoactive (hyporeflexia) may indicate what kind of lesion?

PNS Lesion

Contraction of muscles and deviation of umbilicus towards stimuli.

Abdominal Reflex

Stroke lateral aspect of the sole from the heel to the ball of the foot.

Babinski Sign (Dorsiflexion of Toes and Flaring Out = Positive)

Stroke anus on both sides, watch for reflex contraction of external anal sphincter.

Anal Reflex - Absence suggests lesion of S2 - S4 - Cauda Equina Lesions

With the patient supine, flexion the neck forward for the chin to touch the chest.

Brudzinski Sign (Flexion of Hip and Knees = Positive Test)

Flex patient's leg at the hip and knee. Then slowly extend leg to straighten the knee.

Kernig Sign (Pain and Increased Resistance = Positive Test)

Patient's hands are in the "stop" position while extending both arms. Wrists are dorsiflexed and fingers spread. Wait 1 - 2 minutes.

Asterixis (Flapping Tremor) - Metabolic Encephalopathy

GCS - Eyes

4 Points - Spontaneously - To Command - To Pain - No Response

GCS - Verbal

5 Points - Oriented Conversation - Disoriented Conversation - Inappropriate Words - Inappropriate Sounds - No Response

GCS - Motor

6 Points - Obeys Verbal Orders - Localizes Pain - Withdraws from Pain - Flexion with Pain - Extension with Pain - No Response

What two things should you not do when assessing a comatose patient?

Don't dilate the Pupils Don't flex the neck

Eyes move in the opposite of the direction that the head is being turned.

Doll's Eye Movement Test (Eyes moving in opposite direction of head turn) = Intact Brainstem

COWS Nystagmus

Cold Opposite Warm Same - Detects intact brainstem - Fast Phase

CSWO Initial

Cold Same Warm Opposite - Initial Phase

Nervous System Flashcards

(97 cards)