Neuro Exam/Tests Word Scramble
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Question | Answer |
Myotatic reflex stimulus | muscle stretch |
Myotatic reflex arc | Afferent Ia from muscle spindle to alpha MN and back to muscle |
Myotatic reflex function | maintenance of muscle tone, support agonsist muscle contraction, provide feedback about muscle length |
Myotatic reflex testing | DTR |
Via an inhibitory IN the myotatic reflex inhibits the antagonist | Reciprocal inhibition |
Myotatic reflex effect on synergistic muscles | facilitation |
Inverse myotatic reflex stimulus | muscle contraction |
Inverse myotatic reflex arc | Afferent Ib from GTO via inhibitory IN to muscle |
Function of inverse myotatic reflex arc | provides agonist inhibition, decreases force of agonist, stretch protection reflex |
Allows muscle tension to come under control of descending pathways | Gamma reflex loop |
Gamma reflex loop path | excite gamma MN causing muscle spindle contraction then increased stretch sensitivity and increased firing from spindle afferents then conveyed to alpha MNs |
Flexor withdrawal reflex stimulus | cutaneous sensory stimuli |
Flexor withdrawal reflex arc | cutaneous receptors via Ins to flexor muscles |
Flexor withdrawal reflex arc function | protective withdrawal mechanism |
Crossed extension reflex stimulus and response | noxious stimuli – Flexors excited with extensor inhibition, opposite on CL side |
Crossed extension reflex function | coordinates reciprocal limb activities such as gait |
3 elements of Glasgow Coma Scale | eye opening, motor response, verbal response |
Scoring of GCS | 3-8 severe, 9-12 moderate, 13-15 minor |
State defined by no eye opening even to pain, failure to obey commands, inability to speak | Coma |
Return of sleep/wake cycles, normalization of basic functions, lack of cognitive responsiveness | Vegetative state |
Central language DO with speech is awkward, restricted, interrupted, produced with effort | Expressive aphasia (Broca’s, nonfluent, motor) |
Expressive aphasia result of | L hemisphere – Broca’s area |
Impairment of volitional articulatory control 2/2 cortical dominant hemisphere lesion | Verbal apraxia |
Impairment of speech production | Dysarthria |
Central language DO where spontaneous speech preserved/smooth while auditory comprehension impaired | Receptive or Wernicke’s aphasa |
Receptive aphasia is result of damage to | Posterior frist temporal gyrus of L hemisphere (Wernicke’s area) |
Severe aphasia with impairments in comprehension & production of language | Global aphasia |
Periods of apnea followed by gradually increasing depth/frequency of respirations | Cheyne Stokes respiration |
Cheyne Stokes caused by | depression of frontal lobe and diencephalic dysfunction |
Increased rate and depth of respirations | Hyperventilation |
Hyperventilation can be caused by dysfunction of | lowere midbrain and pons |
Abnormal respiration with prolonged inspiration | Apneustic breathing |
Apneustic breathing is result of damage to | upper pons |
Elevation of temperature may be damage to | hypothalamus or brainstem |
Signs of meningeal irritation | Kernig’s sign, Brudinski’s sign, guarding in neck flexion, photophobia, disorientation, restlessness, persistent HA that increases with head down, altered vitals, weakness |
Kernig’s sign | meningeal irritation. Supine with flexed hip/knee to chest then extend knee. |
Brudzinski’s sign | meningeal irritation. Supine, flex neck. Causes flexion of hips/knees |
Increased ICP leads to | restless, confused, decr LOC, incr BP, widening pulse P & slowed pulse, Cheyne-Stokes, elevated temp, HA, vomiting, unequal pupils, slowed PLRs, dilated pupils*, papilledema, weakness, hemiplegia, Babinski, decorticate or decerebrate rigidity, seizures |
Joint position sense | test for ability to perceive joint position at rest in response to passive positioning |
Kinesthesia | movement sense |
Pallesthesia | vibration sense with tuning fork |
Combined cortical sensation testing | discriminative sensory tests including Steriognosis, Tactile Localization, Two Point Discrimination, Bilateral Simultaneous Discrimination, Barognosis, Graphesthesia, Texture recognition |
Stereognosis | ID familiar objects by touch |
Two point discrimination | ability to recognize one or two blunt points applied to skin simultaneously |
Barognosis | ability to differentiate weights |
Graphesthesia | ability to ID numbers, letters or symbols traced on skin |
Homonymous hemianopsia | loss of half of visual field in each eye contralateral to side of cerebral hemisphere lesion |
Somatognosia | body scheme disorder – unable to ID body parts or relations to each other |
Unilateral neglect | patient ignores one side of body and stimuli from that side |
Anosognosia | severe neglect or denial of severity of condition |
Figure ground discrimination | spatial relations syndrome with lack of ability to pick out object |
Form constancy | pick out object from array of similar shapes but different sizes |
Spatial relations | pt duplicates a pattern of 2-3 blocks |
Topographical disorientation | navigation of a familiar route |
Vertical disorientation | inability to accurately determine what is upright |
Agnosia | inability to recognize familiar objects with one sensory modality |
Apraxia | inability to perform voluntary learned movements in the absence of loss of sensation , strength, coordination, attention, or comprehension. Breakdown in conceptual or motor production system or both |
Ideomotor apraxia | cannot perform task on command, but can do independently |
Ideational apraxia | cannot perform the task at all, either on command or independently |
Clasp-knife response | marked resistance to PROM suddenly gives way |
Clonus | maintained stretch stimulus produces cyclical spasmodic contraction, usu plantar flexors or wrist flexors |
Babinski | DF of great toe with fanning of other toes with stroke to lateral bottom of foot |
Babinski indicates | corticospinal (pyramidal) tract disruption |
Hyperreflexia | increased DTRs |
Lead pipe Rigidity | uniform throughout range |
Cogwheel rigidity | interrupted by series of jerks |
Decerebrate posturing | increased tone in extension, seen in brainstem lesions between superior colliculus and vestibular nucleus |
Decorticate posturing | UEs in flexion, LEs in extension, seen in brainstem lesions above superior colliculus |
Opisthotonos | arching back of head back and heels with UEs rigidly flexed. Seen in severe meningitis, tetanus, epilepsy, strychnine poisoning |
Plantar reflex | Normal is PF of toes in response to stroking lateral sole of foot from calcaneus to 5th met, S1-2, tibial nerve |
Abdominal reflex | T6-L1, lateral to medial scratching of skin to umbilicus in each of 4 quadrants should cause deviation of umbilicus to stimulus |
Cremasteric reflex | L1-L2, stroking of skin on inner thigh elevates testicle, lost in SCI and Corticospinal lesions |
Sources of fatigue | CNS/central fatigue, neural/myoneural fatigue, muscle contractile failure |
CNS/Central fatigue | in MS, ALS, CFS |
Neural/myoneural junction fatigue | MS, Post Polio syndrome, GBS, myasthenia gravis |
Muscle contractile failure fatigue | metabolic changes at muscle, muscular dystrophies |
Extrapyramidal disorders (basal ganglia dysfunction) | Tics, Chorea, athetosis, tremors, myoclonus |
Tics | spasmodic contractions of specific muscles |
Chorea | relatively quick twitches or dancing movments |
Athetosis | slow, irregular, twisting movements, esp in UEs |
Tremor | continuous quivering mvmt, rhythmic, oscillatory observed at rest |
Myoclonus | single, quick jerk |
Cerebellar disorders cause | intention tremors |
Cortical disorders cause | seizures, tonic/clonic convulsive mvmts |
Dyssynergia | impaired ability to associate muscles together for complex mvmt |
Dysmetria | impaired ability to judge distance or range of movement |
Dysdiadochokinesia | impaired ability to perform rapid alternating movements |
Created by:
Jenwithonen
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