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Clinical Skills: Unit 3 > Nervous System > Flashcards

Nervous System Flashcards

1
Q

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

A

Inhibitory

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2
Q

Damage to the Corticospinal Tract System would cause what?

A

Weakness

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3
Q

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

A

Basal Ganglia System

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4
Q

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.

A

Cerebellar System

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5
Q

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

A

Upper Motor Neuron damage

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6
Q

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

A

Lower Motor Neuron damage

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7
Q

Sensory pathway that detects pain, temperature and crude touch.

A

Spinothalamic Tract

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8
Q

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

A

Posterior Column System

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9
Q

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

A
  1. Localization of the responsible lesion
  2. Underlying Pathophysiology
    - Pattern of Symptoms
    - Time course of Symptoms
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10
Q

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

A

Primary Headache

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11
Q

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

A

Secondary Headache

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12
Q

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

A

Vestibular Disease
Vertebrobasilar TIA
Stroke

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13
Q

Feeling faint or like you are about to pass out.

A

Pre-syncope

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14
Q

Unsteady or off balance.

A

Ataxia
Disequilibrium

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15
Q

Spinning sensation within patient or of their surroundings.

A

Vertigo

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16
Q

An actual loss of strength.

A

Weakness

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17
Q

What are some pathologies that may cause weakness?

A

TIA
Stroke
Guillan-Barre
Myopathies
Myasthenia Gravis
Polyneuropathy

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18
Q

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

A

Herniated Disc
Stroke
Multiple Sclerosis
Diabetes

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19
Q

Pins and needles sensation.

A

Paresthesia

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20
Q

Distorted sensations

A

Dysesthesia

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21
Q

Reduced or complete loss of sensation

A

Hypoesthesia (reduced)
Anesthesia (complete)

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22
Q

What is the most common cause of syncope?

A

Vasovagal Syncope

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23
Q

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

A

True Syncope

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24
Q

A sudden excessive electrical discharge from cortical neurons.

A

Seizure

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25
Q

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

A

Epilepsy

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26
Q

What pathologies may cause tremors or involuntary movements?

A

Parkinson’s Disease
Essential Tremor
Restless Leg Syndrome

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27
Q

Smell Test

A

CN I - Olfactory

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28
Q

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

A

CN II - Optic

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29
Q

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

A

CN III - Oculomotor
(AO3)

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30
Q

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

A

CN IV - Trochlear
(SO4)

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31
Q

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

A

CN V - Trigeminal

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32
Q

Moves eyes away from nose. Big H

A

CN VI - Abducens
(LR6)

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33
Q

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

A

CN VII - Facial

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34
Q

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

A

CN VIII - Vestibulocochlear

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35
Q

Taste and Gag Reflex

A

CN IX - Glossopharyngeal

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36
Q

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

A

CN X - Vagus

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37
Q

Turn head and shrug shoulders against resistance.

A

CN XI - Spinal Accessory

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38
Q

Stick out tongue and move it side to side.

A

CN XII - Hypoglossal

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39
Q

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

A

Pronator Drift
(Abnormal = Hands Drift Down or Pronates)

40
Q

Active movement against full resistance without evident fatigue.

A

Grade 5
(Normal Muscle Strength)

41
Q

Active movement against gravity and some resistance.

A

Grade 4

42
Q

Active movement against gravity.

A

Grade 3

43
Q

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

A

Grade 2

44
Q

A barely detectable flicker or trace of contraction.

A

Grade 1

45
Q

No muscular contraction detected.

A

Grade 0

46
Q

Inability to perform rapid and coordinated successive movements.

A

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

47
Q

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

A

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

48
Q

Shoulder Abduction

A

C5
C6

49
Q

Elbow Flexion

A

C5
C6

50
Q

Elbow Extension

A

C6
C7
C8

51
Q

Finger Extension

A

C7
C8
Radial Nerve

52
Q

Wrist Extension

A

C6
C7
C8
Radial Nerve

53
Q

Finger Abduction

A

C8
T1
Ulnar Nerve

54
Q

Thumb Abduction

A

C8
T1
Median Nerve

55
Q

Hip Flexion

A

L2
L3
L4

56
Q

Hip Adduction

A

L2
L3
L4

57
Q

Hip Abduction

A

L4
L5
S1

58
Q

Hip Extension

A

S1

59
Q

Knee Extension

A

L2
L3
L4

60
Q

Knee Flexion

A

L5
S1
S2

61
Q

Foot Dorsiflexion

A

L4
L5

62
Q

Foot Plantar Flexion

A

S1

63
Q

Biceps Flexion

A

C5
C6

64
Q

Brachioradalis

A

C5
C6

65
Q

Triceps

A

C6
C7

66
Q

Knee Extension

A

L2
L3
L4

67
Q

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

A

Proprioception
- Syphilis
- Multiple Sclerosis

68
Q

Identify an object held in the hand

A

Stereognosis
(Diabetic Neuropathy)

69
Q

Identify number drawn in hand

A

Graphesthesia
(Diabetic Neuropathy)

70
Q

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

A

Two-Point Discrimination

71
Q

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

A

Vibration
- Peripheral Neuropathy
- Posterior Column Disease

72
Q

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

A

Cerebellar Ataxia

73
Q

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.

A

Romberg Test

74
Q

Walk heel-to-toe (sobriety test)

A

Ataxia

75
Q

Walk on heels and toes

A

Distal Leg Weakness

76
Q

Casual walk

A

Ataxia

77
Q

Rise from sitting position without pushing up.

A

Proximal Weakness (Hip Extensors)
Quadriceps (Knee Extensors)

78
Q

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

A

Reflex Grade: 4

79
Q

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

A

Reflex Grade: 3

80
Q

Average or normal reflex.

A

Reflex Grade: 2

81
Q

Somewhat diminished reflex, or requires reinforcement.

A

Reflex Grade: 1

82
Q

Absent reflex.

A

Reflex Grade: 0

83
Q

Hyperactive (hyperreflexia) may indicated what kind of lesion?

A

CNS Lesion

84
Q

Hypoactive (hyporeflexia) may indicate what kind of lesion?

A

PNS Lesion

85
Q

Contraction of muscles and deviation of umbilicus towards stimuli.

A

Abdominal Reflex

86
Q

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

A

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

87
Q

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

A

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

88
Q

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

A

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

89
Q

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

A

Kernig Sign
(Pain and Increased Resistance = Positive Test)

90
Q

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

A

Asterixis
(Flapping Tremor) - Metabolic Encephalopathy

91
Q

GCS - Eyes

A

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

92
Q

GCS - Verbal

A

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

93
Q

GCS - Motor

A

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

94
Q

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

A

Don’t dilate the Pupils
Don’t flex the neck

95
Q

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

A

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

96
Q

COWS Nystagmus

A

Cold Opposite
Warm Same
- Detects intact brainstem
- Fast Phase

97
Q

CSWO Initial

A

Cold Same
Warm Opposite
- Initial Phase

Clinical Skills: Unit 3 (3 decks)

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