Neuro Flashcards
Afferent neurons
carry signals from the periphery to the CNS
Efferent neurons
carry signals from CNS out to the periphery
The lobes of the brain are commonly used for what during a physical exam?
landmarks
Frontal lobe
emotional/behavioral, voluntary movements
Temporal lobe
auditory
Parietal lobe
sensation
Wernicke’s area
responsible for comprehension of speech
Broca’s area
responsible for production of speech
Hypothalamus
central control center of the brain
responsible for vital signs
Midbrain, pons and medulla
part of the brainstem and is the central core of the body
Spinal cord
mediates reflexes
Cranial nerve I type and name
sensory
olfactory
Cranial nerve II
sensory
optic
Cranial nerve III
mixed
occulomotor
Cranial nerve IV
motor
trochlear
Cranial nerve V
mixed
trigeminal
Cranial nerve VI
motor
abducens
Cranial nerve VII
mixed
facial
Cranial nerve VIII
sensory
acoustic
Cranial nerve IX
mixed
glossopharyngeal
Cranial nerve X
mixed
vagus
Cranial nerve XI
motor
spinal
Cranial nerve XII
motor
hypoglossal
Cranial nerve I assessment
have patient close eyes, occlude one nostril and have them smell something
Cranial nerve II assessment
Snellen
Cranial nerve III, IV, VI assessment
PERRLA and 6 cardinal gazes
Cranial nerve V assessment
palpate temporal and masseter muscles for mastication
also have them close their eyes and touch cotton swab to face
Cranial nerve VII assessment
have patient smile, frown, close eyes, puff cheeks and then suck them back in
Cranial nerve VIII assessment
hearing acuity
Cranial nerve IX and X assessment
depress tongue with tongue blade and watch uvula contraction while patient says “ahh”
test gag reflex
Cranial nerve XI assessment
check sternomastoid and trapezius muscles for equal size and strength by having patient shrug against resistance
Cranial nerve XII assessment
inspect tongue; have them say “light”, “tight” and “dynamite” and make sure speech is clear and distinct
The cerebellum is responsible for?
equilibrium
Aphasia
loss of ability to express or understand speech
Ataxia
lack of muscle control or coordination of voluntary movements; looks similar to being drunk
Decerebrate rigidity
result of midbrain lesion
exaggerated extensor posture
arms will be extended with wrists turned out
legs will be extended with feet internally rotated
head will be arched backwards
Decorticate rigidity
result of severe damage to the brain
exaggerated flexed posture
arms will be at the chest with hands clenched
legs and knees will be internally rotated and feet may cross
Dysphasia
deficiency in generation or understanding of speech
Dysphagia
difficulty swallowing
Hemiplegia
paralysis of one side of the body
Paraplegia
paralysis of legs or lower body
Tic
repetitive twitching that can usually be surpressed
Tremor
rhythmic involuntary movement of opposing muscle groups
Tension headache origin
musculoskeletal
Tension HA definition
mild-moderate HA that is a less disabling form of migraine
Tension HA location
bandlike; on both sides of the head, forehead or back of the head
Does a tension HA throb or pulse?
No
Tension HA duration
30 minutes to days
Tension HA quality
dull, aching, diffuse
Tension HA timing and triggers
situational, response to overwork or stress
not worsened by physical activity
Migraine HA definition
genetically transmitted vascular origin
prodrome aura
2-3 times more common in women than men
Migraine HA location
can be unilateral or bilateral
behind eyes, temple or forehead
Migraine HA character
throbbing
pulsing
Migraine HA duration
rapid onset
peaks 1-2 hours after and lasts 4-72 hours
Migraine HA timing and triggers
2/month that last 1-2 days
1 in 10 patients have one every week
triggered by hormones, foods, hunger
stress letdown, sleep deprivation
Cluster HA definition
Rare, intermittent
excruciating, unilateral with autonomic symptoms
Cluster HA location
always unilateral
behind eyes, temple, forehead or cheek
Cluster HA character
piercing, burning, continuous
Cluster HA duration
abrupt onset, peaks in minutes, lasts 45-90 minutes
Cluster HA quantity and severity
Severe
can occur multiple times a day in clusters which can sometimes last weeks
Cluster HA timing
1-2/day
each lasts 0.5-2 hours
this will last for months and then patient will go into remission
Cluster HA triggers
alcohol, stress, daytime napping, wind/heat exposure
Acute vs chronic headache
acute headaches have been present for hours or days, are usually severe, and are seen in the ER
chronic headaches have been present for months or years, vary in severity and are often seen by PCP
What is the most important thing to ask when assessing a TBI?
Did the patient lose consciousness? For how long?
What is the most important question to ask as it relates to headaches?
Have you had any unusually frequent or severe headaches?
Objective vertigo
stationary objects in the environment are moving
Subjective vertigo
the person feels as if they are moving
Preictal phase
usually starts with an aura
Aura
a subjective sensation that definitively precedes a seizure; can be auditory, visual or motor
Ictal phase
actual seizure
Postictal phase
After seizure
What questions should be asked regarding the postictal phase?
Do you sleep? Do you have confusion, weakness, headache, or muscle aches?
What commonly occurs in patients who are in the ictal phase of a seizure?
Loss of control of bowel and/or bladder
What questions should be asked regarding seizures?
When did they start? How often do they occur? Do you have an aura? Where in the body do they occur? Do you have any associated signs? Are there are precipitating factors (discontinuing medication, fatigue, stress, hypoglycemia etc)?
What is the most important question that must be asked and addressed when it comes to tremors?
How do tremors affect the patient’s ADLs?
Paresis
partial or incomplete paralysis
Paralysis
completenly absent movement
Expressive dysphasia is also known as?
Broca’s
Broca’s dysphasia?
patient understands/comprehends but cannot respond
Receptive dysphasia is also known as?
Wernicke
Wernicke dysphasia
they can respond but cannot understand or comprehend
Global dysphasia
combination of both expressive and receptive dysphasia
What is the most important thing to remember when assessing atrophy in the aging adult?
It may not be from a neurological deficit, it may just be related to advanced age
What is the correct order of the neurological exam?
mental status (ABCTs; A&O) cranial nerves motor nerves sensory reflexes
Appearance
body movements
dress
grooming
hygiene
Behavior
LOC
facial expressions
speech
mood and affect
Cognition
orientation attention span recent memory remote memory new learning
Thought processes
logical content
perceptions
suicidal ideations
What tests do we use to test muscle strength?
Hand grasp with push-pull
Plantar flexion and dorsiflexion with resistance
What tests can we use to test cerebellar function?
Gait
Romberg
Rapid Alternating Movement
Gait test
watch patient walk 10-20 feet, turn and return to the starting point; have patient walk heel-toe in a straight line
normal gait is smooth and rhythmic
Romberg test
ask patient to stand up with feet together and arms at side; when stable, have patient close eyes and hold position for 20 seconds
Positive vs negative Romberg test
positive = excessive swaying present negative = no swaying present
What are the various RAM tests?
Knee pat with hand flip Thumb to finger Finger to finger (patient to yours) Finger to nose (patient touches their own nose after touching your finger) Heel to shin
What RAM tests are included in the NIH stroke scale?
Finger to finger
Finger to nose
Heel to shin
Bicep reflex test process and what it tests
hold patient’s forearm, place thumb over bicep tendon, hit with reflex hammer
C5 and C6
Tricep reflex test process and what it tests
suspend arm at bicep, strike directly above elbow at tricep tendon
C7 and C8
Brachioradialis relfex test process and what it tests
hold thumbs to suspend arms strike right above radial styloid process
C5 and C6
Quadricep reflex test process and what it tests
let lower legs dangle freely and strike right below knee cap
L2 - L4
Achilles reflex test process and what it tests
knee flexed with hip externally rotated, hold foot in dorsiflexion and strike behind the foot at the heel
L5-S2
Reflex scale
4-point 4+ = very brisk 3+ = brisker than average 2+ = average 1+ = diminished 0 = none
What type of dysfunction is Parkinson’s disease?
motor system dysfunction
Definition of Parkinson’s disease?
defect of extrapyramidal tracts
What are the defining characteristics of Parkinson’s disease?
tremors rigidity cogwheel rigidity in hands stooped posture short and shuffling gait flat, staring, expressionless face pill rolling maneuver with fingers
Which is more ominous; decerebrate or decorticate posturing?
decerebrate
Location of lesion in decerebrate vs decorticate rigidity
brain stem at midbrain or upper pons vs. lesion at or above brain stem
What does a positive babinski reflex indicate?
upper motor neuron lesion
Who has the responsibility of notifying family of status of a brain dead patient?
nurse
What must be checked when doing a neurological recheck?
LOC, motor function, pupillary response, vital signs, glasgow coma scale
Why do we perform a neuro recheck?
monitor those with established neurologic deficits
GCS definition
standardized objective assessment that defines the LOC of a person by using a numeric scale
What GCS score will a fully alert, healthy human have?
15
What GCS score reflects a coma?
7 or less
What is the leading cause of long term disability and the 3rd leading cause of death?
stroke
What are the most common symptoms of a stroke?
weakness in face or arms unilaterally, confusion, slurred speech, changes in vision, trouble walking, sudden and severe headache
TIA
ministroke
isn’t permanent
usually caused by a spasm
What are the three main causes of stroke?
HTN
cigarette smoking
cardiac disorder
Modifiable risk factors for stroke
smoking obesity HTN diabetes heart disease
Nonmodifiable risk factors for stroke
age family history sex race prior stroke
