Pa Final: Neuro

Front 1

What are the components of the PNS?

Back 1

1. 12 Cranial nerves
1. 31 spinal nerves + branches

Front 2

Which hemisphere is dominant in most people?

Back 2

left

Front 3

Name 5 components of the cerebral cortex.

Back 3

1. Frontal lobe
2. parietal lobe
3. occipital lobe
4. Wernicke's area
5. Broca's area

Front 4

Which region of the brain as the greatest amount of brain tissue?
How is this tissue divided?

Back 4

cerebral cortex:

grey (outer): highest human functions
white (inner): neuronal axons coded with myelin

Front 5

Where is Wernicke's area located and what does it do?

Back 5

Wernicke's area is located in the temporal lobe.

Fxn: comprehension of speech

Front 6

Where is the primary motor area located?

Back 6

frontal lobe

Front 7

What are the functions of the frontal lobe?

Back 7

Frontal lobe:
1. intellectual fxns
2. emotions
3. behaviors
4. personality

Front 8

Where is the primary sensory area located?

Back 8

parietal lobe

Front 9

What is the function of the occipital lobe?

Back 9

visual reception

Front 10

Where is Broca's area located? What is its function?

Back 10

Frontal lobe

fxn: (motor) speech formation

Front 11

What are 3 components of the diencephalon?

Back 11

1. basal ganglia
2. thalamus
3. hypothalamus

Front 12

What are the 3 components of the brainstem?

Back 12

1. Midbrain
2. pons
3. medulla

Front 13

What is the function of the cerebellum?

Back 13

1. COORDINATION of VOLUNTARY movements
2. equilibrium
3. muscle TONE

**does NOT initiate movement

Front 14

What is the spinal cord and where is it located?

Back 14

A mass of nerve tissue

medulla-->L1/L2

Front 15

Which NS is associated with the spinal column?

Back 15

CNS

Front 16

Which NS is associated with the spinal nerves?

Back 16

PNS

Front 17

What is the function of the basal ganglia?

Back 17

Controls automatic body movements (normal arm swing while walking)

Front 18

What is the function of the thalamus?

Back 18

Main relay system for the NS; the synapes go to the CORTEX for finite determination

Front 19

What does the hypothalamus regulate?

Back 19

1. T
2. sleep center
3. pituitary
4. emotional status

Front 20

What is the midbrian composed of?

Back 20

nerve fibers that merge with the thalamus

Front 21

Which nerve fibers are assoiciated with the pons?

Back 21

ascending/descending nerve fibers

Front 22

Which nerve tracts are associated with the medulla?

Back 22

all motor/sensory tracts go here

Front 23

What is the function of the medulla?

Back 23

1. Vital autonomic centers (vitals, respiration, heart beat)
2. motor fibers CROSS here (pyramidal decussation)

Front 24

Name 3 major motor pathways.

Back 24

MOTOR pathways:
1. Corticospinal (pyramidal) tract
2. Extrapyramidal tract
3. Cerebellar system

Front 25

Describe the pathway of the corticospinal (pyramidal) tract.

Back 25

motor fibers originate in the cortex-->brainstem (cross over)-->spinal column-->synapse with lower motor neuron or spinal nerve

Front 26

What is the function of the corticospinal tract?

Back 26

controls VOLUNTARY movement (ie skilled, descrete skills like writing)

Front 27

Where do extrapyramidal tracts originate?

Back 27

motor cortex

Front 28

What does the extrapyramidal tract control?

Back 28

controls gross body movements (walking)

Front 29

What are the functions of the cerebellum?

Back 29

1. coordinate arm movement
2. maintain equilibrium, posture

Front 30

What does the cerebellum receive input about?

Back 30

muscle/joint position to keep the body in equilibrium

Front 31

What are the 2 major sensory pathways?

Back 31

SENSORY pathways:
1. spinothalamic tract
2. posterior (dorsal) column

Front 32

What does the spinothalamic tract sense?

Back 32

1. pain
2. T
3. crude/light touch

Front 33

What is the pathway of the spinothalamic tract?

Back 33

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)

Front 34

What are the functions of the posterior (dorsal) column?

Back 34

1. proprioception (sensation of position)
2. vibrations
3. fine localized touch
4. discriminatory touch

Front 35

Where do CN II-XII originate?

Back 35

diencephalon + brainstem (S, M, S+M)

Front 36

3 components of the PNS?

Back 36

1. Cranial nerves
2. spinal nerves
3. reflex arc

Front 37

List the types of the 31 spinal nerves.

Back 37

8 cervical
12 thoracic
5 lumbar
5 sacral
1 coccygeal

**innervates dermatomes

Front 38

Anterior portion of spinal nerves consist of __, Posterior portion consists of __.

Back 38

motor fibers, sensory fibers

Front 39

Describe functions of CN VII

Back 39

CN VII (facial):
sensory fxn: taste
motor fxn

Front 40

CN IX (glossopharyngeal) senses what?

Back 40

eardrum, ear canal

Front 41

Describe the functions of CN X (vagas)

Back 41

motor: palate, pharynx, larynx
sensory: pharynx, larynx

Front 42

Which muscles does CN XI (accessory) innervate?

Back 42

sternocleidomastoid, trapezius

Front 43

What are the functions of CN V (trigeminal)?

Back 43

motor fxn: temporal/masseter
sensory fxn: 3 regions
corneal reflex

Front 44

Which virus follows a dermatome?

Back 44

herpes zoster in shingles

Front 45

What do the cervical spinal nerves C3,4,5,8 innervate?

Back 45

shoulder and arms

Front 46

What do the throacic spinal nerves innervate?

Back 46

chest + abdomen

Front 47

What do lumbar spinal nerves L1-5 and sacral nerves innervate?

Back 47

legs

Front 48

What is the advantage of dermatome overlap?

Back 48

if 1 is severed, the ones above/below it can transmit some sensations still

Front 49

What does the site of numbness/pain tell you?

Back 49

the dermatome where the numbness/pain is located indicates where the nerve is

Front 50

What are the requirements for a reflex arc?

Back 50

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

Front 51

Are reflexes voluntary or involuntary?

Back 51

involuntary

Front 52

What are the fewest number of neruons allowed in a reflex arc?

Back 52

2: 1 motor, 1 sensory (1 synapse)

Front 53

Which nerve does the ankle reflex involve?

Back 53

S1

Front 54

Which nerves do the brachioradialis reflex involve?

Back 54

C5, C6

Front 55

Which nerves does the bicep reflex involve?

Back 55

C5, C6

Front 56

Which nerves does the knee reflex involve?

Back 56

L1, 3, 4

Front 57

Which nerves does the tricep reflex involve?

Back 57

C6, C7

Front 58

Which nerves does the plantar reflex involve?

Back 58

L5, S1

Front 59

What type of problem is Parkinson's?

Back 59

cerebellar; shaking at rest

Front 60

What are the 7 components of the neuro exam?

Back 60

1. mental status
2. CN
3. motor
4. sensory
5. coordination
6. Romberg/gait
7. DTRs (deep tendon reflexes)

Front 61

What should you always compare in the neuro exam?

Back 61

L/R symmetry

Front 62

What do you want to determine about a neuro problem?

Back 62

if it is CNS (upper) or PNS (lower)

Front 63

What components of mental status should you assess in neuro?

Back 63

1. general appearance and behaior
2. level of consciousness
3. orientation: person, place, time
4. attention
5. language
6. memory

Front 64

If someone's eyes are open, they're looking around, and they have a full response to you, that person is…

Back 64

alert

Front 65

If the patient is drowsy, eyes are open and looking at you, and is responding appropriately, that person is __

Back 65

lethargic (concussion?)

Front 66

If a patient opens eyes, has slow responses, and is confused with no environmental interest, that patient is..

Back 66

obtunded

Front 67

If the patient is awakened with painful stimuli only, that person is…

Back 67

stuporous

Front 68

How do you wake a stuporous person?

Back 68

fist rub on the sternum to check for verbal response and bring out of sleep

Front 69

If you patient is always unarousable, that person is…

Back 69

comatose

Front 70

What are 3 types of mental status usually reserved for hospital settings?

Back 70

1. obtunded
2. stuporous
3. comatose

Front 71

What is the first to go in orientation?

Back 71

time

Front 72

What is the 2nd to go in orientaion?

Back 72

place

Front 73

What is the last to go in orientation?

Back 73

person

Front 74

If you are concerned about a patient's attention, whould should you do to assess their attention level?

Back 74

ask them to repeat words/numbers 6-7 forward & 4 backwards

Front 75

Where is language typically located in the brain?

Back 75

usually the L-hemisphere of both R and L handed people

Front 76

What are 3 types of memory?

Back 76

1. Immediate recall
2. short term (demented people have problems here)
3. long term

Front 77

If you're concerned about a patient's language, what should you do to assess the problem?

Back 77

ask them to write a sentence or repeat "no ifs, ands, or buts"

Front 78

How do you test immediate and short term recall?

Back 78

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

Front 79

How do you test CN I?

Back 79

Use cloves, coffee, soap or vanilla to see if patients perceive and identify odor

*not ususally done

Front 80

What are possible reasons for loss of smell?

Back 80

1. nasal dz
2. head trauma
3. smoking
4. aging
5. cocaine
6. congenital

Front 81

What are 5 tests for CN II?

Back 81

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

Front 82

What CNs does the pupillary light reflex test?

Back 82

CN II and III:
Shine light into 1 eye (CN II)
Motor constriction of both pupils (CN III)

Front 83

What are 2 tests for CN III?

Back 83

1. pupillary light reflex
2. accommodation

Front 84

Which cranial nerves are involved in the 6 cardinal fields of gaze?

Back 84

CN III, IV, VI

Front 85

What are the divisions of CN V?

Back 85

Sensory Innervation:
-opthalmic
-maxillary
-mandibular

Motor innervation

Front 86

Describe the innervation in CN VII.

Back 86

Sensory + motor

Front 87

What is Bell's Palsy?

Back 87

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)

Front 88

What type of lesion causes Bell's palsy?

Back 88

peripheral lesion

Front 89

What type of lesion causes a stroke?

Back 89

central lesion (innervates from BOTH sides of the cortex)

Front 90

Describe the signs of a stroke.

Back 90

Lower half of the face is paralyzed

CAN open/shut eye, wrinkle forehead, eyebrows go up, still have nasolabial folds

Front 91

What are 2 portions of CN VIII?

Back 91

1. cochlear portion
2. vestibular portion

*both deal with acoustics

Front 92

How do you test the vestibular portion of CN VIII?

Back 92

Rhomberg test: feet together, arms to the side, eyes closed. See if they can keep their balance

Front 93

What does CN IX and X have on the body?

Back 93

symmetry of uvula

Front 94

What does CN XI innervate?

Back 94

trapezius + sternocleidomastoid

Front 95

What does CN XII innervate?

Back 95

hypoglossal: innervates the tongue

Front 96

What do you assess the muscles for (4)?

Back 96

1. size
2. tone
3. strength
4. involuntary movements (abormal)

Front 97

Which brain areas control tone?

Back 97

cerebellum + basal ganglia

*psych meds may increase tone

Front 98

What is normal tone?

Back 98

not stiff or flaccid; ask the patient to relax while you move the body with passive ROM

Front 99

Describe flaccid tone.

Back 99

limp, flabby

might be from early stroke, lower neuron dz, polio

Front 100

Describe spastic tone.

Back 100

increased tone (which increases resistance to passive lengthening; the more you move it, the tighter it gets)

(injury to corticospinal motor tract)

Front 101

Describe rigid tone.

Back 101

constant state of resistance (cogwheel rigidity)

*from parkinson's, damage to the extrapyramidal tract

Front 102

People with compression of the cervical spine may show it through..

Back 102

flat hands

Front 103

What is atrophy?

Back 103

abnormally small muscle from disuse, injury, lower neuron dz, muscle dz

Front 104

What is hypertrophy?

Back 104

muscle build-up from isometric exercises

Front 105

What is fasiculation?

Back 105

rapid twitching of a flaccid muscle

Front 106

What is a tic?

Back 106

Repetitive, twitching of a muscle at an inappropriate time (psychiatric or neurologic)

Front 107

What are tremors?

Back 107

at rest (pill rolling movement, such as in parkinson's)

Front 108

Describe the grading of muscle strength testing

Back 108

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)

Front 109

How should you test shoulder strength?

Back 109

abduction

Front 110

How do you assess muscle strength of the arms?

Back 110

wonderwoman: push/pull

Front 111

How do you test muscle strength of quads and hamstrings?

Back 111

push/pull on the anterior and posterior portions of the lower legs

Front 112

How do you test for foot muscle strength?

Back 112

ask to dorsiflex and plantar flex against your resistance

Front 113

What does the spinothalamic tract mediate?

Back 113

1. pain
2. T
3. light/crude tough

Front 114

If the patient responds to pain, do you need to test for T response?

Back 114

no

Front 115

How do you test the spinothalamic tract?

Back 115

cotton ball + this is sharp/this is dull

Front 116

What does the posterior column tract mediate?

Back 116

1. vibration- tuning fork
2. position sense (proprioception)- this is up, this is down
3. tactile discrimination (fine touch)

Front 117

How do you test tactile discrimination?

Back 117

1. sereognosis
2. graphesthesia
3. 2-point discrimination
4. extinction

Front 118

How do you test cerebellar function?

Back 118

1. rapid alternating movements (as fast as you can)
2. Point to point movements (finger/finger, finger/nose, heel/shin)

Front 119

What is dysdiadochokinesia?

Back 119

the inability to arrest abruptly one motor impulse and substitute its opposite (rapid alternating movements)

Front 120

What is dysergia?

Back 120

improper coordinate function of given muscle groups (heel/shin)

Front 121

What is dysmetria?

Back 121

inabiity to gauge properly the distance between 2 points or objects (finger/nose)

Front 122

If someone has no coordination, what dz may this indicate?

Back 122

MS

Front 123

Which tests assess cerebellar function?

Back 123

1. tandem walking (gait)
2. Romberg test
3. shallow knee bend
4. pronator drift

Front 124

What are 3 superficial reflexes?

Back 124

1. abdominal reflex
2. cremasteric reflex
3. plantar reflex

Front 125

What does the Achilles reflex test for?

Back 125

clonus (a series of involuntary muscle contractions and relaxations)

Front 126

What type of reflex is the knee jerk reflex?

Back 126

quadricep

Front 127

Describe correct usage of your reflex hammer.

Back 127

tip: your finger flat: patient

Front 128

How do you test the plantar (babinski) reflex?

Back 128

draw a 7 on the bottom of the foot

Front 129

What is a normal plantar reflex finding?

Back 129

toes curl over

Front 130

What is an abnormal plantar reflex finding?

Back 130

big toe goes up while other toes fan out --> a positive babinski

Front 131

When is the Babinski reflex normal?

Back 131

up to 2 y/o

Front 132

Describe reflex grading

Back 132

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

Front 133

What might cause a positive babinski in adults?

Back 133

upper motor neuron problem:
1. drugs, alcohol
2. seizure