Central Nervous System Quiz
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Questions and Answers

What is the primary function of the central nervous system (CNS)?

  • To connect the brain and spinal cord
  • To carry sensory messages from the CNS to muscles
  • To process sensory information and coordinate responses (correct)
  • To regulate blood vessel activity

Which area is responsible for speech comprehension?

  • Precentral gyrus
  • Broca area
  • Cerebellum
  • Wernicke area (correct)

Which layer of the meninges is the outermost and most protective?

  • Arachnoid mater
  • Subarachnoid space
  • Pia mater
  • Dura mater (correct)

What is the role of myelin in the nervous system?

<p>To enhance the speed of nerve impulse conduction (D)</p> Signup and view all the answers

What structure connects the left and right cerebral hemispheres?

<p>Corpus callosum (D)</p> Signup and view all the answers

Which part of the CNS is primarily responsible for motor coordination and equilibrium balance?

<p>Cerebellum (A)</p> Signup and view all the answers

Which of the following structures is NOT part of the brainstem?

<p>Lateral sulcus (C)</p> Signup and view all the answers

What is the primary sensory area of the cerebral cortex?

<p>Postcentral gyrus (C)</p> Signup and view all the answers

What is the primary function of somatic fibers?

<p>Innervate skeletal muscles (A)</p> Signup and view all the answers

Which cranial nerve is responsible for smell?

<p>Olfactory (D)</p> Signup and view all the answers

What type of cranial nerve is the Vagus nerve?

<p>Mixed (D)</p> Signup and view all the answers

What role do autonomic fibers primarily serve?

<p>Maintaining homeostasis (A)</p> Signup and view all the answers

At what stage do infants gain motor control according to the myelination process?

<p>Proximal to distal (D)</p> Signup and view all the answers

What is a sign of CNS dysfunction in infants?

<p>Persistence of primitive reflexes (C)</p> Signup and view all the answers

As a person ages, what happens to the volume of the brain?

<p>It experiences steady loss (C)</p> Signup and view all the answers

Which cranial nerve allows for lateral movement of the eye?

<p>Abducens (C)</p> Signup and view all the answers

What decreases in older adults, leading to slower reaction times?

<p>Velocity of nerve conduction (D)</p> Signup and view all the answers

What sensory function is associated with the Glossopharyngeal nerve?

<p>Taste on posterior one third of tongue (D)</p> Signup and view all the answers

Which cranial nerve is NOT involved in mixed functions?

<p>Trochlear (B)</p> Signup and view all the answers

Which number indicates the lumbar spinal nerves in the human body?

<p>L1 to L5 (D)</p> Signup and view all the answers

What is the primary function of the facial nerve?

<p>Taste and facial muscle control (A)</p> Signup and view all the answers

What does the mnemonic FACE stand for in the recognition of stroke symptoms?

<p>Face, Arms, Speech, Time (B)</p> Signup and view all the answers

Which of the following is NOT a modifiable risk factor for stroke?

<p>Age (C)</p> Signup and view all the answers

For which group is the risk of stroke generally higher than for women?

<p>Men (A)</p> Signup and view all the answers

What is the first action recommended when someone shows symptoms of a TIA?

<p>Call an ambulance (C)</p> Signup and view all the answers

Which of the following nonmodifiable risk factors is mentioned as contributing to a higher prevalence of stroke?

<p>Gender (A)</p> Signup and view all the answers

Which medical condition significantly contributes to the risk of non–pregnancy-related ischemic stroke in women?

<p>Pre-eclampsia (C)</p> Signup and view all the answers

Which of the following is NOT included as a risk factor for stroke?

<p>Increased physical activity (C)</p> Signup and view all the answers

Which of the following lifestyle changes is recommended for stroke prevention?

<p>Participating in smoking cessation (B)</p> Signup and view all the answers

What symptom might indicate a potential stroke that requires immediate medical attention?

<p>Difficulty speaking (D)</p> Signup and view all the answers

Which of the following factors has NOT been associated with a higher risk for stroke among certain ethnic groups?

<p>Regular exercise (C)</p> Signup and view all the answers

Which of the following health history questions would help assess potential stroke risk?

<p>Have you experienced any unusual headaches? (D)</p> Signup and view all the answers

What is the primary purpose of the frontal lobe?

<p>Personality and behavior regulation (C)</p> Signup and view all the answers

What acronym can be used to remember the immediate steps to take in stroke recognition?

<p>FACE (A)</p> Signup and view all the answers

Damage to which area of the brain primarily affects the ability to produce language?

<p>Broca’s area (A)</p> Signup and view all the answers

What is the relationship between age and stroke risk?

<p>Older age is associated with increased stroke risk. (B)</p> Signup and view all the answers

Which part of the brain acts as the main relay station for sensory pathways?

<p>Thalamus (D)</p> Signup and view all the answers

Which condition is NOT classified as a cardiac condition related to stroke risk?

<p>Asthma (D)</p> Signup and view all the answers

Which part of the central nervous system is primarily responsible for coordinating motor movements?

<p>Cerebellum (B)</p> Signup and view all the answers

What is the unique characteristic of crossed representation in the nervous system?

<p>Left cerebral cortex receives information from the right side of the body (B)</p> Signup and view all the answers

What type of sensations does the spinothalamic tract primarily transmit?

<p>Pain and temperature (D)</p> Signup and view all the answers

Where is the primary auditory reception center located in the brain?

<p>Temporal lobe (C)</p> Signup and view all the answers

What results when Wernicke’s area is damaged in the dominant hemisphere?

<p>Receptive aphasia (A)</p> Signup and view all the answers

The hypothalamus plays a crucial role in regulating which of the following functions?

<p>Temperature and heart rate (B)</p> Signup and view all the answers

What is primarily housed in the basal ganglia?

<p>Motor control systems (D)</p> Signup and view all the answers

Which area of the brain would most likely be damaged if a person cannot perceive sensations?

<p>Postcentral gyrus (A)</p> Signup and view all the answers

Which structure is NOT part of the brainstem?

<p>Hypothalamus (A)</p> Signup and view all the answers

What does paresis refer to in neurological terms?

<p>Impaired movement or weakness of voluntary movements (C)</p> Signup and view all the answers

In which part of the brain do pyramidal decussation occur?

<p>Medulla (C)</p> Signup and view all the answers

How does the cerebrospinal fluid travel through the spinal cord?

<p>In the vertical tracts (D)</p> Signup and view all the answers

Which of the following could be considered an aura before a seizure?

<p>Visual changes or auditory sensations (C)</p> Signup and view all the answers

Dysarthria refers to which of the following problems?

<p>Difficulty forming words (D)</p> Signup and view all the answers

What might trigger seizures in some individuals?

<p>High stress or fatigue (B)</p> Signup and view all the answers

What describes dysphagia?

<p>Difficulty swallowing (C)</p> Signup and view all the answers

Which condition involves an inability to control the range of motion of the muscles?

<p>Dysmetria (C)</p> Signup and view all the answers

What is an example of an environmental hazard that could affect cognitive development in children?

<p>Chronic exposure to lead (B)</p> Signup and view all the answers

Which of the following symptoms is indicative of an early sign of muscular dystrophy in children?

<p>Unexplained falling or clumsy gait (B)</p> Signup and view all the answers

What is the significance of the postictal phase following a seizure?

<p>It involves various recovery symptoms such as confusion or headache. (D)</p> Signup and view all the answers

What is the primary sensory function of the dorsal columns?

<p>Position, vibration, and finely localized touch (B)</p> Signup and view all the answers

What does the term 'paraesthesia' refer to?

<p>An abnormal sensation such as tingling or burning (B)</p> Signup and view all the answers

Where do sensory fibers from the dorsal columns cross to the opposite side of the body?

<p>At the medulla (B)</p> Signup and view all the answers

What is primarily assessed when asking about environmental and occupational hazards?

<p>Exposure to harmful substances or conditions (C)</p> Signup and view all the answers

Which cortex is responsible for full interpretation of sensory messages?

<p>Sensory cortex (C)</p> Signup and view all the answers

Which of the following statements best defines tremors?

<p>Involuntary shaking or trembling (D)</p> Signup and view all the answers

Which aspect of a child's development is monitored through reflexes?

<p>Behavioral response to stimuli (B)</p> Signup and view all the answers

What is the role of the corticospinal tract?

<p>Managing skilled voluntary movements (D)</p> Signup and view all the answers

What might indicate that an adult is at a higher risk of falls?

<p>Dizziness with position changes (A)</p> Signup and view all the answers

What is a characteristic of the cortical homunculus?

<p>It shows the spatial distribution of body functions in the brain (C)</p> Signup and view all the answers

What does referred pain mean?

<p>Pain perceived in one area of the body due to another area suffering (B)</p> Signup and view all the answers

Which system is responsible for maintaining muscle tone and controlling gross movements?

<p>Extrapyramidal tracts (B)</p> Signup and view all the answers

How do upper motor neurons influence lower motor neurons?

<p>They convey impulses to them from the CNS (C)</p> Signup and view all the answers

Which of the following is an example of an upper motor neuron disease?

<p>Cerebral palsy (A)</p> Signup and view all the answers

Where are the lower motor neurons predominantly located?

<p>In the PNS (D)</p> Signup and view all the answers

What kind of movements does the cerebellar system primarily coordinate?

<p>Gross automatic movements (A)</p> Signup and view all the answers

What structure is primarily responsible for the exchange of sensory and motor information?

<p>Thalamus (A)</p> Signup and view all the answers

How do proprioceptors function in the sensory pathway?

<p>They provide information on body part position (A)</p> Signup and view all the answers

What do the extrapyramidal tracts primarily regulate?

<p>Automatic body movements and tone (C)</p> Signup and view all the answers

What is a common physical change observed in older adults as they age?

<p>Deterioration of hand strength (D)</p> Signup and view all the answers

What is the primary risk associated with older adults getting up too quickly?

<p>Increased risk of falls (C)</p> Signup and view all the answers

Which demographic is shown to have a higher rate of strokes as compared to the general population?

<p>First Nations, Inuit, and Métis people (C)</p> Signup and view all the answers

What is the leading cause of adult disability in Canada?

<p>Stroke (D)</p> Signup and view all the answers

Which of the following is NOT a common symptom of stroke?

<p>Sudden weight gain (A)</p> Signup and view all the answers

What should not be ignored after experiencing symptoms that disappear within an hour?

<p>Transient ischemic attacks (TIAs) (A)</p> Signup and view all the answers

What contributes significantly to the elevated death rate due to strokes in certain populations?

<p>Experiences of racism and discrimination (D)</p> Signup and view all the answers

Which type of stroke is the most common?

<p>Ischemic stroke (D)</p> Signup and view all the answers

What is a critical factor in the initial assessment of a stroke?

<p>Time from symptom onset (D)</p> Signup and view all the answers

How does socioeconomic status influence stroke risk?

<p>Lower socioeconomic status increases hospitalization rates for stroke. (B)</p> Signup and view all the answers

Which of the following describes a transient ischemic attack (TIA)?

<p>Its symptoms disappear temporarily and often within an hour. (C)</p> Signup and view all the answers

What often contributes to a lack of recognition of stroke symptoms among Canadians?

<p>Symptoms of strokes often do not cause pain. (B)</p> Signup and view all the answers

What health issue is linked to racism and impacts stroke risk among specific populations?

<p>Hypertension (A)</p> Signup and view all the answers

What should be assessed when testing the muscles of mastication?

<p>Symmetry and strength during clenching (A)</p> Signup and view all the answers

What physical characteristic may older adults display while walking, indicating cautiousness?

<p>Careful obstacle surveying (B)</p> Signup and view all the answers

Which cranial nerve is primarily involved in the corneal reflex?

<p>Cranial nerve V (A)</p> Signup and view all the answers

What indicates decreased strength of the muscles of facial expression?

<p>Asymmetry in movement and sagging eyelids (A)</p> Signup and view all the answers

Which action tests cranial nerves IX and X?

<p>Saying 'ahhh' while depressing the tongue (C)</p> Signup and view all the answers

What does the presence of atrophy in a muscle indicate?

<p>Previous injury or disease (D)</p> Signup and view all the answers

Which of the following best describes the normal range of findings for the tongue during evaluation?

<p>Thrusts forward in the midline (D)</p> Signup and view all the answers

What symptom suggests a dysfunction in cranial nerve VII?

<p>Loss of ability to smile symmetrically (D)</p> Signup and view all the answers

Which test assesses the sensory function of the trigeminal nerve?

<p>Cotton wisp touch sensation on the face (C)</p> Signup and view all the answers

What is a common finding in individuals who have worn contact lenses related to the corneal reflex?

<p>Decreased blink reflex (B)</p> Signup and view all the answers

Which assessment technique is used to evaluate cranial nerve XI?

<p>Turning the head against resistance (C)</p> Signup and view all the answers

What does the presence of nasal twang in a patient's voice indicate?

<p>Weakness of the soft palate (A)</p> Signup and view all the answers

What does normal muscle tone demonstrate when a passive ROM test is conducted?

<p>Mild resistance to passive stretch (A)</p> Signup and view all the answers

Which of the following conditions can result in facial muscle weakness?

<p>Any lesion affecting CNS or PNS (C)</p> Signup and view all the answers

How can dizziness impact a person's ability to drive?

<p>It may impair coordination and reaction time. (B)</p> Signup and view all the answers

What is micturition syncope?

<p>A temporary loss of consciousness during urination. (B)</p> Signup and view all the answers

Which of the following changes may indicate a decline in cognitive function?

<p>Sudden confusion or memory loss. (A)</p> Signup and view all the answers

What factors can exacerbate tremors experienced by a patient?

<p>Anxiety, activity, or rest. (C)</p> Signup and view all the answers

What is a critical finding that necessitates immediate medical attention?

<p>Sudden decline in alertness. (B)</p> Signup and view all the answers

Which cranial nerves are involved in assessing eye movement?

<p>Cranial Nerves III, IV, and VI. (C)</p> Signup and view all the answers

Which condition is associated with a sudden and severe headache?

<p>Intracranial pressure increase. (A)</p> Signup and view all the answers

What should be done when a patient shows signs of neurological dysfunction?

<p>Perform a complete neurological examination. (A)</p> Signup and view all the answers

How should olfactory nerve function be evaluated?

<p>By presenting familiar scents to each nostril. (C)</p> Signup and view all the answers

What might unilateral loss of smell indicate?

<p>Neurogenic anosmia. (A)</p> Signup and view all the answers

What is the recommended action if a patient reports sudden vision changes?

<p>Screen for signs of stroke or TIA. (D)</p> Signup and view all the answers

What does increased intracranial pressure often cause regarding pupil response?

<p>Sudden, unilateral dilation and nonreactivity. (D)</p> Signup and view all the answers

What is a common finding in senile tremor?

<p>Relief of tremors with alcohol consumption. (C)</p> Signup and view all the answers

What is the expected finding when assessing joint resistance during movement?

<p>Mild, even resistance (B)</p> Signup and view all the answers

What does an inability to tandem walk indicate?

<p>Upper motor neuron lesion or alcohol intoxication (C)</p> Signup and view all the answers

Which of the following demonstrates an abnormal finding in the Romberg Test?

<p>Loss of balance with eyes closed (B)</p> Signup and view all the answers

What indicates that a patient is fully alert?

<p>Ability to follow commands appropriately (A)</p> Signup and view all the answers

What type of movement is described as dysdiadochokinesia?

<p>Slow, clumsy, and sloppy (A)</p> Signup and view all the answers

What is the first method to increase stimulation for a patient who is not fully alert?

<p>Calling the patient’s name (C)</p> Signup and view all the answers

Which command can be used to check voluntary movement of the patient's extremities?

<p>Push against my hands (A)</p> Signup and view all the answers

Which test assesses lower extremity coordination by running the heel down the opposite shin?

<p>Heel-to-shin test (A)</p> Signup and view all the answers

Which of the following is NOT a method to assess a patient's response to stimuli?

<p>Lightly tapping on the shoulder (C)</p> Signup and view all the answers

In a healthy patient, what should be observed during the finger-to-nose test?

<p>Accurate and smooth movements (D)</p> Signup and view all the answers

Which finding indicates abnormal gait during a walking test?

<p>Staggering or loss of balance (A)</p> Signup and view all the answers

What facial movements should be noted to assess cranial nerve VII?

<p>Symmetrical eyebrow movements (C)</p> Signup and view all the answers

What role do lower motor neurons play in the nervous system?

<p>They translate movement into action by innervating muscles. (C)</p> Signup and view all the answers

Which of the following is not classified as a lower motor neuron disease?

<p>Cerebral Palsy (C)</p> Signup and view all the answers

What does the presence of spasticity indicate during a movement assessment?

<p>Increased resistance to movement (D)</p> Signup and view all the answers

What are the major motor pathways mentioned?

<p>Corticospinal crossed tract, corticospinal uncrossed tract, and extrapyramidal tracts (C)</p> Signup and view all the answers

How should a normal finding appear during rapid alternating movements?

<p>Quick rhythmic pace (C)</p> Signup and view all the answers

Which cranial nerves are involved in supplying the head and neck?

<p>All 12 pairs of cranial nerves, except the vagus nerve (A)</p> Signup and view all the answers

Which condition is associated with an absence of proprioception while performing a Romberg Test?

<p>Cerebellar ataxia (B)</p> Signup and view all the answers

What characterizes deep tendon reflexes?

<p>They involve only one synapse in the spinal cord. (D)</p> Signup and view all the answers

What does a positive finding for involuntary movements indicate?

<p>Presence of various movement disorders (B)</p> Signup and view all the answers

What is a common symptom that may accompany an inability to perform a shallow knee bend?

<p>Weakness in quadriceps or hip extensors (D)</p> Signup and view all the answers

Where do peripheral nerves carry sensory and motor information?

<p>To and from the central nervous system (D)</p> Signup and view all the answers

Which of the following is NOT a component of the deep tendon reflex?

<p>Direct activation by the brain (D)</p> Signup and view all the answers

What is often tested to assess skin sensitivity in a patient?

<p>Pain, light touch, and vibration (A)</p> Signup and view all the answers

What does a reflex arc consist of?

<p>Sensory nerve, spinal cord, and motor nerve (D)</p> Signup and view all the answers

What is the function of spinal nerves in the body?

<p>They relay sensory and motor signals throughout the body. (C)</p> Signup and view all the answers

Which function describes the role of the vagus nerve?

<p>It extends to various organs beyond the head and neck. (B)</p> Signup and view all the answers

Which dermatomes correspond to the thumb, middle finger, and fifth finger?

<p>C6, C7, C8 (B)</p> Signup and view all the answers

What distinguishes somatic from autonomic nerve fibers?

<p>Somatic fibers control skeletal muscle actions. (D)</p> Signup and view all the answers

What happens when a tendon is tapped during a reflex test?

<p>It causes a rapid activation of sensory afferent nerves. (A)</p> Signup and view all the answers

Which of the following options describes the flow of the corticospinal crossed tract?

<p>From the brain to the spinal cord after decussation (B)</p> Signup and view all the answers

What does the inability to recognize a traced number or letter on the palm indicate?

<p>Lesions in the sensory cortex (C)</p> Signup and view all the answers

What is the most sensitive area for two-point discrimination testing?

<p>Fingertips (A)</p> Signup and view all the answers

Which statement about extinction testing is accurate?

<p>Usually only one sensation is felt when stimulated on both sides. (B)</p> Signup and view all the answers

What should be observed to obtain an adequate response during deep tendon reflex testing?

<p>The limb should be relaxed. (C)</p> Signup and view all the answers

How are reflex responses graded?

<p>On a five-point scale from 0 to 4. (A)</p> Signup and view all the answers

What tests should be administered when a patient displays neurological symptoms?

<p>Test all sensory modalities and cover most dermatomes (C)</p> Signup and view all the answers

How should the sensory testing be conducted to avoid suggestion?

<p>Use unbiased directions for the patient (B)</p> Signup and view all the answers

What could cause hyperreflexia during a reflex test?

<p>Release from inhibition by higher cortical levels. (D)</p> Signup and view all the answers

If a patient demonstrates reduced reflex functioning, what does this indicate?

<p>Interruption of sensory afferent pathways. (D)</p> Signup and view all the answers

What is the purpose of letting at least 2 seconds elapse between each stimulus during pain testing?

<p>To prevent summation of stimuli (A)</p> Signup and view all the answers

Which muscle response indicates a normal biceps reflex?

<p>Flexion of the forearm. (B)</p> Signup and view all the answers

Which of the following sensations is assessed using a tuning fork?

<p>Vibration sensation (C)</p> Signup and view all the answers

What does hyperalgesia refer to?

<p>Increased pain sensation (C)</p> Signup and view all the answers

What technique can enhance a reflex response during testing?

<p>Encouraging isometric exercise in a distant muscle group. (D)</p> Signup and view all the answers

What procedure is used to test the ability to recognize an object through touch?

<p>Stereognosis testing (C)</p> Signup and view all the answers

When testing the triceps reflex, where should the hammer strike?

<p>Just above the elbow on the triceps tendon. (A)</p> Signup and view all the answers

Which reflex is specifically associated with segments L2 to L4?

<p>Quadriceps or patellar reflex. (A)</p> Signup and view all the answers

To effectively map decreased sensation, which approach should be taken?

<p>Systematic testing from the decreased area towards the sensitive area (A)</p> Signup and view all the answers

What element is critical to accurately assess the stretch reflex?

<p>The muscle should be partially stretched and relaxed. (C)</p> Signup and view all the answers

How should temperature sensation testing be conducted?

<p>By using two test tubes filled with hot and cold water (D)</p> Signup and view all the answers

What does clonus indicate during a reflex assessment?

<p>Rapid, rhythmic contractions of a muscle. (A)</p> Signup and view all the answers

What is the primary purpose of comparing sensations on symmetrical parts of the body?

<p>To identify differences in sensory responses (B)</p> Signup and view all the answers

Where is loss of vibration sense often first detected in peripheral neuropathy?

<p>Feet (D)</p> Signup and view all the answers

How is sensation typically localized with a sensory cortex lesion?

<p>Inability to localize accurately. (D)</p> Signup and view all the answers

When assessing position sense, how should the examination be conducted?

<p>By moving fingers or toes and asking for direction (C)</p> Signup and view all the answers

What does a deficiency in tactile discrimination indicate?

<p>Lesions of the sensory cortex or posterior column (D)</p> Signup and view all the answers

Which of the following conditions reflects a loss in position sense?

<p>Peripheral neuropathy (D)</p> Signup and view all the answers

What term describes the absence of pain sensation?

<p>Anaesthesia (D)</p> Signup and view all the answers

What reflex involves an infant extending the arm and leg on the same side where the head is turned?

<p>Tonic Neck Reflex (C)</p> Signup and view all the answers

At what age does the Babinski reflex typically begin to disappear?

<p>By 24 months (C)</p> Signup and view all the answers

Which reflex is characterized by the infant demonstrating a symmetrical 'hugging' motion when startled?

<p>Moro Reflex (B)</p> Signup and view all the answers

Which reflex indicates potential severe CNS injury if absent in a newborn?

<p>Moro Reflex (D)</p> Signup and view all the answers

When does the Tonic Neck Reflex typically decrease in infants?

<p>By 3 to 4 months (C)</p> Signup and view all the answers

What abnormal sign is indicated by the persistence of the Moro reflex after 5 months of age?

<p>Severe CNS injury (C)</p> Signup and view all the answers

What does the Placing Reflex test in infants assess?

<p>Motor coordination (B)</p> Signup and view all the answers

What indicates a concern when observing a child's ability to rise from a supine position?

<p>They push off with one hand only (B)</p> Signup and view all the answers

At what age should children normally be able to balance on one foot for about 5 seconds?

<p>By 4 years (D)</p> Signup and view all the answers

What assessment tool is recommended for screening gross and fine motor skills in children?

<p>NDDS (B)</p> Signup and view all the answers

What is the typical response of an infant when the dorsal aspect of their foot touches the underside of a table during the Placing Reflex?

<p>They flex the hip and knee (D)</p> Signup and view all the answers

What movement indicates a possible lower spinal cord problem in an infant?

<p>Absence of movement in one leg (D)</p> Signup and view all the answers

Normal development in children includes the ability to hop by what age?

<p>4 years (D)</p> Signup and view all the answers

At what age can children typically start to have their sensory systems tested similarly to adults?

<p>6 years of age (C)</p> Signup and view all the answers

What action indicates a normal response when testing for spasticity in infants?

<p>Legs unfold slowly when flexed and released. (B)</p> Signup and view all the answers

What is the recommended method for testing deep tendon reflexes (DTRs) in children under 5 years?

<p>With a finger to percuss the tendon (B)</p> Signup and view all the answers

At what age does purposeful release of objects typically develop in infants?

<p>10 months (B)</p> Signup and view all the answers

Which of the following conditions may lead to hyperactivity of deep tendon reflexes (DTRs)?

<p>Hypocalcemia (D)</p> Signup and view all the answers

What is a common sign of cerebral palsy in infants?

<p>Persistent reflex actions with no voluntary movement. (D)</p> Signup and view all the answers

What are common signs of neurological deterioration that should be monitored closely in hospitalized patients?

<p>Alterations in the level of consciousness (A)</p> Signup and view all the answers

Which reflex is assessed by brushing the infant’s cheek?

<p>Rooting reflex (D)</p> Signup and view all the answers

Which position indicates an abnormal finding in an infant after a breech delivery?

<p>Lower extremities in a flat abducted position. (D)</p> Signup and view all the answers

Which reflex is often found to be absent in older adults?

<p>Ankle jerk reflex (C)</p> Signup and view all the answers

What should be observed at 4 months regarding head control?

<p>Baby can hold head midline when sitting. (D)</p> Signup and view all the answers

What is a common age-related change in older adults regarding sensory perception?

<p>Loss of vibration sensation at ankle malleolus (A)</p> Signup and view all the answers

When does the palmar grasp reflex typically disappear?

<p>3 to 4 months (B)</p> Signup and view all the answers

What characteristic distinguishes senile tremors from parkinsonism tremors?

<p>Dyskinesias are associated with senile tremors (D)</p> Signup and view all the answers

What does persistent one-hand preference in infants younger than 18 months indicate?

<p>Possible motor deficit on the opposite side. (B)</p> Signup and view all the answers

When conducting an abbreviated neurological examination, which of the following is assessed first?

<p>Level of consciousness (C)</p> Signup and view all the answers

Which sensory aspect is usually not tested in children younger than 6 years?

<p>Vibration sense (D)</p> Signup and view all the answers

What does head lag in an infant over 6 months suggest?

<p>Possible neurological evaluation needed. (B)</p> Signup and view all the answers

Which of the following indicates hyperaesthesia in an infant?

<p>Excessive rapid withdrawal from stimuli. (A)</p> Signup and view all the answers

In order to assess a patient's orientation, which of the following questions would be inappropriate?

<p>What is your favorite color? (A)</p> Signup and view all the answers

What does the Landau reflex indicate in infants when absent?

<p>Possible upper motor neuron disease. (D)</p> Signup and view all the answers

Which of the following conditions is usually associated with a loss of the ankle jerk reflex in older adults?

<p>Normal aging processes (A)</p> Signup and view all the answers

What sign may indicate brain damage in an infant?

<p>Lag in head control beyond 4 months. (C)</p> Signup and view all the answers

What sensory changes can be expected in older adults regarding pain and light touch?

<p>Stronger stimuli are needed for both sensations (D)</p> Signup and view all the answers

The sucking reflex is strongest in which age range?

<p>1 to 2 months (A)</p> Signup and view all the answers

How should you approach testing deep tendon reflexes in older adults who find it challenging to relax?

<p>By encouraging relaxation (B)</p> Signup and view all the answers

During a sensory examination of a newborn, how should the infant typically respond to a strong stimulus?

<p>General reflex withdrawal of all limbs. (B)</p> Signup and view all the answers

What is the expected response when testing the Achilles reflex?

<p>Plantar flexion of the foot (B)</p> Signup and view all the answers

Which position is appropriate for testing the clonus reflex?

<p>Supine position with one knee supported (D)</p> Signup and view all the answers

A positive Babinski sign is indicated by which response?

<p>Dorsiflexion of the big toe and fanning of toes (A)</p> Signup and view all the answers

Which reflex is not routinely tested in adults?

<p>Cremasteric reflex (D)</p> Signup and view all the answers

What response indicates a problem in the pyramidal tract when assessing superficial reflexes?

<p>Contralateral absence of reflexes (B)</p> Signup and view all the answers

The normal response to an abdominal reflex test should show what?

<p>Ipsilateral deviation of the umbilicus (A)</p> Signup and view all the answers

What happens to superficial reflexes in cases of upper motor neuron lesions?

<p>They may be absent on the contralateral side (B)</p> Signup and view all the answers

How can you confirm the proper functioning of cranial nerves in an infant?

<p>Observing responses in reflex tests (B)</p> Signup and view all the answers

Which developmental milestone is typically observed by 4 months of age?

<p>Babbling (B)</p> Signup and view all the answers

How is muscle tone assessed in infants during a neurological examination?

<p>By observing resting posture (C)</p> Signup and view all the answers

What characterizes a normal response when testing for clonus?

<p>No further movements after stretching (B)</p> Signup and view all the answers

What is a sign of CNS damage in infants regarding their cry?

<p>High-pitched or shrill cry (D)</p> Signup and view all the answers

At what age should you expect a baby to recognize their parent's face?

<p>By 2 months (A)</p> Signup and view all the answers

What would indicate a delay in motor activity during an infant's exam?

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Flashcards

Central Nervous System (CNS)

The CNS is made up of the brain and spinal cord. It's the control center for your body.

Peripheral Nervous System (PNS)

The PNS includes all nerves outside the CNS. It connects the CNS to the rest of your body.

What are Sensory (Afferent) Messages?

They carry information from your senses (sight, touch, etc.) to the CNS.

What are Motor (Efferent) Messages?

They carry commands from the CNS to muscles and glands.

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What are Autonomic Messages?

They regulate internal organs and blood vessels. You don't control them consciously.

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Cerebral Cortex

The outer layer of the cerebrum, responsible for higher-level functions like thinking, language, and memory.

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What is Myelin?

A fatty substance that covers nerve fibers, speeding up nerve impulses.

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What is the Brainstem?

The brainstem connects the brain to the spinal cord. It controls basic life functions.

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Left Hemisphere Dominance

In most people, the left hemisphere controls language, logic, and analytical skills.

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Frontal Lobe

The largest lobe, located at the front of the brain, responsible for personality, behavior, emotions, intellectual function, and initiating voluntary movements.

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Precentral gyrus

The strip of the frontal lobe that controls voluntary movement.

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Parietal Lobe

The lobe located behind the frontal lobe, responsible for processing sensory information.

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Postcentral gyrus

The strip of the parietal lobe that receives sensory information from the body.

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Occipital Lobe

The lobe in the back of the brain, responsible for processing visual information.

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Temporal Lobe

The lobe located below the parietal lobe, responsible for processing auditory information and language comprehension.

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Wernicke's Area

A region in the temporal lobe responsible for understanding language.

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Broca's Area

A region in the frontal lobe responsible for producing speech.

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Basal Ganglia

Deep brain structures involved in controlling smooth, coordinated movements.

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Thalamus

The relay station for most sensory information going to the cerebral cortex.

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Hypothalamus

A small but vital area controlling temperature, heart rate, blood pressure, sleep, and hormones.

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Cerebellum

The structure underneath the occipital lobe, responsible for coordinating movement, balance, and muscle tone.

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Brainstem

The central core of the brain connecting the cerebrum to the spinal cord, responsible for vital functions like breathing, heart rate, and alertness.

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Sensory Cortex

The part of the brain that interprets sensory information from the body, allowing us to experience sensations like touch, temperature, pain, and position.

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Posterior Columns

Nerve pathways that carry information about precise touch, vibration, and body position from the body to the brain.

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Proprioception

The sense of knowing where your body parts are in space, without looking at them.

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Stereognosis

The ability to identify objects by touch alone, without looking at them.

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Referred Pain

Pain felt in a body part different from the source of the pain, often due to shared neural pathways.

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Motor Cortex

The area of the brain responsible for planning and executing voluntary movements.

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Corticospinal Tract

A major pathway in the brain that carries signals for voluntary movement from the motor cortex to the spinal cord.

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Somatotopic Organization

The arrangement of the motor cortex, where different body parts are represented in specific areas.

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Pyramidal Decussation

The crossing over of corticospinal fibers in the brainstem, where signals from one side of the brain control movements on the opposite side of the body.

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Extrapyramidal Tracts

Motor pathways that control muscle tone, posture, and automatic movements.

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Upper Motor Neuron

Neurons located in the central nervous system that convey signals to lower motor neurons, influencing muscle activity.

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Lower Motor Neuron

Neurons located in the peripheral nervous system, directly responsible for stimulating muscle contraction.

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Final Common Pathway

The term referring to the lower motor neuron, which receives input from various sources and ultimately controls muscle contraction.

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Somatic Nervous System

Controls voluntary movements of skeletal muscles.

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Autonomic Nervous System

Controls involuntary functions like heart rate, digestion, and breathing.

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Cranial Nerves

12 pairs of nerves that connect the brain to the head, neck, and torso.

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Olfactory Nerve

Sensory nerve responsible for the sense of smell.

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Optic Nerve

Sensory nerve responsible for vision.

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Oculomotor Nerve

Mixed nerve controlling eye movement, pupil constriction, and eyelid opening.

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Trochlear Nerve

Motor nerve controlling downward and inward eye movement.

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Trigeminal Nerve

Mixed nerve controlling facial sensation, chewing muscles, and taste.

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Abducens Nerve

Motor nerve controlling outward eye movement.

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Facial Nerve

Mixed nerve controlling facial expressions, taste on the anterior tongue, and tear/saliva production.

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Acoustic Nerve (Vestibulocochlear Nerve)

Sensory nerve responsible for hearing and balance.

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Glossopharyngeal Nerve

Mixed nerve controlling swallowing, taste on the posterior tongue, and saliva production from the parotid gland.

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Vagus Nerve

Mixed nerve controlling the heart, lungs, and digestive system.

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Spinal Accessory Nerve

Motor nerve controlling neck and shoulder movement.

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Hypoglossal Nerve

Motor nerve controlling tongue movement.

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Spinal Nerves

Nerves that emerge from the spinal cord and control functions in the rest of the body, carrying sensory and motor information.

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Sensory Afferent Fibers

Nerve fibers that carry sensory information from the body to the central nervous system.

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Motor Efferent Fibers

Nerve fibers that carry motor commands from the CNS to muscles and glands.

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Reflex Arc

The neural pathway responsible for a reflex action, involving sensory input, a processing center, and motor output.

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Deep Tendon Reflexes (Myotatic)

Involuntary muscle contractions triggered by stretching of a muscle tendon, like the knee-jerk reflex.

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Superficial Reflexes

Involuntary muscle contractions triggered by stimulation of the skin, like the corneal reflex.

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Visceral (Organic) Reflexes

Involuntary muscle contractions triggered by stimulation of internal organs, like the pupillary response to light.

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Pathological Reflexes

Abnormal reflexes that indicate damage to the nervous system, like the Babinski reflex.

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Dermatome

A region of skin that is primarily supplied by sensory fibers from a single spinal nerve.

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TIA

A transient ischemic attack (TIA) is a temporary blockage of blood flow to the brain, causing stroke-like symptoms that usually disappear within a few minutes or hours.

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Why is seeking medical attention important after a TIA?

Seeking medical attention after a TIA is crucial to rule out a more serious stroke. Early detection allows for prompt treatment and reduces the risk of future strokes.

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FACE mnemonic for stroke

The FACE mnemonic helps recognize stroke symptoms: F - Face drooping, A - Arm weakness, C - Speech difficulty, E - Emergency call.

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Modifiable risk factors for stroke

These are factors that can be changed to reduce stroke risk, including high blood pressure, diabetes, smoking, inactivity, and high cholesterol.

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Nonmodifiable risk factors for stroke

These are factors that cannot be changed, including age, gender, and genetic factors. They can increase stroke risk.

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Stroke prevention for high-risk individuals

People at risk for stroke should focus on healthy diet, exercise, weight management, smoking cessation, alcohol moderation, and managing medical conditions.

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Subjective data for stroke assessment

These are patient-reported symptoms like headaches, dizziness, weakness, numbness, and difficulty speaking, which can indicate neurological problems.

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Health History: Headache

A history of frequent or severe headaches can be a clue to underlying neurological issues.

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Health History: Head injury

Past head injuries, particularly those involving loss of consciousness, can increase the risk of stroke.

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Health History: Dizziness or Vertigo

Episodes of dizziness or vertigo, especially with changes in position, can indicate inner ear problems or neurological issues.

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Health History: Seizures

A history of seizures, especially those with warning signs or specific patterns, can indicate epilepsy or other neurological conditions.

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Pre-eclampsia and stroke risk

Women who develop pre-eclampsia during pregnancy may have a higher risk of stroke later in life.

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Oral contraceptives and stroke risk

Women who smoke and take oral contraceptives or have high blood pressure, migraines, or blood clotting disorders have an increased stroke risk.

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Ethnocultural background and stroke risk

Indigenous people and those of African or South Asian descent have a higher risk of stroke due to increased rates of high blood pressure and diabetes.

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Genetic disorders and stroke risk

Some genetic disorders, such as Marfan syndrome or CADASIL, can increase the risk of stroke.

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Postictal Phase

The period after a seizure where the patient might experience confusion, fatigue, headache, or muscle aches. This is the 'recovery' phase.

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Tremor

An involuntary shaking or trembling of the body, typically in the hands or face.

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Paresis

Weakness in voluntary movement or impaired movement. It's a partial loss of movement.

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Dysmetria

The inability to control the range of motion of muscles, leading to inaccurate movements or overshooting.

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Paraesthesia

An abnormal sensation of burning, tingling, or prickling often felt in the extremities of the body.

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Dysphagia

Difficulty swallowing.

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Dysarthria

Difficulty forming words, slurred speech.

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Aphasia

Difficulty with language comprehension or expression. It's a language disorder.

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Congenital Defect

A birth defect or a condition present at birth, often due to genetic or environmental factors.

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Maternal Health

The health of the mother during pregnancy.

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Neonatal Period

The first 28 days of life after birth.

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Apgar Score

A quick assessment of a newborn's health, given at 1 and 5 minutes after birth.

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Developmental Milestones

Key physical and cognitive skills a child should achieve at specific ages. It's a guideline for development.

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Risk for Falls

Factors that increase the likelihood of an older adult falling.

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Motor System Changes with Aging

The motor system slows down, muscle strength and agility decrease, muscle bulk shrinks, and tremors might occur in the hands, head, and jaw.

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Cerebral Blood Flow and Aging

As we age, cerebral blood flow and oxygen consumption decrease. This can lead to dizziness and balance issues, especially when changing positions.

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Falls in Older Adults

Older adults are prone to falls because of slowing reflexes, balance issues, and potential forgetfulness. Getting up slowly is essential to minimize risk.

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Walking Changes in Older Adults

While health allows, older adults walk similarly to their younger years, but more slowly and deliberately. They might check for obstacles or uneven terrain, showing hesitation.

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Social Determinants of Health and Stroke

Factors like socioeconomic status and access to healthcare significantly impact stroke risk and outcomes, with disadvantaged populations experiencing higher rates and worse outcomes.

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Stroke Disparities by Income

Stroke disproportionately affects people in lower income areas, contributing to higher hospital admissions for stroke.

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Stroke Disparities in Indigenous Populations

First Nations, Inuit, and Métis people are more likely to have stroke risk factors like hypertension, diabetes, and smoking, leading to higher death rates.

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Stroke Disparities in African Heritage Populations

People of African heritage are more likely to have hypertension and diabetes, increasing their risk for stroke.

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Stroke: Leading Cause of Disability and Death

Stroke is a major health concern, being the leading cause of adult disability and the third leading cause of death in Canada.

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Stroke Risk Factors

Age, hypertension, smoking, and heart conditions like atrial fibrillation increase the risk of stroke.

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Types of Stroke

There are two main types of stroke: ischemic stroke, caused by a blood clot, and hemorrhagic stroke, caused by a ruptured blood vessel.

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Stroke Symptoms

Common stroke symptoms include sudden weakness or numbness, confusion, speech problems, vision changes, walking difficulties, dizziness, and severe headache.

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Importance of Early Stroke Detection

Prompt recognition and treatment are crucial for stroke, as the time from symptom onset is vital for medical intervention.

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Stroke Symptoms vs. Other Conditions

Stroke symptoms can be similar to those of other conditions, like hypoglycemia, migraines, seizures, trauma, or drug overdose.

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Importance of Recognizing TIA (Mini-Stroke)

TIAs are temporary stroke-like symptoms that can be a warning sign of a future stroke. Seeking medical attention after a TIA is essential.

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Dizziness Impact

How dizziness affects your ability to perform daily activities, like driving or walking safely around your home.

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Home Safety Modifications

Changes made to your living space to reduce the risk of falls or accidents when experiencing dizziness.

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Micturition Syncope

Fainting or loss of consciousness that occurs during or immediately after urinating.

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Cognitive Decline

A noticeable decrease in memory, thinking ability, or mental sharpness.

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Sudden vs. Gradual Cognitive Changes

Distinguishing whether the onset of cognitive decline was sudden (happening quickly) or gradual (developing slowly over time).

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Tremor Triggers

Factors that make tremor worse, such as anxiety, physical activity, being at rest, or alcohol consumption.

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Tremor and Daily Life

The extent to which tremor interferes with daily activities, such as writing, eating, or social interaction.

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Senile Tremor

A type of tremor that improves with alcohol, although this is not a recommended treatment.

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Sudden Vision Changes

Rapid and unexpected changes in vision, such as temporary blindness or blurred vision.

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Vision Change and Weakness

When sudden vision changes occur along with weakness or loss of consciousness.

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Critical Findings

Signs and symptoms that require immediate medical attention or transport to a hospital.

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Neurological Examination

A thorough assessment of the nervous system, including mental status, reflexes, and sensory function.

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Range of Motion (ROM)

The full extent of movement possible at a joint. It's tested by moving each extremity smoothly through its full range.

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Flaccidity

Decreased muscle resistance, meaning the muscles feel 'floppy' or weak.

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Spasticity

Increased muscle resistance to passive movement, often described as 'stiffness' or 'tightness'.

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Rigidity

Increased muscle resistance to passive movement that is constant and present throughout the entire range of motion.

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Involuntary Movement

Movement that occurs without conscious control.

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Tandem Walking

Walking heel-to-toe in a straight line, challenging balance and coordination.

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Romberg Test

A test of balance where the patient stands with feet together, eyes closed, and attempts to maintain balance.

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Positive Romberg Sign

Loss of balance that occurs when the eyes are closed during the Romberg test.

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Dysdiadochokinesia

Lack of coordination or difficulty performing rapid alternating movements.

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Finger-to-Nose Test

A test of coordination where the patient touches their nose with their index finger alternating hands.

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Heel-to-Shin Test

A test of lower extremity coordination where the patient runs their heel down their shin.

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Levels of Consciousness

A scale used to assess a patient's alertness and responsiveness, ranging from fully alert to unresponsive.

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Stimulus Response

The way a patient reacts to different types of stimuli, indicating their level of consciousness.

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Motor Function

The ability to move the body voluntarily, assessed by giving specific commands.

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Cranial Nerve VII

The facial nerve, responsible for controlling facial expressions and taste on the front of the tongue.

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Nasolabial Folds

The lines that run from the nose to the corner of the mouth, used to assess facial symmetry and nerve function.

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Cranial Nerve V: Trigeminal Nerve

This nerve controls chewing muscles and facial sensation.

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Trigeminal Nerve - Motor Function

Tests the strength and symmetry of the chewing muscles by palpating the temporal and masseter muscles.

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Trigeminal Nerve - Sensory Function

Tests light touch sensation on the forehead, cheeks, and chin using a cotton wisp.

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Corneal Reflex

Checks if the eye blinks when touched lightly with a cotton wisp - tests both sensory and motor nerves.

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Cranial Nerve VII: Facial Nerve

This nerve controls facial expressions and taste.

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Facial Nerve - Motor Function

Tests facial muscle movement by asking the patient to smile, frown, close eyes, raise eyebrows, show teeth, and puff cheeks.

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Facial Nerve - Sensory Function

Tests the sense of taste by applying sugar, salt, or lemon juice to the tongue.

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Cranial Nerve VIII: Acoustic (Vestibulocochlear) Nerve

This nerve is responsible for hearing and balance.

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Cranial Nerves IX and X: Glossopharyngeal and Vagus Nerves

These nerves control swallowing, taste, and voice.

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Glossopharyngeal and Vagus Nerves - Motor Function

Tests swallowing and voice by observing the uvula and soft palate movement while the patient says 'ahhh' or yawns.

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Glossopharyngeal and Vagus Nerves - Sensory Function

Tests taste on the posterior one-third of the tongue, but it's difficult to test.

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Cranial Nerve XI: Spinal Accessory Nerve

This nerve controls neck and shoulder movement.

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Spinal Accessory Nerve - Function

Tests the strength of the neck and shoulder muscles by asking the patient to rotate their head and shrug their shoulders against resistance.

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Cranial Nerve XII: Hypoglossal Nerve

This nerve controls tongue movement.

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Hypoglossal Nerve - Function

Tests tongue movement by observing the tongue for atrophy, tremors, and symmetry while the patient sticks it out and speaks.

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Newborn Flexion

A newborn's typical posture with extremities folded inward, hips slightly abducted, and fists tightly clenched.

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Breech Delivery Position

Infants born breech may initially lack lower extremity flexion.

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Frog Position

Hips abducted and almost flat, with external rotation. Normal only after breech delivery.

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Opisthotonos

Head arched back, neck stiffness, and extended limbs. Occurs with meningeal or brainstem irritation and kernicterus.

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Extension of Limbs

Can occur with intracranial hemorrhage.

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Asymmetry of Limbs

Continual asymmetry, especially in upper limbs, can indicate brachial plexus palsy.

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Head Control

The ability to hold the head steady and upright.

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Landau Reflex

At 3 months, baby raises head and arches back when held prone. Disappears around 18 months.

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Muscle Strength Assessment

Observing sucking strength and spontaneous motor activity.

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Hypoaesthesia

Decreased sensitivity to touch. Normal in newborns, requiring strong stimuli for response.

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Rooting Reflex

Baby turns head and opens mouth when cheek is stroked. Present at birth and disappears around 3-4 months.

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Palmar Grasp

Baby tightly grasps finger placed in palm. Strongest at 1-2 months, disappears by 3-4 months.

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Plantar Grasp

Baby curls toes down when thumb is placed on ball of foot. Disappears by 8-10 months.

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Graphaesthesia

Ability to recognize numbers or letters traced on the skin. It tests sensory cortex function and is helpful when hand movements are limited.

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Two-Point Discrimination

Measures the distance between two points on the skin that a person can perceive as separate. Tests sensory cortex function.

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Extinction

Tests awareness of simultaneous touch on both sides of the body. One sensation may be 'extinguished' on the side opposite a sensory cortex lesion.

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Point Location

Tests a person's ability to identify the spot touched on their skin. Assess sensory cortex function.

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Stretch (Deep Tendon) Reflexes

Tests the intactness of the reflex arc at specific spinal levels, reflecting the influence of higher cortical levels on reflexes.

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Reflex Grading Scale

A 5-point scale (0-4+) used to measure reflex responses. Values vary depending on reflex briskness and indicate potential neurological issues.

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Clonus

A series of rapid, rhythmic muscle contractions, often seen in hyperactive reflexes, indicating upper motor neuron disease.

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Hyperreflexia

Exaggerated reflexes, indicating an upper motor neuron lesion. The brain's inhibitory control is reduced.

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Hyporeflexia

Reduced or absent reflexes, indicating a lower motor neuron problem. Nerve signals are disrupted.

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Reinforcement Technique

Used to enhance reflexes by having the patient perform isometric exercise in a muscle group away from the test area.

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Biceps Reflex

Tests the C5-C6 spinal nerve levels by striking the biceps tendon, resulting in elbow flexion.

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Triceps Reflex

Tests the C7-C8 spinal nerve levels by striking the triceps tendon, resulting in elbow extension.

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Brachioradialis Reflex

Tests the C5-C6 spinal nerve levels by striking the brachioradialis tendon, resulting in forearm flexion and supination.

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Quadriceps (Patellar) Reflex

Tests the L2-L4 spinal nerve levels by striking the patellar tendon, resulting in knee extension.

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Babinski Reflex

A normal reflex in infants where toes fan out when the sole of the foot is stroked. It disappears by around 2 years old. Persistence beyond this age might indicate a pyramidal tract issue.

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Tonic Neck Reflex

A reflex where infants extend the arm and leg on the same side of the body and flex the opposite arm and leg when their head is turned to one side. Disappears by ages 4 to 6 months.

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Moro Reflex

A startle reflex in infants where they extend arms and legs, spread fingers, and then bring them in. Disappears by ages 1 to 4 months.

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Placing Reflex

A reflex where infants flex their hip and knee, then extend the hip to place their foot on a surface when the top of their foot touches the surface. Appears 4 days after birth.

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Stepping Reflex

A reflex where infants make alternating steps when held upright with feet on a surface. Disappears before walking starts.

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Gower's Sign

A sign of muscular dystrophy where children use their hands to “climb” up their legs to stand from a supine position. They are unable to use their weak pelvic muscles.

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Wide-Based Gait

A normal gait in toddlers where they walk with legs spread wide apart.

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Knock-Kneed Walk

A normal gait in preschoolers where their knees touch when they walk.

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Balance on One Foot

A test of balance where a child is asked to stand on one foot. Children typically can balance for 5 seconds by age 4 and 8 to 10 seconds by age 5.

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Hopping

A gross motor skill where a child can hop on one foot. Children usually develop this by age 4.

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Staggering and Falling

Abnormal gait pattern in children that could indicate a motor delay or other underlying issue.

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Weakness Climbing Stairs

A sign of muscular dystrophy where children have difficulty with stair climbing due to weak muscles.

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Broad-Based Gait

An abnormal gait in children beyond toddlerhood where their legs are spread wide apart. May indicate a balance issue.

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Scissor Gait

An abnormal gait in children where the legs cross over each other while walking. May indicate spasticity or muscle tightness.

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Sensory Testing: When is it necessary?

Complete sensory testing is recommended for patients experiencing neurological symptoms (like pain, numbness, or tingling) or when you discover abnormalities (like motor deficits).

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Sensory Testing: What to test?

When completing sensory testing, examine all sensory modalities (pain, temperature, light touch, vibration, position sense) to determine if the patient's nervous system is functioning correctly.

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Sensory Testing: Compare what?

During sensory testing, compare sensations on symmetrical parts of the body (right vs. left) to establish a baseline and identify any discrepancies.

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Sensory Testing: Mapping out the deficit

If you detect a decrease in sensation during testing, map out the affected area systematically. Start from the point of decreased sensation and move towards the sensitive area.

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Sensory Testing: Glove-and-Stocking Distribution

A topographical pattern of sensory loss over the hands and feet, characteristic of disorders like peripheral neuropathy.

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Sensory Testing: Avoiding Leading Questions

Use unbiased directions and avoid leading questions (like "Can you feel this pinprick?" because they create an expectation of how the patient should feel, which is called suggestion.

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Sensory Testing: Closed Eyes

During each sensory test, the patient's eyes should be closed to avoid visual cues that could influence their response.

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Spinothalamic Tract: What does it test?

The spinothalamic tract is responsible for transmitting pain and temperature sensation to the brain. Testing this tract involves assessing the patient's ability to perceive pinpricks and temperature changes.

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Spinothalamic Tract: Testing Pain Sensation

To test pain sensation, use a broken tongue blade's sharp point and dull end to apply stimuli and ask the patient to differentiate between "sharp" and "dull."

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Spinothalamic Tract: Terms for Abnormal Pain

Hypoalgesia: decreased pain sensation; Analgesia: absence of pain sensation; Hyperalgesia: increased pain sensation.

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Spinothalamic Tract: Temperature Testing

Test temperature sensation only if pain sensation is abnormal. Use two test tubes, one with hot water and one with cold, and apply them to the skin randomly.

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Posterior Column Tract: Testing Vibration

The posterior column tract carries vibration and position sense information. To test this tract, apply a tuning fork to bony prominences on the patient's fingers and toes.

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Posterior Column Tract: Interpreting Vibration Loss

Inability to feel vibration suggests a peripheral neuropathy, often found in conditions like diabetes or alcoholism. The loss is usually worst at the feet and improves gradually upward.

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Posterior Column Tract: Testing Position Sense (Kinaesthesia)

Position sense (kinaesthesia) assesses a patient's ability to perceive the movement of their extremities. Move a finger or toe up and down while the patient's eyes are closed.

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Tactile Discrimination: Stereognosis

Stereognosis is the ability to identify objects by touch with the eyes closed. Place familiar objects like a key or coin in the patient's hand and ask them to name it.

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Tactile Discrimination: Graphaesthesia

Graphaesthesia is the ability to read numbers traced on the skin with the eyes closed. Trace numbers on the patient's palm and see if they can correctly identify them.

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Light Touch Test

A simple sensory test where the child closes their eyes and identifies where they are touched or tickled.

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Vibrational Sense

The ability to perceive vibrations, tested by applying a tuning fork to the body.

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Position Sense

The awareness of where your body parts are in space without looking.

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Deep Tendon Reflexes (DTRs)

Involuntary muscle contractions triggered by tapping on a tendon.

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Hyperactive DTRs

Exaggerated reflexes, indicating possible upper motor neuron dysfunction.

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Hypoactive DTRs

Decreased or absent reflexes, suggesting lower motor neuron problems.

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Dyskinesias

Repetitive movements of the jaw, lips, or tongue, sometimes accompanying senile tremors.

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Orientation Assessment

Evaluating a person's understanding of their identity, location, and current time.

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Neurological Re-check

A brief neurological evaluation for hospitalized patients with potential neurological deficits.

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Achilles Reflex

A deep tendon reflex tested by striking the Achilles tendon while the foot is dorsiflexed, causing plantar flexion of the foot.

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Abdominal Reflexes

Superficial reflexes tested by stroking the abdomen, causing muscle contraction and movement of the umbilicus toward the stimulus.

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Cremasteric Reflex

A superficial reflex tested by stroking the inner thigh in males, causing elevation of the testicle.

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Babinski Sign

An abnormal response to the plantar reflex, characterized by dorsiflexion of the big toe and fanning of the other toes. It indicates an upper motor neuron lesion.

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Primitive Reflexes in Infants

Early reflexes present at birth, such as rooting and sucking reflexes, which should disappear as the infant develops.

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Nipissing District Developmental Screen (NDDS)

A parent-report screening tool used to assess gross and fine motor coordination in infants based on age-specific developmental milestones.

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Muscle Tone in Infants

Observed by assessing resting posture and the infant's resistance to passive movement, indicating the baby's muscle activity.

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Lethargy, Hyporeactivity, Hyperirritability in Infants

Abnormal behavioral signs in infants that could indicate CNS damage or other issues.

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Developmental Delays in Infants

When a child fails to achieve expected developmental milestones, such as walking or talking by a specific age.

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Persistence of Reflex Behavior Beyond Normal Time

When primitive reflexes persist in an older infant, indicating potential neurological issues.

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Cry Assessment in Infants

Analyzing an infant's cry for abnormalities, such as a high-pitched cry, which could indicate CNS damage.

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Smoothness and Symmetry of Movement in Infants

Indicates proper cerebellar function, as observed by the infant's movements and coordination.

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Delayed Motor Activity in Infants

Indicates possible brain damage, intellectual disability, or other underlying conditions.

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Study Notes

Nervous System Structure and Function

  • Nervous System Division: The nervous system is divided into the central nervous system (CNS) and the peripheral nervous system (PNS).
  • CNS Components: The CNS includes the brain and spinal cord.
  • PNS Components: The PNS includes cranial nerves (12 pairs), spinal nerves (31 pairs), and their branches.
  • PNS Functions: The PNS transmits sensory (afferent) messages to the CNS, motor (efferent) messages from the CNS to muscles and glands, and autonomic messages regulating internal organs and blood vessels.
  • Meninges: Protective membranes (dura, arachnoid, pia mater) surrounding the CNS. Cerebrospinal fluid also protects CNS.

Cerebral Cortex

  • Structure: The outermost layer of the cerebrum, composed of nerve cell bodies without myelin ("grey matter"). Myelin increases nerve impulse speed.
  • Function (General): Centre for higher functions: thought, memory, reasoning, sensation, and voluntary movement.
  • Hemispheric Dominance: Left hemisphere dominates in most right-handers and many left-handers.
  • Lobes and Functions:
    • Frontal Lobe: Personality, behavior, emotions, intellectual functions.
    • Precentral Gyrus: Initiates voluntary movement.
    • Parietal Lobe: Primary sensory centre (postcentral gyrus).
    • Occipital Lobe: Primary visual receptor centre.
    • Temporal Lobe: Primary auditory reception, taste, smell, Wernicke's area (language comprehension). Damage causes receptive aphasia (hearing without meaning). Broca's area (motor speech) in frontal lobe; damage causes expressive aphasia (understanding with garbled speech).
  • Damage Effects: Loss of function (motor weakness, paralysis, sensory loss, language impairment) due to blood supply interruption (occluded artery, bleeding, vasospasm).

Basal Ganglia

  • Location: Deep within the cerebral hemispheres.
  • Function: Subcortical associated motor system. Controls automatic associated movements (e.g., arm swing during walking).

Thalamus

  • Function: Main relay station for sensory pathways from spinal cord and brainstem to cerebrum.

Hypothalamus

  • Function: Major control center for vital functions like temperature, heart rate, blood pressure, sleep, pituitary gland regulation, autonomic nervous system and emotional response.

Cerebellum

  • Location: Under the occipital lobe.
  • Function: Coordinates voluntary movements, maintains equilibrium, and muscle tone; does not initiate movement but refines and smoothes it.

Brainstem

  • Structure: Central core of the brain, primarily nerve fibers.
    • Midbrain: Anterior, basic tubular structure, merges into thalamus and hypothalamus, contains many motor neurons and tracts.
    • Pons: Enlarged area with ascending and descending fiber tracts.
    • Medulla: Continuation of spinal cord, contains ascending and descending fiber tracts connecting brain and spinal cord, controls vital autonomic centers (respiratory, cardiac, gastrointestinal functions), and nuclei for cranial nerves VIII–XII (Pyramidal decussation).

Spinal Cord

  • Structure: Long cylindrical structure of nervous tissue, occupying upper two-thirds of vertebral canal from medulla to lumbar vertebrae L1/L2.
  • Function: Main pathway for ascending and descending fiber tracts connecting brain and spinal nerves; mediates reflexes. Grey matter in butterfly shape with anterior and posterior "horns," containing nerve cell bodies.

Pathways of the CNS

  • Crossed Representation: Left cerebral cortex interacts with right body, and vice versa.

Sensory Pathways

  • Sensory Receptors: Extensive network in skin, mucous membranes, muscles, tendons, and viscera. Monitor conscious sensations, internal organ functions, body positions, and reflexes.
  • Spinothalamic Tract: Transmits pain, temperature, and crude/light touch sensations.
  • Posterior (Dorsal) Columns: Conduct sensations of position, vibration, and finely localized touch. (Proprioception, vibration, stereognosis)

Motor Pathways

  • Corticospinal (Pyramidal) Tract: Initiates voluntary movements, especially skilled, discrete movements. Originates in motor cortex.
  • Extrapyramidal Tracts: Older motor system outside pyramidal tract (muscle tone maintenance, gross automatic movements, such as walking).
  • Cerebellar System: Coordinates movement, maintains equilibrium and posture by receiving position and motor messages; subconscious level.

Upper and Lower Motor Neurons

  • Upper Motor Neurons: Located entirely within the CNS; influence lower motor neurons; examples include corticospinal, corticobulbar, and extrapyramidal tracts: cerebral vascular accidents, cerebral palsy, multiple sclerosis.
  • Lower Motor Neurons: Located mostly in the PNS, cell body in spinal cord, nerve fiber extends to muscle, the final common pathway

Peripheral Nervous System

  • Nerves: Bundles of fibers outside the CNS. Carry input (sensory) and output (motor).
  • Reflex Arc: Basic defense mechanisms; involuntary reactions for painful stimuli—deep tendon, superficial, visceral, pathological.
    • Components: Sensory nerve (afferent), synapse in spinal cord, motor nerve (efferent), neuromuscular junction, competent muscle.
  • Cranial Nerves: 12 pairs, mostly supply head and neck.
  • Spinal Nerves: 31 pairs, mixed nerves (sensory and motor fibers). Originate from the length of the spinal cord. Innervate body (each nerve segments body part-dermatome).
  • Somatic & Autonomic Fibers: Somatic: skeletal muscles; Autonomic: smooth muscles, glands, heart; mediates unconscious activity (maintaining homeostasis).

Developmental Considerations

  • Infants: Neurological systems are not fully developed at birth, motor, and sensory systems are rudimentary. Development proceeds in a cephalocaudal (head to tail) and proximal-to-distal (center to extremities) order. Primitive reflexes present at birth normally fade with development.
  • Older Adults: Aging causes atrophy, neuron loss, decrease in brain weight and volume, thinning cortex, reduced subcortical structures, and ventricular enlargement. Slowed nerve conduction, decreased sensation (touch, pain, taste, smell). Motor system showing slowing, decrease in muscle bulk and strength. Stroke risk increased.

Social Determinants of Health Considerations

  • Socioeconomic status: Stroke more prevalent in socioeconomically disadvantaged populations, impacting short/long-term outcomes.
  • Cultural/Ethnic background: Indigenous people, people of African or South Asian descent, demonstrate higher stroke death rates due to underlying factors like higher hypertension and diabetes.

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Test your knowledge on the central nervous system with this quiz. Questions cover various aspects including brain structures, functions, and components of the CNS. Perfect for students studying biology or neuroscience.

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