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NPTE > NM > Flashcards

NM Flashcards

1
Q

What is the insula responsible for?

A

visceral functions

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2
Q

What is the function of the limbic system?

A
  • basic feeding
  • aggression
  • endocrine aspects of sexual response
  • memory
  • motivation
  • learning
  • instincts and emotions
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3
Q

What makes up white matter?

A

myelinated axons

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4
Q

What sensory nuclei are NOT included in the thalamus?

A

olfactory

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5
Q

What does the subthalamus do?

A

assists in controlling functional pathways for motor, sensory, and reticular formation

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6
Q

what does the hypothalamus do?

A
  • controls the ANS and neuroendocrine systems
  • maintains homeostasis (temperaure, eating/drinking, sexual ehavior, emotion)
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7
Q

What CNs are located in the midbrain?

A

CN III and IV

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8
Q

What does the substantia nigra do?

A

nucleus that connects the basal ganglia and cortex for motor control and muscle tone

location: midbrain

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9
Q

What is the superior colliculus a relay station for?

Midbrain

A

vision/visual reflexes

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10
Q

What is the inferior colliculus a relay station for?

A

hearing/auditory reflexes

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11
Q

What are midline raphe nuclei important for?

location: pons

A

modulation of pain and controlling arousal

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12
Q

What CN nuclei are found in the tegmentum of the pons?

A
  1. V
  2. VI
  3. VII
  4. VIII
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13
Q

Where does the medial longitudinal fasciculus originate? What is it important for?

A

a. vestibular nuclei and extends to the upper Cx spinal cord
b. head movement and gaze stabilization (vestibuloocular reflex)

Location: medulla oblongata

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14
Q

What is the olivary nuclear complex important for?

A

voluntary movement control

(location: medulla oblongata) - connects the cerebellum to the brainstem

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15
Q

What CN nuclei does the medulla oblongata contain?

A

CN VIII, IX, X

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16
Q

Where is the Reticular activating system (RAS) found?

A

anterior portion of the brainstem

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17
Q

What do the 4 nuclei of the RAS system produce?

A
  1. serotonin
  2. noepinephrine
  3. ACh

assists with attention, arousal, and muscle tone modulation

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18
Q

What results if the RAS is damaged?

A
  1. dysfunctional circadian rhythm
  2. impaired arousal
  3. impaired attention
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19
Q

What does the flocculonodular lobe regulate?

Vestibulocerebellar lobe, arachicerebellum

A
  1. equilibrium
  2. muscle tone regulation
  3. assists in coordination of vestibuloocular reflex
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20
Q

What does the spinocerebellum do?

rostral cerebellum, paleocerebellum, anterior lobe

A
  1. posture
  2. controls voluntary movements
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21
Q

What does the cerebrocerebellum do?

neocerebellum, lateral cerebellar hemispheres, posterior lobe

A

smooth coordination of voluntary movements - ensures accurate force, direction, and extent of the movement

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22
Q

What part of the cerebellum is important for motor learning, sequencing of movement, and visually triggered movements?

A

cerebrocerebellum

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23
Q

What are the 4 primary ascending columns of white matter? What tracts are included in each?

A
  1. dorsal columns/medial lemniscal system (fasciculus cuneatus and fasciculus gracilis)
  2. spinothalamic tracts (anterior and lateral ascending tracts)
  3. Spinocerebellar tracts (dorsal spinocerebellar tract, ventrospinocerebellar tract)
  4. spinoreticular tracts
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24
Q

What is the function of the dorsal columns/medial lemniscal system?

A

convey sensations of proprioception, vibration, and tactile discrimination

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25
Q

What is the function of the fasciculus cuneatus?

Lateral portion of dorsal columns

A

sensations of proprioception, vibration, and tactile discrimination of the UEs (lateral tract)

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26
Q

What is the function of the fasciculus gracilis?

Medial portion of dorsal columns

A

sensation of proprioception, vibration, and tactile discrimination within the LEs

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27
Q

What is the function of the lateral spinothalamic tract?

A

sensation of pain and temperature

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28
Q

What is the function of the anterior spinothalamic tract?

A

crude touch

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29
Q

What is lassauer’s tract? What tracts make this possible?

A

anterior and lateral spinothalamic tracts ascend 1-2 ipsilateral spinal cord segments and then penetrate the grey matter of the thalamus –> cross –> ascend into the cortex

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30
Q

What is the function of the spinocerebellar tracts?

dorsal spinocerebellar tract, ventrospinocerebellar tract

A

conveys proprioception information from muscle spindles, GTO, touch receptors, and pressure receptors for control of voluntary movements

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31
Q

The —– spinocerebellar tract ascends ipsilaterally to the inferior cerebellar peduncle

A

dorsal spinocerebellar tract

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32
Q

The —- spinocerebellar tract ascends contralaterally and ipsilaterally to the superior cerebellar peduncle

A

anterior spinocerebellar tract

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33
Q

What is the function of the spinoreticular tract?

A

conveys deep and chronic pain to the reticular formation (found in brainstem) via diffuse, polysynaptic pathways

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34
Q

What are the 4 descending tracts?

A
  1. corticospinal
  2. vestibulospinal
  3. rubrospinal
  4. tectospinal
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35
Q

what is the corticospinal tract important for?

A

voluntary motor control

Anterior corticospinal tract is made up on 10% of fibers that do NOT cross at the pyramidal decussation- travel to the cervical and thoracic spine anterior horn cells (voluntary movement of axial and girdle mm.)

Lateral corticospinal tract Crosses over in the medulla (pyramidal decussation) and then travels all the way down the spinal cord and terminates in the anterior horn cells (provides skilled movement of contralateral extremities)

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36
Q

What are the vestibulospinal tracts important for?

A
  1. muscle tone
  2. antigravity muscles
  3. postural reflexes
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37
Q

The vestibulospinal tract fibers that travel laterally (are/are not) crossed.

A

not crossed

Only the medial vestibulospinal tract contains crossed fibers

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38
Q

What are the rubrospinal tracts important for?

A

motor functioning

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39
Q

What are the tectospinal tracts important for?

A

head-turning in response to stimuli

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40
Q

What is the role of the ANS?

A

maintaining homeostasis within the body

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41
Q

What spinal levels are included in the sympathetic portion of the ANS?

A

C8-L2

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42
Q

What does the sympathetic nervous system provide when initiated?

A
  1. fight-or-flight response
  2. increases HR and BP
  3. constricts peripheral blood vessels
  4. redistributes blood
  5. inhibits peristalsis
  6. relaxes airways
  7. stimulates release of epinephrine and noepinephrine from the adrenal medulla
  8. relaxes urinary bladder
  9. widespread effects

thoracolumbar region

Peristalsis: the involuntary constriction and relaxation of the muscles of the intestine and other structures

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43
Q

What spinal levels are included in the parasympathetic system?

A
  1. CN III
  2. CN VII
  3. CN IX
  4. CN X
  5. S2-S4

craniosacral regions

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44
Q

What does the parasympathetic system do when initiated?

A
  1. conserves and restores homeostasis
  2. decreases HR and BP
  3. increases perstalsis
  4. increases glandular activity
  5. constricts airways
  6. stimulates contraction of the bladder
  7. localized effects
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45
Q

What do the vertebral arteries arise from? What do they form when they unite?

A

a. subclavian arteries
b. basilar artery - then branch off to form two posterior cerebral arteries

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46
Q

What does the vertebrobasilar system arteries supply?

A
  1. cerebellum
  2. brainstem
  3. occipital lobe
  4. thalamus
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47
Q

(true/false) Neuroglia (support cells) transmit signals

A

FALSE

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48
Q

What are neuroglia useful for?

A

myelin production and neuronal support

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49
Q

What is the resting membrane potential? Which side of the membrane is a positive charge? Negative charge?

A

a. -70 mV
b. outside: positive charge
c. Inside: negative charge

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50
Q

What 3 tests are used for CN II?

A
  1. visual acuity
  2. snellen eye chart (central vision)
  3. confrontation test (peripheral vision)
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51
Q

What test is used for CN III?

A

pupillary response

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52
Q

What does CN III provide?

A
  1. convergence
  2. accommodation
  3. pupillary reflex
  4. movement: up/down, in, elevates eyelid

CN II has afferent reponse… CN III has efferent response

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53
Q

What movements does CN IV provide?

A

turns ADD eye downward

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54
Q

What are the sensory locations of CN V?

A
  • face
  • cornea
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55
Q

What muscles do CN V innervate?

A
  • temporal muscle
  • masseter
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56
Q

What are the 3 tests for CN V?

A
  1. pain and light touch at jaw, forehead, and cheeks
  2. corneal reflex
  3. palpation w/ teeth clenched
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57
Q

What are the sensory locations of CN VII?

A

Taste of anterior 2/3 of tongue

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58
Q

What 2 tests are used for CN VII?

A
  1. facial expressions
  2. taste on the anterior and lateral aspects of the tongue (using a cotton swab)
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59
Q

What 4 tests can be used for CN VIII?

A
  1. Rinne’s test
  2. VOR
  3. auditory acuity
  4. Weber’s test
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60
Q

Describe how to perform the Weber’s test. What is it used to test?

A

a. place tuning fork on the middle of the head and see if the patient can hear the sound equally on both sides

b. CN VIII - lateralization

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61
Q

Describe how to perform the Rinne’s test. What is it used to test?

A

a. tuning fork is placed on the mastoid bone and then close to the ear canal… sound should be heard longer in the air than on bone.

b. CN VIII - air and bone conduction

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62
Q

What does the glossopharyngeal nerve provide?

CN IX

A
  • taste on posterior 1/3 of tongue
  • sensory of pharynx
  • sensory of middle ear
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63
Q

What are tests used for CN IX?

A

taste on the posterior 1/3 of tongue

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64
Q

What do CN IX and X provide?

A
  1. phonation
  2. swallowing
  3. gag reflex
  4. palatal control
  5. control of pharynx

  • “ah” test to observe palate movement and uvular movement (should remain at midline)
  • stimulating back of the throat
  • listen to voice quality
  • observe swallowing
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65
Q

What does CN XI provide?

A
  • trapezius movement
  • SCM movement

1.Test with examination of bulk/strength 2. SCM movement while in supine

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66
Q

What does CN XII provide?

A

movement of the tongue

Tests: listen to articulation, resting and active tongue positioning

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67
Q

What CN is responsible for chewing?

A

CN V

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68
Q

What CN is reponsible for swallowing?

A

CN IX and X

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69
Q

What CN is responsible for the alimentary tract, heart, BVs, and lungs?

A

CN IX and X

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70
Q

(true/false) there is no dorsal root for C1.

A

True

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71
Q

A person presents with anosmia…. what CN is affected?

A

CN I

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72
Q

What is myopia?

A

Impaired far vision

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73
Q

What is presbyopia?

A

Impaired near vision

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74
Q

What CN is affected when exotropia or anisocoria are observed?

A

CN III

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75
Q

What is anisocoria?

A

Unequal pupils

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76
Q

A person presents with ptosis and/or dilated pupils… what CN is affected?

A

CN III

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77
Q

A patient presents with loss of ipsilateral corneal reflex… what CN is affected?

A

CN V

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78
Q

Describe sensorineural loss.

A

loss of sound in the “good ear”

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79
Q

Describe conductive hearing loss.

A

Sound of a tuning fork heard through the bone is equal to or longer than when in the air

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80
Q

Describe dysphonia.

A

voice dysfunction: hoarseness, slurring

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81
Q

Hoarseness in a person’s voice denotes what?

A

vocal cord paralysis

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82
Q

Altered nasal quality in a person’s voice denotes what?

A

weak palate

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83
Q

A pt presents with dysphonia and/or dysarthria… what CN is affected?

A

CN IX and/or X

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84
Q

A pt presents with an absent gag reflex… what CN is damaged?

A

CN IX

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85
Q

A pt presents with paralysis of their palate (unable to elevate)… what CN is damaged?

A

CN X

86
Q

A pt presents with unilateral paralysis of their palate… what CN is damaged?

A

CN IX and/or X

87
Q

What CN(s) are possibly damaged when a patient presents with dysarthria?

A

CN IX, X, and/or XII

88
Q

A UMN lesion affecting CN XII results in what?

A

mild to moderate contralateral weakness of the tongue - can be transient

89
Q

A LMN lesion affecting CN XII results in what?

A
  • paralysis
  • atrophy
  • fasciculations of the tongue on the involved side
  • deviation of protrusion is towards the weak side
90
Q

(true/false) Bilateral supranuclear/UMN lesions (pseudobulbar palsy) can cause moderate-severe loss of tongue function

A

True

Affects CN XII

91
Q

What CNS structure is critical for maintaining autonomous rhythmic movements (swallowing, chewing, walking)?

A

brainstem

92
Q

what is remote memory?

A

long-term memory

93
Q

What is a popular, brief, screening test for cognitive dysfunction that includes screening items for orientation, registration, attention/calculation, recall, and language?

A

MMSE

94
Q

(true/false) the MMSE is not a stand-alone tool for dx of cognitive impairment

A

true

95
Q

What does the Ranchos los amigos scale assess?

A

cognitive recovery from a TBI

96
Q

How many levels are there on the ranchos los amigos scale?

A

8

Level 1-8

1: no response
2-3: decreased response
4-6: confusion
7-8: appropriate response

97
Q

What portion of the brain causes non-fluent aphasia/expressive aphasia?

A

Broca’s area

impaired motor capabilities of speech

98
Q

What portion of the brain causes fluent/receptive aphasia?

A

Wernicke’s area

impaired auditory comprehension

99
Q

What is conduction/association aphasia?

A

word finding issues and problems with repeating phrases due to damage of the association nerve fibers (arcuate fasciculus) that connect broca’s area and wernicke’s area.

100
Q

What level of O2 sat is required for those with CNS damage?

A

> 94%

101
Q

Describe cheyenne stokes respiration.

A

Period of apnea lasting 10-60 seconds followed by gradually increasing depth and frequency of respirations.

accompanies depression of frontal lobe and diencephalic dysfunction

102
Q

Describe apneustic breathing.

A

prolonged inspiration

accompanies damage to the upper pons

103
Q

Elevated body temperatures can be indicative of damage to what structures?

A

Brainstem or hypothalamus

104
Q

What are the s/s of meningeal irritation/infection?

A
  • impaired neck mobility
  • visual discomfort
  • altered consciousness
  • severe HA/N/V
  • altered vital signs
  • generalized weakness
105
Q

What are the s/s of increased ICP/cerebral edema, and brain herniation?

A
  • altered consciousness
  • altered vital signs (increased systolic BP, widening pulse pressure, bradypnea, apnea, cheyene-stokes respiration, fever, and bradycardia)
  • HA
  • Vomiting
  • pupillary changes
  • motor dysfunction
  • Sz activity
106
Q

The lesion causing homonymous hemianopsia is (ipsilateral/contralateral) to the side of the impaired visual field.

A

contralateral

ex: right lesion = bilateral left visual field loss

107
Q

What is bitemporal hemianopsia?

A

loss of the outer half of both visual fields (loss of peripheral vision)

108
Q

Where is the lesion location that causes bitemporal hemianopsia?

A

optic chiasm

109
Q

A GCS score of 1-8 is indicative of what?

A

Severe brain injury

110
Q

What does the GCS test?

A
  1. motor response
  2. eye opening
  3. verbal response

Assesses acute concussions/TBI

111
Q

The CRSR is used to assess what?

Coma recovery scale- revised

A

brainstem reflexes, consciousness, functioning

112
Q

Description:

Pt is unable to identify body parts or their relationship to each other

A

somatognosia (body scheme disorder)

113
Q

Description:

severe denial, neglect, or lack of awareness to severity of condition

A

anosognosia

114
Q

What is agnosia?

A

pt is unable to recognize familiar objects

115
Q

What is apraxia?

A

inability to perform voluntary, learned, movements in the absence of loss of sensation, strength, coordination, attention, or comprehension

116
Q

Describe ideomotor apraxia.

A

patient cannot perform the task on command but can perform it when alone

117
Q

Describe ideational apraxia.

A

patient cannot perform a task at all (both on their own and with command)

118
Q

What causes apraxia?

A

Damage to the prelateral frontal cortex and somatosensory association cortex

119
Q

What is the MAS used for? How many grades are there?

A

a. grading spasticity
b. 6 grades

0: no increase in muscle tone

1: slight increase in muscle tone w/ minimal resistance at end of PROM

1+ : slight increase in muscle tone with minimal resistance through less than 1/2 of PROM

2: more marked increase in muscle tone through most of PROM

3: considerable increase in muscle tone, PROM is difficult

4: rigidity in FLX or EXT

120
Q

(true/false) sensation is not affected in those with PD

A

true

121
Q

(true/false) rigidity is not velocity-dependent

A

true

122
Q

What DTRs will you see in those with PD?

A

normal but may be decreased

123
Q

(true/false) spasticity is not velocity dependent

A

false (it is velocity dependent)

124
Q

What DTRs are seen in those who experienced a stroke?

A

hyperreflexia

125
Q

What DTRs are seen in those with a cerebellar lesion?

A

normal or decreased

126
Q

What involuntary movements are seen in those with cerebellar lesions?

A

none

127
Q

What DTRs will you see in those with SCI?

A

hyperreflexia

128
Q

definition

Muscles from a specific myotome are affected

A

radiculopathy

129
Q

definition

Distal muscle strength is initially observed and then progresses to proximal muscles

A

polyneuropathy

130
Q

definition

posturing seen in comatose patients with brainstem lesions between the superior colliculus and vestibular nucleus

A

decerebrate ridigity/posturing

Results in increased tone and sustained posturing in rigid EXT of all limbs, trunk, and neck

131
Q

definition

posturing seen in comatose patients with lesions above the superior colliculus

A

decorticate rigidity/posturing

Results in increased tone and sustained posturing of the UEs in FLX and the LEs in EXT

132
Q

How do you test abdominal reflexes (T6-L2)? What should be observed with a neurologically intact individual?

A

Perform lateral –> medial scratching in all 4 quadrants

Should observe movement of the umbilicus in the direction of the stimulation

133
Q

Describe how to perform cesmasteric reflex (L1/L2). What should be observed in neurologically intact individuals?

A

stroking the skin of the proximal and medial thigh

observation: elevation of the testicle

–> reflex is absent in those with SCI and corticospinal lesions

134
Q

(true/false) intention tremors occur when voluntary movement is attempted in those with cerebellar disorders

A

true

135
Q

You primarily see (proximal/distal) weakness of extremities when myopathy is present

A

proximal

136
Q

Describe ataxia

A

wide-based gait with uncoordinated movements

137
Q

What can improve ataxic gait in those with polyneuropathy?

A

looking down

looking down does not improve ataxic gait in those with cerebellar dx

138
Q

What score on the DGI is indicative of fall risk?

A

score <19

139
Q

Describe myopathic gait.

A

hyperlordosis and compensated trendelenburg on the WB limb

cause: pelvic girdle and proximal muscle weakness

140
Q

What diagnostic imaging is useful for detection of abnormal changes in tissue density?

A

CT

ex: cerebral edema (w/in 3 days post-stroke), cerebral infarction (w/in 3-5 days post-stroke), acute brain bleeds

141
Q

When diagnosing an acute stroke, what diagnostic imaging tool can be used to administer TPA (clot-busting drug) in the absence of hemorrhage within 3-4.5 hours of the thromboembolic stroke?

A

CT

142
Q

What diagnostic imaging tool allows for imaging of the spinal cord, nerve roots, and meninges?

A

CT myelography

143
Q

What diagnostic imaging tool is often used in patients with metal or suspected scar tissue in the area of imaging?

A

CT myelography

144
Q

What are complications of CT myelography?

A
  • allergic reaction to dye
  • irritation of meninges
145
Q

What diagnostic test is most sensitive for detecting an acute stroke?

A

MRI

Allows detection of cerebral edema within 30 minutes after the vascular occlusion
Allows detection of infarction within 2-6 hours

146
Q

What is the primary imaging tool used for examination of tumors, demyelination, and vascular abnormalities?

A

MRI

146
Q

What does an MRA do?

A

Images arteries within the brain to identify vascular abnormalities with increased sensitivity and decreased risk

147
Q

What are contraindications of MRI/MRA?

A

pacemakers, metal

148
Q

What imaging tool allows for visualization of axons, pathways, and microstructural characteristics of water?

A

Diffuse tensor imaging (DTI)

149
Q

(true/false) MRI has radiation exposure.

A

FALSE

150
Q

(true/false) DTI does not use radiation

A

true

151
Q

what diagnostic imaging technique examines changes in deoxygenated Hgb and contrast agent?

A

functional MRI

provides good spatial resolution to identify active areas of cortex

152
Q

What diagnostic imaging tool is used for patients who are at risk for stroke?

A

Cartoid/verteral artery doppler ultrasound

153
Q

When does abnormal spontaneous EMG activity occur after a peripheral nerve injury/compression and correlates with Wallerian degeneration?

A

7-21 days after

154
Q

What does an EEG do?

A

measures electrical activity within the brain - collects information on the timing and firing of the neurons in the brain (temporal resolution)

155
Q

Where are lumbar punctures made?

A

below L1-L2

can measure ICP along with analyzing CSF

156
Q

Elevated CSF proteins can be indicative of what diagnoses?

A

tumors and/or inflammation

157
Q

(true/false) TIA causes permanent damage

A

false

158
Q

When does irreversible anoxic damage to the brain occur?

A

after 4-6 minutes

159
Q

(true/false) controlling secondary cell death is critical for mgmt of stroke, TBI, and SCI

A

true

160
Q

(true/false) occlusions proximal to the anterior communicating artery produces maximal deficits due to collateral circulation (circle of willis)

A

false (minimal deficits)

161
Q

What part of the brain does the ACA supply?

A

anterior 2/3 of the middle cerebral cortex

162
Q

What part of the brain does the MCA supply?

A
  1. lateral cerebral cortex
  2. basal ganglia
  3. internal capsule
163
Q

What are the characteristics of MCA syndrome?

internal capsule and cortex lesion

A

Primary characteristics:
- contralateral hemiplegia of the face, UE> LE
- contralateral hemisensory loss, UE >LE
- homonymous hemianopsia

–> other characteristics that can help localize but not always present
- aphasia (dominate hemisphere)
- perceptual deficit (non-dominate hemisphere)
- loss of conjugate gaze to contralateral side
- sensory ataxia

164
Q

What are the characteristics of ACA syndrome?

cortex and internal capsule lesions

A

Primary characteristics:
- contralateral hemiplegia, LE>UE
- contralateral hemisensory loss, LE>UE
- urinary incontinence
- problems with bimanual tasks
- apraxia

–> other characteristics that can help localize but are not always present
- akinesia (decreased mobility)
- mutism

165
Q

What are the characteristics of PCA syndrome?

primary visual cortex, occipital lobe lesions

A

Primary characteristics:
- contralateral sensory loss
- involuntary movements
- transient contralateral hemiparesis
- homonymous hemianopsia

–>other characteristics that can help localize but ae not always present:
- visual agnosia
- memory deficit
- dyslexia
- central/thalamic pain
- Weber’s syndrome
- CN III palsy

166
Q

What are the characteristics of a midbrain lesion?

A
  • contralateral hemiplegia
  • possible contralateral CN III palsy
167
Q

What are the characteristics of medial pontine syndrome?

occlusion of paramedian branch of basilar artery

A
  • ipsilateral cerebellar ataxia
  • ipsilateral nystagmus
  • ipsilateral paralysis of conjugate gaze
  • diplopia
  • contralateral hemiparesis
  • contralateral hemisensory loss
168
Q

What are the characteristics of lateral pontine syndrome?

occlusion of anterior inferior cerebellar artery

A
  • ipsilateral ataxia
  • ipsilateral vertigo and nystagmus
  • ipsilateral facial paralysis
  • ipsilateral paralysis of conjugate gaze
  • ipsilateral deafness/tinnitis
  • ipsilateral impaired facial sensation
  • contralateral impaired sensation of pain and temperature
169
Q

What are the characteristics of medial medullary syndrome?

occlusion of vertebral artery, medullary branch

A
  • ipsilateral paralysis of tongue
  • contralateral hemiplegia
  • contralateral impaired sensation
170
Q

What are the characteristics of lateral medullary (wallenberg’s) syndrome?

occlusion of posterior inferior cerebellar artery/vertebral artery

A
  • ipsilateral ataxia
  • ipsilateral vertigo and nystagmus
  • ipsilateral sensory loss of UE, Trunk, or LE
  • bilateral loss of facial pain and temperature

characteristics that may be present:
- Horner’s syndrome (miosis, ptosis, decreased sweating)
- dysphagia
- impaired speech

171
Q

Where are the lesion(s) located when Lacunar (pure motor) stroke is suspected?

A
  • internal capsule- posterior limb
  • pons
  • pyramids
172
Q

Where are the lesion(s) located when medial pontine syndrome is suspected?

A
  • occlusion of paramedial branch of basilar artery
173
Q

Where are the lesion(s) located when lateral pontine syndrome is suspected?

A

occlusion of anterior inferior cerebellar artery

174
Q

Where are the lesion(s) located when medial medullary syndrome is suspected?

A

occlusion of vertebral artery, medullary branch

175
Q

Where are the lesion(s) located when lateral medullary (wallenerg’s) syndrome is suspected?

A

occlusion of posterior inferior cerebellar artery/vertebral artery

176
Q

Those with (left/right) hemisphere lesions are typically impulsive, quick, and indifferent; poor judgement and safety

A

right hemisphere (left hemiplegia)

177
Q

Those with (left/right) hemisphere lesions are typically slow, cautious, hesitant, and insecure; often aware of impairments and become frustrated

A

Left hemisphere (right hemiplegia)

178
Q

TBI definition

injury at point of impact and opposite point of impact

A

coup-contracoup injury

179
Q

TBI definition

disruption and tearing of axons and small blood vessels from shear-strain of angular acceleration resulting in neuronal death and petechial hemorrhages

A

diffuse axonal injury

180
Q

TBI recovery stage

marked by return of sleep-wake cycles and normalization of respiration, digestion, BP control

A

vegetative state (unresponsive wakefulness syndrome)

181
Q

Persistent vegetative state is determined if a patient remains in vegetative state for ________ after a TBI.

A

1+ year(s)

182
Q

TBI recovery stage

Patient is not vegetative and does show signs of fluctuating awareness

A

minimally responsive (mute responsiveness)

183
Q

TBI recovery stage

patient mainly has a disturbance of attention mechanisms; all cognitive operations are affected and the patient is unable to form new memories; altered arousal

A

confusional state

184
Q

TBI recovery stage

confusion is clearing and some memory is possible; pt has significant cognitive problems and has limited insight; frequent uninhibited social behaviors

A

emerging independence

185
Q

TBI recovery stage

pt is increasing independence but still does have cognitive difficulties (problem solving, reasoning, etc) along with behavioral and social problems

A

intellectual/social competence

186
Q

(true/false) a patient can plateau at any recovery stage from a diffuse axonal injury/TBI

A

true

187
Q

What is sympathetic storming? What is the cause?

A

Result of hypothalamic stimulation for the SNS with an increase in circulating corticoids and catecholamines

s/s:
- minimal alertness
- altered level of consciousness
- dystonia
- tachycardia
- HTN
- hyperthermia
- diaphoresis
- agitation

188
Q

definition

persistent post-concussion symptoms lasting 3+ months

rare after just one concussion

A

post-concussion syndrome

  • s/s can include post-traumatic sz, increased risk of depression, and/or mild cognitive impairment
189
Q

definition

progressive neurodegenerative brain disease resulting from repetitive head trauma

A

CTE (chronic traumatic encephalopathy)

190
Q

What are the s/s of CTE?

A
  • recurrent HA and dizziness
  • cognitive impairments
  • mood/behavioral disturbance
  • impaired judgement/impulse control
  • movement disorders
191
Q

What are the s/s of epilepsy?

A
  • altered consciousness
  • sensory phenomena
  • autonomic phenomena
  • cognitive phenomena
192
Q

definition

characterized by sudden attack of anxiety, tachycardia, sweating, etc

A

autonomic phenomena

193
Q

definition

characterized by sudden failure of comprehension, inability to communicate, intrusion of thought, illusions/hallucinations, and affective disturbances (fear, anger, hate, etc)

A

cognitive phenomena

194
Q

What are common causes of epilepsy?

A
  1. acquired brain disease, trauma, tumor, stroke
  2. degenerative brain diseases (alzheimer’s dementia, amyloidosis)
  3. developmental brain defect (decreased O2 at birth)
  4. drug OD
  5. drug withdrawal
  6. electrolyte disorders
  7. hyperthermia
  8. infection
  9. pregnancy complications (eclampsia)
195
Q

how long do generalized sz commonly last?

A

2-5 minutes

196
Q

What is a petit mal sz?

A

sx that can occur 1+ times per day
- posture is maintained
- repetitive blinking
- small movements
- lasts a few seconds

197
Q

Diagnosis

type of seizure where the person appears dazed or confused, not fully alert or unconscious – type of focal/partial sz

A

complex partial sz

198
Q

Diagnosis

sz characterized by episodic changes in behavior, with complex hallucinations, automatisms, altered cognitive and emotional functioning, preceded by aura – type of focal/partial sz

A

temporal lobe sz

199
Q

What is a simple or complex partial sz that evolves into a general sz?

A

secondarily generalized sz

200
Q

What are the characteristics of a vestibulocerebellar lesion?

flodulonoccular lobe/archicerebellum

A
  • ocular dysmetria
  • poor smooth pursuit
  • VOR dysfunction
  • impaired hand-eye coordination
  • gait and trunk ataxia
  • Wide BOS
  • poor postural control
201
Q

What are the characteristics of a spinocerebellum lesion?

paleocerebellum/rostral cerebellum/anterior lobe

A
  • hypotonia/weakness/fatigue
  • trunk ataxia (increased sway, wide BOS, static postural tremor, high guard arm position, dysequilibrium)
  • ataxic gait
202
Q

What are the characteristics of a neocerebellum lesion?

posterior lobe

A

Ipsilateral
- intention tremor
- dysdiadochokinesia
- dysmetria
- dyssynergia

203
Q

definition

voluntary, irregular oscillatory movements

A

intention tremor

204
Q

What group of diagnoses are the following tests appropriate for?
- Scale for assessment and rating of ataxia (SARA)
- dizziness handicap inventory (DHI)
- modified fatigue impact scale (MFIS)
- balance assessments
- functional gait tests
- FIM

A

cerebellar disorders

205
Q

What SLR position tests the sciatic nerve?

A

neutral

206
Q

What SLR position tests the tibial nerve?

A

DF and eversion

207
Q

What SLR position tests the peroneal nerve?

A

PF and inversion

208
Q

What SLR position tests the sural nerve?

A

DF and inversion

209
Q

What position puts tension on the femoral nerve?

A

Prone knee FLX

NPTE (20 decks)

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