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NPTE Study Flash Cards > Neuro > Flashcards

Neuro Flashcards

1
Q

Levels of Consciousness: Coma

A

a state of unconsciousness and a level of unresponsiveness to internal and external stimuli

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2
Q

Levels of Consciousness: Stupor

A

a state of general unresponsiveness with arousal occurring from repeated stimuli

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3
Q

Levels of Consciousness: Obtundity

A

characterized by a state of sleep, reduced alertness to arousal, delayed response to stimuli

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4
Q

Levels of Consciousness: Delirium

A

characterized by disorientation, confusion, agitation, and loudness.

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5
Q

Levels of Consciousness: Clouding

A

characterized by a quiet behavior, confusion, poor attention, and delayed responses.

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6
Q

Level of Consciousness: Consciousness

A

a state of alertness, awareness, orientation, and memory.

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7
Q

RLA: Level 1

A

No Response: deep sleep and completely unresponsive.

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8
Q

RLA: Level 2

A

Generalized Response: reacts inconsistently and non-purposefully, responses limited and often the same regardless of stimulus presented. Responses include physiological changes, gross body movement, vocalization.

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9
Q

RLA: Level 3

A

Localized Response: reacts specifically, but insconsistently. may follow simple commands such as close eyes or squeeze hand inconsistently, and delayed.

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10
Q

RLA: Level 4

A

Confused-Agitated: heightened state of activity. bizarre and non purposeful. unable to cooperate with treatment efforts. verbalizations incoherent/inappropriate to environment. confabulation. attention to environment is brief. lacks short and long term recall.

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11
Q

RLA: Level 5

A

Confused-Inappropriate: able to respond to simple commands consistently. needs simplicity and external striations or responses become non-purposeful. gross attention to environment. distractible. verbalization inappropriate and confabulatory. Memory impaired. Inappropriate use of objects. unlikely to learn new info.

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12
Q

RLA: Level 6

A

Confused-Appropriate: Goal-directed behavior. dependent on external input/directions. simple directions consistently and shows carryover (for self-care). responses may be incorrect due to memory problems, but are appropriate. past memories show more depth.

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13
Q

RLA: Level 7

A

Automatic-Appropriate: appropriate and oriented within hospital and home settings. goes through daily routine automatically/robot-like. minimal to no confusion and has shallow recall. shows carryover for new learning, but decreased rate. able to initiate social activities with structure. judgement is impaired

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14
Q

RLA: Level 8

A

Purposeful-Appropriate: recall and integrate past and recent events. aware of and responsive to environment. carryover for new learning and needs no supervision. still has difficulty in emergency or unusual circumstances.

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15
Q

Glasgow Coma Scale Categories

A
  1. Eye Opening
  2. Best Motor Response
  3. Verbal Response
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16
Q

Glasgow Coma Scale: Eye Opening

A

1 - nil
2 - pain
3 - speech
4 - spontaneous

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17
Q

Glasgow Coma Scale: Best Motor Response

A

1 - nil / 2 - extensor response
3 - abnormal flexion / 4 - withdraws
5 - localizes pain / 6 - obeys commands

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18
Q

Glasgow Coma Scale: Verbal Response

A 
1 - nil
2 - incomprehensible sounds
3 - inappropriate words
4- confused conversation
5- oriented
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19
Q

Glasgow Coma Scale: Purpose and Norm Values

A

used initially after injury to determine arousal and cerebral cortex function.

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20
Q

Abdominal Reflex

A
  • T8-L1
  • stroke from each quadrant in toward belly button
  • deviation of belly button toward stimulus
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21
Q

Corneal “blink” reflex

A
  • trigeminal/facial nerves
  • pt looks up and away, stroke cornea with cotton
  • both eyes should blink
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22
Q

Cremasteric reflex

A
  • L1-L2
  • scratch skin upper medial thigh
  • elevation of testicle on same side
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23
Q

Gag reflex

A
  • glossopharyngeal and vagus nerves
  • sim each side of back of throat
  • gag
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24
Q

plantar reflex

A
  • L5-S1
  • stroke lateral aspect of the sole of the foot from heel to ball, and medially toward great toe
  • flexion of toes (babinski sign = positive response for CNS lesion)
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25
Q

Superficial Reflex

A
  • response of stimulation of the receptors within the skin
  • sensory response must reach spinal chord, ascend to reach the brain, and then motor music descend to reach motor neurons.
    polysnaptic reflex
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26
Q

Deep Tendon Reflex

A
  • muscle contraction after muscle’s tendon is stimulated due to the reflex arc involving the spinal/brainstem segment that innervates the specific muscle.
  • hyperreflexia = suprasegmental lesion (lesion above the level tested)
  • hypo = injury in reflex arc
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27
Q

Superficial Sensation

A
  • temperature
  • light touch
  • pain
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28
Q

Deep sensation

A
  • proprioception
  • kinesthesia
  • vibration
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29
Q

cortical sensation

A
  • bilateral simultaneous stim
  • stereognosis
  • two-point discrimination
  • barognosis
  • localization of touch
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30
Q

def: allodynia

A

the sensation of pain in response to a stimulus that would not typically produce pain

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31
Q

def: analgesia

A

the absence of pain while remaining consious

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32
Q

def: anesthesia

A

the absence of touch sensation

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33
Q

def: causalgia

A

constant, relentless burning hyperesthesia and hyperalgesia that develops after a peripheral nerve injury

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34
Q

def: dysesthesia

A

distortion of any of the senses, especially the sense of touch

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35
Q

def: hyperesthesia

A

heightened sensation

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36
Q

def: hyperpathia

A

an extreme exaggerated response to pain

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37
Q

def: hypesthesia

A

a diminished sensation of touch

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38
Q

def: neuralgia

A

severe and multiple shock-like pains that radiate from a specific nerve distribution

39
Q

def: pallanesthesia

A

loss of vibration sensation

40
Q

def: paresthesia

A

abnormal sensations such as tingling, pins and needles, or burning sensations

41
Q

Classification of Acute Nerve Injury: Neurapraxia

A
  • mildest
  • nerve conduction preserved proximal an distal to the lesion
  • nerve fibers are NOT damaged
  • sx: pain, minimal atrophy, numbness or loss of motor and sensory function, diminished proprioception
  • recover 4-6 weeks
  • pressure injury most common
42
Q

Classification of Acute Nerve Injury: Axonotmesis

A
  • more severe
  • reversible injury to fibers
  • preservation of endoneurium, epineurium, scwann cells, and supporting structures
  • distal wallerian degeneration
  • recovery is spontaneous, may need surgery, heal 1mm/day
  • traction, compression, crush injury most common
43
Q

Classification of Acute Nerve Injury: Neurotmesis

A
  • most severe
  • axon, myelin, connective tissue all damaged
  • irreversible
  • flaccid paralysis/loss of sensation, distal to lesion impaired
  • surgical reattachment may improve
  • complete transection of the nerve trunk most common
44
Q

Upper Motor Neuron Lesion: Location

A
  • descending motor tracts within the:
    - cerebral motor cortex
    - internal capsule
    - brainstem
    - spinal chord
    (Lat white column of spinal chord)
    EX: CP, hydrocephalus, ALS, CVA, MS, Huntingtons, TBI, pseudobulbar palsy, brain tumor
45
Q

Lower Motor Neuron Lesion: Location

A

lesion that affects nerves or their axons at or below the level of the brainstem.
- “final common pathway”
- ventral gray column of the spinal cord
EX: polio, ALS, Guillain-Barre, Tumors in spinal chord, Trauma, Bell’s Palsy, Carpal Tunnel, MD, SMA

46
Q

UMN Symptoms

A
  • weakness of involved muscles
  • hypertonicity
  • hyperreflexia
  • mid disuse atrophy
  • abnormal reflexes
47
Q

LMN Symptoms

A
  • flaccidity/weakness
  • decreased tone
  • fasciculations
  • muscle atrophy
  • decreased/absent reflexes
48
Q

Peripheral Nerve Lesion: Ant Horn

A
  • sensory intact
  • motor weakness/atrophy
  • fasciculations
  • decreased deep tendon reflex
  • EX: ALS, polio
49
Q

Peripheral Nerve Lesion: Muscle

A
  • sensory intact
  • motor weakness
  • fasciculations are rare
  • normal/decreased deep tendon reflexes
    EX: muscular dystrophy
50
Q

Peripheral Nerve Lesion: Neuromuscular Junction

A
  • sensory intact
  • motor fatigue
  • NORMAL deep tendon reflex
  • EX: myasthenia gravis
51
Q

Peripheral Nerve Lesion: Peripheral Nerve (mononeuropathy)

A
  • sensory loss
  • motor weakness/atrophy along distribution/may have fasciculations
    EX: Trama
52
Q

Peripheral Nerve Lesion: Peripheral Polyneuropathy

A
  • sensory (stocking glove)
  • motor weakness/atrophy
  • weaker distally, may have fasciculations
  • decreased deep tendon reflex
    EX: Diabetic peripheral polyneuropathy
53
Q

Peripheral Nerve Lesion: Spinal Roots and Nerves

A
  • sensory = dermatomal
  • motor weakness = myotomal
  • decreased deep tendon reflexes
    EX: herniated disk
54
Q

Def: Tremor

A

involuntary, rhythmic, oscillatory movement.

  • Postural: hyperthyroidism, fatigue, anxiety
  • Resting: Parkinson’s
  • Intention: cerebellum (or its efferent pathways) - MS
55
Q

Def: Tics

A
  • sudden, brief, repetitive coordinated movements, occur at irregular intervals. (myoclonic jerks)
    EX: tourette syndrom (needs verbal and motor tic)
56
Q

Def: Chorea

A
  • brief, irregular contractions; rapid
  • secondary to damage of the caudate nucleus
  • Ballism = choreic jerks of large amplitude, flailing; typically secondary to damage subthalmic nucleus.

EX: Huntingtons

57
Q

Def: Dystonia

A
  • sustained muscle contractions, cause twisting, abnormal postures, repetitive movements.

EX: parkinson’s, CP, encephalitis.

58
Q

Def: Athetosis

A
  • slow, twisting and writhing, large amplitude.
  • primarily seen in face, tongue, trunk, and extremities
  • associated with spasticity
    EX: forms of CP, secondary to basal ganglia pathology
59
Q

Def: Akinesia

A

inability to initiate movement. seen in parkinson patients

60
Q

Def: asthenia

A

generalized weakness, secondary to cerebellar pathology

61
Q

Def: ataxia

A

inability to perform coordinated movements

62
Q

Def: Athetosis

A

involuntary movements combined with postural instability.

63
Q

Def: clasp-knife response

A

form of resistance seen during range of motion of a hypertonic joint where there is greatest resistance at the initiation of range that lessons with movement through the range.

64
Q

Def: cogwheel rigidity

A

resistance to movement has a phasic quality: parkinsons

65
Q

Def: dystonia

A

postural/central muscle weakness

66
Q

Def: Lead pipe rigidity

A

a form of rigidity where there is uniform and constant resistance to range of motion. Basal ganglia

67
Q

Vistibular Input: Semicircular Canals VS Otolith Organs

A

Semicircular: responds to movement of fluid with head motion.

Otolith Organs: measure the effects of gravity and movement with regard to acceleration/deceleration.

68
Q

Def: Vestibuloocular Reflex (VOR)

A
  • allows for head/eye movement coordination

- supports gaze stabilization, eye movement that counters movements of the head.

69
Q

Def: Vestibulospinal Reflex (VSR)

A
  • attempts to stabilize the body and control movement.
  • assists with stability while the head is moving
  • coordination of the trunk during upright postures.
70
Q

Peripheral Vertigo Symptoms

A
  • episodic and short duration
  • autonomic symptoms
  • precipitating factor
  • pallor, sweating
  • nausea and vomiting
  • auditory fullness
  • tinnitus
71
Q

Central Vertigo

A
  • less severe autonomic symptoms
  • loss of consciousness can occur
  • neurological symtoms including:
    - diplopia, hemianopsia, weakness, numbness
    ataxia, dysarthria
72
Q

Peripheral Vertigo Etiology

A
  • BPPV
  • Meniere’s disease
  • infection
  • trauma/tumor
  • metablic disorders (DB)
  • acute alcohol intoxication
73
Q

Central Vertigo Etiology

A
  • Meningitis
  • Migraine headache
  • complications of neurologic origin post ear infections
  • trauma/tumor
  • cerebellar degeneration (ie alcoholism)
  • MS
74
Q

Characteristics Associated with aphasia that equate to poor prognosis (4)

A
  • perseveration of speech
  • severe auditory comprehension impairments
  • unreliable yes/no answers
  • use of empty speech without recognition of impairments
75
Q

Def: Fluent Aphasia

A
  • lesions frequently involve temporal lobe, wrenches’ area, parietal lobe
  • empty speech/jargon
  • use of neologisms (makes a word unrecognizable)
76
Q

Def: Non Fluent Aphasia

A
  • frontal lobe (ant. speech center) of dominant hemisphere
  • poor word output
  • dysprosodic speech (impairment in rhythm/inflection)
  • content is present, impaired syntactical words
77
Q

Types of Fluent Aphasia

A
  1. Wernicke’s Aphasia: post region of the superior temporal gyrus. (receptive aphasia). comprehension impaired, impaired writing, poor naming, no motor impairment
  2. Conduction Aphasia: supramarginal gyrus/arcuate fasciculus. impairment with repetition. good comprehension. word-finding difficulties. reading intact/writing impaired.
78
Q

Types of Non-Fluent Aphasia

A
  1. Brocas Aphasia: 3rd convolution of frontal lobe. (expressive aphasia). most common. motor impaired. intact comprehension.
  2. Global Aphasia: frontal, temporal, parietal lobes. comprehension SEVERELY impaired. uses non verbal skills.
  3. Verbal Apraxia: non-dysarthric/non-aphasic impairment of prosody and articulation of speech. problems with motor planning. left frontal lobe adjacent to Brocas.
  4. Dysarthria: UMN affects muscles to articulate words. slurred speech.
79
Q

PNF: Agonistic Reversals (AR)

A
  • controlled mobility and skill (proximal dynamic stability)
  • isotonic concentric contraction performed against resistance followed by alternating concentric and eccentric contractions with resistance.
80
Q

PNF: Alternating Isometrics (AI)

A
  • stability/strength and endurance

- isometric contractions alternating from one side of joint to other without rest.

81
Q

PNF: Contract-Relax (CR)

A
  • Increase ROM/Mobility

- at end of range, patient performs a maximal contraction of the antagonistic muscle group.

82
Q

PNF: Hold-Relax (HR)

A
  • Mobility/ increased ROM
  • Isometric contraction, facilitated for all muscle groups at the limiting point, then relax. often used for patients who present with pain.
83
Q

PNF: Hold Relax Active Movement (HRAM)

A
  • Mobility/ initiate movement
  • used with MMT 1/5 or less. place extremity in shortened range, then isometric contraction is performed. relax-and extremity is moved into a lengthened position with a quick stretch. pt is then asked to return the extremity to the shortened position through an isotonic contraction.
84
Q

PNF: Joint distraction

A
  • Mobility/increased ROM and initiation
  • proprioceptive component. manual traction slowly and usually combined with mobs. also can be combined with quick stretch to initiate movement.
85
Q

PNF: Normal Timing (NT)

A
  • Skill/ Distal Functional Movement
  • improve coordination. distal to proximal sequence. proximal components are restricted until the distal components are activated and initiate movement. repetition.
86
Q

PNF: Repeated Contractions (RC)

A
  • Mobility/ initiation of movement / strength
  • quick stretch followed by isometric or isotonic contractions. used to initiate movement, throughout a weak movement pattern or at a joint of weakness.
87
Q

PNF: Resisted Progression (RP)

A
  • Skill / proximal dynamic stability / strength
  • Gait! resistance applied to an area such as the pelvis, hips, or extremity during the gait cycle in order to enhance coordination, strength, or endurance.
88
Q

PNF: Rhythmic Initiation (RI)

A
  • Mobility / initiation of movement

- hypertonia. passive, active assistive, slightly resistive. slow and rhythmical

89
Q

PNF: Rhythmic Rotation (RR)

A
  • Mobility / increase ROM and initiate movement

- passive technique to decrease hypertonia, slowly rotate an extremity around the longitudinal axis. relaxation.

90
Q

PNF: Rhythmic Stabilization (RS)

A
  • mobility / stability / increase ROM
  • isometric contractions of all muscles around a joint against progressive resistance. relax, move into newly acquired range, then repeat. a progression of alternating isometrics.
91
Q

PNF: Slow Reversal (SR)

A
  • Stability, controlled mobility, skill / distal functional movement.
  • a technique of slow and resisted concentric contractions of agonist and antagonists around a joint without rest. improve control of movement and posture.
92
Q

PNF: Slow Reversal Hold (SRH)

A
  • stability, controlled mobility, skill / distal functional movement
  • slow reversal with addition of an isometric contraction performed at the end of each movement, gain more stability.
93
Q

PNF: Timing for Emphasis

A
  • skill / strength / distal functional movement

- strengthen weak component of movement pattern. isotonic/isometric contractions produce overflow to weak muscles.

NPTE Study Flash Cards (13 decks)

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