PD Exam III Flashcards
Mini-Mental State Exam
30 pt questionnaire
cognitive impairment - dementia
cognitive and higher cognitive
What are the categories of Mental Status Exam
appearance and behavior speech and language mood thought processes thought content judgment insight abstract thinking cognitive higher cognitive
speech and language
quantity: talkative, silent
rate: fast or slow
volume: loud or soft
fluency: rate, flow, melody
thought process
flight of ideas, incoherence, confabulation, etc,
thought content
compulsions, obsessions, phobias, anxieties, delusions, unreality
circumstantiality
speech with unnecessary detail, indirection, and delay in reaching the point
derailment
shift topics that are loosely connected or unrelated
flight of ideas
continuous flow of speech but abrupt changes from one topic to next
neologisms
invented or distorted words
incoherence
incomprehensible and illogical speech w/o meaningful connections
blocking
interruption of speech mid-sentence (losing thought)
confabulation
fabrication of facts or events in response to questions; to fill in gaps from impaired memory
preservation
persistent repetition of words or ideas
echolalia
repetition of words and phrases of others
clanging
choosing words based on rhyming rather than meaning
judgment
affected by anxiety, mood, edu, income, intelligence, culture
also delirium, dementia, psychosis
insight
can have denial of impairment (memory loss/confusion)
cognitive function
orientation attention remote memory recent memory new learning ability
higher cognitive function
information and vocab
calculating ability
abstract thinking
constructional ability
high cognitive functions
calculating
abstract thinking: concrete v abstract
information and vocabulary
constructional ability
concrete v abstract thinking
concrete: both mouse and rat have tails, sew rip before it gets bigger
abstract: both are animals, prompt attention to problem prevents trouble
information and vocabulary
name object
word comprehension
reading comprehension
writing
constructional ability
draw clock with hands pointing to specific time
where do the cranial nerves emerge from?
1, 2: cerebrum
3-12: brain stem
which cranial nerve relates BEYOND head and neck?
vagus CN10
Which CNs are Sensory, Motor, Both?*
Some say marry money but my brother says big brains matter more
What two muscles does CN11 (accessory) control?
SCM
Trap
What muscles do CN12 control?
strap muscles - infrahyoid ones
hyposmia v hyperosmia
hyposmia: partial loss of smell
hyperosmia: exaggerated sensitivity
dyosmia
distorted smell
anosmia
total loss of smell
phantosmia
olfactory hallucination
cacosmia
smelling something burned, foul, or rotten
what CN do irritating smells stimulate?
trigeminal (peppermint, NH3 –> dont use to test)
common olfactory disorders
post traumatic
post infection
olfactory hallucinations in epilepsy
what to do to examine olfaction?
inspect for obstruction sniff test (occlude one)
unilateral olfactory disturbance can be from what?
sub-frontal meningioma
rods v cones
rods: low light, low spatial acuity
cones: high light level, color, high spatial acuity
L/R VISUAL FIELDS of BOTH eyes go to which side of brain?*
L visual field of BOTH eyes: right brain
R: left brain
The image on the retina is…?
inverted
outside areas of both L/R visual fields lost, damage is at..?
chiasm`
Isihara’s testing
color vision
optic nerve testing
snellen chart
color vision
visual fields by confrontation
fundoscopic exam
testing CN II, CN III: PERRLA
pupils equal, round, react to light, accomodation
direct and consensual response to light
direct: shine light, pupil constrict
consensual: other pupil also constricts w/o direct light
anisocoria
different of 0.4mm in pupil diameter
testing CN3,4,6
Eyelid for symmetry (ptosis)
extraocular mvmts (6 cardinal directions)
convergence: look towards nose
nystagmus
medial/lateral canthus
corners of the eyes
sclera
whites of eye, covered by conjunctiva
limbus
outer edge between iris and sclera
two types of conjunctiva
bulbar: over sclera
palpebral: under eyelid
meibomian gland
produce mebium: oily substance to prevent tear evaporation
dysfunction: dry eyes
adie’s syndrome
neurological: usually unilateral mydriasis, no reaction to light, loss of deep tendon reflex, abnormal sweating
who can get Adie’s (tonic) pupil?
diabetic neuropathy
alcoholism
what is sustained in Adie’s pupil?
accommodation sustained –> complain blur vision from distant to near
Argyll Robertson Pupil
moisis
iris atrophy
cant dilate in dark
What causes argyl robertson pupil?
neurosyphilis
abducens palsy
eye mvmt disorder: lesion of CN6 –> gaze paresis
cant eye abduct
unilateral or bi- increase intracranial pressure
complete abducens palsy causes…?
convergent strabismus (looking straight, one goes in )
trochlear palsy
CN4: SO weakness
diplopia on downward gaze
oculomotor palsy
CN3 compression from tumor or post communicating a. aneurysm –> dilation (blown pupil)
complete v incomplete
30% pupil sparing
causes of trochlear palsy
myasthenia
dysthyroid eye disease: grave ophthalmology
cause of oculomotor palsy
diabetes
strabismus
eyes don’t align bilaterally: exotropia
complete oculomotor palsy
ptosis
lateral deviation, slightly downward
types of nystagmus (oscillation mvmt)
pendular: slow waveform, congenital ,MS
vestibular: peripheral (suppressed by visual fixation), central (unaffected by fixation)
gaze evoked: certain direction (Tav)
down beat: chiari malformation
convergence: dorsal midbrain
endpoint: physiological
CN5 Trigeminal
pons
facial sensations
mastication: muscles
damage to trigeminal during mastication
jaw deviate to affected side
4 muscles of mastication
masseter
temporalis
medial, lateral pterygoids
3 divisions of trigeminal nerve
ophthalmic n.
maxillary n.
mandibular n.
sensations of trigeminal
sharp-dull
hot-cold
light touch
compare side to side
how to test corneal reflex (trigeminal n.)
cotton to one eye –> blinking of both eyes
Facial nerve CN7
pons
ant 2/3 taste
facial muscle expression
parasymp: submandibular, sublingual, lacrimal glands
Motor function branches of facial n.*
two zebras bit my clavicle: temporal zygomatic buccal mandibular cervical
Bell’s palsy
one sided facial droop
LOWER motor neuron
facial nerve
difference between stroke and bell’s palsy
stroke: UMN, paralysis of lower face
Bell’s: LMN, paralysis of entire side