Numbness And Tingling

Question 1

FAST exam

Answer 1

. For stroke 
. Face droops 
. Arm weakness
. Speech difficulty 
. Time

Question 2

Parenthesia

Answer 2

. Distorted sensation, tingling

Question 3

Anesthesia

Answer 3

. Loss of sensation

Question 4

Hyperesthesia

Answer 4

. Too much sensation

Question 5

Allodynia

Answer 5

. Pain w/ innocuous stimulus

Question 6

What to ask for history numbness

Answer 6

. Duration
. Distribution
. Good neuro ROS
. Check for muscle weakness/atrophy, skin, pulses, edema

Question 7

. Interrelationships of nervous system

Answer 7

. Receiving sensory stimuli from environment
. Identifying/ integrating adaptive processes for maintenance
. Integrating responses of CNS/Endocrine system
. Controlling cognitive/voluntary behavioral processes

Question 8

Frontal lobe functions

Answer 8

. Voluntary skeletal movement 
. Repetitive movement
. Working memory
. Judgement
. Behavior
. Broca’s area

Question 9

Broca’s area

Answer 9

. Language production
. Aphasia: patient knows what they want to say but can’t formulate speech
. Stuttering

Question 10

Parietal lobe functions

Answer 10

. Processes sensory data
. Assists w/ processing of tactile sensation
. Proprioception
. Complex purposeful motor movement

Question 11

Occipital lobe functions

Answer 11

. Interpretation and perception of visual data

. Recognition of color, shapes, and faces

Question 12

Temporal lobe functions

Answer 12

. Emotional responses/ memory
. Integration of taste and smell
. Interpretation of speech (wernicke’s)

Question 13

Wernicke’s area

Answer 13

. Sup. Temporal gyrus
. Comprehension and understanding of written and spoken language
. Difficulty processing incoming speech in your head (receptive aphasia)

Question 14

Upper motor neurons

Answer 14

. Originate in motor region of cerebral cortex or brain stem

Question 15

Lower motor neurons

Answer 15

. Originate in grey columns of spinal cord, ant. Nerve roots or CN nuclei of brainstem

Question 16

Upper motor nerve lesions symptoms

Answer 16

. Weakness
. Reflexes inc.
. Tone inc.

Question 17

Lower motor neuron lesion symptoms

Answer 17

. Weakness
. Atrophy
. Fasciculations 
. Reflexes dec. 
. Tone dec.

Question 18

Things to ask for seizure history

Answer 18

. Sequence of events 
. Symptoms 
. Aura
. LOC
. Muscle activity 
. Postictal state
. Assoc. events (time, sleep, stress, frequency) 
. Meds/drugs/alcohol

Question 19

History to ask related to gait

Answer 19

. A lance/falls

. Leg strength

Question 20

Questions to ask about weakness/paresthia

Answer 20

. Onset
. Character
. Assoc. symptoms
. Concurrent illness

Question 21

Big risk factors for CVA

Answer 21

. High cholesterol
. High bp
. DM

Question 22

Important things in family medical history when patient has numbness/tingling

Answer 22

. Alcohol
. Hereditary disease
. Mental retardation
. Epilepsy/headaches
. Alzheimer’s disease
. Weakness/gait disorders 
. Medical/metabolic disorders

Question 23

CN III/IV/VI examination

Answer 23

. Inspect eyelids for symmetry
. Inspect pupils for size/equality
. Test consensual response/accommodation
. Test extraocular eye movements

Question 24

How to test CN V

Answer 24

. Test pain/sensation
. Corneal reflexes
. Motor: symmetry, palpate jaw for strength/tone in muscles

Question 25

How to test CN VII

Answer 25

. Motor: make faces for facial expression mm. | . Sensory: tongue for salt/sweet

Question 26

How to test VN IX

Answer 26

. Test tongue for sour/bitter | . Test gag reflex

Question 27

how to test CN X

Answer 27

. Inspect palate/uvula (say AHH to see rise) . Swallowing . Guttural speech sounds

Question 28

How to test CN XII

Answer 28

. Inspect tongue for atrophy/symmetry/tremor . Test tongue strength . Evaluate lingual sounds l, t, d, n

Question 29

Cerebellar function

Answer 29

. Coordination and fine motor skills . Movements: thumb-finger, finger-nose, finger-nose-finger, heel chin . Balance equilibrium: observe gait, rhomberg, stand on one foot . Rapid alternating movements

Question 30

How many neurons are lost per minute in ischemia?

Answer 30

1.9 million neurons | . Brain ages 3.8 yrs

Question 31

Cortical sensory functions

Answer 31

. Higher order cortical discriminatory sensory functions . Graphesthesia: number identification . Sterognosis (identification of object by feeling it) . Tactile extinction (simultaneous stimuli test by touching each side . 2 point discrimination: test w/ caliper, 2 sterile needles . Point location: identify area touched on them

Question 32

Primary sensory functions

Answer 32

. Superficial touch . Superficial pain and temperature . Deep pressure/vibration and joint position

Question 33

Examine all sensory function for ___

Answer 33

``` . Symmetry and differences . Patient’s interpretation of sensation . Discrimination . Location . Note impairment using dermatomal chart ```

Question 34

Superficial reflexes

Answer 34

. Upper/lower abdominal . Cremasteric . Plantar: babinski reflex (fanning of toes)

Question 35

Muscle stretch response

Answer 35

. Muscle initially stretched . Afferent signals are sent to spinal cord . Interneuron connects afferent and efferent fibers . Efferent signals sent to mm. To cause contraction

Question 36

Grading of deep reflexes

Answer 36

``` . 0: absent . 1: dec. but present . 2: normal . 3: hyperreflexsive, brisk and excessive . 4: hyperreflexsive, w/ clonus ```

Question 37

Deep reflexes

Answer 37

``` . Biceps: C5 . Brachioradialis: C6 . Triceps: C7 . Patellar: L4 . Achilles: S1 ```

Question 38

Hemiplegia (Early)

Answer 38

. Half of body unresponsive . Externally rotated high . Flaccid arm

Question 39

Decorticate rigidity

Answer 39

``` . Abnormal flexor response . Internally rotated thigh . Plantar flexed foot . Flexed elbow . Adducted arm . Flexed wrist . Insult lesion close to cerebrum, before midbrain and red nucleus ```

Question 40

Decerebrate rigidity

Answer 40

``` . Abnormal extensor response . Plantar flexed foot . Flexed wrist . Pronated forearm . Extended elbow . Adducted arm . Lesion in red nucleus or below ```

Question 41

Mental status

Answer 41

. Assess alert and orientation | . Alert and oriented x3 (person, place, and time)

Question 42

Muscle bulk

Answer 42

. Atrophy: secondary to PNS disorders . Hypertrophy: inc. in mm. Bulk w/ normal or inc. strength . Pseudohypertrophy: inc. bulk w/ diminished strength

Question 43

Eye opening grading

Answer 43

. 1: wont’ open even to supraorbital pressure . 2: open w/ pain from sternum/limb/supraorbital pressure . 3: open to speech, nonspecific response, not necessarily to command . 4: eyes open normally

Question 44

Verbal response grading

Answer 44

1: no verbalization 2: moans/groans, no speech 3: intelligible, no sustained sentences 4: converses but confused, disoriented 5: converses and is oriented

Question 45

GCS

Answer 45

. Glascow coma score . Mild rating: 13-15 . Moderate: 9-12 . Severe: 8 or less, needs intubation

Question 46

Motor response grading

Answer 46

1: non response to any pain, limb remains flaccid 2: shoulder adducted and shoulder and forearm internally rotated, extended (decerebrate) 3: withdrawal response or assumption of hemiplegic posture (decorticate) 4: arm withdrawals to pain, shoulder abducts 5: obeys commands 6: can localize pain

Question 47

Pronator drift

Answer 47

. Stan 20-30 sec w/ eyes closed . Arms held out straight w/ palms up . Arm will drift when asked to pronate arm

Question 48

Oculocephalic reflex

Answer 48

. Doll eye movements . Lifting up eyelids and being able to move eyes back in forth . When lost, can’t move eyes

Question 49

Dysdiadochokinesis

Answer 49

. Occurs in cerebellar disease | . Can’t complete rapid alternating movement