Approach to patients with CNS disorders

Question 1

Frontal lobe is involved in =

Answer 1

Intellectual function
Praxis
Motor function
Inhibition
Bladder continence
Saccadic eye movements 
Broca's area - expression of language

Question 2

Praxis =

Answer 2

Conception and planning of a new action, the performance of an action

Question 3

Difficulty in activites requiring coordination and movement =

Answer 3

Dyspraxia

Question 4

Internal capsule separates =

Answer 4

Thalamus, caudate nucleus and globus pallidus/putamen

Question 5

In the motor homonculus, what is most lateral?

Answer 5

Face - arm

Question 6

In the motor homonculus what is msot medial?

Answer 6

Lower limb

Question 7

Pre-central gyrus =

Answer 7

Primary motor cortex

Question 8

Post-central gyrus =

Answer 8

Primary sensory cortex

Question 9

Problem with Broca’s area =

Answer 9

Expressive dysphasia

Question 10

Where does the majority of the corticospinal tract decussate?

Answer 10

Medullary pyramids

Question 11

What does the corticospinal tract split into?

Answer 11

Lateral, anterior

Question 12

Lateral corticospinal tract =

Answer 12

Distal, fine movements (voluntary)

Question 13

Anterior corticospinal tract =

Answer 13

Proximal muscles

Question 14

lesion in the right motor cortex/right internal capsule will lead to what?

Answer 14

left sided upper motor neurone weakness

Question 15

Lesion to right cranial nerve nuclei in brainstem causes:

Answer 15

Right sided lower motor neurone weakness

Question 16

Temporal lobe is involved in:

Answer 16

Memory
Smell
Auditory cortex
Vestibular
Emotion 
Wernickes

Question 17

Occipital lobe is involved in:

Answer 17

Vision

Question 18

Lesion in the occipital lobe causes what?

Answer 18

Contralateral homonymous hemianopia

Question 19

Parietal lobe is involved in:

Answer 19

Sensory integration

Question 20

Wernickes area problem =

Answer 20

Expressive dysphasia

Question 21

Dysphasia vs dysarthria =

Answer 21

Dysphasia = langusage
Dysarthria = words

Question 22

Lesion in dominant parietal lobe:

Answer 22

Dyslexia
Acalculia
Poor left-right discrimination
Agnosia

Question 23

Spinothalamic tract carries what modalities:

Answer 23

Pain, temperature, crude touch

Question 24

Spinothalamic tract splits into

Answer 24

Anterior (crude touch)

Lateral (pain, temp)

Question 25

Where does the spinothalamic tract decussate?

Answer 25

About 2 spinal levels above entry - early!

Question 26

DCML carries what modalities

Answer 26

Fine touch, pressure, vibration

Question 27

Fasiculus cuneatus =

Answer 27

info from upper body

Question 28

Fasiculus gracillis

Answer 28

info from lower body

Question 29

Where does DCML decussate?

Answer 29

Medulla

Question 30

Spinocerebellar tract remains

Answer 30

Ipsilateral

Question 31

What does the spinocerebellar tract carry

Answer 31

Conscious proprioception

Question 32

Why do lesions in the spinocerebellar tract often not show?

Answer 32

Damaged with other tracts - weakness usually disguises any loss of coordination

Question 33

Brown-sequard syndrome:

Answer 33

Damage to 1 side of spinal cord: ipsilateral posterior column loss contralateral spinothalamic loss

Question 34

Lesion in cortex, internal capsule or thalamus does what to tracts?

Answer 34

full contralateral sensory deficit

Question 35

Weber syndrome is also known as

Answer 35

Midbrain syndrome

Question 36

Weber syndrome effects which CN

Answer 36

CN III

Question 37

Wallenburg syndrome also known as

Answer 37

Lateral medullary syndrome

Question 38

3 zones of cerebellum and functions:

Answer 38

``` cerebrocerebellum = planning movements and motor learning, fine motor spinocerebllum = postural tone, correcting movements vestibulocerebellum = balance ```

Question 39

Acronym to remember features of cerebellar dysfunction:

Answer 39

VANISH'D

Question 40

VANISH'D =

Answer 40

``` Vertigo Ataxia Nystagmus Intention tremor Slurred speech Hypotonia Dysmetria (past-posting), dysdiadochokinesis ```

Question 41

Most malignant primary brain tumour =

Answer 41

Glioblastoma multiforme

Question 42

Features of a complete CN III plasy =

Answer 42

Eyes down and out Mydriasis Partial ptosis

Question 43

Why is the ptosis in CNIII plasey only partial?

Answer 43

Lost levator palpebrase superioris but not Muller's muscle (which has sympathetic innervation)

Question 44

Horner's syndrome is due to problems with which nerve supply?

Answer 44

Sympathetic

Question 45

Symptoms of horner's syndrome:

Answer 45

Miosis Ptosis Anhydrosis Enopthalmos

Question 46

Causes of horner's

Answer 46

Idiopathic C8/T1 pathology Carotid dissection Pancoast tumor

Question 47

Features of a CN IV plasy =

Answer 47

eyes cannot look down

Question 48

Features of an CN VI palsy:

Answer 48

Eye in, diplopia

Question 49

Diplopia =

Answer 49

Double vision

Question 50

CN VI plasy can be indicitive of:

Answer 50

Pons lesion, infarction

Question 51

Facial UMN vs LMN lesion:

Answer 51

UMN: only bottom half effected, upper face has a dual nerve supply LMN: both halves effected

Question 52

Bells palsy is a what lesion of what nerve

Answer 52

LMN lesion of CN VII

Question 53

Bells palsy effects what parts of face?

Answer 53

Both halves on ipsilateral side

Question 54

Plasy of facial nerve features:

Answer 54

``` Ipsilateral wekaness of muscles on top and bottom of face Incomplete eye closure Abnormal taste sensation on ant 2/3rds Hyperacussis Decreased lacrimation and saliva ```

Question 55

Why might CN VII plasy cause hyperacussis?

Answer 55

Supplies the stapedius nerve (one of the ossicles)

Question 56

Features of CN XI plasy:

Answer 56

difficulty shrugging, paralysis of sternocleidomastoid

Question 57

Features of CN XII plasy:

Answer 57

``` Wasting of tongue Fasiculations Weakness of tongue Tongue deviates to side of lesion Dysarthria ```

Question 58

Tongue in LMN lesion points

Answer 58

towards side of lesion

Question 59

Tongue in UMN lesion points

Answer 59

away from side of lesion

Question 60

Ex of tone pathologies:

Answer 60

Cog-wheel Clasp-knife Lead pipe

Question 61

2 types of rigiditiy associated with Parkinson's

Answer 61

Cog-wheel | Leadpipe

Question 62

What is used to grade power?

Answer 62

MRC scale

Question 63

MRC scale goes from:

Answer 63

0-5

Question 64

MRC scale =

Answer 64

``` 0- no movement 1- flicker of movement 2- movement with gravity eliminated 3- movement against gravity 4- movement against resistance 5- normal power ```

Question 65

Examples of LMN lesion areas:

Answer 65

``` anterior horn nerve root brachial, lumbar plexus named nerve NMJ muscle ```

Question 66

Romberg's test assesses

Answer 66

Vestibular function. patient stands with feet together and closes eyes. patient will wobble and lose balance with vestibular dysfunction