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110 Cards in this Set
- Front
- Back
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what is included in the neurologic exam?
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*mental status
*cranial nerves *motor fxn *reflexes *sensory status *coordination and balance |
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are sensory pathways ascending or descenging?
what are tracts that impulses travel? |
ascending tracts
spinothalamic and posterior columns |
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where do motor pathways originate?
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the cerebral cortex and brain stem
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what tract originates in the cerebral cortex?
which originate in the brain stem? |
cerebral cortex:
~corticospinal tracts brain stem: ~tectospinal tract ~rubrospinal tract ~vestibulospinal tract |
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where does the lateral corticospinal motor pathway synapse?
where does the anterior corticospinal tract cross? |
latera-->synapse w/ alpha motor neurons and interneurons
anterior--> cross at cervical level |
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what tract primarily modulates motor neurons that innervate neck and arm muscles?
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anterior cerebral cortex motor pathway
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what is the tract that mediates reflex postural movemetns in response to visular and possible audiroty stimuli?
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tectospinal tract
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what tract in the brain stem controls muscle tone of flexor muscle groups?
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rubrospinal tract
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what motor tract in the brain stem facilitates spinal cord reflexes and muscle tone?
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vestibulospinal tracts
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where are the neurons of the spinothalamic tract located?
what are the sensations of the lateral spinothalamic tract? what are the sensations of the anterior spinothalamic tract? where does the spinothalamic tract cross? |
in dorsal horn
lateral-->pain, tem and crude touch ant-->light touch crosses in the spinal cord and then passes up to thalamus |
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if there is a lesion on the anterior spinothalamic tract is there disturbace of fxn?
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little or none
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whate are the 3 sensations of the posteior columns?
where does the posterior column synapse? |
1. proprioception
2. vibratory sense 3. discriminative touch synapses in medulla and continues to thalamus |
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what are the sensory receptors of proprioception?
what are the sensory receptors of vibratory sense? what are the discriminative sensory receptors? |
proprioception-->muscle spindles and golgi tendon organs
vibratory--> Pacinian corpuscle discriminative--> Meissner corpuscle |
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are there fine distinctions of sensation at the thalamic level?
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no, only general sensation
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where are stimuli localized and discriminated?
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the sensory cortex
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what is a slight or incomplete paralysis?
what is a loss or impariment of motor fxn? what is an enlargement of an organ or part due to an increase in size of its consituent cells? |
slight paralyis-->paresis
loss or impairment of motor-->paralysis(plegia) enlgt-->hypertrophy |
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what is an increase in size w/o true hypertrophy?
what is hypertonicity w/ increased DTR's? |
pseudohypertrophy
hypertonicity-->spasticity |
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what is stiffness or inflexibility?
what is loss of tone w/ dimished DTR's |
stiffness-->rigidity
loss of tone-->flaccidity |
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what are brief repetitive, stereotyped movements occuring at irregular intervals?
what are examples? what are common causes? |
tics
ex include repetitive winking, grimacing and shoulder shurgging causes-->tourette's and drugs(phenothiazines and amphetamines) |
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what are brief movements that are rapid, jerky, irregular and unpredictable. occur at rest or interrupt normal coordinated movements?
how are they different from tics? what areas are commonly involved? what are causes? |
chorea
differ from tics b/c seldom repeat themselves common areas involved include-->face, head, lower arms and hands causes-->sydenhami's chorea(w/ rheumatic fever) and huntingdon's dz |
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what are slower and more twisting and writhing than choreiform mvmts and have larger amplitude?
what areas are most commonly involved? what is this often assoc w/? what are causes? |
athetosis
areas involved include-->face and distal extremities often assoc w/-->spasticity causes-->cerebral palsy |
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what is a movement tha is similar to athetoid but often involves larger portions of body including trunk?
what type of movements may result what are causes? |
dystonia
grotesqu, twisted postures may result cause-->drugs(phenothiazines, spasmodic torticolis) |
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what are impt assoc symptoms to ask about?
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*headache
*vertigo *PQRST *visual disturbance *tremors or dyskinesia *loss of consciousness |
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what are misinterpretations of real external stimuli?
what are subjective sensory perceptions in the absence of stimuli? |
w/ real stimuli-->illusion
w/o stimuli-->hallucinations |
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what is the mini mental status exam a screening test for?
what does it assess? |
screen for cognitive dysfxn
assess: -orientation -attention -immediate and short term memroy -language/speech -ability to follow simple verbal and written commands |
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how do you test attention?
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*spell W-O-R-L-D backwards
*recite the motnhs forwards and backwards *digit span(recite a series of increasing digits increasing in length) *serial 7's(or 5's) ~start at 100 and count down |
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how do you test memory:
~immediate? ~recent? ~remote? |
immediate-->name 3 objects
recent-->ask pt to recall previous 3 objects after 5 minutes remote memory-->ask pt regarding well known events in past **be sure info is verifiable |
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what does judgement require?
how do you test it? |
judgement requires higher cerebral fxn
test: ~what would you do if you were in a crowded movie theater and a fire started |
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what does abstraction require?
how do you test it? |
abstraction requires higher cerebral fxn that requires comprehension and judment
proverbs are commonly used test: ~ask pt to interpret following sayings *"people who live in glass houses should not throw stones" *"a rolling stone gathers no moss" |
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what can a lesion in the dominant hemisphere on broca's or wernickes area cause?
what can a lesion of the tongue and palate cause? |
of dom cerebral hemisphere-->aphasia
aphasia(difficulty producing or understanding language) |
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what are involuntary eye movements usually triggered by?
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inner ear stimulation
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how is nystagmus named?
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by the direction of the fast phase
*right or lft beating *up or down *directon changing *rotational |
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how is nystagmnus assoc w/ BPPV usually provoked?
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w/ head turned to one side
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what are etiologies of nystagmus
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*congenital
*EOM spasms *MS cerebellar *vestibular dz *drug toxicity |
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what is damaged when intellect, memory or higher brain fxn are impaired?
what is damaged when pt is unconscious |
impared higher brain-->cerebrum
unconsciou-->brain stem |
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if pt has paralysis w/ loss of DTR's, muscle atrophy w/ fasciculation what is damaged
if pt has peripheral nerve or spinal root damage? |
loss of DTR's w/ fasci and atrophy-->LMN
periph nerve or spinal root-->LMN +anesthesia |
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if pt has damage involving while muscle groups, increased or spastic muscle tone, +/- paralysis w/ DTR accentutaion and positive babinski
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UMN damage
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what is 5th most common reason for OP visit?
what is the MOST IMPT CLUE? |
headache
impt clue is a steady bilateral nonthrobbing pain that is worse in the am |
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if headache is in these locations think.....?
*unilateral? *periorbital? *parietal/occipital? *neck |
uni-->migraine
periorbital-->glaucoma, uveitis, cluster parietal/occipital-->tension neck--.meningitis or subarach hem |
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if quality of HA is .... think?
*throbbing *intermittent jabbing *pressure |
throb-->vascular
jabbing-->trigem neuralgia Press-->sinus |
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what are other impt HA clues?
what should you suspect if pain is the only sx? |
is it constant or intermittent
is it worse in am or pm is it the worst HA ever if pain only then suspenct an extracranial etiology |
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what are common assoc sx of HA?
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*visu distubance
*vertigo *N/V *dysesthesia *aura |
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what tests should be performed on PE?
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Cn 2-12
*station and gait, grip, romberg *pain, light toubch, two pt discrim, proprio and stereognosis/vibration *DTR *fundoscopic exam *coordiantion |
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what are some special tests to perform?
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*hoover
*patricks *brudzinski *kernigs *Gainslen sign(sacroliliac) *trendelenburg *babinski *SLR |
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what are causes of loos of smell (CN1)?
what should be avoided when testing? |
*nasal dz
*heat trauma *smoking *use of coke *congenital causes avoid noxious odors when testing |
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what are involuntary eye movements usually triggered by?
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inner ear stimulation
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how is nystagmus named?
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by the direction of the fast phase
*right or lft beating *up or down *directon changing *rotational |
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how is nystagmnus assoc w/ BPPV usually provoked?
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w/ head turned to one side
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what are etiologies of nystagmus
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*congenital
*EOM spasms *MS cerebellar *vestibular dz *drug toxicity |
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what is damaged when intellect, memory or higher brain fxn are impaired?
what is damaged when pt is unconscious |
impared higher brain-->cerebrum
unconsciou-->brain stem |
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if pt has paralysis w/ loss of DTR's, muscle atrophy w/ fasciculation what is damaged
if pt has peripheral nerve or spinal root damage? |
loss of DTR's w/ fasci and atrophy-->LMN
periph nerve or spinal root-->LMN +anesthesia |
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if pt has damage involving while muscle groups, increased or spastic muscle tone, +/- paralysis w/ DTR accentutaion and positive babinski
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UMN damage
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what is 5th most common reason for OP visit?
what is the MOST IMPT CLUE? |
headache
impt clue is a steady bilateral nonthrobbing pain that is worse in the am |
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if headache is in these locations think.....?
*unilateral? *periorbital? *parietal/occipital? *neck |
uni-->migraine
periorbital-->glaucoma, uveitis, cluster parietal/occipital-->tension neck--.meningitis or subarach hem |
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if quality of HA is .... think?
*throbbing *intermittent jabbing *pressure |
throb-->vascular
jabbing-->trigem neuralgia Press-->sinus |
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what are other impt HA clues?
what should you suspect if pain is the only sx? |
is it constant or intermittent
is it worse in am or pm is it the worst HA ever if pain only then suspenct an extracranial etiology |
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what are common assoc sx of HA?
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*visu distubance
*vertigo *N/V *dysesthesia *aura |
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what tests should be performed on PE?
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Cn 2-12
*station and gait, grip, romberg *pain, light toubch, two pt discrim, proprio and stereognosis/vibration *DTR *fundoscopic exam *coordiantion |
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what are some special tests to perform?
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*hoover
*patricks *brudzinski *kernigs *Gainslen sign(sacroliliac) *trendelenburg *babinski *SLR |
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what are causes of loos of smell (CN1)?
what should be avoided when testing? |
*nasal dz
*heat trauma *smoking *use of coke *congenital causes avoid noxious odors when testing |
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what are involuntary eye movements usually triggered by?
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inner ear stimulation
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how is nystagmus named?
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by the direction of the fast phase
*right or lft beating *up or down *directon changing *rotational |
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how is nystagmnus assoc w/ BPPV usually provoked?
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w/ head turned to one side
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what are etiologies of nystagmus
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*congenital
*EOM spasms *MS cerebellar *vestibular dz *drug toxicity |
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what is damaged when intellect, memory or higher brain fxn are impaired?
what is damaged when pt is unconscious |
impared higher brain-->cerebrum
unconsciou-->brain stem |
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if pt has paralysis w/ loss of DTR's, muscle atrophy w/ fasciculation what is damaged
if pt has peripheral nerve or spinal root damage? |
loss of DTR's w/ fasci and atrophy-->LMN
periph nerve or spinal root-->LMN +anesthesia |
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if pt has damage involving while muscle groups, increased or spastic muscle tone, +/- paralysis w/ DTR accentutaion and positive babinski
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UMN damage
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what is 5th most common reason for OP visit?
what is the MOST IMPT CLUE? |
headache
impt clue is a steady bilateral nonthrobbing pain that is worse in the am |
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if headache is in these locations think.....?
*unilateral? *periorbital? *parietal/occipital? *neck |
uni-->migraine
periorbital-->glaucoma, uveitis, cluster parietal/occipital-->tension neck--.meningitis or subarach hem |
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if quality of HA is .... think?
*throbbing *intermittent jabbing *pressure |
throb-->vascular
jabbing-->trigem neuralgia Press-->sinus |
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what are other impt HA clues?
what should you suspect if pain is the only sx? |
is it constant or intermittent
is it worse in am or pm is it the worst HA ever if pain only then suspenct an extracranial etiology |
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what are common assoc sx of HA?
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*visu distubance
*vertigo *N/V *dysesthesia *aura |
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what tests should be performed on PE?
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Cn 2-12
*station and gait, grip, romberg *pain, light toubch, two pt discrim, proprio and stereognosis/vibration *DTR *fundoscopic exam *coordiantion |
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what are some special tests to perform?
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*hoover
*patricks *brudzinski *kernigs *Gainslen sign(sacroliliac) *trendelenburg *babinski *SLR |
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what are causes of loos of smell (CN1)?
what should be avoided when testing? |
*nasal dz
*heat trauma *smoking *use of coke *congenital causes avoid noxious odors when testing |
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if there is optic atrophy what is this a possible disorder of?
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optic atrophy
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a pt complains of blindness in the right eye what is damaged?
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optic nerve on RIGHT side (ipsilateral eye)
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what is the loss of peripheral vision in both eyes called?
what is this usually due to? |
loss pf periph viasion in both eyes is clled bitemporal hemianopia
usually due to dmage to medial spect of optic chiasm often seen w/ pituitary gland tumor |
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pt has right side temporal hemiretina what could have happened
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an aneurysm of internal cartoid on right side
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if there is motor or sensory injury what pupil will reflect the damage(ipsi or contra)
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contralateral side
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what does pupil asymmetry of >1mm suggest?
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CNIII compression
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what does bilateral dilation of pupils indicate?
what does unilateral constriction of pupils indicate? what does bilateral constriction of pupils indicate? |
bilateral
~anoxia ~durg affect 2. UNILATERAL ~sypathetic dysfxn(horner syndrome) ~carotid artery dissection 3. BILATERAL constriction ~pontine hemorrhage ~drugs(opiates, clonidine) ~toxins(Organosphosphates) |
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what is aniscoria?
what is adie's tonic pupil? what is argyll robertson pupil |
aniscoria is >2mm diff in size
adies-->sluggish response of pupil argyll-->irregular/unequal pupils, weak /absent rxn to light(poor dilation), exaggerated contraction to accommodation, neurosyphilis? |
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what is horners syndrome characterized by?
what is horners caused by? |
sx
~ptosis, miosis, facial anhydrosis caused by-->central, preganglionic or postganglionic |
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what is marcus gunn pupil?
what causes it? how do you test for this? |
when pupils fail to constrict fully
results from reduced afferent input in the affected eye test by rapidly stimulate each eye in succession and observe the direct and consensual light response in each ~normal will be full constricion ~abnormal is apparent dilation in both pupils |
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if the eye can not look down when turned inward what nerve is damaged?
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CN IV
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if pt cannot abudct the eye beyond the midline of gaze what nerve is damaged?
what is the inability to direct both eyes to the same direction? ~what is a symptom of this |
can't abduct tyee from idline-->CN VI
inability to direct both eyes-->strabismus ~causes diplopia |
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what does a weak or absent contraction of temporal or masseter muscles indicate?
what may abolish the corneal reflex? what is corneal reflex testing? |
weak or absent temporal and masseter muscles-->trigem nerve palsy
corneal reflex may be abolished w/ contact lenses corneal reflex tests sensory CNV and motor CN VII |
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what do branches of the vagus innervate?
what are possible symptoms reflecting CNX palsy |
vagus innervates:
*pharyns *larynx *esophagues *heart *bronchiloes *stomach *liver *celiac sx indicating lesions on CN may be ~horseness, aphonia dyspnea |
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whatis aphasia?
how do you test? |
disorder of comprehension or use of words or symbolic language
test by *word comprehension *word repetition *object naming *reading compreehsnion *writing |
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pt presents with sentences lacking meaning, impaired word comprehesnion, impaired naming and repetition, impaired reading cmprehesnion and writing and speech is fluent w/ good articulation but lacks meaning
what is this and where is lesion? |
wernickes aphasia
lesion is on posterior superior temporal lobe (think Wernick's is worse-->everything impaired |
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pt presents with fair to good word comprehension, impaired naming but recognizes objects, fair to good reading comprehesion, impaired writing, non fluent, slow impaired speech but meaningful
what type of aphasia and where is lesion |
broca's aphasia lesion is post inferior frontal lobe
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pt presens w/ bilateral weakness of sternocleidomastoid muscle (ex. difficulty raising head off pillow) what is possible nerve palsy?
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CN XI (spianl accessory nerve
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pt presents w/ drooping shoulder or displaced scapula?
what is possibe nerve palsy |
CN XI (accessory
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pt presents w/ dysarthria, atrophy and fasciculations, what is nerve palsy?
a unilateral cortical lesion of CN Xii will cause the tongue to deviate which way? |
CN Xii palsy
tongue will deviate toward affected side |
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what is apraxia?
what is dyspraxia how do you test dyspraxia? |
apraxia-->inability to perform voluntary
dyspraxia-->difficulty performing an activity to test dyspraxia ask pt to pour water froma pitcher into a glass and drink the water. pt w/ dyspraxia will either drink water from pitcher or try to drink from empty glass |
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if there is a muscle abnormaliy what are we trying to identify?
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muscle(s) involved, if Central or periph
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what are indications of motor problems?
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*atrophy
*muscle tone *cerebella dz *gait |
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what are causes of muscle atrophy?
what are causes of decreased muscle tone? |
I. atrophy
~motor neuron dz ~disuse of muscles ~rheum arthritis ~PRO-calorie malnutrition 2. Decreased muscle tone? ~disz of PNS ~cerebellum dysfxn ~acute spinal cord injury |
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how do you test for cerebellar dz?
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check corrdiantion by pt to pt movments(will be clumsy, unsteady, inapprpriately varying in speed, forece and direction)
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what are indications of posterior column dz?
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decreased vibration sense
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what are symtpms indicating possible lesion of sensory cortex?
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astereognosis
*inability to recognize numbers *decreased 2 pt discrimination *decreased pt localization *extinction |
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what do hyperactive reflexes suggest?
what do diminished or absent reflexes suggest? |
hyperactive-->CNS dz
~sustained clonus confirms Dimishes or absent *damage to spinal segments *damage tp periph nerves *dz ofmuscles *dz of neuromsuc jxn |
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what are sensory specific tests?
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*temp
*vibration *proprioception *tactile localization *discrminative sensations |
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what is jendrassik's maneuver?
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reinforcemtn technique when testing DTR's
ask pt to clench teeth, squeeze thigh for upper extremities ask pt to lock fingers and pull one against the otehr when testing lower extremities |
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what does a loss of the anal reflex suggest?
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lesion of s2-s4 reflex arc or possible lesion of cauda equina
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what does cerebellar fxn require integration of?
how is cerebellar fxn assessed? |
require integration of:
*motor system *cerebellar system *vstibular system *sensory system assess w/ *rapid alternating movemets *finger to nose *heel to knee test *rombers test *gait |
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how do you differentiate a cerebellar lesion from a basal ganglia?
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cerebellar lesion has awkwarness of intended movments, intention tremor and ataxia
basal ganglia lesion causes involuntary mv w/ resting tremor, chorea, athetosis, and hemiballismus |
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when is lumbar punctur C/I
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if cerebral mass/lesion is suspected b/c will increase pressure
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what are indications of CT?
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*focal neurologic deficit
*altered mental status *head trauma *new onset seizure *increased iCP *suspected mass lesion *suspected subarachnoid hem *w/ absecess intracranial tumor *w/ contrast, chronic subdural hemtoma, infarct, vascular malformation |
