Neuro Flashcards

Question

Mental Status ROS

Answer 1

Level of consciousness Speech Orientation Current events knowledge Judgment Vocabulary Abstraction Memory-immediate recall, recent and remote Language-fluency, comprehension, repetition, naming, reading, writing Calculation Object recognition Emotional responses Praxis Mood and affect Higher intellectual function-knowledge, abstraction, judgment, insight, reasoning

Answer 2

loss of speech comprehension

Answer 3

difficulty controlling the muscles used for speech (Disorder of speech) Speech requires formulation of articulation and pronunciation. This involves the bulbar muscles and the physical ability to form words. Manifests as slurred, slow speech

Answer 4

difficulty in speaking from a physical disorder of the mouth, throat, tongue, or vocal cords (disorder of speech, phonation difficulties, hoarsness)

Answer 5

Recite a short phrase for Pt. to repeat ex. No ifs ands or buts

Answer 6

Disorder of language, difficulty in comprehending or speaking as a result of cerebral dysfunction

Answer 7

Semantics - selection of words to be spoken Syntax - formulation of appropriate sentence phrases

Answer 8

Person, time, place and situation

Answer 9

(Simple question that the answer is obvious) What would you do id you saw someone being attacked?

Answer 10

Ask patient to interpret: How is an apple and an orange alike?

Answer 11

Varies based on education level and diversity. Ask something like, What do you use a pen for? and should be asked in order of increasing difficulty like: car, ability, dominant, voluntary, telescope

Answer 12

Any mood changes? How are your spirits? Are you depressed? [Response-appropriate, abnormal, or flat]

Answer 13

1. Orientation (year, day month, where they are) 2. Registration (name three objects. ask patient to repeat them- repeat until they learn them all) 3. Attention and calculation (serial 7s, spell a word backwards 4. Recall (ask for the 3 items from before) 5. Language (name pencil and watch Repeat "No ifs ands or buts" Follow a 3 stage command - take this paper in your hand, fold it in half, and out it on the floor Read and obey "CLOSE YOUR EYES" Write a sentence Copy the design shown

Answer 14

Gait Finger-to-nose assessment Heel-to-shin Rapid alternating movements(RAM) Romberg

Answer 15

The manner of walking or running. Walk straight ahead and then return on tiptoes and then walk on heels then tandem walk one foot touching the toes of the other. Posture, balance and arm swing. Hop on one foot.

Answer 16

Ataxic Choreiform Diplegic Hemiplegic Myopathic Neuropathic NPH Parkinson Trendelenburg

Answer 17

An unsteady, staggering gait is described as an ataxic gait because walking is uncoordinated. Usually multifactorial Increases with age and most are due to sensory deficits.

Answer 18

Involuntary movements that are superimposed on gait without balance difficulties. Usually due to Huntington’s chorea.

Answer 19

Patients have involvement on both sides with spasticity in lower extremities worse than upper extremities. Cerebral Palsy

Answer 20

Gait in which the leg is stiff, without flexion at knee and ankle, and with each step is rotated away from the body, then towards it, forming a semicircle. Causes-CVA, CP, Parkinson

Answer 21

A particular way or manner of moving on foot: a person who ran with a clumsy, hobbling gait. No weight bearing on the affected side. Seen in myopathies

Answer 22

Steppage gait is a form of gait abnormality characterized by foot drop due to loss of dorsiflexion. The foot hangs with the toes pointing down, causing the toes to scrape the ground while walking, requiring someone to lift the leg higher than normal when walking. Neuropathies

Answer 23

Gait caused by Normal Pressure Hydrocephalus 3W’s Wet -Incontinent Wobbly-Gait unsteady Wacky-Demented

Answer 24

Slow shuffling gait (festinating) Stuck to the floor (freezing) Decreased to absent arm swing

Answer 25

Abnormal gait associated with a weakness of the gluteus med. It is characterized by the dropping of the pelvis on the unaffected side of the body at the moment of heel strike on the affected side. In this deviation the pelvic drop during the walking cycle lasts until heel strike on the unaffected side and is accompanied by an apparent lateral protrusion of the affected hip. The person also shortens the step on the unaffected side and displays a lateral deviation of the entire trunk and the affected side during the stance phase of the affected lower limb. This gait is one of the more common gait deviations.

Answer 26

Rapidly points finger to nose and then to examiners finger, move smoothly and assess quickness. Switch hands and repeat.

Answer 27

Lay on back and slide heel of one extremity down the shin of the other and switch sides. tests cerebellar function and dyssynergia

Answer 28

Alternate rapidly supination and pronation of hands. Toe tapping, finger to thumb. Compare RT to LT, but remember there will be some mild difference (ie RT hand faster in RT dominant)

Answer 29

Stand in front of examiner with feet together with heels touching, extend arms with palms facing upwards. (eyes closed) Positive if pt sways and have to move feet for balance. Pronator drift-one of the arms drift down and fingers flex. Testing joint position sense

Answer 30

The sensory information is mostly somatosensory: touch, temperature, pressure and pain ("somato" = "body"). Axons in these nerves tend to cross to the opposite side of the spinal cord so that sensation-in and control-of the right side of the body are in the left brain, and vice versa. Within the spinal cord axons ascend-from and descend-to the brain in well-segregated tracts: for crude touch, for pain&temperature, for motor control, and for proprioception&kinesthesia (muscle, tendon & joint position as well as muscle tension and movement information).

Answer 31

Paresis: weakness Plegia: no movement Hemi: half Quad: all 4. Praxis-ability to perform a motor activity. Apraxia is the inability to perform a voluntary movement in the absence of deficits in motor strength, sensation or coordination.

Answer 32

Upper Motor Neurons (UMN) are formed from fibers from the corticospinal tracts. UMN synapses with LMN in the ant horn of the spinal cord The motor root leaves the cord anteriorly to join the sensory root and becomes the spinal nerve

Answer 33

Tone-residual tension in a voluntary relaxed muscle and is assessed by resistance to passive movement. Bulk- size Strength-graded It is also important to assess for involuntary movements such as tremors, tics or fasciculation; noting their location, rate, amplitude, intention, quality, rhythm, and relation to posture.

Answer 34

0/5-absent-no contraction 1/5-Trace-slight contraction noted 2/5-weak-movement sideways(no gravity) 3/5-Fair-Movement against gravity-(up) 4/5-Good-Movement against gravity with some resistance 5/5-Normal-Movement against gravity with full resistance

Answer 35

Fibers responsible for pain, temperature and crude touch (light touch without localization) Synapse quickly with secondary neurons in the posterior horn of the spinal cord and then cross to travel contra-laterally to the brain

Answer 36

Fibers responsible for position, vibration detection, along with fibers for fine touch go directly to the posterior columns These fibers travel ipsilaterally up to the lower medulla then synapse with secondary neurons and cross to the contralateral side and travel to the thalamus

Answer 37

If there is solely posterior column damage; a person will have a wide range of sensation, but will lose position and vibration sense inferior to the level of damage

Answer 38

At the thalamic level. Crude sensations are felt (pain, temperature, pleasant, unpleasant); For full sensation the fibers synapse with a third group of neurons (thalamic level) and travel to the sensory cortex of the brain.

Answer 39

Paresthesias-a sensation of pricking or tingling on the skin having no objective cause and usually associated with injury or irritation of a sensory nerve or root. Numbness-Ask meaning, different meaning to different people. Dysthesia- Abnormal, unpleasant sensation to touch. Pain-abnormal unpleasant senation.

Answer 40

Light Touch Pain Vibration Sense Proprioception Tactile Sense Discriminative sensations 2 point stereognosis (identify objects with eyes closed) graphesthesias (identifying shapes traced in hand- parietal lobe problem) point localization

Answer 41

C2 and C3 - Posterior head and neck C4 and T2 - Adjacent to each other in the upper thorax Nipple - T4 or T5 Umbilicus - T10 Upper extremity C5 - Anterior shoulder C6 - Thumb C7 - Index and middle fingers C 7/8 - Ring finger C8 - Little finger T1 - Inner forearm T2 - Upper inner arm T2/3 - Axilla

Answer 42

Lower extremity L1 - Anterior upper-inner thigh L2 - Anterior upper thigh L3 - Knee L4 - Medial malleolus L5 - Dorsum of foot L5 - Toes 1-3 S1 - Toes 4,5; lateral malleolus S3/C1 - Anus

Answer 43

Touch patient with gauze or cotton to distal toes and fingers Sensory deficits are often distal if absent then work proximal until patient can feel and repeat on opposite side(determine sensory level) If specific area c/o numbness etc, check that area

Answer 44

Safety pin/break cotton applicator go to area to show patient the difference between sharp and dull to establish baseline and then begin distal. Close eyes. Determine sensory level.

Answer 45

128 HZ tuning fork Start distal and go proximal over bony prominence Close eyes Patient tells you when it stops vibrating and determine sensory level.

Answer 46

Position sense Have patient close eyes and then move distal digit (toe /finger) up and down and patient will tell you up or down. If can’t tell move proximal.

Answer 47

Double stimulation Eyes closed Touch right and left sides and patient tells you where you touched them

Answer 48

Paper clip and place 3 mm apart and keep moving closer until patient feels only 1 point (<2 mm felt as one point)

Answer 49

Reflex arc, involuntary Some only involve sensory and motor nerves with one synapse. To fire, all of the components must work. The afferent nerve (sensory), the synapse (in the anterior horn of the spinal cord) and the efferent nerve (motor, in the anterior horn).

Answer 50

0-absent 1+-decreased 2+-normal 3+-increased 4+-hyperactive

Answer 51

Biceps-C5-6 Brachioradialis-C5-6 Triceps-C6-8 Patellar-L2-4 Achilles-S1-2

Answer 52

Biceps- The patient should relax and pronate the forearm midway between flexion and extension. Place the thumb firmly on the biceps tendon. Strike the hammer on the examiner's thumb. Observe for contraction of the tendon and flexion at the elbow (C5-C6)

Answer 53

Brachioradialis The arm is rested on the patient's knee and held in semiflexion and pronation. Strike the styloid process of the radius about 1-2 inches above the wrist. Observe for flexion at the elbow and simultaneous supination of the forearm (C5-C6).

Answer 54

Triceps-Flex the patient's elbow and pull the arm toward the chest. The elbow should be midway between flexion and extension. Tap the tendon above the insertion of the ulna's olecranon process 1-2 inches above the elbow. Observe for prompt contraction of the triceps with extension of the elbow (C6- C8)

Answer 55

Patellar Tendon-This is also known as the knee jerk. The patient should sit with the legs dangling off the side of the table. Place your hand on the quadriceps muscle. Strike the patellar tendon firmly with the base of the reflex hammer. Contraction of the quadriceps should be felt and extension of the knee will be observed (L2-L4).

Answer 56

Achilles Tendon-This is also known as the ankle jerk. It is elicited by having the patient sit with the feet dangling off the side of the bed. The leg should be flexed at the hip and knee. The examiner should dorsiflex the patient's foot. Strike the Achilles tendon just above its insertion on the posterior aspect of the calcaneus with the wide angle of the reflex hammer. This can also be done with the patient lying supine. Observe for plantar flexion at the ankle (tests nerve roots at S1-S2).

Answer 57

Abdominal: lie supine and run an applicator stick quickly horizontally lateral to medial toward umbilicus. (upper T8-10 and lower T10-12) Normal-contraction of abdominal muscles deviating towards stimulus

Answer 58

Cremateric: rub the inner thigh with applicator stick. (S2-3) Normal-elevation of testicle on the same side. Anal-pucker around examiner finger (S2-4)

Answer 59

A series of involuntary, rhythmic, muscular contractions and relaxations. A one or two beat clonus may not be abnormal

Answer 60

Meningeal Asterixis Doll’s Eyes Straight Leg Raise Patrick’s Test Waddell’s Babinski Hoffman

Answer 61

Brudzinski: hand behind head and flex neck forward until chin touches chest. Positive: hips and knees flex Kernigs: Flex pts leg at the hip and knee and then straighten knee. Positive: patient resistance to maneuver

Answer 62

Pt has hands cocked up and fingers spread. Positive: brief, non-rhythmatic flexion of the hands and fingers. No movement is normal. Hepatic encephalopathy.

Answer 63

Vestibulo-occular reflex Turn pts. Head and eyes move in opposite direction to remain fixed on an object. Negative-eyes remain fixed in mid position. Cerebellar damage.

Answer 64

Positive if comatose pt’s eyes remain focused on an object despite head movement. When the patient’s head is turned, the eyes move in the opposite direction as though still looking at a stationary object (Positive Doll’s eyes). If this is positive, the reason for coma is above the brainstem. In an alert person, we suppress this reflex. In a comatose patient with brainstem damage, his eyes remain fixed in mid position

Answer 65

To evoke the Babinski reflex, the sole of the foot between the heel and the toe is firmly stroked with a hard tool or a thumb. In infants, this could cause the big toe to extend, pushing outwards, and often the small toes will accompany it in a splaying motion. Infants demonstrate the reflex because their brains are not fully mature, so the protections which prevent this reflex are not yet present.(up to 2yrs)

Answer 66

Hoffman's sign is a neurological sign in the hand which is an indicator of problems in the spinal cord. It is associated with a loss of grip. The test for Hoffman's sign involves tapping the nail on the third or forth finger. A positive Hoffman's is the involuntary flexing of the end of the thumb and index finger - normally, there should be no reflex response.

Answer 67

Hoffman's sign is an indicator of a number of neurological conditions including Cervical Spondylitis, other forms of spinal cord compression and Multiple Sclerosis. In MS, a positive Hoffman's sign is usually caused by lesions in the motor nerve pathways on or above the place in the spinal cord where the nerves that control the hands exit (C5).

Answer 68

Olfactory - smell

Answer 69

Optic Nerve - visual acuity, visual fields, ocular fundi

Answer 70

Oculomotor - pupillary reaction

Answer 71

(Oculomotor, trochlear, abducens) extra-ocular muscle movements, and opening eyes

Answer 72

Trigeminal - Facial sensation, movements of the jaw, and corneal reflexes

Answer 73

Facial Nerve - Facial movements and gustation

Answer 74

Vestibulocochlear nerve - Hearing and balance

Answer 75

Glossopharyngeal, Vagus - Swallowing, elevation of the palate, gag reflex and gustation

Answer 76

Trigeminal, Facial, Vagus, Hypoglossal- Voice and speech

Answer 77

Accessory - Shrugging the shoulders and turning the head

Answer 78

Hypoglossal - Movement and protrusion of tongue

Answer 79

Sensory receptors in the nasal mucosa are stimulated by odors. These stimuli are detected by the olfactory bulb. Nervous impulses then travel through the olfactory tract to terminate in the anterior perforated substance. These intimate connections with the entorhinal cortex, amygdala, hippocampus and other parts of the limbic system.

Answer 80

Test each side separately with eyes closed. Use nonirritating substance as this could trigger pain receptors. Use familiar smells. Compare strength of smell. Often omitted unless trauma or complaint.

Answer 81

Anosomia-colds, rhinitis, tumors Hypersomia- hysterics, cocaine addicts Parosmia-olfactory hallucinations, hysterics, seizures, schizophrenia and uncinate gyrus lesions. Cacosmia- unpleasant odors- decomposition of tissue

Answer 82

Visual Acuity-OS,OD,OU Visual Fields Fundoscopic Examination Pupil Diameter Pupillary Response Accomendation

Answer 83

Pupil Diameter  Pupillary Response  Accommodation  Motor to four eyeball muscles Injury to nerve causes dilated pupil and ptosis “fixed and dilated”

Answer 84

The superior division supplies the levator palpebrae superioris and superior rectus muscles. The inferior division supplies the medial rectus, inferior rectus and inferior oblique muscles.

Answer 85

Normal pupils are equal in size and shape and are situated in center of iris Pupillary size varies with intensity of light is about 3-4 mm Miosis-<2mm Mydriasis->5mm Aniscoria-pupillary asymmetry

Answer 86

Dim Lights Fix gaze on opposite wall to eliminate accomendation Shine bright light obliquely into each pupil Look for both direct (same eye) and consensual (opposite eye) reaction Record pupil size and shape

Answer 87

Hold finger about 10 cm from patient’s nose Alternate looking into distance and at finger Observe pupillary response

Answer 88

Innervates superior oblique muscles

Answer 89

V1-Opthalmic V2-Maxillary V3- Mandible

Answer 90

Palpate Masseter muscle while biting down. Check sharp and dull sensation and if abnormal then warm and cold and vibration. Check next to nose and chin. Have them close their eyes. Corneal Reflex.

Answer 91

to contract the lateral rectus which results in abduction of the eye.

Answer 92

Check for asymmetry. Puff cheeks, smile, close eyes and attempt to open. Peripheral-if whole side is paralyzed. Central-(CVA)- if forehead is spared. Sensory from anterior 2/3 of tongue Motor to muscles of facial expression Parasympathetic to salivary and lacrimal glands Injury causes facial droop, dry eyes, dry mouth

Answer 93

When the whole side of the face is paralyzed the lesion is peripheral. When the forehead is spared on the side of the paralysis, the lesion is central (e.g., stroke). This is because a portion of the VII cranial nerve nucleus innervating the forehead receives input from both cerebral hemispheres. The portion of the VII cranial nerve nucleus innervating the mid and lower face does not have this dual cortical input. Hyperacusis (increased auditory volume in an affected ear) may be produced by damage to the seventh cranial nerve. This is because the seventh cranial nerve innervates the stapedius muscle in the middle ear which damps ossicle movements which decreases volume. With seventh cranial nerve damage this muscle is paralyzed and hyperacusis occurs. Furthermore, since the branch of the seventh cranial nerve to the stapedius begins very proximally, hyperacusis secondary to seventh cranial nerve dysfunction indicates a lesion close to seventh cranial nerve's origin at the brainstem

Answer 94

Whisper test or rub fingers together. Weber Rhinne

Answer 95

Voice Gag Reflex Uvula deviation Sensory posterior 1/3 of tongue, auditory tube, pharynx Parasympathetic to parotid gland

Answer 96

Voice Gag Reflex Uvula deviation towards unaffected side Sensory larynx, pharynx, heart, lungs Motor to larynx, pharynx, heart, lungs

Answer 97

Innervates muscles of larynx and pharynx. Innervates muscles of Trapezii and SCM. Check for asymmetry of trapezius. Shrug shoulders. Push head laterally against hand.

Answer 98

Controls three of four tongue’s extrinsic muscles. Genioglossus, Styloglossus, Hyoglossus Palatoglossus is Vagus. Check for tongue deviation- towards peripheral lesion and away from central Tongue atrophy. Tongue fasiculations.

Neuro Flashcards

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