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Health Assessment > Quiz #4 Neurological > Flashcards

Quiz #4 Neurological Flashcards

1
Q

Central Nervous System

A

brain and spinal cord

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2
Q

Peripheral nervous system

A

Cranial and Spinal nerves.
Afferent fibers to CNS and efferent fibers from CNS.
Autonomic messages to internal organs and blood vessels.

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3
Q

Cerebral cortex

A

Gray matter

Highest functions: thought, memory, reasoning, sensation, voluntary movement

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4
Q

What brain functions should be assessed?

A
  1. Sensation
  2. Vision/Hearing
  3. Language comprehension/Aphasia
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5
Q

What can damage to the cerebral cortex produce? (5)

A
  1. Loss of function in affected area
  2. Motor weakness
  3. Paralysis
  4. Loss of sensation
  5. Impaired ability to understand and process language
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6
Q

Cerebellum function

A
  1. motor coordination of voluntary movements
  2. equilibrium
  3. muscle tone
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7
Q

What cranial nerves originate from the brainstem?

A

CN III through XII

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8
Q

Where are samples of CSF taken from?

A

The lumbar cistern

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9
Q

Crossed representation of nerve tracts

A

The left cerebral cortex receives sensory information from and controls motor function on the right side of the body.

The right cerebral cortex receives sensory information from and controls motor function on the left side of the body.

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10
Q

Sensory pathways

A

Sensory fibers transmit and conduct sensations of:

  1. Pain
  2. Temperature
  3. Crude or Light touch
  4. Position
  5. Finely localized touch
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11
Q

Motor pathways

A

Pyramidal and extrapyramidal tracts

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12
Q

Pyramidal (corticospinal) tract

A

Motor pathway

Skilled and purposeful ovement

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13
Q

Extrapyramidal tracts

A

More primitive motor pathway

Controls muscle tone and gross movements like walking

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14
Q

Upper motor neurons

A

Located completely within the CNS

Disease of UMN includes stroke, CP, and MS

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15
Q

Lower motor neurons

A

Located in peripheral nervous system
Final direct contact with the muscles
Cranial nerves and spinal nerves are LMNs
Diseases of LMN include spinal cord lesions, poliomyelitis, ALS

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16
Q

Reflexes mediated by

A

spinal nerve fibers

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17
Q

Reflex mechanism

A

Tapping a tendon stimulates sensory nerve at a synapse in the spinal cord with the motor neuron, and efferent fibers travel to the muscle snd stimulate a contraction.

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18
Q

5 components of a deep tendon reflex

A
  1. Intact sensory nerve (afferent)
  2. Functional synapse at the spinal cord
  3. Intact motor nerve (efferent)
  4. Neuromuscular junction
  5. Competent muscle
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19
Q

Where do CN I and II begin?

A

The cerebrum

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20
Q

Spinal nerves- 31 pairs arise from:

A 
Spinal cord. Breakdown:
8 cervical
12 thoracic
5 lumbar
5 sacral
1 coccygeal
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21
Q

Sensory nerves exit through

A

posterior (dorsal) roots

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22
Q

Motor nerves exit through

A

anterior (ventral) roots

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23
Q

What controls movements in infants

A

primarily primitive reflexes from the spinal cord and the medulla. Reflexes disappear as the cerebral cortex develops.

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24
Q

What determines infant’s sensory and motor development?

A

Gradual acquistion of myelin

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25
Q

Changes in neurological system in the aging adult

A

Steady loss of neuron structure in the brain and spinal cord

Decrease in weight and volume, thinning of the cerebral cortex

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26
Q

What does neuron loss cause in the aging adult?

A

General loss of muscle bulk
Loss of muscle tone in the face, neck, and spinal area
Impaired fine coordination and agility
Loss of vibratory sense at the ankle
Decreased/absent achilles reflex
Loss of position sense at the big toe
Pupillary miosis
Irregular pupil shape, decrease pupillary reflexes
touch, pain, taste, and smell may diminish
Reaction time slows

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27
Q

Velocity of nerve conduction decreases by what % in aging adult?

A

5-10%

Reaction time is slower

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28
Q

Where is decrease in muscle bulk most apparent in the aging adult?

A

Dorsal hand muscles

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29
Q

What causes dizziness and loss of balance with position change in the aging adult?

A

Decrease in cerebral blood flow and oxygen consumption

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30
Q

When in good health, older adults walk

A

about as well as they did when younger, but more slowly and deliebrately

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31
Q

Where is the stroke belt in the US? Where is the buckle?

A

Southeast US
Buckle is the coastal plain of NC, SC, and Georgia- stroke mortality 20% higher than the rest of the stroke belt and 40% higher than the rest of the US

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32
Q

Subjective Data for neurological assessment (12)

A
  1. Headache
  2. Head injury
  3. Dizziness/vertigo
  4. Seizures
  5. Tremors
  6. Weakness
  7. Incoordination
  8. Numbness or tingling
  9. Difficulty swallowing
  10. Difficulty speaking
  11. Patient centered care/ personal hx
  12. Environmental/occupational hazards
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33
Q

Additional subjective hx for the aging adult

A
  1. Dizziness— When? Rx? Falls?
  2. Decrease in memory or mental function/Confusion
  3. Tremor
  4. Sudden vision change
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34
Q

“Worst headache of my life”

A

Needs emergency referral- possible stroke

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35
Q

Vertigo indicates

A

neurological disease

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36
Q

What to ask about seizures

A
  1. aura
  2. motor activity
  3. associated signs that others notice
  4. post-ictal period: sleepy, confused, weakness, headache
  5. precipitating factors
  6. medications
  7. effect on daily life/quality of life/coping strategies
  8. course of duration of seizure
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37
Q

What to ask about tremors

A

precipitating and palliative factors

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38
Q

paresis

A

partial or incomplete paralysis, diminished strength

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39
Q

paralysis

A

loss of motor function caused by a lesion in the neurologic or muscular system or loss of sensory innervation. absence of strength

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40
Q

paresthesia

A

abnormal sensation- burning, tingling

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41
Q

What to ask about dysphagia

A

Solids or liquids? Excessive saliva or drooling?

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42
Q

dysarthria

A

difficulty forming words

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43
Q

dysphasia

A

difficulty with language expression or comprehension

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44
Q

What to ask about past neuro hx

A
  1. stroke
  2. meningitis
  3. encephalitis
  4. spinal cord injury
  5. congenital defect
  6. alcohol use
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45
Q

Environmental hazards (4)

A
  1. insecticides
  2. organic solvents
  3. lead
  4. mercury
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46
Q

What medications are important for neuro subjective hx (4)

A
  1. anticonvulsants
  2. antitremor
  3. antivertigo
  4. pain meds
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47
Q

Causes of increased fall risk in aging adult (5)

A
  1. dx of stroke
  2. dx of dementia
  3. gait & balance disorders
  4. use of assistive devices
  5. hx of recent falls
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48
Q

micturition syncope

A

Getting up at night and feeling faint while standing to urinate

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49
Q

Change and memory and decrease in cognitive function in the aging adult may indicate

A

Alzheimer’s— often mistaken for normal cognitive decline of aging

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50
Q

Senile tremor may be relieved by

A

alcohol—assess for whether alcohol is being used to relieve tremor symptoms

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51
Q

Objective data for neuro

A
  1. Test cranial nerves
  2. Inspect and palpate the motor system
  3. Test movements
  4. Test sensation
52
Q

Atrophy

A

abnormally small muscle with a wasted appearance. occurs with disuse, injury, LMN disease, diabetic neuropathy

53
Q

hypertrophy

A

increased size and strength of muscle with isometric exercise

54
Q

testing muscle strength

A

test power of homologous muscles simultaneously. test muscle groups of extremities, neck, and trunk

55
Q

muscle tone

A

the normal degree of tension in voluntarily relaxed muscles

56
Q

testing muscle tone

A

move extremities through passive range of motion

57
Q

flaccidity

A

decreased resistance, hypotonia with peripheral weakness. Associated with LMN injurym polio, periperal neuritis, guillain-barre, early stroke and spinal cord injury at first

58
Q

spasticity and rigidity

A

increased resistance that occurs with central weakness- associated with UMN injury to corticospinal motor tract- paralysis with stroke after a few days or weeks

59
Q

dysdiadochokinesia

A

slow, clumsy, sloppy response with cerebellar disease

60
Q

test of coordination and skilled movements

A

Rapid Alternating Movements (RAM) test
Finger-to-nose test (eyes closed)
Heel-to-Shin test

61
Q

dysmetria

A

clumsy movement, overshooting the mark. Occurs with cerebellar disorders and alcohol intoxication

62
Q

past-pointing

A

constant deviation to one side

63
Q

intention tremor

A

occurs when reaching to a visually directed object

64
Q

ataxia

A

uncoordinated or unsteady gait

65
Q

testing gait

A

have pt walk 10-20 feet, turn, and return to starting point

66
Q

Tandem walking

A

have pt walk a straight line in heel-to-toe (tandem) fashion.
More sensitive test for ataxia.
Inability to tandem walk may indicate upper motor neuron lesions—MS, acute cerebellar dysfunction/alcohol intoxication

67
Q

Romberg test

A 
Stand up with feet together and arms to the side. Close eyes and hold position. 
Positive sign (loss of balance) occurs with cerebellar ataxia (MS, ETOH), loss of proprioception, loss of vestibular function
68
Q

Sensations to test for (8)

A 
Pain
Light touch
Vibration
Position
Tactile discrimination
Graphesthesia
Two-point discrimination
Extinction
69
Q

hypoalgesia

A

decreased pain sensation

70
Q

analgesia

A

absent pain sensation

71
Q

hyperalgesia

A

increased pain sensation

72
Q

hypoesthesia

A

decreased touch sensation

73
Q

anesthesia

A

absent touch tensation

74
Q

hyperesthesia

A

increased touch sensation

75
Q

Loss of ability to perceive vibration with

A

peripheral neuroapthy (DM and alcoholism)

76
Q

Kinesthesia

A

position sense

77
Q

test of kinesthesia

A

have person close eyes. Move a finger up or down and ask pt which way finger was moved.

78
Q

Tactile discrimination tests

A 
Stereognosis
Graphesthesia
Two-point discrimination
Extinction
Point location
79
Q

Stereognosis

A

ability to recognize objects by feeling them

astereognosis- occurs in sensory cortex legions (stroke)

80
Q

Graphesthesia

A

ability to read a number traced on the skin.

Inability comes with sensory cortex lesion (stroke)

81
Q

Two-point discrimination test

A

test ability to distinguish separation of two points of a paper clip on the skin. Varies according to location. Increase in distance associated with sensory cortex lesions

82
Q

Extinction test

A

Ability to recognize only one of two applied stimuli. Stimulus extinguished on side OPPOSITE the cortex lesion.

83
Q

Point location

A

Touch the skin, withdraw stimulus.
“Put your finger where I touched you”
Abnormality indicates sensory cortex lesion

84
Q

Reflex response scale

A

4+ very brisk, hyperactive with clonus, indicative of disease
3+ brisker than average, may indicate disease but probably normal
2+ average, normal
1+ diminished, low normal, or only with reinforcement
0 no response

85
Q

Clonus

A

rapid, rhythmic contractions of the same muscle

86
Q

hyperreflexia

A

exaggerated reflex seen when the monosynaptic reflex arc is released from the usually inhibiting influence of high cortical levels. occurs with UMN lesions, eg stroke

87
Q

hyporeflexia

A

absense of a reflex. LMN issue. Occurs with interruption of sensory afferents of destruction of motor efferents and anterior horn c`ells (spinal cord injury)

88
Q

Biceps reflex

A

c5-c6

89
Q

triceps reflex

A

c7-c8

90
Q

brachioradialis reflex

A

c5-c6

91
Q

Quadriceps reflex (knee jerk)

A

L2-L4

92
Q

achilles reflex (ankle jerk)

A

(L5-S2)

93
Q

clonus test

A

Support lower leg and move foot up and down a few times, then stretch the muscle by briskly dorsiflexing the foot. Hold the stretch.
Clonus- rapid, rhythmic contractions of the calf muscle and foot. Occurs with UMN disease.

94
Q

Superficial reflexes

A 
abdominal reflexes- T8-T10, T10-T12
cremaster reflex (L1-L2)
plantar reflex (L4-S2)
95
Q

superficial reflex absent with

A

diseases of the pyramidal tract- absent on contralateral side with stroke

96
Q

Babinski reflex

A

Check plantar reflex (L4-S2). Stroke sole of foot.
If dorsiflexion of big toe and fanning of other toes, positive Babinski sign- indicates UMN disease of corticospinal or pyramidal tract

97
Q

Glasgow coma scale

A

Eye opening response: spontaneous, speech, pain, none
Motor response: to verbal commands, localized pain, flexion/withdrawal, abnormal flexion, extension, none
Verbal response: A&O x3, conversation confused, speech inappropriate, speech incomprehensible, none.

Normal total=15

98
Q

Neurological recheck

A
  1. Level of consciousness
  2. Motor function
  3. Pupillary response
  4. Vital signs
99
Q

Increasing stimuli to use for level of consciousness recheck

A
  1. Name called
  2. Light touch on arm
  3. Vigorous shake of shoulder
  4. Pain applied (pinch, rub knuckles on sternum)
100
Q

Motor function

A

check for weak grip, pronator drift, abnormal posturing of feet, decerebrate rigidity

101
Q

localizing

A

pushing hand away after a painful stimuli- characterized as purposeful movement

102
Q

abnormal posturing, decorticate rigidity, decerebrate rigidity on motor function recheck indicates

A

diffuse brain injury

103
Q

Pupillary abnormalities indicate

A

increasing ICP pushing the brainstaim down (uncal herniation), puts pressure on CN III and causes pupil dilation

104
Q

Cushing reflex vital signs

A

signs of increasing ICP:
Sudden elevation of BP and widening pulse pressure
Decreased and bounding pulse

105
Q

FAST signs of stroke

A

Face drooping
Arm weakness
Speech difficulty
Time to call 911

106
Q

10 Warning signs of Alzheimer’s diease

A
  1. Memory Loss
  2. Losing track of steps in a task
  3. Forgetting words
  4. Getting lost
  5. Poor judgment
  6. Abstract thinking failure
  7. Losing things
  8. Mood swings- changes in mood or behavior
  9. Personality change (dramatic)
  10. Growing passive- loss of initiative
107
Q

Rigidity

A

constant state of resistance- lead pipe rigidity- resists passive movement in any direction, dystonia. Occurs with injury to extrapyramidal motor tracts- eg parkinsonism

108
Q

cogwheel rigisity

A

Rigidity in which increased tone is released by degrees during passive range of motion- feels like small, regular jerks
Associated with parkinsonism

109
Q

Fasciculation

A

Rapid, continuous twitching of resting muscle or part of muscle without limb movement
Fine- occurs with LMN disease, associated with atrophy and weakness
Coarse- occurs with cold exposure or fatigue, not signficant

110
Q

Myoclonus

A

rapid, sudden jerk or series of jerks at regular intervals. Single extremity jerk normal when falling asleep. Severe with grand mal seizures.

111
Q

Tic

A

involuntary, compulsive twiching of a muscle due to neurologic or psychogenic cause. Tardive dyskineasia, tourette’s.

112
Q

Chorea

A

sudden, rapid, jerky movement involving limbs, trunk, or face. More convulsive than a tic. Accentuated with voluntary movement. Occurs in Sydenham chorea and Huntington disease.

113
Q

Athetosis

A

Slow, twisting, writhing, continuous movement. Snakelike. Distal more than proximal. Cerebral palsy- disappears with sleep. Athetoid hand- some fingers flexed, some extended.

114
Q

tremor

A

involuntary contraction of opposing muscle groups, results in rhythmic back and forth movement of one or more joints. May occur at rest or with voluntary movement. Disappears while sleeping. May be slow or rapid.

115
Q

Rest tremor

A

Occurs when muscles are quiet and supported against gravity. Coarse and slow. Disappears with voluntary movement- parkinsonism

116
Q

Intention tremor

A

Worse with voluntary movement, reaching towards an object. Occurs with cerebellar disease and MS

117
Q

Essential tremor (familial)

A

intention tremor, most common tremor in older adults. Benign but may cause emotional stress. Improves with sedatives, propranolol, or alcohol.

118
Q

Parkinsonism vs senile tremors

A

Parkinsonism includes rigidity and slowness, weakness of voluntary movement.

119
Q

Vibration sensation in older adult

A

Loss of sensation of vibration in the ankle malleolus is common along with loss of ankle jerk.

120
Q

Position sense in the big toe in the aging adult

A

may be lost

121
Q

Sensation in the aging adult

A

tactile may be impaired
stronger stimuli for light touch needed
pain sensation dulled

122
Q

DTRs in aging adult

A 
less brisk
usually present in upper extremities
ankle jerk commonly lost
knee jerk may be lost, but less common
Always use reinforcement in aging adult- may be harder to relax limbs
123
Q

Plantar (Babinski) reflex in aging adult

A

May be absent or difficult to interpret

124
Q

Flexor plantar response in aging adult

A

often no normal definite response

125
Q

Extensor plantor response in aging adult

A

Definite response is still abnormal!

Health Assessment (20 decks)

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