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105 Cards in this Set
- Front
- Back
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What brain regions comprise the cerebral cortex?
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1. Frontal lobe
2. Parietal lobe 3. Occipital lobe 4. Temporal lobe 5. Wernicke's area 6. Broca's area |
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What is the purpose of Wernicke's area?
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Comprehension of speech
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What is the purpose of Broca's area?
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Formation of speech
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What is the basal ganglia responsible for?
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Modify movement
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What does the thalamus do?
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Processes sensory impulses and relays them to the cerebral cortex
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What does the hypothalamus do?
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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. Hormones secreted by the hypothalamus act directly on the pituitary |
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What is the brainstem responsible for?
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Life-sustaining activities
Oldest part of the brain |
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What is the cerebellum responsible for?
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Coordinates movement and keeps body upright in space
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What are the three major motor pathways?
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1. Corticospinal (or pyramidal) tract
2. Extrapyramidal tracts 3. Cerebellar system |
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What does the corticospinal tract do?
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Controls voluntary movement, particularly skilled and discrete movements (e.g., writing)
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What does the extrapyramidal tract do?
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Controls voluntary movement, particularly gross movement (e.g., walking)
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What does the cerebellar system do?
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1. Coordinates movement
2. Helps control posture 3. Maintains equilibrium |
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What is the pathway of information for motor tracts?
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CNS --> PNS
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What is the pathway of information for sensory tracts?
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PNS --> CNS
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What are the two major sensory pathways?
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1. Spinothalamic tract
2. Posterior (dorsal) column tract |
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What is the spinothalamic tract responsible for?
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1. Sensation of pain
2. Sensation of temperature 3. Sensation of crude/light touch |
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What is the posterior column tract responsible for?
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1. Proprioception (position of body part in space)
2. Sensation of vibrations 3. Sensation of fine, localized touch |
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Where do cranial nerves II through XII arise from?
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Diencephalon and brainstem
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What is the composition of cranial nerves?
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Nerve fibers may be:
1. Sensory only 2. Motor only 3. Mix of sensory and motor |
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What are the 12 cranial nerves?
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CN I: Olfactory
CN II: Optic CN III: Oculomotor CN IV: Trochlear CN V: Trigeminal CN VI: Abducens CN VII: Facial CN VIII: Vestibulocochlear CN IX: Glossopharyngeal CN X: Vagus CN XI: Accessory CN XII: Hypoglossal |
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What is the composition of spinal nerves?
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Nerve fibers are both sensory (dorsal) and motor (ventral)
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What areas of the spine do spinal nerves arise from and how many pairs arise from each section?
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31 pairs of spinal nerves:
Cervical - 8 pairs Thoracic - 12 pairs Lumbar - 5 pairs Sacral - 5 pairs Coccyx - 1 pair |
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What is a reflex?
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Involuntary, stereotypical response
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How many neurons are involved in a reflex reaction?
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As few as two neurons -- one sensory and one motor.
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What is required for a reflex arc?
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1. Intact sensory neuron
2. Intact synapse 3. Intact motor neuron 4. Intact neuromuscular junction 5. Intact muscle |
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What spinal nerves are involved in the tricep reflex?
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Cervical spinal nerves 6 and 7
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What spinal nerves are involved in the plantar reflex?
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Lumbar spinal nerve 5 and sacral spinal nerve 1
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What spinal nerve is involved in the ankle reflex?
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Sacral spinal nerve 1
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What spinal nerves are involved in the knee reflex?
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Lumbar spinal nerves 2, 3, and 4
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What spinal nerves are involved in the brachioradialis reflex?
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Cervical spinal nerves 5 and 6
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What spinal nerves are involved in the bicep reflex?
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Cervical spinal nerves 5 and 6
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What 12 items should you ask when obtaining a health history for the neurological system?
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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) |
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What are the seven components of a physical exam for the neurological system?
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1. Mental status
2. Cranial nerves 3. Motor 4. Sensory 5. Coordination 6. Romberg/gait 7. Deep tendon reflexes |
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When performing tests of the neurological system what are you looking for?
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Bilaterally symmetric responses
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How wold you describe your patient's level of consciousness?
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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: always unarousable |
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What are the three components of orientation?
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Person, place, and time
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What is the order of loss of orientation?
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Time is the first to go, then place, and lastly person
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How can you assess attention?
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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 |
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What should you evaluate with the patient's language?
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1. Fluency of speech
2. Any hesitancy 3. Does the speech make sense? |
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What are the three different levels of memory?
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1. Immediate recall
2. Short-term (3-5 minutes later) 3. Long-term |
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How do you test CN I (olfactory)?
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Have patient smell a familiar scent (e.g., cloves, coffee, soap, or vanilla). Patient should perceive odor and can often identify it.
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Why should you not use ammonia for the olfactory test?
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Actually tests CN V
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What are some possible causes of loss of smell?
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Nasal disease, head trauma, smoking, aging, and use of cocaine
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What are the tests for CN II (optic nerve)?
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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) |
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What two nerves are tested by the pupillary light reflex?
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CN II (optic) and III (oculomotor)
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What does the pupillary light reflex test?
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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. |
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What does the test for convergence and accommodation do?
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Tests CN II (optic) and CN III (oculomotor).
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What does the six cardinal fields of gaze test?
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CN III (oculomotor), CN IV (trochlear), CN VI (abducens)
Look for nystagmus (shaking of eye), which is normal only at the extreme lateral gaze. |
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What are the three regions of sensory innervation for CN V (trigeminal)?
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1. Ophthalmic
2. Maxillary 3. Mandibular |
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How should you test CN VII (facial)?
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Have patient
1) Raise eyebrows 2) Smile 3) Frown 4) Puff out cheeks 5) Close eyes and don't let examiner open then |
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Which muscles should you assess for the motor portion of CN V (trigeminal)?
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Temporal and masseter muscles
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What effect does a peripheral injury to CN VII (facial nerve) cause?
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Bell's palsy
The peripheral injury affects both the upper and lower face on the same side as the peripheral lesion. Flat nasolabial fold, cannot raise eyebrow, cannot close eye. |
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What effect does a central lesion of CN VII (facial nerve) cause?
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Stroke (cerebrovascular accident)
Lower part of face is controlled by upper motor neurons that project to the opposite side of the face. They are the only neurons innervating the lower face so when damage occurs, the lower face is paralyzed. (E.g., central lesion in CN VII in left hemisphere would result in paralysis of the lower face on the right side) Flat nasolabial fold on side opposite of lesion. Can open and shut eyes, raise eyebrows (wrinkle forehead). |
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How do you test CN VIII (vestibulocochlear)?
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1. Cochlear portion: finger rub test
2. Vestibular portion: have patient stand with his feet together, eyes closed. Any swaying could be a sign of vertigo. If the person falls back, there is a problem with the nerve. |
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How do you test CN IX (glossopharyngeal) and CN X (vagus)?
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Ask patient to open mouth and say "Ah." Look for symmetric rising and falling of soft palate and that the uvula remains midline.
The gag reflex is normally not tested on an A&O patient. |
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What two muscles are you assessing when you perform the test for CN XI (accessory nerve)?
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1. Trapezius (patient shrugs shoulders against resistance)
2. Sternocleidomastoid (patient pushes face against resistance) |
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What are you looking for when you test CN XII (hypoglossal)?
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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. |
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What should you look for when assessing the size of the patient's muscles?
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Pay attention to bilateral symmetry, particularly in the hands.
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What is atrophy of muscle? What might it indicate?
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Atrophy is abnormally small muscles; loss of muscle bulk.
Possible causes: disuse, injury, lower motor neuron problem, muscle disease |
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What is hypertrophy of muscle? What causes it?
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Increase in muscle bulk with corresponding increase in strength.
Caused by isometric exercises. |
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What is muscle tone?
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Slight residual tension of the muscle when it is voluntarily relaxed.
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How can you assess muscle tone?
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Ask patient to relax and perform passive ROM.
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What are some possible causes of muscle flaccidity?
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Polio, early stage of stroke, lower neuromuscular disease
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What are some possible causes of muscle spasticity?
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Injury to corticospinal tract, later stages of stroke
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What is muscle spasticity?
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Increased resistance that worsens at the extremes of ROM.
Increases with rapid movement. |
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What is muscle rigidity?
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Increased resistance throughout the ROM in both directions.
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What are some causes of muscle rigidity?
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Damage to extrapyramidal tract, Parkinson's
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What are the three different types of involuntary movements?
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1. Tremors
2. Fasciculations 3. Tics |
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What are the two types of tremors?
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1. Parkinson's tremors
2. Intention tremors (Occur with task, e.g., pouring water into glass) |
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What are fasciculations?
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Rapid twitching of resting muscle
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What is a tic?
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Repetitive twitching at inappropriate time
Psychiatric or neurologic etiology |
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What are the three components for assessing the spinothalamic tract?
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1. Pain
2. Temperature 3. Light or crude touch |
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How is sensation for light or crude touch assessed?
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With patient's eyes closed, you use zero pressure to touch the patient in different dermatomes with a cotton ball. Patient should tell you when he feels the touch.
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How do you assess sensation of pain?
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Use a sharp edge and dull edge of a paper clip or broken tongue blade. Patient should close eyes and tell you whether she is feeling sharpness or dullness in the different dermatomes you touch.
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How is the pain test different for neuro patients?
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Use a safety clip instead of a paper clip or broken tongue blade
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What dermatomes do you test when assessing the spinothalamic tract?
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Inner and outer sides of:
1. Upper arms 2 Forearms 3. Thighs 4. Lower legs And tops of the hands and feet |
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If a patient can sense pain, what do you not need to test?
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Sensation of temperature
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What are the three tests for assessing the posterior column tract?
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1. Vibration
2. Proprioception 3. Tactile discrimination |
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If vibration can be felt distally (on the toe or thumb), what does that mean?
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The vibration would also be felt further up (proximally).
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What disease causes loss of vibratory sense?
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Diabetes
Vibratory sense is first lost in the feet |
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How is proprioception (aka position sense) tested?
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Hold DIP joint on thumbs and big toes and move up or down. Have patient close eyes and tell you which direction you move the fingers/toes.
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What is stereognosis?
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Ability to identify an object by feeling it.
Have patient close eyes and hand him a familiar object to identify. |
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What is graphesthesia?
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Number identification
Have patient close eyes. "Draw" a number on the patient's palm and ask him to identify it. |
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How do you test two-point discrimination?
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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.
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What does extinction test for?
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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. |
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What are the tests for coordination and skilled movement?
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1. Rapid alternating movements
2. Point-to-point movements |
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What rapid alternating movement tests should be performed?
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1. Touching of pointer finger to thumb on both hands simultaneously.
2. Pronation/supination of hands 3. Dorsiflexion/plantarflexion of feet |
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What is an abnormal result of the rapid alternating movement tests?
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Dysdiadochokinesia: inability to arrest abruptly one motor impulse and substitute its opposite
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What are the tests for point-to-point movements?
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1. Finger-to-finger test
2. Finger-to-nose test 3. Heel-to-shin test |
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What is dysergia?
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Improper coordinated function of given muscle groups
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What is dysmetria?
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Inability to gauge properly the distance between two points or objects
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What is an abnormal response to the heel-to-shin test? What causes it?
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The heel will bounce all over the place. Evident in a patient with multiple sclerosis.
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How is gait assessed?
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Patient walks 10 steps, pivots (turns around), and walks back.
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How is the gait of a Parkinson's patient different?
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Steps are short and shuffling. Less arm swinging. Patient turns around stiffly (turn on point), cannot spin on pivot.
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Why would tandem walking be used after assessing gait?
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It may reveal an ataxia not obvious in the assessment of the gait.
A gait that lacks coordination. with reeling and instability, is called ataxic. |
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What is a positive Romberg test?
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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. |
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What is a positive pronator drift test? What might cause it?
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Patient stands with eyes closed, arms straight out with palms up. The test is positive if the patient's arm moves downward and the forearm pronates.
Pronator drift may be the result of stroke. |
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What side of the hammer do you use for direct contact with tendons?
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Flat side of hammer
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What side of the hammer do you use for indirect contact (hitting your thumb) with tendons?
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Pointed side of hammer.
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What is the grading for tendon reflexes?
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0 = no response
1+ = decreased reflex 2+ = normal 3+ = brisk, may be normal or abnormal 4+ = brisk, abnormal; test for clonus |
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Why would you use reinforcement when testing deep tendon reflexes?
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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.
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What are the deep tendon reflexes we test for?
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1. Biceps reflex
2. Triceps reflex 3. Brachioradialis reflex 4. Knee (quadriceps) reflex 5. Ankle (Achilles) reflex |
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What are the superficial reflexes we test for?
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1. Abdominal reflex
2. Cremasteric reflex 3. Plantar reflex |
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What is an abnormal plantar reflex response?
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Babinski's: toes curl up
Possible causes: upper motor neuron problem; alcohol/drugs; can occur during seizure Positive Babinski's test is normal in children under 2 years old |
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What is clonus?
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Rhythmic oscillations between dorsiflexion and plantar flexion
This is an abnormal finding |
