Cne Etp Pa: Neurologic

Front 1

What brain regions comprise the cerebral cortex?

Back 1

1. Frontal lobe
2. Parietal lobe
3. Occipital lobe
4. Temporal lobe
5. Wernicke's area
6. Broca's area

Front 2

What is the purpose of Wernicke's area?

Back 2

Comprehension of speech

Front 3

What is the purpose of Broca's area?

Back 3

Formation of speech

Front 4

What are the basal ganglia responsible for?

Back 4

Modify movement & autonomic motor function

Front 5

What does the thalamus do?

Back 5

Processes sensory impulses and relays them to the cerebral cortex

Front 6

What does the hypothalamus do?

Back 6

1. Maintains homeostasis.
2. Regulates temperature, heart rate, and BP.
3. Affects the endocrine system
4. Governs emotional behavior such as anger and sex drive
5. Endocrine function --> hormones secreted by the hypothalamus act directly on the pituitary

Front 7

What is the brainstem responsible for?

Back 7

Life-sustaining activities

Oldest part of the brain

Front 8

What is the cerebellum responsible for?

Back 8

Coordinates movement and keeps body upright in space

Front 9

What are the three major motor pathways?

Back 9

1. Corticospinal (or pyramidal) tract
2. Extrapyramidal tracts
3. Cerebellar system

Front 10

What does the corticospinal tract do?

Back 10

Controls voluntary movement, particularly skilled and discrete movements (e.g., writing)

Front 11

What does the extrapyramidal tract do?

Back 11

Controls voluntary movement, particularly gross movement (e.g., walking). Also affects tone of muscles.
** most fibers cross to opposite side

Front 12

What does the cerebellar system do?

Back 12

1. Coordinates movement
2. Helps control posture
3. Maintains equilibrium/proprioception

Front 13

What is the pathway of information for motor tracts?

Back 13

CNS (upper motor neurons) --> PNS (lower motor neurons)

Front 14

What is the pathway of information for sensory tracts?

Back 14

PNS (lower motor neurons) --> CNS (upper motor neurons)
**2 major pathways

Front 15

What are the two major sensory pathways?

Back 15

1. Spinothalamic tract
2. Posterior (dorsal) column tract

Front 16

What is the spinothalamic tract responsible for? Pathway?

Back 16

Sensation of:
1. pain
2. temperature
3. crude/light touch

*Fibers travel to thalamus, synapse on secondary neuron, then travel to cortex.
--> thalamus perceives crude/general sensation
--> sensory cortex interprets/fully perceives what was felt

Front 17

What is the posterior column tract responsible for? Pathway?

Back 17

Sense of:
1. proprioception (self)
2. vibrations
3. fine, localized touch

*Fibers travel to medulla, cross over & synapse onto secondary neuron, then travel to thalamus.

Front 18

Where do cranial nerves II through XII arise from?

Back 18

diencephalon and brainstem
(CN 1 is a fiber tract)

Front 19

What is the composition of spinal nerves?

Back 19

peripheral nerve fibers are both:
- sensory (dorsal)
- motor (ventral)

Front 20

What areas of the spine do spinal nerves arise from and how many pairs arise from each section?

Back 20

31 pairs of spinal nerves:
- 8 cervical pairs
- 12 thoracic
- 5 lumbar
- 5 sacral
- 1 coccygeal

Front 21

What is a deep tendon reflex?

Back 21

Involuntary, stereotypical response, relayed over both CNS & PNS. (1 synapse)
--> in order to elicit, you must tap tendon over partially stretched muscle

Front 22

How many neurons are involved in a reflex reaction?

Back 22

As few as two neurons -- one sensory and one motor.

Front 23

5 requirements for a reflex arc?

Back 23

1. Intact sensory neuron
2. Intact synapse
3. Intact motor neuron
4. Intact neuromuscular junction
5. Intact muscle

Front 24

Spinal nerves involved in tricep reflex?

Back 24

C6 & C7

Front 25

Spinal nerves involved in plantar reflex?

Back 25

Lumbar 5 & sacral 1

Front 26

Spinal nerve involved in achilles reflex?

Back 26

sacral 1

Front 27

Spinal nerves involved in patellar reflex?

Back 27

Lumbar 2, 3, and 4

Front 28

Spinal nerves involved in brachioradialis reflex?

Back 28

C5 & C6

Front 29

Spinal nerves involved in the bicep reflex?

Back 29

C5 & C6

Front 30

What 12 items should you ask when obtaining a health history for the neurological system?

Back 30

1. Headache
2. Head injury
3. Dizziness/Vertigo
4. Seizures
5. Tremors
6. Weakness, any part of the body
7. Incoordination (e.g., falling to one side)
8. Numbness or tingling
9. Difficulty swallowing (dysphagia)
10. Difficulty speaking (aphasia)
11. Significant past history (e.g., meningitis, stroke)
12. Environmental/occupational hazards (e.g., exposure to lead or insecticides, mind-altering drugs, alcohol intake)

Front 31

What are the seven components of a physical exam for the neurological system?

Back 31

1. Mental status
2. Cranial nerves
3. Motor
4. Sensory
5. Coordination
6. Romberg/gait
7. Deep tendon reflexes

Front 32

How could you describe your patient's level of consciousness?

Back 32

1. Alert
2. Lethargic: appears drowsy, still responds to stimuli
3. Obtunded: opens eyes, slow response, confusion
4. Stuporous: only awakened by painful stimuli
5. Comatose: completely unarousable

Front 33

What is the order of loss of orientation?

Back 33

Time is the first to go, then place, and lastly person

Front 34

How can you assess attention?

Back 34

1. Ask patient to repeat months of the year backward
2. Give patient a list of numbers and ask her to repeat back (use a phone number but do not speak it like a phone number). Being able to remember 6 or 7 numbers forward is normal, remembering 4 of the numbers backward is normal

Front 35

What should you evaluate with the patient's language?

Back 35

1. Fluency of speech
2. Any hesitancy
3. Does the speech make sense?

Front 36

What are the three different levels of memory?

Back 36

1. Immediate recall
2. Short-term (3-5 minutes later)
3. Long-term

Front 37

How do you test CN I (olfactory)?

Back 37

Have patient smell a familiar scent (e.g., cloves, coffee, soap, or vanilla). Patient should perceive odor and can often identify it.

Front 38

Why should you not use ammonia for the olfactory test?

Back 38

affects CN V

Front 39

What are some possible causes of loss of smell?

Back 39

Nasal disease, head trauma, smoking, aging, and use of cocaine

Front 40

What are the tests for CN II (optic nerve)?

Back 40

1. Visual acuity (Snellen chart)
2. Visual fields by confrontation
3. Pupillary reactions to light
4. Pupillary reactions to accommodation
5. Examine the optic fundi (using ophthalmoscope)

Front 41

What does the pupillary light reflex test?

Back 41

Direct and consensual pupillary constriction

CN II (optic nerve) receives the sensory input and sends it to the brain. The motor response comes back through CN III (oculomotor) and causes pupil constriction.

Front 42

What are the three regions of sensory innervation for CN V (trigeminal)?

Back 42

1. Ophthalmic
2. Maxillary
3. Mandibular

Front 43

What effect does a peripheral injury to CN VII (facial nerve) cause?

Back 43

Bell's palsy

peripheral injury = damage to FULL side of face on the SAME SIDE of the lesion.

Flat nasolabial fold, cannot raise eyebrow, cannot close eye, drooping lips on that side.

Front 44

What effect does a central lesion of CN VII (facial nerve) cause?

Back 44

Stroke (CVA) --> lesion in cortex

Lower part of face = controlled by upper motor neurons that CROSS OVER --> so when damage occurs, the lower face is paralyzed (i.e., central lesion in CN VII in left hemisphere would result in paralysis of the lower face on the right side) --> only HALF of OPPOSITE side of face affected

Flat nasolabial fold on side opposite of lesion. Can open and shut eyes, raise eyebrows (wrinkle forehead).

Front 45

How do you test CN VIII (vestibulocochlear)?

Back 45

1. Cochlear portion: finger rub test
2. Vestibular portion: Romberg test

Front 46

How do you test CN IX (glossopharyngeal) and CN X (vagus)?

Back 46

- AxO patient --> tongue depressor & have them say "ahh"

- comatose patient --> test gag reflex

Front 47

What two muscles are you assessing when you perform the test for CN XI (accessory nerve)?

Back 47

1. Trapezius (patient shrugs shoulders against resistance)
2. Sternocleidomastoid (patient pushes face against resistance)

Front 48

What are you looking for when you test CN XII (hypoglossal)?

Back 48

With the tongue protruded, you are looking for asymmetry, atrophy, or deviation from midline.

When you ask the patient to move her tongue from side to side, you are looking for symmetry of movement.

Front 49

What should you look for when assessing the size of the patient's muscles?

Back 49

Pay attention to bilateral symmetry, particularly in the hands.

Front 50

What is atrophy of muscle? What might it indicate?

Back 50

Atrophy is abnormally small muscles; loss of muscle bulk.

Possible causes: disuse, injury, lower motor neuron problem, muscle disease

Front 51

What is hypertrophy of muscle? What causes it?

Back 51

Increase in muscle bulk with corresponding increase in strength.

Caused by isometric exercises.

Front 52

What is muscle tone?

Back 52

Slight residual tension of the muscle when it is voluntarily relaxed.

Front 53

How can you assess muscle tone?

Back 53

Ask patient to relax and perform passive ROM.

Front 54

What are some possible causes of muscle flaccidity?

Back 54

Polio, early stage of stroke (progresses to spasticity), lower neuromuscular disease

Front 55

What are some possible causes of muscle spasticity?

Back 55

Injury to corticospinal tract, later stages of stroke

Front 56

What is muscle spasticity?

Back 56

Increased resistance that worsens at the extremes of ROM.

Increases with rapid movement.

Front 57

What is muscle rigidity?

Back 57

Increased resistance throughout the ROM in both directions.

cogwheel rigidity = little jerks, seen in Parkinson's
lead pipe rigidity = unbendable & rigid

Front 58

What are some causes of muscle rigidity?

Back 58

Damage to extrapyramidal tract, Parkinson's

Front 59

What are the three different types of involuntary movements?

Back 59

1. Tremors
2. Fasciculations
3. Tics

Front 60

What are the two types of tremors?

Back 60

1. Parkinson's tremors ("pill rolling tremor" --> happens passively)
2. Intention tremors (occur with task --> e.g., pouring water into glass)

Front 61

What are fasciculations?

Back 61

Rapid twitching of resting muscle

Front 62

What is a tic?

Back 62

Repetitive twitching at inappropriate time (psychiatric or neurologic etiology)

Front 63

What are the three components for assessing the spinothalamic tract?

Back 63

1. Pain
2. Temperature
3. Light or crude touch

Front 64

When do you test sensation of temperature?

Back 64

when pt doesn't pass sense of pain test

Front 65

What are the three tests for assessing the posterior column tract?

Back 65

1. Vibration
2. Proprioception
3. Tactile discrimination

Front 66

If vibration can be felt distally (on the toe or thumb), what does that mean?

Back 66

The vibration would also be felt further up (proximally).

Front 67

What disease causes loss of vibratory sense?

Back 67

Diabetes --> vibratory sense is first lost in the feet

Front 68

What is stereognosis?

Back 68

Ability to identify an object by feeling it.

Have patient close eyes and hand him a familiar object to identify.

Front 69

What is graphesthesia?

Back 69

Number identification

Have patient close eyes. "Draw" a number on the patient's palm and ask him to identify it.

Front 70

How do you test two-point discrimination?

Back 70

Have patient close eyes. First see if patient can identify two simultaneous touches. Next, bring the two points closer and closer together until patient can no longer distinguish them as separate.

Front 71

What does extinction test for?

Back 71

Sensation on the left and right sides.

Have patient close eyes. Simultaneously touch the same areas on both sides of the body (e.g., right and left shoulders). Ask patient where she felt your touch -- normally both stimuli are felt.

Front 72

What are the tests for coordination and skilled movement?

Back 72

1. Rapid alternating movements
2. Point-to-point movements

Front 73

What is an abnormal result of the rapid alternating movement tests?

Back 73

Dysdiadochokinesia: inability to arrest abruptly one motor impulse and substitute its opposite

Front 74

What are the tests for point-to-point movements?

Back 74

1. Finger-to-finger test
2. Finger-to-nose test
3. Heel-to-shin test

Front 75

What is dysergia?

Back 75

Improper coordinated function of given muscle groups

Front 76

What is dysmetria?

Back 76

Inability to gauge properly the distance between two points or objects

Front 77

What is an abnormal response to the heel-to-shin test? What causes it?

Back 77

The heel will bounce all over the place. Evident in a patient with multiple sclerosis.

Front 78

How is the gait of a Parkinson's patient different?

Back 78

Steps are short and shuffling. Less arm swinging. Patient turns around stiffly (turn on point), cannot spin on pivot.

Front 79

Why would tandem walking be used after assessing gait?

Back 79

It may reveal an ataxia not obvious in the assessment of the gait.

Ataxic gait = a gait that lacks coordination, with reeling and instability. Feet are planted far apart.

Front 80

What is a positive Romberg test?

Back 80

The patient stumbles when she has to stand upright, feet together, with eyes closed.

A little swaying is normal and does not count as a positive Romberg sign.

Front 81

What is a positive pronator drift test? What might cause it?

Back 81

The test is positive if the patient's arm moves downward and the forearm pronates.

Pronator drift may be the result of stroke.

Front 82

What side of the hammer do you use for direct contact with tendons?

Back 82

Flat side of hammer

Front 83

What side of the hammer do you use for indirect contact (hitting your thumb) with tendons?

Back 83

Pointed side of hammer.

Front 84

What is the grading for tendon reflexes?

Back 84

0 = no response
1+ = decreased reflex
2+ = normal
3+ = brisk, may be normal or abnormal
4+ = brisk, abnormal; test for clonus

Front 85

Why would you use reinforcement when testing deep tendon reflexes?

Back 85

reinforcement = having them grip fingers and pull apart

Used if a patient's reflexes are symmetrically diminished or absent. The isometric contraction of other muscles for up to 10 seconds may increase reflex activity.

Front 86

What are the superficial reflexes we test for?

Back 86

1. Abdominal reflex
2. Cremasteric reflex
3. Plantar reflex

Front 87

What is an abnormal plantar reflex response?

Back 87

Babinski's: toes curl up

(+) Babinski --> upgoing big toe & toes flex back
Possible causes: upper motor neuron problem; alcohol/drugs; can occur during seizure

Positive Babinski's test is normal in children under 2 years old

Front 88

What is clonus? How do you test for it?

Back 88

Rhythmic oscillations between dorsiflexion and plantar flexion --> abnormal finding

to test: move pt's foot between dorsiflexion and plantar flexion while lying down and watch for oscillation

Front 89

What would happen if you damaged wernicke's area in dominant hemisphere?

Back 89

wernicke's area is associated with auditory reception, so w/ damage --> you can hear but can't comprehend what you're hearing (can't make sense of language)

Front 90

What would happen if you damaged broca's area in dominant hemisphere?

Back 90

broca's area is associated with speech formation, so damage here --> you know what want to say but you can't vocalize/form the words

Front 91

Which side of the brain is dominant in most people?

Back 91

95% of people's left side of brain is dominant

Front 92

spinal nerves that innervate arms

Back 92

cervical spinal nerves

Front 93

spinal nerves that innervate legs

Back 93

lumbar spinal nerves

Front 94

numbness in arms vs numbness in legs

Back 94

numbness in arms = probably a cervical spinal nerve problem

numbness in legs = probably a lumbar spinal nerve problem

Front 95

lower motor neuron disease vs upper motor neuron disease

Back 95

lower motor neuron disease = increased tone (spasticity, rigidity)

lower motor neuron disease = decreased tone (flaccidity)