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Neuroanatomy 2 > Module 8 > Flashcards

Module 8 Flashcards

0
Q

What is stroke?

A

An acute onset of neurological dysfunction due to an abnormality in a cerebral circulation with resultant signs and symptoms that correspond to involvement of focal areas of the brain.

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1
Q

What is another name for stroke?

A

Cerebral vascular accident (CVA)

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2
Q

What number is stroke in regards to death?

A

Number four

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3
Q

What number is stroke in regards to disability?

A

Number one

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4
Q

Are males or females more likely to have stroke?

A

Females

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5
Q

What is the prevalence rate of stroke?

A

7,000,000

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6
Q

What is the incidence rate of stroke?

A

750,000

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7
Q

What is the mortality rate of stroke?

A

140,000

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8
Q

What are the modifiable risk factors?

A 
TIA
HTN
obesity
Alcohol
Smoking
Heart disease
Diabetes mellitus
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9
Q

What are the un-modifiable risk factors?

A 
Age
Race
Gender
Prior stroke
Family history of stroke
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10
Q

What are the symptoms of a transient ischemic attack?

A

Loss of balance
Numbness in the face
Small stroke

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11
Q

What are the diagnostic procedures for stroke?

A

Blood panel
Diagnostic imaging-
ECG/EKG, echocardiogram, CT or MRI, ultrasound transcranial Doppler

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12
Q

What percent of strokes are ischemic?

A

87%

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13
Q

What aspects make up an ischemic stroke?

A

Cerebral thrombosis

Cerebral embolism

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14
Q

What percent of strokes are hemorrhagic strokes?

A

13%

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15
Q

What aspects make up a hemorrhagic stroke?

A

Intracerebral
Subarachnoid
Arteriovenous malformation

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16
Q

What are the symptoms of a right hemisphere stroke?

A

Left hemiparesis
Left hemi-sensory loss
Visual-perceptual deficits
Impulsive/poor judgement

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17
Q

What are the symptoms of a left hemisphere stroke?

A

Right hemiparesis
Right hemi-sensory loss
Slow and cautious behavior
Speech/language deficits

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18
Q

What is the anterior cerebral artery syndrome (ACA)?

A

Branch of internal carotid artery.
Supplies medial cerebral hemisphere (frontal and parietal lobes) and subcritical structures.
Contralateral hemiparesis, sensory loss LE>UE, and usually no facial involvement.
Memory problems
Motor weakness

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19
Q

What is middle cerebral artery syndrome (MCA)?

A

Branch of internal carotid artery
Supplies lateral cerebral hemisphere (frontal, temporal, and parietal lobes) and subcortical structures.
Most common site of occlusion in stroke
Contralateral spastic hemiparesis, sensory loss, UE and face> LE.

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20
Q

What is the internal carotid artery syndrome (ICA)?

A

Supplies anterior and middle cerebral arteries
Complete occlusion usually results in death
Incomplete occlusion procedure combination of ACA and MCA characteristics

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21
Q

What is the posterior cerebral artery syndrome (PCA)?

A

Supplies occipital, medial and inferior temporal lobes, upper brain stem, midbrain, and posterior diencephalon.
Contralateral hemiplegia, sensory loss, visual impairments, and thalamic pain syndrome

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22
Q

What causes lacunar syndromes?

A

Deep small vessel disease and are consistent with specific anatomical sites

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23
Q

What are the symptoms of lacunar syndrome?

A

Poor memory
Weaker areas
Areas of cell death
Punumbra

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24
Q

What is the definition of punumbra?

A

Cell area around it that are effected because first cell death cause further cell death.

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25
Q

What is vertebrobasilar artery syndrome?

A

Supplies cerebellum, medulla, pons, and internal ear.
Complete occlusion frequently results in death
Incomplete occlusion procedures tremendous variety of symptoms ipsilaterally and contralaterally including locked-in syndrome, bulbar palsy, Wallenberg’s syndrome, vestibular deficits, and cerebellar deficits.

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26
Q

What are the drugs used for stroke?

A 
Thrombus-Caumadin
Hypertension-procardia
Seizure-Dilantin
Spasticity-Baclofen
Pain-Vicodin
Insomnia-Ambien
Depression-Paxil
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27
Q

What is the rehabilitation process?

A 
Medically stable
Functional recovery potential
Strength impairments
Sensory and perceptual impairments
Coordination impairments
Balance impairments
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28
Q

Who’s part of the rehabilitation team?

A 
Patient and family
Physician
Nurse
PT/O/ST/OP
Case manager
Social worker
Neuropsychologist 
Recreational therapist
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29
Q

What is involved in subjective examination?

A

Medical chart review
Nursing consultation
Patient and/or family interview

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30
Q

What are the levels of consciousness?

A

Standard descriptive terminology
Normal
Lethargy: drowsy, able to respond briefly
Obtundation: difficult to arouse, confused
Stupor: unresponsive, awakened by intense stimuli
Coma: unresponsive

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31
Q

What is the Glasgow coma scale?

A

Eye opening, best motor response, verbal response
13-15: mild
9-12: moderate
<severe

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32
Q

What are the communication and swallowing neuromotor disorders?

A

Dysarthria
Verbal apraxia
Dysphagia

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33
Q

What is dysarthria?

A

Impaired speech, and non-speech oral muscles
Not smooth speech
Clipped

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34
Q

What is verbal apraxia?

A

Impaired speech muscles/Broca’s aphasia

Hard to get words out

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35
Q

What is dysphagia?

A

Impaired swallowing

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36
Q

What are the communication and swallowing aphasia?

A

Global aphasia
Broca’s aphasia
Wernicke’s aphasia

37
Q

What is global aphasia?

A

Designation of severity versus type

Can’t follow commands or listen

38
Q

What is Broca’s aphasia?

A

Non-fluent or expressive aphasia

Know they are not saying the right thing but still only say one word and phrase

39
Q

What is Wernicke’s aphasia?

A

Fluent or receptive aphasia

Think they are saying something different but say one phrase or word

40
Q

What is involved in a cognitive physical examination?

A

Orientation (person, place, time, and circumstance)
Ability to follow 1-3 step commands
Mini-mental state examination
Perseveration

41
Q

What is perseveration?

A

A thought is persistent.

They can’t get redirected to a test

42
Q

How to examine for a patient’s emotional and behavior status?

A

Emotional lability (pseudobulbar affect)
Depression
Apathy

43
Q

What is emotional lability?

A

May start crying even if they are not sad

44
Q

What is the average temperature range of a person?

A

96.8-99.5 degrees F

45
Q

What is the normal blood pressure range?

A

95-119/60-79mmHg

46
Q

What is the average range for heart rate?

A

60-90 beats/minute

47
Q

What is the average range of respiratory rate?

A

12-20 breaths/minute

48
Q

What is the average range for oxygen saturation rate?

A

95-100%

49
Q

What is involved in a bladder and bowel examination?

A

Hyperreflexia check
Hyporeflexia
Sphincter control
Sensory loss

50
Q

What is hyperreflexia?

A

Stimulus makes them go even faster

51
Q

How to examine the integumentary system?

A

Color
Integrity
Pressure sores

52
Q

How do you measure for sensory integrity?

A

Superficial, deep, and combined cortical

Pain (thalamic pain, hyperalgesia)

53
Q

What are some visual impairments to be checked for in stroke?

A

Visual neglect

Homonymous hemianopsia- half of one eye and half of the other. Can’t see all of the left or right side

54
Q

What is cranial nerve one?

A

Olfactory nerve

55
Q

How is the olfactory nerve tested?

A

Asking patient to identify items with very specific odors (soap, coffee) placed under nose; each nostril tested separately

56
Q

What is cranial nerve two?

A

Optic

57
Q

How do you tested the optic nerve?

A

Asking patient to read an eye chart; peripheral vision is tested by asking patient to detect objects from corners of eye

58
Q

What is cranial nerve three?

A

Occulomotor

59
Q

How do you test the occulomotor nerve?

A

Ability to move each eye up, down, and inward is tested by asking patient to follow a target moved by examiner.
Pupil’s response to light is checked by shining a bright light into each pupil in a darkened room.
Upper eyelid is checked for drooping (ptosis)

60
Q

What is the fourth cranial nerve?

A

Trochlear

61
Q

Hw do you test the trochlear nerve?

A

Test the ability to move each eye down and inward is tested by asking the patient to follow a target moved by the examiner

62
Q

What is the fifth cranial nerve?

A

Trigeminal

63
Q

How do you test the trigeminal cranial nerve?

A

By using a pin and wisp of cotton; blink reflex is tested by touching cornea of eye with cotton wisp
Strength and movement of muscles that control the jaw are tested by asking patient to clench teeth and open jaw against resistance

64
Q

What is the sixth cranial nerve?

A

Abducens

65
Q

How is the abducens cranial nerve tested?

A

Ability to move each eye outward beyond midline is tested by asking patient to look to the side

66
Q

What is the seventh cranial nerve?

A

Facial nerve

67
Q

How do you test the facial cranial nerve?

A

Ability to move face is tested by asking patient to smile, open mouth, show teeth, and close eyes tightly.
Taste is tested using substances that are sweet, sour, and salty.

68
Q

What is the eighth cranial nerve?

A

Vestibulocochlear

69
Q

How do you test the vestibulocochlear cranial nerve?

A

Hearing is tested with a tuning fork.

Balance is tested by asking patient to walk a straight line or by performing head thrust test.

70
Q

What is the ninth cranial nerve?

A

Glossopharyngeal

71
Q

What is the tenth cranial nerve?

A

Vagus

72
Q

How do you test the glossopharyngeal and vagus cranial nerves?

A

The patient is asked to swallow, say “ah” to check movement of palate and uvula, back of throat is touched with a tongue blade to evoke gag reflex, patient is asked to speak to determine whether voice sounds nasal

73
Q

What is e eleventh cranial nerve?

A

Accessory

74
Q

How do you test the accessory cranial nerve?

A

Patient is asked to turn head and shrug shoulders against resistance.

75
Q

Wt is the twelfth cranial nerve?

A

Hypoglossal

76
Q

How do you test the hypoglossal cranial nerve?

A

Patient is asked to stick out tongue and it is observed for deviations to one side or the other.

77
Q

How do you test for joint integrity and mobility in a physical examination?

A

Passive and active ROM

78
Q

What are the three examinations used to test perception in a physical examination?

A

Body Schema/image
Spatial relation
Agnosia- not being able to tell what objects are.

79
Q

What are the brunnstrum stages of motor recovery?

A

Flaccid
Minimal voluntary synergistic movement, spasticity emerges
More voluntary synergistic movement, spasticity maximal
Some movements out of synergy, spasticity declines
Synergy patterns lose dominance
No spasticity, individual joint movements possible

80
Q

What are the two different classifications of weakness?

A

Hemiplegia- complete

Hemiparesis- incomplete

81
Q

What are the different levels of the modified ashworth scale (MAS)?

A

0- no increase in muscle tone
1- minimal increase in muscle tone at end of range
1+- minimal increase in muscle tone (less than half PROM)
2- more marked increase in muscle tone (most PROM)
3- considerable increase in muscle tone (PROM difficult)
4- rigid

82
Q

What are the four abnormal (obligatory) synergy patterns?

A

Upper extremity flexion pattern-muscle man
Upper extremity extension pattern- punching ground across body
Lower extremity flexion pattern
Lower extremity extension pattern

83
Q

What is involved in the upper extremity flexion pattern- muscle man?

A 
Scapular retraction, elevation
Shoulder abduction, external rotation
Elbow flexion
Forearm supination
Wrist and finger flexion
84
Q

What is involved in the upper extremity extension pattern- punching ground with hand twisting outward?

A 
Scapular protraction
Shoulder adduction, internal rotation
Elbow extension
Forearm pronation
Wrist and finger flexion
85
Q

What is involved in lower extremity flexion pattern- sitting with abducted hip and internal rotation?

A

Hip flexion, abduction, external rotation
Knee flexion
Ankle dorsiflexion and inversion
Toe dorsiflexion

86
Q

What is involved in lower extremity extension pattern?

A

Hip extension, abduction, internal rotation
Knee extension
Ankle plantarflexion and inversion
Toe plantarflexion

87
Q

What are the four abnormal reflexes?

A

Hyporeflexia, flaccidity-reflexes aren’t going to work
Hyperreflexia, clonus, clasp knife response, bobinski
Tonic reflexes (ATNR)- turn head, arms out on opposite side
Associated reactions- reaction that pulls it back to the flexed position.

88
Q

What are the three altered coordinations?

A

Ataxia-(cerebellar lesions)
Bradykinesia (basal ganglia lesions)- slow movement
Choreoathetosis and hemiballismus (basal ganglia lesions)- huge random movements.

89
Q

What are the two altered motor programmings?

A 
Ideational apraxia (inability automatically or on command)- cannot understand the idea or what to do
Ideomotor apraxia (automatically but not on command)- may not be able to understand when you request it, but spontaneously they can perform a task.
90
Q

What a the four different postural abnormalities?

A

Asymmetrical stance- not standing straight up and down
Reactive postural control
Anticipatory postural control
Ipsilateral pushing (pusher syndrome)- 18 degrees pushing away from stronger side because they think that’s straight.

91
Q

How do you test for functional mobility and ambulation in a physical examination?

A

Bed mobility
Transfers
Gait/locomotion

Neuroanatomy 2 (8 decks)

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