Exam 2: Ch. 5 & 24

Comprehensive vocabulary flashcards covering Mental Status Assessment (Chapter 5) and the Neurological System Examination (Chapter 24), including cranial nerves, motor/sensory testing, DTR grading, and urgent neurological emergencies.

Mental Status

A person's emotional (feeling) and cognitive (knowing) functioning, inferred through direct assessment of behavior, consciousness, cognition, and thought processes.

Mental Disorder

A clinically significant behavioral, emotional, or cognitive pattern that is apparent when a person's response is much greater than the expected reaction to a traumatic life event.

Organic Disorders

Mental disorders caused by a known, specific brain disease or physiological insult, such as delirium, dementia, or alcohol and drug intoxication and withdrawal.

Psychiatric Mental Disorders

Mental disorders in which a specific organic brain disease etiology has not yet been established, such as anxiety disorders and schizophrenia.

A-B-C-T Framework

The four fundamental components evaluated during a comprehensive mental status examination: Appearance, Behavior, Cognition, and Thought processes.

Four Unrelated Words Test

A sensitive cognitive assessment of new memory and learning ability wherein the patient repeats four unrelated words after intervals of $5$, $10$, and $30$ minutes.

Ask Suicide-Screening Questions (ASQ)

A standardized screening instrument where any single "Yes" response constitutes a positive screen, requiring that the client not be released until formally evaluated for safety.

Mini-Mental Status Examination (MMSE)

A standardized objective cognitive screening tool scoring orientation, registration, attention/calculation, recall, language, and visuospatial construction; prerequisites require intact vision and literacy.

Delirium

An acute, fluctuating confusional state with altered or lost consciousness and impaired attention that is typically transient, reversible, and secondary to an underlying medical illness, medication, or imbalance.

Dementia

A gradual, progressive, irreversible cognitive decline characterized by intact alertness and consciousness until late stages, impairing daily functioning across multiple cognitive domains.

PINCH ME Mnemonic

A clinical diagnostic mnemonic used to identify common reversible triggers of delirium: Pain, Infection, Constipation/Urinary retention, Hydration, Medications/Substances, and Environmental triggers.

Agnosia

The inability to recognize familiar sensory stimuli, objects, or people despite intact sensory perception, typically associated with dementia rather than delirium.

Apraxia

The inability to perform learned, purposeful motor acts or movements despite having preserved motor strength and comprehension; characteristic of dementia or focal cerebral lesions.

Central Nervous System (CNS)

The structural integrator of the nervous system consisting of the brain and spinal cord, responsible for sensation integration, coordination, and command execution.

Peripheral Nervous System (PNS)

The neural communication network outside the brain and spinal cord consisting of $12$ pairs of cranial nerves and $31$ pairs of spinal nerves.

Afferent (Sensory) Nerves

Nerve fibers that carry sensory input and stimuli from peripheral receptors toward the central nervous system.

Efferent (Motor) Nerves

Nerve fibers that transmit motor commands and impulses away from the central nervous system outward to effector muscles and glands.

Somatic Nervous System

The voluntary division of the peripheral motor nervous system that transmits signals between the CNS and skeletal muscles to control conscious body movements.

Autonomic Nervous System (ANS)

The involuntary division of the peripheral motor nervous system that maintains homeostasis by controlling cardiac muscle, smooth muscles, and visceral glands.

Sympathetic Nervous System (SNS)

The "fight or flight" division of the autonomic nervous system that elevates heart rate and respiratory rate, dilates pupils, and shunts blood to skeletal muscles during emergencies.

Parasympathetic Nervous System (PNS)

The "rest and digest" division of the autonomic nervous system that slows heart rate, stimulates digestion, and promotes energy conservation during rest.

Brainstem

The central core of the brain comprising the midbrain, pons, and medulla oblongata, directly controlling autonomic life-sustaining functions such as respiration, heart rate, and blood pressure.

Cerebral Cortex

The unmyelinated outer gray-matter layer of the cerebrum governing higher cognitive faculties, including conscious thought, reasoning, memory, sensation, and voluntary motor action across four lobes.

Basal Ganglia

Subcortical clusters of gray matter deep within both cerebral hemispheres that coordinate voluntary motion, manage automatic movements (such as arm swinging during gait), and mediate procedural motor learning.

Thalamus

The primary sensory relay station situated deep in the center of the brain that sorts and routes sensory signals to the cerebral cortex and regulates alertness and consciousness.

Hypothalamus

The main homeostatic control center located above the brainstem that regulates body temperature, appetite, thirst, sleep cycles, autonomic responses, and pituitary hormone secretion.

Cerebellum

The structure located beneath the occipital lobes responsible for voluntary motor coordination, equilibrium, posture, and motor task learning.

Ataxia

An uncoordinated, stumbling, or unsteady movement pattern marked by severe balance impairment, typically resulting from cerebellar damage.

Decussation (Crossed Representation)

The anatomical crossing of sensory and motor pathways within the central nervous system, causing the left cerebral hemisphere to control and receive input from the right side of the body, and vice versa.

Somatic Reflex Arc

A rapid protective reflex pathway consisting of a receptor, afferent sensory neuron, spinal cord integration center, efferent motor neuron, and effector muscle, bypassing conscious cortical input.

Cranial Nerves

Twelve pairs of peripheral nerves that arise directly from the brain or brainstem, categorized into $5$ purely motor pairs, $3$ purely sensory pairs, and $4$ mixed pairs.

Cranial Nerve I (Olfactory Nerve)

A sensory cranial nerve assessed by having the client close their eyes, occlude one nostril at a time, and identify a familiar non-irritating scent.

Cranial Nerve II (Optic Nerve)

A sensory cranial nerve assessed by testing central visual acuity using a Snellen chart at $20\,\text{ft}$ and peripheral visual fields using confrontation testing.

Cranial Nerves III, IV, and VI (Oculomotor, Trochlear, Abducens)

Motor cranial nerves assessed together by checking pupillary light reflex, accommodation (PERRLA), and extraocular muscle movements through the six cardinal positions of gaze.

Cranial Nerve V (Trigeminal Nerve)

A mixed cranial nerve evaluated by palpating temporal and masseter muscles during jaw clenching (motor) and testing light touch with cotton across ophthalmic, maxillary, and mandibular zones (sensory).

Cranial Nerve VII (Facial Nerve)

A mixed cranial nerve assessed primarily for motor symmetry by asking the client to smile, frown, tightly close eyes, raise eyebrows, show teeth, and puff out cheeks against resistance.

Cranial Nerve VIII (Vestibulocochlear Nerve)

A sensory cranial nerve assessed by the whispered voice test, standing $1-2\,\text{ft}$ behind the client while they occlude the opposite ear.

Cranial Nerves IX and X (Glossopharyngeal and Vagus)

Mixed cranial nerves assessed by observing symmetrical elevation of the soft palate and uvula upon phonation ("ahhh"), checking voice quality, and testing the pharyngeal gag reflex.

Cranial Nerve XI (Spinal Accessory Nerve)

A motor cranial nerve innervating the sternocleidomastoid and trapezius muscles, assessed by having the patient shrug shoulders and rotate the head against examiner resistance.

Cranial Nerve XII (Hypoglossal Nerve)

A motor cranial nerve assessed by inspecting tongue protrusion along the midline without deviation or atrophy and listening to lingual articulation ("light, tight, dynamite").

Dermatome

A circumscribed cutaneous zone innervated by the sensory nerve fibers of a single spinal nerve root; exhibits biological overlap with neighboring segments to protect sensation.

Stereognosis

A higher cortical sensory test of tactile discrimination where the patient identifies a familiar object placed into their hand with eyes closed.

Graphesthesia

A tactile discrimination test of cortical sensation evaluated by tracing a single number or letter onto the patient's palm with their eyes closed for identification.

Deep Tendon Reflex (DTR) Scale

A clinical grading scale: $0$ (absent/areflexia), $1+$ (diminished/hyporeflexia), $2+$ (normal baseline response), $3+$ (brisker than average), and $4+$ (hyperactive with clonus).

Muscle Strength Scale

A standard scoring rubric: $5/5$ (full ROM against gravity and full resistance), $4/5$ (some resistance), $3/5$ (against gravity only), $2/5$ (passive ROM with gravity eliminated), $1/5$ (trace contraction), and $0/5$ (no movement).

Romberg Test

A balance and proprioception assessment where the client stands with feet together, arms at sides, and eyes closed for $20$ seconds; significant loss of balance constitutes a positive sign.

Rapid Alternating Movements (RAM)

A cerebellar coordination test in which the client pats their knees with the palms and backs of their hands at an increasingly rapid tempo.

Flaccidity

Severe hypotonia characterized by loose, limp, floppy muscle tone and reduced resistance to passive stretch, indicating lower motor neuron dysfunction.

Spasticity

A type of hypertonia featuring increased resistance to passive muscle elongation that yields abruptly, signifying upper motor neuron pathway lesions.

Rigidity

A constant, uniform resistance to passive muscle movement across all directions, characteristic of extrapyramidal tract dysfunction such as Parkinson's disease.

Fasciculations

Continuous, rapid, localized twitches of resting muscle fibers that do not generate movement across a joint.

Glasgow Coma Scale (GCS)

A standardized clinical score up to $15$ points evaluating level of consciousness through Eye Opening ($1-4$), Verbal Response ($1-5$), and Motor Response ($1-6$).

PERRLA

A pupillary assessment acronym denoting Pupils Equal, Round, Reactive to Light (direct and consensual constriction), and Accommodation (pupillary convergence and constriction on near focus).

Peripheral Neuropathy

Progressive distal-to-proximal axonal degeneration producing symmetrical numbness and tingling in a "stocking-and-glove" pattern across feet and hands while sparing the face.

Transient Ischemic Attack (TIA)

A temporary episode of focal neurological deficit lasting typically less than $1\,\text{hour}$ caused by transient vascular ischemia that completely resolves; acts as a critical warning for impending stroke.

Ischemic Stroke

An acute upper motor neuron emergency caused by arterial occlusion from a blood clot or atherosclerotic thrombus, depriving cerebral tissue of oxygenated blood flow.

Hemorrhagic Stroke

An acute neurological emergency caused by the rupture and spontaneous bleeding of a cerebral blood vessel into intracranial brain tissues.

Compartment Syndrome

A peripheral vascular emergency caused by elevated pressure within an inelastic fascial compartment, assessed via the 5 Ps: Pain, Paresthesia, Pulselessness, Pallor, and Pressure.

F.A.S.T. Assessment

An emergency public stroke recognition protocol: Face drooping (lower facial paralysis), Arm weakness (motor drift), Speech slurring (dysarthria/aphasia), and Time to activate emergency services.