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Lecture 1: Approach to the Neurologic Patient Flashcards

1
Q

What is the most important thing when it comes to neuro assessments?

A

Change from baseline.

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2
Q

What makes up the CNS?

A
  • Brain
  • Spinal Cord
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3
Q

What makes up the PNS?

A
  • Autonomic (Symp and Parasymp)
  • Somatic
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4
Q

Where is Broca’s area?

A

Frontal lobe (dominant side)

Speaking and writing

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5
Q

Describe what each lobe does.

A
  • Frontal: Decision-making, speech, intelligence
  • Parietal: Interpretation and processing of information
  • Temporal Lobe: understand language, memory, hearing, organization
  • Occipital: Interpreting vision
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6
Q

Where is Wernicke’s area?

A

Temporal lobe

Ability to understand speech

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7
Q

What is the main purpose of the thalamus?

A

Relaying signals back and forth.

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8
Q

What part of the brain controls breathing?

A

Medulla oblongata

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9
Q

What are the 3 meninges?

A
  • Dura mater
  • Arachnoid
  • Pia mater

Our blood vessels sit within the subarachnoid space.

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10
Q

Where do I find Upper Motor Neurons and what do they do?

A
  • Brain and spinal cord
  • Tell the lower motor neurons to relax
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11
Q

What happens with an UMN lesion?

A
  • Antagonist muscle will remain contracted
  • Spasticity
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12
Q

What happens with a LMN lesion?

A

It will stay relaxed (aka muscle weakness)

Lower lesion lax

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13
Q

Lesion Table for Motor Neurons

A
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14
Q

What makes up a neuro exam? (5)

A
  1. Mental Status
  2. Cranial Nerves
  3. Motor
  4. Reflexes
  5. Sensory
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15
Q

What are the 5 levels of consciousness?

A
  1. Alert
  2. Lethargy (verbal, slow to respond)
  3. Obtundation (constant stimulation to stay awake)
  4. Stupor (vigorous, painful, constant stimulation)
  5. Coma (no response)

Sleeping is not altered because if you wake them up, they will become al

ALOSC

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16
Q

What is praxis?

A

Muscle memory (like brushing teeth)

sounds like practiced

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17
Q

What does it mean to write neuro grossly intact?

A

It is purely off observation.

Must write CN 2-12 are grossly intact

Do not write no focal neuro deficits unless you tested it specifically.

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18
Q

What size are pupils normally?

A

2-6mm

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19
Q

What do pinpoint pupils suggest?

A
  • Opiate OD
  • Pontine hemorrhage
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20
Q

What do dilated pupils suggest?

A
  • Severe anoxia-ischemia
  • Anticholinergic drugs

Dilated pupils are ALWAYS abnormal

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21
Q

What do irregular pupil shapes suggest?

A

Traumatic orbital injury

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22
Q

What is the hippus phenomenon?

A
  • Alternating dilation and contraction of pupil
  • Associated with early signs of brain herniation or seizure activity
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23
Q

Abnormal gaits

24
Q

What does the romberg test check for?

A
  • Sensory ataxia (swaying but stops when eyes are open)
  • Cerebellar ataxia (swaying that persists even when eyes are open)
25
How do you grade ROM?
0-5 | Must test resistance and gravity.
26
What are the 3 kinds of hypertonia?
1. Spasticity: moves freely but then the muscle catches and locks. 2. Rigidity: resistance throughout 3. Clonus: Jerking movement | Suggestive of an UMN lesion.
27
What is the underlying etiology of hypotonia?
* LMN lesions * Cerebellar disorders
28
What is paratonia?
* Increased resistance that becomes LESS prominent when you distract the patient. * Suggested cognitive impairment and mental disorders.
29
Where do reflex sensory fibers synapse?
Anterior horn cell
30
What do increased and decreased DTRs suggest? How are they graded?
* Increased: UMN lesion * Decreased: LMN lesion * 0-4 grading, but **2 is normal** | Lower is lax
31
What does a positive babinski reflex suggest?
* UMN lesion * CNS disorders * Alcoholics/postictal periods | **Normal in children < 2y**
32
Define agnosia.
* Inability to interpret sensations or recognize things. * Damage to **occipital or parietal lobes** | They can feel the sensation, but they can't tell what it exactly is. ## Footnote A patient will need to feel, smell, see, and do everything in order to try and recognize something.
33
What is aphasia?
Inability to express speech (verbal and written)
34
What are the two primary types of aphasia?
* Broca's aphasia (Normal comprehension, broken words, difficult to speak) * Wernicke's aphasia (fluent gibberish) ## Footnote Broca's/expressive: they understand your question and can answer it, but they can't form a complete sentence Wernicke's: They understand your question, but answer it with a random assortment of words.
35
What is conduction aphasia?
Cannot repeat statements, which worsens with longer duration.
36
What is dysphasia?
**moderate** loss of language impairment, intact comprehension.
37
What is agraphia?
Inability to write that is **not due** to weakness, poor coordination, or neurologic dysfunction of the hand. ## Footnote Aphasic Constructional (scattered letters and words) Apraxic (distorted, slow)
38
What is apraxia?
Inability to perform a learned movement, **in the absence of weakness, sensory loss, or other deficit** ## Footnote Gait apraxia: difficulty initiating walking, esp. with parkinsons. Apraxia of eyelids: blepharospasms when asked to open eye
39
What is the MC neurologic cause of muscle atrophy?
Carpal tunnel syndrome
40
What are the 3 common neurologic conditions that can result in hypertrophy?
1. Myotonia congenita 2. Torticollis 3. Dystonias
41
What is dysarthria?
Difficulty articulating sounds or words. | **Motor function of speech**
42
What causes dysphagia neurologically?
Lower brain dysfunction
43
What is dysphonia?
Changes in quality, volume, or pitch of voice | parkinson's usually has HYPOphonia ## Footnote Also has spasmodic dysphonia (high-pitched)
44
What are the two types of ataxia?
* Cerebellar: limbs and gait * Sensory: lack/worsening of proprioception when eyes are closed. | Impaired balance/coordination
45
What is plegia vs paresis?
* Paresis: weakness due to nerve damage/disease * Plegia: complete paralysis
46
What is akinesia?
Inability to control **voluntary** movement ## Footnote brady is common in parkinsons and extrapyramidal symptoms. (basal ganglia) hyperkinesia is seen as tardive dyskinesia (fidgety/restless)
47
What is asterixis?
Inability to sustain a stable posture | Makes a floppy motion (id watch a vid of it) ## Footnote Palms forwards and push against them. Patient's hands should start flopping.
48
What are the hyperesthesias?
* Photophobia * Phonophobia * Allodynia (light touch causing pain)
49
What is hypoesthesia?
Decreased sensation | NOT NUMBNESS OR ANESTHESIA
50
What is paresthesia?
Tingling, burning, needles sensation in the skin
51
What is graphesthesia?
Ability to recognize writing on the skin without seeing it visually | Drawing on the hand
52
What is astereognosis?
Inability to recognize an object by touch alone
53
What is dysmetria?
Difficulty judging distance, speed power | Finger-to-nose test
54
What is dysdiadochokinesia?
Inability to perform repetitive movements or rapidly alternating movements | The alternating hands on the thighs thing ## Footnote Often seen in parkinson's and cerebellar
55
What is the key difference between rigidity and spasticity?
Rigidity is the same degree of resistance consistently. | Spasticity varies and Stops
56
When can hyperreflexia be considered normal?
If it is symmetrical, could be normal.
57
What common chronic condition is hyporeflexia seen in?
Hypothyroidism

Neuro (17 decks)

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