2. Cognitive Exam Flashcards Preview

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Flashcards in 2. Cognitive Exam Deck (101)
1

Define agnosia

inability to perceive/understand the import of sensory stimuli despite intact sensory mechanisms. perception devoid of meaning.

2

define anosagnosia

inability to recognize own neurological deficit.

3

define apraxia

inability to perform learned actions despite intact motor functions

4

define receptive aphasia

inability to understand. characteristic of Wernicke's

5

define expressive aphasia

inability to express via speech. characteristic of Broca's

6

define global aphasia

inability to comprehend, produce, repeat speech.

7

define alexia

visual agnosia. inability to read.

8

define agraphia

inability to write. Akin to expressive aphasia

9

define disinhibition

frontal lobe lesion accompanied by inappropriateness, etc

10

define dysnomia

anomia, difficulty naming items

11

define paraphasia

well-articulated but incorrect words. includes neologisms, semantic paraphasia, phonemic paraphasia

12

Language: bilateral or unilateral?

uni.

13

attention to the non-dominant world: bilateral or unilateral?

uni

14

somatic sensation: bilateral or unilateral?

uni

15

vision: bilateral or unilateral?

uni

16

voluntary motor function: bilateral or unilateral?

uni

17

hearing: bilateral or unilateral?

bi (Heschel's gyrus)

18

short term memory: bilateral or unilateral?

bi (medial temopral lobe)

19

frontal lobe functions (mood, behavior, emotional control, motivation, exec function): bilateral or unilateral?

bi

20

long-term memory: bilateral or unilateral?

diffuse (both)

21

visuospatial function: bilateral or unilateral?

bi. parietal lobe

22

aphasia is lateralized where?

to the dominant hemisphere

23

patients with Broca's, Wernicke's, global and conductive aphasias will be unable to do what?

repeat complex phrases

24

Broca's area infarction results in what?

very reduced speech, repetition and naming. intact aud and visual language comprehension (reading). frustration.

25

Wernicke's area infarction results in what?

output that is active but nonsensical, inability to comprehend language. inability to repeat and name things. not frustrated.

26

conduction aphasia is due to a lesion where?

arcuate fasciculus.

27

define conduction aphasia

reasonably normal expression and comprehension, but impaired repetition of simple and complex phrases.
Inability to repeat due to interruption of the arcuate fasciculus. Fluent, but with paraphasias. Comprehension may be OK.

28

damage to the dominant occipital lobe and splenium of the corpus callosum yields what?

alexia without agraphia. can write but can't read what they're written

29

immediate recall occurs where?

frontal lobe

30

short term memory occurs where?

hippocampus

31

long term memory occurs where?

diffusely. only lost if large and diffuse areas are damaged

32

the non-dominant parietal lobe does what?

attention to the contralateral world

33

lesion of the non-dominant parietal lobe yields what?

hemi-inattention/neglect of the non-dominant world. impaired recognition of self, inability to learn that deficits exist in non-dominant motor/sensory functions.

34

what does the frontal lobe do?

exec functions like initiative, sequencing, planning, problem solving.

35

lesion to the frontal lobe yields what?

personality change, failure of executive function, difficulty with activities of daily living

36

orbitofrontal injury can lead to what/

disinhibition, aggression

37

what can a corpus callosum transection yield?

split brain: information not transferred from side to side, R hand not knowing what L hand is doing.

38

what does the neurological exam include?

mental status, cranial nerves, motor systems, reflexes, sensory systems, coordination, gait

39

when to do the mental status exam?

known brain lesion, suspected brain lesion, psychiatric disease, behavioral complaints

40

what is included in the mental status exam?

LOC, attention, concentration, cognitive functions, thought processes, thought content, affect

41

define dementia

a generalized deterioration of intellectual or cognitive function, particularly memory, without altered alertness or perception

42

define confusion

acute thinking disorder. expected to improve.

43

define delirium

acute thinking disorder plus altered consciousness, hyperactivity, irritability etc

44

define encephalopathy

Broadly, diffuse alteration in brain function generally including disordered thinking. Static.

45

define amnesia/retrograde/anterograde

pure loss of memory without other cognitive loss
Retrograde amnesia – loss of memory prior to a specific time
Anterograde amnesia – loss of memory after a specific time

46

define aphasia

language impairment

47

4 levels of consciousness?

awake
somnolent
stuporous
coma

48

how to test attention/concentration?

digit span, spell world/backwards

49

define aprosody

loss or impairment of the use and understanding of inflection

50

semantic paraphasia

substitute wrong word

51

phonemic paraphasia

substitute wrong sound

52

neologism

use of non-existent word

53

why is Broca's often seen with R hemipareisis?

lesion usually on L side because of L sided language dominance

54

what are 4 tests of language?

-pace of speech (should be 12-50 words per minute)
-naming items and parts of items
-comprehension (paper, fold, put on floor)
-repetition of phrases
-reading
-writing

55

where is Broca's aphasia lesion?

inferior precentral gyrus

56

where is Wernicke's aphasia lesion?

upper posterior temporal

57

where is conduction aphasia lesion?

inferior parietal

58

where is global aphasia lesion?

large area in parietal and frontotemporal

59

where is music localized?

R hemisphere

60

72 year old left-handed man was noted by his wife to be confused this morning. On exam he has some difficulty naming items as well as trouble following complex commands. He is noted to have atrial fibrillation on ECG. He is otherwise intact. Where might you expect a lesion?

L posterior temporal

61

what are the parts of memory that we test?

episodic, short term/working

62

where does episodic memory reside?

medial temporal (bil), hippocampus, mammillary body

63

where does short term memory reside?

frontoparietal regions

64

62 year old man was seen in the ED because of “altered mental status”. On exam he has some difficulty remembering events, and in fact seemed to make up some details to mask this problem. He was not well-oriented. Language was good. Where might you expect a lesion?

medial temporal (bil), hippocampus, mammillary body

65

acalculia results from a lesion where?

dominant parietal lobe

66

how to test calculation?

serial 7s, adding

67

prospagnosia

inability to recog faces

68

astereognosia

inability to recognize items by touch

69

visual agnosia

Inability to recognize objects despite normal vision.

70

visual agnosia: location?

Lesion is usually bilateral parieto-occipital cortex.

71

prospagnosia: location?

Lesions usually in bilateral occipital lobes.

72

simultagnosia

Can see objects but cannot sort them out from one another.
Cannot see forest for trees

73

alexia: location?

Lesion in L temp-parieto-occipital region

74

Alexia: be sure to rule out what?

Visual impairment
Diplopia
Field defect - L
Simultanagnosia
Illiteracy

75

Agraphesthesia

inability to recognize numbers traced on hand

76

auditory agnosia

inability to recognize and identify specific sounds despite normal hearing

77

auditory agnosia: location?

Lesion usually in non-dominant temporal lobe. non-dom because that's the side we process music on.

78

anosognosia: location

non-dominant parietal lobe

79

neglect: location

Lesion usually contralateral parietal lobe, esp R
Ventral thalamic lesions can produce neglect too
Visual neglect - parieto-occip lesions

80

Neglect syndrome testing?

cross all the lines in half, circle all the As: pt will only do task in right side of visual field

81

83 year old woman is brought to the ER from for retirement home because of confusion
On exam she is awake and neurologically intact but she seems to ignore you and does not move her left side unless coaxed. MRI reveals a stroke.
Where?

R parietal

82

agraphia: location?

dominant posterior frontal cortex

83

Gerstmann's Syndrome: symptoms?

agraphia
finger agnosia
L/R disorientation
acalculia

84

Gerstmann's Syndrome: location?

dominant angular gyrus, corpus callosum

85

constructional apraxia: definition

inability to copy or construct figures. disturbance in visuo-spatial abilities rather than pure apraxia

86

constructional apraxia: lesion?

non-dominant parietal cortex

87

tests of constructional ability?

clock drawing, overlapping pentagons, cube

88

A 57 year old man with Parkinson’s disease has a great deal of trouble performing simple actions like combing his hair.
What is a likely cause of this?
-Bradykinesia (slowness of movement)
-Dementia
-Procedural memory deficit
-Apraxia
-Depression

all of these

89

ideomotor apraxia

inability to perform a specific task when asked. ie, unable to show how to use a comb, use a key

90

ideomotor apraxia: location

usually non-localizable, but can be due to disconnection (callosal lesion preventing opp side from receiving command from Wernicke's)

91

gait apraxia: location

bil frontal lobes

92

gait: wide based, unable to tandem

ataxia

93

gait: stooped, smalls steps, turns en bloc

Parkinsonian

94

gait: high knee-lift, foot slapping

foot drop

95

gait: stiff, short steps, scissoring

spastic paresis

96

gait: slow and unsteady, magnetic

apractic

97

social inappropriateness, disinhibition, euphoria, abnl sexual beh: where is lesion?

orbitofrontal

98

apathy, akinesis, abulia: where is lesion?

medial frontal

99

irritability, inflexibility, reduced sex interest, loss of exec function: where is lesion?

dorsolateral

100

frontal lobe testing: observe what, and ask what?

observe for perseveration, slowness/abulia, apathy
judgment: pose a scenario
proverbs: ask to interpret
planning: how would you...
working memory

101

types of perceptual disturbances?

illusions - misinterpretation
hallucinations - sensory
depersonalization
derealization