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ICM Exam 2 > Neuro Exam 1 > Flashcards

Neuro Exam 1 Flashcards

1
Q

Psychiatric History Question

A

Do you have any concerns about your mental health such as excessive sadness, memory difficulties, difficulty sleeping, etc?

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2
Q

Neurologic History Question

A

Do you have problems with dizziness or headaches? Any problems with movement or abnormal sensations?

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3
Q

SNMFF

A
  1. Seizures
  2. Nutrition
  3. Medications
  4. Fever
  5. Focal
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4
Q

What is vertigo and where is the malfunction?

A

Feelings of movement; vestibular apparatus (ear or brainstem)

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5
Q

What is ataxia and where is the malfunction?

A

Feelings of imbalance; malfunction of cerebellum, eyes, ears, proprioreceptors

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6
Q

Insomnia vs. Hypersomnia

A

Trouble falling and staying asleep; sleeping too much or problems with staying awake

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7
Q

What level of function is a headache?

A

Lower level

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8
Q

7 things that could cause a headache

A
  1. Meningeal irritation (meningitis, hemorrhage)
  2. Elevated intraocular pressure (acute glaucoma)
  3. Abnormal sensory function (migraine)
  4. Sinus pressure (sinusitis)
  5. Elevated intracranial pressure (tumors, trauma)
  6. Somatization (depression)
  7. Scalp injury/inflammation (temporal arteritis)
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9
Q

5 components of the neuro exam

A
  1. Mental status (neuro 1)
  2. Cranial nerves
  3. Motor system
  4. Sensory system
  5. Reflexes
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10
Q

What are the 5 components to the Mental Status Examination?

A
  1. Appearance and behavior (what you see)
  2. Speech and language (what you hear)
  3. Mood (how they feel)
  4. Thoughts and perceptions (less concrete thinking)
  5. Cognitive function (more concrete thinking abilities)
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11
Q

What 6 things do we look for in Appearance and Behavior?

A
  1. Facial expression
  2. Relationship to people and things
  3. Affect and manner
  4. Grooming, dress, personal hygiene
  5. Posture and motor behavior
  6. Level of consciousness
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12
Q

What 4 things do we look for in Relationship to People and Things?

A
  1. Hallucinations (hearing or seeing things)
  2. Paranoia (anger or suspiciousness)
  3. Schizophrenia (flat affect and remoteness)
  4. Dementia
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13
Q

How is the apathy of dementia dulled?

A

Detachment and indifference

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14
Q

What do we look for in Manner and Affect?

A

Assess the patient’s affect (external expression of inner emotional state)

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15
Q

What 3 things do we look for in assessing the patient’s affect? (Manner and Affect)

A
  1. Variability
  2. Inappropriateness
  3. Mania
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16
Q

What 4 things do we look for in Dress, Grooming, and Personal Hygiene?

A
  1. Clean clothing
  2. Compared clothing to people of comparable age
  3. Compared grooming and hygiene to people of comparable age
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17
Q

What 3 things do we look for in Posture and Motor Behavior?

A
  1. Posture and patient’s ability to relax
  2. Prefer to lie in bed or to walk around?
  3. Pace, range, and character of movements
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18
Q

What 5 things do we look for in Level of Consciousness? What detail is associated with each?

A
  1. Stupor (applying painful stimulus)
  2. Coma (unarousable with eyes closed)
  3. Obtundation (shake the patient gently as if awakening)
  4. Alertness (normal)
  5. Lethargy (speaking to patient in loud voice)
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19
Q

What 3 things could a Coma be affecting?

A
  1. 2 brain hemispheres
  2. Brainstem
  3. Both
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20
Q

If a patient is in a coma, does the normal examination occur?

A

No

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21
Q

What scale can we use for patient’s in a coma?

A

Glasgow Coma Scale

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22
Q

What are the 3 parts to the Glasgow Coma Scale? What would a deceased patient score?

A
  1. Eye
  2. Motor response
  3. Verbal response

Score = 3

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23
Q

What are the 2 Cardinal DONT’s in a coma examination?

A
  1. Don’t dilate the pupils

2. Don’t flex the neck

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24
Q

What findings should we specifically look for in a coma exam?

A

Focal or asymmetric findings

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25
Q

What is a Focal Finding?

A

A certain part of the limb or body wasn’t working; i.e. 1 hand, or 1 foot, etc

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26
Q

What 2 classifications are there for causes of coma?

A
  1. Toxic-Metabolic

2. Structural

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27
Q

What is the pathophysiology of a Toxic-Metabolic cause of coma?

A

Arousal centers poisoned or critical substrates depleted

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28
Q

What is the pathophysiology of a structural cause of coma?

A

Lesion destroys or compresses brainstem arousal nerves, either directly or secondary to more distant expanding mass lesions

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29
Q

What 3 Clinical Features do we look for in a coma?

A
  1. Respiratory pattern
  2. Pupillary size and reaction
  3. Level of consciousness
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30
Q

What is the Toxic-Metabolic clinical finding for Pupillary Size and Reaction?

A

Equal, reactive to light. If pinpoint from opiates or cholinergics, you may need a magnifying glass to see the reaction

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31
Q

What is the Structural finding for Pupillary Size and Reaction?

A

Unequal/unreactive to light (fixed) or mid position fixed suggesting midbrain compression

32
Q

What is the Toxic-Metabolic finding for Level of Consciousness?

A

Changes AFTER pupils change

33
Q

What is the Structural finding for Level of Consciousness?

A

Changes BEFORE pupils change

34
Q

What are 5 examples of Toxic-Metabolic causes for a coma?

A
  1. Meningitis
  2. Uremia
  3. Drugs
  4. Ischemia
  5. Alcohol
35
Q

What are 4 examples of Structural causes for a coma?

A
  1. Hemorrhage
  2. Abscess
  3. Cerebral infart/embolus
  4. Tumor
36
Q

What are 4 types of pupils in comatose patient?

A
  1. Small or pinpoint pupils
  2. Large pupils
  3. Mid position fixed pupils
  4. One large pupil
37
Q

What is associated with small/pinpoint pupils?

A

Effects of morphine

38
Q

What damage is associated with Mid Position Fixed Pupils?

A

Damage to the midbrain

39
Q

What could cause Large Pupils fixed bilaterally and dilated?

A

Severe anoxia

40
Q

What does One Large Pupil warn of?

A

Herniation of the temporal lobe

41
Q

What are the 6 types of Brain Herniation?

A
  1. Cingulate
  2. Uncal
  3. Central
  4. Cerebellotonsillar
  5. Upward
  6. Transcalvarial
42
Q

What is associated with “Doll’s Eye Movements”?

A

Oculocephalic Reflex for comatose patients

43
Q

Explain Doll’s Eye Movements

A
  1. Brain stem is intact
  2. Eyes don’t passively move in the same direction as turning the head, remain looking forward
  3. Eyes turn towards cold water side in ear
44
Q

What is associated with Caloric Stimulation?

A

Oculovestibular Reflex for comatose patients

45
Q

Explain Caloric Stimulation

A
  1. Brain stem depressed
  2. Eyes passively move with turning head
  3. Eyes don’t move when cold water injected into ear
46
Q

What are the 2 types of laying posture we look at for comatose patients?

A
  1. Decerbrate

2. Decorticate

47
Q

Explain Decerebrate Posture

A
  1. Damage to upper brainstem
  2. Arms adducted and extended
  3. Wrists pronated and fingers flexed
  4. Legs stiffly extended with plantar flexion
48
Q

Explain Decorticate Posture

A
  1. Damage to 1 or both corticospinal tracts
  2. Arms adducted and flexed
  3. Wrists and fingers flexed on chest
  4. Legs stiffly extended and internally rotated with plantar flexion of feet
49
Q

What 4 things do we look for in Speech and Language?

A
  1. Quantity
  2. Quality
  3. Rate
  4. Volume
50
Q

What 2 things are associated with the Quality of speech?

A
  1. Articulation of words

2. Fluency

51
Q

What problem is associated with Articulation of Words?

A

Dysarthria - difficulty articulation clear speech

52
Q

What 4 things are involved in Fluency of Speech?

A
  1. Hesitancies and gaps
  2. Montone
  3. Circumlocutions
  4. Paraphasias
53
Q

What is Circumlocutions?

A

Substituting phrases for a word; “Give me that thing you write with” instead of “Give me a pen”

54
Q

What is Paraphasisas?

A

Malformed words, wrong words, or invented words

55
Q

What does abnormal Quality of Speech suggest? What may the patient have difficulty with?

A

Aphasia; talking or understanding others

56
Q

What could slow speech suggest?

A

Depression

57
Q

What could accelerated speech suggest?

A

Mania

58
Q

Explain Broca’s Area

A
  1. Responsible for precise control of the mouth and larynx muscles
  2. Seat of grammar, comprehension, and production
59
Q

Explain Wernicke’s Area

A

Home of meaning; posterior to Broca

60
Q

What can affect performance when testing for Aphasia?

A

Deficiencies in vision, hearing, intelligence, and education

61
Q

How do we assess mood?

A

Exploring patient’s perceptions of his or her mood

62
Q

What do we do if we suspect depression?

A

Assess its depth and any associated risk of suicide

63
Q

What 10 things are associated with Thought and Perceptions? Give a detail about each.

A
  1. Circumstantiality - unnecessary detail
  2. Derailment (loosening of associations)- shifts from one subject to others
  3. Flight of ideas - accelerated speech in which a person changes abruptly from topic to topic
  4. Neoglisms - invented or distorted words
  5. Incoherence - largely incomprehensible because of illogic
  6. Blocking - interruption of speech
  7. Confabulation - fabrication of facts or events in response to questions to fill in gaps in impaired memory
  8. Perseveration - persistent repetitions of words
  9. Echolalia - repetition of words and phrases of others
  10. Clanging - choosing word on basis of sound; “Look at my eyes and nose, wise eyes and rosy nose. Two to one, the ayes”
64
Q

What are the 7 abnormalities of Thought Content?

A
  1. Compulsions (repetitive)
  2. Obsessions
  3. Phobias (unrationalized fear)
  4. Anxieties (focused or free fears/tensions)
  5. Feelings on unreality
  6. Feelings of depersonalization (detached mind and body)
  7. Delusions vs. Illusion
65
Q

Give an example question to get Insight into a patient? Do psychotic patient’s have insight about this?

A

“What brings you to the hospital?”

No

66
Q

How do we assess Judgement?

A

Patient’s responses to family situations, jobs, use of money, and interpersonal conflicts

67
Q

Give 2 example questions for Judgement

A
  1. How do you plan to get help after you leave the hospital?

2. How are you going to manage if you lose your job?

68
Q

Can psychotic patients participate in abstract thinking?

A

No; saying “Don’t count your chickens before they hatch” will imply to them as a literal saying

69
Q

What 3 things do we ask to assess a patient’s Cognitive Function?

A
  1. Time
  2. Place
  3. Person
70
Q

How do we assess Attention?

A

Ask the patients to recite a series of digits or ask simply math problems

71
Q

What 3 things would we ask to asses “Remote” Memory?

A
  1. Birthdays
  2. Anniversaries
  3. Social security number
72
Q

What would we ask to assess “Recent” Memory?

A

Events of the day

73
Q

Explain possibilities of the patient’s calculation ability is bad?

A
  1. Possible dementia
  2. Possible aphasia
  3. MUST be assessed in terms of patients intelligence and education
74
Q

How do we assess Constructional Ability?

A

Copy figures of increasing complexity onto piece of blank unlined pape

75
Q

What does poor constructional ability suggest IF vision and motor ability are intact?

A

Possible dementia or parietal lobe damage

76
Q

What 4 things are in the Mini-Mental State Examination? (MMSE)

A
  1. Orientation to time
  2. Registration (ask to repeat)
  3. Naming
  4. Reading

ICM Exam 2 (10 decks)

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