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H&P Unit II exam

H&P Ii-Spring 2012

What does the CNS include brain, spinal cord
how many nerves in the peripheral nervous system 12 cranial, 31 peripheral n. originating at cord
where are the nurona cell bodies gray matter
what is the greatest mass of brain tissue cerebrum
what is in the white matter neuronal axons, coated w/ myelin to allow n. impulses to travel quickly
what are the lobes inthe cerebral hemisphere frontal, parietal, occipital, temporal
4 regions of the cerebrum cerebral cortex, diencephalon, cerebellum, brainstem
what is the diencephalon comprised of basal ganglia, thalamus, hypothalamus
Processes sensory input and relays to the cerebral cortex thalamus
responsible for movement basal ganglia
4 fxns of the hypothalmus homeostasis, reulates B/P, HR, temp, emotion like anger and sex drive, hypothalmic hormones act directly on the pit
white matter where all parets of the cerbral corte descend into the brainstem internal capsule
what does consciousness depend on interaction b/w cerebral hemisheres and the reticular activating system
3 sections of the brainstem midbrain, pons, medulla
coordinates all movement cerebellum helps maintin body in upright position
LP usually done where b/w L3-5
efferent fibers sending motor signals aways from the cord anterior nerve roots
afferent fibers receiving sensory signals from periphery posterior nerve roots
n. roots converge to form combination nerves where most peripheral n. originate spinal nerves
where are deep tendon reflexes mediated through spinal nerves
how can we touch nose with our eyes closed cerebellum
what mediates voluntary movement and intergreates complicated/delicate movments corticospinal (pyramidal) tracts
what is the anatomical arangement of the pyramidal tracts originates in motor cortex of brain and travels down the medulla where they form a pyramid and cross to contralateral side of medulla
where do upper motor neurons synapse for cranial and peripheral nerves cranial: brainstem, per: spinal cord
where are the cell bodies for lower motor neurons in the anterior horn of the cord
where are UMN and LMN divided pyramids
signs for UMN and LMN lesions UMP: msucle tone and DTR's are exaggerated, LMN: muscle one and DTRs are decreased or abscent
in the corticospinal tract if there is a lesion, what happens fxns are lost below level of injury
helps to maintain muscle tone and control gross body movements like walking basal ganglia
disease in the basal ganglia show what increased muscle tone, posture an gait disturbances (bradykinesia) involuntary movements: tremor (PD)
coordinates motor activity, maintains equilibrium and helps to control posture cerebellar system
damage in the cerebellar system shows what impaired coordination, gait and equilibrium and causes decreased muscle tone
Two sensory tracts spinothalamic tract, posterior colums
crude touch, pain an temperature pass where and synapse where spinothalamic, synapse w/ secondary sensory neurons
where does the spinothalamic tract go to the thalamus
what do the posterior columns sense position, vibration, fine discriminatng touch: travel to medulla
where do the posterior columns cross at the medulla
where do the spinothalamic tract neurons cross at the level of the nerve
a lesion that won't impair perception of pain, touch but will impair finer discrimination sensory CORTEX lesion (3rd set of sensory neurons)
a lesion that will impair position and viration but other sensations are preserved posterior columns
loss of sensation in the legs along w/ paralysis and hyperactive reflexes inicates what cord transection lesion
band of skin innervated by sensory root of a single peripheral sinal nerve dermatome
Grading ot DTR's 0-4 0: absent 4: hyperactive w/ clonus 2: average, normal
What are the DTR's and their corresponding spinal nerves achilles: s1, patellar L234 Brachioradialis C56, biceps C56, Triceps C6,7 Abdoment T9-10 and T10-12 Babinski L5-S1, Anal wink S2,3,4
what does hyperactive reflexes suggest UMN lesion, confirmed w/ clonus
involuntary, rhythmic muscle contractions in response to a sudden stretching of that muscle clonus
diminished reflexes and decreased sensation suggusts what cord segment damage, muscle damage
is lightheadedness vertigo? no must differentiate that and syncope
medical conditions that might cause lightheadedness hypotension, arrhythmia, hypoglycemia, vasovagal stimulation, medications
causes of hemiplegic weakness CVA/TIA
cause of focal weakness ischemic, vascular, mass lesions in the NS or peripheral nervous system or MS disorders
bilateral proximal weakness suggests myopathy
bilateral distal weakness suggests polyneuropathy
weakness made worse w/ repeated effort and improved w/ rest suggests myasthenia gravis
numbness/weakness in feet spreading proximally sggests guillain-Barre syndrome
tingling and numbness in hands, feet and peri-oral areas suggests hyperventilation
3rd leading cause of death in the U.S. cerebrovascular dz
best tx for stroke prevent RF's HTN, BM, obesity, alcohol, dyslipidemia, smoking, sedentary, afib
when is the highest risk of stroke post TIA next 30 days
what are cranial nerves peripheral nerves that originate within the cranium
where do cranial nerves synapse with motor neurons in the brainstem
where do cranial nerves arise from dienceephalon and brainstem
what CN control the eye movemets LR6SO43
what muscles does the trigeminal n. innervate masseter and temporalis
how do we assess the facial n. forehead wrinkling, eyelid closure, whistle/pucker
what nerves controls swallowing, rise of soft palate, and gag reflex glossopharyngeal, vagus
what does the spinal accessory innervate sternocleidomastoid and trapezius
if the tongue protrudes to the left where is the lesion (CN?) hypoglossal and toward the affected sign
causes of muscle atrophy motor neuron dz, peripheral n. compression, RA, protein-calorie malnutrition
what is muscle tone the slight residual tension when reflexxed
what is decreased tone called flaccidity
increased tone at the extremes of range spasticity
persistent increased tone throughtout the ROM lead-pipe rigidity
impared strength or weakness paresis
absence of strength or paralysis plegia
tests to wein out subtle weaknesses heel walk, toe walk, getting out of chair, deep knee bend
strengh grading 0-5 3: movement against gravity
when does clonus present in CNS dzs
inability to hold wrists and fingers in extension asterixsis (hepatic encephalopathy-alcoholic)
causes of scapular winging werratus ant. weakness d/t long thoracic n. palsy
4 parts of coordination motor, cerebellar, vestibular system, sensory
what do clumsy movements like pronating and supinating poorly suggest cerebellar dz, not so much basal ganglia or UMN
what is cerebellar dz dysdiadochokinesis
doing touch finger to nose test that presents worse w/ closing eyes most likely cerebellar or vestibular dz
heel toe walking may wein out what distal msucle weakness, and corticospinal tract weakness
hopping in place on one leg tests proximal and distal muscle trength, position sense and cerebellar fxn
romberg sign standing then closing eyes: worse balance, tests cerebellar fxn and proprioception
+ pronator drift test suggests lesions in contralateral cortoospinal tract
+ for tapped down and fail to return propriopecption: posterior columns
if affected arm overshoots the resting position w/ tap down test cerebellar dysfunction
sensation of pain and temp spinothalamic
sensation of position and vibration posterior columns
light touch both spinothalamic and posterior columns
some disciminative sensations invovles post spinothalamic, post. and also sensory cortex
innervation to each of these areas: shoulders, inner/outer aspect of forearms, thumbs and am fingers, ant thighs, medial/lat aspect of calves, small toes, medial aspect of each buttock S: C4 I: C6 O: T1 Thumbs: C6 F: C8, Ant.: L2, Med: L4, Lat: L5, Toes: S1, Med butt: S3
identifying an object sterognosia
blunt opject or write on their palm a number graphesthesia
worries persisting over a 6m period suggests generalzed anxiety d/o
recurrenty panic attacks followed by periods of anxiety over a futer attack panic d/o
intrusive thoughts and ritualistic behaviors obsessive-compulisve d/o
when are facial expressions masked parkinson's and apathetic in depression
three componants to the GCS eye opening, vebal, motor
defective artciulation/talking dysarthria
d/o of reception or expression of speech aphasia (can be confused w/ psychosis)
phrse substituted for a word that can't be recalled circumlocutions (what you write with) for pen
malformed, wrong, or invented words paraphasia (i write w/ a den, bar, dar)
location and function of wernicke's area receptive area, understanding language: posterior superior temporal lobe
location and fxn of brocas area expressive, or forming words, posterior inferior frontal lboe
misinterpretations of real external stimuli illusions
perceptions in the abscence of real stimuli hallucinations
what does serial 7s or spelling WORLD backwards asses attention
what is remote memory (birthdays anniversarys) impaired by late dementia
what is recent membory impaired by dementia and delirum
what is new learning ability (giving 3 new words to remember) impaired by dementia, delirium, depression or anxiety
how can we asses b/w mild MR and dementia informationand vocabulary, current public officers or state capitals (high cog. fxn)
what is calculating ability often impaired by dementia, aphasia, limited education
how do we test abstract thinking? proverbs: don't count cxns b4 they hatch: concrete responses in delirium and dementia, bizarre interpretations in schizohrenia
what is contrstructional ability effected by dementia, parietal lobe dysfxn, poor vision
what 5 things should we ask the pt about their vision an pain, changes, redness, discharge, trauma
pain w/o redness ddx acute glaucoma, retinal hemorrage,
where does conjunctivitis occur over the sclera and conjuctiva not the cornea
how do we asses the pupil round and smooth borders 3-4mm
slow central VL cataracts, mac degeneration
swiss cheese vision loss dark spots macular degeneration
3 acute causes of vision loss rtinal detachment, vitreous hemorrhage, central retinal a. occlusion
gradual causes of VL mac degen, open-angle glaucoma,
mc causes of hemianopsia stroke, brain tumor, trauma
moving specks or strans indicate vitreous floaters
slow peripheral VL open
fixed defects (scotomas) lesions in retina or visual pathways
flashing lights or new vitrous floaters suggests retinal or vitreous detachment
douple vision, causes diplopia, brainstem or cerebellum lesions, weakness or paralysis of CN III or VI in horizontal, CN III or IV in vertical
diplopia in one eye with the other closed suggests pathology in cornea or lens
what VA is U.S> legal blindness 20/200
partial blindthess in the visual fields of one or both eyes hemianopsia
class of hemianopsia but confined to visual field quadrants quadrantanopsia
implies presence of same defect in both eyes - homonymous
5 step optic pathway eye, optic nerve, optic chiasm, optic tract, lateral genticulate nucleus
lesion on one retina vision completely lost in one eye
lesion on the optic nerve L side lose Right vision of L eye
lesion at optic chiasms lost left vision in left eye and R vision in right eye (peripheral)
lesion in the optic tract on L side loss of right vision both eyes
lesion in occipital lobe inL side loss of R vision both eyes
where is the physiologic blind spot 15 degrees temporal to the central line of gaze
what causes optic disc. enlargement papilledema, glaucoma, optic neuritis
bilateral disc enlargement metabolic or bilogical cause, unilateral: space occupying lesions
prtorusion of the eye exopthalmos d/t lesions or hyperthyroidism
nl corneal convexity in whites and black W: 20mm B: 22mm
thickened conjunciva that may encroach nasal to temporal pterygium
what do we asses the cornea and lense for arcus, cataracts, scars, and pterygium
puckering of pupillary muscles suggests increase pressure in ant chamber
bowing of cornea w/ slit lamp exam glaucoma
unequal size of pupils aniscoia ~20% population have it <.5mm is nl
how do we say assessment of pupils equal round reactive to light and accomidation
where is nl light reflex symmetrical and nasal to center of pupils
nystagumus more than a few beats of lateral nystagmus is abnormal
what happens with the lid in hyperthyroidism lid lag an poor convergence
CI's to dilate pupils head injury, suspicion of narrow angle glaucoma
what will decrease the red reflex cataracts, tumor/lesion
nl color of disc yellow-orange
nl disc ratio 1:2
what will papilledema cause increased cup:disc ration w/ blurry margins
bates 261-267 retinal patholgies
how do we inspect anterior structures increasing diopters to +10 or 12
Created by: becker15