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H&P Unit II exam
H&P Ii-Spring 2012
| Question | Answer |
|---|---|
| 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
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