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Clinical Assessment III- Bates Flashcards > Neuro > Flashcards

Neuro Flashcards

1
Q

Loss of voice that accompanies disease affecting the larynx or its nerve supply

A

Aphonia

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2
Q

Impairment in the volume, quality or pitch of the voice. Example- hoarse or only speak in a whisper. Caused by laryngitis, tumors, unilateral cord paralysis (CN X)

A

Dysphonia

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3
Q

Defect in the muscular control of the speech apparatus (lips,, tongue, palate, pharynx). Worse may be nasal, slurred, or indistinct but central symbolic aspect of language remains intact. Causes include motor lesions of CNS or PNS, parkinsonism, cerebellar disease.

A

Dysarthria

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4
Q

Disorder in producing or understanding language. Often caused by lesion in the dominant cerebral hemisphere (left)

A

Aphasia

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5
Q

In which type of aphasia is speech fluent, rapid, effortless but sentences lack meaning and words are malformed or inverted.

A

Wernicke’s Aphasia

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6
Q

In which type of aphasia is word comprehension good, and reading comprehension fair to good?

A

Broca’s aphasia

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7
Q

In which type of aphasia are word and reading comprehension, repetition, naming, and writing all impaired?

A

Wernicke’s aphasia

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8
Q

IN which type of aphasia is speech nonfluent, slow and laborious. Words are meaningful with nouns and transitive verbs with important adverbs.

A

Broca’s aphasia

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9
Q

What type aphasia is there a lesion in the posterior superior temporal lobe?

A

Wernicke’s

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10
Q

In which type aphasia is there a lesion in the posterior inferior frontal lobe?

A

Broca’s

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11
Q

This type of disorder is characterized by distrust and suspiciousness.

A

Paranoid

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12
Q

Characterized by Detachment from social relations with a restricted emotional range

A

Schizoid

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13
Q

Eccentricities in behavior and cognitive distortions; acute discomfort in close relationships

A

Schizotypal

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14
Q

Disregard for the law and rights of others; a defect in the experience of compunction or remorse for harming others

A

Antisocial

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15
Q

Instability in interpersonal relationships, self-image and affective regulation; impulsivity

A

Borderline

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16
Q

Emotional overreactivity, theatrical behavior, and seductiveness; attention-seeking behavior

A

HIstrionic

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17
Q

Persisting grandiosity, need for admiration and lack of empathy for others

A

Narcissistic

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18
Q

Social inhibition, feelings of inadequacy and hypersensitivity to negative evaluation

A

Avoidant

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19
Q

Submissive and clinging behavior; psychological dependence on others

A

Dependent

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20
Q

Rigid, detail-oriented behavior, often associated w/ compulsions to perform tasks repetitively and unnecessarily and rigid conformity to rules

A

Obsessive-compulsive

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21
Q

Speech characterized by indirection and delay in reaching the point because of unnecessary detail. Occurs in people with obsessions.

A

Circumstantiality

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22
Q

Speech in which a person shifts from one subject to others w/o realizing the subjects aren’t meaningfully connects. Seen in schizophrenia, manic episodes,

A

Derailment (loosening of associations)

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23
Q

An almost continuous flow of accelerated speech in which a person changes abruptly from topic to topic. Changes are usually based on understandable associations and play on words but ideas don’t produce a sensible conversations. Most often seen in manic episodes

A

Flight of ideas

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24
Q

Invented or distorted words, or words w/ new and highly idiosyncratic meanings. Often seen in schizophrenia, psychotic disorders, aphasia

A

Neologisms

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25
Q

Speech that is largely incomprehensible because of illogic, lack of meaningful connections, abrupt changes in topic, disordered grammar or word use. Seen in severe psychotic disturbances (usually schizophrenia)

A

Incoherence

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26
Q

Sudden interruption of speech in mid sentence or before completion of an idea. Person attributes this to losing the though. Also occurs in normal people, but may be striking in schizophrenia.

A

Blocking

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27
Q

Fabrication of facts or events in response to questions to fill in the gaps of invalid memory. Often seen in Korsakoff’s syndrome from alcoholism.

A

Confabulation

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28
Q

Persistent repetition or words or ideas. Seen in schizophrenia and other psychotic disorders

A

Preseveration

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29
Q

Repetition of the words and phrases of others. Occurs in manic episodes and schizophrenia

A

Echolalia

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30
Q

Speech in which a person chooses a word on the basis of sound rather than meaning, as in rhyming and punning speech. Seen in schizophrenia and manic episodes

A

Clanging

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31
Q

Repetitive behaviors or mental acts that a person feels driven to perform in order to produce or prevent some future state of affairs, although such expectations are unrealistic.

A

Compulsions

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32
Q

Recurrent, uncontrollable thoughts, images, or impulses that a person considers unacceptable and alien. Intrusive thoughts.

A

Obsessions

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33
Q

Persistent, irrational fears, accompanied by a compelling desire to avoid that stimulus.

A

Phobias

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34
Q

Apprehensions, fears, tensions or uneasiness that may be focused (phobia) or free-floating ( a general sense of ill-defined dread or impending doom)

A

Anxieties

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35
Q

A sense that one’s self is different, changed or unreal or has lost identity or become detached from one’s mind or body.

A

Feelings of Depersonalization

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36
Q

False, fixed personal beliefs that are not shared by other members of the person’s culture.

A

Delusions

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37
Q

Misinterpretations of a real external stimuli. Seen in greif, PTSD< schizophrenia, delirium

A

Illusions

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38
Q

Subjective sensory perceptions in the absence of relevant external stimuli.

A

Hallucinations

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39
Q

3 tests for attention

A

Digit Span
Serial 7s
Spelling Backwards

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40
Q

Memory about birthdays, anniversaries, social security number, names of schools attended, historical events.

A

Remote Memory

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41
Q

Events of the day (weather, appointment time, medications)

A

Recent memory

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42
Q

A delusion where people are getting thoughts from other sources- television, PC, etc.

A

Delusions of reference

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43
Q

People keep adding on symptoms and have a very elaborate amount of symptoms.

A

systematized delusions

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44
Q

What are the 3 “d’s” to screen for?

A

Delirium
Depression
Dementia

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45
Q

Cranial Never for lateral deviation of the eye.

A

CN VI Abducens

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46
Q

CN for downward, internal rotation of the eye.

A

Trochlear, IV

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47
Q

CN for facial movements and taste on anterior 2/3 of tongue.

A

Facial VII

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48
Q

CN for temporal, masseter, lateral pterygoids movements and sensory from face.

A

Trigeminal, V

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49
Q

CN for hearing and balance

A

VIII, Acoustic (vestibulocochlear)

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50
Q

CN for motor of parynx, sensory from posterior parts of earn and ear drum, pharynx, posterior taste of tongue

A

IX, Glossopharyngeal

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51
Q

CN for motor of the palate, pharynx, larynx. Sensory from pharynx and larynx

A

X, Vagus

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52
Q

CN for movement of SCM, upper part of trapezius

A

XI, Spinal accessory

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53
Q

CN for movement of the tongue

A

XII, Hypoglossal

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54
Q

CN for vision, ocular fundi

A

II, Optic

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55
Q

CN for pupillary constriction, opening of the eye, EOM

A

III, Oculomotor

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56
Q

CN for sense of smell

A

I, Olfactory

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57
Q

What cranial nerves are involved in pupillary reactions?

A

II, III (optic, oculomotor)

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58
Q

WHat CN are involved in EOMs?

A

III, IV, VI (Oculomotor, trochlear, abducens)

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59
Q

What CN are involved in voice and speech?

A

V, VII, X, XII (Trigeminal, Facial, Vagus, Hypoglossal)

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60
Q

What CN are involved in swallowing and risk of the palate, gag reflex

A

CN IX, X (glossopharyngeal, Vagus)

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61
Q

In what condition will the eyes not close and forehead not wrinkle on the affected side.

A

Peripheral lesion of facial nerve i.e. Bell’s Palsy

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62
Q

In what condition will the forehead wrinkle but there is paralysis of the lower face?

A

Central lesion involving UPN between cortex and pons

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63
Q

What is the rhythmic oscillation of the eyes, analogous to a tremor ins other parts of the body?

A

Nystagmus

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64
Q

What are some causes of nystagmus?

A

Impairment of vision early in life
Disorders of the labyrinth and cerebellar system
Drug toxicity

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65
Q

When does nystagmus occur normally?

A

When a person watching a rapidly moving object (ex- passing train)

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66
Q

What tract mediates voluntary movement, and integrates skilled, complicated or delicate movements. Also carry impulses that inhibit muscle tone.

A

Corticospinal (pyramidal) tract

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67
Q

What are tracts that synapse in the brainstem with motor nuclei of the cranial nerves called?

A

Corticobulbar

68
Q

What is a system that helps maintain muscle tone and control body movements, especially gross automatic movements such as walking?

A

Basal ganglia system

69
Q

This system maintains equilibrium, helps to control posture.

A

Cerebellar system

70
Q

Ankle reflex stimulates what?

A

Sacral 1

71
Q

Knee reflex stimulates…

A

Lumbar 2,3,4

72
Q

Supinator (brachioradialis) reflex stimulates

A

Cervical 5,6

73
Q

Biceps reflex stimulates

A

cervical 5,6

74
Q

Triceps reflex stimulates

A

cervical 6,7

75
Q

What is the rhythmic oscillations b/w flexion and extension . Is normal if there is less than 5.

A

Clonus

76
Q

What is a DTR classified as very brisk, hyperactive with clonus.

A

4+

77
Q

What is the DTR classified as average, normal?

A

2+

78
Q

What is a DTR that is somewhat diminished, a low normal?

A

1+

79
Q

What is a DTR that is brisker than average. Possibly indicative of disease.

A

3+

80
Q

What are fine flickering irregular movements in small groups of muscle fibers?

A

Fasciculations

81
Q

Muscle strength is graded on a ___ to ___ scale.

A

0 to 5

82
Q

What is the grade for an active movement of the body part with gravity eliminated?

A

2

83
Q

What is the grade for a barely detectable flicker or trace of contraction?

A

1

84
Q

What is the grade for active movement against full resistance without evident fatigue. Normal

A

5

85
Q

What is the rating for active movement against gravity.

A

3

86
Q

What is the rating for active movement against gravity and some resistance.

A

4

87
Q

What type lesion is spasticity associated with?

A

Upper motor neuron or corticospinal tract system

88
Q

With spasticity there is _______ that is rate dependent.

A

Hypertonia

89
Q

With spasticity during rapid passive movement, initial hypertonia may give way suddenly as the limb relaxes. This catch and relaxation is know as….

A

Clasp-knife resistance

90
Q

Rigidity is due to a lesion where?

A

Basal ganglia system

91
Q

WIth rigidity there is increased resistance that persists throughout the movement arch, independent of rate of movement. This is know as what?

A

Lead- pipe rigidity

92
Q

With rigidity there is a superimposed racketlike jerkiness with flexion and extension called….

A

Cogwheel rigidity

93
Q

What is a common cause of rigidity?

A

Parkinsonism

94
Q

Flaccidity is associated with a lesion where?

A

Lowe motor neuron system. ANy point from the anterior horn cell to the peripheral nerves

95
Q

Flacidity is associated with loss of muscle tone causing the limb to be loose or floppy. This is called….

A

hypotonia

96
Q

In flacidity, the limbs affected may be _____ or ever flail-like.

A

hyperextensible

97
Q

What is a common cause of flacidity?

A

Guillain-Barre syndrome. Initial phase of spinal cord injury

98
Q

With paratonia, where is the lesion?

A

Both hemispheres, usually frontal lobes

99
Q

What is associated with sudden change in tone with passive range of motion?

A

Paratonia

100
Q

What is a sudden loss of tone that increases the ease of motion in paratonia?

A

Mitgehen

101
Q

In paratonia, a sudden increase in tone making motion more difficult is called what?

A

Gegenhalten (holding against)

102
Q

What is a common cause of paratonia?

A

Dementia

103
Q

This gait abnormality is seen in corticospinal tract lesion and causes the affected arm to be flexed, immobile and held to the side. The affected leg extensors are spastic. Patient may drag toe, circle leg stiffly outward and forward or lean towards contralateral side during walk.

A

Spastic hemiparesis

104
Q

This gait abnormality is seen in spinal cord disease and causes bilateral lower extremity spasticity. Gait is stiff, steps are short. Thighs tend to cross forward on each other. Often with cerebral palsy.

A

Scissors Gait

105
Q

This gait abnormality is usually secondary to peripheral motor disease. Seen in foot drop- patients drag their feet or lift them high with knees flexed and bring them down with a thud.

A

Steppage Gait

106
Q

This gait abnormality is seen in basal-ganglia defects. Posture is stooped with flexion fo heads, arm, hips knees. Patients are slow initiating movement, there is festination and retropulsion.

A

Parkinsonian gait

107
Q

In this abnormality, gait is staggering, unsteady, wide based. Patients can’t stand steadily with feet together. There is also dysmetria, nystagmus, intention tremor.

A

Cerebellar ataxia

108
Q

This abnormality is seen in loss of position sense in the legs, gait is unsteady and wide based, patients throw their feet forward and outward then bring them down with a double tapping sound. Watch ground for guidance when walking. Positive Rhomberg.

A

Sensory ataxia

109
Q

This is an abnormal posture seen in comatose patients. Upper arms are flexed tight to the sides with joints flexed. Legs are extended and internally rotated. Feet are plant flexed. Implies a destructive lesion of the corticospinal tracts within or near cerebral hemispheres.

A

Decorticate rigidity (abnormal flexor response)

110
Q

In this abnormal posture seen in comatose patients, jaw is clenched, neck is extended. Arms are adducted and stiffly extended at the elbows. Forearms pronated, wrists and fingers flexed. Legs are extended, feet are planter flexed. Caused by a lesion in the midbrain, pons, or metabolic disorder.

A

Decerebrate rigidity (abnormal extensor resposne)

111
Q

What is the tests where the patient stands for 30 sec with both arms extended forward with palms up and eyes closed. The examiner taps the arms briskly.

A

Pronator Drift

112
Q

This type of vertigo is sudden, on rolling onto affected side or tilting head up. and lasts a few second to less than a minute. Sometimes naseau, vomiting, nystagmus accompany it.

A

Benign positional vertigo

113
Q

This type of vertigo is sudden and can lasts hours up to 2 weeks. Also have N/V, nystagmus

A

Vestibular neuronitis (acute labyrinthitis)

114
Q

This type of vertigo has a sudden onset and can last several hours or equal to one day. There is sensorineural hearing loss, loss recurs and eventually progresses. Tinnitus is present and there may be pressure or fullness in the affected ear along with N/V, nystagmus.

A

Meniere’s Disease

115
Q

This type of vertigo is insidious from CN VIII compression of the vestibular branch. Variable course, hear is impaired on one side. May also involve CN V and VII.

A

Acoustic Neuroma

116
Q

If an individual can’t feel light touch, what 2 locations could the lesion be?

A

Spinothalamic tracts and posterior columns

117
Q

If an individual can’t feel pain, where is the lesion?

A

Spinothalamic tracts

118
Q

If a person can’t determine vibration and proprioception, where is the lesion?

A

Posterior columns

119
Q

If a person can’t determine the where one or two points is touching their skin (discrimination) where is the lesion?

A

Spinothalamic tracts
Posterior columns
Cortex

120
Q

What are two signs that can determine meningeal irritation?

A

Brudzinski’s

Kernig’s

121
Q

If this sign is positive, when the neck is flexed the hips and knees will also flex.

A

Brudzinski’s Sign

122
Q

If this sign is positive, when the patient’s leg is flexed at both the hip and the knee, when extended there is pain and increased resistance.

A

Kernig’s Sign

123
Q

In this test, the patient is supine and the leg is lifted and ankle is flipped. If the person has radiculopathy this will reproduce the pain.

A

Straight leg raise

124
Q

In this test, when the opposite leg is raised the pain on the affected side is reproduced.

A

Crossed straight leg raise

125
Q

This helps to identify metabolic encephalopathy. When patient puts their hand up as if to signal “stop” there is sudden, brief, nonrhythmic flexion of the hands and fingers. This is seen in liver disease, uremia, and hypercapnia.

A

Asterixis

126
Q

This is caused by weakened shoulder muscles (especially serratus anterior) and is seen in muscular dystrophy or injury to the long thoracic nerve.

A

Winging of the scapula

127
Q

For this LOC you apply repeated painful stimuli to wake the patient.

A

Coma

128
Q

In this LOC you apply a painful stimulus (ex- pinch a tendon, rub the sternum) to wake the patient.

A

Stupor

129
Q

In this LOC you shake the patient gently as if awakening a sleeper to have the patient come to.

A

Obtundation

130
Q

In this LOC you speak to the patient in a loud voice to awake the patient.

A

Lethargy

131
Q

In this LOC you speak to the patient in a normal tone of voice and the patient will respond.

A

Arousal

132
Q

This type patient appears drowsy but opens their eyes to respond then falls back asleep.

A

Lethargic patient

133
Q

This type patient opens their eyes and looks at you but responds slowly and is somewhat confused. Alertness and interest in the environment are decreased.

A

Obtunded patient

134
Q

This patient arouses from sleep only after painful stimuli. Verbal responses are slow or even absent. When stimuli ceases, the patient lapses into an unresponsive sate.

A

Stuporous patient

135
Q

This patient remains unarousable with eyes closed. No evident response to inner need or external stimuli.

A

Comatose patient.

136
Q

This reflex helps to asses brainstem function in a comatose patient.

A

Oculocephalic reflex (doll’s eye movements)

137
Q

If there is contralateral leg weakness, where is the stroke?

A

Anterior circulation (Anterior cerebral artery)

138
Q

If there is contralateral face, arm > leg weakness, sensory loss, field cut, aphasia where is the stroke?

A

Anterior circulation- middle cerebral artery (MCA)

139
Q

If there is contralateral motor or sensory deficit without cortical signs where is the stroke?

A

Subcortical circulation- lenticulostriate deep penetrating branches of MCA

140
Q

If there is a contralateral field cut where is the stroke?

A

Posterior circulation- posterior cerebral artery (PCA)

141
Q

If there is dysphagia, dysarthria, tongue/palate deviation and/or with crossed sensory/motor defects where is the stroke?

A

Posterior circulation- brainstem, vertebral, basilar artery branches

142
Q

If there are oculomotor deficit and/or ataxia with crossed sensory/motor defects where is the stroke?

A

Posterior circulation- basilar artery

143
Q

If an individual has “locked-in” syndrome with intact consciousness but with inability to speak and quadriplegia where is the stroke?

A

Complete basilar artery occlusion

144
Q

Define the vertigo: Sudden onset; lasts a few weeks and may recur, hearing is not affected, tinnitus is absent, possible N/V and nystagmus

A

Vestibular neuronitis (acute labyrinth itis)

145
Q

Define the vertigo: insidious onset due to compression of CN VIII; variable duration; hearing is impaired on one side; tinnitus is present; involves CN V and VII

A

Acoustic Neuroma

146
Q

Define the vertigo: Sudden onset, recurrent course, sensorineural hearing loss; tinnitus is present and fluctuating, pressure or fullness of affected ear; N/V, nystagmus

A

Meniere’s Disease

147
Q

Define the syncope: Stressful situation, symbolic expression of an unacceptable idea through body language, hysterical personality traits, slump to the floor

A

hysterical fainting from conversion reaction

148
Q

Define the syncope: sudden peripheral vasodilation w/o compensatory rise in CO; strong emotion; standing; fatigue/hunger, prompt return of consciousness

A

vasodepressor or vasovagal syncope

149
Q

Define the syncope: constriction of cerebral blood vessels; hyperventilation; anxiety; dyspnea, palpitation, numbness of hands; slow improvement; any position

A

hypocapnia due to hyperventilation

150
Q

Define the syncope: insufficient glucose; insulin therapy or metabolic disorders; tremor, hunger, HA, confusion, abnormal behavior; any position

A

Hypoglycemia

151
Q

Define the seizure: tonic/clonic movements; start unilaterally in hand/foot/face, spread to other body parts on same side; normal consciousness in postictal state

A

Jacksonian

152
Q

Define the seizure: brief lapse in consciousness with blinking, staring, or lip/hand movements; Postictal- no aura

A

absence seizure

153
Q

What is the time frame in a typical absence seizure?

A

< 10 seconds

154
Q

What is the time frame in an atypical absence seizure?

A

> 10 seconds

155
Q

What is the difference between petit mal absence and atypical absence?

A

petit mal= prompt return to normal consciousness

atypical= some postictal confusion

156
Q

Define the seizure: sudden loss of consciousness; body stiffens; breathing stops (cyanosis); rhythmic muscle contractions follow; injury, tongue biting, and urinary incontinence occur; following seizure: confusion/drowsiness/fatigue/HA; amnesia and no aura

A

Tonic Clonic seizure

157
Q

Define the tremor:
absent at rest
appear with movement

A

Intention Tremors

158
Q

What diseases intention tremors associated with?

A

disorders of cerebellar pathways (Multiple Sclerosis)

159
Q

Define tremor:

occur when actively maintaining a posture

A

Postural tremor

160
Q

What diseases Postural tremor associated with?

A

hyperthyroidism
anxiety, fatigue
benign essential tremor

161
Q

Define tremor:
at rest
decrease/disappear with voluntary movement

A

Resting (Static) tremor

162
Q

What is the main disease associated with Resting tremor?

A

Parkinson’s

163
Q

T/F: In oral-facial dysinesias, the limbs and trunk are involved.

A

False

164
Q

What is a common cause of athetosis?

A

cerebral palsy

165
Q

What are 2 common causes of chorea?

A

Sydenham’s chorea (with rheumatic fever)

Huntington’s disease

Clinical Assessment III- Bates Flashcards (14 decks)

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