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Health Assessment > NEUROLOGICAL SYSTEM > Flashcards

NEUROLOGICAL SYSTEM Flashcards

1
Q

FN of the cerebral cortex

A
  • thought, memory, reasoning
  • sensation perception
  • controls voluntary movement
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2
Q

4 lobes of the cerebrum

A

FRONTAL

  • personality, behaviour, emotion, cognition
  • precentral gyrus: initiates voluntary movement

PARIETAL

  • sensation
  • associated w/ postcentral gyrus

OCCIPITAL
- primary visual receptor centre

TEMPORAL
- primary auditory reception centre

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3
Q

What are the 2 language areas in the brain?

A

Wernicke’s area

  • language comprehension
  • location: temporal lobe
  • damage: receptive aphasia - lost the ability to grasp the meaning of words

Broca’s area

  • motor speech
  • location: frontal lobe
  • damage: expressive aphasia - cannot produce meaningful language
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4
Q

What are the basal ganglia? What is it responsible for?

A
  • Additional bands of grey matter found deep within the cerebral hemispheres
  • forms the subcortical structures
  • FN: automatic movements of the body (ex. arm swings that alternates w/ legs during ambulation)
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5
Q

Thalamus

A
  • relay station for the NS

- all sensory messages pass through here before being sent to the cerebral cortex

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6
Q

Hypothalamus

A
  • regulation and control
  • temp, HR, BP, sleep, posterior pituitary glands
  • coordinates the NS activity
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7
Q

Cerebellum

A
  • motor coordination of voluntary movements
  • postural balance of body
  • muscle tone
  • adjusts and corrects voluntary movements
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8
Q

3 areas of the brainstem and their FN

A

MIDBRAIN

  • anterior, merges into thalamus and hypothalamus
  • contains motor neurons + tracts

PONS
- enlarged area containing ascending + descending tracts

MEDULLA

  • continuation of spinal cord in the brain
  • contains all ascending + descending tracts that connect the brain and spinal cord
  • contains vital autonomic centers (respiratory, cardiac, gastro-intestinal)
  • nuclei for CN VIII to CN XII found here
  • pyramidal decussation (crossing over of motor fibers) happen here
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9
Q

What is crossed representation in the CNS?

A
  • crossing over of nerve fibers occurs at the medulla

- L cerebral cortex receives sensory info from and controls motor FN to, the R side of the body

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10
Q

What are the 2 sensory pathways?

A

1) spinothalamic tract

2) posterior dorsal columns

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11
Q

Spinothalamic tract

A
  • transmits sensations of pain, temperature, crude or light touch
  • spinal cord –> spinothalamic tract –> thalamus –> sensory cortex
  • note: crossing over of secondary neurons occurs in spinal cord
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12
Q

Posterior dorsal columns

A
  • transmits sensations of position, vibration, and fine touch
  • involved in proprioception - knowing where body parts are in space
  • spinal cord –> medulla –> thalamus –> sensory cortex
  • crossing over of secondary sensory neurons occurs in the medulla
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13
Q

Stereognosis

A
  • Ability to ID familiar objects through touch

- stereognosis is impaired with damage to the posterior dorsal columns

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14
Q

what are the 3 motor pathways?

A

1) corticospinal tract
- mediate voluntary movements (skilled, discrete movements)

2) extrapyramidal tract
- maintain muscle tone and control gross autonomic movements

3) cerebellar systems
- coordinates movement, maintains equilibrium and posture

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15
Q

What is a reflex arc?

A

involuntary, quick reactions to potentially painful or damaging events.

  • sensory neurons involved in reflexes do NOT reach the CNS
  • afferent fibers go to the dorsal root and synapses directly w/an efferent motor neuron in the ventral root
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16
Q

what are the 4 types of reflexes?

A

1) deep tendon
- ex. knee jerk

2) superficial
- ex. abdominal and corneal reflex

3) visceral
- ex. pupillary response to light and accommodation

4) pathological
- ex. Babinski reflex

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17
Q

CN I

A

Olfactory n.
T: sensory
F: smell

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18
Q

CN II

A

Optic n.
T: sensory
F: vision

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19
Q

CN III

A

Oculomotor n.
T: motor
F: extraocular movements + pupil constriction

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20
Q

CN IV

A

Trochlear n.
T: motor
F: downward + inward movement of the eye

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21
Q

CN V

A

Trigeminal n.
T: both
F: muscles of mastication (motor) + sensation of the face, scalp, cornea, mucous membrane (sensory)

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22
Q

CN VI

A

Abducens n.
T: motor
F: Lateral eye movements

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23
Q

CN VII

A

Facial n.
T: both
F: facial muscles, speech, the closing of eyes (motor) + taste (sensory)
Also involved in saliva and tear secretion

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24
Q

CN VIII

A

Vestibulocochlear n.
T: sensory
F: hearing + equilibrium

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25
Q

CN IX

A

glossopharyngeal n.
T: both
F: swallowing and phonation (motor) + taste and the gag reflex (sensory)
involved in parotid and carotid reflex

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26
Q

CN X

A

Vagus n.
T: both
F: pharynx and larynx for swallowing and talking (motor) + general sensation from carotid body, carotid sinus, pharynx, viscera (sensory)

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27
Q

CN XI

A

accessory n.
T: motor
F: movement of trapezius and sternocleidomastoid m.

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28
Q

CN XII

A

Hypoglossal n.
T: motor
F: movement of the tongue

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29
Q

How many spinal nerves are in the body, and name the region?

A 
8 cervical 
12 thoracic
5 lumbar 
5 sacral 
1 coccygeal
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30
Q

Describe what a dermatome is, and what it means in the case of nerve damage

A

A circumscribed skin area that is supplied mainly from one spinal cord segment through a particular spinal nerves

overlapping dermatomes = insurance
- if one nerve is damaged, the nerve below or above it can take over

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31
Q

Developmental considerations when doing a neurological assessment on infants

A
  • NS is not completely developed
  • motor activity largely controlled by spinal cord and medulla (largely reflexes)
  • sensation is rudimentary at birth as neurons are not myelinated
  • newborns need strong stimulus and respond to crying w/ whole body movements
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32
Q

Developmental considerations when doing a neurological assessment on older adults

A
  • general atrophy w/ steady loss of neurons in brain and spinal cord
  • general loss of muscle bulk, and tone in face, neck, and spine
  • decreased muscle strength and impaired fine coordination and agility
  • loss of vibratory sense at the ankle and decreased achilles reflex
  • loss of position sense at the big toe, pupillary miosis, irregular pupil shape, decreased pupillary reflex
  • decreased cerebral blood flow and O2 consumption
33
Q

Syncope

A

sudden loss of strength and a temporary loss of consciousness due to lack of cerebral blood flow that occurs w/ low BP

34
Q

vertigo

A

the sensation of rotational spinning caused by a neurological disease in the vestibular apparatus of in the ear

35
Q

Seizure vs aura

A

seizure - occurs w/ epilepsy or paroxysmal disease

aura - subjective sensation that precedes a seizure

36
Q

Paresis

A

weakness of voluntary movements or impaired movement

37
Q

paralysis

A

loss of motor FN as a result of a lesion in the neurological or muscular system or loss of sensory innervation

38
Q

dysmetria

A

inability to control the range of motion of muscles

39
Q

paraesthesia

A

abnormal sensation like burning or tingling

40
Q

dysphasia

A

difficulty swallowing

41
Q

dysarthria

A

difficulty forming words

42
Q

How do you test CN I function?

A

smell test and patency test

43
Q

what is anosmia?

A

decrease or loss of smell that occurs w/ smoking, allergies, and cocaine use.

neurological anosmia = unilateral loss of smell in the absence of nasal disease

44
Q

how do you test CN II?

A

Confrontation test

- tests visual acuity and visual fields

45
Q

How do you test CN III, IV, VI?

A

pupils - size, regularity, equality, direct, consensual light reactions, accommodation

cardinal positions - extraocular movements

46
Q

Nystagmus

A

An abnormal finding - Back and forth osculation of the eyes

- often occurs w/ disease of the vestibular system, cerebellum, or brain stem

47
Q

strabismus

A

deviated gaze or limited movement

48
Q

Ptosis

A

drooping eyes, caused by dysFN of CN III

49
Q

What is the corneal reflex test and which CN does the corneal reflex test?

A

Bringing an object close to the eye –> should cause blinking

Afferent fibers of CN V
Efferent fibers of CN VII

Lesions to CN V or CN VII = no blinking

50
Q

How do you assess CN V?

A
  • assess muscles of mastication
  • assess pt’s sense of light touch by having pt close their eyes and asking them to say “now” whenever they feel the cotton ball in 3 regions (opthalamic, maxillary, mandibular)
  • corneal reflex
51
Q

A nurse is assessing the mobility and symmetry of facial structures in a patient. The pt’s sense of taste is also assessed. What is being tested?

A

CN VII

abnormal findings

  • muscle weakness: nasolabial folds, drooping of one side of the face, lower eyelid sagging
  • loss of movement and asymmetrical movement
52
Q

Which CN does a hearing test assess?

A

CN VIII - vestibulocochlear

53
Q

What are you testing for when you depress the tongue w/ a tongue blade and ask your pt to say “ahhh”

A

motor FN of CN IX and CN X

  • uvula and soft palate should rise midline
  • tonsils should move medially
54
Q

what should you note as abnormal when assessing CN XI

A

weakness or paralysis of sternomastoid muscle or trapezius muscle

55
Q

When and why would you ask your pt to say “light, tight, dynamite”?

A

Assess CN XII, tongue function

56
Q

What is the balance test?

A

Used to assess gait (walk)

  • should be smooth, effortless, coordinated, opposing arm swings, smooth turns
  • heel-to-toe walking for balance
57
Q

Ataxia

  • what is it?
  • what does it indicate?
A

uncoordinated or unsteady gait

  • stiff, staggering, wide base
  • rigid arms, no arm swings
  • unequal rhythm

Indicative of an upper motor neuron lesion
- ex. multiple sclerosis, acute cerebellar dysFN, alcohol intoxication

58
Q

what is the Romberg test?

A

Pt closes their eyes and holds a standing position for 20 secs
- can do w/ single leg, and single leg hop

59
Q

is a positive Romberg sign normal or abnormal?

A

abnormal finding

  • loss of balance when eyes are closed
  • occurs w/ cerebellar ataxia
60
Q

Dysmetria

A

clumsy movements w/ overshooting of the mark in the finger-to-finger, finger-to-nose, heel-to-chin tests of coordination
- occurs w/ alcohol intoxication and cerebellar disorders

61
Q

How would you assess the spinothalamic tract?

A

Spinothalamic tract is involved in pain, temperature, and light touch perception.

PAIN

  • pt closes eyes
  • apply a tongue blade w/ a sharp and dull end
  • ask pt whether they feel a sharp or dull sensation

TEMP
- only tested when pain sensation is abnormal

TOUCH

  • pt closes eyes
  • apply cotton to skin
  • ask pt to say “now” once they feel the cotton on their skin
62
Q

Hypoalgesia, analgesia, hypergesia

  • what is it?
  • which tract does it involve?
A

decreased, absent, increased pain sensation

involves the spinothalamic tract

63
Q

when would you use the tuning fork? To assess what?

A

Used to assess vibration sensation.

  • place over boney prominences
  • pt to indicate when vibrations start and stop

Assesses FN of the posterior column tract
- inability to feel vibrations occurs in peripheral neuropathy (diabetes, alcoholism)

64
Q

Which tests can be done to assess the FN of the posterior column tract?

A
  • vibration sensation
  • position (kinaesthesia)
  • tactile discrimination (fine touch)
65
Q

Stereognosis vs graphesthesia

A

stereognosis - ability to recognize familiar objects by feeling w/ hands
- astereognosis occurs w/ sensory cortex lesions

graphesthesia - ability to “read” a number or letter traced on the skin

66
Q

What are the tests for tactile discrimination?

A

2 POINT DISCRIMINATION

  • the smallest distance that can be felt/perceived as 2 different points.
  • sensory cortex lesions are associated w/ increased distance in order to ID the 2 different points

Stereognosis and graphesthesia

Extinction

  • simultaneously touch both sides of the body at the same time
  • ask pt to state how many sensations are felt and where they are
  • with cortex lesions, stimulus is extinguished on the side OPPOSITE of the cortex lesion

Point location

  • touch skin and withdraw promptly
  • ask pt to “point your finger to where I touched you”
  • inability to localize sensation associated w/ sensory cortex lesions
67
Q

biceps reflex

  • type
  • spinal segment
A

deep tendon

c5-c6

68
Q

triceps reflex

  • type
  • spinal segment
A

deep tendon

c7-c8

69
Q

brachioradialis reflex

  • type
  • spinal segment
A

deep tendon

c5-c6

70
Q

quadriceps or patellar reflex

  • type
  • spinal segment
A

deep tendon

L2-L4

71
Q

Achilles reflex

  • type
  • spinal segment
A

deep tendon

L2-S2

72
Q

gradation of a reflex

A

4+: v. brisk, hyperactive w/ clonus
- Indicative of disease

3+: brisker than avg.
- May indicate disease

2+: average, normal

1+: diminished, low normal

0: no response

73
Q

clonus

A

set of rapid, rhythmic contractions of the same muscle

when clonus occurs with hyperactive reflexes, this is a sign of upper motor neuron disease

74
Q

abdominal reflex

  • type
  • spinal segment
  • how to do
A
  • superficial reflex
  • upper (T8-T10) and lower (T10-T12)
  • stroke from the side of the abdomen toward the midline
  • should see an ipsilateral contraction of abdominal muscles
  • deviation of umbilicus toward the stroke
75
Q

Cremaster reflex

  • type
  • spinal segment
  • what is it
A
  • superficial
  • L1-L2
  • only done in male pt
  • stroke the inner thigh
  • should see elevation of ipsilateral testicle

this reflex is absent in people w/ upper and lower motor neuron lesion

76
Q

plantar reflex

  • type
  • spinal segment
  • how to do
A
  • superficial
  • L4-S2
  • position thigh in slight external rotation and stroke the lateral side of the sole of the foot inward across the ball of the foot
77
Q

what is a Babinski sign

A

an abnormal finding when doing the plantar flexion
- dorsiflexion of the big toe and fanning of all toes

  • this is ONLY normal in infants
78
Q

Glasgow coma scale

A

Used to assess level of consciousness

Eye opening (1-4)
Verbal response (1-6)
Motor response (1-5) 
Fully alert - 15
< 7 = coma

Limitation of scale - inconsistent interrater reliability

Health Assessment (7 decks)

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