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Neuro BLOCK 1 > Diseases Of The Nerve > Flashcards

Diseases Of The Nerve Flashcards

1
Q

What is the best study for sudden onset head trauma?

A

CT Non Con

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2
Q

What are the 5 red flags of head pain?

A

1) Thunderclap HA
2) Blindness
3) Worse @ Night
4) Incontinent
5) Suicidal Ideations with a plan

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3
Q

What area of the brain is most important for coordination?

A

Cerebellum

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4
Q

What are two examples of cranial nerve symptoms?

A

Vertigo

Dysphagia

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5
Q

What are 2 examples of nervous system disturbance symptoms?

A

Disorientation

Apnea

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6
Q

What is a dyskinesia

A

Uncontrolled involuntary muscle movement

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7
Q

What level on the mini mental status exam is indicative of a cognitive disorder

A

24/30.

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8
Q

Explain CN1

A

Olfactory

Eyes closed, sniff mild stimulus ID

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9
Q

Explain CN2

A

Optic

Visual Acuity
Optic fields with confrontation
Optic fundi exams examine this area

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10
Q

What is the pnuemonic for CN 3,4,6

A

Oculomotor
Trochlear
Abducens

LR6(SO4)3

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11
Q

Explain CN 5

A

Trigeminal

3 Branches

1) Ophthalmic
2) Maxillary
3) Mandibular

Jaw Clench—Masseter Muscle

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12
Q

Explain CN 7

A

Facial Nerve

Face Symmetry
Upper vs Lower Motor Lesion effects
Eye closure, Eyebrow raise, Forehead raise, Smile, Cheek puff

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13
Q

Explain CN8

A

VBC

Finger Rub
Air vs Bone Conduction
Lateralization Tests

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14
Q

Explain CN 9/10

A

Glossy/ Vagus

Symmetry
Gag reflex

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15
Q

Explain CN 11

A

Accessory

Shoulder shrugs (Traps)
Head Rotation (SCM)
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16
Q

Explain CN 12

A

Hypoglossal

Tongue protrusion 
Atrophy 
Fascinations 
Position 
Strength
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17
Q

What are three things to check for on a motor exam

A

Appearance
Tone
Strength

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18
Q

Explain the strength of movement scale

A

0 to 5.

No movement to Full Power with respect to gravity.

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19
Q

What is pronator drift

A

Around 20-30 seconds after extended; one arm floats medially.
Indicates:
Upper Limb Weakness and Loss of position sense

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20
Q

Explain the deep tendon reflex scale

A

Dont forget a little stretch in the leg

4 to 0.
2 = Normal
4 = Hyperactive +/- Clonus
0 = Absent

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21
Q

Motor Sensation Reflex for C5

A

M : Deltoid

S : Lateral elbow (antecubital fossa) to upper arm

R : Biceps Tendon

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22
Q

Motor Sensation Reflex C6

A

M : Wrist Extension

S : C6 Radial Finger/ Arm

R : Brachioradialis Tendon

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23
Q

Motor Sensation Reflex C7

A

M : Wrist Flexion

S : Wrist to middle finger

R : Triceps Tendon

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24
Q

Motor Sensation Reflex C8

A

M : Finger Flexion

S : Fourth/ Fifth Finger Forearm

R : NONE!

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25
Q

Motor Sensation Reflex L4

A

THINK LOW BACK PAIN.

M : Tibialis Anterior (Foot Inversion)

S : Medial foot to ankle

R : Patellar Tendon

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26
Q

Motor Sensation Reflex L5

A

THINK LOW BACK PAIN.

M: Extensor Digitorum Longus

S : Mid foot to Leg

R : NONE!

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27
Q

Motor Sensation Reflex S1

A

THINK LOW BACK PAIN.

M : Peroneus Longus and BRevis

S : Lateral foot to ankle

R : Achilles Tendon

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28
Q

What is babinski’s sign

A

+ = a fanning out of other toes with big toe flexing UP.

= Lesions above S1

  • Positive in kids less than 2 years old
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29
Q

What is the superficial abdominal reflex

A

T9-T12 injury

Umbilicus skin movement reflex

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30
Q

What is the cremaster reflex

A

L1/L2 injury

Ipsilateral ascended testicle with inner thigh stim.

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31
Q

What are the 4 primitive reflexes

A

Suck Response
Root Response
Grasp Response
Palmomental Response

ALZHIEMERS shows a return of these reflexes

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32
Q

What is the anal reflex

A

S2-4 injury

Anal Blink

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33
Q

What are the 3 important peripheral nerves

A

Radial
Ulnar
Medial

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34
Q

What peripheral nerve supplies the 2nd and 3rd digit on the dorsal side of the hand, as well as, the the 1st-3rd digits and the respective palm area on the ventral side?

A

Median Nerve

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35
Q

What is the Vertebra Marking of the nipple and umbilicus

A

T4-5 - nipple

T10 - umbilicus

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36
Q

What is the most important observation for a Neuro exam?

A

Walking

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37
Q

What is a dysdiadochokenesis associated with?

A

Continuous synchronous movements

Upper motor neuron Dz- MS

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38
Q

What space is used for lumbar puncture on the spinal cord?

A

L3-L4

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39
Q

What is the risk of LP with Increased ICP?

A

Herniating

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40
Q

What are 4 indications for CT non Con?

A

AMS
Papillary Edema
Focal Neuro deficit
New onset seizure

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41
Q

What are 3 Contraindications for LP

A

Infxn at the site
Coagulopathy (shown with platelets below 20,000)
Pt. Non-compliance

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42
Q

What diseases are evaluated with LP (6)

A 
Infective meningitis , encephalitis 
Subarachnoid hemorrhage 
Dementia 
Malignancy 
MS 
ICP
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43
Q

Can you use warfarin with LP

A

NO!
Must stop 4-5 days before LP.

Warfarin= indicated for pts w a clot, can be revered with FFP.

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44
Q

What other two meds must be D/C before LP

A

Ticlopidine D/C @14 days before

Clopidogrel D/C @ 7 days before

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45
Q

What is a common side effect of LP

A

Post Dural Puncture Headache

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46
Q

Who is at inc risk for Post LP HA

A

Female
younger Age

Due to decreased CSF pressure
restored 3-5 days later

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47
Q

TXM for Post LP HA

A

Oral analgesics
Tylenol
Advil Caffeine
Blood patch- epidural

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48
Q

When should you order an EEG

A

To eval seizures or check for brain death.
Captures a moment in time
NON invasive
No contra’s

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49
Q

What is EMG

What does it eval?

A 
Electrical activity with shock of a muscle 
Evals: 
Peripheral neuropathy 
Entrapment 
NM disorder
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50
Q

What is a NCV (nerve conduction velocity) test?

A

Stimulates a nerve at one point

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51
Q

Ct Complications

A

Radiation

Contrast Neuropathy - 0.5 mg/dL SrCr incr w/ in 48 hrs of admin

Allergy

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52
Q

What pt population needs tests done before contrast admin?

A

Kidney Diseased Patients

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53
Q

What does the MRI view best?

A

Brain , Spinal Cord, Soft Tissue

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54
Q

When is GFR required for MRI w/ contrast patients?

A

Always.

6 wks before MRI

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55
Q

What are 3 main concerns for admin MRI studies?

A

Must be STABLE
Nephrotoxicity
NO Magnetic implants

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56
Q

What is MRA good for?

A

Blood flow to the brain

Views:
Vascular Stenosis
Acute Stroke
Circle of Willis

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57
Q

PET scan is what?

A

A functional image

Perfusion and metabolic activity

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58
Q

Myelography study?

A

Contrast through LP, of subarachnoid space

Views: 
Cord compression 
AVM’s 
Epidural abscess 
Tumors
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59
Q

Carotid U/S ?

A

Velocity of blood flow through the carotid artery
NON invasive.

Views:
TIA/Stroke eval

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60
Q

Sensory neurons are =

Motor neurons are =

A

S : afferent

M : Efferent

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61
Q

The CNS develops from where?

And PNS?

A

CNS = Neural Tube

PNS = Neural Crest

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62
Q

At what stage of development does the neural plate become the neural tube

A

3rd week

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63
Q 
What are the parts of the 
OUTER 
MIDDLE 
INNER 
Tube?
A

OUT -> Marginal White Matter

MID -> Mantle Grey Matter

INNER -> Ependymal Spinal Cord + Ventricles of the Brain

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64
Q

When does NT closure generally occur

A

26 to 28 days after conception

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65
Q

What are 3 neural tube defects

A

Ancephaly (No BRAIN!)

Encephalocele

Meningomyocele (Spina Bifida)

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66
Q

What is a good treatment to prevent neural tube defects

A

Folic Acid supplements

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67
Q

Pt with low risk for NT defects receive how much FA supplement?

A

.4 mg q day for 1 moth PTC

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68
Q

How much FA do high risk pts receive to prevent NT defects?

A

4 mg day for 3 months PTC

High-= NTD in either parent

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69
Q

Define Meningomyocele

A

Sacralumbar region defect

Failure of Neuro pore to form POSTERIOR

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70
Q

What is the brain stem

A

Continuous with spinal cord
Midbrain
Pons
Medulla oblongata

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71
Q

What is the location of the cerebellum

A

Posterior brain stem

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72
Q

What is the diancephelon

A

Superior to the brain stem

Thalamus
Epithalamus
Hypothalamus
Pineal Gland

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73
Q

Explain the control of the brain

A

Left to right crossed sides

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74
Q

What is the largest part of the brain

A

Cerebrum

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75
Q

What structure connects the left to right side of the Brain and is important in seizure detection

A

Corpus callosum

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76
Q

What does the frontal lone control

A 
Behavior 
Reasoning 
Emotions 
Personally 
Motor PRECENTRAL GYRUS
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77
Q

4 main parts of the frontal lobe

A

Motor
Frontal Eye Field
Bro as Speech
Prefrontal cortex

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78
Q

What is the motor function of the frontal lobe

A

Spastic paresis

= upper motor neuron (INHB) damage to pelvic limbs and gastrocnemius muscle

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79
Q

What is an indication of frontal eye field damage

A

Deviated eyes to the same side

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80
Q

Explain brocas speech area

A

Posterior frontal gyrus of dominant hemisphere
Motor process of speech
ie. breathing patterns and vocalizations

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81
Q

6 functions of the prefrontal cortex GC JOBS

A 
concentration 
Orientation 
Judgement / Problem Solving 
Behavior Changes 
Gait Changes 
Sphincter Incontinence
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82
Q

What characteristics are often seen in orbital prefrontal cortex damage?

A

Obscene language onset with public urination

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83
Q

What is controlled by the temporal lobe

A

Language
Hearing
Short term memory
Olfaction

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84
Q

What are the 6 main areas of the temporal lobe? POW HIM!

A

Primary auditory Cortex

Olfactory bulb tract

Wernickes Speech

Hippocampus and Cortex

Inferomedial occipital cortex

Meyers Loop

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85
Q

If the primary auditory cortex is damaged what is likely?

A

Loss of hearing

bilateral cortical deafness

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86
Q

Explain wernickes speech area

A

Posterior superior GYRUS
Can’t make sense of words.
Fluent speech that does not make sense

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87
Q

Meyers loops refers to what difficulties if damaged?

A

Contra lateral homonymous superior quandrantanopia

PIE IN THE SKY

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88
Q

What is effected by olf bulb tract damage

A

Ipsilateral Anosmia

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89
Q

Explain the effects of a bilateral hippocampus cortex lesion

A

Consolidation of short term memory and then long term

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90
Q

What can cause propagnosia (FACE BLINDNESS)

A

Intermedia occipital cortex lesion / bilateral

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91
Q

3 major functions of the parietal lobe

A

ID of an object
Hemispatial neglect
Ability to copy figures

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92
Q

3 major parts of the parietal lobe

A

Sensory cortex
Inferior Lobe
Superior lobe

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93
Q

Sensory cortex parietal lobe damage would result in what?

A

Astereogonosis

Hemihyperesthesia (incr pain stimuli)

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94
Q

What is effected with inferior lobe damage?

A

Non dominant hemisphere

Topographic memory loss

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95
Q

What is effected with superior lobe damage of the parietal lobe

A

Contra lateral astereognosis and sensory neglect

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96
Q

What is the occipital lobe responsible for (3)

A

Visual processing
Shape
Color ID

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97
Q

A bilateral lesion of the occipital lobe would result in what ?

A

Cortical blindness

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98
Q

A unilateral lesion of the occipital lobe would result in what?

A

Contra lateral hemianopia
Or
Quadrantanopia

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99
Q

Characteristics of the left side hemisphere of the brain

A

Most Common dominant side:

Language Speech Calculations

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100
Q

Characteristics of the right side hemisphere of the brain

A

Non dominant normally
Spatial perception
Face recognition
Ideations

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101
Q

Cerebral dominance is important for what?

A

Check for Aphasia

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102
Q

Ach characteristics

A

Released by PNS/CNS neurons
Excitatory @ NMJ
Opens ligand gated cation channels
INHB @ synapses

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103
Q

Dopamine characteristics

A

Emotional response
Addictive behavior
Pleasure

Decrease : Parkinson’s
Increase : Schizophrenia

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104
Q

NE characteristic

A

Transmitter to post gang symptoms. Neurons

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105
Q

What are two inhibitor amino acids in the brain

A

GABA

Glycine

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106
Q

What is the major excitatory transmitter in the Brain

A

Glutamate

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107
Q

What is glutamate good for?

A

TXM of corticobulbar and corticospinal tract dz

w/ NON-NOCICEPTIVE LARGE EFFERENT FIBERS

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108
Q

What is the most common cerebral sign

A

Anomia

Can’t name certain things

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109
Q

Agraphia vs Aphasia

A

Cant write

Can’t Speak

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110
Q

What is an associated sign of brocas aphasia

A

R Hemiparesis

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111
Q

What is apraxia

A

Frontal lobe deficit
Cant carry our purposeful movements (not paralyzed)
Disturbance of one certain thing or starting it

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112
Q

What two areas produce neglect

A

Right frontal

Parietal Lobe

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113
Q

Basal ganglia does what?

A

Coordinates motor activity
Tremor stiffness

Parkinson’s and Huntingtons

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114
Q

What is the memory pathway with sensory relay

A

Diancephalon

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115
Q

The limbic system controls what

A

Emotion
Reproductive Habits
Eating
Seizures + FEAR

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116
Q

What makes up the limbic system

A

Cingulate Grus
Midbrain Raphae
Locus ceruleus
Hippocampus

FEAR!

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117
Q

What area of the brain is large in autism

A

Amygdala

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118
Q

Blood supply of the cerebellum

A

SCA
AICA
PICA

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119
Q

What is the consciousness center

A

Midbrain

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120
Q

Pyramidal vs. Extrapyramidal

A

Voluntary vs Involuntary

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121
Q

White matter = and Grey Matter =

A

Myelinated nerves

Nerve Cell bodies

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122
Q

What is mediated be the corticospinal tract

A

Voluntary motor activity

WHITE MATTER

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123
Q

Posterior columns mediate what?

A

Fine touch
Proprioception
2 point discrimination

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124
Q

Spinothalmic tract regulates what?

A

Pain
Temperature
Pressure

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125
Q

Voluntary movement starts where?

A

Pyramidal tract

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126
Q

How does the spinothalmic tract run?

A

Crosses over immediately

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127
Q

How do the fibers on the dorsal column run

A

Same side as fibers enter cord

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128
Q

Cord lesion of lateral corticospinal tract produces what symptoms?

A

IPSILATERAL Sxs

-Motor pathway ; crosses at medulla then goes down Lat. cortico. Tract

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129
Q

Cord lesion of the dorsal columns produces what symptoms?

A

IPSILATERAL Sxs d
-Fine touch/2 point discrimination/proprioception
Goes upon dorsal columns crosses at medulla

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130
Q

Cord lesion of spinothalmic tract produces what symptoms?

A

CONTRALATERAL Sxs
Pain/Temperature
-Crosses over immediately goes up in spinothalmic tract

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131
Q

What provides arterial blood to the brain

A

Bilateral internal carotids and

Bilateral Vertebral arteries

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132
Q

Encepholocele NTD

A

Anterior Pore defect
Least common
Based on location

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133
Q

Where is the most common encephelocele

A

Occipital

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134
Q

Where do sympathetic fibers exit

A

T1-L2

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135
Q

Where do parasympathetic. Fibers exit?

A

CN 3, 7, 9 , 10
S2-S4
Gut
Bladder

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136
Q

Who is the master control of the ANS

A

Hypothalamus

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137
Q

Main goals of the ANS

A

Regulate glands smooth muscle and cardiac muscle

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138
Q

How many pairs of nerves were discussed in diseases of the nerve?

A

31

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139
Q

Peripheral NS includes what nerves

A

Spinal and Peripheral

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140
Q

What does the synapse represent

A

Junction of 2 neurons b/w neuron and effector

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141
Q

What structure is the receiving portion of the neuron

A

Dendrite

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142
Q

What structure propagates impulses to other neurons muscles or nerves , around 3 ft long?

A

Axon

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143
Q

What kind of medication is Lidocaine

A

NA+ channel blocker

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144
Q

What condition causes the demyelination of neurons starting in the legs with characteristic slow conduction

A

Guilin Barre Syndrome

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145
Q

What are the 6 neuropathies discussed

A 
Mononeuropathy 
Polyneuropathy 
Mononeurop. Multiplex 
Special cat. Of Neuro 
Inherited neuropathy 
Immune mediated neuropathy
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146
Q

Where are the effects of a mononeuropathy

A

Unilateral

Peripheral

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147
Q

Wha is the Edx for mononeuropathy

A

Transient

Demyelination
Axonal generation

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148
Q

Characteristics of radial neuropathy

A

ABduction
Wrist drop/weakness
Sensory loss

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149
Q

TXM of Radial neuropathy

A

Resolves 6-8 weeks
Cock-up wrist splint
Physical therapy

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150
Q

Carpal tunnel syndrome characteristics

A

Median nerve @ wrist compression
More at night and in pregnant women
Long term-> Thenar Eminence

Numbness
Parenthesias of the thumb Index Middle
Aching pain

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151
Q

2 sings associated with radial neuropathy

A

Tinsel Sign
-Tap median nerve inside forearm @ wrist + = parethesia

Phalen Sign
-Pray then hold your hand down should be able to pray but can’t twist it down

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152
Q

Edx for carpal tunnel

A

Sensory delay before motor delay demonstrated

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153
Q

TXM for carpal tunnel

A

Activity modifications
NSAIDS
Neutral splint @ night

Methylprednisone injection
Surgical decompression
(Long term send to ortho)

154
Q

ADE’s of methylprednisolone injection

A

Melanin turns white

Tendon rupture

155
Q

Ulnar neuropathy of the elbow is also called

A

Cubical tunnel syndrome

156
Q

Ulnar neuropathy characteristics

A

Ulnar nerve compression
4th and 5th digit
Paresthesia with tingling
Pain @ elbow

157
Q

2 signs associated with ulnar neuropathy

A

Tinsel sign- median nerve tap

Froment - Pull the paper = can’t hold paper

158
Q

TXM of ulnar neuropathy

A 
Activity mods 
Elbow pads 
NSAIDs 
Splints 
Surgery-tick the ulnar nerve down
159
Q

Lateral femoral cutaneous neuropathy is also called

A

Neuralgia paresthetica

160
Q

Lateral femoral cutaneous neuropathy characteristics

A

Obese
Pregnant
Over weight

Pain parenthesis a numbness lateral outer thigh
Hyper extension of the hip (Preg. Patients)

161
Q

Txm Lateral Femoral cutaneous neuropathy

A

Wt. Loss
lidoderm patch
NSAIDS / pain meds
(Neuropathic meds)

162
Q

First line neuropathic meds

A 
Lidoderm 
TCA’s
Gabapentin 
Pregablin 
Duloexetine
163
Q

Second line neuropathic meds

A

Carbamazepine
Phenytoin
Duloxetine
Tramadol

164
Q

What neuropathic med has cognitive changes, sedation, dry eyes and mouth, urinary and consitpation symptoms?

A

TCA’s

165
Q

What are side effects of gabapentin

A

Cognitive changes sedation peripheral edema

166
Q

What is the 1st symptoms sin polyneuropathy

A

Sensory

Hands and feet distal

167
Q

Characteristics of polyneuropathy

A

Symmetric
Distal
Serious sensory
Weakness and reflexes are loss

BILATERAL

168
Q

Vitamin B12 def causes (4)

A

Pernicious anemia - most common
Dietary avoidance
Gastrectomy
Info bowel dz

169
Q

Vit B12 def characteristics

A

Numbness and gait instability
GI sxs : diarrhea glossitis, anorexia

Hands numb
Hyperflexia
Achilles reflex

170
Q

What does the Edx show for vit b12 def

A

Axonal sensorimotor neuropathy

171
Q

What is high in b12 def?

A

Homocysteine

172
Q

TXM of b12 def

A

Injections of b122 = if no intrinsic factor

B12 oral dose = if vegan; diet insufficient

173
Q

What do you need to know about mono neuro multiplex

A

Multi focal simultaneous sequential in individuals that can lead to polyneuropathy

174
Q

What nerves are affected in mono neuro multiplex

A

Concluding symmetric peripheral nerves

175
Q

What is the most common cause of peripheral neuropathy

A

Diabetic neuropathy

Diabetic distal symmetric sensory and motor polyneuropathy (DSPN)

176
Q

What test can be used for diabetes neuropathy

A

Filament test

177
Q

What other sxs can accompany diabetic neuropathy

A 
Vasomotor distal 
Sera tong disturbance 
CV:exercise intolerance and dizziness 
GI:GU 
Hypoglycemia unaware
178
Q

What is good treatment for DN

A

Tight glycemic control

Pain control:
TCA : amitriptyline + Nortriptyline 
Gabapentin 
Serotonin / NE reuptake INHB 
Capsain cream
179
Q

1 viral infection that leads to neuropathies in HIV

A

CMV infection

180
Q

What is the most common neuropathy of Lyme disease

A

Facial Neuropathy - Bilateral

181
Q

Characteristics of Herpes Zoster

A 
1st paresthesias, 
Severe Dermal pain, 
Muscles weakness 
PHN 
Vesicular rash

Vaccine is available

182
Q

TXM of herpes zoster

A

With in 72 hours of outbreak antivirals :
Acyclovir
Valacyclovir
Famcyclovir

183
Q

What is the cause of leprosy

A

Acid fast bacilli mycobacterium

184
Q

Where is leprosy most endemic

A

South East Asia
Africa
South America

185
Q

Where does the neuropathy occur in leprosy

A

Ears and Distal Limbs

186
Q

What is the most common hereditary neuropathy?

A

Charcot Marie Tooth disease

187
Q

Characteristics of Charcot Marie Tooth

A

Distal weakness spreads up to arms and legs
Genetically distinct
Autosomal dominant
Foot and gait abnormal

“Champagne Legs”

188
Q

Difference between CMT 1 vs CMT 2

A

CMT 1 = most common , shows demyelination

CMT 2 = Axonal lost, low rate tremor

189
Q

TXM of CMT

A

Physical and occupational therapy
Ankle foot orthotic for foot drop
Treat foot deformity to manage conservatively

190
Q

Most common heredity neuropathy

A

HSAN Type 1

191
Q

Familial Amyloid polyneuropathy has what characteristics

A

Mutated tranthyretin

insidious onset to numbness with parenthesias

Cardiomyopathy and earth autonomic nervous system involvement to CHF

192
Q

TXM of familial amyloid polyneuropathy

A

Liver transplant

Look for renal gastric disease and amyloid deposits in organs and vitreous opacities

193
Q

Refsum’s disease characteristics

A

Starts infancy then flows to adulthood
Back eye arthritis
night blindness(1st sxs)

Peripheral neuropathy
Retinitis pigmented
Cerebellar ataxia
Elevated CSF prot concentration

194
Q

TXM for Refsum’s disease

A

Avoid phyla if acid and plasmaphoresis

195
Q

What type of dz is giullian barre syndrome

A

Immune modulated

196
Q

GBS sxs

A

Polyneuropathy 1-3 weeks after illness or vaccination
(Mostly after campy jejuni)
DTR’s absent
Starts in less and the ascends to autonomic dysfunction in a month

197
Q

CSF character of GBS

A

High protein; normal cell count

198
Q

TXM of GBS

A

IV Ig’s plasmaphoresis
Hospitalization
Steroids to sop demyelination

199
Q

What can persist in GBS

A

Minor arefelxia

Do rehab to regain

200
Q

Characteristics of chronic demyelination polyneuropathy

A 
9 weeks or more than 3 relapses 
Onion bulb change 
Males more than females 
Same starts as GBS 
Motor and Sensory sxs 
Symmetric bilateral
201
Q

CSF findings of chronic inflammatory demyelinating polyneuropathy

A

Acellular high protein

202
Q

How do you make dx of chronic inflammatory demyelinating polyneuropathy

A

Clinical CSF electro physio findings

203
Q

TXM of chronic inflammatory demyelinating polyneuropathy

A

Responds to glucocorticoids
Initiate w progression IV IG / Steroids for its cyclic nature
Plasma exchange
Retreat at 6 weeks

2nd line = immunosuppressant
Azathioprine / Methotrexate / Cyclosporine / cyclophosphamide

Spont recovery common

204
Q

Multiple myeloma characteristics

A

Male more than female
Sensorimotor neuropathy
X-rays with lyric or diffuse bone lesions
Edx = Axonal degeneration

205
Q

Vasculitic neuropathy

A

Polyneuropathy = common in poly arthritis nordosa

Ischemic loss of nerve trunks + roots
Mono neuro multiplex + constitutional sxs

206
Q

How do you dx vasculitic neuropathy ; TXM?

A

Muscle + Nerve biopsy

Glucocorticoids + immunosuppresant agents

207
Q

Myasthenia gravis characteristics (5)

A 
Weakness 
Fatigue in skeletal muscles
ASX ocular palsy 
Variable paresis 
Muscle atrophy -later  
Autoimmune  @ NMJ
208
Q

5 hallmarks of MG

A 
EOM affected 1st 
Dysarthria ; Dysphagia Muscle weakness 
General weakness 
Sxs worse @ night 
Sxs improve with rest /morning
209
Q

What is the best testing for MG

A

1) Ach receptor Abs detected

2) Ice pack test

210
Q

What is the tensilon test

A

Admin edriphonium ;

If sxs improve = positive test for MG

211
Q

TXM for MG

A

Anticholinergic drugs = pyrodostigmine

Thymemectomy

Corticosteroids = prednisone ; 20 mg daily then one week trapper up for 1 mg/hg/day.

Plasmaphoresis = temp improvement

212
Q

Myasthenic syndrome

A

Small cell carcinoma
Defect in release of Ach in response to an impulse

Voltage gated Ca2+ channel response

213
Q

Power increases with contraction which does what to build up?

A

Increases it!

214
Q

TXM of myasthenic syndrome

A

Prednisone 60-80 mg

Azathioprine

215
Q

Botulism occur became of what invasion

A

Clostridium toxin

216
Q

Causes of childhood botulism

A

1 year old with constipation
Poor feeding
Failure to thrive

217
Q

Disorders of amingolycosides are similar at to what?

A

Botulism

Double or blurred vision
Eye Lil ptyosis

218
Q

Tetanus is what ?

A

An irreversible build to GABA

Think lock jaw

219
Q

TXM for tetanus

A

Human test IF win the first 24 hours of presentation
high mortality sedate w/ BZD for muscle spasms
Metronidazole ABX

220
Q

Cholinesterase inhibits what?

A

ACH breakdown = increased Ach

221
Q

What is a good nerve agent pre TXM

A

Pyridostigmine ‘

Emergency = support
Atropine
2- PAM chloride (irreversible bind)

222
Q

Hypertonia =

A

Spasticity
Sensory input
Rigidity brain and spinal cords (UMN)

223
Q

Hypotonia =

A

Myopathy

LMN

224
Q

Sxs of UMN lesion

A

Spasticity
Weakness
Babinski +
No muscle atrophy until late

225
Q

Sxs lower

A 
Flaccidity 
Focal weakness 
Neg babinski 
Hyporeflexia 
Fasciculations (Ca2+)
226
Q

Corticospinal tract =

A

UMN
Pyramidal system
Motor cortex spinal cord

227
Q

Hyperreflexia =

A

UMN

228
Q

HYPOrefelxia =

A

LMN

229
Q

Explain the LMN

A

Positive stimulus
Spinal cord to target muscle
Motor fibers of CN + peripheral nerves
Neg babinski

Excitatory

230
Q

Explain upper motor neuron

A 
Negative stimulus 
hyperreflexia 
Spasticity 
Diffuse weakness 
Positive babinski 
No muscle atrophy - until later
231
Q

What type of motor loss is common in diabetes

A

Assymetric Lateral UMN

232
Q

An injury to the brain and spinal cord would result in what type of loss?

A

UMN

Loss of negative stimulus

233
Q

An injury to the peripheral nerves or anterior horn of spinal nerves results in what?

A

LMN injury
Inhibitory stimulus continues normally
Wasted muscle a/ brief spontaneous twitch’s

234
Q

Hemiparetic gait

A

UPPER MOTOR NEURON LESION

Brain stem stroke tumor trauma
Upper extremity Aduction internal rotation

Flexed elbows
Hips and knees extended
Req’s abduction + circumduction to ambulate

235
Q

Paraperitic or diplegic (scissor gait)

A

Spasticity in lower extremities
Common after stroke
Circumduct both legs

Presence of periventricular lesions

236
Q

Stoppage or neuropathic gait
And
Causes

A 
High stoppage gait 
L5 lesion - if UNILATERAL 
If BILATERAL = POLYNUEIRPATHY OR LUMBOSACRAL POLYRADICULOPTHY 
Weak foot dorsiflexors 
Avoid dragging the toe

Peripheral nerve dz
Causes : Vit B12 def. Tabes Dorsalis

237
Q

Waddling or myopathies gait

A 
Myopathy ; NMJ dz proximal spinal cord 
Pelvis is rotated FWD 
Bilateral weakness 
Throws hip FWD
HIGH FALL RISK
238
Q

Parkinsonism

A 
FWD stop ; Flexion of hip and knees 
Flexed arms @ elbows 
Aduction @ shoulders 
Dec face expression 
“Pill roll remor”

Bradykinetic Gait

239
Q

Apraxia

A

Bilateral Frontal lobe disease -> Dementia and incontinence

Will themselves FWD
Cant plan movement
Parkinson’s Like
Stopped short shuffled gait

240
Q

Choreoathetotic

A

Basal ganglia disorder
Jerky involuntary hunting’s
Lurching appearance
Unpredictable

241
Q

Cerebellar ataxia

A

Wide gait to assist w balance + nystagmus
Trundle instability severe falling

Cerebellar Lesion present.

242
Q

Sensory ataxia

A

Look at their feet balance w eyes open.
Broad based
Close eyes = rapid off balance
+ Romberg sign

just a sensation issue not a lesion

243
Q

Vestibular ataxia

A

Pt falls to one side
Miners disease w walking and standing

ASX
Nystagmus present
Normal proprioception
Normal strength

244
Q

Astasia - Abesia

A

Psychotic gait disorder
PE = normal
Pt can’t stand or walk
Can be distracted and turns normal

Mx balance takes several steps

245
Q

Characteristics of MS

A 
Auto immune disease of the CNS 
Inflammation 
Demyelination 
Gliosis 
Neuronal loss

20-40 yrs old
Women more than Men

Northern European Lineage

246
Q

Risk factors for MS

A

Genetic
Vit D def.
EBV as a kid exposure [7-18yrs old]
Cigarette smoke

247
Q

What two signs are not present in MS but are in ADEM

A

Loss of taste

Retroauricular pain

248
Q

5 initial sxs of MS

A 
Sensory Loss
Optic neuritis w EOM pain 
Weakness 
Paresthesias 
Diplopia
249
Q

Visual symptoms of MS are due to what CN

A

CN 6 Palsy

250
Q

What two sxs are present in Bell’s palsy and not MS

A

Back of head pain

Loss of taste

251
Q

What is a clinical sign of MS

A

Limb weakness w exercise = loss of strength

UMN type sxs

252
Q

6 other sxs assoc w MS

A 
Ataxia 
Bladder bowel dysfunction 
Vertigo 
Fatigue 
Depression
253
Q

What is internal ophthalmoplegia

A

Impaired Adduction and ipsilateral medial fasiculations associated with MS

254
Q

What part of the body is most affected by MS

A

The Legs

255
Q

What is the most common type of MS

A

Relapsing Remiting

256
Q

What is second at progressive MS

A

Begins as RMS -> steady deterioration

257
Q

Primary progressive

A

Study progression @ onset

258
Q

Most useful dx test for MS

A

MRI w and w/o contrast

259
Q

What is a dx finding on MRI for MS

A

2 regions of white central matter brightened @ 2 different occasions , anywhere in the CNS mater

260
Q

Hallmark dx criteria for MS

A

2 sxs or signs or more +

2 episodes or more

261
Q

Where do lesion for MS need to be located

A

CNS white matter

262
Q

What qualifies as 2 episode for MS

A

Longer than 24 hours of sxs separated by more than 1 month

263
Q

CSF of MS includes?

A

Oligoclonal banding w increased protein layer

264
Q

What is the acute TXM for MS

A

Glucocorticoids = prednisone

IV then oral taper

265
Q

What I’d chronic TXM for MS

RMS

A

An immunomodulator
Beta interferon
Avonex or
Glatiramer

266
Q

What treats primary progressive MS best?

A

Ocrelizumab

267
Q

Are immune suppressant drugs effective in secondary progressive MS?

A

No!

268
Q

What conditions lead to a more favorable MS DX

A

Optic neuritis
Sensory sxs w/ less than 2 relapse
Minimal impairment in first 5 yrs

269
Q

What MRI CHARACTERISTIC IS SUGGESTIVE OF MS DX

A

3 or more lesions on MRI

270
Q

What are the presenting sxs of ADEM

A

Optic neuritis W/ EOM movement
Vision loss
Behavior change
Cognitive abnormalities

271
Q

Describe the lesions in the CNS (ADEM)

A

Multiple
Patchy
Bilateral
Confluent

272
Q

Where in the brain does ADEM effect?

A

White matter of posterior hemisphere

273
Q

What usually precedes ADEM

A

Pos infection
Illness
Vaccination

274
Q

MRI findings of ADEM

A

Perivenular

Inflammation and demyelination

275
Q

What shortens the course and lessens the severity of ADEM?

A

IV corticosteroid

276
Q

What does ALS translate to?

A

No Nourishment

277
Q

What is the most common progressive motor neuron DZ

A

ALS

278
Q

Explain the pathology of ALS

A

Degenerating upper and lower motor neurons

279
Q

Amyotrophy =

A

No muscle nourishment

280
Q

Lateral sclerosis =

A

Loss of fibers in the fibrillary lateral columns

with gliosis

281
Q

Describe the weakness with ALS

A

Asymmetric

282
Q

What bodily FXN should are in tact with ALS

A

Sensory
Bowel bladder
Cognition

283
Q

What is the end stage for ALS?

A

Respiratory paralysis

284
Q

ALS effects males or females?

A

Males

285
Q

TXM for ALS

A

No cure.

Rilvzole increases short term survival

286
Q

What slows the progression of ALS in patients w mild dz

A

Edaravone

287
Q

What is the transmission of polio

A

Enterovirus

Fecal to oral route

288
Q

Polio takes advantage of what environments

A

Poor sanitation

Somalia
Papa New Guinea
Afghanistan
Pakistan

289
Q

Is the vaccine as bad as polio?

A

Yes! If it contains the live virus

290
Q

What does polio destroy?

A

Anterior horn of the spinal cord

Weakness
Paralysis

IRON LUNG

291
Q

How do you DX POLIO

A

Viral isolate from stool or nasopharyngeal sample

292
Q

INJURY ABOVE WHAT CERVICAL LEVEL WEAKENS THE DIAPHRAGM AND LEADS TO RESPIRATORY ARREST

A

C5

293
Q

Abdominal reflex loss occurs when?

A

T6

294
Q

Bladder dysfunction occurs when?

A

Lesions Above the sacral layer

295
Q

Legion of the right dorsal column at L1 will cause what?

A

Ipsilateral loss to the right leg
Ipsilateral
Absent vibration and Position sense of the right leg

Think MS

296
Q

Right vascular cutaneous lesion of C3 causes what?

A

Right arm position sense loss and loss of vibration

Think MS

297
Q

Lateral corticospinal tract lesion causes what?

A

L1
Pain temp loss crosses over medulla causes IPSILATERAL
UMN weakness
Below the level of the lesion

Hyper Flexion
Hypertonia
Paralysis
Weakness

298
Q

Right spinothalmic tract causes what?

A 
C5-C6 
Impaired pain BILATERAL ; BOTH ARMS
No cross over 
No pain session 
No temperature sensation
299
Q

Hemicord or Brown Sequard syndrome contains what lesions

A

Dorsal column - ipsilateral
Lateral corticospinal - ipsilateral
Lateral spinothalmic - contralateral

Below opposite lesion side - loss of pain and temperature
Same side as lesion - Proprioceptive loss and UMN weakness position and vibration loss

Partial transection

300
Q

Completes transverse damage of spinal cord @ L1 causes what?

A

Transverse cord lesion
Low vibration and position seven bilateral from the neck down
Fasiculus gracillus
Cutaneous issues

301
Q

Cervical region damage causes what?

A

Absent vibration and position sense bilateral from neck down

302
Q

Anterior cord syndrome causes what?

A

Lateral corticospinal tracts absent of pain

303
Q

What is an example of a neoplasticism cord compression tumor?

A

Epidural abscess/hematoma/granuloma

304
Q

How does an epidural hematoma present?

A

Pain at night with herniated disk
Vertical osteoarthritis is and compression with fracture dislocation

  • back pain
  • bladder disturbance
  • paresthesias
305
Q

Where are tumors typically of the spinal cord

A

Usually extramedullary
“Outside the cord”
Neurofibromas
Meningiomas

306
Q

S/sxs of a neoplastic cord tumor (6) MRS LAW

A

Motor heaviness
Radicular pain
Stiff

Localized and diffuse
Atrophy
Weakness

307
Q

PE findings of a neoplastic tumor

A

Anterior nerve root and posterior nerve root damage with transverse lesion changes

308
Q

Expected deficit of a neoplastic tumor

A

Direct compression
Arterial insuff. Or venous insuff.

Invasive infiltrate w/ intramedualllry lesions

309
Q

What part of the spine is often affected with a neoplastic cord tumor

A

Thoracic spine

310
Q

What do you expect to find in the CSF for a neoplastic tumor of the spinal cord

A

Xanthochromia
Elevated protein
Normal WBC with low glucose

311
Q

What will help decide if the cord tumor is intravascular or extra medullary

A

MRI

312
Q

An intramedullary tumor will effect what structure?

A

The parenchyma

313
Q

An extra medullary tumor will effect what structure

A

The dura

314
Q

Examples of Intra vs Extra -medullary tumors (2)

A

Intra:
Ependymoma
Glioblastoma

Extra:
Meningioma
Schwannoma (neurofibroma)

315
Q

What is transient monocular blindness?

A

CN 2 : Monocular

Sudden transient vision loss in one eye, feels like “curtain over the eye”

Decreased blood flow to the retina
Low glucose

DO A COMPLETE EVAL FOR TIA OR STROKE

316
Q

WHAT is a hollenhorst plaque

A

Carotid fat

317
Q

Explain optic neuritis

A

Inflammation
Pain exacerbated by EOMs
Subacute ; UNILATERAL visual loss [2-3 days]
Retobulbar pain

318
Q

Work up for optic neuritis

A

Ophthalmology consult

MRI head / orbit

319
Q

TXM of optic neuritis and prognosis

A

IV methylprednisone followed by oral taper

Prognosis = MS in 15 yrs for 50% of patients

320
Q

Who is at risk for optic neuritis

A

Female and multiple lesions on brain MRI

321
Q

An optic nerve complete block on the right side would cause what vision?

A

No right eye vision

322
Q

A block at the optic chiasm would cause what vision? And is indicative of what tumor?

A

Lateral sided blindness

Pituitary tumor

323
Q

A lesion of the optic tract would cause what vision?

A

Left sided blindness

324
Q

A lesion of the loop of meters would cause what vision? And is most likely located where?

A

“Pie in the sky”

Temporal Lobe

325
Q

A lesion of the lateral gesticulate nucleus would cause what vision? And is similar to what other location?

A

Left sided blindness

Optic Tract lesion

326
Q

Giant cell arteritis or Temporal arteritis explained

A

Inflammation of the external carotid artery @ the level of the temporal artery

Can extend inflammation to ophthalmic artery

Jaw claudication 
Bad HA 
Temporal tenderness 
Visual sxs 
Throat pain
327
Q

Dx of giant cell

A

ESR artery biopsy

328
Q

TXM of giant cell arteritis

A

Prednisone po daily

329
Q

What is Marcus Gunn pupil?

A

Affarent pupillary defect
Sensory systems optic nerve deficit

Pupil dilates with pen light
Does not constrict with RAPD
UNILATERAL

330
Q

What areas of the eye are affected by Marcus Gunn pupil?

A

Retina

Optic Nerve

331
Q

What is a deficit of CN 2

A

Binocular vision
Papilledema w increased ICP
BILATERAL

332
Q

CN2 deficit indicates what abnormality

A

Swollen optic disc and enlarged physio blind spot

333
Q

Sxs of binocular vision disorder

A

HA
N/V
Neuro dysfunction

334
Q

Explain CN 6 Palsy

A

Pituitary Tumor

Often present as a prolactinoma
Occipital cortex lesions

HA
Galactinoma
Acromegaly
Amenorrhea

335
Q

Describe the CN6 tumor

A

Tumor of the optic chiasm

Bitemporal Hemaniopsia

336
Q

Pituitary tumor

A

Two types :

Functional - HA , Galactorrhea amenorrhea amenorrhea
Acromegaly

Non Functional - tumor on optic chiasm Bitemporal hemaniopsia

REQ MRI EVAL

337
Q

Txm for pituitary tumor

A

Surgical excision ,

**Prolactinomas TXM = bromocriptine or carbergline

338
Q

An occipital cortex lesion causes what? And caused by?

A

Homonymous hemaniopia subtly

Trauma and Tumor infarct of the posterior cerebral artery

339
Q

CN 3 Palsy cause what?

A

Diplopia and ptosis

340
Q

CN 3 Palsy causes the pupils to do what?

A

Fixed down and eye w dilated pupil

341
Q

Largest cause of CN 3

A

Cerebral artery aneurysm

342
Q

Other causes of CN 3 Palsy

A 
Trauma 
Meningioma inflammation 
Tumor 
Opthalmoplegia 
Migraine
343
Q

Anisocoria causes the pupils to do what?

A

ASX

Unequal pupils

344
Q

If anisocoria is increased in the dark (the small pupil abnormal) and there is dilation lag or ptosis, what should you do?

A

Test with 10 percent cocaine

345
Q

After testing anisocoria found in the dark, if the small pupil does not dilate what is the cause?

A

Horners syndrome

346
Q

After testing anisocoria in the dark, if both pupils dilate symmetrically what is the cause?

A

Physiologic anisocoria

347
Q

If anisocoria is equal in the light and dark what should you observe for?

A

Brisk reaction to light

348
Q

If anisocoria is equal in light and dark and thee is a brisk reaction to light, what is the cause?

A

Physiologic anisocoria

349
Q

If anisocoria is more in the light, with the large pupil abnormal what sign would lead you to suspect third nerve palsy

A

Ptosis I and opthalmoplegia

350
Q

If Anisocoria is more in light and you observe isolated sluggish light reaction with light near dissociation what should you do next?

A

Use .1 percent pilocarpine

351
Q

After using pilocarpine in large pupil anisocoria if you observe that the large pupil constricts, what is the cause?

A

Adies tonic pupil

352
Q

What is the order of checking for an abnormal pupil

A

Dark check - both eyes dilate
Light source check one eye - both eyes constrict
Light source check the other eye -both eyes constrict
Near target check - eyes constrict and converge

353
Q

Characteristics of homers

A

Cervical sympathetic nerve interruption

  • ptosis
  • anhydrosis (involved side of face)
  • mitosis

THINK LUNG TUMOR

354
Q

What two diseases are associated with Argyll Robertsons pupil

A

Neurosyphilis or MS

355
Q

AR pupil does what?

A

Accommodates to near vision does not react to light consentually

356
Q

Adies pupil commonly affects what group of people?

A

You do healthy women and also those with diabetes

357
Q

Adies pupil affects what system, causing what?

A

Parasympathetic

= constrict poorly to light

358
Q

CN 4 palsy causes what symptoms

A

Diplopia
Vertical Diplopia

Eye deviates upward and medial and tilts opposite to accommodate

359
Q

CN 6 Palsy

A

Trauma, microvasucalar dz and basal ICP = most common cause

Adducted at rest cannot abduct
BILATERAL = INC. ICP

360
Q

CN 5 TRigeminal neuralgia ; tic douloureux causes what?

A

Laminating pain distributed in one or more branches of the lower 2/3 of the face

Compression of the trigeminal nerve root by a blood vessel

361
Q

TXM of trigeminal neuralgia

A

Spont recovery
Carbamazepine (1st)
Oxcarbazaepine (less bone marrow toxicity the carbamazepine)

362
Q

What is a major ADE of carbamazepine

A

Agranulocytosis

*monitor w CBC and LFT’s

363
Q

What are the ESR and CRP levels in CN 5

A

They are normal

The result is due to compression not inflammation

364
Q

What artery is compressed in CN 5 trigeminal neuralgia

A

Superior cerebral artery

365
Q

Bell’s palsy causes what?

A

Facial Peresis of lower motor neuron
CN7 weakness

Irregular ear pain and loss of taste

366
Q

What happens if the forehead muscle is spared in Bell’s palsy

A

Central lesion

367
Q

TXM of Bell’s palsy includes what?

A

Prednisone, to decrease sxs and protect the eye

368
Q

Ramsay hunt syndrome is associated with what other disease? With what accompanied sxs

A

HVZ (re-reuption)
Facial weakness and prodrome of pain
W/ a vesicular rash and vesicles in the ear

369
Q

TXM of Ramsay hunt

A 
Antivirals 
Acyclovir 
or 
Famcyclovir 
\+ corticosteroid
370
Q

CN8 cochlear portion disease causes what type of hearing loss

A

Conductive hearing loss
(External auditory canal or middle ear)
Earwax often impacted

371
Q

If there is no CN 9, what occurs

A

No gag reflex or swallow

372
Q

If there is no CN 10 what occurs?

A

ASX rise of uvula

373
Q

If there is no CN 12 what occurs?

A

Flaccid paralysis of tongue w atrophy and speech issues

374
Q

Sxs of CN 11 spinal accessory

A

Drooped shoulder
Muscle atrophy
Weak elevation of arm/shoulder
Shoulder pain and scapula winging

375
Q

Altered sense of taste can occur in what diseases where?

A

Ant 2/3 of the tongue

Bells Palsy

376
Q

Somatosensory sensations (of hot peppers) occurs with what CN

A

CN 5

377
Q

Taste is sensed by what three CN’s

A

CN 7,9, and 10

378
Q

Loss of taste on the anterior 2/3 of the tongue occurs where

A

Bells Palsy

379
Q

Loss of taste on the posterior 1/3 of the tongue occurs with what CN

A

CN 9

380
Q

What two things can cause taste loss that are not cranial nerves

A

Medications

Eating too many MRE’s

Neuro BLOCK 1 (1 decks)

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