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Medicine > Approach To A Patient With Neurological Disease > Flashcards

Approach To A Patient With Neurological Disease Flashcards

1
Q

What is the control hub for motor, sensory and cognition (higher cortical functions)

A

The brain

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2
Q

What is a conduit for bidirectional flow of impulses to and from the brain

A

Spinal cord

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3
Q

The central nervous system is made up of

A

The brain and the spinal cord

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4
Q

The peripheral nervous system is made up of

A

Motor nerves
Sensory nerves
Autonomic nerves

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5
Q

What is the use of motor nerves

A

They transmit signals to muscles for contraction/relaxation

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6
Q

What is the use of sensory nerves

A

They transmit signals from sensory receptors to the CNS

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7
Q

What is the function of autonomic nerves

A

Works automatically to control bodily functions such as heart rate, respiratory rate, digestion, urination and sexual arousal

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8
Q

What are the three main symptoms of nervous system disease

A

Motor symptoms
Sensory symptoms
Higher cortical function symptoms

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9
Q

Examples of motor symptoms

A

Weakness (paralysis)
Movement problems (fast or slow)
Ataxia (incoordination)

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10
Q

Examples of sensory symptoms

A

Numbness
Pain syndromes
Tingling
Burning sensations
Special senses

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11
Q

Examples of higher cortical function symptoms

A

Dysphasia (loss of speech)
Amnesia (memory loss)
Poor judgement
Apraxia
Agnosia
Personality changes

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12
Q

What is apraxia

A

Inability to perform tasks

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13
Q

What is agnosia

A

Inability to recognize objects, people, etc

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14
Q

In a single patient, you can have a combination of symptoms depending on where the lesion (problem) is in the nervous system
True or false

A

True

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15
Q

Upper motor neurons transmit impulses from the cortical bodies to which two other parts of the body

A

The motor nuclei in the brain stem
The anterior horn cells of the spinal cord

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16
Q

Lower motor neurons transmit impulses from where to where

A

From the anterior horn cells to the peripheral nerves, terminating in the neuromuscular junction

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17
Q

What should be considered in the history taking of weaknesses in a neurologic patient

A

Duration of weakness
Onset of weakness (sudden vs gradual)
Pattern of weakness (monoparesis, hemiparesis, paraparesis, tetraparesis)
Progression of weakness (ascending from the distal toward proximal)
Distribution of weakness (proximal, distal, total)
Any other symptoms (sensory, higher cortical dysfunction)
Risk factors and possible exposures (vascular risk factors, family history)
Effect of weakness on quality of life

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18
Q

Steps in doing a motor examination to inspect weaknesses in a neurological patient

A

Inspection
Palpation
Check motor strength (power grade from 0 to 5)
Check muscle compartments against resistance
Check for deep tendon reflexes

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19
Q

Active movement with gravity eliminated is what MRC grading

A

2

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20
Q

What does grade 0 correspond to in MRC grading

A

No contraction detected

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21
Q

What does grade 1 in MRC correspond to

A

Barely detectable flicker or trace of contraction

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22
Q

What does grade 3 in the MRC grading mean

A

Active movement against gravity but cannot sustain

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23
Q

What does grade 4 in MRC correspond to

A

Active movement against gravity and some resistance

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24
Q

What does grade 5 in MRC mean

A

Active movement against resistance without evident fatigue (normal)

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25
Q

Upgoing plantar is also known as

A

Babinsky sign

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26
Q

Which myotome does plantar reflex occur

A

S1

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27
Q

Rhythmic oscillations as a reflex of the lower limb is also called

A

Clonus

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28
Q

What is the C5 myotome responsible for

A

Shoulder abduction by deltoid

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29
Q

What is the C6 myotome responsible for

A

Elbow flexion by brachioradialis

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30
Q

What is the C7 myotome responsible for

A

Elbow extension by triceps

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31
Q

What is the T1 myotome responsible for

A

Thumb opposition

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32
Q

What is the C8 myotome responsible for

A

Wrist flexion by palmaris longus

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33
Q

What is the L2 myotome responsible for

A

Hip flexion

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34
Q

What are some reflexes that could be assessed in the upper limb

A

Biceps reflex at C5,6
Triceps reflex at C7,8
Supinator reflex at C5,6

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35
Q

What are some reflexes that could be assessed in the lower limb

A

Patella reflex at L3,4
Achilles ankle reflex at L5
Plantar reflex at S1
Babinsky sign
Clonus

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36
Q

Weakness is a sign of a UMN lesion

A

Yes

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37
Q

Wasting is a sign of a UMN lesion

A

No

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38
Q

Fasciculation is a sign of a UMN lesion

A

No

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39
Q

Is the tone increased in a UMN lesion

A

Yes

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40
Q

Describe the nature of reflexes in a UMN lesion

A

Increased (brisk) reflexes

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41
Q

Name locations of UMN lesions

A

Brain
Spinal cord

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42
Q

Provide yes or not answers to whether or not these various signs apply to LMN lesions. For tone and reflexes, indicate whether they are present or absent
(weakness, wasting, fasciculation, tone, reflexes)

A

Weakness: Yes
Wasting: Yes
Fasciculation: Yes
Tone: Reduced
Reflexes: Reduced or absent

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43
Q

Where do you locate lesions in the LMN

A

Anterior horn cells
Spinal roots
Peripheral nerves

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44
Q

Provide yes or not answers to whether or not these various signs apply to muscle lesions. For tone and reflexes, indicate whether they are present, absent or normal
(weakness, wasting, fasciculation, tone, reflexes)

A

Weakness: Yes
Wasting: Yes
Fasciculation: No
Tone: Normal
Reflexes: Normal

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45
Q

Hemiparesis is only caused in UMNs
True or false

A

True

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46
Q

What are some possible locations of a right hemiparesis

A

Left motor cortex
Left internal capsule
Left brain stem
Left cervical cord

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47
Q

What are some possible causes of a hemiparesis

A

Stroke
Intercranial space occupying lesion (Eg. Brain tumour, abscess, etc)

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48
Q

Paraparesis is seen in both UMNs and LMNs
True or False

A

True

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49
Q

What causes hypokinesis

A

Closure of the gate of the basal ganglia

50
Q

Give one example of a hypokinetic disorder

A

Parkinson’s disease

51
Q

What are some symptoms of Parkinson’s disease

A

Reduced movements
Rigidity
Stooping posture
Shuffling gait
Resting tremor

52
Q

Mention some hyperkinetic disorders

A

Tremors
Chorea
Athetosis
Ballisms
Dystonia
Tics
Myoclonus

53
Q

What are tremors

A

Rhythmic oscillations caused by intermittent muscular contractions

54
Q

What is chorea

A

It is a dance-like, rapid, jerk movement which often involves the distal muscles

55
Q

What is athetosis

A

Writhing movements, often slow, mostly of arms and hands

56
Q

What are ballisms

A

Wild, large-amplitude, flinging movements, affects the proximal muscles

57
Q

What is dystonia

A

Sustained or repetitive muscular contractions often produces abnormal posture

58
Q

What are tics

A

Paroxysmal, stereotyped muscle contraction, may be suppressible

59
Q

What is myclonus

A

Shock-like, arrhythmic twitches. Not suppressible

60
Q

What is the use of the cerebellum

A

The cerebellum coordinates on-going muscle movements using sensory input, vestibular and motor systems to ensure accurate movements

61
Q

The right cerebellar controls which side of the body and vice versa

A

The right side of the body and vice versa

62
Q

Which part of the cerebellum controls the trunk of the body

A

The vermis

63
Q

Mention some cerebellar function tests

A

Finger to nose test
Rapid alternating hand movement (diadochokinesia)
Heel to shin test
Assess gait
Tandem gait
Stance and Rhomberg’s sign

64
Q

Sensory symptoms can be grouped into

A

Positive and negative symptoms

65
Q

What are some positive sensory symptoms

A

Paraesthesia
Pain
Tingling
Shocks
Pricks
Burning

66
Q

Give an example of a negative sensory symptom

A

Numbness

67
Q

What are some examples of increased perception of sensory stimuli

A

Hyperesthesia - Extreme sensitivity to touch
Hyperalgesia - Extreme sensitivity to pain
Hyperpathia - Increased reaction to a stimulus
Allodynia - pain due to a stimulus that does not normally provoke pain

68
Q

List some sensory testing methods for pain

A

Use a sharp safety pin or other tool
Demonstrate sharp and dull
Alternate sharp and dull objects with patient’s eye closed and ask whether instrument is sharp or dull

69
Q

How is light touch sensory testing done

A

Use a wisp of cotton to touch gently and avoid pressure
Ask patient to respond when touch is felt and compare one area with another

70
Q

All the cranial nerves are part of the peripheral nerves except

A

Cranial nerve II

71
Q

Where does the nuclei of CN II originate

A

In the brain stem

72
Q

What is the location of the receptors of CN I

A

Upper third of the nasal septum

73
Q

How do you test CN I

A

Test each nostril separately
Identify familiar odours
Avoid noxious substances

74
Q

A unilateral lesion in CN I leads to what kind of anosmia

A

Ipsilateral anosmia

75
Q

What do you have to test for in CN III

A

Visual acuity
Pupillary size
Visual fields
Fundoscopic examination

76
Q

What test is done to check pupillary size

A

Swinging-flashlight test

77
Q

What tests are done to check for visual fields

A

Peripheral vision
Test by confrontation

78
Q

CN III is involved in

A

Pupillary reflex
Opening of the eyelids
Most extraocular movements

79
Q

What is the function of CN IV

A

It provides downward and inward eye movement

80
Q

What is the function of CN VI

A

It provides lateral eye movement

81
Q

What are the types of pupillary reflex/reaction

A

Direct and consensual

82
Q

Give some examples of pupil abnormalities

A

Adie’s (tonic) pupil
Argyll Robertson pupil
Marcus-Gunn pupil
Bilateral dilation
Unilateral constriction
Bilateral constriction

83
Q

Sluggish response of the pupil is characteristic of

A

Adie’s pupil

84
Q

Irregular/unequal pupils, weak/absent reaction to light, exaggerated contraction to accommodation is characteristic of which pupil abnormality

A

Argyll Robertson pupil

85
Q

What pupil abnormality results from reduced afferent input in the affected eye and pupil tends not to constrict fully

A

Marcus-Gunn pupil

86
Q

Asymmetry of pupil size of >1mm suggests CN III compression which is characteristic of what pupil abnormality

A

Marcus-Gunn pupil

87
Q

Which pupil abnormality suggests anoxia or drugs

A

Bilateral dilation

88
Q

What pupil abnormality is seen with sympathetic dysfunction (Horner’s syndrome) or carotid artery dissection

A

Unilateral constriction

89
Q

Bilateral constriction is seen with

A

Pontine hemorrhage
Drugs (opiates, clonidine)
Toxins (organophosphates)

90
Q

Name some tests done for CN V

A

Test corneal reflex
Test sensation
Jaw reflex
Compare muscle tension bilaterally with teeth clenched

91
Q

CN V is has both motor and sensory functions. What are some muscles it innervates

A

Temporalis
Masseter
Medial and lateral pterygoids

92
Q

The motor nerves of the facial nerve innervates which muscles

A

Muscles of the face, scalp and ears

93
Q

Which parts of the body does the sensory part of the facial nerve innervates

A

Taste in anterior 2/3 of the tongue
Ear canal/ posterioauricular

94
Q

What types of nerves comprise the facial nerve

A

Motor
Sensory
Autonomic

95
Q

Central lesions to CN VIi cause ……..

A

Contralateral paralysis to the lower half of the face (below the eyes)

96
Q

Palsies in CN VII can occur secondary to

A

Polio
Stroke
MS
Tumour
Syphilis
Guillain-Bare syndrome
Lyme disease

97
Q

Higher cortical functions include

A

Language
Vision
Visuospacial recognition
Awareness

98
Q

What are the three characteristics of higher cortical function

A

The cerebral cortex must be involved. Complex interactions occur within the cortex and between it and other brain areas
Both conscious and unconscious information processing occurs
Higher-order functions are adjusted over time. They are inborn (innate), fixed, or reflexive behaviors

99
Q

What are the two classes of memories

A

STM
LTM

100
Q

What are the two subtypes of LTM

A

Secondary and tertiary memories

101
Q

What are secondary memories

A

They are memories which fade over time and require great effort to recall

102
Q

What are tertiary memories

A

They are memories which remain with us throughout life

103
Q

What are the three types of amnesia

A

Anterograde amnesia
Retrograde amnesia
Transient global amnesia (TBA)

104
Q

Loss of ability to remember recent information but remembers old info and event
What type of amnesia is this

A

Anterograde amnesia

105
Q

Loss of the ability to recall episodic memories and past events
What type of amnesia is this

A

Retrograde amnesia

106
Q

Temporary loss of memory involving inability to recall events that have occurred a few minutes ago
What type of amnesia is this

A

Transient global amnesia

107
Q

What are some instruments needed for neurological examination

A

Patellar hammer
Tuning fork 128 Hz (for vibration) and 256/512 Hz (for hearing)
Pointed or sharp object like a tooth pick
Cotton wool
Snellen chart (for assessing visual acuity)
Ishihara chart (for assessing color)
Mildly scented soap (for assessing smell)
Sugar, salt (to assess taste)

108
Q

What is the term given to problems with articulating words not due to language problems

A

Dysarthria

109
Q

What term is given to the quality of rhythm and emphasis that adds more meaning to our words. It’s a function of both hemispheres

A

Prosody

110
Q

What term is given to changes in the intensity of speech, the timing of speech segments and words spoken, including their rhythm and pitch

A

Dysprosody

111
Q

What are some examples of aphasia

A

Global aphasia
Anomic aphasia
Wernicke’s aphasia
Broca’s aphasia

112
Q

Broca’s aphasia: Fluent or non-fluent, patient comprehends speech or patient does not comprehend speech

A

Non-fluent speech
Patient comprehends speech

113
Q

Anomic aphasia: Fluent or non-fluent, patient comprehends speech or patient does not comprehend speech

A

Fluent
Patient comprehends speech

114
Q

Wernicke’s aphasia: Fluent or non-fluent, patient comprehends speech or patient does not comprehend speech

A

Fluent
Patient does not comprehend speech

115
Q

Global aphasia: Fluent or non-fluent, patient comprehends speech or patient does not comprehend speech

A

Non-fluent
Patient does not comprehend speech

116
Q

What are the three tests in the Glasgow coma scale

A

Eye opening
Best verbal response
Best motor response

117
Q

What are the various levels of consciousness

A

Alert and oriented
Disoriented
Obtunded
Stuporous
Comatose

118
Q

Completely unconscious
Cannot be aroused by painful stimuli
Absence of voluntary movement
+/- reflexes
Characteristic of

A

Comatose

119
Q

Drowsy/somnolent
Clouded consciousness
Slow thought, movement, and speech
Characteristic of

A

Obtounded

120
Q

Marked reduction in mental and physical activity
Vigorous stimuli needed to provoke a response
Characteristic of

A

Stuporous

121
Q

What alters the state of wakefulness

A

Abnormal or depressed CNS function

122
Q

What is consciousness

A

A state of alertness and attentiveness

Medicine (38 decks)

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