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Neurology_Clinical Medicine > CABS Topics > Flashcards

CABS Topics Flashcards

1
Q

What neuroglia cell is an important part of the blood brain barrier?

A

Astrocytes

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2
Q

Can your CNS or PNS regenerate?

A

PNS

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3
Q

What virus is associated with causing or triggering MS?

A

Epstien Barre Virus (EBV)

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4
Q

What cell mediated process drives MS?

A

B-cell mediated

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5
Q

How will MS typically start?

A

Clinically isolated syndrome that occurs for at least 24 hours

m/c symptom is optic neuritis

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6
Q

Can you repair myelin?

A

Yeah, you can

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7
Q

Can you repair axons?

A

No

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8
Q

What does the limbic system mediate?

A

Emotional response with memory and learning

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9
Q

What systems are being inhibited with Tourettes disorder?

A

Factors of the limbic and motor system

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10
Q

What is intracranial pressure?

A

BP in the brain (pressure excreted by fluids in the brain, CSF etc.)

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11
Q

What is the triad presentation for normal pressure hydrocephalus?

A

Dementia, gait alteration, and incontinence
(wacky, wobbly, and wet)

Gait alteration presents first m/c

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12
Q

In M. Gravis, what muscles are going to be attacked?

A

ocular, respiratory, head/neck, and limb muscles

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13
Q

What type of hypersensitivity is M. Gravis?

A

Type II

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14
Q

Why do you require surgery when your eye is injured?

A

Nerve, or structures get caught in sinus cavity

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15
Q

What are the cavities in the skull?

A

Cranial cavity, ethmoid sinus, nasal cavity, maxillary sinus, oral (buccal) cavity

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16
Q

Why are your occipital condyles important?

A

Articulates with C1, allows us to say “yes”

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17
Q

What is the thinnest part of the skull?

A

Pterion

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18
Q

What lies across the pterion?

A

Middle minningeal artery

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19
Q

What score requires intubation on GCS?

A

Score of 8 or less, they don’t have their gag reflex (there are exceptions)

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20
Q

What do you see (sign) on imaging in brain herniation?

A

Light bulb sign - lack of activity and metabolism

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21
Q

What is Cushing’s Triad?

A

Elevated ICP

Hypertension, Bradycardia, Irregular breathing

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22
Q

What is the most common type of brain herniation?

A

Uncal transtentorial herniation

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23
Q

What structure is being compressed in an Uncal Transtentorial Herniation and what are the physiologic signs?

A

Compression of CN III (oculomotor) causing ipsilateral fixed, dilated pupil

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24
Q

What type of posturing will be seen in a central transentorial herniation?

A

Decorticate posturing or decerebrate posturing (medical emergency)

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25
Q

What is happening in a cerebellotonsillar herniation?

A

Cerebellar tonsils are pushed through the foramen magnum (pushing on your life stick)

Sx - pinpoint pupils, flaccid paralysis, death!

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26
Q

What are the H-BOMBS?

A

Hypotension
Hypoxia
Hypo/Hypercarbia
Hyper/Hypothermia
Hypoglycemia

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27
Q

What is the respiration mediator in the brain?

A

CO2

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28
Q

Where is the bleed in an epidural hemorrhage?

A

Bleeding between the skull and dura mater, m/c in the temporal fossa (middle meningeal artery)

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29
Q

What is being torn in a subdural hemorrhage?

A

Tearing of the veins between the dura and arachnoid leading to collection of blood

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30
Q

What are common patient cohorts at risk for subdural hemorrage?

A

Elderly, ETOH abuse

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31
Q

What type of bleed has an interval where someone looses consciousness then has a a period of consciousness, and what is it called?

A

Epidural bleed, Lucid interval

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32
Q

What is an intraparenchymal hematoma?

A

Bleeding within the tissue of the brain (not a dural space), may have a single bleed or multiple

Maybe from penetrating or shearing trauma which break local vessels - m/c in the temporal or frontal lobes

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33
Q

Can diffuse axonal injuries heal?

A

No, because of the tearing of axons and vessels

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34
Q

If a patient has a neurologic change in status after initial imaging what would be your next management step?

A

Repeat imaging (always)

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35
Q

Will an initial (first injury) concussion cause structural damage?

A

No, structural damage only occurs with repeat concussions

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36
Q

How is an autonomic lesion going to present?

A

Can’t control what your supposed to - heart, bladder, breathing

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37
Q

What nerve is like the godfather of the autonomic nervous system?

A

Vagus Nerve

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38
Q

What is neurogenic shock?

A

Hemodynamic compromise resulting from autonomic dysfunction

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39
Q

When does spinal shock typically resolve?

A

24-73 hours, makes initial assessment of cord injury difficult (will I walk again?)

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40
Q

What level of the spine is neurogenic shock most commonly seen?

A

Thoracic spine

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41
Q

What structures are part of the limbic system?

A

Hypthalamus, Amygdala, Hippocampus, Thalmus

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42
Q

What is the role of the Hippocampus within the limbic system?

A

Memory conversion, episodic memory

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43
Q

What is the role of the Thalamus within the limbic system?

A

Relays information

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44
Q

What is the role of the Hypothalamus within the limbic system?

A

Homeostasis (parasympathetic/sympathetic nervous system balance) via mammillary bodies

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45
Q

What is the Amydala’s role within the limbic system?

A

Emotion

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46
Q

What is the basal ganglia?

A

Part of the limbic system, group of nuclei that help with motor, emotional, learning reward

Includes the caudate and the putamen (together = stratium)

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47
Q

What type of sensory are free nerve endings responsible for?

A

Temperature
Touch
Noxious

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48
Q

What type of sensory are meissner corpusles responsible for?

A

Shape and texture

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49
Q

What type of sensory are Ruffini endings responsible for?

A

Pressure and Heat

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50
Q

What are the two major pathways that lead to altered mental status?

A

Diffuse dysfunction (metabolic, cardiovascular, uremia, toxins)

Focal lesions

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51
Q

What are the red flags in altered mental status presentation?

A

Sudden Onset
Elderly
Headache
Drug Use
Trauma
Fever

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52
Q

Is altered mental status a diagnosis?

A

No, it is a symptom

53
Q

Why does carbon monoxide cause delirium?

A

Decreased oxygen to the brain

54
Q

What can’t be regulated in delirium?

A

Inability to regulate the arousal system (RAS) and alteration of the reticular activating system with the midbrain, thalamus, and hypothalamus

55
Q

What does increased excitability with change in neurotransmitters cause in hyperactive delirium?

A

Inflammation
Decreased BBB function
Change in CBF
CNS metabolic derangements

56
Q

What can cause agitated delirium?

A

Cocaine (increases dopamine)
Thyroid storm
Methamphetamines

57
Q

Is agitated delirium life threatening?

A

Yes, can lead to death

58
Q

What can cause hypoactive delirium?

A

CNS depressants
Metabolic disorders (liver or kidney disease)

59
Q

What are the Wernicke’s encephalopathy acute phase clinical features?

A

Confusion
Opthalmoplegia
Ataxia
Thiamine (low)

60
Q

What are the Korsakoff’s psychosis chronic phase characteristic findings?

A

Retrograde amnesia
Anterograde amnesia
Confabulation
Korsakoff’s psychosis

61
Q

Where are plaques and tangles found most commonly in Alzheimer’s Disease?

A

Cerebral Cortex and Hippocampus

62
Q

Who commonly gets diagnosed with frontotemporal dementia?

A

Younger adults, <60 years

63
Q

What do prions cause within humans?

A

Neuronal loss
Increased proliferation of glial cells
No inflammatory response
Spongiform appearance of the tissue

64
Q

What are prions?

A

(Infectious) misfolded protein particles that replace normal prion proteins - thought to have a role in memory and sleep

65
Q

Why can Schwann cells repair?

A

Have Dynein protein (growth factor) that will encourage increased protein synthesis to the nucleus

66
Q

What can block Dynein from repairing a Schwann cell?

A

Either scar tissue or damaged soma

67
Q

What are two common electrolytes that can cause seizures?

A

Sodium and glucose

68
Q

What can lower someones seizure threshold?

A

Physical and environmental stressors

69
Q

What is epileptogenic focus?

A

Collection of neurons that are more sensitive, more readily stimulated to begin rapid, unnecessary firing (where seizure starts)

70
Q

In relation to seizures, what is the major excitatory neurotransmitter and inhibitory neurotransmitter?

A

Glutamate = excitatory
GABA = inhibitory

71
Q

If a seizure occurs for a long period of time what is can develop?

A

Mirror focus - this is when the epileptogenic focus can mirror image onto the other side of the brain (same location on opposite side)

72
Q

What time of day do idiopathic seizures most likely occur?

A

In the morning

73
Q

What is the most common age of onset for juvenile myoclonic epilepsy?

A

College age

74
Q

Where do neoplasms classically present in children?

A

Infratentorial

75
Q

Where do neoplasms classically present in adults?

A

Supratentorial

76
Q

What is the most common presenting symptom of a CNS neoplasm and when does it most likely occur?

A

HA, in the morning

77
Q

What are common signs and symptoms when the lesion is in the brainstem?

A

CN findings, elevated ICP (N/V, blurry vision, papilledema, CN VI palsy)

78
Q

What are common signs and symptoms when the lesion is in the cerebellum?

A

Ataxia, falls, balance issues, elevated ICP

79
Q

What are common signs and symptoms when the lesion is in the frontal lobe?

A

Weakness, personality change, cognitive symptoms, psychiatric sxs

80
Q

What are common signs and symptoms when the lesion is in the occipital lobe?

A

Homonymous hemianopia

81
Q

What are common signs and symptoms when the lesion is in the parietal lobe?

A

Numbness, paresthesia

82
Q

What are common signs and symptoms when the lesion is in the temporal lobe?

A

Amnesia

83
Q

What are common signs and symptoms when the lesion is in the dominant hemisphere?

A

Aphasia

84
Q

What is the primary neurotransmitter int he sympathetic nervous system?

A

Norepinephrine (adrenergic)

85
Q

What do splanchnic nerves assist with?

A

Help with vasoconstriction allowing BP to increase, assist vasculature

86
Q

What is the primary neurotransmitter in the parasympathetic nervous system?

A

Acetylcholine (cholinergic)

87
Q

What nervous system is going to be impacted in neurogenic shock?

A

Sympathetic because they are located primarily in the thoracic and lumbar spine

88
Q

What are the catecholamines?

A

Epinephrine, norepi, dopamine

89
Q

What is the number one job of the autonomic nervous system?

A

Vascular tone

90
Q

What needs to occur for it to be defined as syncope?

A

loss of postural tone

91
Q

What are the major types of syncope?

A

Reflex syncope (the neurologic source)
Orthostatic syncope
Cardiac arrhythmia
Structural cardiopulmonary disease

92
Q

What is the #1 test you must order for a patient who suffered a syncopal episode or experienced pre-syncope?

A

EKG

93
Q

What is subclavian steal syndrome?

A

The subclavian artery is stenosed proximal to the vertebral artery and causes reverse flow during times of exertion

94
Q

What test should be completed when diagnosing and typing vertigo?

A

HINTS Exam

Head Impulse
Nystagmus
Test of Skew

95
Q

What two divisions join to make the sciatic nerve?

A

Posterior and Anterior Divisions

96
Q

What will result when the common fibular (peroneal) nerve is severed?

A

Foot drop

97
Q

What will result when the tibial nerve is severed or compressed?

A

Leads to tarsal tunnel and will result in pain and neuropathy in the foot

98
Q

What nerve can be compromised during a traumatic childbirth?

A

Pudendal nerve

99
Q

Is there evidence of peripheral nerve injury on EMG in Type 1 Complex Regional Pain Syndrome?

A

No

100
Q

What is the pain in Complex Regional Pain Syndrome caused by?

A

Neurologic inflammation causes release of neuropeptides causing pain

101
Q

What sensation is impaired with small nerve fiber damage?

A

Decreased perception of pain, decreased temperature perception, burning, numbness, tingling

102
Q

What sensation is impaired with large nerve damage?

A

Decreased light touch, loss of vibration or position sense

103
Q

How does Vitamin B12 deficiency typically present with first?

A

Anemia, then neurologic symptoms (neuropathy)

104
Q

What is Vitamin B12’s role related to the myelin sheath?

A

Maintain the sheath

105
Q

When does Guillain-Barre Syndrome present?

A

After a respiratory or GI illness (4 weeks)

106
Q

What is Guillain-Barre Syndrome?

A

Post infectious autoimmune peripheral demyelinating disease

107
Q

What is the classic presentation symptom seen in Guillain-Barre Syndrome?

A

Symmetrical muscle weakness usually beginning in the legs and ascends

108
Q

What is Brodmann’s area 17 primary responsible?

A

Primary visual cortex

109
Q

What lobe is the Primary Visual Cortex (Brodmann’s area 17) located?

A

Occipital Lobe

110
Q

What is within grey matter?

A

Neurons

111
Q

What is within the white matter?

A

Axons

112
Q

What causes cortical dysplasia?

A

Either a mutation during in-utero development (congenital) or injury/infection during birth

113
Q

How many layers of cortical lamination are typical?

A

6

114
Q

How will cortical dysplasia appear on imaging?

A

Less dense areas within the white matter

115
Q

What layer of the cortical lamination is responsible for receiving information from the thalamus?

A

Layer 4 (Stellate cells)

116
Q

What layer of the cortical lamination layers are responsible for output of information?

A

Layer 5 (Dendrites) and 6 (Descending axon)

117
Q

What is the organization of the somatosensory cortex?

A

Cortical Columnar Organization

118
Q

How many units can your working memory hold at one time?

A

about 7, why phone numbers are 7 numbers long (executive function)

119
Q

How does the orbitofrontal cortex associate an experience of fear?

A

It associates the subjective experience of fear with the “context” of the other information present even if it wasn’t directly associated with the fear provoking sound, object etc.

Workplace example

120
Q

In regards to lateralization (hemispheric specialization) which side does language primarily lateralize too?

A

The left hemisphere

121
Q

What is Broca’s aphasia?

A

impairment in speech production with spared comprehension

speaking, writing, and singling impaired

122
Q

What is Wernicke’s aphasia?

A

Impairment in speech comprehension with spared production (word salad- sentences have no meaning)

123
Q

What causes Conduction (associative) aphasia?

A

Caused by severing the arcuate fasciculus (the connection between Broca’s and Wernicke’s area)

124
Q

What structures are damaged and therefore leading to the confusion and disorientation seen in Wernicke-Korsakoff’s syndrome?

A

Diancephalon damage (hypothalamus and thalamus)

125
Q

What structure is responsible for developing our learned fear emotion?

A

Amygdala

126
Q

What is Kluver-Bucy syndrome?

A

Happens when there is bilateral damage to the temporal lobe or removal of the amygdala - loss of fear, increased/inappropriate sexual arousal

Researched in Monkey’s (removal of amygdala)

127
Q

What is Urbach-Wiethe disease?

A

Calcification of the medial temporal lobe - patient will demonstrate the associated symptoms of Klover-Bucy syndrome and have a loss of fear of social cues (emotional memory), doesn’t recognize emotions on faces

128
Q

What structure does Alzheimer’s disease effect?

A

Hippocampus

Neurology_Clinical Medicine (13 decks)

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