Intro Flashcards
(81 cards)
1
Q
What does VINDICATE STAND FOR?
A
Vascular Infection/Inflammatory Neoplasm Degenerative/Dysfunction Intoxication Congenital Autoimmune/Allergy Trauma Endocrine/Metabolic
2
Q
What are parts of the neurological exam?
A
Mental Status Cranial Nerves Posture, Gait, & Station Coordination Motor Exam Reflexes Sensory Exam
3
Q
What are the parts of the mental status exam?
A
- Evaluate the level of consciousness
- Evaluate for signs of dementia
- Evaluate language and speech function
4
Q
With the Glasgow Coma Scale, what is the worst score possible?
A
3
5
Q
When evaluating the loss of intellectual function or Dementia, what does FOGS stand for?
A
Family Story
Orientation (person, place, time, event)
General information (memory)
Spelling/Calculations (intellectual function)
6
Q
What are the 3 elements required to communicate the spoken word?
A
Phonation
Articulation
Language
7
Q
What is phonation? What CN is related? What is a problem with phonation called?
A
the forced expression of air passing through the
vocal cords allowing for sounds.
Motor function and may be associated with disturbances of CN X or vocal cord or larynx disease
DYSPHONIA: inability/dysfunction of phonation; hoarseness
8
Q
What is articulation? What CN/area is related? What is a problem with articulation called?
A
the ability to enunciate words; slurring speech.
Motor function and indicate problems with any of the muscles involved in speech (CN V, VII, IX, X, XII or nuclei) or the cerebellar problems.
DYSARTHRIA: Speech disorder with loss/difficulty articulating words.
9
Q
What is language? What CN/area is related? What is a problem with language called?
A
the ability to communicate using symbols.
It is a brain function; ability to integrate & interpret information
APHASIA: loss/impairment of language function due to Brain dzz.
10
Q
What are 6 parts to examine language and speech?
A
- Spontaneous Speech
- Comprehension
- Naming (word finding)
- Repetition
- Reading
- Writing
11
Q
What are the he language centers in the brain?
A
- Cerebral Dominance
- Brocca’s Center is in the frontal lobe of the dominant hemisphere & coordinates the motor aspect of language.
- Wernicke’s Center is in the temporal lobe of the
dominant hemisphere & interprets the understanding/receptive aspect. - Aphasia occurs when these language centers or their connections in the brain are damaged.
12
Q
What are 4 types of aphasia?
A
- Broca’s aphasia
- Wernicke’s Aphasia
- Conductive Aphasia
- Global Aphasia
13
Q
What is Broca’s aphasia? Would the patients be frustrated?
A
(Expressive/Motor)-
- Patient has difficulty speaking but not due to paralysis of speech muscles. “Cave man speech”. –
- Seen in Middle Cerebral aa. strokes or IC (dom.)
- Pt is usually aware of deficit & is frustrated.
14
Q
What is Wernicke’s aphasia? Would the patients be frustrated?
A
Receptive/Sensory)-
- Comprehension is poor (verbal or written) but patient can speak. Nonsensical speech.
- Neologisms= meaningless nonsense words;
- Patient may not be aware of deficits.
15
Q
What is conductive aphasia?
A
- Seen in lesions of the connecting fibers (arcuate fasciculus) between Broccas and Wernicke’s.
- Patient usually has intact comprehension but they may not be able to explain what they understood.
16
Q
What is Global Aphasia?
A
- All aspects of the brain’s language centers are damaged; seen in large strokes in the internal carotid artery
- Patient has poor speaking ability and poor
comprehension
17
Q
What is dysgraphia/agraphia?
A
difficulty/inability to write with normal sensorimotor function.
18
Q
What is dyslexia/alexia?
A
difficulty/inability to read.
19
Q
What is anomia?
A
inability in naming things
20
Q
What is apraxia?
A
inability to perform previously learned motor acts
despite normal sensorimotor function
21
Q
What is agnostic?
A
difficulty identifying or recognizing; tactile, visual,
part of body. Astereognosis is a failure of tactile recognition of objects.
Unilateral Neglect is a variant where the patient fails to recognize stimuli in one half of space, contralateral to the brain lesion.
22
Q
What are the cranial nerves and what do they control?
A
- CN I - smells
- CN II - sees
- CN *III, IV, VI - moves eyes; *CN III constricts
pupils and accommodates - CN V - chews & feels face
- *CN VII - moves the face, tastes, cries, and salivates
- CN VIII - hears, regulates balance (from inner ear)
- *CN IX - swallows, salivates, & monitors carotid body & sinus, gag reflex-aff, *taste
- *CN X - *swallows, *lifts palate, talks (larynx), viscera organs, gag reflex
- CN XI - turns head-contra. (SCM), lifts shoulder (traps)
- CN XII - moves tongue & hyoid
23
Q
What is tested when you ask a patient to stand with feet together and eyes open?
A
Cerebellar disease
24
Q
What is test with Romberg sign (eyes closed)
A
Posterior column disease
25
What is ataxia?
incoordination of movement not due to motor weakness
26
What is a broad base gait?
Wide based gait (general)
27
What is a cerebellar gait?
staggering, Clumsy, Drunken; seen in cerebellar disease, alcohol intoxication, MS
28
What is sensory ataxia gait?
slapping foot gait, Tabetic;
| commonly seen in posterior column disease, tabes dorsalis, or polyneuropathy
29
What is Parkinsonian gait?
festinating, shuffling gait, short steps
30
What is hemispheric gait?
swinging gait; often seen in strokes
31
What is stoppage gait?
Equine or foot drop gait; seen in L5 radiculopathy or peroneal nerve disease or weakness of tibialis anterior
32
What is waddling gait?
seen in weak gluteus muscles and muscular dystrophy; Trendelenburg may be +
33
What is scissors gait?
spastic (due to spasticity of adductor mm.); seen in cerebral palsy and myelopathy
34
What is sprain gait?
Magnet gait (like feet are stuck to the floor/sliding along floor); due to diffuse cerebral damage; seen in Alzheimer's, Huntington's, hydrocephalus
35
What is limping/antalgic gait
due to pain; seen in injury, HNP
36
What are ways to test posture, station and gait exam?
```
Observation
Stance/Romberg test
Normal gait to end and turn- 1-2 steps to turn
Tandem Gait
Heel/Toe walk
Squat & Rise
Trendelenburg
Heel to Shin
```
37
What are areas in the NS involved in coordinating movement?
- Cerebellum & connections
- * Extrapyramidal System (basal ganglia & connections)
- * Sensory Proprioceptive System (proprioceptors---posterior columns---brain)
- *Vestibular System & connections (CN VIII & nucleus in BS, inner ear, & connections)
- Visual System & pyramidal motor system- indirectly involved
38
The cerebellar system is involved in (voluntary/involuntary) movements?
Voluntary
39
What is dysmetria? What part of the brain?
inability tracking a moving target; past pointing.
Cerebellar
40
What is intention tremor? What part of the brain?
Tremor when at end range of a movement to obtain accurate movement
Ex: touching finger to nose and shaking when the finger gets close to the nose
Cerebellar
41
What is dysdiodochokinesia? What part of the brain?
incoordination in performing rapidly alternating
movements.
Cerebellar
42
What is rebound phenomenon? What part of the brain?
Impaired check response
Cerebellar
43
What is dysarthria? What part of the brain?
Speech ataxia; slurred speech
Cerebellar
44
What is occulomotor ataxia ? What part of the brain?
Nystagmus, diplopia
Cerebellar
45
What is decompensation of movement? What part of the brain?
Motions appear to be broken up into a series of choppy steps (days-synergy)
Cerebellar
46
What is hypotonia? What part of the brain?
Decreased resistance to PROM
Cerebellar
47
What is the extrapyramidal system (basal ganglia) involved in? What disease is associated with this?
Involuntary movements
Disease causes these involuntary movements to become excessive (hyperkinesia) +/or decreased (hypokinesia
& bradykinesia); and affects muscle tone (rigidity).
Parkinson’s diseas
48
What would you observe with hypokinesia?
- loss/decrease of facial expression, blink response, arm swing
49
What would you observe with hyperkinesia?
- excessive involuntary movements; resting tremor, chorea, athetosis, dystonia, myoclonus
50
What are different kinds of tremors? What part of the brain is it associated with?
- resting tremor (basal ganglia)
| - intention/action tremor (cerebellar)
51
What is chorea?
Rapid, fleeting involuntary movement
52
What is athetosis?
Slow writhing snakelike movement
53
What is dystonia?
Sustained athetoid movement (torticollis, trunk)
54
What is myoclonus?
Sudden rapid twitch-like motion
55
What is hemiballism?
Flinging motion of limb
56
What is a tic?
Quick, twitch-like motions or action (“habit-spasms”); semi-voluntary
57
What are different tests for coordination?
- Observation for abnormal movements; hypo hyperkinesia
- Stance, Romberg test, and Gait testing
- Finger to nose, Finger to finger, finger to nose to finger; look for
past pointing, dysmetria, intention tremors
- Test rapid alternating movements; finger/toe tapping, supination/pronation, etc..; dysdiodochokinesia
- Heel to shin Test
- Examine muscle tone; PROM- hypertonia in extrapyramidal (rigidity) and hypotonia in cerebellar
- Sensory exam (proprioception); JPS, vibration, Romberg's
- Cranial nerve exam (esp. vestibular system); nystagmus, CN VIII
58
What is another name for the pyramidal tract?
Corticospinal
*a patient may complain of weakness with this
59
What are symptoms of an UMN lesion in the pyramidal tract?
Hypertonia/ spasticity
Hyperreflexia
Pathological reflexes
May have atrophy in later stages
60
What are symptoms of an LMN lesion in the pyramidal tract?
- atrophy/flaccidity
- hyporeflexia/absent reflexes
- fasciculations
- EMG/NCV = fibrillations
61
What information is in the dorsal column tract?
Proprioception, fine touch, vibration
62
What information is in the spinothalamic tract?
Lateral - crude/ temperature
| Ventral - nociception
63
Where does the pyramidal tract decussate? Dorsal column tract? Spinothalamic tract?
Brain stem
Brainstem
At level of LMN
64
What does spasticity indicate?
- UMN lesion (pyramidal system)
| - marked resistance to the initiation of PROM, especially if done rapidly. “clasp-knife spasticity”
65
What does rigidity indicate?
- extrapyramidal disease (i.e. Parkinson’s)
| - marked resistance to PRO which persists through the entire ROM. “Lead pipe rigidity, cogwheel rigidity”
66
What does hypotonus (flaccidity) indicate?
- LMN lesion
- cerebellar disease
- primary muscle disease (myopathy)
- in the first 48 hours of an UMN event (i.e. stroke)
67
What is the “trick” used for reinforce a DTR if you are having trouble achieving it?
Jendrasick
68
What is paralysis?
a total loss of voluntary motor control
| – Mono-, Para-, Quad-, Hemi-, & --Plegia
69
What is paresis?
a partial loss of voluntary motor control
70
What is palsy
paralysis of 1 muscle or group of muscles innervated by a peripheral nerve (ulnar nerve palsy)
71
What is clonus
a series of reflex contractions of a muscle caused by a quick stretch of the muscle/tendon (ankle, wrist)
– usually UMN sign
72
What is muscle tone/tonus?
is the resistance that is offered by a limb when it is taken through a PROM
– Hypertonus (Spasticity or Rigidity) verses Hypotonus (Flaccidity)
73
What is fasciculations?
Spontaneous twitches of muscle fibers innervated
| by one motor unit which can be visibly seen (LMN type-denervation)
74
What are fibrillations?
```
spontaneous firing of a single muscle fiber which is
not observable (seen only by the Needle EMG exam) Also, indicates LMN
```
75
What are exteroceptive, proprioceptive and interceptor sensory pathways?
- Exteroceptive= sensory pathways that inform the brain of the external environment
- Proprioceptive= sensory pathways that inform the brain of position & movement
- Interoceptive= sensory pathways that inform the brain of the internal environment
76
What are primary sensory modalities?
requires an appreciation of the sensation
| – Light Touch, Pain, Temperature, Vibration, Proprioception
77
What are secondary sensory modalities?
(Complex/integrative/gnostic; combined, cortical)
These are mediated & integrated thru the Brain (parietal lobe), so an appreciation & interpretation (by the Brain) of the sensation is necessary
– Examples– Stereognosis, agraphesthesia, perception of 2 point
discrimination (4-5 mm at fingertips)
78
How do you test the dorsal column? Where does it decussate?
crosses in the brainstem
– Vibration, conscious proprioception, 2 point & light touch
– TESTED– Joint position sense (JPS) & Romberg's, vibration,
cotton – Touch (-Esthesia– Hypoesthesia/Anesthesia/Hyperesthesia)
79
How do you test the lateral spinothalamic tract? Where does it decussate?
crosses at level
– Carries pain and temperature
– TESTED: Sharp; hot/cold temperature
– Pain (-- Algesia)– Hypoalgesia/Analgesia/Hyperalgesia
80
How do you test the anterior spinothalamic tract? Where does it decussate?
crosses at level
– Carries light touch
– TESTED: Cotton (-esthesia)
81
How do you test the dorsal & ventral spinocerebellar tract? Where does it decussate?
no crossing
– Carries unconscious proprioception;
TESTED— cerebellar tests
