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160 Cards in this Set
- Front
- Back
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The centeral nervous system (brain and spinal cord) is the main network of ___________ and __________________?
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corrdination and control for the body
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What regulates the internal environment of the body, functions over which a person has no voluntary control?
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Autonmoic nervous system
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What does the sympathetic division prods/
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body into action during times of physiologic and psychologic stress
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What is the Parasympathetic division of the ANS?
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complemetary and counterbalance manner to conserve body resours and maintain day-to-day functions such as digestion and elimnation
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The intricate interrelationship of the Nervous system permits the body to perform the following?
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1. receive sensory stimulit from the environement
2. Identify and integrate the adaptive process needed to maintain current body functions 3. Orchestrate body functions changes required for adaptation and survival 4. INtegrate rapid responsiviness of CNS with more gradual responsiviness of the endocrine system 5. Control Cognitive and voluntary behavioral process 6. Control subconscious involuntary body functions |
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What protects the brain and spinal cord?
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skull, vertebrae, meninges, CSF
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What is the job of CSF?
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ciruculates between an interconnecting system of ventricles in the brain and around the brain and spinal cord, serving as shock absorbers
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What percent of blood from total cardiac output supplies the Braine?
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15-20%
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What supples blood to the brain?
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two interal carotid arteries
two vertebral arteries they join to form the basilar artery |
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What drains the brain?
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venous plexus and dural sinuses that empty into the internal jugular veins
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What houses the higher mental functions and is resposible for general movement, visceral functions, perception, behavior, and integration of function?
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Gray outer layer Cerebral cortex
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What interconnects the counterpart areas in each hemispheres, unifying the cerebrums higher sensory and motor functions?
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Comissuarl fibers (corpus callsoum)
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What is the function of the Frontal lobe?
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voluntary skeletal movment and fine repetitive motor movments, control of eye movment.
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the corticospinal tracts exent from where into what?
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extend from the primaryy motor area into the spinal cord
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What is the function of the parietal lobe?
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processing sensory data as it is recieved. Assists with interpreatation of tactil sensations (temp, pressure, pain, size, shape sensations)
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What is proprioception?
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recognition of body parts and awarness of body postion?
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Proprioception is dependent on what?
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parietal lobe
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What contains the primary vision center and provides interpretation of visual data?
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Occiptal lobe
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What is the function of the Temporal lobe?
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Perception and interpretation of sounds and determinationof source.
Integration of taste, smell and balance |
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The reception of speech and interpretation of speech is located where?
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Wernicke area
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What area of the brain determines survival, such as mating, aggression, fear and affection?
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Limbic system
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What aids the motor cortex of the cerebrum in the integration of voluntary movment?
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Cerebellum
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What is the brainstem?
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pathway btw the cerebral cortex and the spinal cord and it controls many involuntary functions
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What are the structurs of the of the Brainstem?
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Medulla oblongata, pons, midbrain, diencepharlon
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The reticular formation contains a network that provides what fucntions?
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constant muslce stimulation to counteract gravitational forces and regulates cardiovascular functioning and respiration
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the reticular formation has fibers that conduct impulses from below the brainstem and up into the cerebral cortex called what?
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Reticular activating system
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the reticular system must function for an individual to maintain what?
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consciousness
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What serves as the relay center btw the basal ganglia and cerebellum.
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thalamus
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the function of the thalamus?
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major integrating cener for preception of various sensations such as pain and tem.What
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What transmits information btw the brainstem and the cerebellum, relaying motor information from the cerbral cortex to the contralateral cerebellar hemisphere.
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Pons
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What is the site where the Descending corticospinal tracts decussate (cross to the contralateral side)
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Medulla oblongata
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What does the basal ganglia or cerebral nuclei function as?
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extrapyrapyamidal system pathway and processing station btw the cerebral motor cortex and the upper brainstem
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Fuction of the medula Oblongata?
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IX-XII
Resp. circualtroy, vasomoter activities, Houses respiratory center Reflexes of swallowing, coughing, vomiting, sneezing Relay cener for major ascending and descneding spinal tracts that decussate at the pymriad |
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What cranial nerves fallunder the pons?
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V-Viii
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Where is the center for reflex for eye and head movment, Auditory relay, Corticospinal tract?
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Midbrain CN 3-5
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The spinal cord (4-50cmlong) begins as the foramen magnum and continuation of the medulla oblongata and terminates where?
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L1 or L2
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The myelin-coated white matter of the spainl cord contains what?
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asceding and descedning tracts
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The gray matter, of the spinal cord contains what?
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nerve cell bodies, arranged in a butterfly shape with anterior and posterior hornes
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What are the descending spinal tracts?
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Corticospinal, Reticulospinal, Vestibulospinal
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What is the function of the Descending tracts?
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convey impules to various muscle groups by inhibiting or exciting spinal acitivy. Role in controlling muscle tone, posture, and precise motor movments
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Whatis the function of the Corticospainl (pyramidal) tract?
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permits skilled, delicate, and purposful movments
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What tract is repsonsible for extensor muscles of the body to suddenly contract when an individual starts to fall?
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Vestibulospinal tract
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What are the Ascending Spinal tracts?
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spinothalamic, spinocerebellar
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Asending spinal tracts facilitate what?
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sesnory signals necessary for complex discrimination tasks and are capable of transmtting precise information about the type of stimulus and its locatoin
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What carries the fibers for Discriminatory senstainos of touch, deep pressure, vibration, positions of the joings, sterognosis, and two-pt discrimination?
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Posterior (dorsal) column spinal tract
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What do Spinothalamic tracts carry?
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fibers for the sensation of light and crude touch, pressure, temperature, pain
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What are motor pathways that all originate and terminate within the central nervous system?
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Upper motor neurosn
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What is the primary function of the UMN?
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influencing, directing, and modifying spinal reflex arcs and circuits
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The upper motor neurons can only affect movement through what?
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Lower motor neurons
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Injury to the upper motor neurons results in what?
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intitial paralysis followed by partial recovery over a extended time
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The sensory and motor fibers of each spinal nerve supply and recieve information in a specific body distribution called what?
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Dermatorme
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Within the spinal cord, each spinal nerve sperates and for what two structurs?
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ventral and dorsal roots
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What carries impulses from the spinal cord to the muslces and glands of the body?
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motor or efferent fibers of anterior (ventral) root
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Changes occur with older adults occur with aging are more _________________than __________________.
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physiologic than anatomic
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What are some riskfactors for Cerbrovascular Accidents (strokes)
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HTN
OBesity Sedentary life Smoking Stress Increases levels of serum cholesterol, lipoproteins and triglycerides..Sickle cell anemia |
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What would be some Family history condistion that could lead to CVA?
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DM, Caridovascular disease, HTN, incresed levels of cholestrol levels
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Ordinarioly what sense are not tested unless a problem is suspected?
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Taste an smell
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What CN are routinely tested?
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2-12
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What is CN 5, and its main function?
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Trigeminal and sensory
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How would you test Olfactory nerve I?
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test ability to id familiary aromatic ordors, one naris at a time with eyes closed
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What procedure used for testing 3,4, and 6 crainal nerves?
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Test visual fields by confrontation
Inspect eyelids for drooping INspect pupils size for equality and PERRLA Test Extraocular eye movements |
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What nerve is test if these procedures are performed/ (Palpate jaw muslces for tone and strength, corneal reflex, inspect face for muslce atrophy and tremors?
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CN V trigeminal
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What procedure for testing CC VII Facial?
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Symmetry of facial features (smile, frown, puffed cheeks wirnkled fored, pursed lips
Test ability to identify sweet and salt on side of tongue |
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Whta does CN IX glossopharyngeal test?
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abiltiy to id sour and bitter
Test gag reflex and ability to swallow |
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What is the procedure for CN X (vagus)
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Inspece palpate uvula for symmetry with speech sounds and gag reflex
observe for swallowing difficulty Quality of guttural speech sounds |
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What nerve are we test with patient prodtruding tougue check for symmetry, tremors and atrophy. Tongue movement toward nose and chin?
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XII hypoglossal
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What could interfer with the ability to distinguish ordors?
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Inflammationof mucous membrane, allergic rhinitis, excessive tobacco smoking
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What is the word for Loss of sense of smell or an inability to discrminate odors
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Anosmia
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How do we test for CN 3,4, and 6?`
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6 cardianl gaze,
Pupil size shape response to light Accommondation and opeing of the upper eyelids |
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If patient comes into the clinic with unremitting headaches we should exam what?
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movment of th eyes for the presence or absence fo lateral (temporal) gaze
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What is commonly the first to lose function in the presence of ICP?
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6th Cranial nerve
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Motor function is evaluted by observing the face for what?
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muscle atrophy, deviationof the jaw to one side and fasicicualtions
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Cliniching of the jaw to test muscle tone is the job of what CN?
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5 trigmenial
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If patient can't feel pain sensation over the 6 areas on the face, then we would test how?
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use test tubes filled with hot and cold water test temperature sensation
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Testing the Facial nerve (VII) would test the pateint how?
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with motor functions asking the patient to make :raise eyebrows, squeeze the eyes shut, wirnkle forehead, frown, smile, shoe the teeth purse lips and puff cheecks
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Whould be evidence of muslce weakness in the face?
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one side of mouth dropping, flattened nasolabila fold and lower eyelid sagging
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When evaluating taste, a sensory function of what CN?
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VII and IX
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What is tested for CN IX glossopharyngeal?
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during eval of taste with VII, simultaneously tested during evaluation of vagus nerve for nasopharyngeal (gag reflex) and motor function of swallowing
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To evaluate nasopharygenal sensation , tell the patient what?
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will be test the gag reflex
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What would happen if vagus (X) or glossopharyngeal nerve was damaged?
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the palate fails to rise, the uvula will deviate from the midline
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How would we test for Rapid Rhymthmic alternating movments to test coordination an fine motor skills?
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Pt seated to pat his/hrer knees with both hands, alternately turing up the palm and back of the hands and increasing the rate gradually
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How do we test for Accuracy of movements?
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Finger to finger test with provider finger at 18 inces and changin location .
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During the finger to finger test, would be indicated if pt consistently past the pointing (missing examiner finger)?
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Cerebellar disease
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How is balance tested?
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with the Romberg test
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Loss of balance or Positive Romber test indicates what?
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cerebellar ataxia vestibular, dysfunction, sensory loss
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If patient staggers or loses balance with the romberg test what should you do?
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postpone other tests of cerebellar function
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To taste bitter and sour, what CN and part of the toungue is being evaluated?
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CN IX
posterier 1/3 |
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Anterior 2/3 of the tongure is what taste sensation and CN?
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Salty
Sweet VII |
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What is the allowable time frame and expectance ,when pt. balancing on one foot with eyes clossed and arms held out?
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5 secs and slight swaying is normal
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Affected leg stiff; extended plantar flexion of foot, movment of foot results from pelvic tilting upward on involved side, foot is dragged often scraping toe.
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Spastic Hemiparesis
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What is Spastic diplegia?
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pt uses short steps, dragging ball of the foot across the floor, legs extended; thighs tend to cross forward on each other at each step INjury to pyramidal system
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Hip and knee are elevated excessively high to lift plantar flexed foot off the ground; foot brought down to the floor with SLAP!!!!!!
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Steppage
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Pt is waddling, legs kept aparts, weight shifted from side to side, abdomen protrudes and Lordosis is commone?
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Dystrophic
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What is Cerebellar Gait (ataxia)?
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pt feet wide based, staggering and lurching from side to side is often accompined by swaying truck
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Patient posture is stooped;body held rigid, steps are short and shuffling with hesitation on starting an difficulty stopping?
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Parkinsonian gait
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Jerky dancing movments appear nondirectional?
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Dystonia
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Uncontrolled falling occurs loss of corrdination?
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Ataxia
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Pt limits the time of weight bearing on the affected leg to limt pain
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Antalgic gait
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During the sensory discriminaton procedure is tested with patients eyes _________?
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closed
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Loss of sensation during the Sensory exam could be an indicator of what?
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Spinal tract, brainstem or cerebral lesions
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During the Superficial pain test, allow what time btw each stimulus to avoid a summative effect?
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2 secs
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When should temperature and deep pressure sensation be tested?
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only when superficial pain sensation is not intact
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How would you test Deep pressure sensation?
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Squeezing the Trapezius , calf, or biceps mucscle
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Evaluating vibratin, what type of tuning fork should you use?
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lower HZ
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Using the vibration testing procedure of the most distal point, what should be felt?
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Buzzing or tingling sensation.
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How would you hold the great toe or finger during evaluation for postition of joints?
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lateral aspects to avoid giving clue about the direction moved
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Loss of sensory modalities during position of joints could be indicator of what?
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Peripheral neuropathy
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symmetric sensory loss indicates?
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polyneuropathy
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What does Cortical or Discriminatory sensory function test for?
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cognitive ability to interpret sensations
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INablity to perform Sterogenosis, 2pt discrimtion, Graphesthesia or extinction phenoenon indicate what?
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lesions in the sensory cortex or the posterior columns of the spinal cord
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What is Sterognosis?
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handing patient familiar object to identify by touch and manipulation.
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What is the inablity to recoginze objects by touch, suggests a pareital lobe lesion?
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Tactile agnosia
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what is the minimal distance for 2pt Discriminating of the Fingertips?
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2-8mm
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distance for 2pt discrimination of the Toes?
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3-8mm
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DTP mininmial distances of the back?
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40-70
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What is Extinction pnhenomenon?
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simultaneously touch the cheeck or hand or other areas of body, poking with sterile needle, pt to tell you how many stimuli there are and were they they are .
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Sensory loss generally less than anatomic distrubtion of nerve, lost senstation in central portion of zone of partial loss due to overlap/
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Single peripeal nerve loss
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Causes glove and stocking anesthesia, sensory loss most sever over legs and feet or over hands. GRadual?
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Multpile Peripheal Nevers (polyneuropathy)
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Pain and temp sensation occur one or two dematomes below the lesion of opposite side of body form lesion/ proprioceptive loss and motor paralysis occur on lesion side of body, what is the problem?
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Partial Spinal sensory syndorm (Brown-Sequard syndrome)
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When abdominal relfexes are absent , what should you expect?
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upper or lower motor neuron disorder should be suspected
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How should you stroke the male patient to test the cremasteric reflexes?
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proxmial to distal on inner thigh
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Performing the Babinski sign, what should you see on a normal and abnoraml exam?
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Pt should have plantar flexion of all toes and
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Postive Babinski sign, you will notice what?
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Dorsiflexion of the great tow with or without fanninf of the other toes
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Performing DTR's and patinet has absence reflexes , what could be the problem?
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neuropathy or lower motor neuron disorders
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Pt with hyperactive relfexes suggest what?
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upper motor neuron disorder
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DTR of the cremasteric reflex is at what level of the spine?
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t12, L1 and L2
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Whatlevel is the Biceps for DTRs?
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C5 and C6
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Spinal level of the Achilles?
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S1 and S2
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Performing a plantar DTRs, what level of the spine are you?
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L4, L5 S1 and S2
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If a patient has grade of 4+ for DTR he would be what?
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reflexs brisk, hyperactive, with intermittent or transient clonus
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Patient has Active or expected response to DTR, what grade would that be?
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2+
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Pt with no response?
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0
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If you have damage with the upper motor neuron above the brainstem, which side is affected?
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contralateral side of body
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In a lower neuron disorder, such as Bell palsy what is affected?
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all facial movments on the affected side are paralyzed
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Striking the Biceps tendon. what is the expected finding?
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contractoin of the biceps muslce causes visilbe or palable flexion of elbow
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Striking the brachioradial tendo (1-2in above the wirst) directly should do what to the arm?
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Pronation of the forearm and flexion of the elbow should occur
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How should you hold and strike for Tricpe reflex?
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flex the patient's are at elbow 90 degrees, supporing the arm proximal to the antecubiatl fossa
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What is clonus ?
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test for ankle clonus, reflex hyperactive,. Suppor the paitents knee partially flexed position and briskly dorsiflex the foot with your other hand, maintaining the foot in flexion.
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Sustained clonus is assiocated with what?
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upper motor neuron disease
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What is a signe associated with meningitis and intracrainal hemorrahge?
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Nuchal rigidity..stiff neck
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What is the Kernig sign/
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flexing the leg at the knee and hip when patient is supine, then attempting to straighten the leg.Pain in lower back and resistance to straight leg at the knee constitues a postive kernig
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Debilitating degenerative disorder in which the blood-brain barrier breakds down and permits immune cells into the myelinated whiter matter of the brain or spinal cord?
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MS
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Characterized by episodic, sudden, involuntary contractions of a group of muslces, resulting form excessive discharge of cerebral neurons.
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Gernalized Seizure enchepalitits
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What is causes meningitis?
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bacterai or viuses
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What is a multisystem infecino caused by Borrelia burgdorferi spirochete carried by ticks?
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Lyme disease
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Abnormal growth of neural or nonneural tissue within the cranial cavity that may be primary or metastatic cancer.
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Space occupying lesions (intracrainal tumors
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What are some signs of intracrainal tumors?
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HA, papilledema, vomiting, change in coginition, motor dysfunction unsteady gait, behavioral
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Sudden, focal neurologic defict resulting from impaired circualation of the brain, CVA or hemorrhage causes circulation impairment?
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CVA or stroke
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5 five major warning signs of brain attack include the following?
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sudden weakness, numbess paralysis offace, arms or legs espically one side
Trouble seeing in one or both eyes, diplopia Difficulty speaking(dysarthia) understanding speech (aphsia) Sever HA, without apparent reson, trouble walking |
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Supplies the cerebral hemisphers and diencephalon by the ophthalmic and ipislateral hemishpers arteries
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Internal Cartiod artery
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What artery affected if patient presents with Transient ischemic attacks, nausea, vertigo, tinnitus, syncope, dysphagia, unilat or bilat weakness of extremities, drowsiness?
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Vertebral or basilar arteries
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What is affected if patient has "locked-in syndrome no movement except eyelids; sensation and consciouness preserved?
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anterior portion of pons
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Pt coma, miotic pupils Decerbrate rigidity, Resp and circulatory abnormalities and Death?
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Complete occulusion or hemmorage (brainstem)
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Chornic autoimmune neuromusscluar disease involving the lower motor neurons and muslce fibers?
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Myasthenia gravis
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Acute polyradiculoneuropathy that commonly follows a nonspecific infection that occured 10-14 days earlier. Primary affects motor and autonomic peripheal nerves/
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guillan Barre syndrome
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Recurrent paroxysmal pain that radiates into one or more of the branches of cranial nerve V?
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Trigeminal neuralgia (TIC doulorueux
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What is the most common sign of Trigeminal Neuralgia?
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sharp jab pain on one side of the face
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Most common cause of Peripheral neuropathy?
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diabetes Melliuts but may also be caused by toxins, or Vit B12 defiiency
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What is I'M DISTAL?
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idiopathic, inherted
M metabloic , mechanical D drugs I..infections S. sarcoidosis T. tumors A autoimmune allergy L lack of vit (b12) |
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What is Parkinson disease?
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slowly progressive, degenerative neurologic disorder of the brain DOPAMINE neuronal systems
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