Bates' Guide to Physical Examination and History Taking: Neurologic Flashcards

four lobes of the cerebral cortex

controls personality, emotion, behavior, intellect

controls sensation

controls vision

controls auditory

area of temporal associated with auditory, reception

caused by damage to Wernicke's area

area of frontal lobe mediates speech

caused by damage to Broca's area

three parts of the forebrain cerebral cortex

primitive motor areas, automatic associated with movement

relay station

temp control and sleep center

primary motor area

primary sensory area

motor coordination equilibrium and balance; located under occipital lobe

sensation

the central core; midbrain pons and medulla

long and cylindrical; main highway for ascending and descending fiber tracts; connects brain to spinal nerves; mediates reflexes

consists of nerve cell bodies and interneurons

consisting of myelinated axons passing to and from the brain or different segments of the spinal cord

arranged in an H shape with anterior and posterior horns

major sensory pathways

controls pain and temperature

controls crude or light touch

position proprioception, vibration, and tactile discrimination

major motor pathways

conscious voluntary movement- skilled purposeful discrete; cross to other side; higher level - body map

older unconscious/lower level; reflexive/responsive, gross automatic movements; muscle tone, balance, posture

coordinates movement, equilibrium, and posture

carry input to CNS via sensory afferent fibers and deliver output from CNS via motor efferent fibers

enter and exit brain; 12 pairs; supply head and neck except for vagus

the 3 sensory nerves

the four motor nerves

nerve that is mostly motor

the four nerves that are both motor and sensory

amount of spinal nerves

amount of cervical spinal nerves

amount of thoracic nerves

amount of lumbar nerves

amount of sacral nerves

amount of coccygeal nerves

dorsal root mixed nerves

ventral root mixed nerves

nerves of the spine that exit as dermal segmentation; areas of the skin that connect to certain spinal nerves

C6 dermatome

T4 dermatome

T10 dermatome

L5 dermatome

S1 dermatome

S2-S4 dermatome

amount of cervical vertebrae

amount of cervical nerves

amount of thoracic vertebrae

amount of thoracic nerves

amount of lumbar vertebrae

amount of lumbar nerves

amount of sacral vertebrae

amount of sacral nerves

amount of coccygeal vertebrae

amount of coccygeal nerves

2 subdivisions of autonomic nervous system

controls fight and flight

controls everyday maintenance and pleasure

mediates unconscious activity; innervate smooth muscle-cardiac, involuntary and glands; made up of sympathetic and parasympathetic

defense mechanism of nervous system; operates below consciousness; permits quick reaction to potentially painful or damaging situations; simple; deep tendon reflexes

6 most important factors of neurological exam

health history cues for Neuro assessment

important past medical history for Neuro assessment

important medication use to document for neurological assessment (4)

6 important family history factors for neurological assessment

11 important social history cues for neurological assessment

screening test for child development milestone neurological assessment

injury to temporal or parietal lobe; talk and read easily but words nonsensical, jumbled or meaningless

frontal lobe lesion; struggle with words, slow, monosyllabic

evaluates level of consciousness- degree of wakefulness - related to the amount of stimuli needed to initiate a response; does not apply to children especially under 3 years

able to respond to various stimuli but may be disoriented and forgetful

fully awake and oriented to person place and time; able to respond and carry out commands

sleepy/drowsy but arousable with gentle shaking, calling of name, falls back to sleep easily, maybe disoriented

sleeps most of the time makes few spontaneous movements; vigorous shaking and name calling required; capable of verbal response but likely inappropriate

semi comatose unconscious most of the time strong painful stimuli required for withdrawal response

cannot be aroused

CN I

CN II

CN III

CN IV

CN VI

CN V

CN VII

acute peripheral facial nerve palsy of unknown cause; CN VII; paralysis or weakness on one side of the face, along with a sagging eyebrow and difficulty closing the eye

four steps for CN VII palsy exam

how to differentiate bells palsy from stroke

CN VIII

CN IX

CN X

CN XI

CN XII

meningeal irritation results in tetanic contractures of the spinal muscles

arms to the core held in flexion internally rotated

violent headache, photophobia, fever, nausea/vomitting, and decreased level of consciousness and convulsions

with patient in supine position flex neck; resisting this movement is a positive sign for irritation (meningitis)

patient in recumbent position, flex hip and flex at knee, attempt to extend knee; positive is resistance to extension and pain (spasm of hamstring) reliable sign of irritation (rule out Herniated Disk)

passively flex neck forward to chest; positive response is flexion of one or both legs to pelvis (failure to raise leg with knee straight indicated irritation of meninges), arms may also flex

stand with feet together and arms at sides, close eyes and hold position for 20 sec; normal able to hold with no or minimal sway; positive sways falls must widen base of feet to stop fall indicating MS ETOH loss of proprioception and vestibular function

pat knees with both hands with increasing speed; normal equal turning and quick rhythmic pace; abnormal lack of coordination slow clumsy sloppy response seen with cerebellar disease

includes Kernig's, Brudzinski, Romberg's, RAM

spinothalamic and posterior columns

tested by pain (pin prick sharp vs dull), temperature (warm vs cold), light touch

increased or altered cutaneous sensitivity to touch, pain or temperature

decreased cutaneous sensitivity to touch pain or temperature

absence of cutaneous sensitivity to touch pain or temperature

place tuning fork over bony prominence starting distally and moving inward until senses comparing side to side; normal detects start and stop; abnormal is loss of vibratory sense = peripheral neuropathy seen in DM and ETOH

tests ability to perceive passive movements of extremities; move big toe up or down and have pt report place; normal slight changes detected; abnormal loss of position sense

stereognosis, graphesthesia, two point discrimination, extinction, point location; abnormal is inability to perform indicates lesion of sensory cortex or posterior column

the mental perception of depth or dimensionally; usually referencing ability to perceive the form of an object by touch

the ability to recognize and discern letters or numbers traced on the skin

two points separated by as little as 2-4mm on the kips and finger pads, 8-15mm on the palms, and 30-40mm on the tibia or back

patient on edge of exam table with eyes closed, touch patient on trunk or legs in one place and tell patient to open eyes and point to where sensation was; repeat a second time touching in two places on opposite sides of body simultaneously and ask patient to point again; normal point to both areas; abnormal patient may have lesions of sensory cortex and parietal lobe

microfilament applied for 1.5 seconds to all sites with enough pressure to cause filament to bend

relaxed hold of hammer strike from wrist with short snappy blow with pointed end at smaller target (thumb) and larger end for wider target using enough force to elicit response; compare side to side; responses should be equal

DTR response very brisk hyperactive with clonus

DTR response brisker than average

DTR response normal

DTR response diminished

DTR response no response

support forearm place thumb on biceps tendon and strike blow with thumb; normal = flexion of forearm

suspend by upper arm, strike tendon directly above elbow; normal = extension of forearm

hold thumb to suspend forearm, strike forearm directly 2-3cm above wrist; normal = flexion and supination

spike tendon just below patella with knees dangling; normal = extension of lower leg

hold foot in doors-flexion and strike tendon directly; normal = plantar flexes against hand; slowed relaxation phase in hypothyroidism

abdominal upper T8-10, abdominal lower T10-12, cremasteric L1-2, and plantar L5-S1

communicates with spermatic cord which shortens when this muscle contracts moving the testicle closer to the body providing warmth and maintaining temperature; relaxes when temperature needs to be lowered

in response to stress raises testicles towards the body in an attempt to protect them

indicated by abnormal grasp reflex after infancy

puckering of lips abnormal after infancy

one indication is snout

hyperactive blinking response with tap to forehead

indicated by glabellar

indicated by sucking abnormal after infancy

upper motor neuron disease, preeclampsia

normal in infancy until 15-18 months; abnormal fan great toe with toes abduct; lesions pyramidal tract, stroke or trauma

support knee in slightly flexed position quickly dorsiflex foot and hold in that position; positive = rhythmic oscillation of involuntary muscle

identifies coffee and peppermint bilaterally

vision 20/20 ou, intact peripheral, Fundi visualized disc margin, without nicking, flame hemorrhages bilaterally

intact EOM, no ptosis or nystagmus PERRLA

sensation intact bilaterally jaw strength intact bilaterally

facial muscles intact and symmetric

hearing whispered words bilaterally at 12 in, Weber midline, RInne ac>bc

swallowing intact, positive gag, uvula rises midline on pronation

positive and equal shoulder shrug head movement

tongue midline no fasciculations

no atrophy weakness tremors; gait smooth, coordinated, able to tandem

intact pin prick vibration and stereognosis bilaterally

draw stick for DTR no Babinski intact abdominal

movement disorder causing involuntary movement and/or impaired voluntary movement

CNS autoimmune destruction of nerve fibers and myelin sheath

sudden uncontrolled electrical activity between brain cells

inflammation of the meninges

inflammation of brain tissue

infection that can cause meningitis temporary paralysis (Bells palsy) numbness or weakness and impaired muscle movement

degenerative disease of nerve cells controlling voluntary muscle movements

chronic autoimmune neromuscular disease causing weakness in skeletal muscles after activity

rare autoimmune syndrome causing weakness and tingling from peripheral to central areas

injury or damage to nerves in the periphery (outside brain)