Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Physical Diagnosis > Neurologic Exam > Flashcards

Neurologic Exam Flashcards

1
Q

Anatomy of CNS and PNS

A
  • Central Nervous System (CNS): Brain and spinal cord
  • Peripheral Nervous System (PNS): 12 Cranial Nerves, Spinal Nerves, Peripheral Nerves, Most contain motor and sensory fibers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Frontal lobe

A

Voluntary skeletal movements, motor speech (Broca’s area), emotions, affect, awareness of self

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

parietal lobe

A

Data processing (math), interpretation of tactile data, comprehension of written words (reading, writing), recognition of body parts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

temporal lobe

A

Sensory speech (Wernicke’s area), long-term memory, hearing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

occipital lobe

A

vision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

cerebral cortex

A
  • frontal lobe, parietal lobe, temporal lobe, occipital lobe

- makes us thinking beings - higher order functions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Broca’s aphasia

A

“expressive aphasia” usually with right sided weakness
-difference between dimentia and with brocas is that with dimentia the writing should still be in tact whereas brocas will not

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Wernicke’s aphasia

A

“sensory aphasia”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Diencephalon

A
  • basal ganglia, thalamus, hypothalamus
  • Processing center, some automatic functions, more basic/primitive behavior – but they all have to be developed and controlled, not born with sophisticated control of these areas
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

basal ganglia

A

Control of gross automatic movements (walking)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

thalamus

A

Processes sensory information, relays signals to cerebral cortex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

hypothalamus

A
  • Maintains homeostasis, regulates temp, controls endocrine system
  • Governs emotional behavior (sex drive, anger)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

deeper brain structures

A
  • brainstem (midbrain, pons, and medulla), cerebellum

- most primitive area of the brain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

brainstem

A
  • (midbrain, pons, and medulla)
  • Coordinates sides of body
  • Controls breathing and heartbeat
  • Controls consciousness and sleep cycle (reticular activating system)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

cerebellum

A
  • Coordinates voluntary movements

- Utilizes sensory data to control muscle tone, equilibrium and posture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Appearance and behavior

A
  • Level of Consciousness
  • Posture and Motor Behavior
  • Dress, Grooming and Personal Behavior
  • Facial Expression
  • Manner, Affect and Relationship to Person and Things
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Speech and language

A
  • Quantity, Rate, Loudness, Articulation
  • Testing speech and language (Point to your nose; repeat “no ifs, ands or buts;” name objects; follow a multi-step command; read a sentence, write a sentence)
  • Fluency: distinguishing aphasia (Wernicke’s (fluent) aphasia – “word salad”; Broca’s (nonfluent) aphasia – comprehension is good, speaking/writing is impaired)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

depression/anxiety screening tools

A
  • Beck Depression/Anxiety Inventory

- Hamilton Depression/Anxiety Scale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

mood disorder screening tools

A
  • SCOFF Questionnaire (eating disorders)
  • Mazmanian Mania-Depression Mood Scale
  • SPAN Scale (PTSD)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

depression screening

A

SIG E CAPS can be helpful mnemonic: (Sleep problems
Interest (loss, including sex), Guilt, Energy (lack), Concentration (lack), Appetite changes, Psychomotor changes (restless or lethargic), Suicidal ideations)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

evaluating thought disorders (thought processes, thought content, perceptions, insight and judgment)

A
  • thought processes (organized, logical, coherent)
  • thought content (obsessions, compulsions, delusions, phobias)
  • perceptions (illusions, hallucinations)
  • Insight and judgment (insight - “what brings you here today?”, judgment - “what do you think will happen if…”)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

cognitive functions

A
  • orientation (time, place, person)
  • attention (digit span, serial 7’s, spelling backward)
  • remote memory (when is you birthday?)
  • recent memory (who is the US president)
  • new learning ability (I’m going to tell you 3 objects. Repeat them after me and again in 2 mins when I ask you to.)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

higher cognitive function

A

-Information and Vocabulary (Intelligence)
-Calculating Ability (Simple math)
-Abstract Thinking (Proverbs, Similarities)
-Constructional Ability
(Draw/copy a clock, Draw shapes (intersecting pentagons))

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

MMSE

A
  • Mini Mental State Examination
  • Used to screen for cognitive dysfunction or dementia, to follow patients with dementia
  • 30 points possible, <23 points suggests cognitive impairment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

MoCA

A
  • Montreal Cognitive Assessment
  • Designed as a rapid screening tool for mild cognitive impairment, takes about 10 min
  • 30 points possible, <26 pts is abnormal
  • Considered more sensitive and specific than MMSE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Mental Status Exam Checklist

A
  • orientation: ask name date location
  • general wellbeing: ask mood, thoughts/perceptions
  • aphasia (speech and language): 1 stage command, repeat phrase, name common objects, read sentence, write sentence
  • cognitive function: repeat 3 objects immediately and in 2 mins; recent and remote memory
  • higher cognitive function: general info, calculation, abstract thinking
  • attention
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

cranial nerves

A
  • 12 pairs emerging from base of brain within the skull
  • Motor, sensory or specialized functions
  • Symptoms specific to area and function of nerve
  • CN deficits can be due to nerve or brain lesions
28
Q

Cranial Nerves

A

CN I – smell
CN II – visual acuity, visual fields, ocular fundi
CN II, III – pupillary reactions
CN III, IV, VI – EOM
CN V – corneal reflex, facial sensation, jaw movements
CN VII – facial movements
CN VIII – hearing
CN IX, X – swallowing, rise of palate, gag reflex
CN V, VII, X, XII – voice and speech
CN XI – shoulder and neck movements
CN XII – tongue symmetry and position

29
Q

Cranial nerve names

A

Oh Oh Oh To Touch And Feel A Very Good Vagina. Ah Heaven

Olfactory
Optic
Oculomotor
Trochlear
Trigeminal
Abducent
Facial
Vestibulocochlear
Glossopharyngeal
Vagus
Accessory
Hypoglossal
30
Q

Cranial nerve functions

A

Some Say Marry Money But My Brother Says Big Boobs Matter More

31
Q

CN 1, Olfactory

A

-located in the olfactory mucosa of the upper parts of the nasal cavity
-do not form two trunks as do the remaining cranial nerves
-consist of a collection of many sensory nerve fibers that extend from the olfactory epithelium to the olfactory bulb
-passing through the many openings of the Cribriform plate of the Ethmoid bone
Olfactory ensheathing glia wrap bundles of these axons and are thought to facilitate their passage into the central nervous system
-The olfactory nerve is the shortest of the twelve cranial nerves and only one of two cranial nerves (the other being the optic nerve) that do not join with the brainstem

32
Q

Sense of smell

A

CN 1

  • arises from the stimulation of olfactory (or odorant) receptors by small molecules of different spatial, chemical, and electrical properties that pass over the nasal epithelium in the nasal cavity during inhalation
  • transduced into electrical activity in the olfactory bulb, which then transmits the electrical activity to other parts of the olfactory system and the rest of the central nervous system via the olfactory tract
33
Q

CN II, Optic

A
  • considered to be part of the central nervous system, as it is derived from an outpouching of the diencephalon during embryonic development
  • covered with myelin produced by oligodendrocytes
  • ensheathed in all three meningeal layers (dura, arachnoid, and pia mater) rather than the epineurium, perineurium, and endoneurium found in peripheral nerves
  • optic nerve damage produces irreversible blindness
  • fibers from the retina run along the optic nerve to nine primary visual nuclei in the brain
  • Each human optic nerve contains between 770,000 and 1.7 million nerve fibers, which are axons of the retinal ganglion cells of one retina
34
Q

blind spot

A

result of the absence of photoreceptors in the area of the retina where the optic nerve leaves the eye.

35
Q

CN III, Oculomotor

A
  • Pupillary constriction
  • Opening the eye
  • Most extraocular movements (CN III, IV, VI)
  • CN III palsy: ptosis OS
36
Q

CN IV, Trochlear

A
  • downward, inward movement of the eye
  • Innervates superior oblique muscle
  • smallest nerve in terms of the number of axons it contains
  • greatest intracranial length
  • only cranial nerve that decussates (crosses to the other side) before innervating its target
  • only cranial nerve that exits from the dorsal aspect of the brainstem
37
Q

CN VI, Abducens

A
  • lateral deviation of the eye

- innervates lateral rectus muscle

38
Q

CN III, CN IV, CN VI

A
  • Test Extraocular Movements (EOM)
  • Check convergence and accommodation
  • Identify nystagmus
  • Test pupillary reactions (CN II, III)
39
Q

convergence

A

having patient follow object to nose and looking at eyes come together

40
Q

constriction

A

changing gaze from close up to far away

41
Q

nystagmus

A

oscillating beating of eyes indicating brain stem lesions like tumors or it could be congenital

42
Q

CN V, Trigeminal

A
  • responsible for sensation in the face and certain motor functions such as biting and chewing
  • It is the largest of the cranial nerves.
  • has three major branches: the ophthalmic nerve (V1), the maxillary nerve (V2), and the mandibular nerve (V3). -The ophthalmic and maxillary nerves are purely sensory. The mandibular nerve has both cutaneous and motor functions.
43
Q

CN V (motor aspect)

A

Temporal/masseter muscle (jaw clench)

Lateral movement of the jaw

44
Q

CN V (sensory aspect)

A
  • light touch, pain
    1. ophthalmic
    2. maxillary
    3. mandibular
45
Q

CN VII, Facial

A
  • emerges from the brainstem between the pons and the medulla, and controls the muscles of facial expression
  • functions in the conveyance of taste sensations from the anterior two-thirds of the tongue and oral cavity
  • supplies preganglionic parasympathetic fibers to several head and neck ganglia
46
Q

Bell’s Palsy vs. Stroke symptoms

A

CN VII is responsible for both but in Bell’s pasly, eye movements will be impaired as well as the rest of their facial side
In stroke patients, their eye movements should still be impaired

47
Q

Corneal reflex

A
  • CN V (sensory ophthalmic branch (CNV1) for sensory reflex)
  • CN VII (motor response to reflex)
  • touch cornea with cotton and look for blinking. If blink, then sensory CN V (Trigeminal) is intact and motor response CN VII (Facial) is intact. Absence of blinking suggests lesion of CN V or VII. May not be intact in contact lens wearers.
48
Q

CN VIII, Acoustic (Vestibulocochlear)

A
  • sensory cells (the hair cells) of the inner ear transmit information to the brain
  • cochlear nerve, carrying information about hearing, and the vestibular nerve, carrying information about balance.
  • consists mostly of bipolar neurons and splits into two large divisions: the cochlear nerve and the vestibular nerve.
49
Q

Cochlear branch of CN VIII

A
  • The cochlear nerve travels away from the cochlea of the inner ear where it starts as the spiral ganglia.
  • Processes from the organ of Corti conduct afferent transmission to the spiral ganglia.
  • inner hair cells of the organ of Corti that are responsible for activation of afferent receptors in response to pressure waves reaching the basilar membrane through the transduction of sound.
  • The exact mechanism by which sound is transmitted by the neurons of the cochlear nerve is uncertain; the two competing theories are place theory and temporal theory.
  • test for lateralization = weber test
  • compare air and bone conduction = rinne test
50
Q

Vestibular branch of CN VIII

A

The vestibular nerve travels from the vestibular system of the inner ear. The vestibular ganglion houses the cell bodies of the bipolar neurons and extends processes to five sensory organs. Three of these are the cristae located in the ampullae of the semicircular canals. Hair cells of the cristae activate afferent receptors in response to rotational acceleration. The other two sensory organs supplied by the vestibular neurons are the maculae of the saccule and utricle. Hair cells of the maculae activate afferent receptors in response to linear acceleration.
-check for nystagmus

51
Q

CN IX, Glossopharyngeal

A
  1. It receives general sensory fibers (ventral trigeminothalamic tract) from the tonsils, the pharynx, the middle ear and the posterior 1/3 of the tongue.
  2. It receives special sensory fibers (taste) from the posterior one-third of the tongue.
  3. It receives visceral sensory fibers from the carotid bodies, carotid sinus.
  4. It supplies parasympathetic fibers to the parotid gland via the otic ganglion.
  5. It supplies motor fibers to stylopharyngeus muscle, the only motor component of this cranial nerve.
  6. It contributes to the pharyngeal plexus.
52
Q

CN IX Afferent and Efferent fibers

A
  1. Branchial motor (special visceral efferent) - supplies the stylopharyngeus muscle.
  2. Visceral motor (general visceral efferent) - provides parasympathetic innervation of the parotid gland.
  3. Visceral sensory (general visceral afferent) - carries visceral sensory information from the carotid sinus and carotid body.
  4. General sensory (general somatic afferent) - provides general sensory information from the skin of the external ear, internal surface of the tympanic membrane, upper pharynx, and the posterior one-third of the tongue.
  5. Special sensory (special afferent) - provides taste sensation from the posterior one-third of the tongue.
    - motor: pharynx
    - sensory: posterior portions of tympanic membrane/ear canal, pharynx, posterior tongue including taste (salty, sweet, sour, bitter)
53
Q

CN X, Vagus

A

-Motor: Palate, Pharynx, Larynx
-Sensory: Pharynx, Larynx
-emerge from or converge onto four nuclei of the medulla:
The Dorsal nucleus of vagus nerve - which sends parasympathetic output to the viscera, especially the intestines

54
Q

CN X: Nucleus ambiguus

A

-which gives rise to the branchial efferent motor fibers of the vagus nerve and preganglionic parasympathetic neurons that innervate the heart

55
Q

CN X: Solitary nucleus

A

-which receives afferent taste information and primary afferents from visceral organs

56
Q

CN X: Spinal trigeminal nucleus

A

-which receives information about deep/crude touch, pain, and temperature of the outer ear, the dura of the posterior cranial fossa and the mucosa of the larynx
Right and left vagus nerves descend from the cranial vault through the jugular foramina, penetrating the carotid sheath between the internal and external carotid arteries, then passing posterolateral to the common carotid artery. The cell bodies of visceral afferent fibers of the vagus nerve are located bilaterally in the inferior ganglion of the vagus nerve (nodose ganglia).

57
Q

muscles controlled by CN X

A
  • Cricothyroid muscle
  • Levator veli palatini muscle
  • Salpingopharyngeus muscle
  • Palatoglossus muscle
  • Palatopharyngeus muscle
  • Superior, middle and inferior pharyngeal constrictors
  • Muscles of the larynx (speech).
58
Q

CN IX, CN X

A
  • Listen to the patient’s voice (Hoarse or nasal?)
  • Ask patient to swallow (Watch for symmetric rise of palate)
  • Gag reflex (Watch for symmetric rise of palate)
59
Q

CN XI, Spinal Accessory

A
  • referred to specifically as the spinal accessory nerve.
  • provides motor innervation from the central nervous system to two muscles of the neck: the sternocleidomastoid muscle and the trapezius muscle.
  • begins in the central nervous system and exits the cranium through a specialized hole (or foramen).
  • begins outside the skull rather than inside
  • the spinal accessory nerve is notable for being the only cranial nerve to both enter and exit the skull.
60
Q

Testing the CN XI

A
  • Motor: SCM, upper trapezius
  • Look for atrophy or asymmetry of the trapezius muscles
  • Ask patient to shrug shoulders against resistance
  • Ask patient to turn their head against resistance; watch and palpate the sternomastoid muscle on the opposite side
61
Q

CN XII, Hypoglossal

A
  • below the tongue
  • It controls tongue movements of speech, food manipulation, and swallowing.
  • It supplies motor fibres to all of the muscles of the tongue, except the palatoglossus muscle, which is innervated by the vagus nerve (cranial nerve X)
  • Swallowing to clear mouth of saliva and other involuntary activities completed by the tongue are controlled by the hypoglossal nerve; however, most functions are voluntary.
  • The function of the hypoglossal nerve in manipulation for speech contributes to learning languages.
62
Q

Testing CNXII

A
  • Motor: tongue
  • Listen to the articulation of the patient’s words
  • Inspect the tongue at rest and with movement (Ask patient to protrude tongue, move tongue from side to side; Look for symmetry and position)
  • Test strength of the tongue
63
Q

Common abnormal CN findings

A
  • Abnormal or Asymmetrical Pupils (II, III)
  • Ptosis (III)
  • Abnormal Eye Position (III, IV, VI)
  • Facial Droop or Asymmetry (VII)
  • Hoarse Voice (X)
  • Articulation of Words (V, VII, X, XII)
64
Q

Asterixis

A
  • Metabolic encephalopathy in patients with impaired cognitive function
  • Ask patients to hold up hands like they are trying to stop traffic; wait for 1-2 mins for flapping motion that is asterixis
65
Q

Meningeal signs

A

Nuchal rigidity, Brudzinski’s sign (pt laying down, when you raise their head, their knees reflexively bend), Kernig’s sign (when you raise their knee, their head reflexively lifts head up or complains of pain at the back of the neck)

Physical Diagnosis (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions