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PCM 2.2 > CNS - Pitcher > Flashcards

CNS - Pitcher Flashcards

1
Q

CNS includes

A 
Cortex
Basal Ganglion 
Brain Stem 
Cerebellum 
Spinal Cord
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2
Q

Neurological Examination

A

A “top to bottom” approach: the cortex to the brainstem, the cerebellum, the spinal cord, and then peripheral nerves

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3
Q

Neurological Examination Order

A
  1. Mental Status Examination (MSE)
  2. Cranial nerves
  3. Cerebellum
  4. Motor
  5. Sensory
  6. Deep Tendon Reflexes
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4
Q

Mental Status Exam

A
  1. Appearance and Behavior
  2. Mood/Affect
  3. Speech/Language
  4. Thoughts/perceptions
  5. Cognitive/Executive functions
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5
Q

Appearance and Behavior

A
  • Level of Consciousness: impaired by disease of brainstem reticular system or BOTH hemispheres
  • Posture and Motor
  • Hygiene
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6
Q

Level of Consciousness

A
  • Alert: Awake, responding appropriate to environment
  • Lethargic: awake, but tending to fall asleep if not gently stimulated
  • Stuporous: Falling asleep unless vigorously stimulated
  • Comatose: sleep like state; patient cannot not be awakened
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7
Q

Mood/Affect

A
  • Observe expression and affect: Appropriate for situation? Engaged? Angry? Anxious? Indifferent? Detached? Fearful?
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8
Q

Language

A
  • Language Exam should include: Spontaneous speech, Naming, Comprehension, Repetition, Reading, Writing
  • Evaluate for aphasia = disorder in producing or understanding language
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9
Q

Spontaneous Speech

A

Look For:

  • Articulation
  • Appropriate word finding; Paraphasic Errors = substituting similar sounding syllables or words (pen for pencil)
  • Normal prosody = the melody or variable tone of speech
  • Verbal Fluency - maintain approp rate, flow, volume, content, meaning and melody
  • if lacking = check for aphasia
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10
Q

Testing for aphasia

A
  1. Ability to name Objects; Anomia = loss of ability to name common objects - true maker of aphasia
  2. Comprehension - follow commands
  3. Repetition - repeat simple words/phrase
  4. Reading and Writing
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11
Q

Aphasia

A
  • Disorder in understanding or producing language - spoken or written
  • d/t injury, disease, psychogenic
  • d/t locaized lesion in dominant hemisphere of the brain; most common in left hemisphere
  • may be the only sign of a new neurological disease (stroke, tumor, head trauma, seizure)
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12
Q

Dysphasia

A

Impairment in the use of Speech - failure to arrange words properly in a sentence

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13
Q

Dysarthria

A

Imperfect articulation due to lack of motor coordination; damaging event to CNS or PNS; Language comprehension and use may be fine

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14
Q

Wernicke’s Area

A
  • Transforms sensory input into neural word representation to give a word meaning
  • Damage to Wernicke, Broca or their interconnections cause aphasia
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15
Q

Broca’s Area

A
  • Transforms neural word representations (from Wernicke’s) into actual articulations that can be spoken
  • Damage to Wernicke, Broca or their interconnections cause aphasia
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16
Q

Brocas Aphasia

A
  • “Expressive” aphasia

- Understanding of spoken language in mostly preserved

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17
Q

Wernicke’s Aphasia

A
  • “Receptive” aphasia

- Fluent speech that makes no sense

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18
Q

Apraxia

A

= Inability to turn verbal request into motor performance

  • associated with aphasia
  • pts have difficulty with complex but familiar activities (ex writing with a pen)
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19
Q

Thoughts and Perception

A
  1. Process - assess logic, relevence and organizations. Are they coherent?
  2. Content - phobias, anxieties, obsessions, delusions, hallucinations
  3. Insight - the ability to understand their own problem
  4. Judgment - approp decisions/actions for situation
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20
Q

Cognitive Function

A
  • Orientation: person, place, time
  • Attention: ability to concentrate
  • Memory: recent and remote
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21
Q

Executive Function

A
  • Abstract thinking/insight
  • Calculation
  • Constructional ability
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22
Q

Orientation

A
  1. Person - usually only lost with aphasia or schizophrenia
  2. Place - lost in delirious/extremely demented outpatients
  3. Time - Most commonly lost of the three; day, time, week, month, year
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23
Q

Recent Memory

A

The ability to store new information - up to a few days

24
Q

Remote Memory

A

More distant memories; includes autobiographical or historical

25
Q

Alzheimer’s Disease

A
  • Almost always begins as a progressive loss of memory; First recent then distant memory
  • Memory loss can be the only symptom of brain disease
26
Q

Recent Memory Testing

A
  • Listen to 3 words and repeat them in 3-5 minutes
  • Normal patient will recall 2/3; recalling 0 or 1 = pathological
  • Can also ask: how long have you been in the hospital? what did you eat for breakfast? etc.
27
Q

Testing Remote Memory

A
  • Tests less often; used to confirm dementia dx

- Ex: when did you graduate/get married/retire?

28
Q

Executive Function Insight

A
  • Insight/Judgement, reasoning ability, abstract thinking
  • tests “higher abilities” pt should have before illness
  • Tests for DEMENTIA, any disease of the FRONTAL LOBES (and their connections)
  • Crucial in dx’ing Alzheimer’s Disease
29
Q

Executive Function Insight testing

A
  1. Proverbs
  2. Insight: “What do you do if….”
  3. Similarities: “How are the following alike…”
30
Q

Delirium

A

Acute confusion episode, may be d/t infection, uremia, alcohol withdrawal. Disoriented, poor judgement, delusions common, poor attention, mood fluctuations

31
Q

Dementia

A
  • Insidious, slowly progressive, mood often flat, maintains orientation and attention until late in process.
  • Altzheimers, B12 deficiency, hypothyroid, head trauma.
  • Can have acute angry delusional episodes later in the course of the disease
32
Q

Executive Function Calculation

A
  1. Number Span: Norm = repeat 5-6 numbers/4 numbers backwards
  2. Spelling common word backwards/forwards
  3. Say days of the week/months of year forward/backward
  4. Doubling a number
33
Q

Executive Functions Constructional Ability

A

Test = Copy a fig or draw something simple

Integration of motor activity = ask to perform a task

34
Q

Apraxia

A

The inability to perform a motor task/command

35
Q

Mini Mental Status Exam

A

Normal = 23-30
Borderline = 19-23
Impaired < 19

36
Q

Cerebellum

A

Receives sensory and motor input to coordinate motor activity, maintains equilibrium and control posture

37
Q

Gait

A
  • Regular walk, tandem, heel/toe

- Cerebellum Testing

38
Q

Heel to knee and slide down shin

A
  • Bilateral smoothness, accuracy

- Cerebellum Testing

39
Q

Romberg/Pronator drift

A

Test: Standing, feet together, arms straight out, palms supinated, fingers spread, hold for 20-30 sec

+ Romberg = loss of balance
+ Pronator Drift = one arm pronates and may drift down

  • Cerebellum Testing
40
Q

Finger-to-Nose Eyes Open

A

Test: make sure pt extends their arm completely; move your finger up/down/across midline

+ = clumsy, vary in speed/force, miss target => DYSMETRIA

  • Cerebellum Testing
41
Q

Finger- to -Nose Eyes closed

A

Test: Standing, eyes closed, arms stretched to side, bring each arm in to touch nose

+ test = poor coordination is worse than with eyes open

  • Cerebellum Testing
42
Q

Rapid Alternating Movements

A

Test: (1) Rapidly flip had over in the other palm; must lift hand off the palm; (2) Rapid, B/L sequential touching of each finger by the pt’s own thumb

+ test = inability to do this => DYSDIADOCHOKINESIS

43
Q

CN II test

A
  1. Acuity
  2. Pupillary Reflex (in by CN II out by CN III)
  3. Ophthalmoscopic Exam - visualization of retina not nerve
  4. Visual Field Exam
44
Q

CN III, IV, VI

A
  1. look for esotropia (med dev) or exotropia (lat. dev)
  2. Efferent Pupillary Reflex Response
  3. H test
  4. Cover/uncover test - B/L central focus; looking for strabismus
45
Q

CN IV Palsy

A
  • Missing superior oblique

- Eye is adducted and elevated (up and in)

46
Q

CN VI Palsy

A
  • Missing Lateral Rectus function = horizontal diplopia
  • Can’t abduct eye
  • INCREASED INTRACRANIAL PRESSURE ANYWHERE can cause U/L or B/L CN VI palsy
47
Q

CN V Test

A
  1. Sensory: test B/L for all 3 divisions; soft or temp and/or pinprick
  2. Motor: Masseter and pterygoid - clench teeth, move jaw side to side
  3. Corneal reflex: Gently touch lat cornea with cotton swab - both eyes should blink together (In by CN V (S) out by CN VII (M) )
48
Q

CN VII Test

A

Innervation = mm of facial expression, ant 2/3 of tongue, stapedius m.

Test Upper face: Closing eyes, raising eyebrows

Test Lower face: smiling; loss of one side = C/L cerebral hemisphere lesion

49
Q

CN VII Central Lesions

A
  1. Cerebral Hemisphere Lesion - lower face weakness of the opposite side
  2. Brainstem Lesion - Lower facial weakness of the same side
  3. In a large brainstem lesion - extremities of the opposite side will also be weak d/t proximity to DEC of CST in medulla oblongata
50
Q

CN VII Peripheral Lesions

A

= Lesion after leaving brain stem

  • commonly compressed in the internal/external auditory canal; likely auto-immune (Bell’s Palsy) or tumors/lacerations/infections (Lyme disease)
  • likely the entire nerve is damaged = weakness of upper and lower facial mm ON THE SAME SIDE
51
Q

CN VIII Test

A
  1. Auditory portion tested by physician directly: how well pt understands speech, rubbing index finger and thumb together, or rubbing pt’s hair together 1” lat to ear
  2. Vestibular Portion - assumed form hx of positional vertigo
52
Q

CN IX and X Test

A

Function: IX = sensory soft palate, taste to post 1/3 of tongue; X = raise the palate

Test: Gag Reflex - Aff = CN IX; Eff = CN X

53
Q

Weakness of Left sided Palatal Contraction

A
  • Uvula points to one side (away from side of weakness)

- CN X damage

54
Q

CN XI Test

A

Function: SCM and Trap innervation

Test: Resist the pt shrugging shoulders B/L; Resist head tilting to each side

55
Q

CN XII Test

A

Function: Motor to the tongue

Test: Ask pt to stick out tongue (note if midline) and move side to side

56
Q

CN XII Peripheral Lesion

A

Tongue deviates to same side of lesion

PCM 2.2 (4 decks)

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