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NBCOT: Neuro
Neurological System Disorders
| Question | Answer |
|---|---|
| What are the functions of the frontal lobe? | -Precentral gyrus: primary motor cortex for voluntary muscle activation -Prefrontal cortex: controls emotions, judgments -Premotor cortex related to planning of movements including Broca's area: controls motor aspects of speech |
| What are the functions of the parietal lobe? | -Postcentral gyrus: primary sensory cortex for integration of sensation -Receives fibers conveying touch, proprioceptive, pain, & temp. sensations from opposite side of body |
| What are the functions of the temporal lobe? | -Primary auditory cortex: receives/processes auditory stimuli -Associative auditory cortex: processes auditory stimuli -Wernicke's area: language comprehension |
| What are the functions of the occipital lobe? | -Primary visual cortex: receives/processes visual stimuli -Visual association cortex: processes visual stimuli |
| What is the function of the insula? | Visceral functions |
| What are the parts & functions of the limbic system? | -Parts: hippocampal formation, amygdaloid nucleus, hypothalamus, anterior nucleus of thalamus, limbic lobe -Instincts & emotions contributing to preservation of the individual -Basic functions of feeding, aggression, emotions, & sexual reponse |
| What is the function of the basal ganglia? | -caudate loop functions in association w/ formation cortex in formation of motor plans -putamen loop functions in association w/ sensorimotor cortex to scale and adjust movements |
| What is the function of the thalamus? | -sensory nuclei integrate & relay sensory info from body, face, retina, cochlea, & taste receptors to cerebral cortex & subcortical regions -motor nuclei relay motor info from cerebellum & globus pallidus to precentral motor cortex |
| What is the function of the subthalamus? | involved in control of several functional pathways for sensory, motor, & reticular function |
| What is the function of the hypothalamus? | -integrates & controls functions of autonomic nervous systen & neuroendocrine system -maintains body homeostasis: regulates body temp., eating, water balance, anterior pituitary function/sexual behavior, & emotion |
| What is the function of the epithalamus? | -integrate olfactory, visceral, & somatic afferent pathways -pineal gland secretes hormones that influence pituitary gland & several other organs, influences circadian rhythm |
| What is the function of the tegmentum (part of midbrain)? | origin for rubrospinal tract, important for coordination |
| What is the function of the substantia nigra (part of midbrain)? | large motor nucleus important in motor control & muscle tone |
| What is the function of the superior colliculus (part of midbrain)? | important relay station for vision & visual reflexes |
| What is the function of the inferior colliculus (part of midbrain)? | important relay station for hearing & auditory reflexes |
| What is the function of the periaqueductal gray (part of midbrain)? | contains endorphin-producing cells (important for suppression of pain) & descending autonomic tracts |
| What is the function of the pons? | -midline raphe nuclei project widely and are important for modulating pain & controlling arousal |
| What is the function of the medulla oblongata? | -important for control of head movements & gaze stabilization (vestibulo-ocular reflex) -- medial longitudinal fasciculus -contains important centers for vital functions: cardiac, respiratory, & vasomotor centers |
| What is the function of the cerebellum? | -equilibrium & regulation of muscle tone -modifying muscle tone & synergistic actions of muscles, maintenance of posture & voluntary movement control -smooth coordination of voluntary movements |
| How many segments in each part of the spinal cord? | -cervical: 8 -thoracic: 12 -lumbar: 5 -sacral: 5 -a few coccygeal segments |
| Anterior horn cell bodies give rise to what kind of neuron? | efferent (motor) neurons |
| Posterior horn cell bodies give rise to what kind of neuron? | afferent (sensory) neurons |
| What is the function of the dorsal columns/medial lemniscal system? | proprioception, vibration, & tactile discrimination |
| What is the function of the spinothalamic tracts? | sensations of pain & temperature, crude touch |
| What is the function of the spinocerebellar tracts? | proprioception information for control of voluntary movements |
| What is the function of the spinoreticular tracts? | convey deep & chronic pain |
| What is the function of the corticospinal tracts? | important for voluntary motor control |
| What is the function of the vestibulospinal tracts? | important for control of muscle tone, antigravity muscles, and postural reflexes |
| What is the function of the rubrospinal tracts? | assists in motor function |
| What is the function of the reticulospinal system? | modifies transmission of sensation, especially pain, & influences gamma motor neurons & spinal reflexes |
| What is the function of the tectospinal tract? | assists in head turning responses in response to visual stimuli |
| What is the function of the autonomic nervous system? | -innervations of involuntary structures (smooth muscle, heart, glands), helps maintain homeostasis |
| What is the function of the sympathetic division of the autonomic nervous system? | prepares body for fight or flight, emergency responses, raises heart rate and blood pressure, constricts peripheral blood vessels and redistributes blood, inhibits peristalsis |
| What is the function of the parasympathetic division of the autonomic nervous system? | conserves & restores homeostasis, slows heart rate & reduces blood pressure, increases peristalsis & glandular activity |
| What are structures in the lower motor neuron system? | cell bodies in anterior horn of spinal cord, spinal nerves, the cranial nerve fibers that travel to target muscles |
| What are the symptoms of a lower motor neuron lesion? | Flaccidity, decreased or absent deep tendon reflexes, atrophy |
| What are the structures in the upper motor neuron system? | any nerve cell body or nerve fiber in the spinal cord (except anterior horn cells), all superior structures (gray & white matter affecting motor function & descending nerve tracts), cranial nerve nuclei |
| What are the symptoms of an upper motor neuron lesion? | increased deep tendon reflexes, spasticity, clonus, emergence of primitive reflexes including Babinski's sign, exaggerated cutaneous reflexes, autonomic dysreflexia, flaccidity may occur at the level of the lesion |
| What is the function of involuntary reflexes? | provide basis for unconscious motor function & basic defense mechanisms |
| What is the function of stretch reflexes? | functions to maintain muscle tone, support agonist muscle contraction, & to provide feedback about muscle length |
| What is the function of inverse stretch reflexes? | functions to provide agonist inhibition, diminution of force of agonist contraction |
| What is the function of flexor (withdrawal) reflexes? | functions as a protective withdrawal mechanism to remove body part from harmful stimuli |
| What is the function of the reflex arc? | coordinates reciprocal limb activities such as gait |
| What is a transient ischemic attack (TIA)? | stroke that only lasts a few minutes, occurs when blood supply to part of brain is briefly interrupted |
| What are the symptoms of a transient ischemic attack (TIA)? | -numbness or weakness in face, arm, or leg, especially on 1 side of body, confusion/difficulty w/ talking or understanding speech, trouble seeing in 1/both eyes, dizziness or loss of balance/coordination -person @ risk for more serious stroke |
| What are symptoms of stroke involving the middle cerebral artery (MCA)? | -contralateral hemiplegia -hemianesthesia -homonymous hemianopsia -aphasia -apraxia |
| What are the symptoms of stroke involving the internal carotid artery (ICA)? | -contralateral hemiplegia -hemianesthesia -homonymous hemianopsia -aphasia -apraxia |
| What are the symptoms of stroke involving the anterior cerebral artery (ACA)? | -contralateral hemiplegia -grasp reflex -incontinence -confusion -apathy -mutism |
| What are the symptoms of stroke involving the posterior cerebral artery (PCA)? | -homonymous hemianopsia -thalamic pain -hemi-sensory loss -alexia |
| What are the symptoms of stroke involving the vertebrobasilar system? | -pseudobulbar signs: dysarthria, dysphagia, emotional instability -tetraplegia |
| What are modifiable risk factors of CVA? | hypertension, cardiac disease, atrial fibrillation, diabetes, smoking, alcohol abuse, hyperlipidemia |
| What are nonmodifiable risk factors of CVA? | age (risk increases with age), gender (males @ higher risk), race (African American & Latino @ greater risk), heredity |
| What is affected from a left hemisphere CVA? | movement of R side of body, processing of sensory info from R side, visual reception from R field, visual verbal processing, bilateral motor praxis, verbal memory, bilateral auditory reception, speech, processing of verbal auditory info |
| What is affected from a right hemisphere CVA? | L side movement, L side processing sensory info, L field visual reception, visual spatial processing, L motor praxis, nonverbal memory, attn. to incoming stimuli, emotion, processing of nonverbal auditory info, interp. of abstract info & tonal inflections |
| What are general symptoms of a TBI? | -hemiplegia or monoplegia & abnormal reflexes -decorticate or decrebrate rigidity -fixed pupils -coma -changes in vital signs |
| What are the values for minor, moderate, & severe on the Glasgow Coma Score scale? | -Minor: Greater than 13 -Moderate: 9-12 -Severe: Less than 8 |
| What are levels of best eye response on Glasgow Coma Score scale? | -4: eyes open spontaneously -3: eyes open to speech -2: eyes open in response to pain -1: no eye opening |
| What are levels of best verbal response on Glasgow Coma Score scale? | -5: oriented -4: confused (some disorientation, confusion) -3: inappropriate (exclamatory speech, not conversational) -2: incomprehensible sounds (moaning, no words) -1: none |
| What are levels of best motor response on Glasgow Coma Score scale? | -6: obeys commands -5: localizes to pain (purposeful movements towards changing painful stimuli) -4: withdraws from pain -3: flexion in response to pain (decorticate response) -2: extension to pain (decerebrate response) -1: none |
| What does A mean on the ASIA Impairment Scale? | complete, no sensory or motor function is preserved in sacral segments S4-S5 |
| What does B mean on the ASIA Impairment Scale? | incomplete, sensory but no motor function is preserved below the neurological level & extends through sacral segments |
| What does C mean on the ASIA Impairment Scale? | incomplete, motor function is preserved below the neurological level, & majority of key muscle groups below neurological level have a muscle grade less than 3/5 |
| What does D mean on the ASIA Impairment Scale? | incomplete, motor function is preserved below neurological level, & majority of key muscle groups below level have muscle grade greater than or equal to 3/5 |
| What does E mean on the ASIA Impairment Scale? | normal, sensory & motor function are normal |
| What is central cord syndrome? | resulting from hyperextension injuries & presenting as more upper extremity deficits vs. lower extremities |
| What is Brown-Sequard syndrome? | Hemi-section of cord resulting in: -ipsilateral: spastic paralysis, loss of position sense, loss of discriminative touch -contralateral: loss of pain, loss of thermal sense |
| What is anterior cord syndrome? | caused by flexion injuries; motor function, pain & temp sensation are lost bilaterally below lesion |
| What is conus medullaris syndrome? | injury of sacral cord & lumbar nerve roots resulting in lower extremity motor & sensory loss and a reflexic bowel & bladder |
| What is cauda equina syndrome? | injury at L1 level & below resulting in LMN lesion-- flaccid paralysis with no spinal reflex activity |
| What is orthostatic hypotension? | an excessive fall in blood pressure upon assuming upright position |
| What is autonomic dysreflexia? | an abnormal response to noxious stimulus that results in extreme rise in BP, pounding headache, & profuse sweating. deemed medical emergency if not reversed by removing irritating stimulus quickly |
| What are characteristics of Rancho Level 1? | no response - total assistance: complete absence of observable change in behavior when presented with visual, auditory, proprioceptive, vestibular, painful stimuli |
| What are characteristics of Rancho Level 2? | generalized response - total assistance: generalized reflex response to painful stimuli, response to repeated auditory stimuli w/ change in activity, response to external stimuli w/ physiologic changes generalized, responses may be similar & delayed |
| What are characteristics of Rancho Level 3? | localized response - total assistance: demonstrates withdrawal/vocalization to painful stimuli, turns to/away from auditory stim., blinks to strong light & follows moving object w/ eyes, responds to discomfort, may respond to some persons |
| What are characteristics of Rancho Level 4? | confused/agitated- maximal assistance: alert/heightened activity state, purposeful attempts to remove restraints/crawl out of bed, absent short-term memory, aggressive behavior, incoherent/inappropriate verbalizations, performs motor acts (sit, walk) |
| What are characteristics of Rancho Level 5? | confused, inappropriate non-agitated- max assist: alert, not oriented, may do previously learned tasks w/ cues, no learning, simple commands w/ cues, brief converse w/ cues (inappropriate w/out cues) |
| What are characteristics of Rancho Level 6? | confused, appropriate-mod assist: inconsist. orient, attend to familiar tasks for 30 min, remote>recent memory, mod. assist to solve probs to complete task, supervision for familiar tasks, max assist for new learning, unaware of impairments, safety risks |
| What are characteristics of Rancho Level 7? | automatic, appropriate- min assist for ADL: consistently orient to person & place, min. supervise for new learning, carry over of new learning, monitors accuracy, superficial awareness of condition, min. supervise for safety, unaware of others' feelings |
| What are characteristics of Rancho Level 8? | purposeful, appropriate-standby assist: consistently orient, 1 hr attn to familiar tasks, uses assistive mem. devices to recall daily schedule, standby assist for regular routines, no assist with learned activities, aware of impairments |
| What are characteristics of Rancho Level 9? | purposeful, appropriate- standby assist on request: 2 hr attn shifting btw tasks, uses assistive mem devices, initiates tasks, aware of impairments & takes corrective action, thinks about consequences of actions, acknowledges others' feelings |
| What are characteristics of Rancho Level 10? | purposeful, appropriate- mod. ind: does multiple tasks w/ breaks, creates own mem devices, ind. completes tasks may need more time, anticipates impact of impairments, acts to avoid probs b4 they occur, accurately estimates abilities, good social interact. |
| What is pyramidal CP? | spastic CP: increased muscle tone that make limbs stiff & rigid, involves upper motor neurons |
| What is extrapyramidal CP? | non-spastic CP: decreased and/or fluctuating muscle tone, may have intention tremor, involuntary movements |
| What is athetoid CP? | CP that includes cases of involuntary movement, especially in arms, legs, & hands |
| What is dystonia CP? | CP that affects the trunk muscles more than the muscles of the limbs and results in fixed, twisted posture |
| What is a dyskinesia? | involuntary, nonrepetitive, but occasionally stereotyped movements affecting distal, proximal, & axial musculature in varying combos. most dyskinesias are representative of basal ganglia disorders |
| What is chorea? | brief, purposeless, involuntary movements of distal extremities & face. usually considered to be a manifestation of dopaminergic overactivity in basal ganglia |
| What disease begins w/ resting "pill-rolling" tremor of one hand? | Parkinsons |
| What are key signs of Parkinsons? | tremor, rigidity, resistance to passive motion that isn't velocity dependent, akinesia, postural instability, festinating gait, falling backwards or forwards, mask face, micrographia |
| What is typical in diagnosis of Parkinsons? | degeneration in dopaminergic pathways in basal ganglia, primarily in substantia nigra |
| What stage in Parkinsons? Symptoms: unilateral tremor, rigidity, akinesia, minimal/no functional impairment | Stage I |
| What stage in Parkinsons? Symptoms: bilateral tremor, ridigity or akinesia, w/ or w/out axial signs, independent w/ ADL, no balance impairment | Stage II |
| What stage in Parkinsons? Symptoms: worsening of symptoms, first signs of impaired righting reflexes, onset of disability in ADL performance, can lead independent life | Stage III |
| What stage in Parkinsons? Symptoms: requires help with some or all ADLs, unable to live alone without some assistance, able to walk and stand unaided | Stage IV |
| What stage in Parkinsons? Symptoms: confined to a wheelchair or bed, maximally assisted | Stage V |
| What are medications used to manage Parkinsons? | Levodoba (metabolic precursor of dopamine), Sinemet, dopamine agonists, anticholinergics for rigidity & tremors, dopamine releasers |
| What are the side effects of medications used to manage Parkinsons? | -early treatment: no major problems -during progression of disease: drugs work less evenly/predictably- involuntary movements (dyskinesia), dose is effective for less time, hallucinations, drop in BP, nausea |
| What are the characteristics of spina bifida occulta? | a bony malformation w/ separation of vertebral arches or one or more vertebrae w/ no external manifestations- usually doesn't result in symptoms-occasional slight instability & neuromuscular impairments, such as mild gait involvement & bowel/bladder probs |
| What is an occult spinal dysraphism (OSD)? | when external manifestations, such as red birthmark, patch of hair, dermal sinus, fatty benign tumor, or dimple covering the site are present- may result in SC being split/tied down, may lead to neuro. damage & developmental abnormality as child grows |
| What are the characteristics of spina bifida w/ meningocele? | protrusion of sac through spine, containing cerebral spinal fluid & meninges; however, doesn't include spinal cord- usually no symptoms impacting funciton, may display slight instability/neuromuscular impair. (mild gait involvement, bowel & bladder probs) |
| What are the characteristics of spina bifida w/ myelomeningocele? | protrusion of a sac through the spine, containing cerebral spinal fluid & meninges as well as the spinal cord or nerve roots- sensory & motor deficits below level of lesion, may results in LE paralysis and/or deformities, and bowel & bladder incontinence |
| What level of myelomeningocele results in bowel/bladder problems? | S2-S4; neurogenic bladder impacts sensation to urinate, control of urinary sphincter, ability to empty bladder completely, constipation & incontinence |
| What are the symptoms of a blocked shunt? | -1st year: extreme head growth & soft spot on forehead -After: severe headache, vomiting, and/or irritability -Intracranial pressure can possibly lead to: vision impairment, seizure disorders & deterioration of physical/cognitive functioning |
| What are the symptoms of an infected shunt? | vomiting, lethargy, and/or fever, seizures & deterioration of physical and/or cognitive functioning |
| What do you do if you suspect a blocked or infected shunt? | immediate notification of child's neurosurgeon |
| What confirms diagnosis of muscular dystrophy & what are common symptoms? | -diagnosis: blood tests demonstrate high elevated level of creatine kinase (CK) -symptoms: hypotonia, muscle weakness, atrophy |
| What are symptoms of Duchenne's muscular dystrophy? | -enlargement of calf, forearm & thigh muscles -weakness of proximal jts.- child has to crawl up thighs w/ hands to stand from kneeling position (Gower's sign) -weakness in voluntary muscles, incl. heart & diaphragm -indivs rarely survive past 20 |
| What is arthrogryposis multiplex congenita? | -detected @ birth, loss of anterior horn cells -weakness, deformities, & associated jt. contractures -int. rotation of shoulders, extension of elbows, flexion of wrists, flexion & int. rotation of hips & clubfeet |
| What is limb-girdle muscular dystrophy? | proximal muscles of pelvis & shoulder are initially affected, progresses slowly |
| What is fascioscapulohumeral muscular dystrophy? | -occurs in early adolescence -involves face, upper arms, scapular region, causing masking & decreased mobility of face & inability to lift arms above shoulder level |
| What is spinal muscular atrophy? | -infantile form known as Wednig-Hoffman disease, has life expectancy of ~2yrs. -Intermediate form is detected 6mos-3yrs & progresses rapidly w/ life expectancy of early childhood |
| What is congenital myasthenia gravis? | -disorder involving transmission of impulses in neuromuscular junction -onset starting near birth |
| What is Charcot-Marie-Tooth disease? | -disease involving peripheral nerves marked by progressive weakness, primarily in-peroneal & distal leg muscles -typically occurs in teenage years |
| What are specific symptoms of muscular dystrophies? | -low muscle tone & weakness, abnormal movement patterns & delayed developmental milestones -difficulty w/ oral motor feeding -weakness contributes to deformities of extremities & spine -difficulty w/ breathing |
| What is progressive supranuclear palsy? | manifested by loss of voluntary, but preservation of reflexive eye movements, bradykinesia, rigidity, axial dystonia, pseudobulbar palsy, & dementia |
| What is Huntington's chorea? | -characterized by choreiform movements & progressive intellectual deterioration -psychiatric disturbance- personality change, manic-depressive symptoms, & schizophreniform illness- may precede onset of movement disorder |
| What are cerebellar/spinocerebellar disorders? | characterized by ataxia, dysmetria, dysdiadochokinesia, hypotonia, movement decomposition tremor, dysarthria, & nystagmus |
| What are spinocerebellar disorders? | characterized by progressive ataxia due to degeneration of cerebellum, brain stem, spinal cord, peripheral nerves, & basal ganglia |
| What is Friedrich's ataxia? | gait unsteadiness, UE ataxia, dysarthria, tremor may be minor feature, areflexia & loss of large fiber sensory modalities, as disease progresses scoliosis & cardiomyopathy are common |
| What is ALS? | -motor neuron disease characterized by progressive degeneration of corticospinal tracts & anterior horn cells or bulbar efferent neurons |
| What are the symptoms of ALS? | -muscle weakness & atrophy, evidence of anterior horn cell destruction, begins distally & asymmetrically -cramps & fasciculations precede weakness -signs usually begin in hands -spasticity, hyperactive deep tendon reflexes -dystarthria & dysphagia |
| What is Erb's palsy? | paralysis of upper brachial plexus including 5th & 6th cervical nerves -muscles most often affected: supraspinatus & infraspinatus, deltoid, biceps, brachialis, subscapularis -arm can't be raised, weak elbow flexion, pro/retraction of scapula |
| What is the typical presentation of Erb's palsy? | waiter's tip position- arm straight & wrist fully bent |
| What is Klumpke's palsy? | paralysis of lower brachial plexus including 7th & 8th cervical & 1st thoracic nerves -results in paralysis of hand & wrist, often w/ ipsilateral Horner's syndrome (miosis, ptosis, facial anhidrosis) -hand limp, fingers don't move |
| What is Guillain-Barre syndrome? | acute, rapidly progressive form of polyneuropathy - symmetric muscular weakness & mild distal sensory loss/paresthesias -@ 1st more prominent distally -painful extremities, deep tendon reflexes lost, sphincters spared -onset of recovery: 2-4 wks |
| What is myasthenia gravis? | usually a progressive disabling process--autoimmune attack on acetylcholine receptor of postsynaptic neuromuscular junction |
| What are the symptoms of myasthenia gravis? | -episodic weakness -ptosis, diplopia, muscle fatigue after exercise, dysarthria, dysphagia, proximal limb weakness -life threatening respiratory muscle involvement may occur -sensation, deep tendon reflexes intact |
| What is multiple sclerosis (MS)? | slowly progressive CNS disease characterized by patches of demyelination in brain & SC |
| What are symptoms of MS? | multiple & varied neurologic symptoms & signs, paresthesias, weakness in leg/hand, visual disturbance, emotional disturbance, bladder dysfunction, memory loss, inattention, lack of judgment, easy fatigue, spasticity, ataxia, weakness, gait instability |
| What are the symptoms of complex regional pain syndrome type I? | -abnormal burning pain -hypersensitivity to light touch -sympathetic hyperfunction (coldness, sweating) -usually associated w/ traumatic injury |
| What is complex regional pain syndrome type II? | pain occurring along branches of a nerve (frequently sudden) |
| What are conditions in which seizures are often associated? | severe head injuries or brain hemorrhage, CP, hydrocephalus, metabolic disorders, infections, meningitis, encephalitis, congenital infections, rubella |
| What are tonic-clonic seizures/grand mal seizures? | -brief warning: numbness, taste, smell, other sensation -tonic phase: loss of consciousness, stiffening of body, heavy/irregular breathing, drooling, skin pallor, bowel/bladder incontinence -Clonic phase: alternating rigidity/relaxation of muscles |
| What are myoclonic-akinetic seizures? | brief, involuntary jerking of extremities, with or without loss of consciousness -difficult to control -akinetic seizures include loss of tone |
| What are simple partial focal seizures? | -abnormal electrical impulses occur in localized area of brain -involuntary, repetitive jerking of left hand & arm occurs, but indiv. can maintain interaction w/ environ. -may become generalized, result in loss of consciousness |
| What are the first aid procedures for someone during a seizure? | -remove dangers objects & protect indiv. from harm (do not disrupt indivs movements) -If person is standing, guide them to floor & loosen clothes -turn indiv. to side -use standard rescue breathing techniques if indiv.'s breathing stops |
| What is involved in post-seizure care? | -allow individual to rest or sleep -call doctor if 1st seizure, seizure is followed by another, or seizure lasts for more than 5 mins. |
Created by:
Jbardenw