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Neurology- PM1 > Week 1 > Flashcards

Week 1 Flashcards

1
Q

FOGS

A

-Assessing pt. cognitive status –> should be assessed at beginning to drive the rest of the eval
F = Family report of memory loss
O = Orientation to person, place, time
G = General info recall
S = Spelling (WORLD forward and backward, or counting task)

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2
Q

Components of the Neuromuscular Assessment

A
  • cognitive assessment
  • communication assessment
  • cranial nerve assessment
  • sensory assessment
  • motor control assessment
  • functional assessment
  • coordination assessment
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3
Q

Aphasia

A

Impairment in Broca’s area (expressive language) or Wernicke’s area (receptive language)
-difficulty with spoken language, reading, writing, hand gestures/sign language

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4
Q

Dysarthria

A

Problems with the motor component of speech

-can’t articulate well, makes their speech slurred

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5
Q

Why assess cranial nerves?

A
  • Allows examiner to localize brainstem dysfunctions
  • May be affected by a wide range of conditions including trauma, infection, CVA, tumor, intracranial inflammation
  • Dysfunction in certain CN may help to rule in or rule out certain diagnoses
  • CN assessment is not necessary for all patients
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6
Q

3 Primary roles of sensation in movement

A
  • Guide selection of motor responses for effective interaction with the environment via feedforward info
  • Adapt movements and shape motor programs through feedback for corrective action
  • Protect the organism from injury
  • Assessment of sensation aids us in diff-dx as well as looking at sensory integrity
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7
Q

Deficits in sensory integrity result it..

A

poor motor planning, organization, and performance

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8
Q

Indications for sensory assessment

A

-Impaired locomotion
-Impaired joint mobility or integrity
-Impaired motor control/motor function
-Impaired muscle performance
-Impaired neuromotor development
-Impaired reflex integrity
-Impaired posture
-Impaired ventilation, respiration, circulation
Pain

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9
Q

What do we assess during sensory assessment?

A
  • Afferent inputs
  • Peripheral sensory processing –> superficial sensation, deep sensation, combined cortical
  • Cortical sensory processing –> DCML and ALS
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10
Q

Combined cortical

A
  • stereognosis: object recognition
  • tactile localization
  • two-point discrmination
  • barognosis (recognition of weight)
  • graphesthesia (identification of traced figure)
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11
Q

ALS

A
  • crude touch: pain, temperature, tickle, itch, sexual sensation
  • activated primarily by mechanoreceptors, thermoreceptors, nocioreceptors
  • small, slow afferent fibers
  • crosses over almost immediately in spinal cord
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12
Q

DCML

A
  • discriminative, finely graded sensation, precise location
  • large, rapidly conducting fibers
  • ascends ipsilaterally to medulla, synapses, then crosses over
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13
Q

Deep Tendon Reflexes

A
  • involuntary, predictable, specific
  • ‘2’ is ‘normal’
  • hyperreflexia may indicate UMN lesion
  • hyporeflexia may indicate LMN lesion
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14
Q

DTR Grading Scale

A 
0 = absent; no reflex response
1 = minimal response
2 = moderate response
3 = brisk, strong response
4 = clonus
*grades of 1-3 are considered WNL for some patient, combined with other findings may indicate something more specific
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15
Q

Muscle tone

A

Resistance of a resting muscle to passive elongation or stretch
-3 main categories: hypotonicity, hypertonicity, and dystonia

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16
Q

Factors that contribute to normal muscle tone:

A
  • physical inertia
  • intrinsic mechanical-elastic stiffness of mm. and connective tissue
  • active muscle contraction
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17
Q

Hypotonicity

A
  • decrease in tone below resting level
  • indicative of LMN lesion (could be in anterior horn, spinal nerves, peripheral nerves, or NMJ)
  • flaccidity
  • diminished DTRs
  • fibrillations on EMG
  • hyperextensibility or “floppy” limbs and joints
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18
Q

Hypertonicity

A

Increase in tone above resting levels

  • 2 types: spasticity (clonus, clasp-knife); rigidity (cogwheel, lead pipe)
  • indicative of UMN lesion (pyramidal pathways, cerebellum, or basal ganglia)
  • abnormal timing
  • paresis or plegia
  • brisk DTRs, +Babinski
  • dysynergic patterns of movement
19
Q

Dystonia

A

Hyperkinesis due to CNS injury; Impaired or disordered tone that fluctuates in an unpredictable pattern

  • repetitive involuntary movements: usually twisting or writhing
  • periods of dystonic posturing (sustained abnormal postures caused by contractures of muscles that may last minutes, hours, or permanently
20
Q

Coordination of movement

A

Ability to execute smooth, accurate, controlled motor responses
-requires coordinated effort of all the components of the motor system

21
Q

Intralimb coordination

A

Using one UE to to brush the hair requires coordination at the shoulder, elbow, wrist, and fingers

22
Q

Interlimb coordination

A

Integrated performance of two or more limbs working together- LEs/UEs during walking

23
Q

Visual motor coordination

A

Integration of visual and motor activities with the environment to accomplish a goal (writing a letter, driving a vehicle)
-eye-hand coordination

24
Q

Nonequilibrium coordination tests

A

address both static & mobile and gross & fine motor components of movement with the subject not attempting to maintain balance

25
Q

Equilibrium coordination tests

A

address static and dynamic components of balance and posture

26
Q

Three main areas that impact higher level processing and execution of coordinated motor responses:

A

-cerebellum
-basal ganglia
-DCML
All three work together with and provide input to the cortex for coordinated movement

27
Q

Ataxia

A

most common term used for cerebellar impairments affecting gait, posture, or patterns of movement (can be caused by other things than cerebellum)

28
Q

Dysarthria

A

disorder of the motor component of speech, can be slow, slurred, hesitant with inappropriate pauses
-manifestation of cerebellar pathology

29
Q

Dysdiadochokinesia

A

unable to perform rapid alternating movements (quickly switching between muscle groups)
-manifestation of cerebellar pathology

30
Q

Dysmetria

A

inability to judge distance or range, can be hyper or hypometric
-manifestation of cerebellar pathology

31
Q

Dyssynergia

A

movement broken into parts rather than smooth simple activity
-manifestation of cerebellar pathology

32
Q

Gait ataxia

A

wide BOS, arms may be in high guard, steps are irregular, unsteady, veering
-manifestation of cerebellar pathology

33
Q

Nystagmus

A

rhythmic, involuntary quick eye movements

-manifestation of cerebellar pathology

34
Q

Rebound phenomenon

A

check reflex

-manifestation of cerebellar pathology

35
Q

Tremors

A

involuntary, oscillating movements

  • intention: during volitional movements
  • postural: back and forth oscillations of body in standing
36
Q

Akinesia

A

inability to initiate movement (freezing)

-manifestations of basal ganglia pathology

37
Q

Athetosis

A

slow, involuntary writhing, twisting, wormlike movements

-manifestations of basal ganglia pathology

38
Q

Bradykinesia

A

decreased amplitude of velocity of movement

-manifestations of basal ganglia pathology

39
Q

Chorea

A

involuntary, rapid, irregular, jerky movements

-manifestations of basal ganglia pathology

40
Q

Dystonia

A

involuntary contractions of agonist/antagonist causing abnormal posturing
-manifestations of basal ganglia pathology

41
Q

Hemiballismus

A

large amplitude sudden violent flailing motions of arm/leg on 1 side
-manifestations of basal ganglia pathology

42
Q

Rigidity

A

increased muscle tone

-manifestations of basal ganglia pathology

43
Q

Resting tremors

A 
pill rolling (you see their tremors when they are still, volitional movement makes them go away)
-manifestations of basal ganglia pathology
44
Q

DCML manifestations

A
  • gait disturbance
  • +Romberg due to proprioceptive loss
  • dysmetria
  • visual feedback can compensate so they mask DCML pathology well a lot of the time

Neurology- PM1 (4 decks)

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