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PassPMR - 05 Neurology > 1- Clinical Neuroscience > Flashcards

1- Clinical Neuroscience Flashcards

1
Q

What are the major cell types in the nervous system? 🔑🔑 EXAM 2021

A

1- Neurons

These comprise a diverse collection of cells that marry afferent input to internal brain states to produce perception and behavior.

2- Astrocytes

Establish the blood–brain barrier, flux ions, repair and form scars in injury

3- Oligodendroglia and Schwann cells

Form myelin in brain/spinal cord and periphery

4- Microglia

Resident inflammatory phagocytes in infection, degeneration, demyelination

5- Ependymal cells

Neuroepithelial cells lining the ventricles, choroid, spinal cord central canal, form cerebrospinal fluid, nonrenewing stem cell pool producing neurons in adult central nervous system (CNS) injury

Neurology Secrets 6th Edition Chapter 1 pg1

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2
Q

What are the major subcellular compartments of the canonical neuron? 🔑🔑

A
  1. Soma: body of the neuron
  2. Dendrites: processes that emanate from the soma and subserve synaptic connections
  3. Axon: projection from the soma that terminates on postsynaptic partners
  4. Nodes of Ranvier: area between myelinated axonal segments densely populated by voltage-gated Na+ channels that regenerate action potentials
  5. Myelin: a sheath comprised primarily of lipids that electrically insulates the axon and allows for salutatory conduction at unsheathed nodes

Neurology Secrets 6th Edition Chapter 1 pg1

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3
Q

What ionic currents support action potential generation and propagation? 🔑🔑

A

1- Depolarizing phase Na+ currents

2- Repolarizing phase

Inactivation of Na+ currents (accounts for refractory period of action potentials)

Activation of K+ currents (accounts for membrane hyperpolarization)

Neurology Secrets 6th Edition Chapter 1 pg4

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4
Q

What are some examples of calcium channelopathies? 🔑

A

1- Lambert–Eaton syndrome (LEMS)

Antibody-mediated autoimmune attack on P/Q type voltage-gated Ca channels in the presynaptic neuron at the neuromuscular junction

2- Hypokalemic periodic muscle paralysis

Mutation in gene coding for the skeletal voltage-gated Ca2+ channel

Neurology Secrets 6th Edition Chapter 1 pg5

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5
Q

What are some examples of sodium channelopathies? 🔑

A

Hyperkalemic periodic paralysis

Generalized episodic flaccid weakness

Neurology Secrets 6th Edition Chapter 1 pg5

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6
Q

What is serotonin syndrome? 4 marks 🔑🔑

A

Serotonin syndrome

  1. Agitation
  2. Confusion
  3. Muscle rigidity
  4. Fever

Medications

  1. SSRI: Prozac, Cipralix
  2. Antipsychotics: Haloperidol, quetiapine
  3. Ondansetron
  4. Metoclopramide

Neurology Secrets 6th Edition Chapter 1 pg7

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7
Q

Cause of Horner Syndrome (Central, Pre & Post Ganglionic)🔑🔑 EXAM 2019-2020

A

Central 1st Order

  1. Stroke
  2. Tumor
  3. Syringomyelia
  4. Myelitis

Pre-Ganglionic 2nd Order

  1. Cervical rib
  2. Brachial Plexopathy
  3. Pancoast Tumor
  4. Iatrogenic (surgery, chest tube)
  5. Thyroid tumor

Post-Ganglionic 3rd Order

  1. Trauma
  2. Internal carotid artery aneurysm
  3. Cavernous sinus lesion
  4. Pituitary Tumor
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8
Q

Give two CNS tracts responsible for a positive Romberg‘s sign

Name 3 different kinds of sensory input required to maintain balance 🔑

A
  1. Dorsal column (proprioception)
  2. Vestibulospinal tract
  3. Visual pathway
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9
Q

Give the spinal tracts for 🔑

a. Tactile and kinesthetic sense from hands
b. Tactile and kinesthetic sense from feet
c. Golgi and spindle afferents from feet/LE

A
  1. Fasciculus cuneatus (vertebral level T7 and above)
  2. Fasciculus gracilis (vertebral level T6 and below)
  3. Spinocerebellar
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10
Q

Name 3 tracts from the midbrain and pons

A
  1. Spinothalamic tract
  2. Corticospinal tract
  3. Dorsal column
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11
Q

Clinical criteria of dementia.

A

DSM-IV Criteria for Dementia

  1. Memory impairment
  2. One or more of the following
    1. Aphasia
    2. Apraxia
    3. Agnosia
    4. Impair executive functions (planning, organizing, sequencing, abstracting)
  3. Significant impairment in social or occupational functioning and represents a decline from prior functions
  4. Deficits do not occur exclusively as part of a delerium

https://www.uptodate.com/contents/image?imageKey=NEURO%2F91276

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12
Q

List 3 locations of lesions causing a left homonymous hemianopsia 🔑🔑

A
  1. Right optic tract (D)
  2. Right optic radiation in parietal lobe (G)
  3. Right occipital lobe (H)

https://geekymedics.com/visual-pathway-and-visual-field-defects/

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13
Q

Name the cranial nerve involved 🔑

a. Left visual field
b. Left tongue deviation
c. Right mastication
d. Right head rotation
e. Inward and downward movement of L eye

A
  1. Left Optic nerve
  2. Left Hypoglossal
  3. Left Trigeminal
  4. Left Spinal Accessory N
  5. Left trochlear (SO)
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14
Q

List 4 Causes of Bulbar vs Pseudobulbar palsy 🔑🔑

Common Sing & Symptoms 🔑

A

Pseudobulbar (UMN)

  1. Amyotrophic lateral sclerosis (ALS) (Corticospital)
  2. Multiple sclerosis (MS) (Corticospital or cortex)
  3. Bilateral Corticobulbar Stroke
  4. Traumatic brain injury
  5. Parkinson’s disease
  6. Multiple system atrophy, Progressive supranuclear palsy
  7. Alzheimer’s disease
  8. High brain stem tumors

Bulbar (LMN)

  1. Brainstem Infarction: lateral or medial medullary infarction
  2. Synringobulbia
  3. Amyotrophic lateral sclerosis (ALS) (Anterior horn cell)
  4. Polio (Anterior horn cell)
  5. Botulism
  6. Guillain–Barré syndrome (Periphral n.)
  7. Myasthenia gravis (NMJ)

Common Sing & Symptoms

  1. Dysphagia (difficulty in swallowing)
  2. Difficulty in chewing.
  3. Nasal regurgitation.
  4. Drooling of saliva
  5. Difficulty breathing (airway obstruction).
  6. Dysphonia
  7. Dysarthria, slurred speech

Difference

  1. Flaccid (LMN) vs spastic (UMN) tongue and jaw
  2. Hypo (LMN) vs Hyperflexia (UMN) Jaw Jerk
  3. Emotional liabelity (pseudobulbar)

https://en.wikipedia.org/wiki/Bulbar_palsy

https://en.wikipedia.org/wiki/Pseudobulbar_palsy

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15
Q

After a history of muscle disease is elicited, what findings can be expected on physical examination?

A

Routine Neuro Exam: Inspection - Sensroy - Tone - Motor - Reflexes

  1. Normal muscle bulk, atrophy or fasciculations
  2. Normal sensory examination
  3. Muscle tone is usually normal or mildly decreased.
  4. Proximal symmetric weakness.
  5. Reflexes are also normal or mildly decreased.

Neurology Secrets 6th Edition Chapter 3 pg43

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16
Q

Which clinical features of neuromuscular junction disease can be elicited by history? What is the clinical hallmark? After a history of neuromuscular junction problems is elicited, what findings can be expected on physical examination?

A

💡 Disease affects NMJ, so patient complains of fatiguable weakness, starting on face.

  1. Fatigability is the hallmark of diseases affecting the neuromuscular junction, such as myasthenia gravis.
  2. Strength improves with rest

Examination

  1. Normal muscle bulk, without atrophy or fasciculations
  2. Normal sensory examination
  3. Normal tone
  4. Fatigable proximal symmetric weakness.
    Involving muscles of the face, eyes (ptosis), and jaw
    Repetitive testing weakens the muscles, regain their strength after a brief period of rest.
  5. Normal reflexes

Neurology Secrets 6th Edition Chapter 3 pg43

17
Q

Which clinical features of peripheral neuropathies can be elicited by history? After a history of peripheral neuropathy is elicited, what findings can be expected on physical examination?

A

💡 Both myopathies and NMJ develop weakness, maybe mild reduced tone and reflexes but in periphral neurpathies, all the 5 examinations are abonormal.

Neuropathy = LMN Syndrome

  1. Atrophy and fasciculations (Denervation changes)
  2. Sensory changes: numbness, tingling, or paresthesias
  3. Muscle tone may be normal but is often decreased
  4. Asymmetrical weakness is distal rather than proximal (i.e. foot drop, weak grip)
  5. Reflexes are usually diminished

Neurology Secrets 6th Edition Chapter 3 pg43

18
Q

Which clinical features of root diseases (radiculopathies) can be elicited by history? What is the clinical hallmark? Most common radiculoapthy? After a history of a radiculopathy is elicited, what findings can be expected on physical examination?

A

💡 Often resemble peripheral neuropathies because of their asymmetric weakness with evidence of denervation (atrophy and fasciculations) and sensory loss.

  • Pain is the hallmark of root disease, which is sharp, stabbing, hot, and electric, and it typically shoots or radiates down the limb.
  • Most common radiculopathies in the legs affect the L5 and S1 roots
  • Most common radiculopathies in the arms affect the C5 and C6 roots

LMN Syndrome + Back Pain

  1. Atrophy and fasciculations.
  2. Sensory loss occurs in a dermatomal distribution.
  3. Tone is normal or decreased
  4. Weakness is confined to one myotomal group of muscles
  5. Reflexes in the involved muscles are diminished or absent.
  6. Positive straight leg raising or neck rotation

Neurology Secrets 6th Edition Chapter 3 pg43

19
Q

Which clinical features of spinal cord disease can be elicited by history? Spinal cord lesions usually cause a triad of symptoms. List 3. 🔑🔑

A

SCI Syndrome

  1. Sensory level is the hallmark of spinal cord disease
  2. Distal leg and arm weakness
  3. Symmetric, and spastic weakness
  4. Bowel and bladder problems

Examination

  1. No significant atrophy or fasciculations
  2. Increased tone (spasticity)
  3. Distal weakness greater than proximal weakness
  4. Greater weakness of the extensors and antigravity muscles than of the flexors
  5. Increased reflexes, Clonus
  6. UMN Signs: Extensor plantar response (positive Babinski sign)
  7. Absent superficial reflexes

Neurology Secrets 6th Edition Chapter 3 pg44

20
Q

List 3 Features that distinguish dementia from delirium.

A
  1. Attention: relatively preserved in dementia, significantly altered in delirium.
  2. Fluctuations: relatively stable/gradual changes in dementia; rapid alterations in delirium.
  3. Etiology: no clear identifiable trigger for dementia; delirium usually related to some cause (medication, illness, drugs, etc).

PassPMR - 05 Neurology (6 decks)

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