Neuro Flashcards
Central Nervous System anatomy ?
Brain
Brainstem
Spinal cord
Peripheral Nervous System anatomy ?
12 pairs of cranial nerves
Peripheral nerves
Brain has 4 regions ?
Cerebrum
Diencephalon
Brainstem
Cerebellum
Brainstem anatomy ?
Connects upper part of brain with spinal cord
Midbrain, pons and medulla
Cerebellum anatomy ?
Coordinates movement
Helps body keep upright
Each cerebral hemisphere divided into lobes ?
Frontal
Parietal
Temporal
Occipital
Grey matter: _________ bodies form the cerebral cortex ( outer layer)
Neuronal cell
Grey matter: Basal ganglia ?
movement
Grey matter: Thalamus ?
processes sensory impulses and relays to cerebral cortex
Grey matter: Hypothalamus ?
homeostasis, endocrine system, emotions
“keep body at even keel”
White matter: Neuronal axons coated with ______
myelin
Myelin sheaths allow faster travel of impulse
**help impulses travel faster
Spinal Cord is a _______ for info to and from the brain
Conduit
Cervical vertebrae ?
C1-C8
Thoracic vertebrae ?
T1-T12
Lumbar vertebrae ?
L1-L5
Sacral vertebrae ?
S1-S5
Lumbar and sacral roots fan out ?
cauda equina
Spinal Nerves ?
20 pairs between brainstem and T12
voluntary movement
involuntary movement
Cauda Equina ?
starts at T12-L1 to coccyx
11 pairs of spinal nerves
PNS: cranial nerves ?
12 pairs
I-II: are fiber tracts emerging from the brain
III-XII: arise from diencephalon and brainstem
Peripheral Nervous Syste: PNS -
Spinal and peripheral
31 pairs attach to the spinal cord
PNS: Each nerve has ?
Anterior root
Posterior root
Posterior (dorsal) root ?
sensory fibers
Anterior (ventral) root ?
motor fibers
PNS: somatic ?
Regulates muscle movement and response to touch and pain
PNS controls?
internal organs, autonomic reflex response ?
Autonomic: Sympathetic ?
mobilizes organs during stress and arousal
- fight or flight
Autonomic: Parasympathetic ?
conserves energy during times of rest and relaxation
- rest and digest
NE: Mental disorders may be expressed as __________.
somatic symptoms
Ex: stress causing headaches
NE: Organic disorders may be expressed as ______________.
mental symptoms
Ex: dementia causing memory loss
NE: Detail varies widely dependent on patient, so be ______
flexible
NE: In a healthy person, exam can be relatively_____
brief
NE: 5 Sections ?
Mental Status Exam Cranial Nerves Motor Sensory Reflexes
Most of neuro exam is integrated into other exams, e.g: MSE during _______ ?
history
- *idea of alter-ness and educational level
- *
Most of neuro exam is integrated into other exams, e.g: Cranial Nerve during ?
Head and Neck
hit them when doing HEENT exam
Most of neuro exam is integrated into other exams, e.g: Motor / sensory during ?
MS / extremity exam
** done alot in MS**
Mental Status Exam reminders ?
Done throughout the interview
↑ detail if a problem is suspected
Be tactful
Don’t offend, frighten or embarrass the pt
MSE -Appearance and Behavior ?
Level of consciousness
MSE: Level of consciousness ? What is it and how do you test it ?
Awareness of environment
Do they understand conversation or lose track?
Timely responses?
Falling asleep?
MSE - Levels of Consciousness: Alert ?
NL
MSE - Levels of Consciousness: Lethargic ?
drowsy but arousable. Opens eyes, answers questions, then back to sleep
MSE - Levels of Consciousness: Obtunded ?
opens eyes, responds but slow and confused ( harder for them to wake up)
MSE - Levels of Consciousness: Stuporous ?
require painful stim to arouse from LOC
knuckle on sternum, squeezing finger
MSE - Levels of Consciousness: Comatose ?
unarousable
MSE- Posturing and Motor Behavior ?
Level of activity vs. immobility
Ability to relax
Voluntary control of motor movements
**look at how they are holding thmeselves **
MSE- Posturing and Motor Behavior: Level of activity vs. immobility ?
Change with discussion of certain topics?
hyper mobility - anxiety, tapping hands etc
slowed mobility
MSE -Dress/Grooming/Hygiene ?
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
MSE -Facial Expression ?
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**
MSE -Affect: Observable ?
Labile
Blunted
Flat
Does it vary appropriately?
MSE -Speech and Language ?
Quantity
Rate
Loudness
Fluency and articulation
MSE -Speech and Language: Quantity ?
spontaneous vs. wont stop
MSE -Speech and Language: Fluency and articulation ?
Dysarthria – defective articulation ( stroke)
Aphasia – disorder of speech
Hesitancies, gaps, disturbed inflection
- monotone voice
- true aphagia they dont talk at all
MSE - Mood ?
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) **
MSE -Mood cont. ?
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
MSE -Thoughts and Perceptions: Thought processes ?
tell HOW a patient thinks, relevance, organization, sequence, coherence, logic
Ex: flight of ideas or echolalia
do there thoughts end in a conclusion
MSE -Thoughts and Perceptions: Thought content ?
tells WHAT a patient thinks, recurring thoughts, obsessions, phobias, anxieties, delusions
** content - recurrent thought, obsession though **
MSE -Thoughts and Perceptions: Perceptions ?
awareness of things and their interrelationship
Perceptions: Illusion ?
misinterpretation of real stimulus
Perceptions: Hallucination ?
subjective sensory perception without relevant stimulus
“Do you hear/see things that other people don’t?”
Hallucinations types ?
Auditory Visual Tactile Olfactory Gustatory Somatic
MSE -Thoughts and Perceptions: Insight ?
“What do YOU think is wrong?”
“Why are you here?”
MSE -Thoughts and Perceptions: Judgement ?
response to a situation, ability to compare and evaluate alternatives
Mature? Realistic? Impulsive?
“If you lost your job, what would you do?”
MSE -Cognitive Functions - Orientation ?
Person
Place
Time
Orientation: Person ?
whats your name, who are you ?,
do you know this person and its there son ?
Orientation: Place ?
where are you ? home address ?
do you know what floor or hospital , what about city and state
Orientation: Time ?
wat day of week is it, month, season, years - keep getting broader if they keep getting it worse
MSE -Cognitive Functions intact then put ?
A & O x 3
Disorientation = ?
problem with memory or attention
MSE -Cognitive Functions: Attention ?
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
MSE -Cognitive Functions: Remote memory ?
birthdays, anniversaries, SSN
↓ in late stage dementia
MSE -Cognitive Functions: Recent memory ?
events of day, meals, weather ( this goes first in dementia)
↓ in dementia, delirium, anxiety, depression, MR
MSE - Cognitive Functions: New learning ability ?
3 or 4 words
Repeat immediately
Repeat in 3-5 minutes
MSE -Higher Cognitive Functions: Fund of information and vocabulary ?
Occupation, current events, 5 large cities, president
↓with ↓ intelligence, dementia, aphasia
MSE -Higher Cognitive Functions: Calculating ability ?
Math problems
Change from a dollar
↓with ↓ intelligence, dementia, aphasia
tells you that something is going on
MSE -Higher Cognitive Functions: Abstract thinking
?
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?
MSE -Higher Cognitive Functions: Constructional ability ?
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 **
Mental Status Exam Write Up ?
S – subjective (what patient tells you)
O – objective (what you observe)
not so much touching or listening
A – assessment (diagnosis)
P - plan
Sample Mental Status Exam #1, #2 : S ?
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.
Sample Mental Status Exam #1, #2 : O ?
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.
Sample Mental Status Exam #1, #2 : A ?
A: Dissociative identity d/o
Depression
Anxiety
A: Major depression with generalized anxiety d/o
Sample Mental Status Exam #1, #2 : P ?
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
