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Clinical Flashcards

1
Q

Frontal lobe

A

Inhibition
Higher level func
Problem solving

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2
Q

Parietal lobe

A

Sensory

Attention

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3
Q

Temporal lobe

A 
Memory
Emotion
Olfaction
Hearing
Spatial awareness
Hippocampus
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4
Q

occipital lobe

A

Vision

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5
Q

Cerebellum

A

Motor corrd and regulation

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6
Q

Brainstem

A

Midbrain- eyes, ears, primit motor
Pons- eat, hear, balance
Medulla- vagus, resp

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7
Q

PNS vs CNS

A

PNS can regenerate
Benign tumours
Schwann myelin

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8
Q

CSF cycle

A

Choroid plexus produc in ventricles. 500ml per day

Arachnoid granulation in sub arach space abs CSF into venous blood. After ventricle IV.

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9
Q

Dorsal and ventral horns

Grey matter cols

A

Dorsal- has DRG, sensory afferents

Ventral- motor efferents

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10
Q

grey matter

A

Cerebral cortex
Nuceli
Horns

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11
Q

White matter

A

Association fibres
Commisural fibres x CC
Projection fibres down SC

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12
Q

Funiculi

A

Dorsal- DCML (split into gracile and cuneate)
Lateral- lat CST
Ventral- ventral CST

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13
Q

defins

A

Ataxia- loss vol musc coord
Apraxia- loss purposeful movem
Dysdiadochokinesia- diffic in repetit movem
Paresis- musc weakness
Chorea- invol spasms and rigidity of limbs and face (eg HD degen corpus striatum)

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14
Q

Spina bifida

A

Fail of usually LS neural fold fusion. Incompl NT closure. Vertebral arch not grow normally. Meningeal herniation.
Occulata- fail L5/S1 arch fus. 25% popn. Hidden. Hair tuft.
Cystica- myelomeningocoele- neural tiss and meninges herniate= neural issues and infec risk.
Meningocoele- only meninges herniate.
Lipomeningocoele

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15
Q

Hydrocephalus

A

Head expans due to accum of CSF in brain ventricles.
Mx- shunt to jugular V or peritoneum.
Communicating- external block eg scarring arachnoid grans
Non comm- internal ventric blockage.

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16
Q

LP

A

L3/4 level of hip crests
Passed end of SC at L1/2
Lower down in a baby

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17
Q

Substantia gelatinosa

A

Tip dorsal horn

Nociception

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18
Q

SNS

A

Efferents from T1 to L2

Synapse with sympathetic chain

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19
Q

Glia

Supp, nourish, insulate, remove waste

A

Astrocyte- supp, nutrit, BBB, env maint, nt remov, K buffer
Oligodendrocyte- insulate
Microglia- immune resp by phagoc and APC

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20
Q

BBB

A

Tight junc
Bm
Astrocyte feet
T cells can cross

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21
Q

inhib nt’s

A

GABA

Glycine

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22
Q

L dopa

A

Can x BBB

AADC enz forms dopamine, carbidopa inhibs this peripherally to prev vessel effects. But it cant x BBB.

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23
Q

transverse foramen

A

Conts vertebral V and A. Artery not C7.

Arth comp may cause vertigo as disrupt vertibrobasillar circ.

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24
Q

Fontanelles

A

Allow squeeze and tiss fluid exc during birth

If breech deliv too fast then brain damage.

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25
Q

disc prolpase

A

Comm L4/5 or L5/S1
Post prolpapse can cause paraplegia
Lat prolapse inv N roots

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26
Q

carotid sheath

A

Extension of neck musc fascia

Conts- carotid As, IJV, vagus

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27
Q

SC BS

A

Anterior spinal A

2x post spinal A

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28
Q

Cerebral A embolus

A

Isch
Lack O, lack gluc, build up K
Infarcted brain

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29
Q

haemorrhage types

A

Extradural- arterial blood
Subdural- venous blood
Subarachnoid- arterial blood

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30
Q

Phasic Rs

A

Eg tough Rs

Adapt fast

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31
Q

Sensory agnosia

A

One side of body no sensation or pain

Parietal lobe, thalamus, or int capsule lesion.

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32
Q

Glove and stocking periph neurop

A

Demyelination
Axon degen
Due to eg vasc dis, AI, infec, degen etc.

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33
Q

dorsal root and col lesions

A

Tabes dorsalis syphillis
Vit B12 defic dorsal col degen
Get loss of light touch and conc proprio, sensory ataxia and pos rhomberg. Stick and stamp gait.

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34
Q

syringomyelia

A

ST tracts affected.
Central canal cavity/syrinx.
Loss of pain and temp. Bilat.

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35
Q

reflex

A

R, afferent neurone, synpase, efferent, effector

Deep tendon reflexes are examined.

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36
Q

pain fibres

A

C slow dull small unmyelinated- mech, thermo, chem
A delta fast sharp large myelinated- mech and thermal only
Ligand gated TRPV1 Ca channel
lat ST tract
Mechano and desc inhibition (PAG, LC) via SG

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37
Q

periph sensitisation

A

Tiss damage and inflamm resp causes more prim afferent activ.
Can lead to central sensitisation (excess gluatamate), wind up, and RF expansion or allodynia.
Hyperalgesia- incr pain at normal thresh.
Allodynia- pain from non painf stim, and in areas with no stim.

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38
Q

Neuropathic pain

A 
Neuronal origin
No specif dis or site of damage
Burn, elec, parasthesia, shooting
Allodynia and hyperalgesia
VGNa upreg and new afferent format (aberrant plasticity= phantom limb)
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39
Q

CRPS

A

Trigger eg trauma, frac, surg, stroke, MI
Contin pain, allodyn, hyperalg after.
Symps- sensory, vasomotor, oedema, motor, trophic.
Stages- acute, dystrophic, atrophic.

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40
Q

Motor unit

A

An alpha MN and the muscle fibres it innervates

41
Q

proprioceptors

A

Muscle spindle- musc str
Tendon organ- contractile tension
Jnt Rs- jnt movem
Skin- skin str

42
Q

LMN

A

Cell body in SC or CN nuclei, innervates skel musc.
Periph patt.
Signs- weakness, wasting, hypotonia, decr reflexes, fascuculation, musc contractures.
Causes- trauma, periph neurop, MND

43
Q

UMN

Pyramidal and extra pyramidal paths

A

Cell body in cerebral cortex of brainstem nuc. Stay in CNS.
Signs often widespread eg mono/hemiparesis
Signs- clasp knife, hypertonia, hyperreflexia, clonus, pos babinski, weakness, pronator drift, loss abdo reflexes.
Causes- stroke, SC inj.

44
Q

PD
Degen dopaminergic neurones SN
Disrup nigrostriatal causes more inhib ad reduced activation
Dop direct path- SN ot D1R stims movem
Dop indirect path- SN to D2R prevents inhib so stims movem.

A 
Hypertonia eg lead pipe, cog wheel
Hypokinesia/bradykinesia
Pill rolling resting tremor
Coord is good
Immobile face
Flexed posture
Festinating gait, reduced arm swing, unsteady on changing direc, difficulty stopping.                                                                                                                                                                                                                                                                                                                                                                             
Sign often unilat initially on contralat side to basalg ganglia inv
45
Q

PD mx

A

Levo dopa. Causes dyskinesia LT.
Dop agonists
MAO inhibs
Deep brain stim

46
Q

cerebellar ataxia

A

Nystagmus
Poor coord
Dysarthria
Tremor
Hypotonia
Broad base staggering gait. Unbalanced heel to toe walk. Incr arm swing.
Cerebellar damage causes fall TOWARDS the lesion.

47
Q

DANISH

A 
Dysdiadochokinesia/dysmetria
Ataxic gait
Nystagmus
Intention tremor
Slurred speech
Hypotonia
48
Q

Cerebellar eye signs

A

Slow jerky persuits with catch up saccades.
Dysmetria of saccades- overshoot when fixing
Nystagmus- maximal on gaze TOWARDS lesion.

49
Q

PASTRIES

Causes of cerebellar dysfunc

A 
Post fossa tum
Alc
MS
Trauma
Rare
Inherited eg friedreichs ataxia
Epil meds eg carbamazepine, phenytoin tox
Stroke
50
Q

Cerebellum lobes

A

Ant paleo- maint gait
Post neo- posture and motor skill modulation
Floculonodular archi- maint balance

Vestibulo- balance
Spino- error correc
Cerebro- motor planning and learning

51
Q

Basal ganglia

Movem control and planning

A 
Caudate nuc
Putamen
Globus pallidus
Substantia nigra
Subthalamic nuc
52
Q

Huntingtons chorea

A

Striatum degen of inhib

Invol spasm and rigidity

53
Q

diplopia

A

Cornea and lens prob- eg cataract
Eye musc- MG
N prob or their BS- MS, DM
Brain- CVA, SOL

54
Q

Conductive hear loss

A

Blockage
Rupt tympanic
OM fluid
Otosclerosis

55
Q

sesnory hear loss

A

Hair cell destruc eg moise, physical

Hair cell death eg tox

56
Q

neural hear loss

A

Spiral ganglion dam eg acoustic neuroma
Age
Tinnitus
Auditory neuropathy

57
Q

Memory

A

Declarative- cortex

Non declarative eg motor, emot- cerebellum and BG

58
Q

Brocas aphasia

A

Makes sense but not fluent.

Thoughts to words.

59
Q

wernickes aphasia

A

Fluent but nonsense

Lang comprehension.

60
Q

Speech path

A

Ear to W to B to motor

61
Q

AD ix

A

Bloods- FBC, UE, LFT, CRP, gluc, Ca, TFT, B12, folate
Urine
MSE and MMSE (under 9 sev, 10-18 mod, 19-23 mild)
MRI head- gen atrophy, esp hippocampus
SPECT

62
Q

AD pathol

A 
Senile amyloid plaques
nf hyperP tau tangles
Reduc nt’s
Loss synpases
Neurone death, cortical atrophy
63
Q

AD px prog

A

Mem, judgem, interest
Loss func, confus, agit, disinhib, hallucin and delusion
Weak, cant eat, incontin, loss speech

64
Q

AD mx

A

AChE inhibs eg galantamine, rivastigmine, donepezil. For mild to mod.
S/e eg headache, GI, seix, urin reten, bradyc, SJS
NMDA antag eg memantine. Severe.
S/e eg drowsy, constip, headache, SOB, hallucin, confus, gait.

65
Q

epilepsy

A 
Excess neurone activ in brain
Partial seiz- one hemis
Generalised- crosses CC
Simple- retain awareness
Complex- loss awareness, physic strange behav
Tonic clonic with post ictal
Atonic
Myoclonic musc jerking
Ansence
66
Q

Emerg epil mx

A

ABCDE
Over 5 mins give midazolam pre hosp
In hosp IV loraz and phenytoin

67
Q

Dementia defin

A

Acq global impair of intellect, reason and personality without impairm of conciosness.
Eg AD, vasc, lewy body, picks.

68
Q

ICP

A

Normal 5-15mmHg
RICP is over 20 for over 5 mins
Compensation- reduc BV, reduc CSF, brain atrophy.
Vasc mechs maint BF at ICP under 60.

69
Q

SOL

A

Brain deformation
Midline displ
Internal herniation

70
Q

stroke defin

A

Sudd events producing a disturb of CNS func due to vasc dis.
Abrupt loss focal brain func lasting over 24hrs or causing death.
Due to either spont haemorr into brain or inadeq BS (embol, thromb).
Includes SAH.

71
Q

Stroke categs

A

-Infarct 85%-
Embol most comm (AF, carotid atheroma, ath plaque thrombus, aneur)
Thrombosis over atheromatous plaque.
-Haemorrhage 15%-
IC 10- HTN dam, charcot bouchard, amyloid depos, inher, RICP.
subarach 5- berry aneur, br pts of circle willis. Thunderclap, sentinel headache, LOC, rap die.

72
Q

Neuro hx

A

HPC- headache, motor, sensory, bal, gait, mem, vsion, seix, wl, impair cog.
PMH- epil, stroke, surg, trauma. Chronic dis. HTN etc.
Soc hx incl recreat drugs, occup, alc, smok, env.
MSE
MMSE

73
Q

Sleep disorders

A

Insom- anx cortex overactive, excess stim to reticular format.
Narcolepsy- loss orexinergic neurones to RF, loss vis sys input.
Sleep apnoea- airway comp. chemoR to thalamus cuases sudd wake.

74
Q

conc disorders

A

Brain death- wide cortic and bstem dam.
Coma- same but disord EEG, unarousable, unresp, no sleep wake cyc.
PVS- wide cortic dam, var EEG, some spont eye open, bstem reflexes, sleep wake cycle.
Locked in synd- basilar or pontine A lesion. Can move eyes somet.

75
Q

alt conc

A

Cortical func eg metab disturb.
Press RICP
Lesion eg infarct.

76
Q

Delerium

A

Acute confus state, fluc arousal, disorient, hallucin.

RFs- eld, dementia, infec, hip frac.

77
Q

RICP causes

A

Oedema- hypox, trauma, enceph, tum, hypoNa, water intox, infarct
SOL- tum, haemorr, trauma, abcess.
Hydroceph- obstruc or not.
Blood flow- venous outflow obstruc, vasodilat eg acidosis, venous sinus thrombosis.

78
Q

herniation

A

Subfalcine- CG
Tentorial- uncus
Tonsillar- cerebellar tonsils through FM. CONING.

79
Q

Gen neural exam

A 
Abn movem
Posture
Meningism
Tone, reflex
Lateralising signs
Pupil reflex and fundosc
AVPU, GCS
Bstem tests
80
Q

Decerebrate

A

Arm ext, flex wrist
Upper BS dam
Worse

81
Q

decorticate

A

Flex elbow

CST damage

82
Q

GCS

A

Eye- none, pain, verbal, spont
Verbal- none, incomp, inapp, confused, orient
Move- none, ext to pain, flex, withdraw, loc, obeys

83
Q

neuro ix

A

Bloods incl pH, lactate, cult, endoc
Imaging- CT, MRI
CSF
EEG

84
Q

TIA defin

A

Focal distrub brain func
Presumed vasc origin
Resolves compl in 24hr

85
Q

stroke hx

A

Onset, prog
Neuro- locat, modalities, pos vs neg
Other- headache, seiz, vom, drowsy, cardiac
Atyp- delerium, confus, collapse, incontin.

86
Q

Stroke ix

A 
GLUC
ECG
Bloods
CXR
CT
MRI
Carotid US
Echo
87
Q

stroke mx

A 
Thrombolysis in 3hr/ectomy
Endovasc interven
Anticoag if not Tlysis
Rehab
Tx HTN, chol, DM
Carotid surg
88
Q

spinal cord BS

A

Ant spinal A- most comm occluded (aorta dis, surg, vasculitis, sickle, hypot, TIA, disc hern)
2x post spinal As
21 pairs segm As
A of adamkeiwicz

89
Q

Spinal isch px

A

Acute pain
Spinal shock LMN init, then UMN
Loss pain and temp

90
Q

RICP symps

A

Headache- worse on lying or bend forw. Worse in morn.
NV
Loss vis
Alt mental state

91
Q

RICP signs

A

Papilloedema- blurr disc margins
CN III palsy- ptosis, dilat, down and out
CN VI palsy- cant abduct
Loss vastibulo occular reflex- normal tow cold.
Confus, impair cognit, reduc GCS
UMN signs
Decort or decerebrate posturing
Biots resp
Cushings reflex- cushings triad- irreg resp, bradyc, HTN.

92
Q

Hydroceph

A

Excess produc- choroid plex papilloma
Block flow- spina bif, sten, clot, SOL
Disrup abs- oblit arachnoiditis post bleed/trauma

93
Q

Normal press HC triad

A

Dementia
UI
Gait abn

94
Q

HC mx

A

VP or VA shunt

Decomp craniectomy

95
Q

extradural haemorr

A

Arterial
Btw skull and dura
High impact
Init regain conc then decline

96
Q

Subdural haemorr

A 
Venous
Btw dura and arachnoid
Acute/sub acute/chronic
Can spread beyond sutures but lim by dural reflecs. 
Crescent CT, acute brighter
97
Q

SAH

A

Arterial
Btw pia and arachnoid
Trauma or psont (aneur/AVM)
Thunderclap, neck stiff, vom, photophob.

98
Q

Base skull frac

A

Periorb ecchymosis
Mastoid ecchymosis
CSF rhinorr
CSF otorr

NS (1 decks)

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