Phys Dx- Neuro Abnormal

Question 1

aphasias

Answer 1

difficulty with speech

Question 2

Expressive/ Broca’s asphasia

Answer 2

able to comprehend, but unable to speak

Question 3

Receptive/ Wernicke’s ashasia

Answer 3

unable to comprehend, fluent nonsensical speech

Question 4

Global Asphasia

Answer 4

unable to undertand and unable to speak

Question 5

Apraxia

Answer 5

unable to perform a learned motor action

- parietal lobe dysfunction

Question 6

Agnosia

Answer 6

inability to recognize sensory stimuli

Question 7

Delirium Vs. Dementia

Answer 7

Delirium: Acute onset, recent memory loss, heightened awareness, incoherent speech, illusions/hallucinations, impaired sense of time, lasts hours to weeks
Dementia: gradual onset, recent and long-term memory loss, normal alertness, difficulty finding words, impaired orientation

Question 8

Coma Definition, Pathologic causes, etiology

Answer 8

inability to respond to internal or external stimuli - associated with mortality, 90% of survivors awaken in the first 3 days
- impaired thalamus bilateral
- bilateral hemisphereic injury
- injury to midbrain or below
Causes: cardiac arrest, overdose, stroke, cerebral edema, metabolic condition, trauma to brain, status epilepticus

Question 9

Definition of Delirium

Answer 9

Hypervigiliant with agitation and impaired concentration and attention

Question 10

Lethargy

Answer 10

arousal possible with light stimulation

Question 11

Confusion

Answer 11

impaired attention and incoherent thought

Question 12

stupor

Answer 12

severly imparied arousal with response to pain

Question 13

obtundation

Answer 13

more alert than stupor, responds to light stimulation such as shaking pt

Question 14

fugue

Answer 14

pt suddenly abandons present activity or life and starts a new life in a new place, with amnesia, usually remembers and returns

Question 15

catatonia

Answer 15

psychomotor disturbances seen in schizophremia characterized by muscular rigidity, excitement or stupor

Question 16

GCS

Answer 16

Eyes (4) spontaneous, to voice, to pain, none
Verbal (5) conversant, conversant/disoriented, inappropriate words, incomprehensible sounds, none
Motor (6) obeys commands, to localize to pain, withdraws to pain, flexor posturing, extension posturing, none
Score of 15 = wide awake
Score of 3 = deep coma
Lower number, worse prognosis (score below 8 or coma > 72 hours is bad)

Question 17

Coma Vigil/Alpha Coma

Answer 17

patients act awake - yawn, cough, move but still in vegetative state

Question 18

Decortitate Posturing

Answer 18

Flexion - adduction and flexion of arms with extension of legs, reflexts destructive lesion in corticospinal tract from cortex to upper midbrain

Question 19

Decerberate Posturing

Answer 19

Extension - extension adduction and internal rotation of arms and extension of legs (palms turned out, legs and arms extended)

Question 20

Cause of hernia

Answer 20

increased intracranial pressure

Question 21

Brainstem Reflex: oculocephalic reflex/Doll’s eyes

Answer 21

hold eyes open and rotate head side to side
if intact, eyes roll to side oppoisite of head movement
if eyes remain fixed and move in the same direction of head movement, suggests lesion in midbrain or pons “dolls eyes absent”

Question 22

Brainstem Reflex: Vestibulochochlear Reflex

Answer 22

lavage ear with cold water - COWS - cold water opposite and warm water same
tonic with slow movement and nystagmus with quick

Question 23

hyposmia or anosmia

Answer 23

decreased or absent smell. CN VI deficit - olfactory groove meningioma

Question 24

pituitary adenoma sxs

Answer 24

p/w HA or visual field defect

increased growth hormone, increased prolactin, increased ACTH (cushing’s)

Question 25

Central VII Lesion p/w

Answer 25

CONTRALATERAL paralysis of lower face (not forehead and able to raise eyebrows) seen with stroke or mass lesion

Question 26

Peripheral VII Leion p/w

Answer 26

IPSALATERAL paralysis of entire side of the face

Question 27

Bell's Palsy

Answer 27

idiopathic facial palsy, LMN lesion results in ipsalateral facial palsy in entire face

Question 28

Acoustic Neuroma

Answer 28

benign growth on CN VIII

Question 29

Glossopharyngeal Lesion

Answer 29

CNIX lesion results in deviation AWAY from side of lesion, loss of gag reflex

Question 30

Hypoglossal Lesion

Answer 30

deviation of tongue toward the side of lesion | lick the lesion

Question 31

CVA signs and sxs

Answer 31

``` acute weakness, numbness abrupt impairment of consciousness worst HA of life inability to produce language - aphasia slurring of speech - dysarthria ```

Question 32

spasticity

Answer 32

increased tone, worse with rapid movement | UMN disease

Question 33

rigidity

Answer 33

increased tone and resistance to movement (Parkinson's)

Question 34

Flaccidity

Answer 34

decreased tone | LMN disease

Question 35

Upper Motor Neuron vs. Lower Motor Neuron

Answer 35

Upper: weakness, spasticity, hyperactive DTR's clonus, babinski Lower: weakness, atrophy, flaccidity, fasciculations, reduced DTR's

Question 36

Cervical Radiculopathy

Answer 36

Nerve root compression C5-C8: | See Slide 54 for specific motor, sensory and DTR loss

Question 37

Lumbar Radiculopathy

Answer 37

Compression of nerve roots L3-S1, See slide 57 for specific deficits

Question 38

Characteristics of Neuromuscular Disease: | Weakness, Reflexes, Sensory

Answer 38

Weakness: Increased with effort Reflexes: Normal Sensory Loss: None

Question 39

Characteristics of Nerve Disease: | Weakness, Reflexes, Sensory

Answer 39

Weakness: Distal Reflexes: Diminished Sensory Loss: Distal

Question 40

Characteristics of Muscle Disease

Answer 40

Weakness: Proximal Reflexes: Normal or decreased late Sensory: None

Question 41

UMN Weakness - weakness presentation based on location of injury

Answer 41

Neurons from motor cortex pass thru brainstem and down spinal cord - disease results from damage to corticospinal tracts (Stroke, mass, lesions, sclerosis, trauma) - weakness will be present below level of lesion - unilateral lesions above medulla - contralateral weakness - unilateral lesions below medulla - ipsalateral weakness

Question 42

Mononueropathy (LMN) Carpal Tunnel

Answer 42

Medial Nerve Compression Sensory loss - first 3.5 digits Motor Loss - thenar Pain - nocturnal in forearm and first 3.5 digits

Question 43

Mononeuropathy (LMN) Ulnar Entrapment

Answer 43

Ulnar Nerve Compression Sensory Loss: 1/2 of 4th and all of 5th Motor Loss: hypothenar Pain: 4th and 5th fingers and tenderness at elbow

Question 44

Resting Tremor

Answer 44

WITH PARKINSONS | - only at rest, not with movement

Question 45

Postural Tremor

Answer 45

Appears when actively maintaining posture (hypothyroid)

Question 46

Intention Tremor

Answer 46

absent at rest, appears when reaching for target | with aging, cerebellar disease, MS

Question 47

Tic

Answer 47

brief, repetitive twitch, usually face or UE | winking, grimacing, shrugging

Question 48

Oral-Facial Dyskinesia

Answer 48

rhythmic, repetitive, bizarre movements of the face mouth, jaw, tongue - psychotropic meds

Question 49

Chorea

Answer 49

rapid, jerky like movements of face, trunk, extremities - HUNTINGTON'S CHOREA

Question 50

Athetosis

Answer 50

writhing, twising, movements of face, trunk, an extremeitis, slower than chorea (CP)

Question 51

Myoclonus

Answer 51

sudden rapid jerks, faster than chorea (infections, stroke, anoxia)

Question 52

Spastic Hemiparesis

Answer 52

associated w/ upper extremity flexed, lower extremity extended, DRAGS OR DRAWS FOOT AROUND

Question 53

Steppage Gait

Answer 53

associated with foot drop | DRAG FOOT or LIFT THEM HIGH with knees flexed then SLAP ON FLOOR

Question 54

Sensory Ataxia

Answer 54

associated w/ proprioception in legs unsteady, wide gait watch the ground while walking + Rhomberg

Question 55

Cerebellar Ataxia

Answer 55

associated with cerebellar disease or associated tracts -staggering, unsteady wide-based gait increased difficulty with turns unable to stand with eyes open or closed

Question 56

Parkinson's Disease

Answer 56

Idiopathic degeneration of neurons in substantia nigra - bradykinesia - rigidity - resting tremor - masked facies - dementia - stooped posture - slow to get started - short shuffling steps - decreased arm swing