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Neurologia > 1 > Flashcards

1 Flashcards

1
Q

MRC muscle strength scale

A

5 - Muscle contracts against full resistance
4 - Strength reduced, but contraction can still
move joint against resistance
3 - Strength further reduced so that joint can be
moved only against gravity with examiner’s resistance completely removed
2 - Muscle can only move if resistance of gravity
is removed.
1 - Only a trace or flicker of movement is seen or
felt, or fasciculations are observed
0 - No movement

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2
Q

Deep Tendon Reflexes scale

A 
0 = no response
1+ = a slight decrease but definitely present response
2+ = a brisk response, normal
3+ = a very brisk response
4+ = a tap elicits a repeating reflex (clonus)
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3
Q

Deep Tendon Reflexes locations - upper limb

A

Biceps C5-C6
Brachioradialis C5-C6
Triceps C6-C7

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4
Q

Deep Tendon Reflexes locations - lower limb

A

Patellar L2-L4

Achilles Tendon S1

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5
Q

Superficial Reflexes locations

A

1) Abdominal
1. upper -> Th8-9
2. medium -> Th10
3. lower Th11-12

2) Cremasteric reflex L1
3) Plantar reflex (if + -> Babinski) S1-S2
4) Perineal/ anal reflex S3-S4

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6
Q

Upper motor neuron lesion

A
  1. Muscle weakness (pyramidal weakness)/ paresis
  2. Spasticity, increased muscle tone -> Clasp-knife response where initial higher resistance to movement is followed by a lesser resistance
  3. Increased deep tendon reflexes
  4. Decreased or absence of superficial reflexes
  5. Pathological reflexes: Babinski sign, pronator drift, Rossolimo sign
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7
Q

Lower motor neuron lesion

A
  1. Muscle paresis or paralysis
  2. Hypotonia or atonia – Tone is not velocity dependent
  3. Hyporeflexia (decreased or absence of both deep reflexes and cutaneous reflexes)
  4. Muscle atrophy
  5. Fibrillations or fasciculations (caused by increased receptor concentration on muscles to compensate for lack of innervation)
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8
Q

Extrapyramidal symptoms

A
  1. Altered quantity and velocity of movement (bradykinesia/ hyperkinesia)
  2. Altered muscle tone (hypotonia/ hypertonia)
  3. Involuntary movement (tremors, chorea, dystonia, ballismus)
  4. Akathisia - a feeling of internal motor restlessness that can present as tension, nervousness, or anxiety
  5. Altered posture reflexes
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9
Q

Cerebellar symptoms

A
  1. Ataxia
  2. Intention tremor
  3. Dysmetria (undershoot or overshoot of intended position with the hand, arm, leg, or eye)
  4. Dysdiadochokinesia (impaired ability to perform rapid, alternating movements)
  5. Dysarthria - speech disorder (motor)
  6. Nystagmus (involuntary movement of the eye)
  7. Ataxic Gait -> wide-based gait
  8. Muscle hypotonia
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10
Q

sensory pathways

A
  1. spino-thalamic tract ->
    a) anterior -> touch (inconcrete localization), slow transmission of pain
    b) lateral -> temprature, fast transmission of pain
  2. spino-bulbar tract -> touch - concrete localization, placing, vibration, proprioception
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11
Q

Horner syndrome

A 
Ptosis - drooping of the upper eyelid
Anhidrosis - decreased sweating
Miosis - constriction of the pupil
Enophthalmos - posterior displacement of the eyebal
Loss of ciliospinal reflex

+ Heterochromia iridum -> in congenital Horner syndrome -> difference in coloration of the iris

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12
Q

Bulbar palsy symptoms

A

-> impairment of function of the cranial nerves 9, 10, 11, 12 -> due to a lower motor neuron lesion in the medulla oblongata or in the cranial nerves outside the brainstem

  1. dysarthria
  2. dysphagia (difficulty in swallowing)
  3. difficulty in chewing
  4. absent or decreased jaw jerk
  5. palate paralysis + absent/ decreased gag reflex
  6. atrophic tongue or its fasciculations or tongue paresis
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13
Q

Pseudobulbar palsy symptoms

A

-> the result of damage of motor fibers from the cerebral cortex to the lower brain stem

  1. dysarthria
  2. dysphagia (difficulty in swallowing)
  3. difficulty in chewing
  4. brisk jaw jerk
  5. Positive primitive (atavistic) reflexes = frontal release signs (ex. snout reflex = Pout)
  6. Small, stiff and spastic tongue
  7. Labile affect -> involuntary laugh or cry
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14
Q

Frontal release signs

A
  • > sign of disorders that affect the frontal lobes or piramidal or extrapiramidal tract
    1. Palmar grasp - baby naturally grabs objects placed in palm
    2. Palmomental reflex - stroking on the thenar eminence of the hand causes contraction of submental muscles
    3. Sucking reflex - instinctively sucking anything that touches the roof of their mouth (babies)
    4. Snout reflex - pouting or pursing of the lips that is elicited by light tapping of the closed lips near the midline
    5. Glabellar reflex - persistent blinking in response to repetitive tapping on the forehead (normally blinking stops after a few secends)
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15
Q

Glasgow scale

A 
A) eye opening
1-none
2-to pain
3-to voice
4-spontaneous
B) best motor response 
1-none
2-extensor posturing
3-flexor posturing
4-withdraws to pain
5- localizes to pain
6-obeys commands
C) best verbal response
1-none
2-incomprehensible sounds
3-inappropiate words
4-conversant and disoriented
5-conversant  and oriented
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16
Q

EEG rhythms

A
  1. α=PDR - posterior dominant rhythm
  2. β
  3. θ (theta)
  4. δ
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17
Q

PDR

A
  1. Main feature in normal EEG in wakeful adults
  2. 8-13 Hz (cycle-per-second = cps)
  3. Best observed in parietal and occipital regions
  4. Shape: sinusoid -> increasing and decreasing amplitude
  5. In relaxed individuals manifests with eye closure and attentuates with alerting or eye opening
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18
Q

rhythm β

A
  1. In normal EEG in wakeful adults in front-central areas
  2. 14-30 Hz (cycle-per-second = cps)
  3. They don’t attentuate with eye opening
  4. Decrease of amplitude (local) suggest disease spot (ex. tumor, place after a stroke, brain edema)
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19
Q

rhythm θ (theta)

A
  1. In normal EEG in wakeful adults there can be a small amount, more seen while sleeping
  2. 4-7 Hz (cycle-per-second = cps)
  3. Increase suggests pathology
20
Q

rhythm δ

A
  1. DON’T occur in wakeful adults, only while sleeping -> NREM 3&4
  2. <4 Hz (cycle-per-second = cps)
  3. Suggest pathology
21
Q

Herniation syndromes

A
  1. Subfalcine hernation
  2. Central transtentorial herniation
  3. Uncal transtentorial herniation
  4. Tonsillar herniation
  5. Upward herniation
22
Q

Epilepsy treatment generalized-onset tonic-clonic

A
  1. Lamotrigine
  2. Valproic acid
  3. Levetiracetam
  4. Carbamazepine
  5. Oxcarbazepine
23
Q

Epilepsy treatment focal

A
  1. Lamotrigine
  2. Carbamazepine
  3. Oxcarbazepine
  4. Phenytoin
  5. Levetiracetam
  6. Gabapentin
  7. Valproic acid
24
Q

Epilepsy treatment typical absence

A
  1. Valproic acid
  2. Ethosuximide
  3. Lamotrigine
25
Q

Epilepsy treatment myoclonic

A
  1. Valproic acid
  2. Lamotrigine
  3. Topiramate
  4. Levetiracetam
26
Q

Epilepsy treatment tonic/ atonic

A
  1. Valproic acid
27
Q

MS McDonald criteria

A

-> either:
1. Prove 2 or more attacks (dissemination in time) AND
prove 2 or more lesions (dissemination in space)

  1. 1x objective clinical evidence of attack with reasonable historical evidence of a prior attack
  2. Insidious neurologic progresion suggestive of PPMS
28
Q

MS McDonald criteria dissemination in time

A
  • > either:
    1) 2x objective clinical evidence of attacks or
    2) simultaneous presence of gadolinium-enhancing and nonenhancing lesions at any time
29
Q

MS McDonald criteria dissemination in space

A
  • > 2 or more lesions on MRI in either:
    1. periventricular
    2. juxtracortical
    3. infratentorial
    4. spinal cord
30
Q

MS McDonald criteria Insidious neurologic progresion suggestive of PPMS

A

both:

  1. 1 year of disease progression (retrospectively or prospectively)
  2. 2 out of the 3 criteria:
    1) evidence of at least 1 lesion in MRI in brain
    2) evidence of dissemination in space in spinal cord (at least 2 lesions)
    3) Positive CSF (isoelectric focusing evidence of oligoclonal bands and/or elevated IgG index)
31
Q

Drugs frequently used in MS

A

A) Modestly Effective

  1. Interferon β -> sc or im
  2. Glatiramer Acetate -> sc

B) Moderately Effective -> orally

  1. Fingolimod
  2. Dimethyl Fumarate (DMF)

C) Highly Effective -> iv

  1. Natalizumab
  2. Ocrelizumab
32
Q

Drugs less commonly used in MS

A
  1. Teriflunomide -> modestly effective
  2. Alemtuzumab -> highly effective
  3. Mitoxantrone -> highly effective
33
Q

MS ataxia/ tremor symptomatic therapy

A
  1. Clonazepam
  2. Primidone
  3. Propranolol
  4. Ondansetron
34
Q

MS spasity and spasm symptomatic therapy

A
  1. Baclofen
  2. Diazepam
  3. Tizanidine
  4. Dantrolene
  5. Cyclobenzaprine hydrochloride
  6. Baclofen pump
  7. Botulinum toxin
35
Q

MS weakness symptomatic therapy

A
  1. Aminopyridine

2. 3,4-diaminopyridine

36
Q

MS pain symptomatic therapy

A 
A) Anticonsulvants 
1. Carbamazepine
2. Phenytoin
3. Gabapentin
4. pregabalin
B) Antidepressants
1. Amitriptyline
2. Nortripyline
3. Desipramine
4. Venlafaxine
C) Benzodiazepins
D) Baclofen
37
Q

MS automatic bladder symptomatic therapy

A

(antimuscarinic)

  1. Propantheline
  2. Oxybutynin
  3. Tolterodine
  4. Hyoscyamine
38
Q

MS detrusor sphincter dyssynergia (DSD) symptomatic therapy

A
  • > α1-antagonist
    1. Terazosin
    2. Phenoxybenzamine
    3. Doxazosin
    4. Tamsulosin
39
Q

MS fatique symptomatic therapy

A
  1. Amantadine
  2. Methylphenidate
  3. Modafinil
  4. Armodafinil
40
Q

MS depression symptomatic therapy

A
  1. SSRI (Fluoxetine, Sertraline)
  2. Tricyclic antidepressants (Amitriptyline, Nortripyline, Desipramine)
  3. Nontricyclic antidepressants (Venlafaxine)
41
Q

MS sexual dysfunction symptomatic therapy

A
  1. Sildenafil
  2. Tadalafil
  3. Vardenafil
42
Q

Initial Symptoms of MS

A
  1. Sensory loss
  2. Optic neuritis
  3. Weakness/ Paralysis of limbs
  4. Paresthesias/ transverse myelitis
  5. Cerebellar syndrome
  6. Pseudobulbar syndrome
43
Q

Clinical types of MS

A
  1. Relapsing RMS (nawracająco-zwalniający)
  2. Secondary Progressive SPMS
  3. Primary Progressive PPMS
    - > + postępująco-nawracający
44
Q

Characteristic syndromes associated with MS

A
  1. Lhermitte’s syndrome
  2. Uhthoff’s syndrome
  3. Acute Marburg variant of MS
  4. Balo’s concentric sclerosis
45
Q

Amyotrophic Lateral Sclerosis treatment

A
  1. Riluzole -> NMDA antagonist

2. Edaravone -> antioxidant

Neurologia (5 decks)

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