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133 Cards in this Set
- Front
- Back
What are the components of the PNS?
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1. 12 Cranial nerves
1. 31 spinal nerves + branches |
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Which hemisphere is dominant in most people?
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left
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Name 5 components of the cerebral cortex.
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1. Frontal lobe
2. parietal lobe 3. occipital lobe 4. Wernicke's area 5. Broca's area |
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Which region of the brain as the greatest amount of brain tissue?
How is this tissue divided? |
cerebral cortex:
grey (outer): highest human functions white (inner): neuronal axons coded with myelin |
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Where is Wernicke's area located and what does it do?
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Wernicke's area is located in the temporal lobe.
Fxn: comprehension of speech |
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Where is the primary motor area located?
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frontal lobe
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What are the functions of the frontal lobe?
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Frontal lobe:
1. intellectual fxns 2. emotions 3. behaviors 4. personality |
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Where is the primary sensory area located?
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parietal lobe
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What is the function of the occipital lobe?
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visual reception
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Where is Broca's area located? What is its function?
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Frontal lobe
fxn: (motor) speech formation |
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What are 3 components of the diencephalon?
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1. basal ganglia
2. thalamus 3. hypothalamus |
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What are the 3 components of the brainstem?
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1. Midbrain
2. pons 3. medulla |
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What is the function of the cerebellum?
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1. COORDINATION of VOLUNTARY movements
2. equilibrium 3. muscle TONE **does NOT initiate movement |
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What is the spinal cord and where is it located?
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A mass of nerve tissue
medulla-->L1/L2 |
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Which NS is associated with the spinal column?
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CNS
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Which NS is associated with the spinal nerves?
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PNS
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What is the function of the basal ganglia?
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Controls automatic body movements (normal arm swing while walking)
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What is the function of the thalamus?
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Main relay system for the NS; the synapes go to the CORTEX for finite determination
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What does the hypothalamus regulate?
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1. T
2. sleep center 3. pituitary 4. emotional status |
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What is the midbrian composed of?
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nerve fibers that merge with the thalamus
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Which nerve fibers are assoiciated with the pons?
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ascending/descending nerve fibers
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Which nerve tracts are associated with the medulla?
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all motor/sensory tracts go here
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What is the function of the medulla?
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1. Vital autonomic centers (vitals, respiration, heart beat)
2. motor fibers CROSS here (pyramidal decussation) |
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Name 3 major motor pathways.
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MOTOR pathways:
1. Corticospinal (pyramidal) tract 2. Extrapyramidal tract 3. Cerebellar system |
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Describe the pathway of the corticospinal (pyramidal) tract.
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motor fibers originate in the cortex-->brainstem (cross over)-->spinal column-->synapse with lower motor neuron or spinal nerve
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What is the function of the corticospinal tract?
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controls VOLUNTARY movement (ie skilled, descrete skills like writing)
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Where do extrapyramidal tracts originate?
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motor cortex
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What does the extrapyramidal tract control?
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controls gross body movements (walking)
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What are the functions of the cerebellum?
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1. coordinate arm movement
2. maintain equilibrium, posture |
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What does the cerebellum receive input about?
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muscle/joint position to keep the body in equilibrium
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What are the 2 major sensory pathways?
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SENSORY pathways:
1. spinothalamic tract 2. posterior (dorsal) column |
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What does the spinothalamic tract sense?
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1. pain
2. T 3. crude/light touch |
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What is the pathway of the spinothalamic tract?
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fibers enter the POSTERIOR root of the spinal cord-->synapse&crossover-->goes up to the thalamus (tells you if good/bad)-->cortex (tells you what's going on)
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What are the functions of the posterior (dorsal) column?
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1. proprioception (sensation of position)
2. vibrations 3. fine localized touch 4. discriminatory touch |
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Where do CN II-XII originate?
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diencephalon + brainstem (S, M, S+M)
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3 components of the PNS?
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1. Cranial nerves
2. spinal nerves 3. reflex arc |
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List the types of the 31 spinal nerves.
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8 cervical
12 thoracic 5 lumbar 5 sacral 1 coccygeal **innervates dermatomes |
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Anterior portion of spinal nerves consist of __, Posterior portion consists of __.
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motor fibers, sensory fibers
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Describe functions of CN VII
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CN VII (facial):
sensory fxn: taste motor fxn |
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CN IX (glossopharyngeal) senses what?
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eardrum, ear canal
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Describe the functions of CN X (vagas)
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motor: palate, pharynx, larynx
sensory: pharynx, larynx |
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Which muscles does CN XI (accessory) innervate?
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sternocleidomastoid, trapezius
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What are the functions of CN V (trigeminal)?
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motor fxn: temporal/masseter
sensory fxn: 3 regions corneal reflex |
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Which virus follows a dermatome?
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herpes zoster in shingles
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What do the cervical spinal nerves C3,4,5,8 innervate?
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shoulder and arms
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What do the throacic spinal nerves innervate?
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chest + abdomen
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What do lumbar spinal nerves L1-5 and sacral nerves innervate?
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legs
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What is the advantage of dermatome overlap?
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if 1 is severed, the ones above/below it can transmit some sensations still
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What does the site of numbness/pain tell you?
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the dermatome where the numbness/pain is located indicates where the nerve is
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What are the requirements for a reflex arc?
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1. intact sensory nerve
2. functional synapse in spinal cord 3. intact motor nerve 4. intact NMJ (neuromuscular junction) 5. competent muscle *relay of structures across the CNS-PNS |
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Are reflexes voluntary or involuntary?
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involuntary
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What are the fewest number of neruons allowed in a reflex arc?
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2: 1 motor, 1 sensory (1 synapse)
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Which nerve does the ankle reflex involve?
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S1
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Which nerves do the brachioradialis reflex involve?
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C5, C6
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Which nerves does the bicep reflex involve?
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C5, C6
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Which nerves does the knee reflex involve?
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L1, 3, 4
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Which nerves does the tricep reflex involve?
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C6, C7
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Which nerves does the plantar reflex involve?
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L5, S1
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What type of problem is Parkinson's?
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cerebellar; shaking at rest
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What are the 7 components of the neuro exam?
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1. mental status
2. CN 3. motor 4. sensory 5. coordination 6. Romberg/gait 7. DTRs (deep tendon reflexes) |
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What should you always compare in the neuro exam?
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L/R symmetry
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What do you want to determine about a neuro problem?
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if it is CNS (upper) or PNS (lower)
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What components of mental status should you assess in neuro?
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1. general appearance and behaior
2. level of consciousness 3. orientation: person, place, time 4. attention 5. language 6. memory |
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If someone's eyes are open, they're looking around, and they have a full response to you, that person is…
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alert
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If the patient is drowsy, eyes are open and looking at you, and is responding appropriately, that person is __
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lethargic (concussion?)
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If a patient opens eyes, has slow responses, and is confused with no environmental interest, that patient is..
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obtunded
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If the patient is awakened with painful stimuli only, that person is…
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stuporous
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How do you wake a stuporous person?
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fist rub on the sternum to check for verbal response and bring out of sleep
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If you patient is always unarousable, that person is…
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comatose
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What are 3 types of mental status usually reserved for hospital settings?
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1. obtunded
2. stuporous 3. comatose |
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What is the first to go in orientation?
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time
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What is the 2nd to go in orientaion?
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place
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What is the last to go in orientation?
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person
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If you are concerned about a patient's attention, whould should you do to assess their attention level?
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ask them to repeat words/numbers 6-7 forward & 4 backwards
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Where is language typically located in the brain?
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usually the L-hemisphere of both R and L handed people
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What are 3 types of memory?
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1. Immediate recall
2. short term (demented people have problems here) 3. long term |
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If you're concerned about a patient's language, what should you do to assess the problem?
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ask them to write a sentence or repeat "no ifs, ands, or buts"
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How do you test immediate and short term recall?
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tell the patient 3 words to remember. For immediate, ask them to repeate it right back. For short term, ask them to repeat words in 3-5 min
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How do you test CN I?
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Use cloves, coffee, soap or vanilla to see if patients perceive and identify odor
*not ususally done |
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What are possible reasons for loss of smell?
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1. nasal dz
2. head trauma 3. smoking 4. aging 5. cocaine 6. congenital |
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What are 5 tests for CN II?
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1. test visual acuity
2. screen visual fields by confontation 3. test pupillary reactions to light 4. test pupillary reactions to accomodation 5. examine the optic fundi |
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What CNs does the pupillary light reflex test?
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CN II and III:
Shine light into 1 eye (CN II) Motor constriction of both pupils (CN III) |
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What are 2 tests for CN III?
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1. pupillary light reflex
2. accommodation |
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Which cranial nerves are involved in the 6 cardinal fields of gaze?
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CN III, IV, VI
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What are the divisions of CN V?
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Sensory Innervation:
-opthalmic -maxillary -mandibular Motor innervation |
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Describe the innervation in CN VII.
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Sensory + motor
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What is Bell's Palsy?
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Paralysis in CN VII; possibly caused by Lyme Dz
Causes all muscles on 1 side of the face to be paralyzed, no nasolabial fold, can't close eye (the eye rolls up and stays open) |
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What type of lesion causes Bell's palsy?
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peripheral lesion
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What type of lesion causes a stroke?
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central lesion (innervates from BOTH sides of the cortex)
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Describe the signs of a stroke.
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Lower half of the face is paralyzed
CAN open/shut eye, wrinkle forehead, eyebrows go up, still have nasolabial folds |
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What are 2 portions of CN VIII?
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1. cochlear portion
2. vestibular portion *both deal with acoustics |
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How do you test the vestibular portion of CN VIII?
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Rhomberg test: feet together, arms to the side, eyes closed. See if they can keep their balance
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What does CN IX and X have on the body?
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symmetry of uvula
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What does CN XI innervate?
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trapezius + sternocleidomastoid
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What does CN XII innervate?
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hypoglossal: innervates the tongue
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What do you assess the muscles for (4)?
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1. size
2. tone 3. strength 4. involuntary movements (abormal) |
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Which brain areas control tone?
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cerebellum + basal ganglia
*psych meds may increase tone |
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What is normal tone?
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not stiff or flaccid; ask the patient to relax while you move the body with passive ROM
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Describe flaccid tone.
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limp, flabby
might be from early stroke, lower neuron dz, polio |
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Describe spastic tone.
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increased tone (which increases resistance to passive lengthening; the more you move it, the tighter it gets)
(injury to corticospinal motor tract) |
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Describe rigid tone.
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constant state of resistance (cogwheel rigidity)
*from parkinson's, damage to the extrapyramidal tract |
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People with compression of the cervical spine may show it through..
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flat hands
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What is atrophy?
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abnormally small muscle from disuse, injury, lower neuron dz, muscle dz
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What is hypertrophy?
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muscle build-up from isometric exercises
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What is fasiculation?
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rapid twitching of a flaccid muscle
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What is a tic?
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Repetitive, twitching of a muscle at an inappropriate time (psychiatric or neurologic)
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What are tremors?
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at rest (pill rolling movement, such as in parkinson's)
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Describe the grading of muscle strength testing
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0=no muscular contraction
1=a barely detectable flicker 2=active movement of the body part with gravity eliminated 3=active movement of the bdoy part against gravity 4=active movement of body part against gravity + some resistance 5=active movement against full resistance without evident fatigue (normal) |
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How should you test shoulder strength?
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abduction
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How do you assess muscle strength of the arms?
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wonderwoman: push/pull
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How do you test muscle strength of quads and hamstrings?
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push/pull on the anterior and posterior portions of the lower legs
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How do you test for foot muscle strength?
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ask to dorsiflex and plantar flex against your resistance
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What does the spinothalamic tract mediate?
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1. pain
2. T 3. light/crude tough |
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If the patient responds to pain, do you need to test for T response?
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no
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How do you test the spinothalamic tract?
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cotton ball + this is sharp/this is dull
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What does the posterior column tract mediate?
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1. vibration- tuning fork
2. position sense (proprioception)- this is up, this is down 3. tactile discrimination (fine touch) |
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How do you test tactile discrimination?
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1. sereognosis
2. graphesthesia 3. 2-point discrimination 4. extinction |
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How do you test cerebellar function?
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1. rapid alternating movements (as fast as you can)
2. Point to point movements (finger/finger, finger/nose, heel/shin) |
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What is dysdiadochokinesia?
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the inability to arrest abruptly one motor impulse and substitute its opposite (rapid alternating movements)
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What is dysergia?
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improper coordinate function of given muscle groups (heel/shin)
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What is dysmetria?
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inabiity to gauge properly the distance between 2 points or objects (finger/nose)
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If someone has no coordination, what dz may this indicate?
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MS
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Which tests assess cerebellar function?
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1. tandem walking (gait)
2. Romberg test 3. shallow knee bend 4. pronator drift |
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What are 3 superficial reflexes?
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1. abdominal reflex
2. cremasteric reflex 3. plantar reflex |
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What does the Achilles reflex test for?
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clonus (a series of involuntary muscle contractions and relaxations)
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What type of reflex is the knee jerk reflex?
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quadricep
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Describe correct usage of your reflex hammer.
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tip: your finger flat: patient
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How do you test the plantar (babinski) reflex?
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draw a 7 on the bottom of the foot
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What is a normal plantar reflex finding?
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toes curl over
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What is an abnormal plantar reflex finding?
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big toe goes up while other toes fan out --> a positive babinski
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When is the Babinski reflex normal?
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up to 2 y/o
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Describe reflex grading
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4+ definitely abnormal, test for clonus
3+ pretty brisk, may be normal or dz 2+ normal 1+ diminished reflex (may only feel muscle instead of see it) 0 no response |
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What might cause a positive babinski in adults?
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upper motor neuron problem:
1. drugs, alcohol 2. seizure |