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Patient Evaluation > Neuro > Flashcards

Neuro Flashcards

1
Q

Central Nervous System anatomy ?

A

Brain

Brainstem

Spinal cord

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2
Q

Peripheral Nervous System anatomy ?

A

12 pairs of cranial nerves

Peripheral nerves

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3
Q

Brain has 4 regions ?

A

Cerebrum

Diencephalon

Brainstem

Cerebellum

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4
Q

Brainstem anatomy ?

A

Connects upper part of brain with spinal cord

Midbrain, pons and medulla

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5
Q

Cerebellum anatomy ?

A

Coordinates movement

Helps body keep upright

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6
Q

Each cerebral hemisphere divided into lobes ?

A

Frontal

Parietal

Temporal

Occipital

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7
Q

Grey matter: _________ bodies form the cerebral cortex ( outer layer)

A

Neuronal cell

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8
Q

Grey matter: Basal ganglia ?

A

movement

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9
Q

Grey matter: Thalamus ?

A

processes sensory impulses and relays to cerebral cortex

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10
Q

Grey matter: Hypothalamus ?

A

homeostasis, endocrine system, emotions

“keep body at even keel”

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11
Q

White matter: Neuronal axons coated with ______

A

myelin

Myelin sheaths allow faster travel of impulse

**help impulses travel faster

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12
Q

Spinal Cord is a _______ for info to and from the brain

A

Conduit

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13
Q

Cervical vertebrae ?

A

C1-C8

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14
Q

Thoracic vertebrae ?

A

T1-T12

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15
Q

Lumbar vertebrae ?

A

L1-L5

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16
Q

Sacral vertebrae ?

A

S1-S5

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17
Q

Lumbar and sacral roots fan out ?

A

cauda equina

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18
Q

Spinal Nerves ?

A

20 pairs between brainstem and T12

voluntary movement

involuntary movement

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19
Q

Cauda Equina ?

A

starts at T12-L1 to coccyx

11 pairs of spinal nerves

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20
Q

PNS: cranial nerves ?

A

12 pairs

I-II: are fiber tracts emerging from the brain

III-XII: arise from diencephalon and brainstem

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21
Q

Peripheral Nervous Syste: PNS -

A

Spinal and peripheral

31 pairs attach to the spinal cord

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22
Q

PNS: Each nerve has ?

A

Anterior root

Posterior root

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23
Q

Posterior (dorsal) root ?

A

sensory fibers

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24
Q

Anterior (ventral) root ?

A

motor fibers

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25
Q

PNS: somatic ?

A

Regulates muscle movement and response to touch and pain

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26
Q

PNS controls?

A

internal organs, autonomic reflex response ?

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27
Q

Autonomic: Sympathetic ?

A

mobilizes organs during stress and arousal

  • fight or flight
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28
Q

Autonomic: Parasympathetic ?

A

conserves energy during times of rest and relaxation

  • rest and digest
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29
Q

NE: Mental disorders may be expressed as __________.

A

somatic symptoms

Ex: stress causing headaches

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30
Q

NE: Organic disorders may be expressed as ______________.

A

mental symptoms

Ex: dementia causing memory loss

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31
Q

NE: Detail varies widely dependent on patient, so be ______

A

flexible

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32
Q

NE: In a healthy person, exam can be relatively_____

A

brief

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33
Q

NE: 5 Sections ?

A 
Mental Status Exam
Cranial Nerves
Motor
Sensory
Reflexes
34
Q

Most of neuro exam is integrated into other exams, e.g: MSE during _______ ?

A

history

  • *idea of alter-ness and educational level
  • *
35
Q

Most of neuro exam is integrated into other exams, e.g: Cranial Nerve during ?

A

Head and Neck

hit them when doing HEENT exam

36
Q

Most of neuro exam is integrated into other exams, e.g: Motor / sensory during ?

A

MS / extremity exam

** done alot in MS**

37
Q

Mental Status Exam reminders ?

A

Done throughout the interview

↑ detail if a problem is suspected

Be tactful

Don’t offend, frighten or embarrass the pt

38
Q

MSE -Appearance and Behavior ?

A

Level of consciousness

39
Q

MSE: Level of consciousness ? What is it and how do you test it ?

A

Awareness of environment

Do they understand conversation or lose track?

Timely responses?

Falling asleep?

40
Q

MSE - Levels of Consciousness: Alert ?

A

NL

41
Q

MSE - Levels of Consciousness: Lethargic ?

A

drowsy but arousable. Opens eyes, answers questions, then back to sleep

42
Q

MSE - Levels of Consciousness: Obtunded ?

A

opens eyes, responds but slow and confused ( harder for them to wake up)

43
Q

MSE - Levels of Consciousness: Stuporous ?

A

require painful stim to arouse from LOC

knuckle on sternum, squeezing finger

44
Q

MSE - Levels of Consciousness: Comatose ?

A

unarousable

45
Q

MSE- Posturing and Motor Behavior ?

A

Level of activity vs. immobility

Ability to relax

Voluntary control of motor movements

**look at how they are holding thmeselves **

46
Q

MSE- Posturing and Motor Behavior: Level of activity vs. immobility ?

A

Change with discussion of certain topics?

hyper mobility - anxiety, tapping hands etc

slowed mobility

47
Q

MSE -Dress/Grooming/Hygiene ?

A

Clothing, hair, nails, teeth

Compared to their age and social group

Decreased attention - depress , schizo,

Increased attention

One-sided neglect - lesion of opposite parietal cortex

depress , schizo, OCD - increased attention

48
Q

MSE -Facial Expression ?

A

At rest

When interacting

With different topics - generate spark /response ?

Are these reactions:

  • Appropriate?
  • Immobile?

**appropriate amount of facial expression

labile - big swings, manic depressives bipolar

flat - low

we want to be in the middle,

blunted

dull - not interested in being there schizo**

49
Q

MSE -Affect: Observable ?

A

Labile
Blunted
Flat

Does it vary appropriately?

50
Q

MSE -Speech and Language ?

A

Quantity

Rate

Loudness
Fluency and articulation

51
Q

MSE -Speech and Language: Quantity ?

A

spontaneous vs. wont stop

52
Q

MSE -Speech and Language: Fluency and articulation ?

A

Dysarthria – defective articulation ( stroke)

Aphasia – disorder of speech

Hesitancies, gaps, disturbed inflection

  • monotone voice
  • true aphagia they dont talk at all
53
Q

MSE - Mood ?

A

More sustained than affect, more overall picture
“Mood is to affect as climate is to weather”

Ex: sad, melancholic, euphoric, angry, worried, indifferent

Intensity

Lability

Appropriateness

Ask patient, significant others

**affect is right now

mood is more this month ( overall picture) **

54
Q

MSE -Mood cont. ?

A

If depressed – ask about suicidal ideations
-“Do you ever feel that life isn’t worth living?”

Does NOT implant the idea

DOES open it up for discussion

55
Q

MSE -Thoughts and Perceptions: Thought processes ?

A

tell HOW a patient thinks, relevance, organization, sequence, coherence, logic

Ex: flight of ideas or echolalia

do there thoughts end in a conclusion

56
Q

MSE -Thoughts and Perceptions: Thought content ?

A

tells WHAT a patient thinks, recurring thoughts, obsessions, phobias, anxieties, delusions

** content - recurrent thought, obsession though **

57
Q

MSE -Thoughts and Perceptions: Perceptions ?

A

awareness of things and their interrelationship

58
Q

Perceptions: Illusion ?

A

misinterpretation of real stimulus

59
Q

Perceptions: Hallucination ?

A

subjective sensory perception without relevant stimulus

“Do you hear/see things that other people don’t?”

60
Q

Hallucinations types ?

A 
Auditory
Visual
Tactile
Olfactory
Gustatory
Somatic
61
Q

MSE -Thoughts and Perceptions: Insight ?

A

“What do YOU think is wrong?”

“Why are you here?”

62
Q

MSE -Thoughts and Perceptions: Judgement ?

A

response to a situation, ability to compare and evaluate alternatives

Mature? Realistic? Impulsive?

“If you lost your job, what would you do?”

63
Q

MSE -Cognitive Functions - Orientation ?

A

Person

Place

Time

64
Q

Orientation: Person ?

A

whats your name, who are you ?,

do you know this person and its there son ?

65
Q

Orientation: Place ?

A

where are you ? home address ?

do you know what floor or hospital , what about city and state

66
Q

Orientation: Time ?

A

wat day of week is it, month, season, years - keep getting broader if they keep getting it worse

67
Q

MSE -Cognitive Functions intact then put ?

A

A & O x 3

68
Q

Disorientation = ?

A

problem with memory or attention

69
Q

MSE -Cognitive Functions: Attention ?

A

ability to focus and concentrate

Digit span – forward/backward

Serial 7’s

Spell WORLD backwards

Note speed, effort, accuracy

up to 4 is average , take effort and attention to do this, it might be a problem with math, spelling, or attention

70
Q

MSE -Cognitive Functions: Remote memory ?

A

birthdays, anniversaries, SSN

↓ in late stage dementia

71
Q

MSE -Cognitive Functions: Recent memory ?

A

events of day, meals, weather ( this goes first in dementia)

↓ in dementia, delirium, anxiety, depression, MR

72
Q

MSE - Cognitive Functions: New learning ability ?

A

3 or 4 words

Repeat immediately

Repeat in 3-5 minutes

73
Q

MSE -Higher Cognitive Functions: Fund of information and vocabulary ?

A

Occupation, current events, 5 large cities, president

↓with ↓ intelligence, dementia, aphasia

74
Q

MSE -Higher Cognitive Functions: Calculating ability ?

A

Math problems

Change from a dollar

↓with ↓ intelligence, dementia, aphasia

tells you that something is going on

75
Q

MSE -Higher Cognitive Functions: Abstract thinking

?

A

Interpret a proverb

-A stitch in time saves 9
fixing something before situation gets worse

-Don’t count your chickens before they’re hatched
its about bigger things ( thinking beyond the literal words)

Similarities
-How are a cat and mouse alike?

76
Q

MSE -Higher Cognitive Functions: Constructional ability ?

A

Copy figures

Clock drawing task

↓ with dementia, ↓ attention, MR, visual or motor problems, etc. so it’s just a screening test

**see if there has been 5 sides and that they are crossing \, does tell us what are wrong, maybe they have visual problem, motor

not what is wrong, its a screening test—— if pos, you need to look at it closer **

77
Q

Mental Status Exam 
Write Up ?

A

S – subjective (what patient tells you)

O – objective (what you observe)
not so much touching or listening

A – assessment (diagnosis)

P - plan

78
Q

Sample Mental Status Exam #1, #2 
: S ?

A

S: This is a 42 y.o. female presenting for f/u of anxiety, depression and dissociative identity d/o. She has continued to feel very anxious and out of control. She reports she has been obsessed with counting things like people and dashed lines on the road. She becomes frustrated while counting if the objects move, for example people in the grocery store. She has locked herself inside her home to avoid the anxiety associating with going out. She is requesting something “to take the edge off” of her anxiety. She denies any personality switches since her last appointment 1 month ago.

S. This is a 55 y.o. female presenting for f/u of depression. She reports that she is feeling good today, but her stress level has not decreased any since her last visit. Her depression has not worsened. One of the stressors in her life is her son, who was recently diagnosed with malignant melanoma. He also has a hx of several psychiatric illnesses and she continues to worry about him more than her own problems. She has been having financial difficulties but is receiving aid from Agency for the Elderly which helps her stress level somewhat.

79
Q

Sample Mental Status Exam #1, #2 
: O ?

A

O: App/Beh: Pt was alert and very anxious and agitated. Her dress and grooming were appropriate. Pt. had reactive facial expressions and a broad affect.

Speech/lang: speech was fast, coherent and goal-directed.

Mood: very anxious. No suicidal/homicidal ideations.

Thought/percep: concrete and goal-directed thoughts with no A/V hallucinations. Pt’s insight and judgment were good.

Cogn: A&Ox3 with good attention span and preserved recent and remote memory. New learning ability was not tested. Abstraction was good.

O: App/Beh: pt is sitting, relaxed with neatly pressed clothes, well-groomed, hands clenched in lap. Pt appeared anxious.

Speech/lang: speech is full and fast and stuttery when speaking of stressors

Mood: depressed, no suicidal/homicidal ideations

Thought/Percep: pt’s thoughts seem disorganized at times and hard to follow, slightly circumstantial. Pt was very worried about stressors in her life. Insight is good with limited judgment.

Cogn: A&Ox3, pt has limited attention span, but good remote and recent memory, good new learning ability. Abstraction good.

80
Q

Sample Mental Status Exam #1, #2 
: A ?

A

A: Dissociative identity d/o
Depression
Anxiety

A: Major depression with generalized anxiety d/o

81
Q

Sample Mental Status Exam #1, #2 
: P ?

A

P: Increase Zoloft to 100 mg po q AM

Continue other medications

Enter the partial hospitalization problem if sxs get worse

f/u in month, sooner prn

P: ↑ Imipramine to 50 mg every am and 100 mg at hs

Pt was encouraged to think of herself, and not only her son

Continue psychotherapy

F/U in 3 weeks

Patient Evaluation (29 decks)

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