H&P Ii-Spring 2012
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| What does the CNS include | brain, spinal cord
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| how many nerves in the peripheral nervous system | 12 cranial, 31 peripheral n. originating at cord
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| where are the nurona cell bodies | gray matter
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| what is the greatest mass of brain tissue | cerebrum
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| what is in the white matter | neuronal axons, coated w/ myelin to allow n. impulses to travel quickly
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| what are the lobes inthe cerebral hemisphere | frontal, parietal, occipital, temporal
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| 4 regions of the cerebrum | cerebral cortex, diencephalon, cerebellum, brainstem
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| what is the diencephalon comprised of | basal ganglia, thalamus, hypothalamus
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| Processes sensory input and relays to the cerebral cortex | thalamus
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| responsible for movement | basal ganglia
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| 4 fxns of the hypothalmus | homeostasis, reulates B/P, HR, temp, emotion like anger and sex drive, hypothalmic hormones act directly on the pit
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| white matter where all parets of the cerbral corte descend into the brainstem | internal capsule
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| what does consciousness depend on | interaction b/w cerebral hemisheres and the reticular activating system
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| 3 sections of the brainstem | midbrain, pons, medulla
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| coordinates all movement | cerebellum helps maintin body in upright position
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| LP usually done where | b/w L3-5
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| efferent fibers sending motor signals aways from the cord | anterior nerve roots
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| afferent fibers receiving sensory signals from periphery | posterior nerve roots
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| n. roots converge to form combination nerves where most peripheral n. originate | spinal nerves
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| where are deep tendon reflexes mediated | through spinal nerves
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| how can we touch nose with our eyes closed | cerebellum
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| what mediates voluntary movement and intergreates complicated/delicate movments | corticospinal (pyramidal) tracts
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| 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
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| where do upper motor neurons synapse for cranial and peripheral nerves | cranial: brainstem, per: spinal cord
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| where are the cell bodies for lower motor neurons | in the anterior horn of the cord
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| where are UMN and LMN divided | pyramids
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| signs for UMN and LMN lesions | UMP: msucle tone and DTR's are exaggerated, LMN: muscle one and DTRs are decreased or abscent
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| in the corticospinal tract if there is a lesion, what happens | fxns are lost below level of injury
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| helps to maintain muscle tone and control gross body movements like walking | basal ganglia
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| disease in the basal ganglia show what | increased muscle tone, posture an gait disturbances (bradykinesia) involuntary movements: tremor (PD)
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| coordinates motor activity, maintains equilibrium and helps to control posture | cerebellar system
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| damage in the cerebellar system shows what | impaired coordination, gait and equilibrium and causes decreased muscle tone
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| Two sensory tracts | spinothalamic tract, posterior colums
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| crude touch, pain an temperature pass where and synapse where | spinothalamic, synapse w/ secondary sensory neurons
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| where does the spinothalamic tract go | to the thalamus
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| what do the posterior columns sense | position, vibration, fine discriminatng touch: travel to medulla
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| where do the posterior columns cross | at the medulla
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| where do the spinothalamic tract neurons cross | at the level of the nerve
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| a lesion that won't impair perception of pain, touch but will impair finer discrimination | sensory CORTEX lesion (3rd set of sensory neurons)
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| a lesion that will impair position and viration but other sensations are preserved | posterior columns
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| loss of sensation in the legs along w/ paralysis and hyperactive reflexes inicates what | cord transection lesion
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| band of skin innervated by sensory root of a single peripheral sinal nerve | dermatome
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| Grading ot DTR's | 0-4 0: absent 4: hyperactive w/ clonus 2: average, normal
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| 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
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| what does hyperactive reflexes suggest | UMN lesion, confirmed w/ clonus
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| involuntary, rhythmic muscle contractions in response to a sudden stretching of that muscle | clonus
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| diminished reflexes and decreased sensation suggusts what | cord segment damage, muscle damage
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| is lightheadedness vertigo? | no must differentiate that and syncope
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| medical conditions that might cause lightheadedness | hypotension, arrhythmia, hypoglycemia, vasovagal stimulation, medications
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| causes of hemiplegic weakness | CVA/TIA
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| cause of focal weakness | ischemic, vascular, mass lesions in the NS or peripheral nervous system or MS disorders
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| bilateral proximal weakness suggests | myopathy
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| bilateral distal weakness suggests | polyneuropathy
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| weakness made worse w/ repeated effort and improved w/ rest suggests | myasthenia gravis
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| numbness/weakness in feet spreading proximally sggests | guillain-Barre syndrome
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| tingling and numbness in hands, feet and peri-oral areas suggests | hyperventilation
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| 3rd leading cause of death in the U.S. | cerebrovascular dz
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| best tx for stroke | prevent RF's HTN, BM, obesity, alcohol, dyslipidemia, smoking, sedentary, afib
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| when is the highest risk of stroke post TIA | next 30 days
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| what are cranial nerves | peripheral nerves that originate within the cranium
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| where do cranial nerves synapse | with motor neurons in the brainstem
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| where do cranial nerves arise from | dienceephalon and brainstem
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| what CN control the eye movemets | LR6SO43
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| what muscles does the trigeminal n. innervate | masseter and temporalis
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| how do we assess the facial n. | forehead wrinkling, eyelid closure, whistle/pucker
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| what nerves controls swallowing, rise of soft palate, and gag reflex | glossopharyngeal, vagus
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| what does the spinal accessory innervate | sternocleidomastoid and trapezius
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| if the tongue protrudes to the left where is the lesion (CN?) | hypoglossal and toward the affected sign
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| causes of muscle atrophy | motor neuron dz, peripheral n. compression, RA, protein-calorie malnutrition
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| what is muscle tone | the slight residual tension when reflexxed
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| what is decreased tone called | flaccidity
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| increased tone at the extremes of range | spasticity
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| persistent increased tone throughtout the ROM | lead-pipe rigidity
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| impared strength or weakness | paresis
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| absence of strength or paralysis | plegia
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| tests to wein out subtle weaknesses | heel walk, toe walk, getting out of chair, deep knee bend
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| strengh grading | 0-5 3: movement against gravity
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| when does clonus present | in CNS dzs
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| inability to hold wrists and fingers in extension | asterixsis (hepatic encephalopathy-alcoholic)
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| causes of scapular winging | werratus ant. weakness d/t long thoracic n. palsy
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| 4 parts of coordination | motor, cerebellar, vestibular system, sensory
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| what do clumsy movements like pronating and supinating poorly suggest | cerebellar dz, not so much basal ganglia or UMN
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| what is cerebellar dz | dysdiadochokinesis
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| doing touch finger to nose test that presents worse w/ closing eyes most likely | cerebellar or vestibular dz
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| heel toe walking may wein out what | distal msucle weakness, and corticospinal tract weakness
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| hopping in place on one leg tests | proximal and distal muscle trength, position sense and cerebellar fxn
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| romberg sign | standing then closing eyes: worse balance, tests cerebellar fxn and proprioception
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| + pronator drift test suggests | lesions in contralateral cortoospinal tract
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| + for tapped down and fail to return | propriopecption: posterior columns
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| if affected arm overshoots the resting position w/ tap down test | cerebellar dysfunction
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| sensation of pain and temp | spinothalamic
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| sensation of position and vibration | posterior columns
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| light touch | both spinothalamic and posterior columns
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| some disciminative sensations invovles | post spinothalamic, post. and also sensory cortex
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| 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
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| identifying an object | sterognosia
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| blunt opject or write on their palm a number | graphesthesia
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| worries persisting over a 6m period suggests | generalzed anxiety d/o
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| recurrenty panic attacks followed by periods of anxiety over a futer attack | panic d/o
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| intrusive thoughts and ritualistic behaviors | obsessive-compulisve d/o
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| when are facial expressions masked | parkinson's and apathetic in depression
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| three componants to the GCS | eye opening, vebal, motor
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| defective artciulation/talking | dysarthria
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| d/o of reception or expression of speech | aphasia (can be confused w/ psychosis)
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| phrse substituted for a word that can't be recalled | circumlocutions (what you write with) for pen
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| malformed, wrong, or invented words | paraphasia (i write w/ a den, bar, dar)
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| location and function of wernicke's area | receptive area, understanding language: posterior superior temporal lobe
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| location and fxn of brocas area | expressive, or forming words, posterior inferior frontal lboe
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| misinterpretations of real external stimuli | illusions
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| perceptions in the abscence of real stimuli | hallucinations
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| what does serial 7s or spelling WORLD backwards asses | attention
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| what is remote memory (birthdays anniversarys) impaired by | late dementia
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| what is recent membory impaired by | dementia and delirum
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| what is new learning ability (giving 3 new words to remember) impaired by | dementia, delirium, depression or anxiety
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| how can we asses b/w mild MR and dementia | informationand vocabulary, current public officers or state capitals (high cog. fxn)
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| what is calculating ability often impaired by | dementia, aphasia, limited education
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| how do we test abstract thinking? | proverbs: don't count cxns b4 they hatch: concrete responses in delirium and dementia, bizarre interpretations in schizohrenia
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| what is contrstructional ability effected by | dementia, parietal lobe dysfxn, poor vision
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| what 5 things should we ask the pt about their vision | an pain, changes, redness, discharge, trauma
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| pain w/o redness ddx | acute glaucoma, retinal hemorrage,
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| where does conjunctivitis occur | over the sclera and conjuctiva not the cornea
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| how do we asses the pupil | round and smooth borders 3-4mm
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| slow central VL | cataracts, mac degeneration
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| swiss cheese vision loss dark spots | macular degeneration
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| 3 acute causes of vision loss | rtinal detachment, vitreous hemorrhage, central retinal a. occlusion
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| gradual causes of VL | mac degen, open-angle glaucoma,
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| mc causes of hemianopsia | stroke, brain tumor, trauma
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| moving specks or strans indicate | vitreous floaters
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| slow peripheral VL | open
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| fixed defects (scotomas) | lesions in retina or visual pathways
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| flashing lights or new vitrous floaters suggests | retinal or vitreous detachment
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| douple vision, causes | diplopia, brainstem or cerebellum lesions, weakness or paralysis of CN III or VI in horizontal, CN III or IV in vertical
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| diplopia in one eye with the other closed suggests | pathology in cornea or lens
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| what VA is U.S> legal blindness | 20/200
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| partial blindthess in the visual fields of one or both eyes | hemianopsia
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| class of hemianopsia but confined to visual field quadrants | quadrantanopsia
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| implies presence of same defect in both eyes - homonymous |
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| 5 step optic pathway | eye, optic nerve, optic chiasm, optic tract, lateral genticulate nucleus
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| lesion on one retina | vision completely lost in one eye
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| lesion on the optic nerve L side | lose Right vision of L eye
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| lesion at optic chiasms | lost left vision in left eye and R vision in right eye (peripheral)
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| lesion in the optic tract on L side | loss of right vision both eyes
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| lesion in occipital lobe inL side | loss of R vision both eyes
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| where is the physiologic blind spot | 15 degrees temporal to the central line of gaze
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| what causes optic disc. enlargement | papilledema, glaucoma, optic neuritis
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| bilateral disc enlargement | metabolic or bilogical cause, unilateral: space occupying lesions
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| prtorusion of the eye | exopthalmos d/t lesions or hyperthyroidism
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| nl corneal convexity in whites and black | W: 20mm B: 22mm
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| thickened conjunciva that may encroach nasal to temporal | pterygium
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| what do we asses the cornea and lense for | arcus, cataracts, scars, and pterygium
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| puckering of pupillary muscles suggests | increase pressure in ant chamber
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| bowing of cornea w/ slit lamp exam | glaucoma
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| unequal size of pupils | aniscoia ~20% population have it <.5mm is nl
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| how do we say assessment of pupils | equal round reactive to light and accomidation
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| where is nl light reflex | symmetrical and nasal to center of pupils
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| nystagumus | more than a few beats of lateral nystagmus is abnormal
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| what happens with the lid in hyperthyroidism | lid lag an poor convergence
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| CI's to dilate pupils | head injury, suspicion of narrow angle glaucoma
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| what will decrease the red reflex | cataracts, tumor/lesion
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| nl color of disc | yellow-orange
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| nl disc ratio | 1:2
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| what will papilledema cause | increased cup:disc ration w/ blurry margins
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| bates 261-267 retinal patholgies |
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| how do we inspect anterior structures | increasing diopters to +10 or 12
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