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NPTE Final Frontier > Neuro Examination > Flashcards

Neuro Examination Flashcards

1
Q

Main brain==

A

Cerebrum
2 lobes– R & L

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2
Q

SMALL brain–>

A

Cerebellum

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3
Q

Human NS
- UMN?

A

Brain + SC

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4
Q

Human NS
- LMN?

A

N. roots
P. nerves

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5
Q

UMN vs LMN picture

A

see pics
Red==Brain + SC–UMN
Green== N roots and P nerves–LMN
Orange== cerebellum (small brain)

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6
Q

Cerebrum==R & L hemis
4 lobes

A
  1. Frontal (A.CEO)
  2. Parietal
  3. Temporal
  4. Occipital
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7
Q

Function of Lobes:

Frontal lobe lesion: “on top of” everything
Remember Frontal lobe is “A.CEO”—-EXECUTIVE DECISIONS

A

A:Apraxia and Aphasia: Broca’s (remember FB, Frontal, Brocas)
C:Controls plan, programming, mvmt
E:Emotional, behavior, personality affected
O:Olfactory (smell)
NOTE: A. CEO is in CHARGE!–> EXECUTIVE DECISIONS

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8
Q

APraxia?
Think P for Planning problem!!!

A

Inability to perform LEARNED, PURPOSEFUL motor task
esp when commanded to do it

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9
Q

Function of Lobes:

Temporal lobe lesion:
Remember Temporal lobe right above EAR

A
  • HEARING (bc Temporal lobe rt above EAR)
  • Language comprehension (aka understanding WHAT we hear)
  • Aphasia: Wernicke’s (comprehension prob bc is its Temporal lobe) rememer TW: Temporal, Wernickes
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10
Q

Note on Broca’s vs Wernickes

A
  • UPPER MCA= Frontal=Broca’s
  • LOWER MCA= Temporal=Wernicke’s
  • STEM of MCA=Global aphasia (you’ll see BOTH)– give pt gestures**
  • L. sided MCA-> Aphasias bc speech areas here (mostly)
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11
Q

EASY way to memorize Broca’s
*Frontal lesion

A

BEN has Broca’s
B: Broca’s
E: Expressive (trouble Expressing)
N: NON-fluent (broken speech)

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12
Q

Broca’s/Expressive/Non-Fluent: BEN has Broca’s

A
  • Slow, hesitant speech, broken, trouble Expressing
  • Tx: Yes/No questions, make it easy!
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13
Q

Wernicke’s aphasia–Temporal lesion
*remember Temporal is hearing and understanding WHAT we hear—–that’s why makes sense its Temporal!!!

COMPREHENSION PROB!!!

A
  • Pt cannot comprehend
  • Word salad–“wowsome”, “fantabulous”
  • Tx: Gestures and demonstration, aka Don’t SAY it, DEMO it!!!
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14
Q

Wernicke’s aphasia–Temporal lesion
*remember Temporal is hearing and understanding WHAT we hear—–that’s why makes sense its Temporal!!!

COMPREHENSION PROB!!!

A
  • Pt cannot comprehend
  • Word salad–“wowsome”, “fantabulous”
  • Tx: Gestures and demonstration, aka Don’t SAY it, DEMO it!!!
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15
Q

Practice!
65yo pt and ask “how doing?”. Response is “sun is yellow and water is cold.” most approp dx?
Did not comprehend what you were asking!!!!

A

Wernicke’s aphasia–temporal lobe–Inf MCA
Trouble understanding you/comprehending

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16
Q

Function of Lobes:

Parietal lobe lesion
Think P in Parietal and P in Perception

A
  • Perceptual disorders
  • Sensory loss

*RIGHT sided region
here you will see U/L Neglect

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17
Q

L vs R side clarity

A
  • Lang defs–> Left
  • Parietal (Perception)–> Right, the P is IN the R (see notes) but this is how you memorize that Perception is Right side
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18
Q

Function of Lobes:

Occipital lobe lesion
*think VISION
O-SEE-PITAL LOBE

A
  • Vision loss
  • C/L homonymous hemianopsia
  • Inability to ID prev known objs
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19
Q

Cranial Nerves Mnemonic

A

Oh: Olfactory
Oh: Optic
Oh: Oculomotor
To: Trochlear
Touch: Trigeminal
And: Abducens
Feel: Facial
Virgin: Vestibulocochlear
Girls: Glossopharyngeal
Vaginas: Vagus
And: Accessory (spinal accessory)
Hymens: Hypoglossal

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20
Q

Cranial N mnemonic to remember S, M, B

A

Some Say Marry Money But My Brother Says Big Boobs Matter More

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21
Q

How do you remember LOCATION of CN’s???
MNEMONIC

CI MI PONS MEDU

A

(2 letters= 2 nerves) CI– I, II
(2 letters= 2 nerves) MI–III, IV
(4 letters= 4 nerves) PONS– V, VI, VII, VIII
(4 letters= 4 nerves) MEDU– IX, X, XI, XII

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22
Q

CN I: Olfactory

A

Type: Sensory
Function: Sense of smell
Affected: Anosmia (lose smell)

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23
Q

CN II: Optic (2 for 2 eyes)

A

Type: Sensory
Function: Vision (all)- color, acuity, peripheral vision
Pupillary Light Reflex (the messenger)
Affected: Blindness, myopia (shortsight), presbyopia (long sight)

24
Q

Pupillary Light Reflex
what two CNs and whats NORMAL?

A

CN II (sensory afferent, senses it, messenger)
CN III (motor efferent)
- NORMAL== BOTH pupils constrict, think DANGER–too much light==DANGER!
- CN II senses it, then messages CN III L & R

25
Q

Normal vs Abnormal Pupillary Light Reflex
CN II (sensory)/III (motor)

A

Normal= Light IN, BOTH constrict- CN II/III normal (NOTE you are only testing CN II on side you shine light!)
Abnormal-R CN III= shine light L, R does not constrict
Abnormal- L CN III= shine light L, L does not constrict
Abnormal- L CN II= shine light L, NEITHER constricts (CN II not sending message)
must shine light into side you want to check for CN II

26
Q

Practice!
PT assessing CN integrity. On shining light in pts R EYE NONE of pupils constrict (messenger prob, CN II PUP LIGHT REFLEX), however shining light in L EYE BOTH CONSTRICT. What is finding?

A

RIGHT CN II PROB! Messenger prob, R CN II not sending message to CN III to constrict pupils!
A: R optic N (CN II) affected

27
Q

3 CN’s withmotor function of eyes

A

CN III, IV, VI
- Oculomotor, Trochlear, Abducens

28
Q

CN III: Oculomotor

its in the name!!!

A

Type: Motor
Function: Moves eyeballs UP/IN, opens eyelids, constricts pupils (Pup. Light Reflex)
Affected: Strabismus (Lateral) (abnorm eye pos.), ptosis, DILATION of pupils (bc Pup Lt Reflex)

29
Q

CN IV: Trochlear

A

Type: Motor
Function: Look DOWN/IN (aka look @ nose (4 letter word=CN IV)

30
Q

CN VI: Abducens

think ABducens ABDucts

A

Type: Motor
Function: ABDucts eye, ABducens ABDucts
Affects: opp of ABD’s=== Medial strabismus

31
Q

CN VIII: VestibuloCochlear
Vestibulo= balance
Cochlear= hearing

A

Type: Sensory
Function: Balance, Hearing
Affected: Hearing loss
- 1. Conduction Loss vs. 2. Sensorineural Loss
- 1. Conduction= EXTERNAL PROB Ex. noise cancel headphones
- 2. Sensorineural= INTERNAL PROB

32
Q

2 Tests associated w/ CN VIII: VestibuloCochlear

A
  1. Weber
  2. Rinne’s

ALWAYS DO BOTH!

33
Q

Rinne’s vs Weber Tests

A

R before W–> Do RINNE’S FIRST!
- Rinne’s–> What TYPE-Conduction or Sensorineural
- Weber–> What SIDE (based on loudness)

34
Q

Rinne’s Test for TYPE
sensorineural vs conduction
Air conduction vs Bone conduction w/ Tuning Fork

A
  • Air conduction&raquo_space; Bone conduction==> Norm OR Sensorineural loss aka pt can hear fork @ ear
  • Bone conduction&raquo_space; Air conduction==> Conduction loss aka pt will not hear fork @ ear
35
Q

How can you remember Weber’s Test for SIDE?

A

CANS
- Conduction= Sound Louder in Affected side
- Sensorineural= Sound Louder in Normal side

36
Q

Practice!
Pt c/o of sudden onset mild hear loss on RIGHT SIDE. Rinne (type) was consistent w/ AC&raquo_space; BC (norm or SN) on both sides. Webers (side) findings show Louder in L. ear (normal side). Which is most likely?

AC» BC= norm or SN, louder in L ear
CANS= Sensorneural louder in Normal

A

Sensorineural hearing loss R side
REMEMBER
Weber= SIDE – CANS
Rinne= Type
- AC» BC= SN or norm
- BC&raquo_space; AC= Conduction

37
Q

CN V: Trigeminal

A

Type: Both
Function:
- Sensation to face
- MM’s of mastication (think Tri-chewminal)
- Corneal reflex–afferent sensory (messenger)– touch cornea, BOTH eyes close=normal
- Sensation to ANT tongue
- Dampens sounds (affeced= hyperacusis)

38
Q

CN VII: Facial

A

Type: Both
- mm’s of face- smile, frown, eyebrows Exceptions: CN III- eyelids open, CN V: mastication
- Corneal reflex-efferent motor (receives message from CN V)
- TASTE to Ant tongue
- also dampens sounds

39
Q

Corneal Reflex
works same as Pup Lt Reflex

A

CN V, VII
- CN V== sensory afferent, sends message
- CN VII== motor efferent, receives message
- WORKS SAME AS PUP LT REFLEX!!!

40
Q

Eyelids OPEN/CLOSE help

CN III and CN VII

A

Restaurants OPEN @ 3 (CN III) and CLOSE @ 7 (CN VII)

41
Q

More about the tongue

Think SENSORY: 5, 7 (Anterior 2/3), 9 (Posterior 1/3)

A

Tongue
- Sensory= 5, 7, 9
- Movement= 12

Anterior 2/3–> CN V, VII (BEST FRIENDS)
- Sensory- CN V (S-5) S and 5 shaped like S!
- Taste- CN VII (T-7) 7 looks like T!

Posterior 1/3 –> CN IX (P-9) 9 is backwards P!
- also does Sensory and Taste of post 1/3 tongue

42
Q

CN XII: Hypoglossal
“Lick your Lesion”

A

Type: Motor
Function: Mm’s of tongue
Affected: I/L deviation of tongue aka “Lick your lesion”
Ex. R CN XII lesion==> R side tongue deviation (goes to R side) and vice versa

bc if R. sided lesion of R CN XII, L is STRONGER and pushes tongue R.

42
Q

CN XII: Hypoglossal
“Lick your Lesion”

A

Type: Motor
Function: Mm’s of tongue
Affected: I/L deviation of tongue aka “Lick your lesion”
Ex. R CN XII lesion==> R side tongue deviation (goes to R side) and vice versa

bc if R. sided lesion of R CN XII, L is STRONGER and pushes tongue R.

43
Q

Ex. R Hypoglossal (CN XII) lesion?

A

R sided tongue deviation (aka tongue goes TOWARDS LESION SIDE)
“Lick your lesion”

44
Q

CN IX: Glossopharynegeal
Think 9 is backwards P for POSTERIOR tongue sensation and taste
Think Glossopharyngeal for Gag reflex (afferent)

A

Type: Both
Function: Posterior 1/3 tongue sesnation/taste (backwards P)
Gag reflex (G in Glossopharyngeal, G in Gag)- afferent (sensory messenger, CN X is the motor efferent for gag reflex)
Motor– Salivation*

45
Q

CN X: Vagus N.

A

Type: Both
Function: Gag reflex–motor efferent (CN IX is the sensory messenger for gag reflex)
Sensory component== thoracic viscera
Testing CN X: Pt says “Ahh”–> CN X PULLS Uvula to SAME side—-OPPOSITE TONGUE MOTOR FUNCTION OF CN XII
- if this is Affected–> Uvula deviates C/L OR OPP side

46
Q

Practice!
Pt presents w/ neuro sx’s, so we do CN assess. PT asks pt to say “Ah” (CN X assess.) Uvula deviates to L SIDE. Which CN affected?

Remember CN X lesion Uvual goes OPP side

A

R. CN X (Vagus)

47
Q

Deciphering bw CN X (Vagus) vs CN XII (Hypoglossal) motor deviations
Tongue vs Uvula deviations

A
  • CN X (Vagus): Uvla deviates to C/L or OPP side (bc PULLS uvula same side, so when lesion it cannot pull)
  • CN XII (Hypoglossal): Tongue deviates to I/L OR SAME SIDE “Lick your lesion” (bc CN XII PUSHES tongue to opp side and when lesion cannot do so so stronger side pushes it towards lesion side)
48
Q

Practice!
Which CN MOST likely affected in pt w/ lesion in PONS?

CI MI PONS MEDU

A

CI: 1, 2
MI: 3, 4
PONS: 5, 6, 7, 8
MEDU: 9, 10, 11, 12

49
Q

Lesion to which CN affects TASTE to tongue

A

Sensory tongue is 5, 7, 9
Anterior 2/3–> 5 (sensation), 7 (taste)
Posterior 1/3–> 9 (sensation AND taste)

50
Q

Lesion to which CN NOT likely to affect MOTOR fucntion of eyeball

A

Motor to eyes== III (up/in), IV (down/in), VI (ABDucts)
also remember restarurants open @ 3 (CN III) and close @ 7 (CN VII) for eyelids

CN II is SENSORY ONLY (messenger for Pup Lt Reflex, think constriction)

51
Q

Anatomy Summary of Brain:

Frontal Lobe
A.CEO–> Executive Decisions

A
  • Motor control (Premotor)
  • Problem solve (Prefrontal)
  • Speech production (motor-Broca’s area)

A. CEO

52
Q

Anatomy Summary of Brain:

Parietal Lobe

A
  • Touch perception (somatosensory cortex)
  • Body orientation and sensory discrim
53
Q

Anatomy Summary of Brain:

Temporal
remember right above EAR

A
  • Auditory processing (WHAT we hear)
  • Lang comprehension (comprehend what we hear)– Wernicke’s
  • Memory/info retrieval
54
Q

Anatomy Summary of Brain:

Occipital
VISION

A
  • Sight (visual cortex)
  • Visual reception and visual interp
55
Q

Anatomy Summary of Brain:

Cerebellum

When Dr. Cohen says cerebellum you say….COORDINATION!

A

BALANCE & COORDINATION

56
Q

Anatomy Summary of Brain:

Brainstem

A

INvoluntary mvmts

NPTE Final Frontier (19 decks)

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