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Neuro Final Review > Clinical - Block 1 > Flashcards

Clinical - Block 1 Flashcards

1
Q

Consciousness

A

Awake and Aware

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2
Q

Wakefulness

A

Arousal and ability to open eyes

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3
Q

Awareness

A

Experience of thoughts, emotions and memories

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4
Q

What lesion most commonly causes locked-in syndrome?

A

Lesion of bilateral ventral pons

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5
Q

Cortex injury does not usually cause. . .

A

loss of consciousness

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6
Q

Locked in syndrome

A

Everything is normal in brain except you cannot move (quadraplegia) except maybe blink or move eyes

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7
Q

Damage to what can result in chronic neuropathic pain?

A

Thalamus

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8
Q

Function of midbrain:

A

Vertical eye movements, pupil control, posture, locomotion, non-rapid eye movement, level of arousal

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9
Q

Function of pons:

A

Conjugate horizontal eye movements, posture, rapid eye movements, facial expressions

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10
Q

Function of medulla:

A

Blood pressure, breathing, GI motility, Ingestion, Equilibrium

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11
Q

What are the parts of the forebrain?

A

Cerebral cortex, basal ganglia, thalamus

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12
Q

Vegetative state

A

Not aware but:

  • Has sleep-wake cycles, opens eyes
  • May smile, grimace, reflexively grip hand
  • Does not feel pain or pleasure
  • Not aware of self or others
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13
Q

In coma, what might you have?

A

spinal reflexes

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14
Q

When are you awake but not aware?

A

Vegetative state

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15
Q

Corneal reflex tests. . .

A

CN V - wiping cotton on eye of coma patient to look for response of nerve. CN V will detect sensation and CN VII will control the blink reflex.

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16
Q

What will be spared in a central lesion (stroke)?

A

Forehead!

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17
Q

Weber test:

A

Hold tuning fork on middle of head

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18
Q

Rinne test:

A

Check air to bone conduction

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19
Q

Stroke (central facial weakness):

A

Can still raise eyebrows

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20
Q

Bell’s Palsy:

A

Cannot raise eyebrows

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21
Q

Peripheral facial weakness:

A

whole side of face is lateral/weak

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22
Q

Where are things louder in the weber test?

A

Conductive hearing loss - louder in affected ear

Sensorineural loss - louder in unaffected ear

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23
Q

Where will the tongue deviate when you stick it out?

A

To the affected side/weak side of CN XII

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24
Q

What is the “clasp knife” tone?

A

Spastic, clonus

  • One direction, better with repetition, worse with speed
  • UMN problem, pyramidal
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25
Q

What is the “lead pipe” tone?

A
  • Rigid in every direction
  • Basal ganglion may be damaged, extrapyramidal
  • Both flexion and extension is difficult (ex: Parkinson’s disease)
26
Q

What happens in pronator drift?

A

If UMN weakness, fingers flex, arm pronates, drifts downward. If patient has had a stroke, they will have fingers that flex and arm that slowly drops.

27
Q

What is the grading system for strength?

A 
5 - cannot overcome 
4 - can overcome
3 - antigravity only 
2 - not antigravity
1 - feel or see
0 - no movement
28
Q

What tract has large fibers and what tract has small fibers?

A

Large fibers - Dorsal columns

Small fibers - Spinothalamic tract

29
Q

Positive Romberg means. . .

A

Lost proprioception!

30
Q

What cranial nerves for the biceps reflex?

A

C5-6

31
Q

Brachioradialis reflex?

A

C6-7

32
Q

Triceps reflex?

A

C7-8

33
Q

Patellar reflex?

A

L3-4

34
Q

Achilles reflex?

A

S1-2

35
Q

What can hyperreflexivity mean?

A

Brain lesion, spinal cord lesion!

36
Q

Where do corticospinal tracts (descending) cross?

A
  • Axons from motor cortex (UMN) descend on the same side of the brain until the level of the SPINOMEDULLARY JUNCTION
  • This is where the fibers cross to the opposite side and continue to descend through the spinal cord until they reach the lower motor neuron on that side [crosses at lower medulla]
37
Q

What are the two somatosensory ascending tracts?

A
  1. Spinothalamic tract (pain and temperature)

2. Dorsal Column-Medial Lemniscus System (discriminatory touch and position sense)

38
Q

When do the spinothalamic tracts cross?

A

Almost immediately after entering the spinal cord

39
Q

When do the dorsal column-medial lemniscus tracts cross?

A

When they reach the level of the medulla

40
Q

When does the spinothalamic and dorsal column-medial lemniscus tracts start to travel together to the thalamus (and then onto the sensory cortex)?

A

Rostral pons

41
Q

What CN has the longest path as it exits the brainstem?

A

Trochlear nerve

42
Q

What does the brain use all of its energy for?

A
  • Membrane depolarization & repolarizatio
  • NT release & uptake
  • NT synthesis & metabolism
  • Ion pumping
  • “Housekeeping Activities”
43
Q

What is the function of astrocytic endsheaths?

A

They cover blood vessels.
-While neuron is firing, astrocyte is sensing what is going on (energy level used) and responding by sending signal to vessel to dilate or constrict to regulate the flow of blood and nutrients

44
Q

When is the pentose phosphate pathway used?

A

In ketone breakdown

  • Most active in newborn
  • It requires vitamin B1 (thiamine) for its transketolase
  • Alcoholics deficient in VB1 can get Wernicke-Korsakoff syndrome!
45
Q

What does pos. and neg. CMR-G indicate?

A 
\+ = brain is using glucose (more glucose going in than out)
- = brain is producing glucose (more glucose going out than in)
46
Q

What is the formula for CMR-G?

A

(A-V) F/W

47
Q

Glucose metabolism formula:

A

1 glucose + 6O2 = 6CO2 + 6H2O

48
Q

Where is low glucose metabolism seen?

A

Alzheimers brains

49
Q

When eyes are stimulated, what increases?

A

Blood flow, glucose use and oxygen availability

50
Q

What is the Glucose and Oxygen use in coma and epilepsy?

A

Low CMRG & Low CMRO2 in Coma

High CMRG & High CMRO2 seen in Epilepsy (neurons firing out of control)

51
Q

Glucose and O2 in person who is drowning, AD and Strong anesthetic?

A

Drowning - CMRG same or higher, CMRO2 low
AD - Low CMRG & Low CMRO2
Strong anesthetic - Low CMRG & Low CMRO2

52
Q

What is ischemia?

A

Local anemia due to lack of blood flow

53
Q

What is infarction?

A

Severe ischemia leading to cell death or necrosis

54
Q

What is a thrombus?

A

Clot that forms in place where it blocks blood flow

55
Q

What is an embolus?

A

Clot that forms in one location and travels to the brain where it blocks blood flow.

56
Q

What syndromes affect supratentorial structures?

A

Middle cerebral artery syndrome & Anterior Cerebral Artery syndrome

57
Q

What syndromes affect posterior fossa structures?

A

Lateral Medullary syndrome (PICA), Medial medullary syndrome (anterior spinal artery) and Weber’s syndrome (superior alternating hemiplegia - posterior cerebral artery affecting midbrain)

58
Q

What does acetazolamide do?

A

Inhibits CA (carbonic anhydrase) - helps reduce CSF production

59
Q

What does furosemide (Lasix) do?

A

It blocks the Na/K/2Cl pump & is often used to treat children with over production of CSF (& congestive heart failure!!) - helps reduce CSF production

60
Q

What does ouabain do?

A

Inhibits Na/K/ATPase - helps reduce CSF production

Neuro Final Review (11 decks)

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