CNS - Pitcher Flashcards
(56 cards)
1
Q
CNS includes
A
Cortex Basal Ganglion Brain Stem Cerebellum Spinal Cord
2
Q
Neurological Examination
A
A “top to bottom” approach: the cortex to the brainstem, the cerebellum, the spinal cord, and then peripheral nerves
3
Q
Neurological Examination Order
A
- Mental Status Examination (MSE)
- Cranial nerves
- Cerebellum
- Motor
- Sensory
- Deep Tendon Reflexes
4
Q
Mental Status Exam
A
- Appearance and Behavior
- Mood/Affect
- Speech/Language
- Thoughts/perceptions
- Cognitive/Executive functions
5
Q
Appearance and Behavior
A
- Level of Consciousness: impaired by disease of brainstem reticular system or BOTH hemispheres
- Posture and Motor
- Hygiene
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
7
Q
Mood/Affect
A
- Observe expression and affect: Appropriate for situation? Engaged? Angry? Anxious? Indifferent? Detached? Fearful?
8
Q
Language
A
- Language Exam should include: Spontaneous speech, Naming, Comprehension, Repetition, Reading, Writing
- Evaluate for aphasia = disorder in producing or understanding language
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
10
Q
Testing for aphasia
A
- Ability to name Objects; Anomia = loss of ability to name common objects - true maker of aphasia
- Comprehension - follow commands
- Repetition - repeat simple words/phrase
- Reading and Writing
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)
12
Q
Dysphasia
A
Impairment in the use of Speech - failure to arrange words properly in a sentence
13
Q
Dysarthria
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Imperfect articulation due to lack of motor coordination; damaging event to CNS or PNS; Language comprehension and use may be fine
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
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
16
Q
Brocas Aphasia
A
- “Expressive” aphasia
- Understanding of spoken language in mostly preserved
17
Q
Wernicke’s Aphasia
A
- “Receptive” aphasia
- Fluent speech that makes no sense
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)
19
Q
Thoughts and Perception
A
- Process - assess logic, relevence and organizations. Are they coherent?
- Content - phobias, anxieties, obsessions, delusions, hallucinations
- Insight - the ability to understand their own problem
- Judgment - approp decisions/actions for situation
20
Q
Cognitive Function
A
- Orientation: person, place, time
- Attention: ability to concentrate
- Memory: recent and remote
21
Q
Executive Function
A
- Abstract thinking/insight
- Calculation
- Constructional ability
22
Q
Orientation
A
- Person - usually only lost with aphasia or schizophrenia
- Place - lost in delirious/extremely demented outpatients
- Time - Most commonly lost of the three; day, time, week, month, year
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
Alzheimer's Disease
- 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
Recent Memory Testing
- 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
Testing Remote Memory
- Tests less often; used to confirm dementia dx
| - Ex: when did you graduate/get married/retire?
28
Executive Function Insight
- 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
Executive Function Insight testing
1. Proverbs
2. Insight: "What do you do if...."
3. Similarities: "How are the following alike..."
30
Delirium
Acute confusion episode, may be d/t infection, uremia, alcohol withdrawal. Disoriented, poor judgement, delusions common, poor attention, mood fluctuations
31
Dementia
- 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
Executive Function Calculation
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
Executive Functions Constructional Ability
Test = Copy a fig or draw something simple
Integration of motor activity = ask to perform a task
34
Apraxia
The inability to perform a motor task/command
35
Mini Mental Status Exam
Normal = 23-30
Borderline = 19-23
Impaired < 19
36
Cerebellum
Receives sensory and motor input to coordinate motor activity, maintains equilibrium and control posture
37
Gait
- Regular walk, tandem, heel/toe
| - Cerebellum Testing
38
Heel to knee and slide down shin
- Bilateral smoothness, accuracy
| - Cerebellum Testing
39
Romberg/Pronator drift
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
Finger-to-Nose Eyes Open
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
Finger- to -Nose Eyes closed
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
Rapid Alternating Movements
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
CN II test
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
CN III, IV, VI
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
CN IV Palsy
- Missing superior oblique
| - Eye is adducted and elevated (up and in)
46
CN VI Palsy
- 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
CN V Test
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
CN VII Test
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
CN VII Central Lesions
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
CN VII Peripheral Lesions
= 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
CN VIII Test
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
CN IX and X Test
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
Weakness of Left sided Palatal Contraction
- Uvula points to one side (away from side of weakness)
| - CN X damage
54
CN XI Test
Function: SCM and Trap innervation
Test: Resist the pt shrugging shoulders B/L; Resist head tilting to each side
55
CN XII Test
Function: Motor to the tongue
Test: Ask pt to stick out tongue (note if midline) and move side to side
56
CN XII Peripheral Lesion
Tongue deviates to same side of lesion
