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Physical Diagnosis > Bates-Nervous System > Flashcards

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

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2
Q

internal capsule

A

white-matter structure where myelinated fibers converge from all parts of the cerebral cortex and descend into the brainstem

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3
Q

reticular activating system

A

in the diencephalon and upper brainstem; consciousness depends on this

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4
Q

spinal cord termination

A

L1/L2

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5
Q

where are lumbar punctures performed

A

L3/L4 or L4/L5

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6
Q

corticospinal (pyramidal) tract

A

mediate voluntary movement and integrate skilled, complicated, or delicate movements by stimulating selected muscular actions and inhibiting others

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7
Q

bradykinesia

A

damage to basal ganglia

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8
Q

pain and temperature

A

pass into the posterior horn of the spinal cord and synapse with secondary neurons

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9
Q

crude touch fibers

A

pass into posterior horn and synapse with secondary neurons

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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

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11
Q

thalamic level

A

quality of sensation is perceived but fine distinctions are not made

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12
Q

loss of position and vibration sense with preservation of other sensations- where is the lesion?

A

posterior columnstransection of the spinal cord

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13
Q

loss of all sensations from waist down, with paralysis and hyperactive reflexes in the legs- lesion where?

A

transection of spinal cord

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14
Q

reflex

A

involuntary sterotypical response that involves at least one afferent and one efferent across a single synapse

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15
Q

all componenets of a reflex arc

A

sensory nerve fibers

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16
Q

ankle reflex

A

S1

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17
Q

knee reflex

A

L2-4

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18
Q

brachioradialis reflex

A

C5-6

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19
Q

biceps reflex

A

C5-6

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20
Q

triceps reflex

A

C6-7

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21
Q

abdominal reflex (upper)

A

T8-10

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22
Q

abdominal reflex (lower)

A

T10-12

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23
Q

plantar reflex

A

L5-S1

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24
Q

anal reflex

A

S2-4

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25
Q

different presentation of myopathy vs polyneuropathy

A

b/l proximal weakness in myopathy

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26
Q

presentation of paresthesias around the mouth and in hands Ddx?

A

hyperventilation

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27
Q

dysesthesias

A

distorted sensation in response to a stimulus (light touch or pinprick as burning or tingling sensation)

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28
Q

vasovagal syncompe

A

emotional stress and warning symptoms (flushing, warmth, nausea); slow onset, slow offset

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29
Q

cardiac syncope

A

arrhythmias, sudden onset/offset

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30
Q

presentation of tonic-clonic motor activity, bladder or bowel incontinence, and postictal state

A

generalized seizure; may bite tongue

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31
Q

stroke

A

sudden neurologic deficit caused by CV ischemia (80-85%) or hemorrhage (15-20%)

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32
Q

hemorrhagic strokes- two types

A

intracerebral (10-15%) or subarachnoid (5%)

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33
Q

TIA

A

sudden focal neurologic deficit- lasting less than 24 hours- more recent: less than 1 hour without underlying structural defects

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34
Q

predictive value of TIAs

A

15% of patients progress to stroke w/i first 3 months

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35
Q

when is risk of stroke highest

A

first 30 days after TIA

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36
Q

middle cerebral artery occlusion symptoms

A

visual field cuts and contralateral hemiparesis and sensory deficits

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37
Q

MCA occlusion in L hemisphere

A

aphasia

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38
Q

MCA occlusion in R hemisphere

A

hemineglect

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39
Q

most common cause of hemorrhagic stroke from subarachnoid hemorrhage

A

rupture of saccular aneurysms in circle of Wilils

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40
Q

ideal level of HgA1C in diabetics to control risk for stroke

A

< 7.4% so onset of neuropathy drops by 50-60%

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41
Q

loss of sense of smell indicates

A

sinus congestion, head trauma, smoking, aging, use of cocaine, parkinsons

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42
Q

disc pallor vs disc bulging

A

pallor: optic atrophy

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43
Q

prechiasmal, anterior defects (visual)

A

glaucoma, retinal emboli, optic neuritis

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44
Q

bitemporal hemianopsias

A

defects at optic chiasm- pituitary

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45
Q

homonymous hemianopsias or quadrantanopsia

A

postchiasmal lesions- parietal lobe- acuity normal

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46
Q

monocular diplopia

A

local problems with glasses or lenses, cataracts, astigmatism, ptosis

47
Q

binocular diplopia

A

CN III, IV, VI, neuropathy (40%), MG, trauama, thyroid ophthalmopathy, INO (muscle disease)

48
Q

nystagmus (define and when you see it)

A

involuntary jerking movement of the eyes with quick and slow components

49
Q

how is nystagmus named

A

for the direction of the fast component

50
Q

unilateral weakness in CN V pontine lesions

A

b/l weakness in cerebral hemispheric disease because of b/l cortical innervation

51
Q

ipsilateral face but contralateral body sensory loss localizes lesion to?

A

brainstem

52
Q

acoustic neuroma presentation

A

absent blinking and sensorineural hearing loss

53
Q

conductive vs. sensorineural hearing loss

A

conductive: impaired air thorugh ear transmission

54
Q

Rinne vs Weber test

A

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
Q

causes of conductive hearing loss

A

cerumen, otosclerosis, otitis media

56
Q

b/l lesion of vagus nerve

A

failure of palate to rise

57
Q

u/l lesion of vagus

A

one side doesnt rise and with uvula is pulled toward normal side

58
Q

tongue atrophy and fasciculations

A

amyotrophic lateral sclerosis, polio

59
Q

unilateral cortical lesion

A

protruded tongue deviates transiently in a direction away from the side of cortical lesion, toward side of weakness

60
Q

pseudohypertrophy and when seen

A

increased bulk with diminished strength: DMD

61
Q

sign of atrophy in the hands

A

flattening of thenar and hypothena eminences and furrowing b/w metacarpals; median and ulnar nerve damage, respectively

62
Q

weakness of extension

A

peripheral nerve disease such as radial nerve damage and in CNS disease producing hemiplegia- stroke/MS

63
Q

weak grip (C7-T1)

A

cervical radiculopathy, de Wuervain’s tenosynovitis, CTS, arthritis, epicondylitis

64
Q

weak finger abduction

A

ulnar nerve disorders

65
Q

weak opposition of the thumb

A

medial nerve

66
Q

flexion of hip tests

A

L2-L4; iliopsoas

67
Q

signs of cerebellar disease

A

ataxia, nystagmus, dysarthria, hypotonia

68
Q

dysdiadochokinesis

A

when one movement cannot be followed quickly by its opposite; movements are irregular, slow, clumsy- cerebellar disease

69
Q

dysmetria

A

finger initially overshoots but eventually reaches it

70
Q

differentiation of ataxia from dorsal column disease vs cerebellar disease

A

cerebellar: difficulty standing with feet together whether eyes are open or closed

71
Q

pronator drift

A

sensitive and specific for corticospinal tract lesion originating in contralateral hemisphere

72
Q

stereognosis, number identification, two-point discrimination impaired in?

A

posterior column disease

73
Q

astereognosis

A

inability to recognize objects placed in hand

74
Q

lesions in sensory cortex

A

astereognosis, inability to recognize numbers (graphesthesia), increase distance between two recognizable points, impairs ability to localize points accurately

75
Q

neck stiffness and resistance to flexion in what perfect of pts with acute bacterial meningitis vs subarachnoid hemorrhage

A

90%- meningitis

76
Q

Brudzinski’s Sign

A

flex the neck; watch the hips and knees- positive when hips and knees flex

77
Q

Kernig’s Sign

A

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
Q

positive straight leg test?

A

pain radiating into ipsilateral leg indicating lumbosacral radiculopathy, sciatic neuropathy, or both

79
Q

sensitivity and specificity of straight leg raise for disc herniation vs crossed straight-leg raise

A

95% and 25%

80
Q

asterixis

A

sudden, brief, nonrhythmic flexion of hands and fingers- liver disease, uremia, hypercapnia

81
Q

winging of scapula

A

weakness of serratus anterior/ long thoracic nerve

82
Q

*Five clinical signs that stronly predict death in coma

A

absent corneal response, absent pupillary response, absent withdrawal response to pain, no motor response; at 72 hours-no motor response

83
Q

DONTS when assessing comatose patient

A

1.) don’t dilate the pupils! (most important clue to underlying cause of coma [structural vs. metabolic])

84
Q

structural hemispheric lesions (eye direction)

A

look at the lesion in the affected hemisphere

85
Q

comatose pt with lack of doll’s eye movements

A

-ability to move both eyes to one side is lost–> lesion of midbrain or pons

86
Q

hemiplegia of sudden cerebral accidents

A

flaccid at first causing limp hand drops to form a right angle with the wrist

87
Q

movement of flaccid leg in acute hemiplegia

A

falls fast into extension with external rotation at hip

88
Q

mechanism of acute ischemic stroke

A

-ischemic brain injury begins with a central core of very low perfusion and often irreversible cell death

89
Q

most irreversible damage occurs when

A

3-6 hrs after onset of symptoms

90
Q

NAME THAT STROKE! contralateral leg weakness

A

ACA

91
Q

NAME THAT STROKE! contralateral face, arm>leg weakness, sensory loss, field cut, aphasia (L lesion), neglect/apraxia (R lesion)

A

anterior circulation of MCA

92
Q

NAME THAT STROKE! contralateral motor or sensory deficit without cortical signs

A

subcortical circulation- leticulostriate deep penetrating branches of MCA

93
Q

four common syndromes of lacunar infarcts

A

1.) pure motor hemiparesis

94
Q

NAME THAT STROKE! contralateral field cut

A

posterior ciruclation- PCA

95
Q

NAME THAT STROKE! cortical blindness but preserved pupillary light reaction

A

b/l PCA infarction

96
Q

NAME THAT STROKE! dysphagia, dysarthria, tongue/palate deviation and/or ataxia with crossed sensory/motor deficits (ipsilateral face/contralateral body)

A

posterior circulation- brainstem, vertebral, basilar artery branches

97
Q

NAME THAT STROKE! oculomotor deficits and/or ataxia with crossed sensory/motor deficits

A

posterior circulation- basilar artery

98
Q

decerebrate rigidity (abnormal extensor response)

A

-jaws clenched, neck extended, arms adducted and stiffly extended at elbows, forearms protonated, wrists/fingers flexed

99
Q

hemiplegia (early)

A

-flaccid (later spastic)

100
Q

decorticate rigidity (abnormal flexor response)

A
  • upper arms flexed tight to the sides with elbows, wrists, fingers flexed
101
Q

bilaterally small pupils

A

1.) damage to sympathetic pathways in hypothalamus

102
Q

pinpoint pupils (<1 mm)

A

1.) hemorrhage in pons

103
Q

midposition fixed pupils

A

midposition of slightly dilated (4-6mm)- damage in midbrain

104
Q

b/l fixed and dilated pupils

A

severe anoxia and its sympathomimetic effects

105
Q

b/l large reactive pupils

A

cocaine, amphetamine, LSD, sympathomimetics

106
Q

one large pupil (fixed and dilated)

A

herniation of the temporal lobe (compression of CN III and midbrain)

107
Q

features of toxic-metabolic coma

A

arousal centers poisoned or critical substrates depleted

108
Q

causes of toxic-metabolic coma

A

uremia, hyperglycemia, alcohol, drugs, liver failure, hypothyroidism, hypoglycemia, anoxia, ischemia, meningitis, encephalitis, hyperthermia, hypothermia

109
Q

features of structural coma

A

lesion destroys or compresses brainstem arousal areas

110
Q

causes of structural coma

A

epidural, subdural, intracerebral hemorrhage, cerebral infarct or embolus, tumor, abscess, brainstem infarct, tumor, hemorrhage, cerebellar infarct, hemorrhage, tumor or abscess

111
Q

steppage gait

A
  • foot drop
112
Q

parkinsonian gait

A
  • basal-ganglia defects
113
Q

cerebellar ataxic gait

A

staggering, unsteady, wide based

114
Q

sensory ataxia

A
  • gait unsteady, wide based

Physical Diagnosis (9 decks)

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