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Patient Assessment > Neuro > Flashcards

Neuro Flashcards

1
Q

Frontal lobe

A

voluntary skeletal, behavioral, visceral functions

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2
Q

Parietal

A

processing sensory data; proprioception

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3
Q

Occipital

A

vision

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4
Q

Temporal

A

Sound and integration of taste, smell, and balance

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5
Q

Speech center is called

A

Wernicke

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6
Q

Basal ganglia

A

refine motor movements

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7
Q

Cerebellum

A

muscle tone, balance, posture; integration of voluntary movement

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8
Q

Thalamus

A

pain and temperature

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9
Q

Brainstem structures:

A

medulla oblongata, pons, midbrain, and diencephalon

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10
Q

Two structures of diencephalon

A

thalamus; hypothalamus

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11
Q

Pons

A

transmits information between the brainstem and cerebellum

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12
Q

Medulla olbongata is the site where

A

descending corticospinal tracts decussate

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13
Q

ascending spinal tracts

A

complex discrimination tasks

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14
Q

posterior (dorsal) column spinal tracts

A

fine touch, 2-point discrimination, and proprioception

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15
Q

Spinothalamic

A

light and crude touch; pressure, temp, and pain

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16
Q

How long is the spinal cord

A

40-50 cm

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17
Q

where does the spinal cord begin and end?

A

begins at foramen magnum and ends at L1 or L2

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18
Q

The gray matter contains:

A

the nerve cell bodies associated with sensory pathways and the ANS

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19
Q

The white matter of the spinal cord contains

A

the ascending and descending spinal tracts

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20
Q

descending spinal tracts

A

brain to muscles; muscle tone, posture, and precise motor movements

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21
Q

Corticospinal

A

skilled, delicate movements

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22
Q

vestibulospinal

A

extensor muscles to contract during fall

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23
Q

UMN

A

nerve cell bodies for the motor pathways; begin and end within the CNS

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24
Q

UMN role

A

influencing, directing, and modifying spinal reflex arcs and circuits; can affect movement only through LMN

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25
Q

UMN injury causes

A

initial paralysis, followed by partial recovery

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26
Q

LMN

A

originate in anterior horn of spinal cord and extend to PNS; transmit signals directly to muscles

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27
Q

LMN injury

A

permanent paralysis

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28
Q

motor/efferent go to what horn

A

anterior

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29
Q

sensory/afferent go to what horn

A

posterior

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30
Q

how many pairs of spinal nerves?

A

31

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31
Q

The major portion of the brain growth occurs in the x year of life, along with myelinization of the brain and nervous system?

A

first

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32
Q

At birth the neurologic impulses are primarily handled by the?

A

brainstem and spinal cord

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33
Q

The following reflexes are present at birth

A

sucking, rooting, yawning, sneeze, hiccup, blink at bright light, and withdrawal from pain

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34
Q

Motor maturation proceeds in what direction

A

cephalocaudal

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35
Q

What change in pregnant patients leads to neurologic changes?

A

hypothalamic-pituitary neurohormonal changes

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36
Q

Do tendon reflexes increase or decrease in the elderly?

A

decreased

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37
Q

Three screening questions for fall risk?

A

have you fallen in the past year? Do you feel unsteady when standing or walking? Do you worry about falling?

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38
Q

Corneal reflex is associated with what CN?

A

V (trigeminal)

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39
Q

Palate and uvula movement is associated with what CN?

A

IX and X

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40
Q

Guttural speech sounds are associated with CN?

A

IX and X

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41
Q

Tongue movement is associated with CN?

A

XII

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42
Q

Lingual speech sounds are associated with CN?

A

XII

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43
Q

The loss of sense of small or an inability to discriminate odors called

A

anosmia

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44
Q

Anosmia is due to

A

trauma to the cribriform plate or an olfactory tract lesion

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45
Q

What’s the first thing to lose function in the presence of increased intracranial pressure

A

sixth cranial nerve

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46
Q

Impaction of sixth cranial nerve can lead to what vision abnormality

A

absence of lateral (temporal) gaze

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47
Q

When UMN are affected what is paralyzed?

A

voluntary motor paralyzed, but emotional movements are spared

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48
Q

What is paralyzed in LMN?

A

all facial movements on the affected side are paralyzed

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49
Q

posterior tongue taste and nerve?

A

bitter and sour; 1/3; IX

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50
Q

anterior tongue taste and nerve?

A

sweet and salty; 2/3; VII

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51
Q

enhanced physiologic tremor is seen when?

A

hands are held extended, disappears when limb at rest

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52
Q

Potential cause of enhanced physiologic tremor

A

drug or alcohol withdrawal; hyperthyroidsm; hypoglycemia; toxicity

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53
Q

describe tremor of essential tremor

A

symmetric; worse with stress or fatigue; improved with alcohol

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54
Q

cause of essential tremor:

A

AD

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55
Q

Intentional tremor describe

A

seen during intentional movements; does not occur with rest

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56
Q

Cause of intentional tremor

A

cerebellar disorder like MS or alcohol abuse

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57
Q

Describe resting tremor

A

seen at rest; slow supination-pronation

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58
Q

Cause of resting tremor

A

PD

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59
Q

a positive romberg test indicates

A

cerebellar ataxia, vestibular dysfunction, sensory loss

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60
Q

For all the Romberg tests (standing on foot; bouncing on foot) what is the time frame?

A

5 seconds

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61
Q

Heel-toe walking is called?

A

tandem gait

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62
Q

the affected leg is stiff and extended with plantar flexion of the foot ; movement of the foot results from pelvic tilting upward on the involved side; the foot is dragged, often scraping the toe, or it is circled stiffly outward and forward; the affected arm remains flexed and adducted and does not swing

A

spastic hemiparesis

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63
Q

the patient uses short steps, dragging the ball of the foot across the floor; the legs are extended and the thighs tend to cross forward on each other at each step due to injury to the pyramidal system

A

spastic diplegia

64
Q

the hip and knee are elevated excessively high to lift the plantar flexed foot off the ground; the foot is brought down to the floor with a slap; unable to walk on heels

A

steppage

65
Q

the patient’s feet are wide-based; staggering and lurching from side to side is often accompanied by swaying of the trunk

A

cerebellar gait

66
Q

the patient’s gait is wide-based; the feet are thrown forward and outward, bringing them down first on heels, then on toes; the patient watches the ground to guide his or her steps; positive romberg present

A

sensory ataxia

67
Q

the patient limits the time of weight bearing on the affected leg to limit pain

A

ataxia

68
Q

the patient’s posture is stooped and the body is held rigid; steps are short and shuffling, with hesitation on starting and difficulty stopping

A

parkinsonian gait

69
Q

loss of position of joints indicates?

A

peripheral neuropathy

70
Q

polyneuropathy manifests in what distribution?

A

glove and stocking

71
Q

manifestations of complete transverse lesion of the spinal cord

A

all sensation lost below the level of the lesion; pain/temp/touch sensation lost one or two dermatomes below lesion

72
Q

partial spinal sensory syndrome aka

A

brown-sequard

73
Q

partial spinal sensory syndrome manifestations

A

pain and temp sensation loss one or two dermatomes below the lesion on the opposite side of the body from the lesion; proprioceptive loss and motorparalysis occur on the lesion side of the body

74
Q

familiar object test

A

sterognosis

75
Q

touch two areas of body and ask how many and where test

A

extinction phenomenon

76
Q

upper abdominal reflexes

A

T8, T9, T10

77
Q

lower abdominal reflexes

A

T10, T11, T12

78
Q

cremasteric reflxes

A

T12, L1, L2

79
Q

Plantar reflxes

A

L5, S1, S2

80
Q

biceps reflex

A

C5 C6

81
Q

brachioradial reflex

A

C5 C6

82
Q

triceps reflex

A

C6 C7 C8

83
Q

patellar reflex

A

L2, L3, L4

84
Q

Achilles reflex

A

S1 and S2

85
Q

the babinski sign indicates a

A

pyramidal tract UMN disorder

86
Q

Babinski sign is expected in children younger than

A

2 years old

87
Q

With abdominal reflex do you stroke toward or away from umbilicus?

A

away

88
Q

With abdominal reflex how does the abdomen respond?

A

slight movement of the umbilicus toward each area of stimulation, bilaterally equal

89
Q

Diminished abdominal reflex seen in?

A

obese patients, stretched abdominal muscles (pregnancy); absent on side of corticospinal tract lesion

90
Q

absent reflexes may indicate

A

neuropathy or LMN disorder

91
Q

Hyperactive reflexes may indicate

A

UMN disorder

92
Q

UMN muscle tone

A

increased tone, muscle spasticity, risk for contractures

93
Q

LMN muscle tone

A

decreased tone, muscle flaccidity

94
Q

UMN muscle atrophy

A

little or none, but decreased strength

95
Q

LMN muscle atrophy

A

loss of muscle strength; muscle atrophy or wasting

96
Q

UMN sensation

A

sensation loss may affect entire limb

97
Q

LMN sensation

A

sensory loss follows the distribution of dermatome or peripheral nerves

98
Q

UMN reflexes

A

hyperactive deep tendon and abdominal reflexes; + babinski

99
Q

LMN reflexes

A

weak or absent deep tendon, plantar, and abdominal reflexes, negative plantar reflex, no pathologic reflexes

100
Q

UMN fasiculations

A

none

101
Q

LMN fasiculations

A

present

102
Q

UMN motor effect

A

paralysis of voluntary movements

103
Q

LMN motor effect

A

paralysis of muscles

104
Q

uMN location of insult

A

damage above level of brainstem affects opposite side of body; damage below the brainstem affects the same side of body

105
Q

LMN location of insult

A

damage affects muscle on same side of body

106
Q

grade 0 reflex

A

no response

107
Q

grade 1+ reflex

A

sluggish or diminished

108
Q

grade 2+ reflex

A

active or expected response

109
Q

grade 3+ reflex

A

more brisk than expected, slightly hyperactive

110
Q

grade 4+ reflex

A

brisk, hyperactive, with intermittent or transient clonus

111
Q

brachioradial reflex results in what action?

A

pronation

112
Q

sustained clonus indicate?

A

UMN disease

113
Q

diabetic foot exam filament?

A

5.07

114
Q

monofilament should be applied for x time

A

1.5 seconds

115
Q

how to test for nuchal rigidity?

A

with patient supine, slip hand under head and raise it, flexing neck. Try to make patient’s chin touch sternum. Placing hand under shoulders and raising will help relax the neck. Pain and resistance is positive.

116
Q

Brudzinski sign

A

involuntary flexion of the hips and knees when flexing the neck

117
Q

Kernig sign

A

flexing the leg at the knee and hip when patient is supine, then attempting to straighten the leg. positive is present when the patient has pain in the lower back and resistance to straightening the leg at the knee.

118
Q

jolt accentuation of HA

A

ask pt to move head horizontally at a rate of 2-3 rotations per second. Positive is increased HA over the baseline.

119
Q

decorticate is associated with

A

corticospinal tracts injury above the brainstem

120
Q

decerebrate is associated with injury to

A

the brainstem

121
Q

coordinated sucking and swallowing is a function of the

A

cerebellum

122
Q

hands are usually held in fists for first

A

3 months

123
Q

Purposeful movements begin at about

A

2 months

124
Q

taking objects with one hand at

A

6 months

125
Q

transferring objects between hands at

A

7 months

126
Q

purposefully releasing objects by

A

10 months

127
Q

which reflex is present at birth?

A

patellar

128
Q

achilles and brachioradial reflex appear at age

A

6 months

129
Q

Ankle clonus in an infant?

A

one or two beats

130
Q

positive babinski normal until

A

16-24 months

131
Q

rooting reflex

A

touch corner of infant’s mouth, when hungry will move head and open mouth on side of stimulation

132
Q

rooting reflex disappears by

A

3-4 months

133
Q

palmar grasp

A

touch palm of infant’s hand from ulnar side, note strong grasp of finger

134
Q

palmar grasp strongest between

A

1-2 months

135
Q

palmar grasp disappears by

A

3 months

136
Q

plantar grasp

A

touch plantar surface of infant’s feet at base of toes; toes should curl downard

137
Q

plantar grasp strong up to

A

8 months

138
Q

moro

A

with infant supported in semisitting position, allow the head and trunk to drop back to 30 degree, observe symmetric abduction and extension of arms, fingers fan out and thumb and index finger form a C; the arms then adduct in an embracing motion followed by relaxed flexion; legs follow a similar pattern

139
Q

moro diminishes by

A

3-4 and disapears by 6 months

140
Q

placing reflex

A

hold infant upright under arms next to table or chair; touch the dorsal side of the foot to table/chair; observe flexion of the hips and knees and lifting of the foot as if stepping up on the table

141
Q

stepping reflex

A

hold infant upright under arms and allow soles of feet to touch the surface; observe for alternate flexion and extension of the legs; simulating walking

142
Q

Asymmetric tonic neck or “fencing”

A

with infant lying supine and relaxed, turn his or her head to one side so jaw is over shoulder; observe for extension of arm and leg on the side to which the head is turned and for flexion of the opposite arm and leg

143
Q

asymmetric tonic neck or “fencing” diminishes by

A

3-4 months and disappears by six

144
Q

what four baby reflexes are present at birth?

A

rooting, palmar grasp, plantar grasp, moro

145
Q

placing is present by

A

4 days of age

146
Q

stepping present by

A

birth to 8 weeks

147
Q

asymmetric tonic neck or “fencing” present by

A

2-3 months

148
Q

In a child, delaying in sitting or walking may be sign of

A

cerebellar disorder

149
Q

the child beginning to walk has what type of gait?

A

wide-based

150
Q

what type of taste is lost with aging?

A

salty

151
Q

gait of advancing age

A

shorter steps with less lifting; shuffling; arms are more flexed and legs may be flexed at hips and knees

152
Q

Screening test of balance, strength and cerebellar function

A

The Timed Up and GO Test

153
Q

Timed Up and Go Test

A

stand up from chair without using arms; walk 10 feet to mark on floor, turn around, walk 10 feet, and sit down without using chair arms; assistive devices ok

154
Q

How long does it take to complete Timed Up and Go test

A

10 seconds

155
Q

Fall risk tool

A

Performance Oriented Mobility Assessment Tool AKA Tinetti Balance and Gait tool

156
Q

are lower extremities or upper extremities reflexes diminished first in elderly

A

lower first

157
Q

What reflexes may be absent in the elderly?

A

achilles and plantar

Patient Assessment (3 decks)

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