NEUROLOGICAL SYSTEM Flashcards
(78 cards)
1
Q
FN of the cerebral cortex
A
- thought, memory, reasoning
- sensation perception
- controls voluntary movement
2
Q
4 lobes of the cerebrum
A
FRONTAL
- personality, behaviour, emotion, cognition
- precentral gyrus: initiates voluntary movement
PARIETAL
- sensation
- associated w/ postcentral gyrus
OCCIPITAL
- primary visual receptor centre
TEMPORAL
- primary auditory reception centre
3
Q
What are the 2 language areas in the brain?
A
Wernicke’s area
- language comprehension
- location: temporal lobe
- damage: receptive aphasia - lost the ability to grasp the meaning of words
Broca’s area
- motor speech
- location: frontal lobe
- damage: expressive aphasia - cannot produce meaningful language
4
Q
What are the basal ganglia? What is it responsible for?
A
- Additional bands of grey matter found deep within the cerebral hemispheres
- forms the subcortical structures
- FN: automatic movements of the body (ex. arm swings that alternates w/ legs during ambulation)
5
Q
Thalamus
A
- relay station for the NS
- all sensory messages pass through here before being sent to the cerebral cortex
6
Q
Hypothalamus
A
- regulation and control
- temp, HR, BP, sleep, posterior pituitary glands
- coordinates the NS activity
7
Q
Cerebellum
A
- motor coordination of voluntary movements
- postural balance of body
- muscle tone
- adjusts and corrects voluntary movements
8
Q
3 areas of the brainstem and their FN
A
MIDBRAIN
- anterior, merges into thalamus and hypothalamus
- contains motor neurons + tracts
PONS
- enlarged area containing ascending + descending tracts
MEDULLA
- continuation of spinal cord in the brain
- contains all ascending + descending tracts that connect the brain and spinal cord
- contains vital autonomic centers (respiratory, cardiac, gastro-intestinal)
- nuclei for CN VIII to CN XII found here
- pyramidal decussation (crossing over of motor fibers) happen here
9
Q
What is crossed representation in the CNS?
A
- crossing over of nerve fibers occurs at the medulla
- L cerebral cortex receives sensory info from and controls motor FN to, the R side of the body
10
Q
What are the 2 sensory pathways?
A
1) spinothalamic tract
2) posterior dorsal columns
11
Q
Spinothalamic tract
A
- transmits sensations of pain, temperature, crude or light touch
- spinal cord –> spinothalamic tract –> thalamus –> sensory cortex
- note: crossing over of secondary neurons occurs in spinal cord
12
Q
Posterior dorsal columns
A
- transmits sensations of position, vibration, and fine touch
- involved in proprioception - knowing where body parts are in space
- spinal cord –> medulla –> thalamus –> sensory cortex
- crossing over of secondary sensory neurons occurs in the medulla
13
Q
Stereognosis
A
- Ability to ID familiar objects through touch
- stereognosis is impaired with damage to the posterior dorsal columns
14
Q
what are the 3 motor pathways?
A
1) corticospinal tract
- mediate voluntary movements (skilled, discrete movements)
2) extrapyramidal tract
- maintain muscle tone and control gross autonomic movements
3) cerebellar systems
- coordinates movement, maintains equilibrium and posture
15
Q
What is a reflex arc?
A
involuntary, quick reactions to potentially painful or damaging events.
- sensory neurons involved in reflexes do NOT reach the CNS
- afferent fibers go to the dorsal root and synapses directly w/an efferent motor neuron in the ventral root
16
Q
what are the 4 types of reflexes?
A
1) deep tendon
- ex. knee jerk
2) superficial
- ex. abdominal and corneal reflex
3) visceral
- ex. pupillary response to light and accommodation
4) pathological
- ex. Babinski reflex
17
Q
CN I
A
Olfactory n.
T: sensory
F: smell
18
Q
CN II
A
Optic n.
T: sensory
F: vision
19
Q
CN III
A
Oculomotor n.
T: motor
F: extraocular movements + pupil constriction
20
Q
CN IV
A
Trochlear n.
T: motor
F: downward + inward movement of the eye
21
Q
CN V
A
Trigeminal n.
T: both
F: muscles of mastication (motor) + sensation of the face, scalp, cornea, mucous membrane (sensory)
22
Q
CN VI
A
Abducens n.
T: motor
F: Lateral eye movements
23
Q
CN VII
A
Facial n.
T: both
F: facial muscles, speech, the closing of eyes (motor) + taste (sensory)
Also involved in saliva and tear secretion
24
Q
CN VIII
A
Vestibulocochlear n.
T: sensory
F: hearing + equilibrium
25
CN IX
glossopharyngeal n.
T: both
F: swallowing and phonation (motor) + taste and the gag reflex (sensory)
involved in parotid and carotid reflex
26
CN X
Vagus n.
T: both
F: pharynx and larynx for swallowing and talking (motor) + general sensation from carotid body, carotid sinus, pharynx, viscera (sensory)
27
CN XI
accessory n.
T: motor
F: movement of trapezius and sternocleidomastoid m.
28
CN XII
Hypoglossal n.
T: motor
F: movement of the tongue
29
How many spinal nerves are in the body, and name the region?
```
8 cervical
12 thoracic
5 lumbar
5 sacral
1 coccygeal
```
30
Describe what a dermatome is, and what it means in the case of nerve damage
A circumscribed skin area that is supplied mainly from one spinal cord segment through a particular spinal nerves
overlapping dermatomes = insurance
- if one nerve is damaged, the nerve below or above it can take over
31
Developmental considerations when doing a neurological assessment on infants
- NS is not completely developed
- motor activity largely controlled by spinal cord and medulla (largely reflexes)
- sensation is rudimentary at birth as neurons are not myelinated
- newborns need strong stimulus and respond to crying w/ whole body movements
32
Developmental considerations when doing a neurological assessment on older adults
- general atrophy w/ steady loss of neurons in brain and spinal cord
- general loss of muscle bulk, and tone in face, neck, and spine
- decreased muscle strength and impaired fine coordination and agility
- loss of vibratory sense at the ankle and decreased achilles reflex
- loss of position sense at the big toe, pupillary miosis, irregular pupil shape, decreased pupillary reflex
- decreased cerebral blood flow and O2 consumption
33
Syncope
sudden loss of strength and a temporary loss of consciousness due to lack of cerebral blood flow that occurs w/ low BP
34
vertigo
the sensation of rotational spinning caused by a neurological disease in the vestibular apparatus of in the ear
35
Seizure vs aura
seizure - occurs w/ epilepsy or paroxysmal disease
aura - subjective sensation that precedes a seizure
36
Paresis
weakness of voluntary movements or impaired movement
37
paralysis
loss of motor FN as a result of a lesion in the neurological or muscular system or loss of sensory innervation
38
dysmetria
inability to control the range of motion of muscles
39
paraesthesia
abnormal sensation like burning or tingling
40
dysphasia
difficulty swallowing
41
dysarthria
difficulty forming words
42
How do you test CN I function?
smell test and patency test
43
what is anosmia?
decrease or loss of smell that occurs w/ smoking, allergies, and cocaine use.
neurological anosmia = unilateral loss of smell in the absence of nasal disease
44
how do you test CN II?
Confrontation test
| - tests visual acuity and visual fields
45
How do you test CN III, IV, VI?
pupils - size, regularity, equality, direct, consensual light reactions, accommodation
cardinal positions - extraocular movements
46
Nystagmus
An abnormal finding - Back and forth osculation of the eyes
| - often occurs w/ disease of the vestibular system, cerebellum, or brain stem
47
strabismus
deviated gaze or limited movement
48
Ptosis
drooping eyes, caused by dysFN of CN III
49
What is the corneal reflex test and which CN does the corneal reflex test?
Bringing an object close to the eye --> should cause blinking
Afferent fibers of CN V
Efferent fibers of CN VII
Lesions to CN V or CN VII = no blinking
50
How do you assess CN V?
- assess muscles of mastication
- assess pt's sense of light touch by having pt close their eyes and asking them to say "now" whenever they feel the cotton ball in 3 regions (opthalamic, maxillary, mandibular)
- corneal reflex
51
A nurse is assessing the mobility and symmetry of facial structures in a patient. The pt's sense of taste is also assessed. What is being tested?
CN VII
abnormal findings
- muscle weakness: nasolabial folds, drooping of one side of the face, lower eyelid sagging
- loss of movement and asymmetrical movement
52
Which CN does a hearing test assess?
CN VIII - vestibulocochlear
53
What are you testing for when you depress the tongue w/ a tongue blade and ask your pt to say "ahhh"
motor FN of CN IX and CN X
- uvula and soft palate should rise midline
- tonsils should move medially
54
what should you note as abnormal when assessing CN XI
weakness or paralysis of sternomastoid muscle or trapezius muscle
55
When and why would you ask your pt to say "light, tight, dynamite"?
Assess CN XII, tongue function
56
What is the balance test?
Used to assess gait (walk)
- should be smooth, effortless, coordinated, opposing arm swings, smooth turns
- heel-to-toe walking for balance
57
Ataxia
- what is it?
- what does it indicate?
uncoordinated or unsteady gait
- stiff, staggering, wide base
- rigid arms, no arm swings
- unequal rhythm
Indicative of an upper motor neuron lesion
- ex. multiple sclerosis, acute cerebellar dysFN, alcohol intoxication
58
what is the Romberg test?
Pt closes their eyes and holds a standing position for 20 secs
- can do w/ single leg, and single leg hop
59
is a positive Romberg sign normal or abnormal?
abnormal finding
- loss of balance when eyes are closed
- occurs w/ cerebellar ataxia
60
Dysmetria
clumsy movements w/ overshooting of the mark in the finger-to-finger, finger-to-nose, heel-to-chin tests of coordination
- occurs w/ alcohol intoxication and cerebellar disorders
61
How would you assess the spinothalamic tract?
Spinothalamic tract is involved in pain, temperature, and light touch perception.
PAIN
- pt closes eyes
- apply a tongue blade w/ a sharp and dull end
- ask pt whether they feel a sharp or dull sensation
TEMP
- only tested when pain sensation is abnormal
TOUCH
- pt closes eyes
- apply cotton to skin
- ask pt to say "now" once they feel the cotton on their skin
62
Hypoalgesia, analgesia, hypergesia
- what is it?
- which tract does it involve?
decreased, absent, increased pain sensation
involves the spinothalamic tract
63
when would you use the tuning fork? To assess what?
Used to assess vibration sensation.
- place over boney prominences
- pt to indicate when vibrations start and stop
Assesses FN of the posterior column tract
- inability to feel vibrations occurs in peripheral neuropathy (diabetes, alcoholism)
64
Which tests can be done to assess the FN of the posterior column tract?
- vibration sensation
- position (kinaesthesia)
- tactile discrimination (fine touch)
65
Stereognosis vs graphesthesia
stereognosis - ability to recognize familiar objects by feeling w/ hands
- astereognosis occurs w/ sensory cortex lesions
graphesthesia - ability to "read" a number or letter traced on the skin
66
What are the tests for tactile discrimination?
2 POINT DISCRIMINATION
- the smallest distance that can be felt/perceived as 2 different points.
- sensory cortex lesions are associated w/ increased distance in order to ID the 2 different points
Stereognosis and graphesthesia
Extinction
- simultaneously touch both sides of the body at the same time
- ask pt to state how many sensations are felt and where they are
- with cortex lesions, stimulus is extinguished on the side OPPOSITE of the cortex lesion
Point location
- touch skin and withdraw promptly
- ask pt to "point your finger to where I touched you"
- inability to localize sensation associated w/ sensory cortex lesions
67
biceps reflex
- type
- spinal segment
deep tendon
| c5-c6
68
triceps reflex
- type
- spinal segment
deep tendon
| c7-c8
69
brachioradialis reflex
- type
- spinal segment
deep tendon
| c5-c6
70
quadriceps or patellar reflex
- type
- spinal segment
deep tendon
| L2-L4
71
Achilles reflex
- type
- spinal segment
deep tendon
| L2-S2
72
gradation of a reflex
4+: v. brisk, hyperactive w/ clonus
- Indicative of disease
3+: brisker than avg.
- May indicate disease
2+: average, normal
1+: diminished, low normal
0: no response
73
clonus
set of rapid, rhythmic contractions of the same muscle
when clonus occurs with hyperactive reflexes, this is a sign of upper motor neuron disease
74
abdominal reflex
- type
- spinal segment
- how to do
- superficial reflex
- upper (T8-T10) and lower (T10-T12)
- stroke from the side of the abdomen toward the midline
- should see an ipsilateral contraction of abdominal muscles
- deviation of umbilicus toward the stroke
75
Cremaster reflex
- type
- spinal segment
- what is it
- superficial
- L1-L2
- only done in male pt
- stroke the inner thigh
- should see elevation of ipsilateral testicle
this reflex is absent in people w/ upper and lower motor neuron lesion
76
plantar reflex
- type
- spinal segment
- how to do
- superficial
- L4-S2
- position thigh in slight external rotation and stroke the lateral side of the sole of the foot inward across the ball of the foot
77
what is a Babinski sign
an abnormal finding when doing the plantar flexion
- dorsiflexion of the big toe and fanning of all toes
- this is ONLY normal in infants
78
Glasgow coma scale
Used to assess level of consciousness
```
Eye opening (1-4)
Verbal response (1-6)
Motor response (1-5)
Fully alert - 15
< 7 = coma
```
Limitation of scale - inconsistent interrater reliability
