CNS Part 1 Flashcards
(36 cards)
What are some potential reasonings for the following:
Dec brain weight
Dec cerebral blood flow
alterations in CNS NTs
Drug toxicities
Altered mental status
Parkinsons
What are some potential reasonings for the following:
Dec Memory
Dec Reation time
Dec sleep/Inc waking
Dec Vibratory senses
Dec Righting reflec/postural instability, altered gait
Benign senile forgetfulness, MCI, dementia
Dec IQ score
Inc Sleep disturbances
Altered gait
Falls/accidnets/ syncope
What are some expected age related changes in the BRAIN
Dec NT (GABA, seratonin, dopamine, choline o acetyltransferase)
Compensatory mechanisms reduce clinical effects age related changes
- redundancy minimizes age related effects of neuron loss
- plasticity nerve cell offsets loss and deterioration - non dominant hemisphere or other motor systems
What are some age related changes to spinal cord
loss of cells, but not assoc w loss functional capacity, most changes 2ndary to sacropenia, osteoporosis
What are some age related changes to peripheral nerves
conduction slows w age but functional change not evident
re innervation -not as effective
Stoke prevention:
what are RFs
weight/obesity, diet/nutrition, sedentary lifestyle, nicotine and ETOH
dyslipidemia, atherosclerosis, DM, metabolic syndrome, HTN, carotid art dz, a fib
OSA
Herpes zoster:
What is the recommended age for vaccination
> 60 y/o
Behavioral Health
ID pt for co existent mental health issues
physical symptoms w/o medical explination
CAGE Assesment
Cutdown, Annoy, Guilt, Eye-opener
Suicide rfs (warrants screening)
- idiopathic physical symptoms
- high symptom count
- chronic pain >6 weeks
- difficult encounters
- high severity for somatic complaint
- hx recent stressor
- pt self rates poor health
- substance abuse
- abuse
- grief
- financial issues
- BH disorders
- hx of selfharm
Suicide Impedning
sudden happiness
- flat affect
- giving away possesions
- plan/note
- abuse
- selfharm
- depressive social media posts
- no plans/care for the future
- catasrophizing
How do we assess Mental status (CNS exam)
LOC
Posture/motor activity,
grooming/dress/hygiene
facial expression
affect
How do we asess speech?
Quantity rate volume articulation Fluency
Speech disorders:
Dysarthria?
Fluency absence?
Disarthria is physical inabilty to form words d/t issue with BULBAR MUSCLES
Language issue, impaired ability to understand or use spoken words
affects reading, writing, abonromal spont speech
Fluency abnormalities:
Hesitancy
Disturbed inflections?
Circumlocutions?
Paraphasia?
monotone
describe object instead of word
malformed word or wrong word (snoop instead of spoon, cut food with a saw)
APHASIA types?
Receptive and Expressive
what is receptive aphasia?
aka?
WERNICKES APHASIA
language with normal rhythm and articulation but meaningless content d/t difficulty in comprehension
Expressive Aphasia?
BROCAS APHASIA
preserved comprehension with slow speech
describe wernickes aphasia ?
rapid, effortless and spont speech, good articulation, impaired word comp, repetition, naming, reading /writing
paraphasa, neologims, or incomprehensible
fluent w/out content: person seldom understands whats being said or controls what they are saying
Describe brocas aphasia
Laborius speech effort
words/content meaningful but articulation impaired
Know what they are saying just cant get words out
How do we screen for aphasia (aphasia testing CNS exam)
Word comp: 3 stage command
repetition: repeat a phrase or one syllable words
Naming: ask pt to name familiar objects
reading comp: silently read a written request
Writing ability: write sinple sentence
Thought process and content:
Abnormalities:
Circumstantiality? Blocking? Perservation? Neologisms? Derailment? Flight of ideas? Incoherence? Confabulation? Echolalia? Clanging? Obsessions? Compulsions? Phobias?
Delay getting to point of convo
stop mid sentence before thought is completed
persistent repitition of word or idea
invented words
Little to no meaningful connection when shifting topics of convo
continous flow of accelerated speech w poorly connected ideas
incomp and illogical convo w/out meaningful connections
Fabricate facts to compensate for mem gaps
korsakoff syndrome-
alchis
Repeat word or phrase of another person
like the sound of a word to rhyme or pun (nose froze, tips of toes)
Intrusive reccurent uncontrollable thoughts, images, or impulses
repetetive bx or mental acts to produce or prevent some future state of affairs in response to obsesion
persistent irrational fears
Perception disorders:
Derealization?
Depersonalization?
Delusions?
Illusions?
exp objects, people, surroundings as unreal
feel detached from self, numb from emotions or exp
false, fixed personal beliefs that are not substantiated & not altered by evidence to the contrary
Misinterpretation of real external stimuli
perceptions seem real but absence of actual ext stimuli
How do we assess pt judgement?
pt ability to compare and eval alt course of action
