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PD Block 3 > Neurological Exam > Flashcards

Neurological Exam Flashcards

1
Q

Cerebrum

A

2 hemispheres right and left. Big part of brain

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2
Q

Gray outer layer

A

Cerebral cortex houses higher mental functions

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3
Q

What is the cerebral cortex responsible for

A
  1. Higher mental functions
  2. Movement
  3. visceral functions
  4. Perception
  5. Behavior
  6. Integration of all functions
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4
Q

Frontal lobe

A

Area at front of cerebrum. Responsible for higher order functions, emotions, personality

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5
Q

Two other areas within frontal lobe

A
  1. Motor cortex - movement

2. Sensory cortex - sensation

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6
Q

Parietal lobe

A

Located posteriorly to frontal lobe. Responsible for interpretation of info and sensations (perception). Also aids in proprioception and small amounts of taste, smell, hearing

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7
Q

Occipital lobe

A

Posterior portion of cerebrum. Responsible for vision

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8
Q

Temporal lobe

A

Located on lateral portion of cerebrum. Responsible hearing!! and for memory and language interpretation

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9
Q

Cerebellum

A

Responsible for fine tuning movements from the cerebrum. Processes sensory info from the eyes, ears, and touch receptors. Big part of balance!! (DOES NOT INITIATE MOVEMENT)

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10
Q

Which part of the brain aids in balance and muscle tone

A

The cerebellum

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11
Q

Brainstem

A

Pathway between cerebrum and spinal cord. Controls many involuntary functions

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12
Q

Some involuntary controls of the brainstem

A
  1. respiratory
  2. circulatory functions
  3. eye movements
  4. releasing hormones from pituitary gland/hypothalmus
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13
Q

Limbic system

A

Structure deep in the cerebrum that controls mood and emotions (i.e. fear, pleasure, anger, sex, hunger). Amygdala

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14
Q

What are the 3 areas that make up the brainstem

A
  1. Midbrain
  2. Pons
  3. Medulla oblongata
    Superior to inferior
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15
Q

Cranial nerve I

A

Olfactory nerve. Responsible for smell (S)

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16
Q

Cranial nerve II

A

Optic nerve. Responsible for visual acuity and visual fields. (S)

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17
Q

Cranial nerve III

A

Oculomotor. Responsible for muscle movement of eye, except LR and SO. Also helps with pupillary constriction. (M)

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18
Q

Cranial nerve IV

A

Trochlear. Responsible for movement of superior oblique muscle of eye. Moves eye in and down. (M)

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19
Q

Cranial nerve V

A

Trigeminal. Responsible for opening and closing of jaw, clenching teeth, chewing, mastication. Sensory function: eyelids, forehead, nose, moth, teeth, tongue. (B)

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20
Q

Cranial nerve VI

A

Abducens. Lateral eye movement (M)

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21
Q

Cranial nerve VII

A

Facial. Movement of all facial expressions (smile, frowning, etc) DOES NOT MOVE JAW, but does move lips. Sensory - taste on anterior 2/3 of tongue. (B)

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22
Q

Cranial nerve VIII

A

Acoustic. Responsible for hearing. (S)

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23
Q

Cranial nerve IX

A

Glossopharyngeal. Responsible for voluntary muscles of swallowing and phonation. Sensory - nasopharynx, gag reflex. Taste on posterior 1/3 of tongue (B)

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24
Q

Cranial nerve X

A

Vagus. Sensation behind ear and part of ear canal. Parasympathetic: secretes digestive enzymes, peristalsis. (B)

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25
Q

Cranial nerve XI

A

Accessory (spinal). Turns head, shrug shoulders. (M)

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26
Q

Cranial nerve XII

A

Hypoglossal. Tongue movement for speech and swallowing. (M)

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27
Q

Branches of cranial nerve V

A

“Tri” 3 parts, (sharp, dull, light)
V1 - ophthalmic nerve
V2 - maxillary nerve
V3 - mandibular nerve

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28
Q

Basal ganglia

A

Group of structures in deep brain. Relay station for indirect motor pathway. Refines motor movements

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29
Q

3layers of the spinal cord

A
  1. Dura mater
  2. Arachnoid mater
  3. Pia mater
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30
Q

Where does spinal cord start

A

At the foramen magnum as a continuation of medulla oblongata. Terminates at L1

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31
Q

What does the white matter of the spinal cord contain

A

Ascending and descending spinal tracts

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32
Q

What does the gray matter of the spinal cord contain

A

Nerve cell bodies associated with sensory pathways and the ANS.

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33
Q

Ascending spinal tracts

A

Located in the white matter of the spinal cord and relay sensory signal from the body back to the brain

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34
Q

Descending spinal tracts

A

Located in the white matter of the spinal cord and relay information from the brain to various muscle groups (Inhibitory or excitatory)

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35
Q

Spinal nerves

A

31 pairs of nerves that arise from the spinal cord and exit at each intervertebral foramen.

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36
Q

Dermatome

A

area of skin that is innervated by each spinal nerve

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37
Q

Where do upper motor neurons begin and end

A

All the cell bodies for the motor pathway begin and end within the CNS

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38
Q

Are the upper motor neurons ascending or descending pathways

A

Descending pathways from brain to spinal cord

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39
Q

What is the function of the upper motor neurons

A
  1. influence, direct, and modify spinal reflexes

2. Can only affect movement by connecting with lower motor neurons

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40
Q

What happens to the muscle tone and DTR with upper motor neuron lesions

A

Increased tone and DTR. Hypertonia, clonus, paralysis of voluntary movements, babinski sign

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41
Q

What happens to the muscle tone and DTR with lower motor neuron lesions

A

Decreased tone and DTR. Muscle atrophy, fasciculations, polio

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42
Q

What is the one disease that has crossover in both upper and lower motor neurons

A

Lou Gehrig disease (ALS)

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43
Q

Where do the lower motor neurons originate

A

In the anterior horn of the spinal cord (gray matter). Extend to the peripheral system.

44
Q

Function of the lower motor neurons

A

Transmit neural signals directly to the muscles which creates movement. “final pathway”

45
Q

What is the result of injury to the upper motor neuron

A

May result in initial paralysis but may be followed by partial recovery over extended period of time

46
Q

What is the result of injury to the lower motor neuron

A

Often results in permanent paralysis

47
Q

Division of the PNS

A

Sensory and motor

48
Q

Division of the motor

A

Autonomic (ANS) - involuntary

Somatic (SNS) - voluntary

49
Q

Function of the ANS

A

INVOLUNTARY. Coordinates and regulates internal organs and conducts impulses from CNS to cardiac and smooth muscles.

50
Q

2 branches of the ANS

A

Parasympathetic and sympathetic

51
Q

Function of the SNS

A

VOLUNTARY. Conducts impulses from the CNS to skeletal muscles. also assists in reflex arc.

52
Q

What areas would you test for sharp, soft, or dull

A

Face, legs, and hands. Use cotton wish, broken tongue blade, and a paperclip

53
Q

What areas would you test for vibratory sensation

A

On the joints of the fingers and toes. May also test shoulder, elbow wrist. Ask pt to tell you where to sensation is felt

54
Q

Temperature sensation test

A

Only done if superficial pain sensation is not intact. Roll test tube of hot and cold water against the skin.

55
Q

What areas of the the body would use the two point discrimination test

A

Fingers, toes, back. use a paper clip or needles. place them apart from each other.
On fingers= 2-8mm apart
On back=40-70mm

56
Q

Scoring scale of DTR

A 
0 - no response
1+ sluggish or diminished
2+ active or expected response
3+ brisk or more than expected
4+ hyperactive, clonus
57
Q

Superficial reflexes above umbilicus

A

Stroke out and up. Muscle movement should be in that same direction. T8,9,10

58
Q

Superficial reflexes below umbilicus

A

Stroke down and out. Muscle movement should be in that same direction. T10, 11, 12

59
Q

Two other superficial reflexes

A
  1. Cremasteric

2. Plantar reflex (babinski)

60
Q

Plantar reflex

A

Take end of reflex hammer and run along lateral edge of plantar surface from heel to ball of foot. Should get plantar flexion in all toes

61
Q

Babinski sign

A

Occurs during plantar reflex test, great toe dorsiflexes. Indicates upper motor neuron disease

62
Q

Which nerves are associated with cremasteric reflex

A

T12, L1, L2

63
Q

Normal finding in children under 2 (superficial reflex)

A

Babinksi sign

64
Q

Oculocephalic reflex (doll’s eyes)

A

Used to assess health of comatose/lethargic pts. Hold eyes open and rotate head around. Reflex intact if eyes move opposite direction of the head. If dolls eyes not happening, it is a brainstem dysfunction

65
Q

Kerig sign

A

“K for knee” Flex leg, attempt to straighten. Assess for low back pain and watch for involuntary head flexing, may suggest meningitis

66
Q

Brudzinski sign

A

Pt supine, Flex the neck and watch for involuntary flexion of hips/knees. If this happens it may be meningitis

67
Q

Gower sign

A

Seen often in children. When they get up off the floor they push off the floor and then push off legs (knees) to help stand up the rest of the way. May be proximal muscle weakness

68
Q

Clonus

A

Muscle spasm that is often repeated and rhythmic contractions. Often seen with upper motor neuron lesions. These are large motions (unlike fasciculations)

69
Q

Clonus test of ankle

A

Done when reflexes are hyperactive. Support pts knee in flexed position and briskly dorsiflex foot. If oscillation occurs, it is a positive clonus test

70
Q

Romberg sign

A

Tests for balance and proprioception. Pt stands with fee together, eyes closed. If pt loses balance it indicates cerebellar ataxia (loss of control), vestibular issue, or sensory problem

71
Q

Pronator drift

A

Done after romberg, have pt stand with arms extended. Watch for arms drifting from that position. Can also tap the arm and see if it stays in place or if it then drifts.

72
Q

Decorticate

A

Posture in which pts arms are adducted and flexed. Wrists/fingers flexed and on chest. Legs stiff, extended and internally rotated, with plantar flexion of foot. Due to corticospinal tract damage

73
Q

Decerebrate

A

Posture where arms are adducted and extended, wrists pronated fingers flexed. Legs are stiff, extended with plantar flexion of foot. Caused by upper brain stem damage

74
Q

Spasticity

A

Condition in which skeletal muscles are continuously stiff or tight. Can lead to paralysis and increased DTR

75
Q

Flaccidity

A

Reduced skeletal muscle tone/contractability, also leads to paralysis. Caused by disease/trauma.

76
Q

Hemiplegia

A

Paralysis of entire side of the body. Most common in strokes

77
Q

Paraplegia

A

Paralysis of lower half of body

78
Q

Delerium

A

Condition of confusion and problems with perception, mood, behavior, attention

79
Q

Dementia

A

A longterm, gradual decline in mental ability that affects memory, thinking, social abilities

80
Q

Depression

A

Mood disorder persistant feelings of sadness and loss of interest

81
Q

Stupor

A

Lack of critical cognitive function and state of consciousness. Person pretty unresponsive, only responds to pain

82
Q

Coma

A

State of unconsciousness. Does not respond to stimuli, caused from brainstem injury or injury to the RAS

83
Q

Paresthesia

A

Abnormal tingling/pricking sensation caused by pressure or damage to a peripheral nerve

84
Q

Receptive aphasia

A

aka wernickes aphasia. Unable to understand written or spoken language, but can speak with normal grammar, syntax, intonation. Don’t know what they are saying. Damage to temporal lobe

85
Q

Expressive aphasia

A

Person is unable to produce spoken or written language. Speech is extremely slow, inflection impaired, but words are meaningful. Damage to anterior region of brain

86
Q

Areflexia

A

Absence of neuro reflexes. LMN problem

87
Q

Hyperreflexia

A

Overactive reflexes, UMN problem

88
Q

Hyporeflexia

A

Underactive or absent reflexes. LMN problem

89
Q

What is the glasgow coma scale used for

A

To estimate the conscious state of a person.

90
Q

Sections of the glasgow and max score

A

Eye response, verbal response, motor response. 15

91
Q

What PE tests do you do for mental status

A
  1. A & O
  2. Recent memory
  3. Remote memory
92
Q

What test do you do for cranial nerve I

A

Smell something with eyes closed

93
Q

Test for CNII

A

Visual acuity, fields of confrontation

94
Q

Test for CNIII

A

Cardinal directions (except LR and SO) down and inward eye movement

95
Q

Test for CNIV

A

Cardinal direction only tests the superior oblique (SO0

96
Q

Test for CNV

A

Motor - open close jaw, side to side with jaw, clench.

Sensory - opthalamic, maxillary, mandibular - test sharp, dull, soft in those areas

97
Q

Test for CNVI

A

Lateral eye movement, done with cardinal directions

98
Q

Test for CNVII

A

6 facial expression

99
Q

Test for CNVIII

A

Whisper test

100
Q

Test for CNIX and X

A

Gag reflex and swallow - 9,10

say ah and watch uvula rise - 10

101
Q

Test for CNXI

A

Trapezius and SCM resistance

102
Q

Test for CNXII

A

Stick out tongue move side to side, then push tongue against cheek and external resistance

103
Q

Cerebellar (proprioception) tests

A
  1. Romberg
  2. Nose to finger test
  3. Gait
  4. Shin scrape
  5. Rapid alternating movements of hands and feet
104
Q

Test for motor

A

AROM, grip strength,

105
Q

Tests for superficial reflexes

A
  1. Babinski
  2. Cremasteric
  3. Abdominal

PD Block 3 (10 decks)

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