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319 Cards in this Set
- Front
- Back
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What are the four regions of the brain? |
cerebrum, diencephalon, brainstem, cerebellum
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What are the lobes of the brain from anterior to posterior?
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frontal, parietal, temporal, occipital
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_____ consists of aggregations of neuronal cell bodies that rim the surfaces of the cerebral hemispheres, forming the cerebral cortex.
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Grey matter
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))) consists of neuronal axons that are coated with myelin
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White matter
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The myelin sheaths allow for what?
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Nerve impulses to travel more rapidly.
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The _____ processes sensory impulses and relays them to the cerebral cortex.
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thalamus
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the ____ regulates homeostasis and temperature, heart rate, and blood pressure.
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hypothalamus.
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What is the internal capsule?
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a white matter structure where myelinated fibers converge from all parts of the cerebral cortex and descend into the brainstem.
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What are the three sections of the brainstem?
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midbrain, pons, medulla
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What structure in the diencephalon and upper brainstem is important in consciousness and interacts with both cerebral hemispheres?
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reticular activating system (arousal system)
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The ____ coordinates all movement and helps maintain the body in an upright position.
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cerebellum
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At what spinal level does the spinal cord fan out into the cauda equina?
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L1 to L2
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Which CN produces sight?
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CN II - optic
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Which CN produces smell?
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CN I - olfactory
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Which CN produces sound?
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CN VIII - acoustic
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How many pairs of spinal nerves are there? How many are cervical, thoracic, lumbar, sacral, and coccygeal?
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31 pairs:
- 8 cervical - 12 thoracic - 5 lumbar - 5 sacral - 1 coccygeal |
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CN I functions to do what?
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sense of smell
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CN II functions to do what?
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sense of sight
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CN III functions to ___
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pupillary constriction, eyelid elevation, most extraocular movements
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CN IV functions to ____
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downward, internal rotation of the eye
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What are the three sensory branches of CN V?
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trigeminal:
- ophthalmic, - maxillary, - mandibular |
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What is the motor function of the trigeminal nerve?
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temporal and masseter muscles, lateral pterygoids
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Describe the function of the CN VI
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Abducens - lateral devation of the eye
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CN VII has what functions?
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Facial -
Motor: facial movement of expression, closing eyes, and closing mouth Sensory - taste for salty, sweet, sour, and bitter on anterior 2/3 tongue |
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CN VIII has what function?
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Acoustic (vestibulocochlear)
Hearing (cochlear) and balance (vestibular) |
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Describe the function of CN IX
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Glossopharyngeal -
motor - pharynx sensory - posterior eardrum, ear canal, pharynx, posterior tongue |
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Describe the function of CN X
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Vagus -
Motor - palate, pharynx, larynx Sensory - pharynx and larynx |
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Describe the functiosn of CN XI
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Accessory -
Motor - SCM, upper trapesius |
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Describe the function of CN XII
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Hypoglossal -
motor: tongue |
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What are the principal motor pathways?
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Corticospinal tract, basal ganglia system, cerebellar system
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Which spinal tract mediates voluntary movement?
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Corticospinal
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When the corticospinal tract is damaged above ____, impairment occurs on the ____ side.
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1. the medulla
2. contralateral |
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When the corticospinal tract is damaged below the ____, impairment occurs on the ____ side.
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1. medulla
2. ipsilateral |
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A patient with a lower motor neuron lesion has what symptoms?
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weakness/paralysis, loss of fine movement, hyporeflexia, decreased muscle tone
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A patient with an upper motor neuron lesions has what symptoms?
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muscle tone and reflexes increased.
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____ damage impairs coordination, gait, equilibrium, and ____ muscle tone
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Cerebellum
Decreases |
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___ Damage produces (usually) ___ muscle one, disturbance in posture, gait, and bradykinesia
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Basal ganglia
Increases |
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What are the two sensory pathways?
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spinothalamic (pain/ temp, crude touch), posterior (dorsal) columns (light touch)
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Describe the levels of deep tendon reflexes
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Ankle: Sacral 1
Knee: Lumbar 2,3,4 Supinator/ Brachioradialis: C5,6 Biceps: C 5,6 Triceps: C 6,7 |
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Describe the spinal levels of the superficial (cutaneous) reflexes.
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Abdominal upper: T8,9,10
Abdominal lower: T10, 11, 12 Plantar: L5, S1 Anal: S2,3,4 |
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___ and ___ are two of the most common symptoms in neurologic disorders.
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Dizziness and headache
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_____ may present as "the worst headache of my life"
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Subarachnoid hemorrhage
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Dull headache worse with coughng, sneezing, or sudden movement could suggest ___
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brain lesions or abscesses
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___ is the perception of the room spinning or rotating.
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Vertigo
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___ is difficulty forming words.
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Dysarthria
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Focal weaness may arise from ___, ___ or ___ lesions in the CNS
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ischemic, vascular, or mass lesions
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For weakness without lightheadedness, try to distinguish between ____ and ___
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proximal and distal weakness
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What actions would be difficult with proximal weakness?
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combing hair, reaching up, or difficulty getting up from a chair or taking a high step.
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What actions would be difficult with distal weakness?
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use of hand tools, frequent tripping
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Weakness can be made worse with repeated effort and improved with rest in _____
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myasthenia gravis
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What are dysesthesias?
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distorted sensations in response to a stimulus as in perception of a light touch as burning or tingling
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Tonic-clonic actifity with bowel incontinence indicate ____ and may be accompanied by what other symptoms?
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Seizure - tongue biting or bruising of limbs
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What is a seizure?
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a paroxysmal disorder caused by sudden excessive electrical discharge in the cerebral cortex or underlying structures.
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_____ is the third leading cause of death in the US and leading cause of long-term disability.
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Stroke
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A TIA is most recently defined as lasting less than ____.
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1 hour
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Risk of stroke is highest in the first ___ days after a TIA.
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30
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Who is at disproportionately greater risk for stroke incidnece and mortality
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African americans (when compared to white)
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The most common cause of ischemic stroke symptoms and signs is occlusion of the _____ artery. What does this cause?
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Middle cerebral artery
- visual field cuts, contralateral hemiparesis, and sensory deficits |
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Describe the 5 basic warning signs of stroke.
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1. sudden numbness or weakness of face, arm or leg
2. sudden confusion, trouble speaking or understanding 3. sudden trouble walking 4. sudden trouble seeing 5. sudden severe headache |
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Primary prevention of stroke targets _____
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modifiable risk factors for ischemic stroke
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What are modifiable risk factors of stroke?
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HTN, smoking, hyperlipidemia, diabetes, excess weight, lack of exercise, heavy alcohol use
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What is the most common cause of hemorrhagic stroke from subarachnoid hemorrhage?
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Rupture of saccular aneurysms in the circle of willis
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What is the leading determinant risk for both ischemic and hemorrhagic stroke?
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HTN
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How long does it take for ex-smokers to return to the same risk for CVA as non-smokers?
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5 years
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Obesity ____ the risk of stroke
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doubles.
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What is the most common cause of peripheral neuropathy?
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Diabetes
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What are the "Three D's" of CNS exam?
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Delirium, dementia, and depression
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The major categories of a CNS screening exam should include:
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1. mental status, speech, and language
2. cranial nerves 3. motor system 4. sensory system 5. reflexes |
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CN I - tests for ___ by ___
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Olfactory - smell, occlude and have pt smell from each nostril
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CN II can be examined by _____
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Optic - visual acuity, field of vision, fundal exam
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CN II and III can be examined together by ___
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Optic, Oculomotor - pupillary reactions
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CN III, IV, and VI can be examined by _____
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Oculomotor, trochlear, Abducens- extraocular movements
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CN V can be examined by ____
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Trigeminal -
Motor: clenching jaw, temporalis muscle & masseter Sensory: pain sensation with sharp object & light touch with cotton Corneal reflex: wisp of cotton |
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CN VII can be examined by ____
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Facial -
facial expressions to include frowning, raise eyebrows, resistance to opening, smiling with teeth, without teeth, puffing cheeks |
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CN VIII can be examined by ____
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Acoustic -
- whispered voice test - rinne test/ webber test |
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CN IX and X can be examined by ___
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glossopharyngeal and vagus -
- have pt swallow. listen for hoarseness or vocal problem, observe deviation of the uvula (X), gag reflex |
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CN XI can be observed by ____
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Spinal accessory - atrophy or fasciculations of trapezius. shrug shoulders against resistance, turn head against resistance
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CN XII can be observed by ___
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hypoglossal - listen for speech articulation, inspect tongue at neutral and protruded, note symmetry of tongue movement.
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In ___, pupils constrict to light, but remain small and do not dilate due to abnormal pupillary dilator muscle.
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Horner's syndrome
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What type of diplopia occurs with neuropathy of CN III, IV, and VI?
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binocular
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In what conditions would you find monocular diplopia?
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local problems with glasses or contacts, cataracts, astigmatism, or ptosis
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In CNV pontine lesions, one would expect ____ weaness.
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Unilateral
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In cerebral hemispheric disease, one would expect _____ weakness
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bilateral (due to cortical innervation)
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In brainstem lesions, one would expect ___ face but ___ body sensory loss
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ipsilateral face, contralateral body
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CNS patterns of strok include ____ sensory loss of face and body from ___ cortical or thalamic lesions
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same side sensory loss face and body, but come from contralateral lesion
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When testing corneal reflex, you should tell the patient to look which direction?
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Up and away
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What is the normal reaction to the corneal reflex test?
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bilateral blinking
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Sensory limb of the corneal reflex is carried by CN ___, the motor by CN ___
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CN V= sensory
CN VII = motor |
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What may diminish or abolish the corneal reflex?
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Use of contact lenses
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If you have absent blinking in the corneal reflex test, you should suspect lesions of what cranial nerves?
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V or VII
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A peripheral injury of CN VII presents how?
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Unilateral upper and lower face weakness.
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A central lesion would affect which part of the face?
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Mainly lower
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Unilateral absence of the gag reflex suggests a lesion of which cranial nerve(s)?
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CN IX or possibly X
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In ___ the shoulder droops and the scapula is displaced downward and laterally.
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Trapezius muscle paralysis (consider problem with CN XI)
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How does the tongue deviate in a unilateral cortical lesion?
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Transiently away from the side of the lesion, toward the side of weakness.
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When looking for atrophy, pay particular attention to the ____
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Hands, shoulders, and thighs
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____ refers to a los of muscle bulk, or wasting.
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Muscular atrophy
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___ is an increase in bulk wiht proportionate strength
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Hypertrophy
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___ is an increase in bulk with diinished strength and is seen in ___
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Pseudohypertrophy, seen in duchenne MD.
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Fasciculations with atrophy and muscle weakness suggest ___
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disease of peripheral motor unit
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Hypotonia or flaccidity is described as _
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"marked floppiness"
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___ is increased resistance that worsens at the extremes of range and is rate-of-movement dependent.
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Spasticity
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____ is increased resistance throughout the range of movement and in both directions, and is not rate dependent.
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Rigidity
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What is Paresis?
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weakness
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Describe the scale for grading muscle strength.
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0- no contraction
1- barely detectable contraction 2- active movement with gravity eliminated 3- active movement against gravity 4- active against gravity and some resistance 50 active against full resistance without fatigue |
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Nystagmus, dysarthria, hypotonia, and ataxia may all be present in _____ disease.
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Cerebellar
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What is dysdiadochokinesis?
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One movement cannot be followed quickly by its opposite and movements are slow, irregular, and clumpsy (while doing RAM)
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Deficiencies found during the point-to-point test indicate a possible problem where?
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Cerebellar disease
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Define what "ataxic" means.
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A gait that lacks coordination, with reeling and instability.
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______ walking is a sensitive test for corticospinal tract damage
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Heel walking
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Rhomberg sign would be most likely positive in damage to what area?
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Dorsal column tract
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If apt has difficulty standing with feet together whether the eyes are open or closed, it suggests ___
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cerebellar ataxia
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A positive pronator drift test sugests _____
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corticospnal tract lesion originating in the contralateral hemisphere
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The "glove and stocking" sensory loss is characteristic of what?
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a polyneuropathy as often seen in alcoholism and diabetes
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___ is the term describing decreased sensitivity to pain.
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Hypalgesia
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___ describes increased sensitivity to pain.
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Hyperalgesia
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___ is the term used to describe the absence of touch sensation, __ is decreased touch sensation, and ____ is increased touch sensitivity.
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1. anesthesia
2. hypesthesia 3. hyperesthesia |
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When would testing vibratory sense in the trunk be useful?
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In estimating the level of a cord lesion
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Defects identified in stereognosis, two=point discrimination, or graphesthesia suggest a lesion where?
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Sensory cortex
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Describe the test for extinction.
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Simultaneously stimulate corresponding areas on both sides of the body. Ask where the patient feels your touch - they should identify both
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What reflex findings are associated with a CNS lesion along the descending cortico-spinal tract?
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Hyperactive, possibly also spastic movements and pos babinski sign
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In the babinski test, you would normally expect what finding>
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big toe to plantar flex.
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Describe Brudzinski's sign.
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as you flex the neck, watch the hips and knees in reaction. Normally they should stay relaxed and motionleses
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Describe a positive Brudzinski's sign, and what does it suggest?
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1. flexion of the hips and knees when lifting(flexing) the neck.
2. Meningeal irritation |
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Describe Kernig's sign. What does a positive test suggest?
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flex th patient's leg at both the hip and knee, and then straighten just the knee. Discomfort behind the knee during extention may be normal, but should not produce pain. Pain and increased resistance to knee extension suggest meningeal irritation (IF BILATERAL)
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WHat may cause a UNILATERAL Kernig's sign?
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Compression of a lumbosacral nerve root
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The majority of disc herniations occur between which two discs?
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L5-S1
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What is a positive crossed straight leg test, and what does it suggest?
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1. increased pain when the contralateral healthy leg is raised.
2. Suggests lumbosacral radiculopathy |
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Describe asterixis. What does it suggest?
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1. Ask pt to "STOP" traffic by flexing wrist with fingers spread. sudden brief, nonrhythmic flexion of the hands and fingers
2. metabolic encephalopathy (liver disease, uremia, hypercapnia) |
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Which muscle is most likely affected when pt has "winging"?
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Serratus anterior (as in muscular dystrophy or injury to long thoracic nerve)
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What are the priorities of assessing a comatose patient?
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1. ABCs
2. LOC 3. Neurological function |
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Five clinical signs that strongly predict death or poor outcome are:
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at 24 Hours: absent corneal response, absent pupillary response, absent withdrawal to pain, no motor response
at 72 hours: no motor response |
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What are the two "DONT's" of assessing a comatose patient?
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1. don't dilate the pupils
2. Don't flex the neck if there is any question of trauma |
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Describe a lethargic patient.
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appears drowsy, but opens eyes and looks at you, answers questions, and then falls asleep
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Describe an obtunded patient.
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opens eyes and looks at you, responds slowly and confused, Alertness and interest in environment are decreased
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Describe a stuporous patient.
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Arouses only with painful stimuli. Verbal response slow or absent. Pt lapses into an unresponsive state when stimulus ceases. Minimal awareness of self or environment
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Describe a comatose patient.
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Remainse unarousable with eyes closed. No evident response to inner need or external stimuli
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What is gaze preference?
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horizontal deviation of the eyes to one side.
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In structural hemispheric lesions, the eyes look where?
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Toward the affected hemisphere
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In irritative lesions from epilepsy or early cerebral hemorrhage, the eyes look where>
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away from affected hemisphere
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A comatose patient with an intact brainstem, the eyes move _____
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(toward the opposite side... aka doll's eyes.
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Absent dolls eyes are a (normal/abnormal) finding in a comatose patient
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Abnormal (doll's eyes are normal)
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Describe "dolls eyes".
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Holding open the upper eyelids so you can see the eyes, turn the head quickly to one side hten the other. As the head is turned, the eyes shoudl move toward the opposite side.
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In a comatose pt with absence of doll's eye movements, it suggests what?
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lesion of midbrain or pons
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When injecting ice water into the ear canal, the eyes should drift _____ the irrigated ear.
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Toward
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If a patient does not respond to ice water in the ear canal as expected, it suggests what?
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brainstem injury
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Clinical finding of contralateral leg weakness in a CVA suggests what vascular area?
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Anterior - Anterior cerebral artery.
Also includes stem of circle of willis connecting internal corotid to ACA, segment distal to ACA, and anterior choroidal branch |
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A pt presents with weakness of contralateral face, arm>leg weakness, sensory loss, field cut, and [apahsia] or [neglect and apraxia]. What do you suspect?
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Middle cerebral artery lesion (left side= aphasia, right side= neglect and apraxia)
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What is the largest vascular bed for stroke?
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Middle cerebral artery
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A patient presents with contralateral motor or sensory deficit without cortical signs. What do you suspect?
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A subcortical lesion, lenticulostriate deep penetrating branches of MCA
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Small vessel subcortical lacunar infarcts in internal capsule, thalamus or brainstem are types of ____
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Subcortical lesions (MCA)
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What are the four common syndromes of subcortical MCA lesions?
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1. pure motor hemiparesis
2. Pure sensory hemianesthesia 3. Ataxic hemiparesis 4. Clumsy hand-dysarthria syndrome |
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_____ includes paired vertebral and basilar artery, paired posterior cerebral arteries.
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Posterior circulation (PCA)
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A lesion of the PCA would present in
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contralateral field cut, cortical blindness but preserved pupillary light reaction
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A patient presents with dysphagia, dysarthria, tongue/palate deviation, and/or ataxia with crossed sensory/motor deficits (ipsilateral face, contralateral body) waht do you suspect?
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Posterior circulation lesion (brainstem, vertebral, or basilar artery branches)
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A patient presents with oculomotor deficits and/or ataxia with crossed sensory motor deficits (ipsilateral face, contralateral body). what do you suspect?
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lesion of the basilar artery.
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Describe "locked-in syndrome". What does it indicate?
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Complete basilar artery occlusion - intact consciousness but inability to speak and quadriplegia
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Broca's area is ____ to Wernicke's area
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anterior
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Where is wernicke's area and what does it control?
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Posterior most aspect of superior temporal lobe, sensory speech
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Where is Broca's area, what does it control?
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Between anterior parietal lobe just superior to temporal lobe - motor speech (between motor and premotor cortex)
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A patient has been outside on a humid/hot day at a park and is hit in the abdomen with a softball accidently. The patient immediately becomes weak, pale, and feels nauseous and then loses consciousness. Someone near her catches her fall and helps her to the ground. She has most likely suffered ____
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vasovagal syncope
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Another term for the "common faint" is ___
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vasovagal or vasodepressor syncope
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Describe the mechanism of vasovagal syncope.
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sudden peripheral vasodilation without compensatory cardiac output. Slow onset, slow offset
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Factos that predispose someone to vasovagal syncope are what?
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fatigue, hunger, a hot/humid environment
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Describe the mechanism of postural (orthostatic) Hypotension.
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1. Inadequate vasoconstrictor reflexes in both arterioles and veins, with resultant venous pooling, decreased cardiac ouput, and low blood pressure
2. Hypovolemia |
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Orthostatic hypotension most commonly occurs upon ___
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standing
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What would predispose a patient to postural hypotension as a result of inadequate vasoconstrictor reflex?
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peripheral neuropathy, disorders affecting autonomic nervous system, drugs such as antihypertensives and vasodilators, prolonged bed rest
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A patient presents after a syncopal episode during a severe fit of coughing. This is called ___
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cough syncope
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What is micturition syncope?
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syncope occuring after emptying the bladder after getting out of bed, usually in elderly or adult men
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What type of cardiovascular disorders can cause syncope?
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arrhythmias, aortic stenosis and hypertrophic cardiomyopathy, myocardial infarction, or massive pulmonary embolism
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What causes syncope in aortic stenosis and hypertrophic cardiomyopathy?
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vascular resistance falls with exercise and cardiac output cannot rise - associated with exercise.
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A 70 year-old female just finished exercising followed by a syncopal episode. After a brief period of unconsciousness, she returned to normal mentation. WHat disease process could you suspect?
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aortic stenosis or hypertrophic cardiomyopathy
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In ____, the symbolic expression of an unacceptable through body language. Skin color and vital signs may be normal, sometimes with bizarre and purposive movements, occurring in the presence of other people.
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hysterical fainting from conversion reaction
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_____ start with focal manifestations in one area.
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Partial seizures
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What are the two types of partial seizures?
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simple partial seizures - do not impair consciousness
complex partial seizures - impair consciousness (petite mal?) |
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____ occurs with tonich then clonic movements that start unilaterally in the hand, foot, or face and spread to other body parts on teh same side.
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Jacksonian (simple partial)
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___ seizures include turning of the head and eyes to one side, or tonic and clonic movements of an arm or leg without spreading.
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"other motor " or "non-Jacksonian" simple partial seizure
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Describe a simple partial seizure with sensory symptoms.
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Numbness, tingling, simple visual auditory or olfactory hallucinations such as flashing lights, buzzing, or odors
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Autonomic symptoms of a simple partial seizure include ___
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a "funny feeling" in the epigastrium, nausea, pallor, flushing, or lightheadedness
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An alert patient presents with uncontrollable tremoring in his right hand. Within 30 seconds his entire right arm and his right shoulder is shaking, and it seems to be progressing to his lower extremity as well. You suspect what
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Jacksonian simple partial seizure
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A patient presents with the sensation fo flashing lights and sensation of a strange smell. Shortly after they become dazed, unresponsive to you, and are smacking their lips randomly. After about 2 minutes, the patient becomes alert with a little confusion and headache. You suspect ___
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complex partial seizure.
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What two attributes indicate a partial seizure that becomes generalized?
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1. an aura
2. a unilateral neurologic deficit during the postictal period |
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Describe the 4 types of generalized seizures.
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1. tonic-clonic (grand mal)
2. absence 3. atonic (drop attack) 4. myoclonus |
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A patient presents to the ED after losing conscious suddenly and stiffening into tonic rigidity. Bystanders state he quit breathing and then a clonic phase of rhythmic muscular contraction follows. Upon awaking, the pt is confused, drwsy, and a little combative. They also have a babinski reflex and amnesia. They deny any strange feeling or sensations prior.
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Grand mal seizure
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Describe "tonic" activity.
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THe patient suddenly becomes stiff and muscles may contract toward or away from teh core
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Describe "clonic" activity.
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The patient's muscles contract and relax rapidly.
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Describe an absence seizure.
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a sudden brief lapse of consicouness with momentary blinking, staring, or movements in the lips but no falling. No aura.
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Describe the two types of absence seizures. What is the difference?
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1.petit mal absence - <10sec, stop abruptly, prompt return to normal
2. atypical absence - >10sec, may be slightly postictal |
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in ____ patients experience a sudden LOC with falling, but no movements. They may return to normal briefly or be slightly confused.
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Atonic seizure/ drop attack
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____ is the presentation of sudden, brief, rapid jerks involving the trunk or limbs.
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Myoclonus
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Define pseudoseizures.
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May mimic seizure but usually due to a conversion reaction (psych disorder).
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Static tremors are most common ____ and disappear with ___
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1. rest
2. voluntary movement |
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An example of a static tremor woudl be seen in ____
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Parkinsons
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____ appear when affective part is maintaining a posture. It may worsen with intentional movement.
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Postural (action) tremors
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Intention tremors are ____ at rest, ____ with activity, and ge worse as ____.
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Absent at rest
Appear with activity Worse as target is neared |
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What are causes of intention tremors?
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cerebellar disorders, multiple sclerosis, etc
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___ are rhythmic, repetitive, bizarre movements involving the face, mouth, jaw, and tongue.
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Dyskinesias
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What is a tic?
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Brief, repetitive, stereotyped coordinated movements occuring at irregular intervals.
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What is dystonia?
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twisting, writhing movmenets with great amplitude. May be caused by phenothiaznes, primary torsion dystonia, and spasmodic torticollis
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___ movements are slower and more twisting, with larger amplitude. It is often associated with spasticity and most commonly involves face and distal extremities.
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Athetosis
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___ are brief, rapid, jerky, irregular, and unpredictable movments that occur at rest or interrupt normal coordintated movments. Sedlome repeat, face, head, arms and hands usually involved.
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Chorea (huntington's chorea)
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___ is the loss of voice that accompanies disease
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Aphonia. (dysphonia = impairment to volumve, quality, or pitch)
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____ is a defect in the muscular control of the lips, tongue, palate, or pharynx making words nasal, slurred, or indistinct.
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Dysarthria
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Describe the presentation of speech in Wernicke's aphasia.
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fluent, rapid, voluble, and effortless. Articulatio is good but words are malformed or invented and sentences make no sence. Speech may be incomprehensible
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Describe the presentation of speech in Broca's aphasia.
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Nonfluent, slow, few words and laboriuos effort. Inflection and articulation impaired. WOrds make sense with nouns, verbs, and adjectives.
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A patient presents with impaired worde comprehension, immpaired naming, and impaired reading comprehension. You suspect ___ aphasia.
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Wernicke's (sensory/ receptive)
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A patient presents with slow, laborious speech that is meaningfull but elementary and missing small conjunction words. You suspect ___
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Broca's aphasia (motor/ expressive)
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A patient that presents with good word comprehension and reading comprehension, but poor repetition, naming, or writing most likely has a lesion where?
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Posterior inferior frontal lobe
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A patient who presents with impaired reading and writing comprehension, and impaired repetition, naming, and writing most likely has a lesion where?
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Posterior superior temporal lobe
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Rhythmic oscillation of the eyes, analogous to a tremor in other body parts is called _____
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Nystagmus
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What are the three important characteristics of nystagmus to observe?
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1. direction of gaze in which it occurs
2. Direction of quick and slow components 3. Plane of the movements |
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Nystagmus is defined by its ____ phase.
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Fast - if the eyes jerk quickly to the pts left and drift back to right, it is said to be "left-beating" nystagmus
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What is pendular nystagmus?
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only coarse oscillations without a fast or slow phase.
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A patient is diagnosed with horizontal left-beating nystagmus
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yees shift horizontally with fast phase toward pts left
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Bell's palsy is an example of a ____ lesion of CN ____
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Peripheral, CN VII
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Lower motor neurons control _____ (part of face)
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upper motor neurons, contralateral lower face.
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The upper face is controlled by:
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UMN from both sides of the brain
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Peripheral nerve damage to the right CN VII damages ____ of the face. (does this include forehead?)
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Entire right side including forehead
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Central lesion of left CN VII would result in what presentation?
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mild weakness of upper right face, paralysis of lower R face
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THe most common cause of a basal ganglia problem is ___
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Parkinson's
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Spacicity often occurs as a result of a ____. Describe it.
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Stroke, especially late stage/chronic - upper motor neuron of corticospinal tract any point between cortex and spinal cord.
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"Clasp-Knife" resistance is ___
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During rapid passive movement, initial hypertonia may suddenly give way as limb relaxes. (spacicity)
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Describe lead-pipe rifidity.
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Increased resistance that persists throughout the movement arc, independent of rate
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Describe cogwheel rigidity.
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a superimposed rachetlike jerkiness with flexion and extnesion of the forearm.
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A LMN lesion between anterior horn cell to peripheral nerves results in ____ (describe)
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flaccidity - loss of muscle tone causing limb to become floppy.
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What are the most common causes of flaccidity?
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Guillain- Barre, initial phase of spinal cord injury or stroke
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What is the most common cause of paratonia?
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Dementia
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___ describes sudden changes in tone with passive range of motion.
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Paratonia
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___ describes Sudden loss of tone that increases the ease of motion.
____ is sudden loss of tone that makes motion more difficulty. |
1. mitgehen (moving with)
2. gegenhalten (holding against) |
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A lesion at the cerebral cortex will result in what presentation?
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- contralateral weakness and spasticity, flexion stronger than extension in arm, plantar flexion stronger in foot, leg externally rotated at hip,
- contralateral sensory loss in limbs and contralateral trunk - hyperreflexia -ex) cortical stroke |
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A lesion in the brainstem willr esult in what presentation?
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- weaness and spasticity on contralateral side, CN deficits such as diplopia and dysarthria
- no typical sensory findings - hyperreflexia - ex) brainstem stroke, acoustic neuroma |
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A lesion of the spinal cord woud result in :
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- weakness and spasticity often affecting bloth sides (depending on area of cord damage). Para or quadriplegia, dependign on level of injury
- dermatomal sensory deficit bilaterally at level of lesion, sensoryloss from trac damage below level of lesion. - hyperreflexia -ex) trauma, cord compression |
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A lesion in the subcortical gray matter aka basal ganglia would present how?
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- slowness of movement (bradykinesia), rigidity, tremor
- sensation not affected - normal or decreased DTR -ex) parkinsonism |
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A lesion of the cerebellum would present how?
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- hypotonia, ataxia, abnormal movement including nystagmus, dydiadochokinesis, and dysmetria
- sensation not affected - normal or decreased DTR - ex) cerebellar stroke, tumor |
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A lesion in the anterior horn cell would present with ___
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- weakness and atrophy in a segmental or focal pattern, fasciculations
- no sensory loss - decreased DTR - ex) polio, amyotrophic lateral sclerosis |
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A lesion in the spinal root or nerve would result in what?
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- weakness and atrophy in a root-innervated pattern, with or without fasciculations.
- corresponding dermatomal sensory deficits, - decreased DTR - ex) herniated cervical or lumbar disc |
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A lesion in the peripheral nerve (mononeuropathy) would result in:
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- weakness and atrophy in a peripheral nerve distribution, sometiems with fasciculations
- sensory loss in the pattern of that nerve - decreased DTR - Ex) trauma |
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A lesion in the peripheral nerve (polyneuropathy) would result in _
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- weakness and atrophy more distal than proximal. sometimes with fasciculations
- sensory deficit commonly in stocking-glove distribution - decreased DTR - Ex) peripheral polyneuropathy of alcoholism, diabetes |
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A lesion at the neuromuscular junction would result in:
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- fatigability more than weakness
- sensory intact - normal DTR - ex) myasthenia gravis |
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A lesion at the muscle would result in :
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- weakness more proximal than distal, fasciculations rare
- sensory intact - normal or decreased DTR - muscular dystrophy |
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Describe spastic hemiparesis.
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- poor control of flexor muscles during swing phase
- affected arm flexed, immobile, and held close to side with elbows, wrists, and interphalangeal joints flexed - affected leg extensors spastic - ankle plantar-flexed and inverted. |
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____ is described as having bilateral lower extremity spaciticity with adductor spasm and abnormal proprioception. Stiff gait, each leg advances slowly and the thighs tend to cross forward on each other.
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Scissors gait - appears to be "walking through water"
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Steppage gain, seen with ____, is described as:
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1. foot drop
2. drag feet or lift them high with knees flexed and bring down with a "slap" onto the floor. Cannot wlak on heels. |
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Another word for the shuffling seen in parkinsonian gait is ___
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festination.
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Describe what you would expect in a patient presenting with cerebellar ataxia.
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- gait is staggering, unsteady, and wide-based, with exaggerated difficulty on turns.
- Patients cannot stand with feet together steadily, eyes open or closed. May have other cerebellar signs (nystagmus, dysmetria, etc) |
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In _____ gait is unstead and wide-based. Pts throw feet forward and outward first on heels then toes. Watch teh ground for guidance while walking. With eyes closed cannot stand with feet together.
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Sensory ataxia
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Define the two subtypes of coma.
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1. structural (lesion destroys or compresses brainstem arousal areas)
2. metabolic (arousal centers are poisoned or critical substrates depleted) |
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A patient presents comatose with irregular respirations. Pupils equal and reactive to light, and LOC changed after pupils changed. They are most likely comatose due to ____
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toxic-metabolic
*pupils could be dilated or constricted in toxin situations |
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A comatose patient presents with irregular ataxic respirations, with pupils fixed. LOC changed prior to pupils changing. They are most likely suffering what cause of coma?
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Structural
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In a comatose patient, pupils that are midposiiton and fixed suggest ____, wheres fixed and dilated suggests _____.
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1. midbrain compression
2. CN III compression from herniation |
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In the comatose patient, bilaterally small pupils suggest what?
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1. damage to sympathetic pathways in hypothalamus
2. metabolic encephalopathy. (light reactions normal) |
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In the comatose patient, pinpoint pupils suggest what?
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1. hemorrhage int he pos
2. effects of narcotics (light reaction seen with magnifying glass) |
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In the comatose patient, bilaterally fixed and dilated pupils may be due to ____
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1. anoxia and its sympathomimetic effects, anticholinergics, phenothiazines, TCAs
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In the comatose patient, bilaterally large but reactive pupils may be due to what?
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1. cocaine, amphetamine, LSD, orother sympathetic NS agonists
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In the comatose patient, a unilateral dilated pupil suggets what?
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Impending herniation of teh temporal lobe causing comression of the oculomotor nerve and midbrain
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In ____ the upper arms are flexed tight to the sides with elbows, wrists, and fingers flexed. Legs extended and internally rotated. Feet plantar flexed.
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Decorticate rigidity
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Decorticate rigidity suggests ___
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destructive lesion of the corticospinal tracts within or very near cerebral hemispheres (if bilateral)... if unilateral - spastic hemiplegia
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In _______, jaws are clenched and neck extended. Arms adducted with elbows extended, forearms pronated, and wrists and fingers flexed. Legs stiffly extended at knees and feet plantar flexed.
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Decerebrate rigidity
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Decerebrate rigidity suggests
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A lesion in the diencephalon, midbrain, or pons
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___ is when a patient describes the word they cannot think of. Ex) "the writing thing that has ink" instead of pen
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Circumlocution
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What is paraphasia.
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Pt misuses a word (gets them mixed up)
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Broca's aphasia may occur with a lesion where?
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posterior, inferior frontal lobe
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Wernicke's aphasia may occur with a lesion where?
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Posterior superior temporal lobe
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What is confabulation?
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Lying/ fabricating memories unintentionally
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What syndrome is associated with confabulation?
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Korsakoff's - alcoholics will unknowingly create memories to fill gaps left by blackouts
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what is derailment?
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Pt can't stay on track with story... go off on tangents without realizing
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A _____ is when a patient just makes up a new word to describe something.
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neologism
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what is "blocking"?
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trying to remember what you were trying to say but can't... thinking faster than talking and forget where you are.
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What is "Perseveration"?
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unintentional Repetition of a phrase or word
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Describe "clanging"
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A patient uses a word that sounds fun or something.... over and over
(ex: "bipidy boo, bipidy boo, ..) |
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____ is when a patient takes a long time in a description of an event or story to get to the point.
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Circumstantiality
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What is the difference between an illusion and a hallucination?
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illusion : misinterpretation of an external stimuli
Hallucination: sensory perception in absence of real external stimuli |
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Describe the "eyes" scale of GCS:
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4- spontaneously opne
3- open to speech 2- open to pain 1- do not open |
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Describe "verbal" of GCS:
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5- clear, oriented
4- confused speech 3- inappropriate word use 2 - incoherent word use 1- nonverbal |
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Describe "motor" of GCS:
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6- follows commands
5- localizes painful stimuli 4- withdraws from painful stimuli 3- flexes to painful stimuli (decorticate) 2- extends to painful stimuli (decerebrate) 1- no response |
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What is the difference between a physical symptom and a somatoform symptom?
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physical- explained physically or medically or unexplained
somatoform- lacks adequate medical or physical explanation |
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List 10 factors that can help you determine which patients need a mental health screening.
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1. medically unexplained physical symptoms
2. high symptom count 3. high severity of the presenting somatic symptom 4. chronic pain 5. >6weeks duration 6. "difficult encounter" 7. recent stress 8. low self-rating of health 9. high use of healthcare services 10. substance abuse |
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What is the characteristic behavior pattern for:
a) paranoid b) schizoid c) schizotypal d) antisocial e) borderline |
a) distrust and suspiciousness
b) detachment from social relationships with range of emotional expression c) eccentricities in behavior and cognitive distortion, acute discomfort in social relationships d) disregard for rights of others, defect in experience of compunction or remorse for harming others e) instability in interpersonal relationships, self image, and affective regulation |
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What is the characteristic behavior pattern of:
a) histrionic b) narcissistic c) avoidant d) dependent e) obsessive- compulsive |
a) emotional overreactivity, theatrical behavior, seductiveness
b) persisting grandiosity, need for admiration, lack of empathy for others c) social inhibition, feelings of inadequacy, hypersensitivity to negative evaluation d) submission and clinging behavior e) rigid, detail-oriented behaior, often associated with compulsions to perform tasks repetitively and unnecessarily |
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Describe common or concerning symptoms while taking a mental health history.
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1. changes in attention, mood, or speech
2. changes in insignt, orientation, or memory 3. anxiety, panic, ritualistic behavior, phobias 4. delirium or dementia |
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___ is the alertness or state of awareness of the environment.
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level of consiousness
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___ is the ability to focus or concentrate over time on one task or activity.
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Attention
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___ is the awareness of personal identity, place, and time (requires memory and attention)
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Orientation
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___ are sensory awareness of objects in the environment and their interrelationships.
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Perceptions
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Define affect
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Observable, usually episodic, feeling or tone expressed through voice, facial expression, and demeanor.
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__ is the awareness that symptoms or disturbed behaviors are normal or abnormal.
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Insight
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The logic, coherence, and relevance of the patients thought as it leads to selected goals is called ____
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thought processes
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A sustained emotion that may color a person's view of the world.
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Mood
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The mental status exam consists of what 5 main components?
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1. appearance and behavior
2. speech and language 3. mood 4. thoughts and perceptions 5 cognition (memory, attention, information and vocab, calculations, abstrat thingking, constructional ability) |
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What conditions should you be aware of if a patient presents in deteriorating grooming and personal hygiene?
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depression
schizophrenia dementia |
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What should you consider if you see a patient has one-sided grooming neglect?
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Lesion in the opposite parietal cortex (usually nondominant)
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What facial expression would you expect in a patient with parkinsonism?
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Facial immobility "stone face"
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Define dysarthria.
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Defective articulation of speech
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Circumstantiality is observed commonly in people with _____
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obsessions
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What is derailment, and who is commonly observed?
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1. person shifts from one subject to others that are unrelated without realizing the subjects are not meaningfully connected
2. schizophrenia, manic episodes, psychotic disorders |
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_____ is a continuous flow of accelerated speech in which a pt changes abruptly from topic to topic and do not progress to sensible conversation.
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Flight of ideas (most frequently seen in manic episodes)
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A ___ is a repetitive behavior or mental act that a person feels driven to perform in order to produce or prevent some future state of affairs despite it being unrealistic.
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Compulsion
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What is a phobia?
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Persistent, irrational fear accompanied by a compelling desire to avoid the stimulus
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Define delusion.
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a false, fixed, personal believe not shared by other members of the person's culture or subculture.
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Concrete responses to abstract thinking questions are often given by people with ____
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limited educaiton, mental retardation, delirium, dementia
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Describe the features of somatization disorders
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-chronic, multisystem.
- complaints of pain, GI and sexual dysfunction, and the pseudoneurologic symptoms - onset is usually early in life, and psychosocial and vocational achievements are limited |
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Describe the features of conversion disorder.
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- sympoms of deficits mimickng neurologic or medical illness in which psychological factors are of etiologic importance
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___ is a clinical syndrome characterized predominantly by pain in which psychological factors are of etiological importance.
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Pain disorder
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What is hypochondriasis?
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a chronic preoccupation with the idea of having a serious disease. It is poorly amenable to reassurance.
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What is body dysmorphic disorder?
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preoccupation with imagined or exaggerated defect in physical appearance.
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somatization disorder, conversion disorder, pain disorder, hypochondriasis, and body dysmorphic disorder are considered ___ disorders
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Somatoform
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Describe factitious disorder.
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Intentional production or feigning of physical or psychological signs when external reinforcers are not clearly present
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___ is intentional production or feigning of physical or psychological signs when external reinforcers ARE present
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Malingering
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Dissociative disorders are _____
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disruptions of consciousnes, memory, identity, or perception judged to be due to psychological factors
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Mood disorders may be either ___ or ___
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depressive or bipolar
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A ____ disorder can include manic, hypomanic or depressive features.
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Bipolar
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A major depressive disorer includes only)_____ whereas a bipolar disorder combines ____
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1. major depressive episodes
2. four types of episodes: major depressive, mixed, manic, hypomanic, cyclothymic, dysthymic |
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A _____ is defined as a distinct period of abnormally and persistently elevated, expansive, or irritable mood for at least a week.
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Manic episode
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A _____ is a depressed mood and symptoms for most of the day, more days than not, over at least 2 years. Freedom lasts no longer than 2 months at a time.
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Dysthymic disorder
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What is a cyclothymic disorder?
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numerous periods of hypomanic and depressive symptoms that last for 2+ years. Freedom for no more than 2 months at a time
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In a ____ the mood and symptoms resemle those in a manic episode but less impairing, no hospitalization, no delusions or hallucinations, and have shorter minimum duration (4 days)
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Hypomanic episode
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Define panic disorder.
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Recurrent, unexpected panic attacks followed by persistent concern about future attacks.
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A ____ is a discrete period of intense fear or dicomfort that develops abruptly and peask within 10 minutes and may involve palpitations, sweating, trembling, shortness of breath, dizziness, unreality, feeling of going crazy, fear of dying
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Panic attack
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___ is the anxiety about being in places or situations where escape may be difficult or embarrassing.
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Agoraphobia
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