neuro oh oh oh Flashcards
1
Q
What are the functions of the frontal lobe?
A
Personality, behavior, emotion, intellectual functions
2
Q
Which area of the brain controls speech production?
A
Broca’s area
3
Q
What functions are associated with the temporal lobe?
A
Hearing, taste, and smell
4
Q
What is the role of Wernicke’s area?
A
Speech comprehension
5
Q
Which brain structure is responsible for motor coordination, balance, and equilibrium?
A
Cerebellum
6
Q
What type of movement should normal cerebellar function produce?
A
Smooth, rhythmic, effortless movements; coordinated arm swing; smooth turns
7
Q
How is the Romberg test performed?
A
Person stands with feet together, arms at sides, eyes closed for 20 seconds; they should maintain balance without visual input.
8
Q
What does an abnormal Romberg test indicate?
A
Possible cerebellar abnormality
9
Q
What is the primary function of the occipital lobe?
A
Visual reception
10
Q
Which lobe of the brain is responsible for sensation?
A
Parietal lobe
11
Q
What is the function of the postcentral gyrus?
A
Primary sensory area
12
Q
What is the function of the precentral gyrus?
A
Primary motor area
13
Q
Which part of the brain is involved in regulating breathing?
A
Brain stem
14
Q
What is the function of the thalamus?
A
Acts as a relay station where sensory pathways from the spinal cord, cerebellum, and brainstem form synapses on their way to the cerebral cortex.
15
Q
What are the major functions of the hypothalamus?
A
Regulates basic vital functions: temperature, appetite, sleep, sex drive, heart rate, and blood pressure; also a major respiratory center.
16
Q
Where is the cerebellum located, and what does it control?
A
Located under the occipital lobe; controls motor coordination of voluntary movements, equilibrium, and muscle tone.
17
Q
What functions are regulated by the brainstem?
A
Maintains consciousness, regulates sleep, cardiac and respiratory function, and the central nervous system (CNS).
18
Q
How does the brainstem interact with cranial nerves?
A
Provides main motor and sensory innervation to the face and neck via cranial nerves.
19
Q
What is the spinal cord’s primary role?
A
Acts as the main highway for ascending and descending fiber tracts connecting the brain to the spinal nerves; mediates reflexes.
20
Q
Why is a neck fracture more concerning than a lower back injury?
A
Neck fractures can affect vital functions by damaging structures like the brainstem, which regulates breathing and heart rate.
21
Q
What are normal neurological findings related to speech and coordination?
A
Clear speech and coordinated movements without tremors, numbness, or weakness.
22
Q
What is an abnormal neurological sign related to unilateral weakness and facial droop?
A
Possible cerebrovascular accident (CVA) or Bell’s Palsy.
23
Q
What subjective symptoms may indicate neurological issues?
A
Headaches, dizziness, seizures, tremors, numbness/tingling, weakness, speech, or swallowing difficulties.
24
Q
What are key signs of a cerebrovascular accident (CVA)?
A
Unilateral numbness, confusion, slurred speech, loss of balance, severe headache, and face droop.
25
Why is the time of symptom onset important in stroke management?
A 3-4 hour window exists for certain treatments, such as thrombolytic therapy.
26
What conditions increase the risk of stroke?
Hypertension, lipidemia, tobacco use, obesity, metabolic syndrome, and air pollution.
27
What are the symptoms of Bell’s Palsy?
Unilateral facial paralysis or weakness due to CN-7 dysfunction; symptoms mimic CVA but have no known cause, possibly viral.
28
What causes Parkinsonian symptoms, and what are the signs?
Caused by dopamine deficiency; signs include a shuffling gait, "pill rolling" hand motions, drooling, expressionless face, and impaired swallowing.
29
What should you assess if a patient experiences a seizure?
Note the seizure's duration, presence of tremors, incontinence, aura, and any precipitating factors (fever, alcohol, disease).
30
What precautions should be taken during a seizure?
Keep the patient safe by protecting their head and preventing aspiration.
31
What are common types of involuntary movements?
Tic, ptosis, tremor, and fasciculations.
32
What is the difference between resting tremors and intention tremors?
Resting tremors occur at rest and partially disappear with movement (e.g., Parkinson's); intention tremors worsen with voluntary movements.
33
What are fasciculations?
Rapid, continuous twitching of resting muscles without movement of a joint.
34
What is a tic?
An involuntary, compulsive, repetitive twitching of muscles (e.g., head movement, wink, grimace, shoulder shrug).
35
What does ptosis refer to?
Drooping of the eyelid.
36
What defines a tremor?
An involuntary rhythmic contraction of opposing muscle groups, resulting in back-and-forth movement of one or more joints; can occur at rest or with voluntary movement and disappears during sleep.
37
What are resting tremors, and in which condition are they commonly seen?
Coarse, slow tremors that partly disappear with voluntary movement; commonly seen in Parkinsonian symptoms with “pill rolling” hand movements.
38
What is an intention tremor?
A tremor that worsens with voluntary movement, such as trying to pick something up.
39
What is decorticate posturing, and what causes it?
Caused by a cerebral cortex lesion. The arms are flexed at the elbows, held close to the body, and the wrists and fingers are clenched. Legs are extended with internal rotation and plantar flexion.
40
What are the upper and lower body positions in decorticate posturing?
Upper body: Flexion of the arm, wrist, and fingers; adduction of the arm.
Lower body: Extension, internal rotation, and plantar flexion of the legs.
41
What is decerebrate posturing, and why is it more ominous?
Caused by a brainstem lesion, indicating more severe brain damage. The arms are extended at the sides, wrists and fingers flexed, and legs extended with internal rotation.
42
What are the upper and lower body positions in decerebrate posturing?
Upper body: Arms stiffly extended, adducted, with internal rotation and palms pronated.
Lower body: Legs stiffly extended with plantar extension.
43
Which posturing indicates more severe brain damage?
Decerebrate posturing indicates more severe brain damage due to a brainstem lesion.
44
What is the purpose of sensory assessment with eyes closed?
To test the function of peripheral nerve fibers, sensory tracts, and higher cortical discrimination by comparing sensations side-to-side.
45
How is light touch sensation tested?
Use a wisp of cotton on the skin randomly, and have the person say “now” when they feel it.
46
What is stereognosis?
The ability to recognize objects by feeling their forms, sizes, and weights.
47
What is graphesthesia?
The ability to identify a number traced on the skin by touch alone.
48
How is 2-point discrimination tested?
Test the ability to distinguish the separation of two simultaneous stimuli on the skin.
49
What is the mnemonic for cranial nerves?
OH OH OH TO TOUCH AND FEEL A GIRL'S VAGINA AH HEAVEN
50
What is CN I?
Olfactory – responsible for the sense of smell.
51
What is CN II?
Optic – responsible for vision and visual fields.
52
What is CN III?
Oculomotor – controls most eye movements, pupil constriction, and eyelid elevation.
53
What is CN IV?
Trochlear – controls downward and inward eye movement.
54
What is CN V?
Trigeminal – responsible for facial sensation and motor functions (chewing).
55
What is CN VI?
Abducens – controls lateral eye movement.
56
What is CN VII?
Facial – controls facial expressions, taste on the anterior 2/3 of the tongue, and tear/saliva production.
57
What is CN VIII?
Vestibulocochlear (Acoustic) – responsible for hearing and balance.
58
What is CN IX?
Glossopharyngeal – controls taste on the posterior 1/3 of the tongue and aids in swallowing.
59
What is CN X?
Vagus – regulates heart rate, digestion, and voice production.
60
What is CN XI?
Spinal Accessory – controls the sternocleidomastoid and trapezius muscles for head and shoulder movement.
61
What is CN XII?
Hypoglossal – controls tongue movements for speech and swallowing.
62
How is CN I (Olfactory) tested?
With eyes closed, occlude one nostril and present an aromatic substance (e.g., coffee, vanilla). Look for anosmia (loss of smell).
63
What are possible causes of abnormal CN I findings?
URI, tobacco smoking, inhalants, or neurological issues.
64
How do you assess CN II (Optic)?
Test visual acuity with a Snellen chart and perform the confrontation test for peripheral vision using wiggling fingers from 6 directions.
65
Which cranial nerves are tested together for eye movement?
CN III (Oculomotor), CN IV (Trochlear), and CN VI (Abducens).
66
How is CN III (Oculomotor) assessed?
Check pupil size, direct/consensual light reaction, and accommodation (PERRLA). Test for ptosis and eye movement in the 6 cardinal positions of gaze.
67
How is CN V (Trigeminal) tested?
Motor: Palpate the temporal and masseter muscles while the patient clenches their teeth.
Sensory: Lightly touch the face with cotton; patient says “now” when they feel it.
68
How is CN VII (Facial) assessed?
Ask the patient to smile, frown, raise brows, puff cheeks, and show teeth. Press cheeks to check for equal air escape.
69
What is Bell’s Palsy?
Unilateral paralysis of the facial nerve (CN VII) causing facial weakness.
70
How is CN VIII (Acoustic/Vestibulocochlear) tested?
Perform the whisper test by whispering numbers/letters into one ear while occluding the opposite ear.
71
How do you assess CN IX (Glossopharyngeal) and CN X (Vagus)?
Ask the patient to say “ahh” and watch for uvula rise and medial movement of tonsils. Test gag reflex by touching the posterior pharynx with a cotton applicator.
72
How is CN XI (Spinal Accessory) tested?
Ask the patient to shrug shoulders and turn their head against resistance. Both movements should feel equally strong on both sides.
73
How do you assess CN XII (Hypoglossal)?
Ask the patient to stick out their tongue and look for midline alignment. Test speech clarity with “light, tight, dynamite.” Look for tremors or weakness.
74
What does PERRLA stand for?
Pupils Equally Round and Reactive to Light with Accommodation.
75
Which cranial nerves are assessed with PERRLA?
CN III (Oculomotor), CN IV (Trochlear), and CN VI (Abducens).
76
How is the light reaction part of PERRLA tested?
Use a pen light to shine into each eye and observe if pupils constrict together (consensual response).
77
How is accommodation assessed in PERRLA?
Ask the patient to focus on a distant object and then on a pen or your finger held close to their nose. Observe for pupillary constriction and convergence (crossing of the eyes).
78
What indicates a normal PERRLA response?
Pupils should be equally round, reactive to light, and constrict with accommodation while converging toward the midline.
79
How is the Brudzinski test performed?
With one hand under the head/neck and the other on the chest, flex the chin to the chest. Observe for any movement in the hips and knees.
80
What is an abnormal response in the Brudzinski test?
Resistance and pain in the neck, along with flexion of the hips and knees, indicating possible meningeal irritation.
81
How is the Kernig's test performed?
The patient lies flat and raises one leg straight at the hip while keeping the knee straight.
82
What is an abnormal response in the Kernig's test?
Resistance to straightening the leg and pain down the posterior thigh. Severe stiffness may prevent leg straightening when the hip or neck is flexed to 90 degrees.
83
What is the Rapid Alternating Movements (RAM) test?
Ask the patient to pat their knees with both hands, lift up, turn hands over, and pat the knees again. They should also touch their thumb to each finger in succession.
84
What is a normal finding in the RAM test?
The patient should perform the movements quickly and accurately without difficulty.
85
How is the Finger to Finger test conducted?
With eyes open, the patient uses their index finger to touch your finger and then their own nose. After a few repetitions, move your finger to a new spot.
86
What indicates a normal response in the Finger to Finger test?
The movements should be smooth and accurate.
87
How is the Finger to Nose test performed?
With eyes closed, the patient stretches out their arms and alternately touches the tip of their nose with each index finger, increasing speed.
88
What indicates a normal response in the Finger to Nose test?
The patient should touch their nose accurately and smoothly, without difficulty.
89
How is the Heel to Shin test conducted?
The patient lies down, places the heel of one foot on the opposite knee, and runs it down the skin from the knee to the ankle.
90
What is a normal finding in the Heel to Shin test?
The patient should be able to move their heel in a straight line down to the shin without wobbling or veering off course.
91
What is the Rooting Reflex?
When the baby's cheek is stroked, they turn their head toward the touch and open their mouth. This reflex helps with feeding.
92
What is the Sucking Reflex?
Touching the roof of the baby's mouth triggers them to suck, which is essential for feeding.
93
What is the Palmar Grasp Reflex?
When an object is placed in the baby’s palm, they grasp it tightly.
94
What is the Babinski Reflex?
Stroking the sole of the foot causes the toes to fan out and the big toe to dorsiflex.
95
What is the Tonic Neck Reflex?
When the baby’s head is turned to one side, the arm on that side stretches out while the opposite arm bends (fencing posture).
96
What is the Moro Reflex?
In response to a sudden loss of support, the baby throws their arms out, spreads the fingers, and then pulls the arms back in.
97
What is the Placing Reflex?
When the back of the baby’s foot touches a surface edge, they lift the foot to "place" it on the surface.
98
What is the Stepping Reflex?
When held upright with feet touching a surface, the baby makes stepping motions.
99
What are Deep Tendon Reflexes (DTRs)?
DTRs are involuntary muscle contractions in response to a stimulus, primarily assessed to evaluate the integrity of the nervous system and muscle function.
100
What are the four types of reflexes?
1. Stretch or deep tendon reflexes (e.g., Patellar/knee jerk)
2. Superficial reflexes (e.g., corneal reflex, abdominal reflex)
3. Visceral reflexes (e.g., pupillary response to light)
4. Pathologic reflexes (e.g., Babinski reflex in adults)
101
How are DTRs graded?
0 = no reaction
1+ = diminished
2+ = normal
3+ = brisker
4+ = hyperreflexia (exaggerated reflex seen in stroke patients)
102
What is the purpose of reinforcement in reflex assessment?
Reinforcement encourages relaxation and can change the position or increase hammer strength if the reflex response fails to appear.
103
Why are DTRs often assessed in OB patients?
Because magnesium (Mg) is administered to manipulate contractions, and excess Mg can lead to hyporeflexia (diminished reflexes).
104
What is the use of a reflex hammer?
A reflex hammer is used to elicit reflex responses by striking specific tendons; the wrist action of the hammer helps in assessing the strength and integrity of reflexes.
105
How do you assess the Brachioradialis reflex?
Hold the person's thumb to suspend the forearm in relaxation or let it rest in their lap. Strike the forearm 2-3 cm above the radial styloid process. Normal response: flexion and supination of the forearm.
106
How do you assess the Bicep reflex?
Support the person’s forearm, let it relax, place your thumb on the biceps tendon, and strike your thumb. Normal response: contraction of the bicep muscle and flexion of the forearm.
107
How do you assess the Tricep reflex?
Suspend the person's arm, strike the triceps tendon just above the elbow. Normal response: extension of the forearm.
108
How do you assess the Quadriceps reflex (Knee-jerk reflex)?
Let the lower leg dangle freely, strike the tendon directly below the patella. Normal response: extension of the lower leg.
109
How do you assess the Achilles reflex?
Position the person with the knee flexed and hip externally rotated. Hold the foot in dorsiflexion and strike the Achilles tendon directly. Normal response: the foot flexes against your hand.
110
What are the three types of objective assessments?
1. Screening Exam: Performed on well individuals with no significant subjective findings.
2. Complete Exam: Conducted on individuals with identified neurologic concerns, including history taking and objective assessment.
3. Recheck (Focused) Exam: Performed on individuals for follow-up care, such as hospitalized patients due to head trauma or systemic disease.
111
What is the anticipated effect of a frontal lobe lesion during an objective assessment?
Potential changes in personality, behavior, emotional regulation, and cognitive functions; may present with difficulty in planning, judgment, and impulse control.
112
What are the anticipated effects of a temporal lobe lesion?
Impaired hearing, taste, smell, and difficulty with language comprehension (Wernicke's area) and memory issues; may also lead to changes in emotional responses.
113
What is the expected impact of a parietal lobe lesion?
Difficulty with sensory perception, spatial awareness, and coordination; may result in deficits in proprioception or inability to recognize objects through touch (astereognosis).
114
What are the effects of an occipital lobe lesion?
Visual field deficits, impaired visual processing, and difficulties in recognizing objects or faces (visual agnosia).
115
What effects are associated with a cerebellum lesion?
Poor coordination, balance issues, and difficulty in performing smooth and controlled movements; may result in intention tremors and dysmetria.
116
What are the anticipated findings from a brain stem lesion?
Impaired respiratory function, consciousness disturbances, and motor/sensory deficits in the face and neck; may affect cranial nerve functions.
117
How does a spinal cord lesion affect assessment findings?
Impaired reflexes, loss of sensation below the level of the injury, and potential motor deficits; may result in spasticity or flaccidity depending on the location of the injury.
118
What aspects are assessed in a motor assessment?
1. Muscle Size: Check for atrophy (decrease) or hypertrophy (increase).
2. Symmetry: Compare muscle size and strength between sides.
3. Strength: Evaluate for paresis (weakness) or paralysis (absence of strength).
4. Tone: Assess for flaccidity (decreased resistance) or spasticity/rigidity (increased resistance).
119
What are some common abnormalities found in a motor assessment?
1. Paresthesias: Abnormal sensations like burning or tingling.
2. Weakness: Generalized or specific muscle weakness.
120
Define hemiparesis.
Hemiparesis is unilateral weakness, affecting one side of the body.
121
What is the difference between hemiplegia and paraplegia?
- Hemiplegia: Paralysis of one half of the body (one side).
- Paraplegia: Paralysis affecting the lower part of the body, typically legs.
122
What is quadriplegia?
Quadriplegia is paralysis of all four limbs (both arms and legs).
123
What does flaccidity indicate in terms of muscle tone?
Flaccidity indicates decreased resistance in the muscles, often resulting in weakness or loss of muscle tone.
124
What is the significance of spasticity and rigidity in a motor assessment?
Spasticity and rigidity indicate increased resistance in the muscles, which can suggest underlying neurological issues affecting motor control.
