Midterm Flashcards
(37 cards)
What is VINDICATE?
A DDx list for why someone is having neurological Sx
Vascular
Infection/ inflammatory
Neoplasm
Degenerative / dysfunction
Intoxication
Congenital
AI / allergy
Trauma
Endocrine/ metabolic
What are the parts of a neurological exam? (8)
Hx
Mental status exam
Posture, gait, station
Coordination
Cranial nerve exam
SMR exam
Provocative tests
Ancillary tests
What are the parts of the mental status exam? (3)
Eval level of consciousness (attn & alertness)
Eval signs of dementia (cognitive)
Eval language and speech function
How do you eval level of consciousness?
Glasgow Coma Scale (GCS)
- Eye opening
- Best verbal response
- Best motor response
What are the 5 parts of the signs of dementia?
Loss of memory
Disorientation
Loss of intellectual fxn
Loss of abstract thinking
Loss of judgement
How do you eval for signs of dementia?
*hint: mnemonic
FOGS
Family story
Orientation (person, place, time)
General information (memory)
Spelling/ calculations
What are the 6 pieces of evaluating for language and speech function?
Spontaneous speech Comprehension Naming (word finding) Repetition Reading Writing
How do you test abstract though and judgement?
Ask patient to list difference between orange and apple
What is the language center in the frontal lobe of the dominant hemisphere and what does it do?
Broca’s center
Coordinates motor aspect of language
What is the language center in the temporal lobe of the dominant hemisphere and what does it do?
Wernicke’s center
Interprets the understanding/receptive aspect of language
What occurs when the language centers or their connections in the brain are damaged?
Aphasia
What is the connection between Broca’s and Wernicke’s called?
Accurate fasciculus
What are the 4 types of aphasia?
Broca’s aphasia Wernicke’s aphasia Conductive aphasia Global aphasia
Describe Broca’s aphasia
Expressive/motor aphasia Patient has difficulty speaking and is usually aware of deficit. Patient can comprehend language, and so is able to do tasks when asked. Therefore they are aware of deficit and frustrated.
Describe Wernicke’s aphasia
AKA Receptive/sensory aphasia Patient cannot comprehend or repeat language. Cannot follow oral or written commands, but can imitate examiner’s actions when prompted by a gesture. Language expression is preserved, so patient can speak though it is nonsensical words (neologisms). Patient may not be aware of deficits because their comprehension is disrupted.
What is global aphasia?
All aspects of brain’s language centers are damaged. As seen in large strokes of the internal carotid artery. No comprehension No expression No repetition
What CN nuclei are in the pons?
5,6,7,8 in the pons (8 also spans into the medulla)
How do you test visual acuity?
S Ellen chart
How do you test visual fiends?
Confrontation: cover 1 eye and then patient look at doc’s eye. Have doctor test the peripheral vision by starting with finger outside quadrant and then moving in until patient can detect the finger. The object is to determine whether patient’s visual field is coextensive with-more restricted than-the examiner’s.
Where are sensory integration disorder lesions from anatomically? And what do they cause?
Parietal lobe Cause misperception of or inattention to sensory stimuli not he side of the body opposite the lesion, even though primary sensory modalities (e.g. touch) are intact
What are you looking for with pupillary reaction to light?
PERRLA Pupils: diameter & shape Equal: ~3 mm and can differ in size from side to side ~1mm Round: should be round React to Light and : constrict briskly in response to direct light and less so when the opposite pupil is illuminated (consensual response) AccomModation: eyes converge to focus on nearer object
Miosis (pupillary constriction) is mediated through parasympathetic fibers that originate in ___ What would cause interruption of this p/way?
the midbrain and travel with oculomotor nerve to the eye Interruption of this pathway (tumor) would compress oculomotor nerve as it exits brain stem and produce dilated uncreative pupil. Interruption would NOT be caused by cerebral Lesion because its a brain stem mediated response.
Normal visual fields: __ ˚ superior __ ˚ nasally __ ˚ temporally __ ˚ inferiorly
Superior 50˚ Nasally 60˚ Temporally 90˚ Inferiorly 70˚
What happens to the visual field if there is inflammation of the optic disk or optic nerve?
See page 13 Large central scotoma (blind spot)
