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neuro assessment Flashcards

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1
Q

HOW DOES THE CNS COMMUNICATE WITH THE PNS? (think neurons)

A

VIA NEURONS AND NERVE FIBERS
Sensory neurons from the PNS transmits information to the CNS for processing

CNS sends signal via motor neurons back to the PNS to respond

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2
Q

Dendrite

(dend is the receiver)

A

Dendrite
Receives stimulation in order for the cell to become active

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3
Q

Cell body (Soma) - what does it do?

(soma has the info)

A

Cell body (Soma)
Processes information

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4
Q

axon

A

Axon
Conducts and transmits impulses to other neurons or end organ; varies in length from few centimeters up to few feet

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5
Q

Myelin sheath - produced by what in the PNS?

(schwann has PNS)

A

Myelin sheath
Produced by schwann cells in the PNS
Insulates the axon; allows for faster conduction

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6
Q

Axon terminal

A

Axon terminal
Releases neurotransmitter

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7
Q

NEUROTRANSMITTERS

A

Chemicals that are released by the presynaptic cells at the end of the axon
These chemicals bind to the receptors at the post-synaptic dendrites to initiate an electrical impulse
Whether there is depolarization “action potential” depends on the number of presynaptic cells firing (summation) or the frequency with which one cell fires (temporal summation)

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8
Q

Excitatory neurotransmitters - examples

(excite the GHN)

A

Excitatory neurotransmitters
Norepinephrine, glutamate, histamine

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9
Q

Inhibitory neurotransmitters - ex.

(inhibited by G)

A

Inhibitory neurotransmitters
Gamma-amino butyric acid ( GABA), glycine
Drugs and toxins can modify or block these neurotransmitters

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10
Q

Both excitatory and inhibitory

(sneeze in the dope for both)

A

Both
Acetylcholine, Dopamine

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11
Q

FUNCTIONS OF A NEURON - can they regenerate?

A

Functions:
Initiates (nerve impulse), receives and processes messages from internal and external signals
Neurons are not mitotic: therefore “can not regenerate” themselves if damaged.
Thus, primary tumors of neurons are rare
However recent evidence shows astrocytes play in role in reducing neuroinflammation during damage and may proliferate after certain CNS injuries

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12
Q

Sensory neuron

A

Sensory neuron
Activated by sensory input from sensory receptor neurons

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13
Q

Interneurons

A

Interneurons
transmits impulses between nearby motor and sensory neurons (bypasses signal to brain as in reflex arc to prevent injury)

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14
Q

Motor neuron

A

Motor neuron (Upper and Lower Motor neuron)
Sensory input processed by the cerebral cortex transmits impulses via upper and lower motor neurons to elicit a motor response

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15
Q

UPPER MOTOR NEURON

(up must go down)

A

Located in the cerebral cortex
Signal travels down Corticospinal tract (descends to spinal cord to control movements below neck)

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16
Q

LOWER MOTOR NEURON - where is it located?

(the lower horn)

A

Located in anterior horn of the spinal cord
Controls skeletal muscles
Corticobulbar tract (ends at the brain stem; controls mov’t of cranial nerves)

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17
Q

UMN LESION (damage to motor neurons) - what are the symptoms?

(uma is a spaz)

A

Spasticity
Hypertonia
hyper-reflexia
+Babinski reflex
Muscle atrophy due loss of innervation

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18
Q

LMN LESION

(lame is flaccid)

A

Flaccidity
Hypotonia
Hypo-reflexia
- Babinski
Muscle atrophy due to disuse

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19
Q

PROTECTING THE NEURONS: GLIAL CELLS (NEUROGLIA)

(glee protects me)

A

FUNCTION:
Surround neurons, provide support and insulation
Most abundant cells in the brain (comprise ½ the mass of the brain and spinal cord)

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20
Q

Left Hemisphere

A

Logic and reasoning
Math and Science
Speech, words, and language
Detail oriented
Reality based

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21
Q

Right Hemisphere

A

Creativity/imagination
Impulse control
Feelings and intuition
Spatial perception
Abstract meaning

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22
Q

ANATOMY OF THE BRAIN

A

The brain includes:
The cerebrum (left/right cerebral hemispheres) 4 lobes
The cerebellum
The brain stem 3 parts (midbrain, pons, medulla oblongata)

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23
Q

Broca’s area: on TEST - where is it located?

(broc expresses himself in the front)

A

Located in the frontal lobe (left hemisphere)

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24
Q

Wernicke’s area: where is it located? and what type of language?

(Wernicke is receptive in the temple)

A

Located in the temporal lobe (left hemisphere)
Enables the processing of words into coherent thought and recognition of the idea behind the written or heard words
Responsible for receptive language

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25
Limbic System: Emotion and Motivation - parts of the limbic system? (FAT CHH - ic)
Amygdala Hippocampus Thalamus Hypothalamus Cingulate gyrus Fornix
26
Basal Ganglia
Group of structures located centrally in cerebrum Responsible for: Initiation, execution, and completion of movements Learning and emotional response Autonomic movements (blinking, swallowing, swinging of arms)
27
CEREBELLUM (belly dancer is fine)
Receives input from the cerebral cortex, spinal cord, sensory and inner ear Coordinates: Voluntary movements Sense of body position Balance and equilibrium Speech Fine movements
28
BRAIN STEM - on TEST (brain stem is the worst stroke you can have) - parts of the brainstem (stem is having PMM)
Consists of : Midbrain Pons Medulla oblongata
29
Grey Matter - composed of what? (TBD grey)
Mainly composed of cell bodies, dendrites and axon terminals of neurons
30
White Matter (myla is white)
Mainly composed of myelinated axons connecting all the neurons in the brain and spine
31
WHAT IS PROTECTING YOUR BRAIN
Skull – physical barrier Meninges Blood Brain Barrier Cerebral Spinal Fluid
32
Dura mater (dura ble skull and arachnoid)
Dura mater – tough membrane between the skull and arachnoid
33
Arachnoid (bathethe arachnoid)
Arachnoid bathed in CSF and contains blood supply
34
Pia mater (pia is full of fluid)
Pia mater – additional barrier, secretion and containment of CSF
35
THE BLOOD BRAIN BARRIER (BBB)
Complex of tightly joined endothelial cells of the cerebral capillaries and astrocyte end feet together keep some substances of plasma out of the CSF and brain
36
CEREBROSPINAL FLUID (CSF) - where is it located? (school is sub ventricles)
Located in the subarachnoid and *ventricles
37
FUNCTION OF CSF - 3 things
Buoyance- allows brain to float in the cranium Protection – cushions the brain from impact Chemical stability – removes waste and optimizes environment for neurons
38
CEREBRAL CIRCULATION
Internal carotid artery supplies blood to the cerebrum Anterior cerebral artery Middle cerebral artery Posterior cerebral artery Vertebral artery From the subclavian artery join to form the basilar artery to provide blood flow to the cerebellum
39
CEREBRAL CIRCULATION - Pontine branches (ponte puts in basil stem)
Pontine branches Branches from the basilar artery providing blood to brain stem
40
CEREBRAL CIRCULATION - Circle of Willis - on TEST (Willis is my collateral)
Circle of Willis Arterial structures that provides collateral circulation through alternate arteries to prevent brain ischemia
41
VERTEBRAL COLUMN - what about sacral and coccygeal?
There are 4 curves in the spine: 7 cervical 12 thoracic 5 lumbar 5 fused sacral 4 fused coccygeal The spinal cord passes through the vertebrae
42
THE SPINAL CORD - where does it end? and what covers it?
Spinal cord : ends between L1 and L2. Axons from the lumbar and spine extend downward and exit the intervertebral foramen Note the meninge layers also cover the spinal cord
43
PERIPHERAL NERVOUS SYSTEM - comprised of which nerves? (2 types)
PNS: comprises of spinal nerves and cranial nerves 31 pairs of spinal nerves (8 cervical, 12 thoracic, 5 lumbar, 5 sacral and I coccygeal)
44
NERVE TRACTS - 2 types - you know this
Ascending tracts: nerve fibers that carry sensory stimuli from periphery (e.g. skin, muscle, blood vessels) toward the brain Descending tracts: nerve fibers that carry impulses responsible for motor movement
45
Peripheral Nervous System - Dermatomes - innervated by what?
Dermatomes: Area on the skin that is innervated by spinal nerves. Each of these spinal nerves relay sensation from a particular region of skin to the brain
46
Peripheral Nervous System - Sensory receptors
Sensory receptors: located throughout the body to monitor and transmit sensation of pain, temp, touch, vibration, pressure, visceral sensation and proprioception.
47
Plexus - passes through where? and injury to plexus can cause what?
Plexus: areas where the nerves join together. Cervical, brachial, lumbar and sacral Often passes through or are surrounded by bones. Injury can cause entrapment to many nerves
48
NEUROLOGICAL ASSESSMENT
Establish a basement Mentation, vision, speech, motor, sensation, reflex For past medical hx, ask about: Medical, family, diet, cancers, infections, bowel and bladder functions Social Hx: substance abuse, living situation, social support, sleep pattern Surgical hx: traumas and surgeries Nutrition: chewing or swallowing issues. Vitamin supplements such as B1, niacin, B6 that are required for CNS function
49
NEUROLOGICAL ASSESSMENT
There is no clear consensus regarding the optimal order of performing or presenting the neuro exam. “Be systematic” A thorough neuro exam should include : Mental status Cranial nerve exam Motor system exam Reflexes Sensation test Compare Left and Right sides to each other Compare upper to lower extremities
50
NEUROLOGICAL ASSESSMENT:
Mental Status Examination - on TEST (CA)
Components are: General appearance and behavior LOC: Change in LOC is the first indication of decline in CNS function Level of consciousness: Arousal: a state of wakefulness that an individual exhibits. It is mediated via RAS (awake, alert, lethargic, obtunded, stuporous, comatose) Awareness: encompasses all cognitive functions that embody awareness of self, environment and affective states
51
NEUROLOGICAL ASSESSMENT:
Mental Status Examination - cognition - how to measure attention?
Orientation to person, time, place, situation General knowledge (e.g. who is the current president) Memory: immediate (what did you have for breakfast), recent (where did you go to HS) and remote Executive functioning Note impairment such as dementia and delirium Calculation Attention: Count backward from 100 by 5. Stop when they reach 65, say the alphabet backwardsv
52
How to Assess Memory - Long term/remote
Memory: very important part to note loss of memory as it can be an early sign of dementia and Alzheimer’s Assess for Long term/remote: ask birth date, schools attended, place of birth …any info you can verify
53
Mental Status Examination - Language and copying
Language and copying Can they follow commands Any hesitancy in speech Point to an item and ask patient to name it Draw something simple and ask to copy Reading/comprehension only if patient can read
54
MOTOR EXAM - Cerebellar and coordination test (think balance) and which test?
Gait and balance Rapid alternating movement Finger to nose testing or heel to shin testing
55
REFELX TESTING - grade, and what's important?
Relaxation is key during the reflex exam The joint under consideration should be about 90 degrees and fully relaxed Reflexes are graded by 0-5 scale. However, comparison between reflexes in one part of the body with another is much more important than the absolute reflex grade.
56
SENSORY EXAM
Light touch Vibration Pain: Nociceptive: Somatic pain Visceral Neuropathic Nerve pain Temperature
57
AGE RELATED NEURO CHANGES - CNS - neurons?
CNS: Normal loss of neurons → ↓in brain mass
58
AGE RELATED NEURO CHANGES - pupil size?
Pupil size decrease and slower accommodation to light changes
59
X-ray for bone density Cerebral angiography - what to watch out for? (2 main things)
To evaluate cerebral, carotid and vertebral circulation Using contrast medium may sting or have burning sensation behind the eyes or in the face when injected, feeling flushed Check allergies to contrast dye Dyes can cause allergic reaction and vasospasm. If this occurs, stop the test. Can cause ischemia and hemiparesis. Monitor puncture site for bleeding and pulse Bed rest and immobilization of limb for the prescribed number of hrsv
60
Diagnostics: best test for neurologic problems?
CT scan - Quickest, easiest and least expensive method for diagnosing a neurologic problem Can distinguish bone, soft tissue and CSF or blood Can help identify tumors, infarcts, bleeding, and hydrocephalus
61
Diagnostic: what is the most sensitive test?
MRI - Most sensitive for detecting abnormalities of the brain and spinal cord May use gadolinium: non-iodine based contrast Screening form required to rule out contraindications for MRI
62
Diagnostic: PET SCAN (Positron Emission Tomography)
A type of nuclear medicine procedure that measures metabolic activity of tissue cells. Preparation NPO except water 6 hrs prior to exam Limit carb intake 24 hrs prior to exam Hold diabetic medications and sources of glucose per doctor’s orders Used to detect cancers, heart disease and brain disorders Provides information about function such as blood flow, glucose and O2 metabolism
63
Diagnostic: Lumbar Puncture (LP)
Lumbar puncture or spinal tap: A needle is inserted into the subarachnoid space to obtain pressure readings and to collect CSF Nursing role: During procedure: help position patient and provide physical and emotional support. Post procedure: monitor puncture site and report signs of severe headache
64
Diagnostic: Electroencephalogram (EEG)
Detects electrical activity in the brain Useful in diagnosing brain disorders, especially epilepsy, seizure disorder, level of induced coma
65
cranial nerve 1
olfactory (cover one nostril)
66
pupil check
check if they constrict - 2nd time if they're symmetrical
67
cranial nerve 2
optic (paper 20 inches from pt about)
68
3,4,6 cranial nerve check
checking your eye muscles
69
check peripheral vision
cover one eye
70
receptive aphasia
when someone is able to speak well and use long sentences, but what they say may not make sense. They may not know that what they're saying is wrong,
71
if block in carotid = symptoms
can be headache, dizziness
72
reflex arc
Reflexes: an involuntary and nearly instantaneous movement in response to a stimulus. A reflex is made possible by neural pathways called reflex arc which can act on an impulse before that impulse reaches the brain.
73
need to know slide 58 and 59
on test
74
mylin sheath - produced by what in the CNS?
Produced by oligodendrocytes in the CNS
75
neurotransmitters that inhibit pain
Endorphins and Enkephalins: inhibits pain
76
lower motor neuron - is it one side, or both?
*Notice contralateral involvement of muscle
77
the skull - how many bones
The skull: protects the brain from trauma. Consists of: 8 cranial bones 14 facial bones
78
Amygdala
Amygdala: fear, anger, anxiety
79
Hippocampus
Hippocampus: formation of new memories
80
Thalamus
Thalamus: relay center of sensory inputs to the cerebral cortex
81
Hypothalamus
Hypothalamus: regulates ANS and the endocrine system
82
Cingulate gyrus
Cingulate gyrus: pain and emotion
83
Fornix
Fornix: the primary outgoing pathway from the hippocampus
84
brainstem - vital function
Vital function: Respiratory and cardiac functions
85
brainstem - Reflexive function
Reflexive function: swallowing, gag, digestion, vomiting Reticular Activating System (RAS) Net-like formation of nerve cells along brainstem
86
brainstem - Responsible for
sleep-wake cycle, alertness and arousal
87
grey matter - what does it control?
Controls higher functions of the CNS: emotions, cognition, consciousness
88
white matter - what does it do?
Conducts, processes, and sends signals up and down the spinal cord.
89
Meninges
physical barrier and contains blood supply
90
Blood Brain Barrier
limits metabolite, chemical/toxic entry
91
Cerebral Spinal Fluid
cushions and optimizes environment
92
what can cross the BBB?
O2, glucose, CO2, ETOH and anesthetics crosses freely
93
what can't cross the BBB?
Large molecules such as albumin, toxins, and many antibiotics cannot cross BBB
94
CSF - color?
Clear, colorless
95
CSF - specific gravity, glucose, and pH?
Specific gravity: 1.007 Glucose: 45-75 No RBCs pH: 7.35
96
CSF - produced where?
Produced by the ependymal cells of the Choroid plexus: complex of tiny blood vessels in the lateral, 3rd & 4th ventricles of the brain
97
PNS - dorsal root
ON TEST - Dorsal root travels afferent path: -carries sensory information from the peripheral toward the CNS***
98
PNS - Ventral root
Ventral root travels efferent path: - carries impulse away from the CNS toward the periphery for motor control
99
sensory receptors also include what?
Also includes the “special senses” of vision, taste, smell, hearing, sight
100
neuro assessment - LOC
Components are: General appearance and behavior LOC: Change in LOC is the first indication of decline in CNS function
101
neuro assessment - Arousal
Level of consciousness: Arousal: a state of wakefulness that an individual exhibits. It is mediated via RAS (awake, alert, lethargic, obtunded, stuporous, comatose)
102
neuro assessment -Awareness
Awareness: encompasses all cognitive functions that embody awareness of self, environment and affective states
103
how to assess memory - Recall/recent
Recall/recent: how good a historian are they (if the info is consistent). Dates of appointment? Date of admission?
104
how to assess memory - Immediate or new
Immediate or new: 3 non-related words and ask to repeat after a couple of minutes
105
motor exam - strength test
Strength testing – push and pull test against resistance
106
motor exam - Tone
Tone Passive movement of limbs should elicit slight resistance. Note tics, tremors, spasticity, flaccidity
107
sensory exam - Stereognosis
ability to recognize objects in hand
108
sensory exam - Graphesthesia
ability to recognize writing on the skin purely by the sensation of touch
109
age related changes - PNS
PNS Degeneration of myelin → slower conduction → decline in neuromuscular coordination orthostatic hypotension more common temperature regulation less optimal (vulnerable to hypo and hyperthermia) Slower reflexes
110
brocka's area - what type of language?
Composed of neurons responsible for the formation of speech (expressive language) It requires activation of the vocal cords which must occur at the same time as the tongue and mouth movement
111
age related changes - CNS - ventricles?
Widening of the ventricles
112
age related changes - CNS - blood flow? and CSF?
Cerebral blood flow and CSF production decline
113
age related neuro changes - memory?
Memory, vision, taste, smell, muscle strength decline Touch and position sense decrease: ↑ Fall risk Vibration sense in hands and feet may decline Loss of hearing in the high pitched ranges Require more time for thought processing. Intelligence not affected Long term memory better than short term memory Insomnia, wakefulness at night (require less sleep than when younger)
114
what xray for bone density?
Cerebral angiography
115
CT scan - does it use contrast?
Can be done with or without contrast (using contrast yields more detailed imaging)

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