Bates-Nervous System Flashcards
1
Q
gray matter vs white matter
A
gray: aggregations of neuronal cell bodies; rims the surfaces of the cerebral hemispheres forming the cerebral cortex
2
Q
internal capsule
A
white-matter structure where myelinated fibers converge from all parts of the cerebral cortex and descend into the brainstem
3
Q
reticular activating system
A
in the diencephalon and upper brainstem; consciousness depends on this
4
Q
spinal cord termination
A
L1/L2
5
Q
where are lumbar punctures performed
A
L3/L4 or L4/L5
6
Q
corticospinal (pyramidal) tract
A
mediate voluntary movement and integrate skilled, complicated, or delicate movements by stimulating selected muscular actions and inhibiting others
7
Q
bradykinesia
A
damage to basal ganglia
8
Q
pain and temperature
A
pass into the posterior horn of the spinal cord and synapse with secondary neurons
9
Q
crude touch fibers
A
pass into posterior horn and synapse with secondary neurons
10
Q
position and vibration fibers
A
pass directly into posterior columns of the cord and travrel up to medulla with fibers of fine touch
11
Q
thalamic level
A
quality of sensation is perceived but fine distinctions are not made
12
Q
loss of position and vibration sense with preservation of other sensations- where is the lesion?
A
posterior columnstransection of the spinal cord
13
Q
loss of all sensations from waist down, with paralysis and hyperactive reflexes in the legs- lesion where?
A
transection of spinal cord
14
Q
reflex
A
involuntary sterotypical response that involves at least one afferent and one efferent across a single synapse
15
Q
all componenets of a reflex arc
A
sensory nerve fibers
16
Q
ankle reflex
A
S1
17
Q
knee reflex
A
L2-4
18
Q
brachioradialis reflex
A
C5-6
19
Q
biceps reflex
A
C5-6
20
Q
triceps reflex
A
C6-7
21
Q
abdominal reflex (upper)
A
T8-10
22
Q
abdominal reflex (lower)
A
T10-12
23
Q
plantar reflex
A
L5-S1
24
Q
anal reflex
A
S2-4
25
different presentation of myopathy vs polyneuropathy
b/l proximal weakness in myopathy
26
presentation of paresthesias around the mouth and in hands Ddx?
hyperventilation
27
dysesthesias
distorted sensation in response to a stimulus (light touch or pinprick as burning or tingling sensation)
28
vasovagal syncompe
emotional stress and warning symptoms (flushing, warmth, nausea); slow onset, slow offset
29
cardiac syncope
arrhythmias, sudden onset/offset
30
presentation of tonic-clonic motor activity, bladder or bowel incontinence, and postictal state
generalized seizure; may bite tongue
31
stroke
sudden neurologic deficit caused by CV ischemia (80-85%) or hemorrhage (15-20%)
32
hemorrhagic strokes- two types
intracerebral (10-15%) or subarachnoid (5%)
33
TIA
sudden focal neurologic deficit- lasting less than 24 hours- more recent: less than 1 hour without underlying structural defects
34
predictive value of TIAs
15% of patients progress to stroke w/i first 3 months
35
when is risk of stroke highest
first 30 days after TIA
36
middle cerebral artery occlusion symptoms
visual field cuts and contralateral hemiparesis and sensory deficits
37
MCA occlusion in L hemisphere
aphasia
38
MCA occlusion in R hemisphere
hemineglect
39
most common cause of hemorrhagic stroke from subarachnoid hemorrhage
rupture of saccular aneurysms in circle of Wilils
40
ideal level of HgA1C in diabetics to control risk for stroke
< 7.4% so onset of neuropathy drops by 50-60%
41
loss of sense of smell indicates
sinus congestion, head trauma, smoking, aging, use of cocaine, parkinsons
42
disc pallor vs disc bulging
pallor: optic atrophy
43
prechiasmal, anterior defects (visual)
glaucoma, retinal emboli, optic neuritis
44
bitemporal hemianopsias
defects at optic chiasm- pituitary
45
homonymous hemianopsias or quadrantanopsia
postchiasmal lesions- parietal lobe- acuity normal
46
monocular diplopia
local problems with glasses or lenses, cataracts, astigmatism, ptosis
47
binocular diplopia
CN III, IV, VI, neuropathy (40%), MG, trauama, thyroid ophthalmopathy, INO (muscle disease)
48
nystagmus (define and when you see it)
involuntary jerking movement of the eyes with quick and slow components
49
how is nystagmus named
for the direction of the fast component
50
unilateral weakness in CN V pontine lesions
b/l weakness in cerebral hemispheric disease because of b/l cortical innervation
51
ipsilateral face but contralateral body sensory loss localizes lesion to?
brainstem
52
acoustic neuroma presentation
absent blinking and sensorineural hearing loss
53
conductive vs. sensorineural hearing loss
conductive: impaired air thorugh ear transmission
54
Rinne vs Weber test
Rinne: air and bone conduction- normal air > bone- conductive- bone longer than air in affected ear- sensorineural- air longer than bone but less than 2:1 ratio
55
causes of conductive hearing loss
cerumen, otosclerosis, otitis media
56
b/l lesion of vagus nerve
failure of palate to rise
57
u/l lesion of vagus
one side doesnt rise and with uvula is pulled toward normal side
58
tongue atrophy and fasciculations
amyotrophic lateral sclerosis, polio
59
unilateral cortical lesion
protruded tongue deviates transiently in a direction away from the side of cortical lesion, toward side of weakness
60
pseudohypertrophy and when seen
increased bulk with diminished strength: DMD
61
sign of atrophy in the hands
flattening of thenar and hypothena eminences and furrowing b/w metacarpals; median and ulnar nerve damage, respectively
62
weakness of extension
peripheral nerve disease such as radial nerve damage and in CNS disease producing hemiplegia- stroke/MS
63
weak grip (C7-T1)
cervical radiculopathy, de Wuervain's tenosynovitis, CTS, arthritis, epicondylitis
64
weak finger abduction
ulnar nerve disorders
65
weak opposition of the thumb
medial nerve
66
flexion of hip tests
L2-L4; iliopsoas
67
signs of cerebellar disease
ataxia, nystagmus, dysarthria, hypotonia
68
dysdiadochokinesis
when one movement cannot be followed quickly by its opposite; movements are irregular, slow, clumsy- cerebellar disease
69
dysmetria
finger initially overshoots but eventually reaches it
70
differentiation of ataxia from dorsal column disease vs cerebellar disease
cerebellar: difficulty standing with feet together whether eyes are open or closed
71
pronator drift
sensitive and specific for corticospinal tract lesion originating in contralateral hemisphere
72
stereognosis, number identification, two-point discrimination impaired in?
posterior column disease
73
astereognosis
inability to recognize objects placed in hand
74
lesions in sensory cortex
astereognosis, inability to recognize numbers (graphesthesia), increase distance between two recognizable points, impairs ability to localize points accurately
75
neck stiffness and resistance to flexion in what perfect of pts with acute bacterial meningitis vs subarachnoid hemorrhage
90%- meningitis
76
Brudzinski's Sign
flex the neck; watch the hips and knees- positive when hips and knees flex
77
Kernig's Sign
flex the leg at both hip and knee then straighten- pain and increased resistance to extending the knee- (+) Kernig's sign- b/l indicates meningeal irritation
78
positive straight leg test?
pain radiating into ipsilateral leg indicating lumbosacral radiculopathy, sciatic neuropathy, or both
79
sensitivity and specificity of straight leg raise for disc herniation vs crossed straight-leg raise
95% and 25%
80
asterixis
sudden, brief, nonrhythmic flexion of hands and fingers- liver disease, uremia, hypercapnia
81
winging of scapula
weakness of serratus anterior/ long thoracic nerve
82
*Five clinical signs that stronly predict death in coma
absent corneal response, absent pupillary response, absent withdrawal response to pain, no motor response; at 72 hours-no motor response
83
DONTS when assessing comatose patient
1.) don't dilate the pupils! (most important clue to underlying cause of coma [structural vs. metabolic])
84
structural hemispheric lesions (eye direction)
look at the lesion in the affected hemisphere
85
comatose pt with lack of doll's eye movements
-ability to move both eyes to one side is lost--> lesion of midbrain or pons
86
hemiplegia of sudden cerebral accidents
flaccid at first causing limp hand drops to form a right angle with the wrist
87
movement of flaccid leg in acute hemiplegia
falls fast into extension with external rotation at hip
88
mechanism of acute ischemic stroke
-ischemic brain injury begins with a central core of very low perfusion and often irreversible cell death
89
most irreversible damage occurs when
3-6 hrs after onset of symptoms
90
NAME THAT STROKE! contralateral leg weakness
ACA
91
NAME THAT STROKE! contralateral face, arm>leg weakness, sensory loss, field cut, aphasia (L lesion), neglect/apraxia (R lesion)
anterior circulation of MCA
92
NAME THAT STROKE! contralateral motor or sensory deficit without cortical signs
subcortical circulation- leticulostriate deep penetrating branches of MCA
93
four common syndromes of lacunar infarcts
1.) pure motor hemiparesis
94
NAME THAT STROKE! contralateral field cut
posterior ciruclation- PCA
95
NAME THAT STROKE! cortical blindness but preserved pupillary light reaction
b/l PCA infarction
96
NAME THAT STROKE! dysphagia, dysarthria, tongue/palate deviation and/or ataxia with crossed sensory/motor deficits (ipsilateral face/contralateral body)
posterior circulation- brainstem, vertebral, basilar artery branches
97
NAME THAT STROKE! oculomotor deficits and/or ataxia with crossed sensory/motor deficits
posterior circulation- basilar artery
98
decerebrate rigidity (abnormal extensor response)
-jaws clenched, neck extended, arms adducted and stiffly extended at elbows, forearms protonated, wrists/fingers flexed
99
hemiplegia (early)
-flaccid (later spastic)
100
decorticate rigidity (abnormal flexor response)
- upper arms flexed tight to the sides with elbows, wrists, fingers flexed
101
bilaterally small pupils
1.) damage to sympathetic pathways in hypothalamus
102
pinpoint pupils (<1 mm)
1.) hemorrhage in pons
103
midposition fixed pupils
midposition of slightly dilated (4-6mm)- damage in midbrain
104
b/l fixed and dilated pupils
severe anoxia and its sympathomimetic effects
105
b/l large reactive pupils
cocaine, amphetamine, LSD, sympathomimetics
106
one large pupil (fixed and dilated)
herniation of the temporal lobe (compression of CN III and midbrain)
107
features of toxic-metabolic coma
*arousal centers poisoned or critical substrates depleted*
108
causes of toxic-metabolic coma
uremia, hyperglycemia, alcohol, drugs, liver failure, hypothyroidism, hypoglycemia, anoxia, ischemia, meningitis, encephalitis, hyperthermia, hypothermia
109
features of structural coma
*lesion destroys or compresses brainstem arousal areas*
110
causes of structural coma
epidural, subdural, intracerebral hemorrhage, cerebral infarct or embolus, tumor, abscess, brainstem infarct, tumor, hemorrhage, cerebellar infarct, hemorrhage, tumor or abscess
111
steppage gait
- foot drop
112
parkinsonian gait
- basal-ganglia defects
113
cerebellar ataxic gait
staggering, unsteady, wide based
114
sensory ataxia
- gait unsteady, wide based
