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Physical Assessment > Nervous System > Flashcards

Nervous System Flashcards

1
Q

Four Brain Regions

A

Cerebrum: frontal, parietal, temporal, occipital
Diencephalon-Thalmus, Hypothalmus and basal ganglia
Brainstem- Midbrain, Pons, Medulla
Cerebellum

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2
Q

Brain Tissue

A

Gray- formed by collection of erve cell bodies
White- myelin coated axons
Internal capsule- where all myeinated fibers from cerebral cortex converge and descend into brainstem

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3
Q

Diencephalon

A 
Thalmus(sensory impulses relay to cerebral cortex)
Hypothalmus( homeostasis- reg HR,BP, Temp also endocrine, emo behavior. Hormones excreted from hypothalmus directly affect pituitary)
basal ganglia(affect movement)
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4
Q

Thalmus vs Internal Capsule

A

Thalmus bus stop for all sensroy impulses going into brain, Internal capsule bus stop for all sensory impules going out of brain

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5
Q

Consciousness

A

interaction between cerebral hemispheres, diencephalon, upper brainstem, RAS

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6
Q

Cerebellum

A

base of brain, coordinates movement, maintains upright position

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7
Q

Spinal Cord

A 
C1-8
T1-12
L1-5
S1-5
C
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8
Q

Cauda Equina

A

Spinal cords ends at L1-2, then the lumbar and sacral roots fan out like horse tail

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9
Q

Lumbar puncture

A

done L3-4 or L4-5

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10
Q

CN 1-12

A

On old olympus towering tops a finn and german viewed some hopps

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11
Q

CN can be motor, sensory or both

A

Some say marry money but my brother says big breasts matter more

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12
Q

Nerve Roots

A

Ant root- motor/efferent

Post root- sensory/afferent

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13
Q

Upper motor neurons

A

cell bodies originate in brain and spinal cord. UA to leave CNS, must synapse with lower motor neurons, which carry message to muscle/rest of body

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14
Q

Lower motor neurons

A

cell bodies located in brain stem, but axons can leave CNS to synapse with muscles- These are cranial/spinal nerve

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15
Q

Motor: Corticospinal (pyramidal) tract

A

mediate voluntary movement by stim muscle action and inhibiting others. Carry impulses that inhibit muscle tone. Originates in motor cortex of brain. Motor fiber travels down lower medulla, cross to opposite side of medulla, cont down, syn with ant horn/immediate neurons.

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16
Q

Corticobulbar

A

tracts synapsing in brainstem with motor nuclei of CN

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17
Q

Motor: Basal Ganglia System

A

complex system includes motor pathway between cerebral cortex, basal ganglia, brainstem, spinal cord. Maintains muscle tone and control body movements

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18
Q

Motor: Cerebellar System

A

receives sensory/motor input and coordinates motor activity, maintains equilibrium, helps control posture.

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19
Q

Movement

A

Voluntary- Cortex
Automatic- basal ganglia
reflex sensory- sensory receptors.

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20
Q

Higher motor pathways

A

affect motor mvmt only through lower system- translates into sction in ant horn. Lesion in any areas- will affect mvmt or reflex activity

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21
Q

Upper vs Lower motor neuron damage

A

Upper- inc muscle tone/DTR

Lower- dec muscle tone/DTR

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22
Q

Damage to Basal Ganglia

A

inc muscle tone, diturbs posture/gait, bradykinesia, invol mvmt

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23
Q

Damage to Cerebellum

A

dec muscle tone, imp coordination/gait & equilibrium

Nystagmus, dysarthria, hypotonia and ataxia

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24
Q

Sensory Pathways

A

reflex activities, conscious sensation, body position, reg ANS(HR,BP,RR), relays impulses from skin/mucous membranes/ tendons/ viscera, reg sensation of pain/temp/position/touch.

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25
Q

Sensory: Spinothalmic Tract 1

A

from neuron to post horn, synapse with secondary neurons- cross to opposite side and travel up to thalmus (Pain, temp, crude touch-light touch not localized)

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26
Q

Sensory: Spinothalmic Tract 2

A

sensations of vibration/position/fine touch(with localization)- pass directly into post horn- travel up to medulla with secondary sensory neurons, cross to opposite side at medullary level and cont to thalmus.

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27
Q

Thalmic Level

A

Quality of sensation perceived, fine distinction not made

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28
Q

Sensory Cortex

A

Full perception, localization, high order discrimination made

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29
Q

Sensory Cortex Lesions

A

may not impair perception of pain/touch/ position but will impair finer discrimination.
Cannot appreciate size/shape/texture of object by feel.

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30
Q

Proprioception

A

sense of mvmt, body position independant of vision. Gained from input of sensory nerve terminals in muscles/tendons/joints/vestibuar apparatus
Loss of position sense- tabes dorsalis, MS, B12 def from post colum disease, PN form DM

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31
Q

Dermatome

A

band of skin innervated by sensory root of a single spinal nerve
Sensory level may be several segments below injury- reason unknown

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32
Q

DTR

A

tap on tendon, activates special sensory fibers, trigger sensory impulse to spinal cord via peripheral nerve synapses directly with ant horn innervating same muscle, crosses NM junction, muscle contracts, completes reflex arc

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33
Q

HH c/o

A

HA, dizzy, vertigo, weakness, numbness, abn/loss of sensation, LOC, syncope/near-syncope, Sz, tremors/invol mvmt

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34
Q

HA

A

Ask: severity, location, duration assoc Sx like visual, wkns, loss of sens. Affected by sneezing, coughing or suddent mvmt of head- which can inc ICP
SAH- worst HA of life
Meningitis- severe HA
Mass lesions/absess- dull HA in same location

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35
Q

Dizzy

A

what experienced, light headed/faint, room spining/rotating
Light-headedness in plapitations, near syncope from VV stim, low BP, febile, or others.
Vertigo- inner ear, brainstem tumor.
Elderly- meds may contribute
Assoc Sx- diplopia, dysarthria, ataxia- may be present in vertebrobasilar TIA or CVA

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36
Q

Weakness

A

Assoc with, gen/location, paralysis, onset, progression, mvmt affected?
TIA/CVA- wkns/paralysis
Focal wkns- ischemia, vasc, mass lesion CNS, PNS, MS DO, muscle diseases
Bilat prox wkns- myopathy

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37
Q

Myasthenia Gravis

A

wkns made worse by repeated effort and imp with rest

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38
Q

Loss of Sensation

A

numb, diff moving a limb, alter sens, tingling/pins-needles

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39
Q

Parasthesia

A

Limb goes to sleep= compresion of nerve, tingly. prickly, feeling of warmth, coolness or pressure.
If in hands and around mouth- hyperventilation

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40
Q

Dysesthesia

A

distorted sensation in repsonse to stim, may last longer than stimulus

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41
Q

Pain

A

May arise from neurologic causes but often reported with Sx of other body systems
Burning pain- painful sensory neuropathy

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42
Q

LOC/ fainting

A

Complete black out or hear voices.
Symptoms of feeling faint- light headed, weak, wo actual LOC- near/presyncopal
Anyone witness- Sz mvmt, onset/offset sudden/slow

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43
Q

Syncope

A

sudden temp LOC and postural tone- dec blood flow to brain
Cardiac- arrythmias cause- more common in older pt, sudden onset/offset. AS, HOCM, MI, Massive PE
Other causes of syncope: Hypocapnea d/t hyperventilation, hypoglycemia, hysterical fainting.
Unlike Sz- no incontinence, tonic-clonic mvmt, postictal state but may have bitten tongue or bruised limbs.

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44
Q

Vasovagal

A

young people with stress- warning symptoms- flushed, warmth, N- slow onset, slow offset

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45
Q

Seizures

A

Paroxysmal DO sudden excessive electrical DC in cerebral cortex or underlying structure. May or may not LOC. Any abn feelings, thought process, sensation, smells, abn mvmt.

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46
Q

Tremors

A

unable to controll trembling/shaking/body mvmt.

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47
Q

RLS

A

develops at rest, accompanied by urge to move, relief with walking. Usually occurs at night. CNS iron/dopamine def, or dysmetabolism. Chronic ext tissue pathology/inflammation
Tx: daily exercise, adequate sleep, Dopaminergic meds (Requip,Mirapex), Correction of Fe def.

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48
Q

Health Promotion

A

Stroke/TIA prevention
Reduced periphearl neuropathy
Three D’s

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49
Q

Stroke stats

A

Ischemia 80-85%
Hemmorhage 15-20%
ICH 10-15%
SAH 5%

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50
Q

TIA

A

sudden focal neuro deficit lasts less than 24 hours. Precursor to stroke, 3 months after TIA, 15% progrss to CVA esp if RF present.

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51
Q

Stroke warning signs

A

sudden numbness, wkns, confusion, aphasia/dysathria, understanding, walking, dizzy, loss of balance/coordination, trouble seeing in 1 or 2 eyes, severe HA

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52
Q

S/S of stroke depend on area affected

A

Most common MCA- visual field cuts, contralat hemoparesis, sens deficits
Left hemi-aphasia
Right hemi- neglect/inattention to opposite side of body

53
Q

Stroke RF Primary prevention

A

modifiable RF- HTN, smoking, HPL, DM, obesity, lack of exercise, heavy ETOH. Careful mngmt afib, asymp carotid disease. For ICH/SAH- BP MNGMT. RF for SAH- smoking, HTN, ETOH abuse, family HX first degree relative

54
Q

Stroke RF Secondary Prevention

A

If TIA, focus on cause: atherosclerotic lg vessel disease, carotid emboli, small vessel lacunar disease, idiopathic.
Younger pt- consider Takayasu arteritis, art dissection, fibromuscular dysplasia, cocaine, drug use. May need ASA/coumadin for prevention.

55
Q

Peripheral Nueropathy

A

Polyneuropathy
Autonomic Dysfunction
Mononeuritis Multiplex
Diabetic Amyotrophy

56
Q

Dementia

A

Alzheimers
Vascular
Lewy Body- Parkinsons
Frontotemporal

57
Q

Depression neurotransmitters

A

Serotonin- if depleted: irratabilty, hostility, SI

Norepi depletion: dullness, lethargy

58
Q

CN 1: Olfactory

A

Test for common odors one side at a time with eyes closed.

Loss of smell with: sinus conditions, head trauma, smoking, aging, cocaine, Parkinsons

59
Q

CN 2: Optic

A

Inspect optic fundi, check disc. Test visual fields by confrontation bilaterally
Visual field deficits. Can occur with glaucoma, retinal hemm, optic neuritis. Bitemp hemianopsias-defect at optic chiasm- usually pituitary tumor.
Homonymous hemianopsias or quad in postchiasmal lesions- usually parietal lobe assoc w/CVA

60
Q

CN 2&3: Optic and Oculomotor

A

Inspect size/shape pupil, can be 0.4mm between pupils.
CN 3 palsy- larger pupil abn constriction- parasympathetic denervation, ptosis, opthalmoplegia. In Horner’s Syndrome- pupils constrict to loght but d/t sym degen the affected pupil remains small(miosis) d/t abn pupillary dilator muscle

61
Q

CN 3,4,6: Oculomotor, Trochlear, Abducens

A

EOM’s, ?diplopia, convergence, ?nystagmus, Look at distant object- check for inc/dec nystagmus, ?ptosis
Dysconjugate gaze?
Diplopia? Monocular with glasses/contacts/cataracts/astigmatism/ptosis. Binocular with CN 3/4/6 neuropathy (40%), muscle disease from MG/trauma/throid opthalmopathy, internuclear opthalmoplegia.

62
Q

Nystagmus

A

cerebellar disease esp with gait ataxia & dysarthria & vestibular DO.

63
Q

Ptosis

A

CN 3 palsy, Horner’s syndrome(ptosis, meiosis, anhidrosis), MG

64
Q

CN 5: Trigeminal

A

M: Temporal & Masseter muscle
S: Pain at forehead, cheek & jaw, sharp vs dull. If abn- test for temp too. Also check for light touch.
Masseter- diff chewing
Pterygoid- diffmoving in opposite direction
Unilateral wkns- CN 5- pontine lesion
Bil wknsin cerebral hemispheris disease because of bil cortical innervation.
Corneal refelx: look away and touch cornea with something soft- should blink

65
Q

Stroke pattern

A

facial/body sensory loss on same side but contralateral cortical or thalmic lesion.
Ipslateral face but contralateral body sensory loss in brainstem lesions

66
Q

Trigeminal Neuralgia

A

isolated facial sensory loss in peripheral nerve DO

67
Q

Absent corneal reflex

A

CN 5 or 7 lesion. Abs blinking and sensorineural hearing loss= acoustic neuroma

68
Q

CN 7: Facial

A

raise eyebrows, frown, close eyes tightly, show upper and lower teeth, smile, puff out cheeks.
flattening of asolabial fold/drooping of lower eyelid- facial weakness
In unilateral paralysis, mouth droops on the paralyzed side when pt smiles or grimaces.

69
Q

Bell’s Palsy

A

Injury to CN 7, affects upper and lower face, a central lesion affects lower face. Other symptoms Bell’s Palsy- loss taste, hyperacusis, inc or dec tearing

70
Q

CN 8: Acoustic

A

Whispered voice; conductive vs sensorineural
AC/BC- Weber test
Rinne test
Hearing loss from: excess cerumen, otosclerosis, OM- hearing loss, presbyacusis- aging- usually SN loss

71
Q

CN 9&10: Glossopharyneal & Vagus

A

Diff swallowing
mvmt soft palate and uvula when saying “AHHHH”
Gag refex
Hoarse = vocal cord paralysis
Nasal= palate paralysis
Check for unilateral palate mvmt= lesion CN 9 or CN10

72
Q

CN 11: Spinal Accessory

A

shoulder shrug, turn head into hand on face

trapezius wkns with atrophy and fasiculations in PN DO. If paralysis- shoulder droops down and lat.

73
Q

CN 12: Hypoglossal

A

tongue protruded, move side to side
Unilateral cortical lesion- tongue deviates away from side of lesion, toward side of wkns
Dysrthria and amyotrophic lat scleoris, polio

74
Q

Hypertrophy or Pseudohypertrophy

A

check muscl bulk/atrophy/hypertrophy. Flattening in prominences between metacarpals suggests atrophy but in median and ulnar nerve damage.

75
Q

Muscular Atrophy

A

PN DO- spinal cord, RA, protein calorie malnutrition

76
Q

Dec Muscle Tone

A

PN DO, cerebellar disease or acute stages of spinal cord injury

77
Q

Hypotonia

A

flaccidity, PN DO.

78
Q

Paresis

A

wekness. Hemiparesis is one sided

79
Q

Paralysis

A

plegia or absense of strength. Para- legs, Quad- all ext.

80
Q

Weak grip

A

cervical radiculopathy, deQuervains tenosynovitis, carpal tunnel syndome, arthrits, epicondylitis

81
Q

Wkns extention at elbow

A

radial nerve damage

82
Q

Weak finger abduction

A

ulnar nerve DO

83
Q

Weak opposition of thumb

A

median nerve DO- carpal tunnel

84
Q

Myopathy

A

Proximal symmetric muscle weakness- muscle DO

85
Q

Polyneuropathy

A

Distal symmetric muscle weakness- PN DO

86
Q

Coordination= Cerebellum

A

RAS
Pt to Pt mvmt
Gait
Stand specified way

Coordination worsens with eyes closed

87
Q

Dydiadochokinesis

A

cerebellar dysfunction. Cannot perform RAS- irregular and clumsy
Upper motor neuron wkns and basal ganglia disease may impair RAS but not same way

88
Q

Dysmetria

A

While doing RAS, patient overshoots but corrects self and reaches goal.

89
Q

Intention tremor

A

at the end of movement

90
Q

Past pointing

A

Repetitve consistent deviation to one side, while eyes closed suggests cerebellar or vestibular disease

91
Q

Ataxia

A

gait instability

causes: cerebellar disease, ETOH, loss of position sense.

92
Q

Gait

A

across room, heel to toe, on heels, on toes, hop in one leg in place, shallow knee bend, rise from sitting
UA heels and toes- distal muscular weakness
UA heel walk- corticospinal tract damage
UA hop- wkns, lack of position snese, cerebellar dysfunction
UA shallow knee bend- prox muscle wkns
UA rising from sit- prox muscle wkns

93
Q

Stance

A

Rhomberg

Pronator drift

94
Q

Rhomberg

A

Position sense test- feet together, stand with eyes closed 30-60 seconds, min sway normal. Positive test= cerebellar ataxia

95
Q

Pronator drift

A

Stand 20-30 sec arms forward palms up, eyes closed. Should be able to hold, tap down on arms, should be able to hold. Sens and Spec for corticospinal tract lesion
Downward drift with flex fingers and elbow may occur
Sideward/upward- loss position sense

96
Q

Anestesia

A

abs of touch sensation

97
Q

Hypesthesia

A

dec sensitivity

98
Q

Hyperestesia

A

ins sensitivity

99
Q

Vibration

A

1st sense lost in PN neuropathy. Common causes: DM, ETOH, Post colum disease- tertiary syphyllis or vit B def
Can use to test cord lesion on trunk

100
Q

Astereoognosis

A

UA to recognize objects in hand with eyes closed

101
Q

Discriminative Sensations

A 
Stereognosis
Graphestesia
2 Pt discrim
Pt localization
Extinction
Alterations indicate lesion in sensory cortex
102
Q

Hyperreflexia

A

CNS lesion along desc corticospinal tract

Look for assoc upper neuron- wkns, spasticity, + Babinski

103
Q

Hyporeflexia

A

Diseases of spinal nerve root, Spinal nerve, plexuses, PN. Look for assoc lower motor unit disease- wkns, atrophy, fasciculations
Use reinforcement if dim or absent- isometric contraction of other muscle for 10sec before testing to inc reflex activity

104
Q

Positive Babinski/Plantar Reflex

A

DF big toe, CNS lesion. Also from drug, ETOH, postictal after Sz

105
Q

Meningeal Signs: Brudzinski

A

hands behind head while supine, flex neck forward, Normal neck supple. Stiff/Resistance in 90% with meningitis, 20-85% for SAH, also present in arthritis and neck injury

106
Q

Meningeal Sign: Kernig

A

supine, flex leg at hip and knee, then straighten knee- may cause some discomfort but not pain. Pain is positive finding- If bilateral = meningeal irritation

107
Q

Lumbosacral RadiculopathY

A

straight leg raise, DF foot, pain= + finding
Compression spinal nerve root as it exits vertebral foramen, assoc with wkns, dermatomal sensory loss, usually herniated disc, Most common herniated disc- L5-S1, spinal angles sharply. Ipsilateral calf wasting, wk ankle DF.

108
Q

Sciatica

A

S1 distribution- low back pain with nerve pain that radiates down leg

109
Q

Asterixis

A

ID metabolic encephalopathy when mental function impaired. Stop sign with hands, watch 1-2 minutes
Sudden breif nonrythmic flexion of hands/fingers: liver disease, uremia, hpercapnia

110
Q

Winging of Scapula

A

Shoulder muscles weak or atrophic, push hands against wall- scapula lie close to thorax.
In winging, medial border of scapula juts backwards- wkns serratus muscle- MD or injury to long thoracic nerve
If thin, may appear winged

111
Q

Stupous/Comatose Patient

A

ABC’s, LOC, Neuro exam

112
Q

2 Don’t with coma pt

A

don’t dialate pupils- single most important clue about cause(structural vs metabolic)
Don’t flx neck if trauma

113
Q

5 clinical signs strongly predict death

A 
abs corneal reflex
abs pupillary response
abs WD to pain
no motor response
at 72 hrs, no motor response
114
Q

Doll’s eyes

A

In comatose pt with no neck injury turn head side to side. Eyes should move toward opposite side. If eyes don’t move=midbrain or pons lesion

115
Q

Oculovestibular Reflex with Caloric Stimulation

A

If oculocephalic reflex abs, assess brainstem fxn, not performed on an awake pt.Ice cold water into ear canal. If brainstem intact eyes will move toward cold water. No response= brainstem injury

116
Q

CSF/Blood in nose/ears

A

suggests skull fracture or OM- possible brain absess

117
Q

ACA

A

contralat leg wkns

118
Q

MCA

A

largest vasc bed for stroke.

contralat facial, arm>leg wkns, sensory loss, field cut, aphasia(L MCA), or neglect,apraxia(R MCA)

119
Q

Subcortical

A

contralat motor or sensory deficit w/o cortical signs

120
Q

PCA

A

contralat field cut

cortical bindness, but pupil response present.

121
Q

Brainstem/Vertebral or Basilar Artery branches

A

dysphagia, dysarthria, tongue/palate dev, ataxia, crossed sensory/motor deficits(ips face with contra s/m deficits)

122
Q

Basilar Artery

A

Oculomotor deficits, ataxia, crossed s/m deficits

Complete occlusion= lock in syndrome

123
Q

Tremors

A

Resting/Static
Postural/Action
Intention

124
Q

Types of seizures

A

Partial: Simple partial, Complex partial
Gen: Grand Mal, Absence, Atonic or drop attack, Myoclonic
Pseudoseizures

125
Q

Wernicke’s Aphasia

A

fluent receptive aphasia

Post superios temporal lobe

126
Q

Broca’s Aphasia

A

non fluent expressive aphasia

Post inferior frontal lobe

127
Q

Muscle Tone Disorders

A

spasticity
rigidity
flaccidity
paratonia

128
Q

Speech Disorders

A

Aphonia
dysphonia
dysarthria
aphasia: exp/rec

129
Q

Facial Dyskinesias

A 
Tic
Chorea
Athetosis
Dystonia
Spatic Torticollis

Physical Assessment (7 decks)

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