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518 Exam 1 > Neuro > Flashcards

Neuro Flashcards

1
Q

What regulatory brain functions does serotonin have?

A

Helps regulate mood, arousal and cognition

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2
Q

What regulatory brain functions does dopamine have?

A

Helps regulate mood, arousal, motor control and cognition

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3
Q

What regulatory brain functions does norepinephrine have?

A

Helps regulate mood, arousal, attention and cognition

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4
Q

What regulatory brain functions does acetylcholine have?

A

regulates sleep, arousal and attention

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5
Q

What symptoms have been associated with low levels of serotonin, dopamine and norepinephrine?

A

Depressive symptoms

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6
Q

What neurotransmitters are associated with anxiety symptoms?

A

Low levels of serotonin and high levels of norepinephrine

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7
Q

What neurotransmitters are associated with mania and psychosis?

A

Low levels of serotonin and high levels of dopamine in some areas of the brain

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8
Q

What neurotransmitter has been associated with dementia?

A

Low levels of actylcholine

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9
Q

What are some risk factors for anxiety disorder?

A

family history of anxiety,
personal history of anxiety or mood disorder,
childhood stressful life events or trauma, being female,
chronic medical illness,
behavioral inhibition.

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10
Q

How long would you expect a patient to be experiencing symptoms of anxiety/extreme worrying if you suspect they have generalized anxiety disorder?

A

At least 4 weeks

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11
Q

When considering a diagnosis of anxiety, what other diagnosis might you consider? What might be contributing to symtoms?

A

Other diagnosis could include hyperthyroidism, cardiopulmonary disorders or traumatic brain injury, all of which could accompany anxiety.
Anxiety can also be exacerbated by caffeine, alcohol, illicit drug use or other psychiatric comorbidities

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12
Q

If a patient is experiencing depressive symptoms that are in sync with her menstrual cycle, what might she be experiencing?

A

Premenstrual dysphoric disorder (PMDD)

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13
Q

Major depressive disorder (MDD) is characterized by at least 2 weeks of depressed/irritable mood, with at least four of the following:

A

anhedonia,
insomnia or hypersomnia,
decreased self-esteem,
low energy,
poor concentration or indecision, changes in appetite,
feeling slowed or restless,
thoughts of death or suicide.

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14
Q

How does bipolar disorder present?

A

Bipolar disorders present with both depressive episodes, such as in major depressive disorder (MDD), as well as manic or hypomanic episodes. Symptoms of manic episodes include euphoric/irritable mood, grandiosity, decreased need for sleep, talkativeness, racing thoughts, distractibility, increased goal-directed behavior or agitation, and an increase in reckless pleasure-seeking (having unprotected sex, spending excess money, foolish investments).

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15
Q

What diagnosis’s may mimic depression?

A

Parkinson disease, traumatic brain injury (TBI), recent myocardial infarction (MI) or stroke, and hypothyroidism may mimic depressive symptoms. Additionally, alcohol use and recent substance use may present in a similar way to depressive symptoms.

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16
Q

Why would sudden onset memory problems not be indicative of dementia? What might it indicate?

A

Sudden-onset memory problems are concerning for major vascular neurocognitive disorders, wherein vascular occlusion damages structusres important for memory. Rapid-onset memory problems after a head injury should raise suspicion for a major neurocognitive disorder due to TBI.

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17
Q

What diagnosis would be likely in a patient with slow onset memory loss and one sided tremor with difficulty starting movements?

A

Parkinson’s; in a younger adult, it could be Huntington’s, particularly if there is a family history

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18
Q

What are the six components of the mental status evaluation?

A

The mental status examination consists of six components: appearance and behavior; speech and language; mood; thoughts and perceptions; insight and judgment; and cognitive function.

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19
Q

What are dysarthria, aphasia and dysphnia?

A

Dysarthria refers to defective articulation, aphasia is a disorder of language and dysphonia results from impaired volume, quality or pitch of voice.

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20
Q

Differentiate between Broca aphasia and Wernicke’s aphasia

A

Broca aphasia is also called expressive aphasia, which has preserved comprehension but difficult speech.
Wernicke’s aphasia is receptive aphasia, in which the patient has fluent speech but impaired comprehension.

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21
Q

Describe the language pattern of blocking? In what disorder might it be present? Is it normal?

A

Blocking is a sudden interruption in speech before the idea is completed, also known as “losing the thought”. It occurs in normal people. It may also be striking in schizophrenia

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22
Q

Describe the language pattern of circumstantiality. In what disorder might you see this pattern? Is it normal?

A

The mildest thought disorder, consisting of speech with unnecessary detail, indirection, and delay in reaching the point. Some topics may have a meaningful connection. Many people without mental disorders have circumstantial speech. It may be present in people with obsessive compulsive disorder or obsessions.

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23
Q

Describe the language pattern of “clanging”. In what disorders might it be present?

A

Speech with choice of words based on sound, rather than meaning, as in rhyming and punning. For example, “Look at my eyes and nose, wise eyes and rosy nose. Two to one, the ayes have it!”
Clanging may be present in schizophrenia or mania.

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24
Q

Describe the language pattern of “Confabulation”. In what disorders might it be present?

A

Confabulation is fabrication of facts or events in response to questions, to fill in the gaps from impaired memory. May be present in alcoholism or dementia.

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25
Describe the language pattern of "derailment". In what disorders might it be present?
Tangential speech with shifting topics that are loosely connected or unrelated. The patient is unaware of the lack of association.
26
Describe the language pattern of "flight of ideas". In what disorders might it be present?
An almost continuous flow of accelerated speech with abrupt changes from one topic to the next. Changes are based on understandable associations, plays on words, or distracting stimuli, but ideas are not well connected. Most commonly noted in manic episodes.
27
Describe the language pattern of "incoherance". In what disorders might it be present?
Speech that is incomprehensible and illogical, with lack of meaningful connections, abrupt changes in topic, or disordered grammar or word use. Flight of ideas, when severe, may produce incoherence. Most frequently noted in severe psychiatric disturbances, particularly schizophrenia.
28
Describe the language pattern of "neologisms". In what disorders might it be present?
Invented or distorted words, or words with new and highly idiosyncratic meanings. May be present in schizophrenia, psychiatric disorders or aphasia.
29
Describe the language pattern of "perseveration". In what disorders might it be present?
Persistent repetition of words or ideas. May be present in schizophrenia and other psychiatric disorders.
30
Differentiate between hallucinations and illusions.
Illusions are misinterpretations of real external stimuli, such as mistaking the rustling of leaves for whispered voices. Hallucinations are perception-like experiences that seem real but are not based on external stimuli. The person experiencing them may or may not be able to identify them as false.
31
Describe the digit span test
Explain that you would like to test the patient’s ability to concentrate, perhaps adding that this can be difficult if the patient is in pain or ill. Recite a series of digits, starting with two at a time and speaking each number clearly at a rate of about one per second. Ask the patient to repeat the numbers back to you. If this repetition is accurate, try a series of three numbers, then four, and so on as long as the patient responds correctly. Jot down the numbers as you say them to ensure your own accuracy. If the patient makes a mistake, try once more with another series of the same length. Stop after a second failure in a single series. Causes of poor performance include delirium, dementia, intellectual disability, and performance anxiety. When choosing digits, use street numbers, zip codes, telephone numbers, and other numerical sequences that are familiar to you, but avoid consecutive numbers, easily recognized dates, and sequences that are familiar to the patient. Now, starting again with a series of two, ask the patient to repeat the numbers to you backward. Normally, a person should be able to repeat correctly at least five digits forward and four backward.
32
What does the digit span test assess?
Attention
33
Describe the serial 7s test. what does it assess for?
Instruct the patient, “Starting from 100, subtract 7, and keep subtracting 7….” Note the effort required and the speed and accuracy of the responses. Writing down the answers helps you keep up with the arithmetic. Normally, a person can complete serial 7s in 1½ minutes, with fewer than four errors. If the patient cannot do serial 7s, try 3s or counting backward. This test assess for attention. Poor performance may result from delirium, the late stage of dementia, intellectual disability, anxiety, or depression. Also consider educational level.
34
differentiate between short term and long term memory
Recent or short-term memory covers minutes, hours, or days; remote or long-term memory refers to intervals of years.
35
In what disorders is remote memory impaired? Recent memory?
Remote memory is usually preserved in early stages of dementia but may be impaired in its later stages. Recent memory is impaired in dementia and delirium. Amnestic disorders impair memory or new learning ability and reduce social or occupational functioning but lack the global features of delirium or dementia. Anxiety, depression, and intellectual disability may also impair recent memory.
36
How can you assess new learning ability?
Give the patient three or four words such as “83, Water Street, and blue,” or “table, flower, green, and hamburger.” Ask the patient to repeat them so that you know that the information has been heard and registered. This step, like digit span, tests registration and immediate recall. Then proceed to other parts of the examination. After 3 to 5 minutes, ask the patient to repeat the words. Note the accuracy of the response, awareness of whether it is correct, and any tendency to confabulate. Normally, a person should be able to remember the words.
37
What factors can you consider to assess higher cognitive function?
Higher cognitive functions are assessed by vocabulary, fund of information, abstract thinking, calculations, and construction of objects that have two or three dimensions.
38
Define dementia
Dementia is “an acquired condition that is characterized by a decline in at least two cognitive domains (e.g., loss of memory, attention, language, or visuospatial or executive functioning) that is severe enough to affect social or occupational functioning. It is a major neurocognitive disorder
39
Describe the confusion assessment diagnostic method for diagnosing delirium.
Diagnosing delirium requires features 1 and 2 and either 3 or 4. Acute change in mental status and fluctuating course: Is there evidence of an acute change in cognition from baseline? Does the abnormal behavior fluctuate during the day? Inattention: Does the patient have difficulty focusing attention? Disorganized thinking: Does the patient have rambling or irrelevant conversations, unclear or illogical flow of ideas, or unpredictable switching from subject to subject? Abnormal level of consciousness: Is the patient anything besides alert—hyperalert, lethargic, stuporous, or comatose?
40
Who should be screened for drug and/or alcohol abuse?
Every patient should be asked about alcohol use, substance abuse, and misuse of prescription drugs.
41
What is the difference between grey matter and white matter?
Brain tissue may be gray or white. Gray matter consists of aggregations of neuronal cell bodies. It rims the surfaces of the cerebral hemispheres, forming the cerebral cortex. White matter consists of neuronal axons that are coated with myelin. The myelin sheaths, which create the white color, allow nerve impulses to travel more rapidly.
42
what is the primary function of the thalamus?
processes sensory impulses and relays them to the cerebral cortex
43
where do hormones secreted by the hypothalamus act?
directly on the pituitary gland
44
what are the three areas of the brainstem?
the midbrain, the pons and the medulla
45
what area of the brain coordinates all movement and helps maintain the body upright in space?
the cerebellum
46
what area of the lower brainstem connects directly to the spinal cord?
the medulla
47
what are the first three crainial nerves and their function?
I - Olfactory: Sense of smell II - Optic: Vision III - Oculomotor: Pupillary constriction, opening the eye (lid elevation), and most extraocular movements
48
what is the 4th cranial nerve and its function?
troachlear, controls downward, internal rotation of the eye
49
what is the fifth cranial nerve and its function?
trigeminal - it is a mixed motor and sensory neuron. Motor function - jaw clenching and lateral jaw movements Sensory - facial. The nerve has three divisions: (1) ophthalmic, (2) maxillary, and (3) mandibular.`
50
What are the three divisions of the fifth cranial sensory nerve?
The nerve has three divisions: (1) ophthalmic, (2) maxillary, and (3) mandibular.
51
what is the 6th cranial nerve and its function?
abducens - lateral deviation of the eye
52
What is the 7th cranial nerve and its function?
VII - Facial Motor—facial movements, including those of facial expression, closing the eye, and closing the mouth     Sensory—taste for salty, sweet, sour, and bitter substances on the anterior two-thirds of the tongue and sensation from the ear
53
what is the 8th cranial nerve and its function?
Hearing (cochlear division) and balance (vestibular division)
54
What is the 9th cranial nerve and its function?
Motor—pharynx sensory—posterior portions of the eardrum and ear canal, the pharynx, and the posterior tongue, including taste (salty, sweet, sour, bitter)
55
What is the 10th cranial nerve and its function?
Motor—palate, pharynx, and larynx Sensory—pharynx and larynx
56
What is the 11th cranial nerve and its function?
Motor—the sternocleidomastoid and trapezius
57
What is the 12th cranial nerve and its function?
Motor—tongue
58
What is a mnemonic for remembering the cranial nerves?
On Old Olympus Towering Tops, a Finn and German Viewed Some Hops
59
What is a mnemonic for remembering which cranial nerves are sensory, motor or both?
Some Say Marry Money, But My Brother Says Big Brains Matter More
60
What does damage to the corticospinal (pyramidal) tract cause?
weakness
61
What does damage to the basal ganglia system cause (as it relates to motor function)?
rigidity, slowness of movement (bradykinesia), involuntary movements, and/or disturbances in posture and gait. (i.e. parkinsons)
62
What does damage to the cerebeller system of movement cause?
impair coordination (called ataxia), gait, equilibrium, and decrease muscle tone. The cerebellum also helps coordinate eye movements and speech, so other signs like nystagmus or dysarthria may be seen.
63
True or false: Disease of the basal ganglia system or cerebellar system does not cause paralysis but can be disabling.
True
64
Differentiate how diabetic patients describe pain from damage to small fiber neuropathy, vs the pain from damage to large fiber neuropathy
Patients with diabetes with small-fiber neuropathy report sharp, burning, or shooting foot pain, whereas those with large-fiber neuropathy experience numbness and tingling or even no sensation at all.
65
What is a dermatone?
A dermatome is the band of skin innervated by the sensory root of a single spinal nerve
66
What components of the reflex arc need to be intact in order to illicit a deep tendom reflex?
For the reflex to occur, all components of the reflex arc must be intact: sensory nerve fibers, spinal cord synapse, motor nerve fibers, neuromuscular junction, and muscle fibers.
67
What spinal segmental level does the triceps reflex target?
Cervical 6, 7
68
What segmental level does the Brachioradialis (supinator) reflex target?
Cervical 5, 6
69
What segmental level does the biceps reflex target?
Cervical 5, 6
70
What segmental level does the knee reflex target?
Lumbar 2, 3, 4
71
What segmental level does the ankle reflex target?
Sacral 1
72
What are three examples of life threatening causes of headaches?
Meningitis, subarachnoid hemorrhage or mass lesion
73
What are some examples of primary headache causes?
Primary headaches include migraine, tension, cluster, trigeminal autonomic cephalalgias and chronic daily headaches
74
What are the POUND features of migraine headaches?
Pulsatile or throbbing; One-day duration, or lasts 4 to 72 hours if untreated; Unilateral; Nausea or vomiting; Disabling or intensity causing interruption of daily activity.
75
True or false: visual aura is generally present in the majority of patients with migraines
False, it occurs in about 1/3 of patients
76
Why would valsalva or lying down increase headache pain in patients with brain mass?
It causes increased intercrainial pressure
77
True or false: Migraines are genetic
True, Genetic inheritance is present in 30% to 50% of patients with migraine.
78
What does progressive but rapid development of lower extremity weakness followed by upper extremity weakness suggest?
Guillain–Barré syndrome
79
What does multiple patchy areas of sensory loss in different limbs suggest?
mononeuritis multiplex, seen in vasculitis and rheumatoid arthritis
80
How is "epilepsy" defined?
two or more seizures that are not provoked by other illnesses or circumstances
81
True or false: Generalized epilepsy syndromes usually begin in childhood or adolescence; adult-onset seizures are usually partial.
true
82
what is the most common movement disorder?
tremor
83
what is a "tremor"?
a rhythmic oscillatory movement of a body part resulting from the contraction of opposing muscle groups,
84
what is an essential tremor?
Essential tremor is a high-frequency, bilateral, upper extremity tremor that occur with both limb movement and sustained posture and subsides when the limb is relaxed; head, voice, and leg tremor may also be present.
85
how is "restless leg syndrome" described?
described as an unpleasant sensation in the legs, especially at night, that gets worse with rest and improves with movement of the symptomatic limb(s).
86
what are some reversible causes of restless leg syndrome?
Reversible causes of restless legs syndrome include pregnancy, renal disease, and iron deficiency.
87
What are the five areas that should be assessed in a comprehensive physical neurological exam?
(1) mental status, speech, and language; (2) cranial nerves (CNs); (3) motor system; (4) sensory system; and (5) reflexes.
88
What can you do to assess your patients coordination?
Rapid alternating movements: - Rapid alternating arm movements - Rapid finger tapping - Point-to-point movements Finger-to-nose test Heel-to-shin test Gait: - Casual walk - Walk on toes and on heels - Walk heel to toe in a straight line (tandem) Assess position sense: - Romberg test - Pronator drift test
89
What spinal segments does the patellar reflex test?
(L2, L3, L4)
90
How can you test the motor function of the trigeminal nerve?
While palpating the temporal and masseter muscles in turn, ask the patient to firmly clench the teeth (Figs. 24-10 and 24-11). Note the strength of muscle contraction. Ask the patient to open and move the jaw from side to side.
91
If you are testing for light touch and sensation (during cranial nerve exam) and you suspect sensory lost, how would you confirm?
Test temperature sensation using hot/cold
92
If there is paralysis of the palate due to damage of the vagus nerve, what might the patients voice sound like?
Nasal
93
Describe spasticity
Spasticity is increased tone that is velocity-dependent and worsens at the extremes of range of motion. Resistance increases with more rapid movement. Spasticity is seen in central diseases affecting the corticospinal tract.
94
Describe rigidity
Rigidity is increased tone that remains the same throughout the range of motion; it is not velocity dependent. Rigidity is seen in central disorders affecting the basal ganglia, such as Parkinson disease.
95
what is ataxia?
a loss of control of coordinated voluntary movements.
96
what is dysdiadochokinesis?
When assessing rapid reversing movements in cerebellar disease, instead of alternating quickly, these movements are slow, irregular, and clumsy, an abnormality called dysdiadochokinesis
97
If a patient has cerebellar disease and you ask them to perform the heel to shin test, what would you find?
In cerebellar disease, the heel may overshoot the knee (dysmetria), then oscillate from side to side down the shin (intention tremor). If position sense is absent, the heel lifts too high and the patient tries to look. With eyes closed, performance is poor
98
What diagnosis would you consider in a patient with a gait that consists of short, shuffling steps, stooped posture and minimal arm swing?
Parkinsons
99
What does a sensory level (when one or more sensory modalities are reduced below a dermatome on one or both sides) suggest?
Spinal cord lesion
100
What is typically the first sense lost in peripheral neuropathy?
Vibration
101
what is Astereognosis?
Inability to recognize an object by feel when placed in the hand
102
What is graphesthesia? What might it indicate?
The inability to recognize a number drawn in the palm. It may indicate a lesion in the sensory cortex
103
Where is the dermatone level of s5?
Perianal
104
Where is the dermatone level of the thumb?
c6
105
Where is the dermatone level of c3?
back of neck/front of neck
106
Where is the dermatone level of t4?
nipples
107
Where is the dermatone of t10?
umbilicus
108
Where is the slow relaxation of muscles in hypothyroidism best assessed?
The achilles reflex
109
Where do the majority of disc herniations occur in the spinal column?
95% occur at L4-L5 or L5-S1
110
What are "dolls eyes movements"?
In a comatose patient with an intact brainstem, as the head is turned in one direction, the eyes move toward the opposite side
111
What is the leading modifiable risk factor for stroke?
Hypertension is the leading modifiable risk factor for both ischemic and hemorrhagic stroke. Pharmacologically reducing blood pressure significantly reduces stroke risk, particularly among African Americans and older adults.
112
True or false: Stroke risk is about doubled with diabetes, and 16% of patients with diabetes over age 65 will die of stroke
True

518 Exam 1 (3 decks)

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