N202 Neuro

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gymnastlrl
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N202 Neuro
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2010-12-01 18:25:19
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N202 Neuro
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Neurologic System
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  1. What makes up the CNS?
    brain and spinal cord
  2. What makes up PNS?
    cranial nerves and spinal nerves
  3. How many pairs of cranial nerves are there? Spinal nerves?
    • 12 cranial
    • 31 pairs
  4. Name the meningeal layers and spaces from superficial to deep.
    • (skull)
    • epidural space
    • dura
    • subdural space
    • arachnoid
    • subarachnoid space
    • pia mater

    *pia = faithful (like pious). This layer faithfully follows all the contours of the brain b/c it's the closest to it.
  5. Where do the high functions of the brain take place?
    examples of high functions?
    cerebral cortex

    high fx: thought, memory, reasoning, sensation, voluntary mvmts
  6. name the 4 lobes of each brain hemisphere
    • frontal
    • parietal
    • occipital
    • temporal
  7. which lobe is responsible for personality, behaviors, emotions, and intellect
    frontal
  8. where is the motor cortex? what does it do?
    frontal lobe, precentral gyrus.

    responsible for voluntary skeletal muscle mvmt and fine repetitive mvmt
  9. where is broca's area? which type of aphasia results if it is damaged?
    frontal lobe of dominant hemi. results in expressive aphasia - can't articulate words (talk), but can write
  10. where is the sensory cortex?
    parietal lobe, postcentral gyrus
  11. which lobe is responsible for vision?
    occipital
  12. what does the temporal lobe control?
    • interpretation of sound
    • balance
    • integration of taste and smell
  13. where is wernicke's area? which type of aphasia results if damaged?
    temporal lobe

    receptive aphasia - can understand sounds, but can read
  14. increased muscle tone (rigidity), ataxia, and bradykinesia result form damage to what part of the NS?
    basal ganglia (the gray matter lying deep in brain)
  15. what disease effects basal ganglia?
    parkinson's
  16. the thalamus and hypothalamus make up which brain structure?
    diencephalon
  17. what does the hypothalamus regulate?
    • temperature
    • sleep
    • anterior and posterior pituitary
    • coordination of ANS activity
    • emotional status
  18. name the 3 components of the brain stem
    • midbrain
    • pons
    • medulla
  19. what is pyramidal decussation? where does it occur?
    crossing of motor fibers from one side of the body to other.

    occurs in medulla
  20. from where do most cranial nerves originate?
    brain stem
  21. from where does CN1 originate?
    brain
  22. from where does CN2 originate?
    diencephalon
  23. which cranial nerves originate in the midbrain?
    CN3-4
  24. which cranial nerves originate in the pons?
    CN5-8
  25. which cranial nerves originate in the medulla?
    CN9-12
  26. where is the autonomic center? what does it control?
    medulla. controls respiration, heart, GI fx
  27. which part of the brain coordinates mvmts and maintains equilibrium, posture, and muscle tone?
    cerebellum
  28. damage to which part of the brain would result in problems with gait and decreased muscle tone?
    cerebellum
  29. cerebral artery blockage will cause permanent brain damage if not treated with thrombolytics within how much time?
    4 hrs
  30. trace sensation from stimulus to brain
    afferent fibers in peripheral nerves --> enters spinal cord thru dorsal/posterior root --> up spinal cord to brain stem --> pyramidal decussation and travels to thalamus --> sensory cortex
  31. spinothalamic track conducts sensation of:
    • pain
    • crude/light touch
    • temp
    • deep pressure
  32. posterior columns conduct sensation of what?
    • position
    • vibration
    • deep pressure
    • fine touch
  33. give 3 examples of fine touch
    • stereognosis
    • graphesthesia
    • 2-point discrimination
  34. which motor tract relays voluntary mvmt?
    corticospinal / pyramidal
  35. trace motor impulse from brain to LMN
    motor cortex --> brain stem --> pyramidal decussation (cross to other side of brain stem) --> down spinal cord until synapses with LMN contained in the spinal cord
  36. which motor tract is controlled by basal ganglia?
    extrapyramidal
  37. trace path of motor impulse from brain to spinal cord
    motor cortex --> basal ganglia --> brain stem --> spinal cord

    NO DECUSSATION
  38. which part of the NS controls DTRs?
    spinal cord
  39. name anatomical landmarks for beginning and end of spinal cord
    • begins at foramen magnum of skull
    • ends at L1-2 of vertebral column
  40. name the 2 functional parts of the cranial and spinal nerves
    • somatic fibers - innervated skeletal/voluntary mm
    • autonomic fibers - innervate involuntary mm and glands
  41. name the 12 cranial nerves
    handy pneumonic, courtesy of Chelsea: Oh, Oh, Oh, to take a family vacation, go Vegas after hours.

    • Olfactory
    • Optic
    • Oculomotor
    • Trochlear
    • Trigeminal
    • Abducens
    • Facial
    • Vestibular/Acoustic
    • Glossopharyngeal
    • Vagas
    • Accessory (spinal accessory)
    • Hypoglossal
  42. Name how many of each spinal nerve pairs exit at each vertebral level. Ex: cervical, thoracic, etc.
    • Cervical - 8
    • Thoracic - 12
    • Lumbar - 5
    • Sacral - 5
    • Coccygeal -1
  43. motor fibers exit the spinal cord thru where? sensory fibers enter thru where?
    • motor exit: ventral
    • senSORy enter: dORSal
  44. what's a dermatome?
    a circumscribed area supplied by mainly one spinal cord segment
  45. give 2 exmaples of LMN diseases
    • myesthenia gravis
    • Guillian-Barre
  46. give 2 examples from notes of UMN disease
    CVA, multiple sclerosis
  47. paresis vs. paralysis
    • paresis is slight paralysis/weakness
    • paralysis is complete loss of motor fx

    both are motor sx
  48. define dysphagia
    difficulty swallowing
  49. define dysphasia
    difficulty speaking
  50. PMH pertinent to neuro exam
    • CVA
    • SCI (spinal cord injury)
    • meningitis
    • congenital defect
    • ETOHism
  51. what score is used to measure birth trauma in children?
    APGAR score
  52. define micturition syncope
    when male faints while urinating d/t decreased cerebral blood flow
  53. what is the exam sequence for the objective portion of a neuro exam?
    • mental status
    • cranial nerves
    • motor/cerebellar fx
    • sensory system
    • reflexes
  54. define anosmia. which CN is involved?
    loss of sense of smell. involves CN1 - olfactory
  55. name 3 tests used to test CN2
    CN2: optic

    • Snellen - tests visual acuity
    • confrontation - tests visual fields
    • fundoscopic exam
  56. which 2 CNs are involved in PERRLA? which is afferent? efferent?
    • CN2: optic - afferent
    • CN3: oculomotor - efferent
  57. which CN is responsible for ptosis? what would you observe in a pt with ptosis?
    • CN3: oculomotor
    • ptosis = unequal palpebral fissures
  58. what eye mvmts do CN3, 4, and 6 control? how do you assess them?
    • 3 (oculomotor): most eye mvmts
    • 4 (trochlear): down and inward eye mvmts, controls superior oblique muscle
    • 6 (abducens): lateral eye mvmt

    assess with EOMs, look for nystagmus
  59. which CN is responsible for sweet and salt taste on the anterior 2/3 of the tongue?
    facial / 7
  60. which CN is responsible for innervating the muscles involved in chewing? which muscles are they?
    CN 5 / trigeminal

    mm: temporal, masseter
  61. where are the 3 zones of sensation that the trigeminal nerve is responsible for? how do we test them?
    • ophthalmic
    • maxillary
    • mandibular

    test with light touch (cotton wisp) to forehead, cheeks, and chin
  62. which CN is responsible for facial mvmts and expression
    facial / 7
  63. which CNs are responsible for the blink reflex? what is another name for this reflex?
    • 5 (sensory)
    • 7 (motor)

    blink reflex aka corneal reflex
  64. how do we test CN8
    • whisper test
    • Weber
    • Rinne
    • Romberg
  65. which CN is responsible for sour and bitter taste on the posterior 1/3 of tongue?
    CN9 / glossopharyngeal
  66. which CN is responsible for shoulder strength?
    CN 11 / spinal accessory
  67. how do we assess CN 9 and 10 fx?
    • say "ahhh," look for soft palate rise
    • gag reflex
  68. which CNs are responsible for talking and swallowing?
    CN9 and 10 / glossopharyngeal and vagus
  69. how do we assess CN12?
    assess tongue posn, looking for deviation towards paralyzed side

    test tongue strength against cheek resistance
  70. what does Romberg's test assess? how do you do it?
    assesses balance, CN8 fx

    stand with feet together, eyes closed for 20sec. positive test if pt takes a step.
  71. name 4 tests to assess upper extremity coordination
    • RAMs
    • thumb to each finger
    • finger-to-finger (pt's to examiner's)
    • finger-to-nose with eyes closed
  72. how do you assess muscle tone?
    check resistant to passive muscle stretching (e.g., flex and extend arm)
  73. name 2 ways to assess lower extremity coordination
    • tap feet on floor repeatedly
    • heel-to-shin test
  74. what's the best way to test for peripheral neuropathy? for which population is this especially important?
    use monofilament (10gm)

    muy importante for diabetics
  75. when assessing pain sensation of the spinothalamic tract, why wait 2 sec b/w each check?
    <2 sec will lead to summation of stimuli that will be perceived as one
  76. define analgesia
    no pain perception
  77. how do you assess the deep pressure sensation of the spinothalamic tract?
    squeeze trap, calf, or biceps
  78. which type of sensation is usually lost first with peripheral neuropathy? how do we test for it?
    vibration

    test with tuning fork at DIP of fingers and big toes
  79. what is kinesthesia? how do you assess for it?
    positional awareness

    move finger or toe up or down and ask pt to ID position
  80. what is astereognosis?
    the inability to recognize objects by feel
  81. what is graphesthesia?
    the ability to read a letter or number traced on the skin
  82. where on the body is 2-point discrimination most sensitive?
    fingers
  83. simultaneously touching both sides of the body in the same location tests for what?
    sensory extinction. if only felt unilaterally, extinction has occurred.
  84. name the 5 examples of fine touch sensation
    • sterognosis
    • graphesthesia
    • 2-point discrimination
    • extinction
    • point location
  85. trace the DTR pathway
    begins at sensory / afferent nerve --> synapses at spinal cord --> motor / efferent nerve --> neuromuscular junction (consists of nerve dendrite and muscle spindles --> ends with functioning muscle response
  86. what does the neuromuscular junction consist of?
    nerve dendrites and muscle spindles
  87. what do DTRs reveal about the spinal cord?
    its intactness at specific levels
  88. describe reflex grading scale
    • 4+ hyperactive
    • 3+ above avg
    • 2+ normal
    • 1+ low normal
    • 0 absent
  89. with CVAs, you expect to see what kind of reflexes (hyper/hypo/normal)? why?
    hyperreflexia - seen with UMN lesions.

    normally reflexes or modulated by high cortical inhibition in the brain, but when brain is damaged, this inhibition is lost and reflex is hyperactive
  90. with SCIs, you expect to see what kind of reflexes (hyper/hypo/normal)?
    hyporeflexia
  91. incomplete quadriplegia is seen with spinal cord injuries below what level?
    incomplete below C6, complete above C6
  92. which spinal nerves are involved in the brachioradialis DTR?
    C5-6
  93. which spinal nerves are involved in the biceps DTR?
    C5-6
  94. which spinal nerves are involved in the triceps DTR?
    C6-8
  95. which spinal nerves are involved in the quadriceps / patellar DTR?
    L2-4
  96. which spinal nerves are involved in the achilles DTR?
    S1-2 (according to notes, book includes L5)
  97. name the 4 superficial reflexes listed in the notes
    • upper abd
    • lower abd
    • cremasteric
    • plantar reflex / babinski
  98. which spinal nerves are involved in the upper abd reflex?
    T7-9
  99. which spinal nerves are involved in the lower abd reflex?
    T10-11
  100. which spinal nerves are involved in the cremasteric reflex?
    T12-L2
  101. how do you assess the cremasteric reflex?
    stroke inner thigh of male, testicle and scrotum should rise
  102. which spinal nerves are involved in the plantar reflex? what's another name for this reflex?
    babinski

    L4-S2
  103. for what population is a positive babinski abnormal? what would you see with a positive test?
    abnormal in adults. normal in kids <2 y/o.

    dorsiflexion of big toe and fanning of other toes when stroking lateral aspect of sole of foot
  104. which 3 factors does the glasgow coma scale use to assess LOC?
    • eye opening
    • verbal response
    • motor response
  105. what's the name for a herniation of the brainstem? what would happen if this caused pressue on CN3
    uncal herniation

    pressure on CN3 - would see unilateral, dilated, and nonreactive pupil
  106. VS changes are an early or late sign of ^ ICP? what changes would you see?
    late

    • increased SBP with widening pulse pressure (pulse pressure = SBP - DBP)
    • decreased HR
  107. what is nuchal rigidity? what is it a sign of?
    extremely stiff neck.

    sign of meningeal irritation
  108. what is prolonged arching of the back with head and knees bent backward called?
    opisthotonos
  109. what is decorticate position? damage to which part of the NS would cause this?
    flexor posturing, with arms brought to core of the body, look like a mummy

    damage to cerebral cortex

    CORtex --> arms to CORE of body
  110. what is decerebrate position? damage to what part of the NS would cause it?
    extensor posturing, with extended arms and LEs

    damage to brain stem
  111. what is dyskinesia? for what population is it common?
    repetitive mvmt in jaw, lips, or tongue.

    seen in older adults

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