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What makes up the CNS?
brain and spinal cord
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What makes up PNS?
cranial nerves and spinal nerves
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How many pairs of cranial nerves are there? Spinal nerves?
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Name the meningeal layers and spaces from superficial to deep.
- (skull)
- epidural space
- dura
- subdural space
- arachnoid
- subarachnoid space
- pia mater
*pia = faithful (like pious). This layer faithfully follows all the contours of the brain b/c it's the closest to it.
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Where do the high functions of the brain take place?
examples of high functions?
cerebral cortex
high fx: thought, memory, reasoning, sensation, voluntary mvmts
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name the 4 lobes of each brain hemisphere
- frontal
- parietal
- occipital
- temporal
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which lobe is responsible for personality, behaviors, emotions, and intellect
frontal
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where is the motor cortex? what does it do?
frontal lobe, precentral gyrus.
responsible for voluntary skeletal muscle mvmt and fine repetitive mvmt
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where is broca's area? which type of aphasia results if it is damaged?
frontal lobe of dominant hemi. results in expressive aphasia - can't articulate words (talk), but can write
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where is the sensory cortex?
parietal lobe, postcentral gyrus
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which lobe is responsible for vision?
occipital
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what does the temporal lobe control?
- interpretation of sound
- balance
- integration of taste and smell
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where is wernicke's area? which type of aphasia results if damaged?
temporal lobe
receptive aphasia - can understand sounds, but can read
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increased muscle tone (rigidity), ataxia, and bradykinesia result form damage to what part of the NS?
basal ganglia (the gray matter lying deep in brain)
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what disease effects basal ganglia?
parkinson's
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the thalamus and hypothalamus make up which brain structure?
diencephalon
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what does the hypothalamus regulate?
- temperature
- sleep
- anterior and posterior pituitary
- coordination of ANS activity
- emotional status
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name the 3 components of the brain stem
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what is pyramidal decussation? where does it occur?
crossing of motor fibers from one side of the body to other.
occurs in medulla
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from where do most cranial nerves originate?
brain stem
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from where does CN1 originate?
brain
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from where does CN2 originate?
diencephalon
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which cranial nerves originate in the midbrain?
CN3-4
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which cranial nerves originate in the pons?
CN5-8
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which cranial nerves originate in the medulla?
CN9-12
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where is the autonomic center? what does it control?
medulla. controls respiration, heart, GI fx
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which part of the brain coordinates mvmts and maintains equilibrium, posture, and muscle tone?
cerebellum
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damage to which part of the brain would result in problems with gait and decreased muscle tone?
cerebellum
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cerebral artery blockage will cause permanent brain damage if not treated with thrombolytics within how much time?
4 hrs
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trace sensation from stimulus to brain
afferent fibers in peripheral nerves --> enters spinal cord thru dorsal/posterior root --> up spinal cord to brain stem --> pyramidal decussation and travels to thalamus --> sensory cortex
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spinothalamic track conducts sensation of:
- pain
- crude/light touch
- temp
- deep pressure
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posterior columns conduct sensation of what?
- position
- vibration
- deep pressure
- fine touch
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give 3 examples of fine touch
- stereognosis
- graphesthesia
- 2-point discrimination
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which motor tract relays voluntary mvmt?
corticospinal / pyramidal
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trace motor impulse from brain to LMN
motor cortex --> brain stem --> pyramidal decussation (cross to other side of brain stem) --> down spinal cord until synapses with LMN contained in the spinal cord
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which motor tract is controlled by basal ganglia?
extrapyramidal
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trace path of motor impulse from brain to spinal cord
motor cortex --> basal ganglia --> brain stem --> spinal cord
NO DECUSSATION
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which part of the NS controls DTRs?
spinal cord
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name anatomical landmarks for beginning and end of spinal cord
- begins at foramen magnum of skull
- ends at L1-2 of vertebral column
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name the 2 functional parts of the cranial and spinal nerves
- somatic fibers - innervated skeletal/voluntary mm
- autonomic fibers - innervate involuntary mm and glands
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name the 12 cranial nerves
handy pneumonic, courtesy of Chelsea: Oh, Oh, Oh, to take a family vacation, go Vegas after hours.
- Olfactory
- Optic
- Oculomotor
- Trochlear
- Trigeminal
- Abducens
- Facial
- Vestibular/Acoustic
- Glossopharyngeal
- Vagas
- Accessory (spinal accessory)
- Hypoglossal
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Name how many of each spinal nerve pairs exit at each vertebral level. Ex: cervical, thoracic, etc.
- Cervical - 8
- Thoracic - 12
- Lumbar - 5
- Sacral - 5
- Coccygeal -1
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motor fibers exit the spinal cord thru where? sensory fibers enter thru where?
- motor exit: ventral
- senSORy enter: dORSal
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what's a dermatome?
a circumscribed area supplied by mainly one spinal cord segment
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give 2 exmaples of LMN diseases
- myesthenia gravis
- Guillian-Barre
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give 2 examples from notes of UMN disease
CVA, multiple sclerosis
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paresis vs. paralysis
- paresis is slight paralysis/weakness
- paralysis is complete loss of motor fx
both are motor sx
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define dysphagia
difficulty swallowing
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define dysphasia
difficulty speaking
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PMH pertinent to neuro exam
- CVA
- SCI (spinal cord injury)
- meningitis
- congenital defect
- ETOHism
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what score is used to measure birth trauma in children?
APGAR score
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define micturition syncope
when male faints while urinating d/t decreased cerebral blood flow
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what is the exam sequence for the objective portion of a neuro exam?
- mental status
- cranial nerves
- motor/cerebellar fx
- sensory system
- reflexes
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define anosmia. which CN is involved?
loss of sense of smell. involves CN1 - olfactory
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name 3 tests used to test CN2
CN2: optic
- Snellen - tests visual acuity
- confrontation - tests visual fields
- fundoscopic exam
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which 2 CNs are involved in PERRLA? which is afferent? efferent?
- CN2: optic - afferent
- CN3: oculomotor - efferent
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which CN is responsible for ptosis? what would you observe in a pt with ptosis?
- CN3: oculomotor
- ptosis = unequal palpebral fissures
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what eye mvmts do CN3, 4, and 6 control? how do you assess them?
- 3 (oculomotor): most eye mvmts
- 4 (trochlear): down and inward eye mvmts, controls superior oblique muscle
- 6 (abducens): lateral eye mvmt
assess with EOMs, look for nystagmus
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which CN is responsible for sweet and salt taste on the anterior 2/3 of the tongue?
facial / 7
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which CN is responsible for innervating the muscles involved in chewing? which muscles are they?
CN 5 / trigeminal
mm: temporal, masseter
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where are the 3 zones of sensation that the trigeminal nerve is responsible for? how do we test them?
- ophthalmic
- maxillary
- mandibular
test with light touch (cotton wisp) to forehead, cheeks, and chin
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which CN is responsible for facial mvmts and expression
facial / 7
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which CNs are responsible for the blink reflex? what is another name for this reflex?
blink reflex aka corneal reflex
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how do we test CN8
- whisper test
- Weber
- Rinne
- Romberg
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which CN is responsible for sour and bitter taste on the posterior 1/3 of tongue?
CN9 / glossopharyngeal
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which CN is responsible for shoulder strength?
CN 11 / spinal accessory
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how do we assess CN 9 and 10 fx?
- say "ahhh," look for soft palate rise
- gag reflex
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which CNs are responsible for talking and swallowing?
CN9 and 10 / glossopharyngeal and vagus
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how do we assess CN12?
assess tongue posn, looking for deviation towards paralyzed side
test tongue strength against cheek resistance
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what does Romberg's test assess? how do you do it?
assesses balance, CN8 fx
stand with feet together, eyes closed for 20sec. positive test if pt takes a step.
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name 4 tests to assess upper extremity coordination
- RAMs
- thumb to each finger
- finger-to-finger (pt's to examiner's)
- finger-to-nose with eyes closed
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how do you assess muscle tone?
check resistant to passive muscle stretching (e.g., flex and extend arm)
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name 2 ways to assess lower extremity coordination
- tap feet on floor repeatedly
- heel-to-shin test
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what's the best way to test for peripheral neuropathy? for which population is this especially important?
use monofilament (10gm)
muy importante for diabetics
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when assessing pain sensation of the spinothalamic tract, why wait 2 sec b/w each check?
<2 sec will lead to summation of stimuli that will be perceived as one
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define analgesia
no pain perception
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how do you assess the deep pressure sensation of the spinothalamic tract?
squeeze trap, calf, or biceps
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which type of sensation is usually lost first with peripheral neuropathy? how do we test for it?
vibration
test with tuning fork at DIP of fingers and big toes
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what is kinesthesia? how do you assess for it?
positional awareness
move finger or toe up or down and ask pt to ID position
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what is astereognosis?
the inability to recognize objects by feel
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what is graphesthesia?
the ability to read a letter or number traced on the skin
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where on the body is 2-point discrimination most sensitive?
fingers
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simultaneously touching both sides of the body in the same location tests for what?
sensory extinction. if only felt unilaterally, extinction has occurred.
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name the 5 examples of fine touch sensation
- sterognosis
- graphesthesia
- 2-point discrimination
- extinction
- point location
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trace the DTR pathway
begins at sensory / afferent nerve --> synapses at spinal cord --> motor / efferent nerve --> neuromuscular junction (consists of nerve dendrite and muscle spindles --> ends with functioning muscle response
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what does the neuromuscular junction consist of?
nerve dendrites and muscle spindles
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what do DTRs reveal about the spinal cord?
its intactness at specific levels
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describe reflex grading scale
- 4+ hyperactive
- 3+ above avg
- 2+ normal
- 1+ low normal
- 0 absent
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with CVAs, you expect to see what kind of reflexes (hyper/hypo/normal)? why?
hyperreflexia - seen with UMN lesions.
normally reflexes or modulated by high cortical inhibition in the brain, but when brain is damaged, this inhibition is lost and reflex is hyperactive
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with SCIs, you expect to see what kind of reflexes (hyper/hypo/normal)?
hyporeflexia
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incomplete quadriplegia is seen with spinal cord injuries below what level?
incomplete below C6, complete above C6
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which spinal nerves are involved in the brachioradialis DTR?
C5-6
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which spinal nerves are involved in the biceps DTR?
C5-6
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which spinal nerves are involved in the triceps DTR?
C6-8
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which spinal nerves are involved in the quadriceps / patellar DTR?
L2-4
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which spinal nerves are involved in the achilles DTR?
S1-2 (according to notes, book includes L5)
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name the 4 superficial reflexes listed in the notes
- upper abd
- lower abd
- cremasteric
- plantar reflex / babinski
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which spinal nerves are involved in the upper abd reflex?
T7-9
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which spinal nerves are involved in the lower abd reflex?
T10-11
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which spinal nerves are involved in the cremasteric reflex?
T12-L2
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how do you assess the cremasteric reflex?
stroke inner thigh of male, testicle and scrotum should rise
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which spinal nerves are involved in the plantar reflex? what's another name for this reflex?
babinski
L4-S2
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for what population is a positive babinski abnormal? what would you see with a positive test?
abnormal in adults. normal in kids <2 y/o.
dorsiflexion of big toe and fanning of other toes when stroking lateral aspect of sole of foot
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which 3 factors does the glasgow coma scale use to assess LOC?
- eye opening
- verbal response
- motor response
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what's the name for a herniation of the brainstem? what would happen if this caused pressue on CN3
uncal herniation
pressure on CN3 - would see unilateral, dilated, and nonreactive pupil
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VS changes are an early or late sign of ^ ICP? what changes would you see?
late
- increased SBP with widening pulse pressure (pulse pressure = SBP - DBP)
- decreased HR
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what is nuchal rigidity? what is it a sign of?
extremely stiff neck.
sign of meningeal irritation
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what is prolonged arching of the back with head and knees bent backward called?
opisthotonos
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what is decorticate position? damage to which part of the NS would cause this?
flexor posturing, with arms brought to core of the body, look like a mummy
damage to cerebral cortex
CORtex --> arms to CORE of body
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what is decerebrate position? damage to what part of the NS would cause it?
extensor posturing, with extended arms and LEs
damage to brain stem
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what is dyskinesia? for what population is it common?
repetitive mvmt in jaw, lips, or tongue.
seen in older adults
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