What area of the brain houses the higher mental functions and is responsible for general movement, visceral functions, perception, behavior and integration of these functions.
A. Corpus callosum
B. Cerebellar
C. Cerebrum
D. Brainstem
C. cerebrum
Cerebellar - integration of voluntary movement, process sensory information from eyes, ears, touch receptors and m/s
Brainstem - The 12 cranial nerves arise from this part of the brain that controls involuntary functions.
The 12 cranial nerves arise from this part of the brain that controls involuntary functions.
A. Autonomic nervous system
B. Cerebellar
C. Cerebrum
D. Brainstem
D. Brainstem
Cerebellar - integration of voluntary movement, process sensory information from eyes, ears, touch receptors and m/s
Cerebrum - houses higher mental functions, responsible for general movement, visceral functions, perception, behavior and int
Name the 12 cranial nerves and whether they are sensory, motor or both
I - olfactory - sensory
II - optic - sensory
III - oculomotor - motor
IV - trochlear - motor
V - trigeminal - sensory and motor
VI - abducens - motor
VII - facial - sensory and motor
VIII - Acoustic - sensory
IX - Glossopharyngeal - sensory and motor
X -
Permanent paralysis is a result of injury in which motor neurons?
A. Upper motor neurons
B. Lower motor neurons
B. Lower motor neurons
Upper motor neurons - initial paralysis followed by partial recovery
Any intruding event (infection, biochemical imbalance or trauma) to the brain during the first year can result in profound effects because the major portion of brain growth occurs? T/F
True
Older adults experience a decrease/increase in the number of cerebral neurons, this is not necessarily associated with deteriorating mental function.
Decrease
Risk factors for stroke (brain attack or cerebrovascular accident)?
Hypertension
Obesity
Secondary lifestyle
Smoking
Stress
Increased levels of serum cholesterol, lipoproteins and triglycerides
Oral contraceptives
Sickle cell anemia
Family history: diabetes, CV disease, HTN, hyperlipidemia
Congenital cerebrovascular anoma
Visual acuity and visual fields are testing what cranial nerve?
A. I
B. II
C. III
D. IV
B. Cranial nerve II - Optic
Cranial nerve I - Olfactory - not routinely tasted
Cranial nerve III - oculomotor - tests eye movements
Cranial nerve IV - trochlear - ocular movements
What three cranial nerves are tested together by the six cardinal points of gaze, pupil size, shape, response to light and accommodation, and opening of the upper eyelids?
A. II, III, VI
B. III, VI, VII
C. III, IV, VI
D. II, IV, VI
C. III - oculomotor
IV - trochlear
VI - abducens
What cranial nerve has three divisions: the ophthalmic, maxillary and mandibular?
A. III
B. V
C. VI
D. VII
B. V trigeminal nerve
Inspecting the patient's tongue while at rest on the floor of the mouth and while protruded from the mouth assesses Cranial nerve XII? T/F
True - cranial nerve XII - hypoglossal
Rapid rhythmic alternativing movments tests proprioception and cerebellar function? T/F
True
Romberg is a test for balance? T/F
True
Jerky, dancing movements appear nondirectional when a patient walks?
A. Dystonia
B. Ataxia
C. Antalgic limp
D. Spastic hemiparesis
A. Dystonia
Ataxia - uncontrolled falling occurs
Antalgic limp - pt limits the time of weight bearing on the affected leg to limit the pain
Spastic hemiparesis - affected leg is stiff, plantar flexion of the foot, movement of foot results from pelvic tilt
The hip and knee are elevated excessively high to lift the plantar flexed foot off the ground; the foot is brought down to the floor with a slap, the patient is unable to walk on the heels. This type of gait is called?
A. Dystrophic (waddling)
B. Tabetic
D. Steppage
Dystrophic - legs are apart, weight is shifted from side to side in a waddling motion (weak hip abductor muscles, abdomen protrudes, lordosis
Tabetic - legs are positioned far apart, lifted high and forcibly brought down with each step; the he
Patient uses short steps, dragging the ball of the foot across the floor, the legs are extended and the thighs tend to cross forward on each other at each step, due to injury to the pyramidal system. What form of gait?
Spastic diplegia (scissoring)
Patient's gait is wide-based; the feet are thrown forward and outward, bringing them down first on heels, then on toes; the patient watches the ground to glide his or her steps; a postiive Romberg sign
Sensory Ataxia
Patient's posture is stooped and the body is held rigid; steps are short and shuffling, with hesitation on starting and difficulty stopping is called?
Parkinsonian gait
Tactile agnosia is the inability to differentiate two points? T/F
False
Tactile agnosia is an inability to recognize objects by touch
Name the three superficial reflexes?
Abdominal
Cremasteric
Plantar
A patient has brisk, hyperactive reflexes with intermittent or transient clonus, this is graded 2+. T/F
False - Grade 4+
Grade 0 - no response
Grade 1+ - sluggish or diminished
Grade 2+ - active or expected response
Grade 3+ - more brisk than expected, slightly hyperactive
Grade 4+ - brisk, hyperactive, with intermittent or transient clonus
Sustained clonus is associated with which type of neuron disease?
A. Upper motor neuron
B. Lower motor neuron
A. Upper motor neuron
Nuchal rigidity may be associated with what type of infection and/or hemorrhage?
Meningitis
Intracranial hemorrhage
Involuntary flexion of the hips and knees when flexing the neck which may indicated meningeal irritation is what sign?
A. Kernig
B. Brudzinski
B. Brudzinski
Kernig - flexing the leg at the knee and hip then attempt to straighten leg - lower back pain and resistance
Low-set ears or port-wine stains are odd facies that may be suggestive of _______ conditions that include neurologic problems in the infant?
congenital
All of the following are primitive reflexes EXCEPT?
A. Palmar grasp
B. Moro
C. Placing
D. Deep tendon
D. Deep tendon
Primitive Reflexes
Palmar grasp (at birth till 3 months)
Plantar grasp (at birth to 8 months)
Moro (at birth to 6 months)
Placing (by 4 days to varies)
Stepping (birth-8 weeks to before voluntary walking)
Fencing (2-3 months to 6 months)
One to two beats of clonus are a common finding in the newborn? T/F
True
Older adults have no change in vision, smell and taste. T/F
False
All diminish with age
reduced ability to differentiate colors, reduced upward gaze, slower adjustment to lighting changes, decreased corneal reflex
Middle to high-frequency hearing loss
Reduced gag reflex
Acute inflammation of the brain and spinal cord, involving the meninges often due to a virus such as herpes simplex virus?
A. Multiple sclerosis (MS)
B. Meningitis
C. Encephalitis
D. Guillain-Barre Syndrome
C. Encephalitis
MS - progressive autoimmune disorder characterized by a combination of inflammation and degeneration of the myelin of the brain's white matter leading to decreased brain mass and obstructed transmission of nerve impulses.
Meningitis - an i
Unilateral blindness, severe contalateral hemiplegia and hemianesthesia with profound aphasia?
A. Internal carotid artery
B. Middle cerebral artery
B. Internal carotid artery
Middle cerebral artery - alterations in communication, cognition, mobility and sensation, contralateral homonymous hemianopia, contralateral hemiplegia or hemiparesis, motor and sensory loss, greater in face and arm than leg.
An autoimmune disorder of neuromuscular transmission involving the production of autoantibodies directed against the nicotinic acetylcholine receptor, leading to the destruction and inflammatory changes in the postsynaptic membranes?
A. Guillain Barre Syn
D. Myasthenia Gravis
Guillian- an autoimmune mediated destruction of peripheral nerve myelin sheaths and inflammation of nerve roots that occurs following a nonspecific GI or URI 1-3 weeks earlier or immunization
Trigeminal - recurrent paroxysmal sharp pa
Hemianesthesia, contralaterial hemiplegia, greater in face and upper extremities than lower, cerebellar ataxia, tremor, visual loss, receptive aphasia, memory deficits?
A. Anterior cerebral artery
B. Posterior cerebral artery
B. Posterior cerebral artery
ACA - emotional lability, confusion, amnesia, personality changes, urinary incontinence, contralateral hemilegia or hemiparesis greater in lower extremities
A temporary acute paralysis or weakness of one side of the face is called?
A. Peripheral neuropathy
B. Cerebral palsy
C. Spina Bifida
D. Bells Palsy
D. Bells Palsy
Peripheral neuropathy- disorder of PNS that results in motor and sensory loss in the distribution of one or more nerves: DM
Cerebral palsy - permanent disorder of movement and posture development associated with nonprogressive disturbances
Bilateral retinal hemorrhages with retinal detachments or folds is a sign of Shaken Baby syndrome? T/F
True
A slowly progressive, degenerative neurologic disorder in which deficiency of dopamine neurotransmitter results in poor communications between parts of the brain that coordinates and controls movement and balance?
Parkinson Disease
A syndrome simulating degenerative diseases?
Normal pressure hydrocephalus
gait impairment is first symptom
What is the different between vertigo and syncope?
Vertigo you are dizzy
Syncope you have a loss of consciousness
If the patient presents with left hand weakness and numbness, there is a problem with which motor cortex?
A. Right
B. Left
C. Central
D. None of the above
A. Right
When assessing for a headache, it is important to remember the mneumonic SNOOP. What does SNOOP stand for?
Systemic (fever, LOC, chills, weight loss, HIV, Cancer)
Neurolgic signs and symptoms
Onset (abrupt, acute "worse headache ever" thunderclap)
Older age (after age 40)
Pattern of headache history changed
All of the following are deep tendon reflexes EXCEPT:
A. Triceps
B. Biceps
C. Patellar
D. Cremasteric
D. Cremasteric
Deep tendon reflexes
Biceps
Brachioradialis
Triceps
Patellar
Achilles
A patient presents with drooping of the corner of their mouth, dry mouth and impaired taste, which area of the V cranial nerve is affected?
A. V1
B. V2
C. V3
C. V3 - Mandibular
V1 - Ophthalamic - droopy eyelid, dry eye or excessive tearing
V2 - facial paralysis, twitching or weakness
Name the three layers of the meninges?
Pia
Arachnoid
Dura
Which area of the brain is responsible for interpreting speech?
A. Broca
B. Wernicke
C. Reticular activating system
D. None of the above
B. Wernicke - interpreting speech, found in temporal
- damage - receptive aphasia
Broca - motor control of speech - frontal lobe
damage - Expressive aphasia
Which area of the brain is responsible for arousal, sleep and wake cycles
A. Broca
B. Wernicke
C. Reticular activating system
D. None of the above
C. Reticular Activating System - has relay nuclei within the Thalamus - arousal, sleep and wake cycles
What is Acalculia or dyscalculia?
Acalculia is the inability or difficulty performing calculations
What is apraxia?
Apraxia: inability to translate an intention into action
Repetition of a word phrase or gesture suggestions possible frontal lobe lesion and is called?
A. Circumlocution
B. Perservation
C. Echolalia
D. Neologism
B. Perseveration: repetition of a word, phrase, or gesture (possible frontal lobe lesion)
Circumlocution: word substitution to avoid revealing a forgotten word
Echolalia: repetition of another person's words
Neologism: words with meaning only to patient
Ash leaf or hypopigmented macules are a sign of what congenital Autosomal dominant disorder?
Tuberous sclerosis
A neurodevelopmental disorder of UNKNOWN etiology diagnosed at or around age 3? Characterized by qualitative impairment in areas of language development, social interactions, and reciprocity and imagination and play
Autism
What cranial nerve deficit manifests with anosmia (impairment or loss of smell) and diminished taste for food
A. CN I
B. CN II
C. CN III
D. CN IV
A. Olfactory (CN I)
What cranial nerve deficits manifests with dilation of pupil with unilateral loss of light reflex, ocular movement impairment, diplopia: double vision, ptosis - lagging lid and gaze palsies: unable to move right eye all the way to right side VI cranial ne
Oculomotor (CN III), Trochlear (CN IV), Abducens (CN VI)
The autonomic nervous system is responsible for what?
A. Balance and equilibruim
B. Emotions and behavior
C. Awake and alertness
D. Internal environment of the body
D. Internal environment of the body
A strong tonic neck at 6 months would be an area of concern in an infant? T?F
True
A babinski sign is a normal finding in what age group?
A. Adult
B. Adolescent
C. 3 year old
D. 16 -24 month old
D. 16- 24 month old
All of the following characteristics EXCEPT which are signs of benign paroxysmal positional vertigo?
A. hearing loss
B. tinnitis
C. dizziness
D. vertigo
D. Hearing loss
BPPV does not have hearing loss, but it is present in Meniere Disease
Stereognosis is when you lace an object in the patients hand with their eyes closed and they identify an object it, while graphesthesia is what?
When you draw an item in their hand and they identify it.
LDL goal
<100 mg/dL
HDL cholesterol range
40-80 mg/dL
decorticate
severe damage to the cortico-spinal tract, the pathway between the brain and spinal cord.
Abnormal posturing
involves rigidity, flexion of the arms, clenched fists, and extended legs.
The arms are bent inward toward the body with the wrists and fingers be
decerebrate
Progression from decorticate posturing to Decerebrate posturing is often indicative of brain herniation (lesions forebrain, midbrain or pons)
The head is arched back, the arms are extended by the sides, and the legs are extended.
Indicates an injury to th
fasculation
rapid muscle movement
Brief, spontaneous contraction affecting a small number of muscle fibers
romberg test
test position sense
(in a positive test, the patient sways and falls over; suspects disease of the posterior columns of the spinal cord)
babinski
fanning of toes (positive sign)
suggests presence of an upper motor neuron lesion
Broca's area
Controls language expression - an area of the frontal lobe, usually in the left hemisphere, that directs the muscle movements involved in speech.
Wernike
left frontal lobe: receptive language
frontal lobe
A region of the cerebral cortex that has specialized areas for movement, abstract thinking, planning, memory, and judgement
parietal lobe
A region of the cerebral cortex whose functions include processing information about touch.
Miosis
constricted pupils
mydriasis
dilation of the pupil
Bell's Palsy
temporary paralysis of the seventh cranial nerve that causes paralysis only on the affected side of the face
CN VII
Bruzdzinski's sign
This is a test for CNS infection or meningeal irritation.
- Patient in supine flex neck to chest
(+) causes flexion of hips and knees (drawing up) suggests meningela irritation. This is called?
essential tremor
a nerve disorder causing tremors to occur in a person who is moving or trying to move. Not usually associated with Parkinson's disease
intention tremor
involuntary trembling when an individual attempts a voluntary movement
doesnt occur at rest
resting tremor
a tremor that is apparent when the client is at rest and diminishes with activity
parkinsons
muscle tone in upper motor
increased tone, risk for contractures
muscle tone in lower motor
flaccidity
reflexes in upper motor
hyperactive, positive babinski
reflexes in lower motor
weak or absent deep tendon
...
...
commonly tested reflex
plantar reflex
plantar reflex
stroking, with a noxious stimulus such as a tongue blade, the lateral surface of the sole of the foot beginning near the heel and moving across the ball of the foot to the great toe.
The normal reflex consists of plantar flexion of the toes
biceps
c5 and c6
branchioradial
c5 and c6
triceps
c6, c7, c8
patellar
l2, l3, l4
achilles
s1 and s2
hyperactive reflexes suggest
upper motor neuron disorder
hypo or absent reflexes indicate
lower motor neuron disorder
Doll's eye maneuver
Testing of the horizontal eye movement reflex by passively turning the head from side to side; if the reflex is intact, the eyes will move in the direction opposite to movement. This is a brain stem reflex.
CN nerve VII
rooting reflex
a baby's tendency, when touched on the cheek, to turn toward the touch, open the mouth, and search for the nipple
CN V
disappears by 3-4 months
palmar grasp
An infant reflex that occurs when something is placed in the infant's palm; the infant grasps the object.
disappears by 3 months
plantar grasp
Apply pressure with thumb on the ball of infant's foot. >
Toes flex.
Relevance: Increases tactile input to sole of foot.
Onset: 28 wks gestation_____Integration: 9 mths
Moro reflex
Infant reflex where a baby will startle in response to a loud sound or sudden movement.
disappears by 6 months
multiple sclerosis
A chronic disease of the central nervous system marked by damage to the myelin sheath. Plaques occur in the brain and spinal cord causing tremor, weakness, incoordination, paresthesia, and disturbances in vision and speech
internal carotid artery
unilateral blindess
severe contralateral hemiplegia and hemianthesia
aphasia
middle cerebral artery
supplies frontal, temporal, and parietal lobes
alterations in communication , cognition, mobility and session