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Clinical Neuro Lecture 1 Flashcards

1
Q

What is involved when taking a history (Hx) of a patient?

A

Chief Complaint
Hx of Present illness
Past medical Hx
Past surgical Hx
Family Hx
Medications
Social Hx

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2
Q

What is taken during a physical exam?

A

-Vital signs
- General examination
- Focused exam:
-eg. neurologic, cardiovascular, opthalmologic, Gynecologic

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3
Q

What are Diagnostic studies as part of an evaulation?

A

X-ray
CT
MRI
Blood chemistry
Hematologic
Microbiologic
lumbar puncture and EEG

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4
Q

T/F: Etiogic diagnosis takes precendence over anatomic localization when it comes to initial analysis of neurologic disorders

A

False; anatomic localization takes precendence over etiologic diagnosis (slide 3 lecture 1)

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5
Q

What is the first step in clinical encounters in order to properly assess a patient, especially when patients’ symptoms are in the sensory sphere?

A

To enlist in the patients trust and cooperation and make them realize the importance of the history and examination procedure

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6
Q

What should be taken down when performing a neurological examination (Neurological complaint)?

A

Age
Chief Complaint
History of Present Illness
Past Medical History
Family History
Social History
Review of Systems

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7
Q

What should be recorded when evaluating the history of present illness?

A

1.) When the problem began
2.) Whether it came on abruptly or insiduously
3.) Subsequent course has been characterized by improvement, worsening, or exacerbation and remission
4.) For episodic disorders, such as headaches or seizures, the time course of individual episodes should also be determined

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8
Q

What are the 10 brief neurologic examination in general medical or surgical patient?

A

1.) Orientation, insight into illness, language assessed during taking of the history
2.) Size of pupils, reactions to light, visual and auditory acuity
3.) Movement of eyes, face, and tongue
4.) Examination of the outstretched hands for atrophy, pronating or downward drift, tremor power of grip, and wrist dorsiflexion
5.Biceps, supinator, and triceps tendon reflexes
6.) Inspection of the legs during active flexion and extension of the hips, knees, and feet
7.) Patellar, achilles and plantar reflexes
8.) Vibration sensibility in the fingers and toes
9.) Finger to nose and heel to shin testing of coordination
10.) Gait

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9
Q

After the 10 steps of evaluation, what follows immediately after?

A

Examination of the cranial nerves including the optic discs, neck, and trunk to the testing of motor, reflex, and sensory function of sphincters and the autonomic nervous system if appropriate and testing for meningeal irriation by examining the suppleness of the neck and spine

Gait and station (standing position) are observed before or after the rest of the examination

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10
Q

When are higher cortical functions tested?

A

Tested in detail if the patients history or behavior has provided a reason to suspect some defect

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11
Q

What are the two aspects a part of the mental status examination?

A

Psychiatric aspects:
Affect, mood, and normality of thought process and content

Cognitive aspects:
Level of consciousness, awareness (attention), language, memory, visuospatial, and other executive abilities

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12
Q

What is praxis?

A

The ability to carry out commanded tasks

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13
Q

What is an good example used to test visuospactial perception and are indicated in cases of suspected cerebral disease?

A

Bisect a line, Have a patient draw a clock or a floor plan of ones home or a map of ones country , and copying figures

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14
Q

What is memory?

A

the ability to register, store, and retrieve information and can be impaired by either diffuse cortical or bilateral temporal lobe disease

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15
Q

How can you test a patients immediate recall?

A

have a patient immediately repeat a list of numbers or objects

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16
Q

What is a way to test recent memory?

A

the patient can be asked to repeat a list of items 3 to 5 minutes later

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17
Q

How can you test remote memory?

A

Can ask a patient about facts he or she can be expected to have learned in the past years

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18
Q

Confusion states can impair what form of memory?

A

Immediate recall

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19
Q

How is amnesia affecting memory?

A

Amnesia is associated with predominant involvement of recent memory, with remote memory preserved until late stages
- personal and emotionally charged memories tend to be preferentially spared

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20
Q

What suggest a psychiatric disorder?

A

Inability of an awake and alert patient to remember his or her own name

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21
Q

T/F: Psychogenic amnesia patients lose their personal and emotionally charged memories

A

TRUE

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22
Q

What can lesion in the parietal lobe cause?

A

Cause misperception of or inattention to sensory stimuli on the side of the body opposite the lesion

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23
Q

What is astereognosis?

A

The inability to identify by touch an object placed in the hand

24
Q

What is Agraphesthesia?

A

the inability to identify by touch a number written on the hand

25
When a patient presents a two-point discrimination, what does this mean?
inability to differentiate betwee a single stimulus and two simultaneously applied
26
What is allesthesia?
misplaced (typically more proximal) localization of a tactile stimulus
27
What is extinction?
the failure to perceive a visual or tactile stimulus when it is applied bilaterally, even though it can be perceived when applied unilaterally
28
What is anosognosia?
Unawareness of a neurologic deficit
29
What is constructional apraxia?
the inability to draw accurate representation of external space, such as filling in the numbers on a clock face
30
What is contralateral neglect syndrome?
When damage to the right parietal association area, where patient tends to ignore things on his surroundings left side
31
What is Apraxia? How do you test for it?
the inability to convert an idea into a skilled act - it is best tested by attempting previously learned tasked despite intact motor and sensory function - Tests for apraxia include asking the patient to stimulate the use of a key, comb, or fork - **UNILATERAL** apraxias are commonly caused by contralateral premotor frontal cortex lesions - **BILATERAL** apraxias, such as gait apraxia, may be seen with bifrontal or diffuse cerebral lesions
32
What is testing of reflexes?
Testing of the biceps, triceps, supinator-brachioradialis, patellar, achilles, and cutaneous abdominal and plantar reflexes permits an adequate sampling of reflex of the spinal cord (JENDRASSIK MANEUVER)
33
What are the general examinations focuses on in this lecture?
Testing of Cranial Nerves Testing of Motor Function Testing of Reflexes Testing of Sensory Function Testing of Gait and Stance
33
What is the testing of Gait and Stance?
The examination is completed by observing the patient arise from a chair, stand and walk. An abnomality of stance or gait may be the most prominent or only neurologic abnormality, as in certain cases of cerebellar or frontal lobe disorder
33
What is testing of sensory function and how is it performed?
Usually, sensory testing is reserved for the end of the examination - a quick survey of the face, neck, arms, trunk, and legs with a pin takes only a few seconds, seeking differences between the two sides of the body, a level below which sensation is lost, or a zone of relative or absolute analgesia (loss of pain sensibility) or anesthesia (loss of touch sensibility) - The finding of a zone of heightened sensation ("hyperesthesia") calls attention to a disturbance of superficial sensation
34
What is a way to test motor function? (strength)
Ex: have a patient flex the arm, and the examiner tries to overcome this movement
35
What are examples of somatosensory function testing?
- Touch (using finger or dull end of safety pin) and pain (sharp end of safety pin) - Joint position sense - Vibration sense (using 128-Hz Tuning fork)
36
What test can be performed to test tendon reflexes? (more coordination reflexes but lecture says tendon reflexes)
Tests of cerebellar function: finger-to-nose test, test for rebound , and heel-knee-shin test
37
What nerves are stimulated with a bicep reflex and brachioradialis reflex?
C5, C6
38
What nerves are stimulated with the tricep reflex?
C7-C8
39
What nerves are stimulated with quad reflex?
L3-L4
40
What nerves are stimulated with achilles reflex?
S1,2
41
# d What are different gait pathologies?
hemiplegic gait paraplegic gait parkinsonian gait steppage gait dystrophic gait
42
What can lumbar puncture information help us with? When should they be performed?
Help identify infection or inflammatory conditions in the CSF - useful in subarachnoid hemorrage, and processes that alter intracranial pressure - To obtain pressure measurements and procure a sample of the CSF for cellular, cytologic, chemical and bacteriologic examination - To aid in therapy by the admininstration of spinal anesthetics and occasionally, antibiotics or antitumor agents, or by reduction of CSF pressure - To inject a radiopaque substance, as in myelography, or a radioactive agent as in radionuclide cisternography
43
What is Computed Tomography?
Shows the skull differing densities, CSF, blood, and gray and white matter are distinguishable in the resulting picture with great clarity - One can see **hemorrhage**, **infarcted**, **contused** and **edematous** brain, **abscess** and tumor tissue and also the precise size and position of the ventricles and midline structures
44
What is Magnetic Resonance Imagining?
MRI provides images in any plane, but it has the greatest advantage over CT in using **nonionizing energy** and providing higher resolution views, and improved contrast between different structures within the nervous system - most neurologic lesions, MRI is the preferred procedure - The terms TI (enhace fat) and T2 (enhance water contrast) weighting refer to the time constants fro proton relaxation **BEST FOR MS
45
What is CT Contrast Myelography?
CT images of the lumbosacral spine obtained after the intrathecal administration of radioopague contrast material - The vertebral bodies are separated by intervertebral discs and the spinous processes are seen posteriorly - Contrast contained within the thecal sac appears white - The conus medullaris terminates at the L2 vertebral level and the nerve roots of the cauda equina are clearly seen within the posterior thecal sac **GREAT FOR HERNIATED DISC**
46
What is Angiography?
Technique is best for vasculature - A safe and valuable method for diagnosis of aneurysms, vascular malformations, narrowed or occluded arteries and veins, arterial dissections and angitis - the use of angiography has practically been limited to the diagnosis of these vascualr disorders, and refinements in the megnetic resonance angiogrpahy [MRA] adn computed tomography angiography [CTA] promise to reduce conventional x-ray angiography
47
What is electroencephalogrpahy (EEG)?
A standard lab procedure in the study of all forms of cerebral disease, and basically replaced by CT and MRI for the purposes of localization of stuctural lesions **continues to be an essential part of the assessment of patients with seizures and those suspectred of seizures, as well as in brain death and for the study of sleep (polysomnography) - also used in evaluating the cerebral effects of many systemic metabolic diseases and in the operating room to monitor cerebral activity in anesthetized patients. Fro a few diseases, such as subacute spongiform encephalophathy (prion disease), it is a useful confirmatory laboratory test - the electroencephalograph records spontaneous electrical activity generated in the cerebral cortex
48
What are beta brain waves?
14-30Hz patient awake with mental activity
49
What are alpha waves?
8-13Hz awake and resting
50
What are theta waves?
4-7Hz Sleeping
51
What are Delta waves?
Deep sleep <3.5Hz
52
What are evoked potentials?
The stimulation of sense organs or peripherla nerves evokes an electrical response in the corresponding cortical receptive areas and in a number of subcortical relay stations These waveforms are maximized by the computer to a point where their latency can easily be measured The interpretation of evoked potentials (visual, auditory, and somatosensory) is based on the prolongation of the latencies of the waveforms after the stimulus, the interwave latencies, and asymmetries in timing
53
What are electromyography and Nerve conduction studies?
tests that use electrodes to detect, translate and record the electical signals in your muscles and nerve cells while they are active and at rest - While an EMG may be done with or without NCS, the two tests are generally performed together - The information each yields is complementary and when reviewed as a set, presents a more comprehensive picture than one test alone - EMG can detect if muscle weakness or numbness is due to a nervous systme disorder or injury to a nerve that's attached to the muslce, and the two tests together can differentiate of you have a muscle disroder or a nerve disorder
54

Clinical Neuro (1 decks)

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