Download Bates Chapter 17 Neuro Test Review with Complete Definitions. and more Exams Nursing in PDF only on Docsity!
with Complete Definitions.
Brain has 4 regions - Correct Answer: 1. Cerebrum
- Diencephalon
- Brainstem
- Cerebellum Brain hemisphere - Correct Answer: 1. Frontal
- Parietal
- Temporal
- Occipatal Neurons - Correct Answer: Interconnecting nerve cells, consisting of cell bodies Axons - Correct Answer: Single long fibers conduct impulses to other parts of nervous system Basal Ganglia (deep in brain) - Correct Answer: Affects movement Thalamus - Correct Answer: Process sensory impulses Hypothalamus - Correct Answer: Maintains homeostasis & temperature regulation, HR, BP Affects endocrine system Governs emotional behaviors e.g. anger, sexual drive
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Hormones act directly on pituitary gland structures in diencephalon Gray matter - Correct Answer: Aggregations neuronal cell bodies. Rims surfaces of cerebral hemispheres = forms cerebral cortex White matter - Correct Answer: neuronal axons coated w myelin (white color), allow nerve impulses to rapidly travel Consciousness - Correct Answer: interactions between intact cerebral hemispheres & reticular activating (arousal) system in (diencephalon & upper brainstem) Identify the following... cerebellum occipital lobe parietal lobe corpus callosum frontal lobe midbrain pons medulla - Correct Answer: Identify the following...
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Spinal cord - Correct Answer: Contains: grey matter (aggregations of nerve cell nuclei & dentrites) and white matter connect to brain to PNS Cord provides: segmental relays with the periphery, servings as a conduit for info flow to and from brain. Motor and sensory nerve pathways enter/exit through posterior/anterior nerve roots and spinal & pheripheral nerves. How many pairs of spinal nerves? Cervical? Thoracic? Lumbar Sacral? Coccygeal? - Correct Answer: 31 pairs 8 cervical 12 thoracic 5 lumbar 5 sacral 1 coccygeal Peripheral nervous system (PNS) - Correct Answer: CNS & peripheral nerves. project to heart, visceral organs, skin, & limbs Pheripheral nerves includes - Correct Answer: Spinal and pheripheral nerves carry impulses to and from spinal cord
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Brain stem - Correct Answer: Connects upper brain w/ spinal cord. Consist 3 sections:
- Midbrain (CN II-IV)
- Pons (CN V-VIII)
- Medulla (CN IX-XII) CN III-XIII diencephalon & brainstem CN I & II actual fiber tracts emerging from brain Cranial nerve - Correct Answer: Oh, Oh, Oh, To Touch And Feel Virgin Girls' Vaginas and Hymens Ventral Root - Correct Answer: Motor neurons (efferent)
- Involuntary control (cardiac)
- Voluntary control (skeletal) Dorsal Root - Correct Answer: Sensory neurons (afferent) ie: touching hot pot sense sensory to brain. Ganglion - Correct Answer: locations synapse occurs, & cell bodies located (bundle of neurons)
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Originate Motor cortex-Travels down to lower medula-cross contralateral side medulla-synapse w/ anterior horn cells Tracts synapsing brainstem w/ motor nuclei of cns are termed corticobulbar Damage basal ganglia system - Correct Answer: Does not cause paralysis. Increases in muscle tone, gait and posture disturbances, Bradykinesia: slowness or lack of spontaneous & automatic movements. Cerebellar system - Correct Answer: Receives sensory & motor input coordinates motor activity, maintains equilibrium, & helps control posture. Cerebellar damage - Correct Answer: Impairs coordination Impairs gait equilibrium decreases muscle tone Upper motor neurons damage, above crossover medulla will develop motor impairment: - Correct Answer: Contralateral side (opposite)
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Lower motor neurons damage below crossover medulla will develop motor impairment: - Correct Answer: ipsilateral side (same) Upper motor lesion - Correct Answer: Increased Muscle tone Increased deep tendon reflexes exaggerated. *NO fasciculation/atrophy Damage lower motor neuron - Correct Answer: ipsilateral weakness & paralysis BUT muscle tone and reflexes decreased or absent Sensory pathways - Correct Answer: reflex activity, conscious sensation, locate body position in space, help regulate autonomic functions (ie: BP, HR, respirations) Sensory receptors - Correct Answer: relay impulses from skin, mucous membranes, muscle, tendons, viscera, through pheripheral projections to posterior root ganglion where 2nd ganglia directs impulses to into spinal cord -
brain Sensory impulses - Correct Answer: Travel to sensory cortex via 2 pathways:
- spinothalamic tract: smaller sensory neurons w/ unmyelinated or thinly myelinated axons
- posterior columns: larger neurons w/ heavily myelinated axons
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Ankle reflex - Correct Answer: Sacral 1 Knee reflex - Correct Answer: Lumbar 2,3, Supinator (brachioradialis) reflex & Biceps reflex - Correct Answer: Cervical 5, Triceps reflex - Correct Answer: Cervical 6, Abdominal lower reflex - Correct Answer: Thoracic 8,9, Abdominal upper reflex - Correct Answer: Thoacic 10,11, Plantar response - Correct Answer: Lumbar 5, Sacral 1 Anal reflex - Correct Answer: Sacral 2,3, Common/concerning symptoms - Correct Answer: HA Dizziness/vertigo Weakness (generalize, proximal, distal) Numbness, abnormal or absent sensation Fainting or blacking out (near syncope & syncope) Seizures
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Tremors or involuntary movements Primary HA - Correct Answer: migrane, cluster, and trigeminal, autonomic cephalagias Secondary HA - Correct Answer: structural, systemic or infectious (life threatening) HA warning signs - Correct Answer: -sudden onset like "thunderclap" or "worst HA of my life" -new onset after 50 y/o -associated papilledema, neck stiffness, or focal neurologic deficits -Precipitated by valsalva maneuver or exertion -recent head trauma -change in patter from past HA -Lack of a similar HA in the past -Lack of similar HA in the past episodic and tend to peak over several hours. - Correct Answer: Migrane and tension New and persisting progressively severe HA
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Atypical HA - Correct Answer: suspicious for stroke especially women using contraceptives Older patient with dizziness/vertigo - Correct Answer: Ask about medications ie: Feeling light headed, weak in legs or about to faint - Correct Answer: Presyncope from Vasovagal stimulation, orthostatic hypotension, arrhythmia or SE: BP & other meds Vestibular dx: peripheral etiology (inner ear eg: benign positional vertigo, labyrinthitis, Meniere dx) - Correct Answer: Vertigo Spining sensation - Correct Answer: True Vertigo Ataxia (problem w/ gait & balance) diplopia dysarthria (difficult forming words) - Correct Answer: Suspicious Vertebrobasilar TIA or stroke consider fossa tumor, migrane with brainstem aura Peripheral vertigo: Benign positional vertigo: - Correct Answer: Sudden, tilting head/rolling to affected side
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<1min last few weeks, n/v/nystagmus Peripheral vertigo: Vestibular Neuronitis (Acute labyrinthitis - Correct Answer: Sudden, Hrs-2wks, n/v/d/nystagmus Peripheral vertigo: Meniere Disease - Correct Answer: Sudden, > or = day, sensorineural hearing loss, pressure fullness, n/v/nystagmus Peripheral vertigo: Drug Toxicity - Correct Answer: Insdious or acute (loop diuretic, aminoglycosides, salicylates, alcohol) may or may not reverse, hearing imparied, tinnitus, n/v Peripheral vertigo: Acoustic Neuroma - Correct Answer: CN VIII compression, Vestibular, imparired one side, may involve CN V VII Central Vertigo - Correct Answer: Sudden, brainstem deficits, dysartharia, ataxia, crossed motor and sensory deficits Have patient clarify weakness - Correct Answer: Fatigue? Apathy? Drowsiness? Actual loss of strength? True Motor Weakness - Correct Answer: Arise from CNS, peripheral nerve, neuromuscular junction or a muscle
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Myopathies from ETOH, drugs (gluccocorticoids), inflammatory muscle disorder (polymyositis & dermatomyositis) - Correct Answer: Proximal limb weakness Proximal typically asymmetric weakness gets worse w/ effort (fatigability) associated w/ bulbar symptoms (diplopia, ptosis, dysarthria, dysphagia) - Correct Answer: Neuromuscular junction disorder: Myasthenia Gravis Questions to ask to assess Proximal weakness - Correct Answer: Difficulty combing hair? reaching shelf? getting out of chair? climbing stairs? Does weakness gets worse w/ repetition or improve after rest? any associated sensory or other symptoms. Questions to ask to evaluate distal weakness - Correct Answer: Difficulty opening jar? or using scissors? screwdriver? problem tripping when walking? Bilateral predominatly distal weakness often with sensory loss - Correct Answer: suggest polyneuropathy in DM Pins and needle numbness - Correct Answer: Paresthesias: altered sensation Light touch or pinprick, may cause burning or irritating sensation - Correct Answer: Dysesthesias
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Burning pain - Correct Answer: Painful sensory neuropathies seen in DM. Local nerve compression or "entrapment" - Correct Answer: Seen in hand numbness in distributions specific to median, ulnar, or radial nerve Vertebral bone spurs or herniated discs - Correct Answer: Nerve root compression with dermatomal sensory loss Central lesion - Correct Answer: Stroke or MS Pattern of stocking then glove - Correct Answer: Polyneuropathies (ei: DM) Multiple patchy areas sensory loss in different limbs - Correct Answer: mononeuritis multiplex (DM, RA) Sudden, but temporary LOC & postural tone from transient global hypoperfusion of brain - Correct Answer: True syncope Hear external voices, feel lightheaded, or weak, fail to lose consciousness - Correct Answer: near syncope or presyncope LOC etiology - Correct Answer: Seizures
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tongue biting/bruising of limbs Childhood/adolescent seizure - Correct Answer: generalized epilepsy Adults seizure - Correct Answer: Partial seizure more than 1 seizure - Correct Answer: consider epilepsy Tremor - Correct Answer: a rhythmic oscillatory movement of a body part resulting from contraction of opposing muscle most common movement disorder low-frequency unilateral resting tremor, rigidity, bradykinesia - Correct Answer: Parkinson DX High frequency bilateral upper extremity w both limb movement & sustained posture & subside when limb relaxed; head, voice, leg tremor may also be present
- Correct Answer: Essential tremors Unpleasant sensation in legs especially at night, gets worse w rest & improves w movement of symptomatic limbs - Correct Answer: Restless leg syndrome Reversible causes = pregnancy, renal dx, iron deficiency
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Glasgow Coma Scale - Correct Answer: GCS < or = 8 Severe GCS 9-12 Moderate GCS >13 Minor Ischemic stroke - Correct Answer: 'an infarction of CNS tissue' may be symptomatic or silent. 'symptomatic ischemic strokes manifest by clinical signs of focal or global cerebral, spinal, or retinal dysfunction' document silent stroke as 'CNS infarction that was asymptomatic' TIA - Correct Answer: Transient episode of neurological dysfunction caused by focal brain, spinal cord, or retinal ischemia w/o acute infarction'. AHA/ASA recommends: neurodiagnostic imaging within 24 hrs. of symptom onset & routine noninvasive imaging of carotid & intracranial vessels. ABCD2 scoring system: system for predicting ischemic stroke within 2, 7, 90 days post TIA - Correct Answer: Age ≥60y/o Initial BP ≥140/90mm Hg Clinical features of focal weakness or impaired speech w/o focal weakness
