FINAL: Neurology

Question 1

what are the four clinical signs of increased intra-cranial pressure

Answer 1

projectile vomiting, uneven pupil size, pupil not reactive to light, declining level of consciousness

Question 2

what are the three clinical signs of cushings syndrome

Answer 2

hypertension, brachycardia, abnormal resupiration (also indicitave of increased intra-cranial pressure)

Question 3

when completing neurological testing, if it appears that the patient has one normally-responsing side of the body and one weak side, what is this an indication of?

Answer 3

decreased lateralization of neurological signs and it would indicate increased intra-cranial pressure

Question 4

what are the four clinical signs of meningitis

Answer 4

photophobia, neck stiffness, positive brudinsky &/or kernigs test

Question 5

under what circumstances would a spinal tap be a contraindication for someone we suspect has meningitis

Answer 5

if there are more prevalent increased intracranial pressure signs than meningeal signs, then we cannot do a spinal tap. due to the pressure inside the skull, a spinal tap would cause the brain to fall down and herniate into the formen magnum, killing the patient.

Question 6

what are the three possible types of hemorrhages one can have in the brain

Answer 6

epidural hematoma, subdural hematoma, subarachnoid hematoma

Question 7

what is the cause for an epidural hemorrhage

Answer 7

trauma that causes a tear in the middle meningeal artery

Question 8

what are the clinical signs of an epidural hemorrhage

Answer 8

initial brief loss of consciousness, lucid interval after re-gianing consciousness, and death shortly after if left undiagnosed.

Question 9

what is the cause for a subdural hemorrhage

Answer 9

trauma with tearing the bridging veins

Question 10

what are the clinical signs of a subdural hemorrhage

Answer 10

stubborn headache increasing in intensity over time, and often in a fixed location

Question 11

what is the source of a subarachnoid hemorrhage

Answer 11

ruptured aneurysm

Question 12

what are the clinical signs of a subarachnoid hemorrhage

Answer 12

perceived as “the worse headache ever;” comes on suddenly followed by loss of consciousness minutes after

Question 13

PERLA

Answer 13

acronymn for: pupils are equal, and reactive to light, and accomodation - if these tests are not positive, then we can suspect an injury in the midbrain

Question 14

hydrocephalus

Answer 14

accumulation of excess cerebrospinal fluid

Question 15

cause of hydrocephalus

Answer 15

lack of absorption of CSF into the dural sinuses as a result of atrophy of arachnoid granulations, which normally deliver CSF (communicating hydrcephalus)
also could be due to an obstruction of flow of CSF (non-communicating hydrocephalus)

Question 16

what population is communicating hydrocephalus mostly found in

Answer 16

geriatric population

Question 17

what is the cause of non-communicating hydrocephalus

Answer 17

may be a result of a congenital defect or a complication of meningitis (ie: adhesions after a surgery)

Question 18

eitiology of ALS

Answer 18

loss of anterior horn cells

Question 19

ALS presentation

Answer 19

patient presents with progressive weakness that proceeds to paralysis fromneurogenic muscular atrophy
degeneration of MOTOR neurons only!!

Question 20

pathomechanism of ALS

Answer 20

because of the loss of anterior horn cells, the anterior (ventral) spinal motor nerve roots demonstrate atrophy. Upper motor neurons within the brain and the brain stem (pyramidial or corticospinal) may degernate as well.

Question 21

clinical presentations of upper motor neuron injury

Answer 21

spinal reflexes are exaggerated; positive babinski

Question 22

clinical presentations of lower motor neuron injury

Answer 22

disconnect to muscle-muscle becomes weak, reflexes become diminished and muscle atrophies; flacidity

Question 23

which kind of meningitis is usually the most severe form

Answer 23

bacterial meningitis

Question 24

which form of meningitis can be described as the following:
1. highly contageous
2. edema of the brain
3. disseminated intravascular coagulation

Answer 24

bacterial meningitis

Question 25

disseminated intravascular coagulation

Answer 25

two events at once:
extreme bleeding of internal organs & extreme thrombosis within vasculature of the body

Question 26

how do we see DIC clinically

Answer 26

IV line starts bleeding; come into hospital with bruises all over body; apply a little bit of pressure and you easily cause a bruise; patient may bleed form nose or bleed vaginally

Question 27

end stage of meningitis infection

Answer 27

when adrenals are bleeding (waterhouse friderichen syndrome)

Question 28

when bacterial meningitis is present, what 6 presentations will we see in a CSF analysis

Answer 28

CSF turbidity
increased protein CSF level
decreased glucose level in the CSF
neutrophilia in blood and CSF
bacteria in CSF
incresed pressure upon CSF withdrawal