Chapter 16

Watch this video (http://openstaxcollege.org/// neuroexam2) for an introduction to the neurological exam. Studying the neurological exam can give insight into how structure and function in the nervous system are interdependent. This is a tool both in the clinic and in the classroom, but for different reasons. In the clinic, this is a powerful but simple tool to assess a patient's neurological function. In the classroom, it is a different way to think about the nervous system. Though medical technology provides noninvasive imaging and real-time functional data, the presenter says these cannot replace the history at the core of the medical examination. What does history mean in the context of medical practice?

Watch the video (http://openstaxcollege.org/1/2brains) titled "The Man With Two Brains" to see the neuroscientist Michael Gazzaniga introduce a patient he has worked with for years who has had his corpus callosum cut, separating his two cerebral hemispheres. A few tests are run to demonstrate how this manifests in tests of cerebral function. Unlike normal people, this patient can perform two independent tasks at the same time because the lines of communication between the right and left sides of his brain have been removed. Whereas a person with an intact corpus callosum cannot overcome the dominance of one hemisphere over the other, this patient can. If the left cerebral hemisphere is dominant in the majority of people, why would right-handedness be most common?

Read this article (http://openstaxcollege.org///3word) to learn about a young man who texts his fiancée in a panic as he finds that he is having trouble remembering things. At the hospital, a neurologist administers the mental status exam, which is mostly normal except for the three-word recall test. The young man could not recall them even 30 seconds after hearing them and repeating them back to the doctor. An undiscovered mass in the mediastinum region was found to be Hodgkin's lymphoma, a type of cancer that affects the immune system and likely caused antibodies to attack the nervous system. The patient eventually regained his ability to remember, though the events in the hospital were always elusive. Considering that the effects on memory were temporary, but resulted in the loss of the specific events of the hospital stay, what regions of the brain were likely to have been affected by the antibodies and what type of memory does that represent?

Watch this video (http://openstaxcollege.org///2point) to see a quick demonstration of two-point discrimination. Touching a specialized caliper to the surface of the skin will measure the distance between two points that are perceived as distinct stimuli versus a single stimulus. The patient keeps their eyes closed while the examiner switches between using both points of the caliper or just one. The patient then must indicate whether one or two stimuli are in contact with the skin. Why is the distance between the caliper points closer on the fingertips as opposed to the palm of the hand? And what do you think the distance would be on the arm, or the shoulder?

Watch this video (http://openstaxcollege.org/I/ reflextest) to see how to test reflexes in the abdomen. Testing reflexes of the trunk is not commonly performed in the neurological exam, but if findings suggest a problem with the thoracic segments of the spinal cord, a series of superficial reflexes of the abdomen can localize function to those segments. If contraction is not observed when the skin lateral to the umbilicus (belly button) is stimulated, what level of the spinal cord may be damaged?

Which major section of the neurological exam is most likely to reveal damage to the cerebellum? a. cranial nerve exam b. mental status exam c. sensory exam d. coordination exam

What function would most likely be affected by a restriction of a blood vessel in the cerebral cortex? a. language b. gait c. facial expressions d. knee-jerk reflex

Which major section of the neurological exam includes subtests that are sometimes considered a separate set of tests concerned with walking? a. mental status exam b. cranial nerve exam c. coordination exam d. sensory exam

Memory, emotional, language, and sensorimotor deficits together are most likely the result of what kind of damage? a. stroke b. developmental disorder c. whiplash d. gunshot wound

Where is language function localized in the majority of people? a. cerebellum b. right cerebral hemisphere C. hippocampus d. left cerebral hemisphere

Which of the following could be elements of cytoarchitecture, as related to Brodmann's microscopic studies of the cerebral cortex? a. connections to the cerebellum b. activation by visual stimuli C. number of neurons per square millimeter d. number of gyri or sulci

Which of the following could be a multimodal integrative area? a. primary visual cortex b. premotor cortex c. hippocampus d. Wernicke's area

Which is an example of episodic memory? a. how to bake a cake b. your last birthday party c. how old you are d. needing to wear an oven mitt to take a cake out of the oven

What region of the cerebral cortex is associated with understanding language, both from another person and the language a person generates himself or herself? a. medial temporal lobe b. ventromedial prefrontal cortex c. superior temporal gyrus d. postcentral gyrus

Without olfactory sensation to complement gustatory stimuli, food will taste bland unless it is seasoned with which substance? a. salt b. thyme c. garlic d. olive oil

Which of the following cranial nerves is not part of the VOR? a. optic b. oculomotor c. abducens d. vestibulocochlear

Which nerve is responsible for controlling the muscles that result in the gag reflex? a. trigeminal b. facial c. glossopharyngeal d. vagus

Which nerve is responsible for taste, as well as salivation, in the anterior oral cavity? a. facial b. glossopharyngeal C. vagus d. hypoglossal

Which of the following nerves controls movements of the neck? a. oculomotor b. vestibulocochlear c. spinal accessory d. hypoglossal

Which of the following is not part of the corticospinal pathway? a. cerebellar deep white matter b. midbrain c. medulla d. lateral column

Which subtest is directed at proprioceptive sensation? a. two-point discrimination b. tactile movement C. vibration d. Romberg test

What term describes the inability to lift the arm above the level of the shoulder? a. paralysis b. paresis c. fasciculation d. fibrillation

Which of the following is a feature of both somatic and visceral senses? a. requires cerebral input b. causes skeletal muscle contraction c. projects to a ganglion near the target effector d. involves an axon in the ventral nerve root

Which white matter structure carries information from the cerebral cortex to the cerebellum? a. cerebral peduncle b. superior cerebellar peduncle c. middle cerebellar peduncle d. inferior cerebellar peduncle

Which region of the cerebellum receives proprioceptive input from the spinal cord? a. vermis b. left hemisphere c. flocculonodular lobe d. right hemisphere

Which of the following tests cerebellar function related to gait? a. toe-to-finger b. station c. lah-kah-pah d. finger-to-nose

Why is a rapid assessment of neurological function important in an emergency situation?

How is the diagnostic category of TIA different from a stroke?

A patient's performance of the majority of the mental status exam subtests is in line with the expected norms, but the patient cannot repeat a string of numbers given by the examiner. What is a likely explanation?

A patient responds to the question "What is your name?" with a look of incomprehension. Which of the two major language areas is most likely affected and what is the name for that type of aphasia?

As a person ages, their ability to focus on near objects (accommodation) changes. If a person is already myopic (near-sighted), why would corrective lenses not be necessary to read a book or computer screen?

When a patient flexes their neck, the head tips to the right side. Also, their tongue sticks out slightly to the left when they try to stick it straight out. Where is the damage to the brain stem most likely located?

The location of somatosensation is based on the topographical map of sensory innervation. What does this mean?

Alcohol intoxication can produce slurred speech. How is this related to cerebellar function?