Phys Di Neuro

Front 1

-Folstein possible points
-Normal
-organic problem
-Depressed score
-Dementia/delirium/schozo

Back 1

-30
->23
-<27
-20-24
-<20

Front 2

Components of Folstein (11)

Back 2

1. year, season, date, month
2. State, county, town, hospital, floor
3. Name 3 objects
4. Spell world backwards
5. Repeat 3 objects
6. ID 2 objects pointed to
7. Repeat "no ifs ands or buts"
8. Follow 3 stage command
9. Close eyes
10. Write a senstence
11. Copy design

Front 3

Testing CN II

Back 3

Eye chart, visual fields

Front 4

CNs in midbrain/pons

Back 4

3 - 6

Front 5

Testing CN III

Back 5

Focus far to near vision; pupillary light reflex

Front 6

CN IV

Back 6

Rotate eye up, down, R L

Front 7

Testing CN 7

Back 7

Facial expression

Front 8

Bells Palsy symptoms

Back 8

Can't raise ipsilateral eyebrow (CN7)

Front 9

Stroke symptomes

Back 9

Can raise eyebrows

Front 10

Testing CN 5

Back 10

Touch on bilat forehead, maxilla, mandible; clench teeth

Front 11

Testing CN 8

Back 11

Balance
Whisper test

Front 12

CN 9

Back 12

Swallow, gag

Front 13

CN 10

Back 13

Uvula rise midline "Ahhh"; hoarseness

Front 14

CN 11

Back 14

Shrug shoulders (trap), turn head (SCM)

Front 15

CN 12

Back 15

Protrude tongue (midline)

Front 16

CNs in Medulla

Back 16

9-12

Front 17

Why can pt raise eyebrows w/ stroke?

Back 17

Bilateral innervation to facial motor nucleus to mm above eye; Bells palsy affects the n. after the nucleus

Front 18

If a pt has decreased touch sensation, test ___ next

Back 18

Vibration w/ tuning fork

Front 19

Common reasons for decreased touch sensation DCSBP

Back 19

Diabetes
Compression
Syphilis
B12/folate deficiency
Peripheral vascular dz

Front 20

What is considered a sufficient screen for dorsal colum?

Back 20

If pt feels fingers/toes & has not SC injury

Front 21

How will touch sensation return after SC injury?

Back 21

Top down (prox --> distal)

Front 22

Idiopathic dz where central canal becomes cystic/expands in parts of SC

Back 22

Syringomyelia

Front 23

Demyelinating disease of PERIPHERAL NERVOUS SYSTEM
Associated with a viral syndrome (EBV, CMV)
Rapidly progressive motor and sensory neuropathy

Back 23

Gion Beret

Front 24

Symptom of syringomyelia

Back 24

Loss of P&T bc enlarged canal compresses spinothalamic tract
Then beings to put pressure on motor neurons (LMN type lesion)

Front 25

If pt has decr perception of pain, do ___ next

Back 25

Use vacutainer filled w/ hot/cold, start w/ lowest dermatome work way up

Front 26

Common reasons for decr pain sensation

Back 26

Diabetes
N. compression

Front 27

C1-4 myotome

Back 27

Neck

Front 28

C4-5 myotome

Back 28

Shoulders

Front 29

C6 & 7 mytome

Back 29

Elbow/wrist

Front 30

C8

Back 30

Thumb

Front 31

T1

Back 31

finger abduction

Front 32

L2

Back 32

Hip flexion

Front 33

L3

Back 33

Knee extension

Front 34

L4

Back 34

Ankle dorsiflexion

Front 35

Types of reflexes

Back 35

Deep Tendon
Cutaneous

Front 36

Normal and symmetrical reflexes tell you:

Back 36

Ipsilateral reflex arc & contralateral descending inputs are intact

Front 37

S/S of problems w/ Reflex arc

Back 37

Hyporeflexia
Muscle atrophy
Decr strength

Front 38

S/S of problems w/ descending inputs

Back 38

Hyperreflexia
Disuse atrophy only
Spasticity

Front 39

Hyperreflexia (enhanced stretch reflex)
No m atrophy
Affects groups of mm
Babinski present

Back 39

Upper motor neuron lesion

Front 40

Decreased m tone
Atrophy
Fasciculations
Hyporeflexia
No Babinski

Back 40

LMN

Front 41

3 tests require the pt to integrate sensation of touch, recognition of object, & speech

Back 41

Stereognosis
Graphesthesia
Point localization

Front 42

Recognition of object occurs in:

Back 42

Contralateral Parietal lobe

Front 43

Speech originates from:

Back 43

Left frontal lobe in all R handed & 80% of L handed

Front 44

Stereognosis procedure

Back 44

Pt close eyes, ID object placed in hand

Front 45

Graphesthsia procedure

Back 45

Pt close eyes, trace number on palm

Front 46

Point localization

Back 46

Pt close eyes, touch point on upper & lower extremities, pt points to where they were touched

Front 47

Key structure for modulating movement/making them smooth

Back 47

Cerebellum

Front 48

Tests of cerebellar fxn (6)

Back 48

1 Pat hands on legs
2 Pat hands back/forth on legs
3 Touch each finger w/ thumb
4 Tap feet on floor
5 Touch nose, then your finger back/forth
6 Run heal down opposite shin

Front 49

If the head and body are in motion: ___- drives the movement, ____ coordinates through input from ____, and balance must be maintained via ___

Back 49

Cerebrum; cerebellum; proprioceptors, CN 8

Front 50

5 tests that test integration of all these, but don't allow pinpoint of lesion

Back 50

Romberg
Stand on 1 foot for 5 s
Hop on 1 foot
Walk
Walk heal to toe

Front 51

Romburg procedure
--What it's testing

Back 51

-Pt close eyes, arms out
--Relying on CN 8, proprioceptors in feet, motor fxn for standing

Front 52

___ important in modulating unconscious m. tone

Back 52

BG

Front 53

Lesions of BG produce ____

Back 53

movement disorders at rest (dyskinesias)

Front 54

5 dyskinesias common to BG:

Back 54

1 Tremor (e.g. resting of Parkinson's)
2 Athetosis
3 Chorea
4 Ballismus
5 Tics

Front 55

-Athetosis
-D/t:

Back 55

Slow, writing, snake like movement of limbs; begins in infancy d/t viral encephalopathy

Front 56

-Chorea
-E.g.

Back 56

Rapid, jerky movements in distal limbs/face
-E.g. Huntington's, Sydenham's

Front 57

-Ballismus
-E.g
-Resolution

Back 57

-Violent flailing of entire limb
-Hemiballism 2nd to infarct; resolves weeks to months

Front 58

Tics

Back 58

-Stereotypical & repetitive movements of face/tongue
-E.g. Tardive dyskinesia d/t long term tx w/ neuroletpics (Thorazine, Prolixen)

Front 59

Allows level of consciousness to be evaluated & quantified when pt has acute brain injury

Back 59

Glascow coma scale

Front 60

Coma scale < __ gets automatic head scan

Back 60

8

Front 61

Max Glascow score

Back 61

14

Front 62

Assessed behaviors of Glascow (3 major categories)

Back 62

Eye opening
Appropriate verbal response
Integrated motor response

Front 63

Eye opening response scoring Glascow
1
2
3
4

Back 63

Spontaneous (4)
To verbal stim (3)
To pain (2)
None (1)

Front 64

Verbal response scoring Glascow
(5)

Back 64

Oriented 5
Confused 4
Inappropriate words 3
Incoherent 2
None 1

Front 65

Motor response scoring Glascow (5)

Back 65

Obeys commands 5
Localizes pain 4
Flexion to pain (decorticate) 3
Extension to pain (decerebrate) 2
None 1

Front 66

Numbness in feet/hands after vaccination, hx of Camplobactor

Back 66

Gion Baret

Front 67

Tx of Gion Baret

Back 67

ICU

Front 68

Test for R/L brain dominance

Back 68

Run cath in L internal carotid, have pt count back from 100
--If speech is on L, pt will stop talking b/c brocas on that side

Front 69

Dominance determined by:

Back 69

Side speech center is on

Front 70

Anoxi during birth leads to

Back 70

Cerebral palsy

Front 71

Anoxic during birth, late decels, movement disorder affecting limbs

Back 71

Cerebral palsy

Front 72

Dementia vs delirium

Back 72

Delirium gets better

Front 73

Meds to prevent withdraw symptoms in alcoholics

Back 73

Adovan, Librium, Valium

Front 74

Autoimmune against ACh receptor in middle age male w/ global m. weakness, can;t wink fast --> give parasympathetic blockers --> gets better

Back 74

Myestinia gravis

Front 75

2 tests for Memingitis

Back 75

Kernigs
Broudzinkskis

Front 76

Kernigs procedure

Back 76

Pt lay down, flex knees, then hips, then extend knees up in air --> pt will resist re-flexion of knees

Front 77

Brudzinksi's procedure

Back 77

Pt laying down, raise head, will bring knees to fetal to reduce stretch

Front 78

Always do Brud & Kernig when?

Back 78

Exams for pharyngitis/URI etc note absence of meningitis

Front 79

To test meningitis on babies:

Back 79

Take them away from mom, they'll turn

Front 80

Ankle Clonys

Back 80

Quickly dorsiflex ankle, with UMN lesion = hyperreflexia & ankle will plantar flex against

Front 81

Describe motor fxn on scale of __-

Back 81

0-4; 2 is normal

Front 82

First sensation lost in diabetics

Back 82

vibration

Front 83

Tabes Dorsalis; indicative of:

Back 83

Clopping walk w/ planting of feet while looking; Tertiary syphilis

Front 84

Tertiary syphilis is a ___ disruption of ___

Back 84

Selective; dorsal column

Front 85

If pt has true problem w/ touch sensation, will also have:

Back 85

Vibration/proprioception problem