PTAP 2715 Final

Cause of blood detected in CSF (after drawing the 4th vial) is due to:

Subarachnoid hemorrhage

Crescent shaped abnormality detected on the CT scan is due to:

Subdural hematoma

You have a patient that exhibits involuntary flailing movements of one arm. Where is themes likely location of this lesion?

Subthalamic nucleus

Receptor: Meissner Location: ?

Superficial (hair)

Receptor: Merkel Location: ?

Superficial (hair)

Reflex: Patellar Nerve root: ?

L4

When testing the patellar reflex, you are testing the integrity of this spinal nerve:

L4

Where are Meissner corpuscles located?

Superficially (especially the fingertips)

You suspect damage to this cranial nerve if the patient has vocal hoarseness and difficulty swallowing

Vagus nerve

A deep tendon reflex response with a grade of 2+ means it has a characteristic of..

Active; normal response

Galant reflex

Hold a baby on their stomach, stroke one side of the spine and the infant will bend to that side

You notice that your patient's right eye is drooping. Upon closer inspection, you also realize their right pupil constricted and that their face is reddened on the right side. You suspect the patient to have:

Horner's syndrome on the right side

A lesion to this nerve causes the tongue to deviate toward the side of the lesion:

Hypoglossal

Inflammation of a nerve causing alterations in sensation and eventual muscle weakness inc cases of severe nerve damage

Neuropathy

Which artery is damaged with cortical blindness?

Posterior cerebral artery

Vestibulospinal tract:

Postural adjustments and head movements

The nuclei for this cranial nerve originates in the spinal cord:

Spinal accessory

What is the shape of the Ruffini endings?

Spindle shaped

Rooting reflex

Stroke the side of the mouth and the baby will turn toward that direction

Plantar (Babinski) reflex

Stroking the bottom of the foot resulting in plantarflexion of the toes normally; abnormal reflex results in dorsiflexion and flailing of the toes

Palmar grasp reflex

Stroking the palm of the hand to stimulate a grasp

Erb's palsy

A traction injury to the upper brachial plexus occurring most commonly during childbirth. Results in the arm hanging in shoulder hyperextension and medial rotation, elbow extended, forearm pronated and wrist flexed

Extrafusal muscle fibers

- The functional unit of muscle - Responsible for the heavy lifting accomplished by muscle fibers - Can be subdivided into type I and type II fibers - Contraction results when an alpha motor neuron from the anterior horn stimulates the muscle

C-fiber characteristics:

- Unmyelinated - Slow signal - Located deep; autonomic NS - Dull aching pain, burning pain, warm temperatures

Free nerve endings

- Unspecialized sensory receptor - Do not have complex sensory structures - Varying rate of adaptation --A-delta --C-fibers

Terms confused with muscle tone:

- Voluntary muscle contraction - Posture - Fluctuating abnormal tone

Receptor: Free nerve ending Adaptation: ?

A-delta: rapid C-fiber: slow

Receptor: free nerve ending Sensation: ?

A-delta: sharp/cold C-fiber: dull/warm

Receptor: free nerve ending Location: ?

A-delta: superficial C-fiber: everywhere

Craniopharyngioma

A supratentorial pediatric tumor

A patient who can only communicate though blinking may exhibits signs of a :

"Locked-in" syndrome

What is true regarding astrocytes?

- Active during the healing phase after brain trauma - Remove excess neurotransmitter from the synaptic cleft of neurons - Participate in reactive gliosis

Characteristics of Guillain Barre syndrome:

- Ascending muscle weakness due to the loss of function in the peripheral nerve axon -- Starts in legs, then to hands, and trunk; may involve face - Mostly a muscle problem; few sensory effects - Weakness progressing days to weeks - Diagnosed via nerve conduction velocity testing

Guillain Barre Syndrome (GBS)

- Autoimmune inflammatory condition attacking the Schwann cells of peripheral nerves - Associated with GI illness, stress, or respiratory infection

Abnormal involuntary movement or dyskinesias

- Chorea - Ballismus - Tremor - Athetosis

Qualitative measures for muscle tone:

- Clinical tone scale - Muscle stretch reflex test - Ashworth or Modified Ashworth Scale

Quantitative measures for muscle tone:

- Dynamometer or myometer - Isokinetic testing systems - EMG - Pendulum test

Rehabilitation approaches for treating patients with alpha motor neuron damage:

- Electrical stimulation - Hydrotherapy - Quick ice - Exercises - Orthotics

Charcot-Marie-Tooth disease

- Hereditary motor and sensory neuropathy - Progressive loss of muscle tissue and touch sensation across various parts of the body, usually starting in the feet and progressing to the hands and beyond - Caused by genetic mutations, which result in problems in the neuron and myelin sheaths

Sensory receptors:

- Merkel nerve endings - Meissner corpuscles - Ruffini endings - Pacinian corpuscles - Free nerve endings

Associated effects of high muscle tone:

- Muscle spasms - Contractures - Abnormal postures leading to skin ulcers - Difficulty with functional mobility - Movement patterns or synergies

Challenges in assessing muscle tone:

- Must be assessed when there is no active resistance to muscle stretch - Changes with: -- Movement -- Posture -- Intention -- Environment

A-delta characteristics:

- Myelinated - Fast signal - Located on the skin or near the skin - Prickling type pain and cold temperatures

Pacinian corpuscles

- Myelinated - Rapidly adapting receptors

Meissner Corpuscles

- Myelinated - Sensitivity to light touch - Rapidly adapting receptor

Merkel nerve endings

- Myelinated - Slowly adapting receptors - Widely distributed in the superficial skin layers (fingertips) and hair follicles

Cellular elements for muscle tone:

- Neural stimulation of calcium release - Formation of actin/myosin cross-bridge - ATP release

Intrafusal muscle fibers

- Not responsible for heavy lifting - Contain muscle spindles and golgi tendon organs, which monitor the contractile or tensile stress being placed on the muscle

General considerations when assessing and measuring muscle tone:

- Note positions of the limb, body, neck and head relative to each other and to gravity - Standardize your touch - Consider the patient's muscle strength - Measure at the mid-range of the muscle's length

Insufficient activation of motor units needed to create movement or hold positions leads to:

- Poor posture - Mobility deficits

Rehabilitation approaches for patients with high muscle tone:

- Prolonged stretching - Prolonged icing - Inhibitory pressure or casting - Continuous passive motion - Biofeedback - Task specific training

Hypertonicity is confused with:

- Rigidity - Spasticity - Clonus

Ruffini endings

- Slowly adapting receptors - Sensitive to skin stretch and sustained pressure on the skin

Merkel nerve endings transmit information about:

- Static pressure - Texture - Position sense

How many distinct nuclei are there within the entire structure of the hypothalamus?

12

Spasm are more frequent in ______ joint muscles of the body

2

If you patient exhibited a brisk, exaggerated response during a reflex test, you would assign their reflex a grade of:

3+

Thoracic outlet

A group of disorders causing compression to the neuromuscular bundle between the clavicle, first rib, and the scalene muscles

Bell's Palsy

A lesion of the facial nerve or facial nerve nucleus causing a weakness of both the upper and lower portions of the ipsilateral face

Presents as a mixture of UMN and LMN deficits:

ALS

A lesion to this nerve may cause the eyes to cross:

Abducens

Hypertonicity

Abnormally high tone

Hypotonicity

Abnormally low tone

A grade of 4 for the Modified Ashworth Scale for grading spasticity means:

Affected part(s) rigid in flexion or extension

Scapular winging

An injury to the long thoracic nerve weakens the serratus anterior causing the medial border of the scapula to lift from the rib cage

Muscle tone

An underlying tension in the muscle that serves as a background for muscle contraction (irritability)

What is the energy source for type II muscle fibers?

Anaerobic glycolysis

Titin

Anchors myosin to the Z line

Which artery is damaged with unilateral motor and sensory loss to the legs and feet?

Anterior cerebral artery

The artery usually at fault in a patient with lateral inferior pontine syndrome is

Anterior inferior cerebellar artery

The facial nucleus in the pons is supplied blood by which of the following arteries?

Anterior inferior cerebellar artery

What artery supplies the medullary pyramid and the medial lemniscus in the medulla?

Anterior spinal artery

The loss of the ability to create new memories after the event, leading to a partial or complete inability to recall the recent past, while long-term memories from before the event remain intact describes:

Anterograde amnesia

_____ can be made more challenging or impossible by a patient who is not willing or able to relax

Assessing tone

This cell structure makes up part of the blood brain barrier

Astrocytes

The most common site for an aneurysm is:

At the junction of the anterior communicating artery and anterior cerebral artery

Which artery is damaged with brainstem lesions?

Basilar artery

A tumor of the pituitary gland will likely compress the optic chiasm. What visual clinical presentation would you expect of a patient with a pituitary tumor?

Bitemporal hemianopsia

Z line

Border of each sarcomere

A deep tendon reflex response with a grade of 3+ means it has a characteristic of..

Brisk; exaggerated response

Ipsilateral UMN signs below the lesion, contralateral loss of pain and temperature 2 levels below the lesion:

Brown-Sequard syndrome

A lesion to the reticular activating system will cause which of the following clinical symptoms?

Coma

Reflex: Biceps Nerve root: ?

C5

The gamma loop

Comes from the brain via a descending pathway - Regulates the sensitivity of the muscle spindle and therefore increases or decreases the sensitivity of the reflex arc

Reflex: Brachioradialis Nerve root: ?

C6

Reflex: Triceps Nerve root: ?

C7

_____ is released at the sarcoplasmic reticulum of the muscle, which triggers an action potential in the muscle

Calcium

M line

Center of the sarcomere

This landmark separates the primary motor cortex area from the primary sensory cortex area:

Central sulcus

The mesencephalon gives rise to the:

Cerebellum and pons

A brief, non-purposeful, repetitive jerking of individual muscles is characteristic of this condition

Chorea

Responsible for the production of CSF?

Choroid plexus

The term "anopsia" refers to ...

Complete blindness in one eye

Saturday night palsy

Compression of the radial nerve as it spirals in the radial groove in the humerus resulting in weakness of the triceps and wrist extensors

This term describes falsification of memories in which gaps in recall are filled by fabrications that the individual accepts as reality

Confabulation

Internuclear ophthalmoplegia

Conjugate lateral gaze palsy with nystagmus and diplopia during lateral gaze

A grade of 3 for the Modified Ashworth Scale for grading spasticity means:

Considerable increase in muscle tone, passive movement difficult

The cerebrocerebellum has which of the following functions?

Control of the extremities

Which cranial nerves can be found in the forebrain?

Cranial nerves 1 and 2

List the cranial nerves found in the lower portion of the pons

Cranial nerves 7 and 8

List the cranial nerve nuclei located within the medulla oblongata

Cranial nerves 9 , 10, and 12

Ventral spinothalamic tract:

Crude touch and pressure

This neural tube defect is characterized by the presence of a fluid-filled cyst, which enlarges the posterior fossa, causing compression of the cerebellum

Dandy-Walker syndrome

Receptor: Pacinian Location: ?

Deep (onion)

Receptor: Ruffini Location: ?

Deep (spindle)

What does the Pacinian corpuscles do?

Detect vibration and dynamic pressure changes

Spasticity

Develops after the onset of the injury after a period of flaccidity - Recovery follows a predictable course

A deep tendon reflex response with a grade of 1+ means it has a characteristic of..

Diminished / depressed response or sluggish response

Hypotonicity is commonly seen in patients with ______ or ______

Down's syndrome; poliomyelitis

What does Meissner corpuscles sense?

Dynamic changes

This lines the ventricles and is responsible for the production of the cerebrospinal fluid

Ependymal cells

After sustaining a blow to the head, you are told not to fall asleep and to have someone stay with you to ensure that your mental status does not change. The doctor is most concerned that you may have an:

Epidural hematoma

Lucid interval following a head trauma relates to an:

Epidural hematoma

Tremor that occurs both with movement and at rest

Essential tremor

This artery is responsible for supplying blood to the face, scalp, and meninges

External carotid

This cranial nerve provides taste sensation to the anterior aspect of the tongue

Facial nerve

Type II muscle fibers

Fast twitch muscle fibers

Hypotonicty is confused with:

Flaccidity

This part of the cerebellum is located deep inside of the cerebellum against the posterior aspect of the brainstem

Flocculonodular lobe

This structure forms the entryway from the 1st and 2nd ventricles into the 3rd ventricle

Foramen of Monro

Where are Pacinian corpuscles located?

Found in the deeper tissues

Sensory receptor that detects pain and temperature sensations

Free nerve ending

What is the most common type of receptor?

Free nerve endings

Patients with this type of dementia often have personality and behavioral changes prior to the onset of their dementia

Fronto-temporal dementia

This tumor in the brain is associated with having the worst prognosis

Glioblastoma

This tumor is characterized as being the most common adult brain tumor, usually with a poor prognosis of 6 months to 1 year of life expectancy:

Glioblastoma

This cranial nerve provides innervation to the parotid gland

Glossopharyngeal

_____ is an inhibitory transmitter in the CNS, while ______ is excitatory

Glycine; glutamate

What do the Ruffini endings do?

Help with position sense and joint movement - Control of finger position and movement

The prognosis for recovery from hemorrhagic stroke is often less optimistic than if the patient suffered an embolic stroke. What explains the rationale for this phenomenon?

Hemorrhagic strokes cause compression damage at the site of the bleed and ischemia at the distal end of the vessel

Where are Ruffini endings located?

In the deeper tissues (subcutaneous)

Where are the free nerve endings located?

In the epidermis

Neuropathy

Inflammation of a nerve causing alterations in sensation and eventual muscle weakness in cases of severe damage

Tremor that appears only with voluntary movements

Intention tremor

This type of brain hemorrhage is caused by severe hypertension, vascular malformations, anti-coagulation therapies, or a brain tumor that eats into the blood vessel walls

Intraparenchymal hemorrhage

The effects of dopamine in the basal ganglia

It is both an excitatory and inhibitory neurotransmitter

You notice that your patient when saying "ahhhh" doesn't appear to elevate their palate on the left side and the ulna deviates to the right. You suspect damage to which cranial nerve?

Left vagus nerve

What color are type II muscle fibers and why?

Less red in appearance because there is less mitochondria and myoglobin

Moro reflex

Lift the baby 1-2 inches from a support surface, let go to observe for a startle response

Receptor: Meissner Sensation: ?

Light touch

Dorsal columns:

Light touch, vibration and proprioception

Hallmark characteristic of a brainstem lesion:

Long tract symptoms on one side of the body, cranial nerve symptoms on the other side of the body

Sensory receptor that detects light touch

Meissner corpuscles

Provide the name of the neurotransmitter primarily secreted by the pineal gland:

Melatonin

Sensory receptor that transmit information about static pressure, texture and position sense:

Merkel nerve endings

This structure is known as the "macrophage of the CNS"

Microglia

Which artery is damaged with Broca's aphasia?

Middle cerebral artery

The most common qualitative assessment for muscle tone is ..

Modified Ashworth Scale

Reticulospinal tract:

Modulation of pain and autonomic functions

A grade of 2 for the Modified Ashworth Scale for grading spasticity means:

More marked increase in muscle tone through most of the ROM, but affected part(s) easily moved

Astrocytoma

Most common pediatric brain tumor

Ependymoma

Most likely to metastasize to other parts of the brain, brainstem, or spinal cord

This type of dementia is characterized as occurring due to a long term history of atherosclerosis in the blood vessels, which have accumulated over time to restrict blood flow in the smaller vessels of the brain

Multi-infarct dementia

_______ will change based on the type of exercise they are exposed to or to the functional responsibilities assigned to them

Muscle fiber types

This type of seizure is characterized by a brief, involuntary twitching of a muscle or muscle group

Myoclonic seizure

Contractile elements for muscle tone

Myofilaments

A grade of 0 for the Modified Ashworth Scale for grading spasticity means:

No increase in muscle tone

A deep tendon reflex response with a grade of 0 means it has a characteristic of..

No response

A decrease in the amount of this neurotransmitter is associated with depression, while increased amounts of this neurotransmitter are associated with anxiety or euphoria

Norepinephrine

The signs and symptoms of this condition produce urinary incontinence, cognitive decline and unstable gait

Normal pressure hydrocephalus

This nerve provides innervation to the majority of the extra ocular eye muscles

Oculomotor

A lesion to this nerve causes a loss of the sense of smell:

Olfactory

Which of the following cell structures is responsible for myelination of the CNS axon?

Oligodendrocytes

What is the shape of the Pacinian corpuscles?

Onion-like shape

I band

Only actin fibers, no myosin

H band

Only myosin fibers, no actin

The integrity of this nerve is tested using visual acuity chart:

Optic nerve

What is the energy source for type I muscle fibers?

Oxidative phosphorylation and ATP

Sensory receptor that detects vibration and dynamic pressure change

Pacinian corpuscles

Free nerve endings detect?

Pain and temperature

Lateral spinothalamic tract:

Pain and temperature sensations

Which of the adult brain tumors is most likely to be associated with hormonal alterations within the body?

Pituitary adenoma

Sucking reflex

Place your finger on the top of the baby's mouth, which triggers the baby to suck

Receptor: Ruffini Sensation: ?

Pressure and position

Ventral spinocerebellar:

Proprioceptive input to the cerebellum

Your patient is perfectly steady while in standing position with their head still and eyes open. However, becomes very instead when their head is still and eyes are closed. Patient has a deficiency in what balance system?

Proprioceptive system

______ measures for measuring muscle tone are more reliable and valid in research

Quantitative

Receptor: Meissner Adaptation: ?

Rapid

Receptor: Pacinian Adaption: ?

Rapid

What color are type I muscles fibers and why?

Red and dark in appearance due to the increased number of mitochondria and myoglobin

Tremor that occurs at rest and disappears with voluntary movement

Resting tremor

Rigidity

Result of central nervous system pathology - Posturing -- Decorticate posture -- Decerebrate posture

When light is shown in the pt's right eye, his pupil fails to constrict, but his left pupil constricts normally. When light is shown into the left eye, the left pupil constricts, but the right does not constrict. Where is the most likely defect and what type of defect is it?

Right oculomotor nerve, right efferent defect

A lesion to the right cerebellum is likely to cause deficits in the patients mobility in this portion of the body

Right upper and lower body

Sensory receptor sensitive to skin stretch and sustained pressure on the skin

Ruffini nerve endings

Reflex: Achilles Nerve root: ?

S1

Charcot's triad?

Scanning speech Intention tremor Nystagmus

This cell structure is damaged in those patients who are diagnosed with Guillain- Barre- syndrome

Schwann cells

______ line the periphery of each peripheral nerve axon

Schwann cells

Where are type II muscle fibers found?

Seen in groups where explosive movements are required

Where are type I muscle fibers found?

Seen in muscles and muscle groups where sustained contractions are required

Slowly adapting fiber type characteristic:

Sends a continuous electrical signal through a continuous stimulus resulting in a slow response to a stimuli. When the stimuli is removed, the response falls slowly

Rapidly adapting fiber type characteristic:

Sends an electrical signal only at the beginning and at the end of a continuous stimulus. This receptor responds quickly, but will not give a sustained response

The golgi tendon organ protect the muscle tissue by:

Senses the tension being applied to the muscle and reacts by inhibiting the muscle

A grade of 1 for the Modified Ashworth Scale for grading spasticity means:

Slight increase in muscle tone manifested by a catch and release or by minimal resistance at the end of the ROM when the affected part(s) is move in flexion or extension

A grade of 1+ for the Modified Ashworth Scale for grading spasticity means:

Slight increase in muscle tone manifested by a catch, followed by minimal resistance throughout the remainder (less than half) of the ROM

Receptor: Merkel Adaptation: ?

Slow

Receptor: Ruffini Adaptation: ?

Slow

Type 1 Muscle Fibers

Slow twitch muscle fibers

Receptor: Merkel Sensation: ?

Static pressure

This type of seizure is considered to be a medical emergency

Status epilepticus

Bilateral loss of pain and temperature:

Syringomyelia

This patient will have intact strength, but have significant ataxia:

Tabes dorsalis

Medulloblastoma

Tends to aggressively spread into the bones and other parts of the CNS

A band

The area containing the entire length of the myosin fiber

Describe the effect of the direct pathway between the neostriatum and GPI

The direct pathway inhibits GPI, thus strengthening the stimulus for movement

You suspect the patient to have a lesion of the right trochlear nerve. Which of the following defects would you most likely observe?

The patient will not be able to look medially and down

The presence of what structure clearly indicates that you are observing the cross-section of the rostral midbrain?

The red nucleus

A lesion within the basal ganglia is most likely to affect:

The speed of the movement

Rule 3:

There are 4 "medial" or "midline" structures that begin with the letter "m"

Rule 4:

There are 4 "side" or lateral structures beginning with the letter "s"

Rule 2:

There are 4 cranial nerve nuclei organized sequentially in each position of the brainstem

Rule 1:

There are 4 major arteries that supply blood to the brainstem

This cranial nerve is the largest within the pons:

Trigeminal

The nerve provides innervation to the superior oblique:

Trochlear nerve

A deep tendon reflex response with a grade of 4+ means it has a characteristic of..

Very brisk; hyperactive; abnormal response affecting other joints

A lesion of this nerve will result in balance difficulties:

Vestibulocochlear nerve

Receptor: Pacinian Sensation: ?

Vibration

Lateral corticospinal tract:

Voluntary motor commands

This syndrome is characterized by double vision, contralateral spastic paralysis and weakness to the arm and leg as well as dysphagia, dystonia, and dysarthria

Weber syndrome

A patient who complains of extreme hyperthermia or hypothermia may have ..

a lesion to the hypothalamus

The trigger of the action potential then triggers the ________, thus producing a muscle contraction

actin and myosin cross-bridging

Lesion to dominant angular gyrus causes

agraphia and acalculia

Tension headaches have a _____ presentation

bilateral

A type II fiber tends to convert to a type I fiber in the presence of ______-

deconditioning

Spasticity--velocity ____ resistance to stretch

dependent

Lesion to the frontal lobe causes

disinhibition and personality changes

High muscle tone is associated with abnormally high _____ input to an intact alpha motor neuron

excitatory

Lesion to non-dominant Broca's area causes

expressive dysprosody

Delirium can _____ significantly, while dementia is ______

fluctuates; relatively constant

Lesion to non-dominant angular gyrus causes

hemispatial neglect syndrom

A patient with a diagnosis of AD is admitted to you unit. The pt exhibits a significant loss of short term memory. You are certain the pt has neuronal death in the:

hippocampus

The true assessment of tone requires _______ from the patient

honest and cooperation

Abnormal increases in tone is due to __________ of a peripheral nerve as a result of an upper motor neuron lesion

hyper-excitability

Rigidity-- velocity ____ resistance to stretch

independent

A lesion within the pineal gland would most likely result in

insomnia

In regards to therapeutic exercises with a patient who has a brain tumor, you should exercise ____ muscle groups before exercising ___ muscle groups

large; small

Most actin/myosin cross bridges are formed at _____ of the muscle

mid-range

Low muscle tone is associated with ______ neuron damage

motor neuron

This protein within the sarcomere, through its actions provides the power displayed during a muscle contraction

myosin

Neural stimulation of calcium release goes from..

periphery, spinal cord, and brain centers

Lesion to Wernicke's area causes

poor comprehension

Lesion to arcuate fasciculus causes

poor repetition (conduction aphasia)

Lesion to Broca's area causes

poor verbal expression

Clonus--involuntary muscle contractions in response to a _____ stretch

quick

Most common cause of a subdural hematoma

rupture of a bridging vein

Most common cause of epidural hematoma

rupture of the middle meningeal artery

A person under a lot of _____ will have more tone than someone without emotional distress

stress

Damage to the periphery of the oculomotor nerve is likely to result in ..

the loss of the accommodation reflex

Myosin is a _____ filament

thick

Actin is a _____ filament

thin

Flaccidity--_____ absence of tone

total

A clinical test of the inferior oblique requires that you ask your patient to look:

up and in

Due to the _______, the brain cannot effectively dampen the reflex arc at the spinal levels below the injury in the CNS, and the peripheral nerve keeps getting stimulated due to some abnormal sensory event

upper motor neuron lesion

For Guillain Barre syndrome, recovery is ______ to _____

weeks; months