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PCA > Nuero II > Flashcards

Nuero II Flashcards

1
Q

Lumbar and sacral roots fan out like a horses tail around_______ and this is called the ________

A

L1-L2
“cauda equina”

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2
Q

Where are most lumbar punctures performed at?

A

L4/5

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3
Q

The PNS consists of _________ and ________. They project to the heart, visceral organs, skin, limbs.

A

cranial nerves peripheral nerves.

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4
Q

The PNS controls the ____________ which regulates 2 things:

A

somatic nervous system
1. muscle movement
2. responds to sensations of pain/touch

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5
Q

The ____________ connects to organs and generations autonomic responses. This consists of what?

A

autonomic nervous system

  1. sympathetic NS
    -activates organs and their functions during times of stress and arousal
  2. parasympathetic NS
    -conserves energy during rest/relxation
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6
Q

What are the 3 motor pathways?

A
  1. corticospinal (pyramidal tract)
  2. basal ganglia system
  3. cerebellar system
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7
Q

Corticospinal (pyramidal tract)

A

-Upper and lower motor neurons
-Mediate voluntary movement
-Stimulate selected muscular actions by inhibiting others
-Damage to this system causes weakness

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8
Q

Basal Ganglia System

A

-Maintains muscle tone to control body movements
-Gross movements: walking
-Damage cause movement issues (disturbances in posture and gait)

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9
Q

Cerebellar System

A

Coordinates motor activity
Equilibrium
Posture
Damage: impairs coordination

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10
Q

What are sensory pathways?

A

Reflex activity
Conscious sensation
Body positioning
Blood pressure regulation
Heart rate regulation
Respiration

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11
Q

What are dermatomes?

A

Band of skin innervated by sensory root of spinal nerve
Can help localize a lesion to a specific spinal cord segment

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12
Q

What are the 3 facial branches?

A

V1 opthalmic
V2 maxillary
V3 mandibular

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13
Q

CNI

A

Olfactory: smell

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14
Q

CNII

A

Optic: vision

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15
Q

CNIII

A

Oculomotor: pupillary constriction, opening eye, EOM

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16
Q

CNIV

A

Trochlear: downward internal eye rotation

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17
Q

CNV

A

Trigeminal: motor—temporal/masseter/lateral pterygoid muscle movement (chewing), sensory—facial

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18
Q

CNVI

A

Abducens: lateral eye deviation

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19
Q

CNVII

A

Facial: motor—facial movements, sensory—salty/sweet/sour/bitter tastes

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20
Q

CNVIII

A

Acoustic aka vestibulocochlear: hearing and balance

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21
Q

CNIX

A

Glossopharyngeal: motor—pharynx, sensory—posterior ear drum, canal, posterior pharynx, tastes

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22
Q

CNX

A

Vagus: motor—palate, pharynx, larynx, sensory—pharynx, larynx

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23
Q

CNXI

A

Accessory: motor—SCM/upper trapezius

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24
Q

CNXII

A

Hypoglossal: motor–tongue

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25
Q

Exam for CN1: Olfactory

A

Loss of smell occurs in: sinus conditions, head trauma, smoking, aging, use of cocaine, Parkinson’s Disease, COVID

TEST:
Test nasal patency

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26
Q

Exam for CNII Optic

A

Visual acuity (Snellen, Rosenbaum)
Visual fields by confrontation
Fundoscopic exam
Paying special attention to the optic disc

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27
Q

Exam for CN III, CN IV CN VI (oculomotor, trochlear, abducens

A

-inspect pupils
-EOM
-looking for diplopia
-looking for nystagmus > vestibular and cerebellar disease
pupillary reactions (direct/consensual)
-if ptosis and opthalmoplegia also present, consider intracranial anyreusm if pt is awake
-if comatose, transtentorial herniation
-accomodation/convergence, lid lag/ near response

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28
Q

Exam for CN V trigeminal

A

-Palpate masseter and temporal muscles
-Close eyes> check light sensation with cotton
-Close eyes> check sharp/dull
-Corneal reflex test> touch cornea with cotton (pt should blink)

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29
Q

While doing the exam for CN VII (facial) the flattening of the nasolabial fold/drooping of lower lid suggests ________

A

weakness

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30
Q

_______ injury to the facial nerve affects the upper and lower face: _________

A

peripheral, bells palsy

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31
Q

________ injury/lesion of the facial nerve affects just the_______ face.

A

central, lower

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32
Q

Exam for CN VIII Vestibulocochlear

A

-auditory acuity
-weber, rinne (is hearing loss sensorineural- damage to CNVIII (hearing loss from aging)

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33
Q

Exam for CN IX: Glossopharyngeal

A

-Symmetrical movement of soft palate and uvula with phonation
-Gag reflex

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34
Q

Exam for CN X Vagus

A

Hoarseness of voice, Observe for difficulty swallowing

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35
Q

Exam for CN XI: Spinal accessory

A

-Inspect muscle groups for atrophy/fasciculation
-inspect muscle strength of SCM

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36
Q

Exam for CN XII: Hypoglossal

A

-Inspect tongue at rest for atrophy, fasciculation
-Move tongue from side to side
-Tongue muscle strength

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37
Q

Involuntary Movements

A

Tremors
Tics
Brief, repetitive, coordinated movements
Tourettes, phenothiazine reaction

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38
Q

Athetosis

A

Slow twisting movements, hands/feet, face. Spastic, cerebral palsy

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39
Q

Dystonia

A

Like athetosis but involving larger parts of body: trunk

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40
Q

Oral-Facial Dyskinesias

A

Arrhythmic, repetitive, bizarre motions of face/mouth/jaw
Phenothiazine reactions not corrected

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41
Q

Chorea

A

Brief, rapid, jerking movements. Huntingtons Disease

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42
Q

Atrophy

A

loss of muscle bulk
Aging, diabetic neuropathy

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43
Q

Hypertrophy

A

increase in bulk with normal or increasing strength

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44
Q

Pseudohypertrophy

A

increase in bulk with diminished strength
Duchenne muscular dystrophy

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45
Q

Muscle Tone

A

When a normal muscle with an intact nerve supply is relaxed voluntarily it maintains slight residual tension

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46
Q

What is Hypotonia/Flaccid and what type of disorder is associated with it ?

A

marked floppiness
Peripheral motor system disorder

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47
Q

Spasticity indicates a ________ tract disorders. Explain what it is?

A

Central corticospinal tract disorder
increased tone that intensifies at end range movements, increases with rapid movements

48
Q

Rigidity

A

increased resistance through all ROM

49
Q

What are the 6 abnormalities of muscle strength?

A

Paresis: impaired strength
Plegia: absent strength
Hemiparesis: weakness on ½ of body
Hemiplegia: paralysis on ½ of body
Paraplegia: paralysis of legs
Quadriplegia: paralysis if all 4 limbs

50
Q

Muscle strength scale

A

5- active movement against full resistance without evident fatigue normal muscle strength

4- active movement against gravity and some resistance

3- active movement against gravity

2- active movement of the body part with gravity eliminated

1- a barely detectable flicker or trace contraction

0- no muscular contraction detected

51
Q

Spinal cord syndrome

A

Loss of pain and temperature, but intact touch and vibration

52
Q

Define light touch and the different indications

A

Touch skin lightly with fine wisp of cotton, ask pt to respond whenever touch is felt

Anesthesia: Absence of touch sensation
Hypesthesia: Decreased sensitivity
Hyperesthesia: Increased sensitivity

53
Q

For the vibration part of the sensory exam, you want to use a _________ hz fork and place it on the patients _______ joints of finger/toe

A

128 Hz, IP joints

54
Q

________is the FIRST SENSE to be lost in peripheral neuropathy. It is also lost in posterior column disease such as_________ and _______

A

vibration, tertiary syphilis, vit B12 def

55
Q

Define the three types of abnormalities related to feeling pain

A

Analgesia: absence of pain
Hypalgesia: decreased sensitivity to pain
Hyperalgesia: increased sensitivity to pain

56
Q

Proprioception/Position Sense is lost in _______, _______, _______, and _________

A

in tertiary syphilis, MS, B12 deficiency, diabetic neuropathy

57
Q

Point localization

A

touch patient and ask them to point where you touched them

58
Q

Extinction

A

touch each arm individually, then simultaneously. Ask where patient feels each stimulus

59
Q

Stereognosis

A

identify object placed in hand (key, pen, etc) within 5 seconds

60
Q

Graphesthesia

A

write a number in patients hand, ask them to identify

61
Q

Two point discrimination

A

using paperclip, touch pad of index finger and move the two points closer together (secondary, confirmation test)

62
Q

In __________ one movement CANNOT be followed quickly but its opposite. movements are ____, _______ and ______

A

cerebellar disease
slow, irregular, culmsy

63
Q

Point-to-point movement UE and LE

A

UE: have patient touch your finger then their nose
LE: run heel down the shin

64
Q

Rapid alternating movements (RAM)

A

Pat thighs alternating with dorsal and palmar aspects of hands
Tap feet against your hands

65
Q

What occurs during a + Romberg (position sense) test? In ataxia, from ____________ disease, __________ compensates for sensory loss

A

balance is lost with eyes closed

Swaying is normal: proprioceptive correction
dorsal column disease, vision

66
Q

Pronator Drift

A

Eyes closed
Arms fully extended with palms up (occurs when one forearm and palm turn inward and down – both sensitive and specific for a corticospinal tract lesion)
Briskly tap arms downward

67
Q

A gait that lacks coordination is called

A

ataxia

68
Q

Reflex

A

involuntary stereotypical response that may involve 1 sensory and 1 motor neuron across a single synapse

69
Q

For a reflex to occur, all components of the reflex arc must be intact:

A

Sensory nerve fibers
Spinal cord synapse
Motor nerve fibers
Neuromuscular junction
Muscle fibers

70
Q

Biceps__________ Strike your thumb overlying pts bicep tendon

A

(C5, C6)

71
Q

Triceps _______Strike directly behind and above elbow

A

(C6, C7)

72
Q

Brachioradialis _________ Strike directly 1-2 inches above radial aspect of wrist

A

(C5, C6)

73
Q

Patellar/Quadriceps________Strike directly on patellar tendon w knee flexed

A

(L2, L3, L4)

74
Q

Achilles/Ankle______Strike directly on Achilles tendon, watch for plantar flexion

A

(S1)

75
Q

A slowed down Achilles/ankle reaction is seen in ___________

A

HYPOthyroidism

76
Q

If reflexes seen hyperactive, test for _________

A

clonus

77
Q

Sustained clonus indicates ___________ disease. 1-3 bears can be a normal finding

A

CNS disease

78
Q

Ankle/wrist clonus> rapidly dorsi/plantar flex foot, hold in dorsiflexion and feel for _____________ muscle rhythmic oscillations (“tapping”)

A

continued

79
Q

Clonus must be present to document a grade ________ reflex

A

4

80
Q

Hyperactive Reflexes/Hyperreflexia indicates CNS lesions of __________ corticospinal tract. May have associated ___________ motor neuron findings such as?

A

descedning
upper
Weakness, spasticity, +babinski sign

81
Q

Absent Reflexes/Hyporeflexia
indicates lesions of ________, __________, and ____________. May have associated __________ motor neuron findings such as?

A

spinal nerve roots, spinal nerves, peripheral nerves
lower
Weakness, atrophy, fasciculations

82
Q

DTRs in hypothyroidism displays a ____________________ of reflex. It is best detected in __________ reflex

A

slowed relaxation phase of reflex

Achilles reflex

83
Q

DTR Grading

A

4+ very brisk, hyperactive, with clonus

3+ brisker than average, slightly hyperreflexic

2+ average, expected response, normal

1+ somewhat diminished, low normal

0 no response, absent

84
Q

DTRs: plantar response _______ on bottom of foot slide bottom of reflex hammer laterally to medially

A

L5-S1

85
Q

What is a positive test for DTR plantar response

A

great toe extends (+Babinski)

86
Q

What is a negative test for DTR plantar response?

A

great toe plantar flex (negative = good)

87
Q

A positive test for plantar DTR can indicate a spinal lesion. What area does this affect? When is this usually seen?

A

affects corticopsinal tracts
seen in post-ictal states, drug/ETOH use

88
Q

For the plantar response DTR, a positive test in adults is ________ in babies

A

normal

89
Q

Abnormal cutaneous reflexes _________. This may be absent in both _________ and _______ disorders

A

T8-12
Run handle of reflex hammer from each corner of abdomen towards umbilicus
Umbilicus will pull towards hammer

central, peripheral

90
Q

Loss of anal reflex indicates problems with what?

A

S2, S3, S4 CAUDA EQUINA

91
Q

Nuchal Rigidity + test

A

neck stiffness
Caused by inflammation in subarachnoid space
Found in subarachnoid hemorrhage, meningitis

92
Q

Brudzinski’s Sign + test

A

BL active hip/knee flexion

93
Q

Kernig’s Sign + test

A

pain with extension of knee
Pain from stretched nerves when leg is extended

94
Q

With the straight leg raise, pain radiating to leg is a _______ straight leg test. Tightness or discomfort in the buttocks/hamstrings is ______ positive test

A

positive, not

95
Q

When doing a straight leg raise, what does pain in the ipsilateral leg indicate?

A

positive straight leg test for lumbosacral radiculopathy

96
Q

When doing the straight leg raise, when pain is present in the contralateral healthy leg what does this indicate?

A

positive crossed straight-leg raise sign

97
Q

In the glasgow coma scale, a score between _____ and ______ is good

A

13-15

98
Q

In the glasgow coma scale, patients who are between ______ and ______ are comatose

A

3-8

99
Q

In comatose patients, light reaction remains_______ in a _________coma

A

intact, metabolism

100
Q

What are metabolic reasons associated with a comatose patient

A

uremia, hyperglycemia, etoh/drugs, anoxia(not getting enough oxygen), meningitis, encephalitis, hyper/hypothermia

101
Q

What are structural reasons associated with a comatose patient?

A

hemorrhage, cerebral infarct, tumor, abscess

102
Q

In a comatose patient,_________ lesions from stroke/abscess/tumor may lead to asymmetrical pupils and _______ of light reaction

A

structural
loss
-small/pinpoint
-midposition fixed
-large
-one large

103
Q

What do b/l small pupils suggest?

A
  1. damage to the sympathetic pathways in the hypothalamus
  2. metabolic encephalopathy
  3. diffuse failure of cerebral function that has many causes, including drugs
    -light reactions are normal
104
Q

What do pinpoint pupils suggest?

A
  1. hemorrhage in pons
  2. effect of morphine, heroin, other narcotics
    -light rxn may be seen with magnifying glass
105
Q

What do midposition fixed pupils indicate?

A

structural damage in the midbrain
-fixed to light

106
Q

What do b/l fixed and dilated pupils suggest?

A
  1. anorexia
  2. some meds
107
Q

What do b/l reactive pupils suggest?

A
  1. cocaine, LSD, etc
108
Q

What does a pupil that is fixed and dilated suggest?

A
  • warns of herniation in the temporal lobe causing compression in the oculomotor nerve and midbrain
109
Q

A single large pupil is commonly seen in _______ patients with infarction of CN _________

A

diabetIc, 3

110
Q

When checking for ocular movement in a comatose patient with an INTACT brainstem, their eyes will move ….

A

towards the opposite direction e.g. head to the right..eyes to the left

111
Q

When doing the neuro exam on comatose patients and assessing posture, you may need to apply painful stimuli. What will the normal-avoidant pt, sterotypic pt and flaccid pt do?

A

normal avoidant- pt pushes stimulus away
Sterotypic- stimuli evokes abnormal postural response of trunk/extremities
Flaccid- no response

112
Q

When doing the neuro exam on comatose patients, Decorticate Rigidity is an (abnormal _________ response)

A

flexor

113
Q

When doing the neuro exam on comatose patients, Decerebrate Rigidity is an (abnormal______________response)

A

extensor

114
Q

Decorticate

A

Destructive lesion of the corticospinal tracts within or very near to the cerebral hemispheres

115
Q

Decerebrate

A

Caused by a lesion in the diencephalon, midbrain, or pons. May arise from severe metabolic disorders (hypoxia, hypoglycemia)

PCA (17 decks)

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