Chapter 18 - Nervous System Flashcards Preview

Pt Assess II Final > Chapter 18 - Nervous System > Flashcards

Flashcards in Chapter 18 - Nervous System Deck (91)
1

Cerebrovascular disease is ___ leading cause of death in US

3rd

2

Mental status exam evaluates:

-Level of consciousness
-Speech
-Orientation
-Knowledge of current events
-Judgment
-Abstraction
-Vocab
-Emotional responses
-Memory
-Calculation ability
-Object recognition
-Praxis

3

Describe patients in a coma

-Completely unconscious
-Cannot be roused even by painful stimuli

4

How to assess level of consciousness

Awake? Alert? Responsive?

5

How to evaluate a patient's speech

Recite a short phrase like "no ifs, ands, or buts"

6

Define dysarthria

Difficulty in articulation

7

Define dysphonia

Difficulty in phonation (resulting in alteration in volume and tone of voice)

8

Lesions of the ____ are responsible for dysarthria

Tongue and palate

9

Lesions of the ____ are responsible for dysphonia

Palate and vocal cords

10

Define dysphasia

Difficulty comprehending or speaking

11

What causes dysphasia?

Cerebral dysfunction

12

Define aphasia

Total loss of speech

13

How to evaluate orientation

Patient's awareness of self in relation to person, place, time

14

An abnormality in recent memory may be caused by a lesion where?

Temporal lobe

15

The ability to calculate depends on the integrity of what?

Dominant cerebral hemisphere AND patient's intelligence

16

Define agnosia

Failure to recognize a sensory stimulus despite normal primary sensation

17

Define visual agnosia

Patient has normal vision and fails to recognize an object

18

Define tactile agnosia

Inability to recognize an object by palpation (w/o a sensory defect)

19

A lesion located in the ___ can cause tactile agnosia

Non-dominant parietal lobe

20

Define autotopagnosia

Patient's inability to recognize his or her own body part

21

Define praxis

Ability to perform a motor activity

22

Define apraxia

Inability to perform a voluntary movement (w/o deficits in motor strength, sensation, or coordination)

23

Define dyspraxia

Decreased ability to perform a motor activity

24

Define constructional apraxia

Patient is unable to construct or draw simple designs (e.g. face of a clock)

25

A lesion in the ____ causes dyspraxia

Deep frontal lobe

26

A lesion in the ___ causes constructional apraxia

Posterior parietal lobe

27

CN 1 name and function

Olfactory - Smell

28

CN 2 name and function

Optic - Vision

29

CN 3 name and function

Oculomotor - eye movements, pupillary constriction, accommodation

30

CN 4 name and function

Trochlear - eye movements

31

CN 5 name and function

Trigeminal - general sensation of face/scalp/teeth, chewing movements

32

CN 6 name and function

Abducens - eye movements

33

CN 7 name and function

Facial - expressions, taste, general sensation of palate/external ear, salivary gland secretion

34

CN 8 name and function

Vestibulocochlear - hearing and equilibrium

35

CN 9 name and function

Glossopharyngeal - taste, elevation of palate, parotid gland secretion, general sensation of pharynx and ear

36

CN 10 name and function

Vagus - taste, swallowing, phonation, parasympathetic innervation of heart and abdominal viscera, general sensation of pharynx, larynx, ear

37

CN 11 name and function

Spinal accessory - phonation, head/neck/shoulder movements

38

CN 12 name and function

Hypoglossal - tongue movements

39

When should CN 1 be tested?

Suspected frontal lobe disorder

40

Divisions of trigeminal nerve

Ophthalmic
Maxillary
Mandibular

41

Unilateral weakness of CN 5 (motor) causes what to happen when patient chews?

Jaw deviates TOWARD side of lesion

42

How do upper motor neuron lesions affect the face?

Contralateral weakness of lower face but SPARES forehead (e.g. stroke)

43

How do lower motor neuron lesions affect the face?

Total paralysis of ipsilateral face, does NOT spare forehead
(e.g. Bells palsy)

44

Fasciculations are indicative of a ___ lower motor neuron lesion

Hypoglossal

45

The motor system is evaluated for:

Muscle bulk, strength, tone

46

Proximal muscle weakness is related to:

Muscle disease

47

Distal muscle weakness is related to:

Neurologic disease

48

Define muscle tone

Slight residual tension in a voluntarily relaxed muscle

49

How is muscle tone assessed?

Resistance to passive movement

50

What clinical features do upper motor neuron lesions produce?

Hyperreflexia
Babinski's sign
Clonus
Spasticity

51

What clinical features do lower motor neuron lesions produce?

Hyporeflexia
Fasciculations
Atrophy
Decreased tone

52

How can you make fasciculations more apparent?

Gently tap muscle with reflex hammer

53

Define cogwheeling

Ratchety jerkiness to motion

54

Hyperactive reflexes are characteristic of what type of disease?

Pyramidal tract
(electrolyte abnormalities, hyperthyroid)

55

Diminished reflexes are characteristic of what type of disease?

Anterior horn cell disorders and myopathies

56

What is a hung reflex?

-Decreased relaxation after a DTR
-Occurs with hypothyroidism pts

57

Describe reinforcement with DTRs

-When someone has decreased DTRs, try reinforcement
-Isometric contraction of other muscles (clenching teeth, push down on bed with thighs)

58

What is Jendrassik's maneuver?

-A form of reinforcement to try to elicit LE DTRs
-Patient locks fingers and tries to pull them apart

59

What DTRs are routinely tested?

Biceps
Triceps
Brachioradialis
Patellar
Achilles

60

What are the superficial reflexes?

-Abdominal (umbilicus moves toward stimulus)
-Cremasteric (men only, ipsilateral testicle raises)

61

The superficial abdominal reflex is frequently NOT seen in which patients?

Obese

62

What is the clinical significance of superficial reflexes?

LITTLE significance

63

What is Chaddock's sign?

-Abnormal reflex a/w pyramidal disease
-Lateral aspect of foot is stroked and big toe dorsiflexes

64

What is Oppenheim's sign?

-Abnormal reflex a/w pyramidal disease
-Downward pressure along the shin causes big toe to dorsiflex

65

What is Hoffmann's sign?

-Abnormal reflex a/w pyramidal disease
-Flick fingernail of middle finger
-Positive response is adduction and flexion of thumb (the ok symbol)

66

Sensory exam consists of:

-Light touch
-Pain sensation
-Vibration sense
-Proprioception
-Tactile localization
-Discriminative sensations (2 point, stereognosis, graphesthesia)

67

Vibration sense is tested using what?

128-Hz tuning fork

68

How is proprioception tested?

Moving distal phalanx subtly (hold the sides of the digit)

69

Stereognosis is the integrative function of which lobes?

Parietal and occipital

70

How is cerebellar function tested?

FNF (finger nose finger)
HKS (heel knee shin)
Rapid alternating movement
Romberg
Gait

71

Define past pointing

Patients with cerebellar disease persistently overshoot the target in FNF testing

72

Define diadochokinesia

Ability to perform rapid alternating movements

73

Pronator drift is seen in patients with:

Mild hemiparesis

74

What is the Romberg test examining?

Posterior columns (rather than actual cerebellar function)

75

A patient with ____ tends to drag or circumduct a weak and spastic leg

Hemiplegia

76

A patient with ____ tends to shuffle with short, hurried steps

Parkinson's

77

A patient with ____ walks with a wide based gait

Cerebellar ataxia

78

A patient with ____ has a slapping gait resulting from weakness of the ankle dorsiflexors

Footdrop

79

A patient with ____ has a high stepping gait in which the feet are slapped down firmly

Sensory ataxia

80

Decorticate posture - which abnormalities/lesions?

Cerebral hemispheric dysfunction OR destructive lesion of pyramidal tracts

81

Decerebrate posture - which abnormalities/lesions?

Midbrain or pons lesion

82

What does decorticate posture look like?

Arms adducted
Elbows/wrists/fingers flexed
Legs internally rotated
Feet plantarflexed

83

What does decerebrate posture look like?

Arms adducted
Elbows extended, forearms pronated
Wrists/fingers flexed
Feet plantarflexed

84

Central neurogenic hyperventilation is see in lesions of:

Midbrain or pons

85

Describe Cheyne-Stokes breathing

Rapid breathing separated by apnea episodes
A/w brainstem compression or bilateral cerebral dysfunction

86

Brainstem lesion and doll's eyes reflex

Doll's eyes reflex is ABSENT with a brainstem lesion

87

Doll's eye reflex

-Turning a comatose pt's head rapidly to one side while eyelids are held open
-Eyes SHOULD move conjugately to the other side

88

Why can doll's eyes reflex only be elicited in a comatose patient?

Alert individuals will fixate on an object and override the reflex

89

What is caloric stimulation and what is it used for?

-Head flexed at 30 degrees, syringe of ice water is squeezed into one of the external auditory canals
-NORMAL response is nystagmus away from irrigation (warm water would cause nystagmus toward irrigation)
-Used to enhance doll's eyes reflex or to test movements in a person with fractured cervical spine

90

How to remember caloric stimulation?

COWS - Cold Opposite, Warm Same
-Cold water causes nystagmus to other side of irrigation
-Warm water causes nystagmus to same side of irrigation

91

Extrapyramidal system is composed of:

Basal ganglia
Nuclei of midbrain and reticular formation
Cerebellum