Bates ch17.txt

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Bates ch17.txt
2011-08-03 13:06:29
chapter bates

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  1. 4 regions of the brain
    • cerebrum
    • diencephalon
    • BS
    • cerebellum
  2. Aggregations of neuronal cell bodies
  3. Neuronal axons coated w/meylin
  4. Allows nerve impulses to travel more rapidly
    myelin sheaths
  5. What structures are located in the diencephalon
    • thalamus
    • hypothalamus
  6. processes sensory impulses & relays to cerebral cortex
  7. maintains homeostasis & regulates temp, HR, BP
  8. affects endocrine system & governs emotional behaviors
  9. hormones secreted in hypoth act on what
    pituitary gland
  10. coordinates all movement & helps maintain body upright in space
  11. spinal cord extends from what to what
    BS to L1-L2
  12. motor & sensory pathways enter/exit spinal cord via what
    • anterior=motor
    • posterior=sensory
    • spinal & peripheral nerves
  13. Spinal cord is divided into 5 segments name them
    • C1-C8
    • T1-T12
    • L1-L5
    • S1-S5
    • coccygeal
  14. which CN's arise from the diencephalon & brainstem
  15. How many pairs of peripheral nerves are there
    • 31
    • 8-C
    • 12-T
    • 5-L
    • 1-coccygeal
  16. anterior or ventral root contains what type of fibers
  17. posterior or dorsal root contains what type of fibers
  18. these nerve cell bodies lie in the motor strip of cerebral cortex & in BS nuclei; with axons synapsing w/motor nuclei
    upper motor neurons
  19. These have cell bodies in spinal cord termed ant horn cells in which their axons transmit impulses through the ant roots & spinal nerves into peripheral nerves that terminate at the NMJ
    lower motor neurons
  20. this tract mediates vol movement & integrates skilled, complicated, delicate movements by stimulating selected muscular actions while inhibiting others
    corticospinal tract (pyramidal)
  21. which tract inhibits muscle tone
  22. where does the corticospinal tract orginate
    motor cortex
  23. where does the corticospinal tract fibers cross & explain their route
    lower medulla & continue down & synapse w/ant horn cells or intermediate neurons
  24. Tracts synapsing in BS w/motor nuclei of CN's are termed
  25. which system helps to maintain musc tone & control body movements such as gross automatic movements such as walking
    basal ganglia sys
  26. which system receives both sensory & motor input & coordinates motor activity; maintains EQ & helps to control posture
    cerebellar sys
  27. what kind of motor pathways impinge on the ant horn cells
    • CST
    • BGS
    • CS
  28. what happens when UMN systems are damaged above the crossover of its tracts in the medulla
    you will have motor impairment to the contralateral side
  29. what happens when UMN systems are damaged below the crossover of its tracts in the medulla
    you will have motor impairment to the ipsilater side
  30. this type of lesion produces increased musc tone & deep tendon reflexes are exaggerated
    UMN lesions
  31. does disease to the BGS or CS produce paralysis
    no but can be disabling
  32. Damage to this sys will produce an increase in musc tone, disturbances in posture & gait or bradykinesia
  33. What is a slowness or lack of spontaneous & automatice movements termed
  34. damage to this area impairs coordination, gait, EQ & decreases musc tone
  35. what do sensory impulses participate in
    • reflex
    • conscious sensation
    • calibrate body pos in space
    • regulate internal autonomic fx:BP HR Resp
  36. how do the sensory fibers that register sensations such as temp, position, touch pass through what
    peripheral nerves & post roots where they enter the SC. Once there the sensory impulse reaches either the spinothalamic tracts or post columns
  37. where do the fibers conducting pain & temp sensations pass into
    post horn of SC & synapse w/2nd sens neurons
  38. where do the fibers conducting crude touch pass through
    post horn & synapse w/ 2nd neurons
  39. where do the fibers that elicit pain, temp, crude touch cross into after synapsing w/2nd neurons
    cross over into & upward to the spinothalamic tract into the thalamus
  40. these fibers that conduct sensations pass directly into post columns of the cord & travel upward to medulla together w/fibers transmitting fine touch & synapse in the medulla w/2nd sens neurons
    position & vibration
  41. at what level is the general quality of sensation is perceived as pain, pleasant, unpleasant or cold
    thalamic level
  42. where are full perceptions of sens impulses from the thalamus conducted to
    sens cortex where higher order discriminations are made
  43. A lesion in sensory cortex may not impair perception pain, touch, position but may impair what
    finer discrimination
  44. Band of skin innervated by the sensory root of a single spinal nerve
  45. involuntary stereotypical response that may involve 2 neurons across a single synapse
  46. the deep tendon reflex in the arms & legs in what type of reflex
    monosynaptic that illustrates the simplest unit of sens & mot fx
  47. when are reflexes termed polysynaptic
    when they involve interneurons btwn sens & mot neurons
  48. what must be intact for the reflex to fire
    • sens nerve fib
    • SP synapse
    • MN fib
    • NMJ
    • musc fib
  49. when does the musc suddenly contract in a reflex arc
    when impulse crosses the NMJ
  50. what are the deep tendon reflexes
    • Biceps-c5 & c6
    • tri-c6 & c7
    • Brachiorad-c5 & c6
    • knee-l2,l3,l4
    • ankle=s1
  51. what are the cutaneous stimulation reflexes
    • plantar resp=L5 & S1
    • anal reflex=S2,S3,S4
    • Abdominal=upper=T8,9,10
    • Lower=T10,11,12
  52. what are the common or concerning symptoms of the NS
    • headache
    • dizzy or vertigo
    • general, proximal, distal weakness
    • numbness
    • abnormal or loss of sensations
    • loss of consciousness, syncope, near syncope
    • seizures
    • tremors or inv movements
  53. what are the 2 most common symp in neurologic disorders
    • headache
    • dizziness
  54. worst headache of life may indicate
    sub A hem
  55. difficulty forming words
  56. difficulty with gait or balance
  57. peculiar sensations w/out obvious stimulus
    paresthesias=arm goes to sleep
  58. distorted sensations in response to stimulus & may last longer than stimulus itself
  59. vertebrobasilar TIA can result in what
    • diplopia
    • dysarthria
    • ataxia
    • weak or paralysis
  60. Focal weakness may arise from what type of lesions in the CNS
    • ischemic
    • vascular
    • mass lesions
  61. Bilateral predominantly distal weakness in what
  62. What is it when weakness is made worse w/repeated effort & improved w/rest suggests
    myastenia gravis
  63. burning pain in painful sensory what
  64. Sudden but temp loss of consciousness & postural tone that occurs w/decreased blood flow to the brain refered to as fainting
  65. A paroxysmal disorder caused by sudden excessive electrical discharge in the cerebral cortex
  66. What are some areas of health promotion & counseling in regards to the NS
    • preventing stroke or TIA
    • reducing risk of peripheralneurophathy
    • detecting 3 D's=delirium; dementia & depression
  67. A sudden neurological deficit caused by CVI or hemorrhage
  68. This type of stroke may be intracerebral or subarachnoid
  69. this type of stroke is a sudden focal neurologic deficit defined as lasting less than 24hrs but typically less than an hour
  70. After a TIA when is the risk of a stroke the highest
    first 30 days after TIA
  71. What is the most common cause of an ischemic symptoms & signs
    occlusions of MCA which can cause visual field cuts & contralateral hemiparesis & sensory deficits
  72. In the left hemisphere occlusion of MCA will produce what
  73. In the Right hemisphere occlusion of MCA will produce what
    • neglect
    • inattention
    • to opposite side
  74. what are some warning sign of a stroke
    sudden numbness, confusion, trouble speaking & walking & severe headache
  75. Risk factors for stroke
    • hypertension
    • smoking
    • hyperlipidemia
    • diabetes
    • heavy alcohol use
  76. what is key for preventing a hemorrhagic stroke from a intracerebral hemorrhage
    controlling hypertension
  77. What is the most common cause of peripheral neuropathy
  78. Diabetes causes several types of neuropathy including
    • distal symmetric sensorimotor polyneurophathy
    • autonomic dysfunction
  79. What is the most common of the diabetic neuropathies
    autonomic dysfunction leading to ED, orthostatic hypotension, gastroparesis
  80. what causes patchy sensory & motor deficits in at least 2 separate nerve areas
    neuritis multiplex
  81. What causes thigh pain & proximal lower extremity weakness that is initially unilateral
    diabetic amyotrophy
  82. how to test CN I
    occlude each nostril & test different smells
  83. how to test CN II
    • Visual acuity
    • inspect fundi
    • Vis fileds by Confr
  84. how to test cn II,III
    • inspect pupil size & shape
    • Light & near response
  85. hot to test cn III, IV, VI
    • EOM's in 6 cardinal directions
    • lid elevation & convergence
  86. how to test cn V
    • palpate temporal, masseter musc
    • clench teeth
    • forehead, cheek, jaw=sharp,dull sensation
    • may need to test corn reflex
  87. how to test cn vii
    • face=asymmetry
    • tics & abnormal movements
    • rais eyebrows
    • frown
    • close eyes tightly
    • show upper teeth
    • smile
    • puff cheeks
  88. hot to test cn viii
    • hearing=lateralization
    • AC vs BC
  89. how to test ix & x
    • voice is hoarse
    • swallowing
    • inspect movement of palate=ah
    • Gag reflex if needed (warn patient)
  90. how to test xi
    • patient shrug shoulders=resistance
    • contraction of SCM against resistance
  91. how to test xii
    • protrude tonge & move it side to side
    • assess for symmetry & atrophy
  92. you could see disc pallor in what
    optic atrophy
  93. you could see disc bulging in what
  94. Difference in pupil size or shape
  95. involuntary jerking movement of eyes w/quick & slow components
  96. What should you look for when examining the motor system initially
    • position
    • movement=tremors, tics, fasciculations
    • muscle bulk
    • tone
    • presence of atrophy
  97. what nerves are possibly involved when there is localized atrophy of the thenar & hypothenar eminences
    • median damage
    • ulnar damage
  98. Fasciculations w/atrophy & musc weakness suggest disease of what motor unit
  99. marked floppiness indicates what
    musc hypotonia or flaccidity
  100. Increased resistance that worsens at the extremes of range
    spasticity & is often seen in corticospinal tract disease
  101. Increased resistant throughout ROM & in both directions that is not rate-dependent
  102. Impaired strength is called weakeness or what
  103. Absence of strength is called what
    paralysis or plegia
  104. Weakness of 1/2 of the body
  105. paralysis of 1/2 of the body
  106. paralysis of legs
  107. paralysis of all four limbs
  108. inability to form the OK sign normally with the thumb & index finger pinched together; weakened pronation
    Ant interosseous
  109. Thenar eminience wasting;sensory loss to thumb,index finger, mid finger;benediction hand
  110. inability to extend the wrist(wristdrop) w/out sensory loss to the dorsum of hand
    post interosseous
  111. Wristdrop w/sensory loss to dorsum of the hand
  112. Clawhand; motor deficits of intrinsic musc of hand; first dorsal interosseous wasting; hypothenar eminence wasting
  113. how is muscle strenght graded
    0 to 5 scale
  114. what does 0 represent on the musc str scale
    no musc contr detected
  115. what does 1 represent on the musc str scale
    barely detectable flicker or trace of contr
  116. what does 2 represent on the musc str scale
    active movement of the body part w/gravity eliminated
  117. what does 3 represent on the musc str scale
    active movement against gravity
  118. what does 4 represent on the musc str scale
    active movement against gravity & some resistance
  119. what does 5 represent on the musc str scale
    active movement against full resistance w/out evident fatigue; this is normal musc str
  120. what does weakness of extension in the wrist possibly caused by
    • radial nerve damage
    • CNS damage=hemiplegia (stroke or MS)
  121. nerve root & nerve for bi flexion
    c5 & c6 musculocutaneous n
  122. nerve root & nerve for tri ext
    c6 & c7 radial n
  123. nerve root & nerve for wrist ext
    c6 & c7 radial n
  124. nerve root & nerve for hand grip
    C7,8 T1 via median n
  125. nerve root & nerve for finger abd
    C8 & T1 ulnar n
  126. nerve root & nerve for thumb opposition
    C8 & T1 median n
  127. nerve root & nerve for hip flexion
    l2,3,4 femoral n
  128. nerve root & nerve for hip ext
    L4,5,S1,2 gluteal n
  129. nerve root for hip abd
  130. nerve root for hip add
  131. nerve root for kn flexion
    L4,5,S1, S2
  132. nerve root for kn ext
  133. A weak grip in cervical radiculopathy could be a sign of what
    • de quervain's tensosynovitis
    • CTS
    • arthritis
    • EPI Condylitis
  134. WEak finger abduction could be a disorder of what nerve
  135. Weak opposition of the thumb in what disorders affects what nerve
  136. symmetric weakness of the proximal musc suggest what
  137. symmetric weakness of distal musc suggest what
    polyneuropathy or peripheral nerve disorder
  138. Testing for coordination test what important function
  139. how should you test for coordination
    • rapid alternating movements
    • point to point movements
    • heel down shin
  140. unable to perform one movement quickly after the other in cerebellar disease is termed what
  141. Besides cerebellar disease what also can contribute to an impairment of rapid alternating movements
    UMN weakness & BG disease
  142. A gait that lacks coordination with reeling & instability is termed
  143. how to do you want to assess gait
    • walk across room
    • heel to toe
    • on toes then on heels
    • hop in place
  144. when we test rapid alternating movements what part of the brain are we assessing
    cerebellum function
  145. when we test a patients ability to walk on toes & heals what part of the brain are we assessing
    corticospinal tract
  146. Coordination of muscle movement requires that four areas of the nervous system function in an integrated way. Coordinating eye, head, and body movements applies to which area of the nervous system?
    Vestibular system
  147. Difficulty w/hoping may be caused by what type of dysfunction
  148. Which test is it when the patient stands w/feet together & eyes opn then closes eyes for 30-60 sec w/out support
    romberg test
  149. A positive romberg test could be caused by what
    cerebellar ataxia
  150. Patient stands for 20�30 seconds with both arms straight forward, palms up, and eyes closed; tap arms briskly downward
    pronator drift
  151. Pronation and downward drift of the arm is a positive test for what
    pronator drift & caused by lesion in the corticospinal tract of the contralat hemisphere
  152. what are the general principles for examining the sensory system
    • compare both sides
    • think dermatomes
    • testing pain, temp, touch=compare distal & proximal
    • map out boundaries
  153. how should you test pain
    use a disposable object such as a broken cotton swab or paper clip
  154. how should you test light touch
    cotton wisp
  155. how should you test vibration
    with a 128-Hz tuning fork on hand, DIP joint then big toe; compare both sides
  156. how should you test proprioception
    hold the big toe by its sides between your thumb and index finger, pull it away from the other toes, and move it up then down. Ask the patient to identify the direction of movement
  157. place a key or familiar object in the patient�s hand and ask the patient to identify it (coin or other easy ID object)
  158. outline a large number in the patient�s palm and ask the patient to identify the number (1 or 8)
  159. using two ends of an opened paper clip, or two pins, touch the finger pad in two places simultaneously; ask the patient to identify 1 touch or 2 (5mm is the standard)
    2pt discrimination
  160. lightly touch a point on the patient�s skin and ask the patient to point to that spot
    point localization
  161. touch an area on both sides of the body at the same time and ask if the patient feels 1 spot or 2
  162. Inability to recognize numbers may suggest a lesion where
    sensory cortex
  163. what increases the distance btwn 2 recognizable pts
    lesions of sens cortex
  164. what are the gen principles for the examining of deep tendon reflexes
    • proper wt hammer
    • patient to relax
    • hold hammer loosley
    • strike tendon very brisk
    • reinforcement
    • grade=absent-brisk
  165. What does 4+ describe on the reflex scale
    clonus=very brisk hyperactive rhythmic oscillations btwn flex/ext
  166. what does 3+ describe on the reflex scale
    brisker than avg possibly but not necessarily of disease
  167. what does 2+ describe on the reflex scale
  168. what does 1+ describe on the reflex scale
    somewhat diminished;low normal
  169. what does 0 describe on the reflex scale
    no response
  170. hyperactive reflexes in the CNS lesions along desc corticospinal tract
  171. hypoactive or absent reflexes in diseases of spinal nerve roots spinal nerves or peripheral nerves
  172. which reflex is hypothyroidism often easily seen & felt
  173. Sustained clonus indicates what type of disease
    CNS disease
  174. Bi reflex spinal root
  175. tri reflex sp root
  176. supinator or brachioradialis reflex sp root
  177. kn reflex sp root
  178. ankle reflex sp root
  179. a hyperactive response required for assigning a reflex grade of 4, usually elicited at the ankle
  180. what is considered the deep tendon reflexes
    • bi
    • tri
    • brachiorad
    • knee
    • ankle
  181. what is considered the cutaneous stim reflexes
    • abdominal
    • plant resp
    • anal reflex
  182. Abd reflex sp root
    • t8-10
    • low=t10-12
  183. pl resp sp root
    • l5
    • s1
  184. anal reflex
  185. sudden brief nonrhythmic flex of hands & fingers indicates what
    asterixis seen often in liver disease, uremia & hypercapnia
  186. including the ABC�s (airway, breathing, circulation), level of consciousness (see table on next slide), pupillary response, ocular movements, and posture and muscle tone
    assessment of stuporous or comatose patient
  187. Dorsiflexion of big toe in plantar response signals what
    Babinski response indicating CNS lesion of corticospinal tract
  188. A marked babinski response is occasionally accompanied by what reflex response
    flex of hip & knee
  189. loss of anal reflex suggests a lesion in s2,3,4 reflex arc indicating what
    cauda equina lesion
  190. flexion of the hips & knees is a positive brudzinski's sign indicating what
    possible menigeal inflammation
  191. pain & increased resistance to extending the knee are positive kernig's sign that when bilateral could suggest what
    menigeal irritation
  192. what are the level of consciouseness arousal techniques & patient response
  193. Speak to the patient in a normal tone of voice. An alert patient opens the eyes, looks at you, and responds fully and appropriately to stimuli (arousal intact).
  194. Speak to the patient in a loud voice. For example, call the patient�s name or ask, �How are you?�
  195. Shake the patient gently, as if awakening a sleeper
  196. Apply a painful stimulus. For example, pinch a tendon, rub the sternum, or roll a pencil across a nail bed. (No stronger stimuli are needed.)
  197. apply repeated painful stimuli
  198. A lethargic patient appears drowsy but opens the eyes and looks at you, responds to questions, and then falls asleep.
    abnormal response to lethargy
  199. An obtunded patient opens the eyes and looks at you, but responds slowly and is somewhat confused. Alertness and interest in the environment are decreased.
    abnormal resp to obtundation
  200. A stuporous patient arouses from sleep only after painful stimuli. Verbal responses are slow or even absent. The patient lapses into an unresponsive state when the stimulus ceases. There is minimal awareness of self or the environment.
    abnormal resp to stupor
  201. A comatose patient remains unarousable with eyes closed. There is no evident response to inner need or external stimuli.
    abnormal resp to coma