Clin Med 2 Flashcards by TT Nguyen

Signs of neuromuscular jxn vs peripheral nerve problems vs muscle myositis

Diffuse weakness w/o sensory changes, worse/improving w/ exer, double vision vs numb/tingling, sensory changes; if there’s pain or dec reflexes —> radiculopathy/nerve root vs Proximal weakness, atrophy +/- pain, high CK & ESR

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Signs of cerebellum ataxia. How is bil cerebellum is affected?

Ipsi ataxia w/o weakness, eye movement abnlities. By VZV —> immune system attacks both sides of cerebellum

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Signs of Brown-Sequard syndrome

Ipsi motor weakness, contralat sensory, Ipsi DCML

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arm fl>ex, leg ex>fl, sustained clonus, inc reflexes, spastic, memory change = sign of? Muscle fascicuations = sign of? Signs of motor neuron dz?

UMN sxs. LMN sxs. Mix of U/LMN sxs, involves 3+ limbs including head/face/tongue, progressive weakness, spastic, fasc, atrophy, cramps

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If there are crossing of sxs, which structure should you think is affected? If you have urin retention or incont, which structure should you think is affected?

Brainstem. Spinal cord

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aphasia vs naming (2nd order)

can’t produce or comprehend spoken/written lang vs ability to produce proper names of objects’ parts (2nd order)

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clin features of parietal/sup MCA syndrome

all contralat hemiparesis/plegia, lower facial weakness, hemisensory loss, homonymous hemianopsia, Broca’s

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anomic aphasia, Wern aphasia, amnesia, Kluver Bucy, contralat sup quadrantinopsia, visual/olf halluc

clin features of temporal/inf MCA syndrome

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clin features of Gerstmann (special MCA)

acalculia, agraphia (can’t write despite know lang), finger agnosia, L/R confusion

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clin features of acute internal carotid occlusion

contralat hemiplegia, lower facial weakness, homonymous hemianopsia, sensory deficit; mute, aphasia, dysarthria; eye dev towards lesion, ipsi Horner’s; cerebral edema

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clin features of frontal lobe/ACA syndrome

contralat hemiparesis leg>arm; akinetic mute (no movements or speech, medial); dysarthria, transcortical motor aphasia; eye toward lesion; urin incont (medial), disinhibition

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alexia w/o agraphia (can’t read but write), visual agnosia/Anton’s syndrome, optic apraxia/absent optokinetic nystagmus; contralat homonymous hemianopsia

clin features of occ lobe/PCA syndrome

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how does CNS demyelinate?

T cells enter BBB –> macs come & eat myelin and axons –> demyelinated nerve fibers send signals slowly & irreg –> sclerotic/scarred plaques

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risk factors of MS

females, Af-Am, teens to 40s, neuro impairment

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what does CSF look like in MS?

inc markers in CSF v serum –> primary CNS inflamm; >2 oligoclonal bands, inc igG

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optic neuritis sxs. how to eval? tx?

inflamm optic n, loss vision/color, pain w/ eye movement. ophthal eval: optic disc pallor; pupillary eval: afferent pupillary defect/Marcus Gunn pupil; VEP shows slowed conduction thru pupil; optical coherence tomography shows thick (acute) or thin (optic neuritis) retinal fibers. IV methylprednisolone

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exec fxn vs attn vs agnosia vs apraxia

ability to organize, sequence, abstract info vs sel conc vs inability to recognize sensory input; occiptotemporal vs inability to carry out familiar actions; dom inf par lobe

how does hippo vs amygdala contribute to mem?

spatial learning vs emotional mem

cortical vs subcortical vs neurodegen amnesia w/ examples of each

changes in mem, lang, perception, fxn; temp, par, front. Alz, Lewy, vasc, frontotemporal dementia vs behavior, emotional, motor fxn, exec fxn; striatum, thal, midbrain. Parkinson, progressive supranuclear palsy, nml pressure hydrocephalus, CJakob dz, Huntington vs primary degen CNS dz. Alz, Lewy, frontotemporal dementia

dementia w/u

H&P
Serum, UA, CBC w/ diff
folate, B12
Neuroimging: <65yo, <2y hx, focal neuro sxs, nml pressure hydrcephalus, trauma, neuropsych test

examples of neuropsych testing

Mini Mental state Exam for mem & lang fxn
clock drawing test for visuospatial processing
“comb your hair”, “blow out match” for apraxia

sxs of Alzheimers. chrm? gait?

dec mem & lang, disorientation, impaired reason/judge, decline in performing routine tasks. early = 1, 14, 21; late = APOE in 17. dementia-related gait changes –> dec in walking speed & stride, inc support phase; dual task-related gait changes –> in Alz & non-Alz dementia

how to dx Alz? tx?

comprehensive hx, PE, labs, neuroimging of parietotemporal cortices; post mortem bx = definitive. cog enhancers (cholinesterase inhibitors, gluE antagonists), behavior (antipsychotics, antidepress, mood stabilizers, pain meds)

carotid a dissection sxs. dx? tx?

HA, neck pain, ocular pain, partial Horner’s. duplex, CTA, MRA. anticoag w/ IV heparin, lovenox, ASA, plavix, tPA

lacunar infarcts = caused by?

occlusion of deep penetrating aa

brain venous infarct leads to?

venous congestion --> hemorrhagic changes

arteriovenous malformation. tx?

abnl vessels b/w aa & vv w/o capillaries --> steals oxygenated blood --> hypoxic adjacent tissue --> axs, hemorrhage, sz. glue embolotherapy

high altitude cerebral edema. tx?

going too high too fast --> vasogenic edema --> hypoxic cerebral vasodil --> capillary HTN, brain petechial bleed, CC edema --> atax, confusion, incont. acetazolamide, dexamethasone

delirium confusion assessment method

presence of 1+2, or 3+4: 1. acute change in mental status 2. inattn 3. altered thinking 4. disorg thinking

dementia

personality change, mem loss, impaired intellect from dz or trauma (NOT from age)

Parkinson's sxs vs dx vs tx

triad; bradykin, exec fxn, depression vs sensitive to psychotic & delirium meds --> must rule out before dx w/ dementia; Lewy in brainstem; DaT scan = sPECT scan w/ iodine labeling dopamine containing cells (not sensitive for early stage) vs dopamine/agonists, acetylcholine blockers (too much dopamine --> dyskinesia)

Lewy body dementia. sxs?

Lewy bodies in brainstem, limbic system, cortex; can overlap w/ Alz or Park's --> do PET to differentiate. visual halluc, abnl gait

nml pressure hydrocephalus sxs vs dx vs tx. vasc dementia dx vs tx

wet, wobbly, wacky vs CT --> spinal tap vs shunt. MRI vs tx their HTN

Creutzfeldt-Jakob dz

dementia, myoclonus, abnl EEG (periodic spikes) caused by prions. assoc w/ spongiform encephalopathy

Wern vs Korsakoff. how to tx for both?

ocular, cerebellar, confusion, malnut vs anterograde, confab, malnut. IV thiamine, other B vit before B12

AIDs. transient global amnesia. TBI. psychogenic amnesia

apathy, behavioral, cog decline, IVDU. antero/retrograde >50yo, temporal & spatial disorient, vasc insufficeny in midbrain. retrograde post fall/trauma. recent & remote mem loss, indifferent to deficits

subdural hematoma. ca-related cog decline

fall, HA, lateralized sxs (hemianopsia, hemiplegia, CN abnlities). chemo + brain fog + weakness

Huntington's cause vs sxs vs tx

CAG rpt + loss cholinergic neurons in striatum --> GABA dec GPe to inc subthal to dec GPi --> inc thal --> inc movement vs dementia + chorea vs dopamine blockers for movement, bal dopamine & acetylcholine

signs of unfavorable prog?

>6cm, astrocytoma histo, cross midbrain, neuro deficits before resect

hedgehog pathway

hedgehog make ligand to bind to PTCH --> initiates degradation --> SMO released --> activates Gli --> mostly for basal cell ca or medulloblastoma