Neurological Exam Flashcards
(105 cards)
1
Q
Cerebrum
A
2 hemispheres right and left. Big part of brain
2
Q
Gray outer layer
A
Cerebral cortex houses higher mental functions
3
Q
What is the cerebral cortex responsible for
A
- Higher mental functions
- Movement
- visceral functions
- Perception
- Behavior
- Integration of all functions
4
Q
Frontal lobe
A
Area at front of cerebrum. Responsible for higher order functions, emotions, personality
5
Q
Two other areas within frontal lobe
A
- Motor cortex - movement
2. Sensory cortex - sensation
6
Q
Parietal lobe
A
Located posteriorly to frontal lobe. Responsible for interpretation of info and sensations (perception). Also aids in proprioception and small amounts of taste, smell, hearing
7
Q
Occipital lobe
A
Posterior portion of cerebrum. Responsible for vision
8
Q
Temporal lobe
A
Located on lateral portion of cerebrum. Responsible hearing!! and for memory and language interpretation
9
Q
Cerebellum
A
Responsible for fine tuning movements from the cerebrum. Processes sensory info from the eyes, ears, and touch receptors. Big part of balance!! (DOES NOT INITIATE MOVEMENT)
10
Q
Which part of the brain aids in balance and muscle tone
A
The cerebellum
11
Q
Brainstem
A
Pathway between cerebrum and spinal cord. Controls many involuntary functions
12
Q
Some involuntary controls of the brainstem
A
- respiratory
- circulatory functions
- eye movements
- releasing hormones from pituitary gland/hypothalmus
13
Q
Limbic system
A
Structure deep in the cerebrum that controls mood and emotions (i.e. fear, pleasure, anger, sex, hunger). Amygdala
14
Q
What are the 3 areas that make up the brainstem
A
- Midbrain
- Pons
- Medulla oblongata
Superior to inferior
15
Q
Cranial nerve I
A
Olfactory nerve. Responsible for smell (S)
16
Q
Cranial nerve II
A
Optic nerve. Responsible for visual acuity and visual fields. (S)
17
Q
Cranial nerve III
A
Oculomotor. Responsible for muscle movement of eye, except LR and SO. Also helps with pupillary constriction. (M)
18
Q
Cranial nerve IV
A
Trochlear. Responsible for movement of superior oblique muscle of eye. Moves eye in and down. (M)
19
Q
Cranial nerve V
A
Trigeminal. Responsible for opening and closing of jaw, clenching teeth, chewing, mastication. Sensory function: eyelids, forehead, nose, moth, teeth, tongue. (B)
20
Q
Cranial nerve VI
A
Abducens. Lateral eye movement (M)
21
Q
Cranial nerve VII
A
Facial. Movement of all facial expressions (smile, frowning, etc) DOES NOT MOVE JAW, but does move lips. Sensory - taste on anterior 2/3 of tongue. (B)
22
Q
Cranial nerve VIII
A
Acoustic. Responsible for hearing. (S)
23
Q
Cranial nerve IX
A
Glossopharyngeal. Responsible for voluntary muscles of swallowing and phonation. Sensory - nasopharynx, gag reflex. Taste on posterior 1/3 of tongue (B)
24
Q
Cranial nerve X
A
Vagus. Sensation behind ear and part of ear canal. Parasympathetic: secretes digestive enzymes, peristalsis. (B)
25
Cranial nerve XI
Accessory (spinal). Turns head, shrug shoulders. (M)
26
Cranial nerve XII
Hypoglossal. Tongue movement for speech and swallowing. (M)
27
Branches of cranial nerve V
"Tri" 3 parts, (sharp, dull, light)
V1 - ophthalmic nerve
V2 - maxillary nerve
V3 - mandibular nerve
28
Basal ganglia
Group of structures in deep brain. Relay station for indirect motor pathway. Refines motor movements
29
3layers of the spinal cord
1. Dura mater
2. Arachnoid mater
3. Pia mater
30
Where does spinal cord start
At the foramen magnum as a continuation of medulla oblongata. Terminates at L1
31
What does the white matter of the spinal cord contain
Ascending and descending spinal tracts
32
What does the gray matter of the spinal cord contain
Nerve cell bodies associated with sensory pathways and the ANS.
33
Ascending spinal tracts
Located in the white matter of the spinal cord and relay sensory signal from the body back to the brain
34
Descending spinal tracts
Located in the white matter of the spinal cord and relay information from the brain to various muscle groups (Inhibitory or excitatory)
35
Spinal nerves
31 pairs of nerves that arise from the spinal cord and exit at each intervertebral foramen.
36
Dermatome
area of skin that is innervated by each spinal nerve
37
Where do upper motor neurons begin and end
All the cell bodies for the motor pathway begin and end within the CNS
38
Are the upper motor neurons ascending or descending pathways
Descending pathways from brain to spinal cord
39
What is the function of the upper motor neurons
1. influence, direct, and modify spinal reflexes
| 2. Can only affect movement by connecting with lower motor neurons
40
What happens to the muscle tone and DTR with upper motor neuron lesions
Increased tone and DTR. Hypertonia, clonus, paralysis of voluntary movements, babinski sign
41
What happens to the muscle tone and DTR with lower motor neuron lesions
Decreased tone and DTR. Muscle atrophy, fasciculations, polio
42
What is the one disease that has crossover in both upper and lower motor neurons
Lou Gehrig disease (ALS)
43
Where do the lower motor neurons originate
In the anterior horn of the spinal cord (gray matter). Extend to the peripheral system.
44
Function of the lower motor neurons
Transmit neural signals directly to the muscles which creates movement. "final pathway"
45
What is the result of injury to the upper motor neuron
May result in initial paralysis but may be followed by partial recovery over extended period of time
46
What is the result of injury to the lower motor neuron
Often results in permanent paralysis
47
Division of the PNS
Sensory and motor
48
Division of the motor
Autonomic (ANS) - involuntary
| Somatic (SNS) - voluntary
49
Function of the ANS
INVOLUNTARY. Coordinates and regulates internal organs and conducts impulses from CNS to cardiac and smooth muscles.
50
2 branches of the ANS
Parasympathetic and sympathetic
51
Function of the SNS
VOLUNTARY. Conducts impulses from the CNS to skeletal muscles. also assists in reflex arc.
52
What areas would you test for sharp, soft, or dull
Face, legs, and hands. Use cotton wish, broken tongue blade, and a paperclip
53
What areas would you test for vibratory sensation
On the joints of the fingers and toes. May also test shoulder, elbow wrist. Ask pt to tell you where to sensation is felt
54
Temperature sensation test
Only done if superficial pain sensation is not intact. Roll test tube of hot and cold water against the skin.
55
What areas of the the body would use the two point discrimination test
Fingers, toes, back. use a paper clip or needles. place them apart from each other.
On fingers= 2-8mm apart
On back=40-70mm
56
Scoring scale of DTR
```
0 - no response
1+ sluggish or diminished
2+ active or expected response
3+ brisk or more than expected
4+ hyperactive, clonus
```
57
Superficial reflexes above umbilicus
Stroke out and up. Muscle movement should be in that same direction. T8,9,10
58
Superficial reflexes below umbilicus
Stroke down and out. Muscle movement should be in that same direction. T10, 11, 12
59
Two other superficial reflexes
1. Cremasteric
| 2. Plantar reflex (babinski)
60
Plantar reflex
Take end of reflex hammer and run along lateral edge of plantar surface from heel to ball of foot. Should get plantar flexion in all toes
61
Babinski sign
Occurs during plantar reflex test, great toe dorsiflexes. Indicates upper motor neuron disease
62
Which nerves are associated with cremasteric reflex
T12, L1, L2
63
Normal finding in children under 2 (superficial reflex)
Babinksi sign
64
Oculocephalic reflex (doll's eyes)
Used to assess health of comatose/lethargic pts. Hold eyes open and rotate head around. Reflex intact if eyes move opposite direction of the head. If dolls eyes not happening, it is a brainstem dysfunction
65
Kerig sign
"K for knee" Flex leg, attempt to straighten. Assess for low back pain and watch for involuntary head flexing, may suggest meningitis
66
Brudzinski sign
Pt supine, Flex the neck and watch for involuntary flexion of hips/knees. If this happens it may be meningitis
67
Gower sign
Seen often in children. When they get up off the floor they push off the floor and then push off legs (knees) to help stand up the rest of the way. May be proximal muscle weakness
68
Clonus
Muscle spasm that is often repeated and rhythmic contractions. Often seen with upper motor neuron lesions. These are large motions (unlike fasciculations)
69
Clonus test of ankle
Done when reflexes are hyperactive. Support pts knee in flexed position and briskly dorsiflex foot. If oscillation occurs, it is a positive clonus test
70
Romberg sign
Tests for balance and proprioception. Pt stands with fee together, eyes closed. If pt loses balance it indicates cerebellar ataxia (loss of control), vestibular issue, or sensory problem
71
Pronator drift
Done after romberg, have pt stand with arms extended. Watch for arms drifting from that position. Can also tap the arm and see if it stays in place or if it then drifts.
72
Decorticate
Posture in which pts arms are adducted and flexed. Wrists/fingers flexed and on chest. Legs stiff, extended and internally rotated, with plantar flexion of foot. Due to corticospinal tract damage
73
Decerebrate
Posture where arms are adducted and extended, wrists pronated fingers flexed. Legs are stiff, extended with plantar flexion of foot. Caused by upper brain stem damage
74
Spasticity
Condition in which skeletal muscles are continuously stiff or tight. Can lead to paralysis and increased DTR
75
Flaccidity
Reduced skeletal muscle tone/contractability, also leads to paralysis. Caused by disease/trauma.
76
Hemiplegia
Paralysis of entire side of the body. Most common in strokes
77
Paraplegia
Paralysis of lower half of body
78
Delerium
Condition of confusion and problems with perception, mood, behavior, attention
79
Dementia
A longterm, gradual decline in mental ability that affects memory, thinking, social abilities
80
Depression
Mood disorder persistant feelings of sadness and loss of interest
81
Stupor
Lack of critical cognitive function and state of consciousness. Person pretty unresponsive, only responds to pain
82
Coma
State of unconsciousness. Does not respond to stimuli, caused from brainstem injury or injury to the RAS
83
Paresthesia
Abnormal tingling/pricking sensation caused by pressure or damage to a peripheral nerve
84
Receptive aphasia
aka wernickes aphasia. Unable to understand written or spoken language, but can speak with normal grammar, syntax, intonation. Don't know what they are saying. Damage to temporal lobe
85
Expressive aphasia
Person is unable to produce spoken or written language. Speech is extremely slow, inflection impaired, but words are meaningful. Damage to anterior region of brain
86
Areflexia
Absence of neuro reflexes. LMN problem
87
Hyperreflexia
Overactive reflexes, UMN problem
88
Hyporeflexia
Underactive or absent reflexes. LMN problem
89
What is the glasgow coma scale used for
To estimate the conscious state of a person.
90
Sections of the glasgow and max score
Eye response, verbal response, motor response. 15
91
What PE tests do you do for mental status
1. A & O
2. Recent memory
3. Remote memory
92
What test do you do for cranial nerve I
Smell something with eyes closed
93
Test for CNII
Visual acuity, fields of confrontation
94
Test for CNIII
Cardinal directions (except LR and SO) down and inward eye movement
95
Test for CNIV
Cardinal direction only tests the superior oblique (SO0
96
Test for CNV
Motor - open close jaw, side to side with jaw, clench.
| Sensory - opthalamic, maxillary, mandibular - test sharp, dull, soft in those areas
97
Test for CNVI
Lateral eye movement, done with cardinal directions
98
Test for CNVII
6 facial expression
99
Test for CNVIII
Whisper test
100
Test for CNIX and X
Gag reflex and swallow - 9,10
| say ah and watch uvula rise - 10
101
Test for CNXI
Trapezius and SCM resistance
102
Test for CNXII
Stick out tongue move side to side, then push tongue against cheek and external resistance
103
Cerebellar (proprioception) tests
1. Romberg
2. Nose to finger test
3. Gait
4. Shin scrape
5. Rapid alternating movements of hands and feet
104
Test for motor
AROM, grip strength,
105
Tests for superficial reflexes
1. Babinski
2. Cremasteric
3. Abdominal
