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NEUROMUSCULAR > lecture 1: neurology > Flashcards

lecture 1: neurology Flashcards

1
Q

central nervous system is considered a ____

A

upper motor neuron disorder

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2
Q

what are 2 examples of my or neuron disorders in the peripheral nervous system (UMN/LMN)

A

• Amyotrophic Lateral Sclerosis (Lou Gherig’s disease)*
• Polio/post polio syndrome*

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3
Q

what are 3 examples of peripheral nerve disorders in the peripheral nervous system

A

• Radiculopathies
• Plexopathies
• Polyneuropathy

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4
Q

• Myasthenia gravis
• Lambert Eaton’s myasthenic syndrome
• Botulism

these are all examples of what kind of disorders

A

neuromuscular junction

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5
Q

what is capgras delusion

A

recurrent belief that a person has been replaced by an imposter

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6
Q

capgras delusion , stiffperson syndrome , and prosopagnosia are examples of what

A

fascinomas

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7
Q

capgras delusion is reported with lesions in the ___ hemisphere

A

right

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8
Q

what syndrome is diffuse stiffness without weakness or numbness and is an autoimmune disorder

A

stiffperson syndrome

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9
Q

define prosopagnosia and what side hemispheric lesion is it

A

inability to recognize faces of familiar people

right side

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10
Q

good ___ is essential tp the diagnosis

A

history

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11
Q

• Disordered mentation, attention, memory, behavior
• Language and communication disturbances
• Excessive daytime sleepiness, insomnia, fatigue
• Visual disturbances (vision loss, diplopia)
• Weakness, numbness, other sensory alterations, balance
problems
• Sphincter disturbances (urinary or fecal incontinence, inability
to void)
• Erectile or ejaculatory dysfunction
• Sudden (paroxysmal) behavioral changes (seizures, loss of
consciousness)

these are all complaints of what

A

neurologic

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12
Q

what are the 8 things that weakness could mean

A

– Fatigue
– Apathy
– Pain
– Decreased sensation
– Imbalance
– Incoordination
– Drowsiness
– Loss of muscle strength

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13
Q

what are the 7 things to check for neurologic exam

A

I. Mental Status & Language
II. Cranial Nerves
III. Motor
IV. Sensation
V. Reflexes
VI. Coordination
VII.Gait

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14
Q

what are the 4 levels of consciousness

A

alert

lethargy

stupor

coma

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15
Q

what level of consciousness are you awake and interactive

A

alert

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16
Q

what level of consciousness will the pt appear asleep but may be aroused with stimulation to interact with environment

A

lethargy

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17
Q

what level of consciousness will the pt arouse briefly to vigorous stimuli but not to the point of being interactive

A

stupor

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18
Q

what level of consciousness is the pt unresponsive to external stimuli

A

coma

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19
Q

what is apraxia

A

inability to carry out a motor act int he absent of weakness or ataxia

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20
Q

what is dysarthia and what kind of disorder is it and ehat does it affect

A

slurred speech

motor disorder affecting the muscles of articulation

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21
Q

what is aphasia

A

impairment of lang production or comprehensions

  • broca’s area
  • wernickes area
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22
Q

whar are the 6 components of language

A

spontaneous speech

naming

comprehension

repetition

reading

writing

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23
Q

what is the path of language in the brain

A
  1. heschl’s gyrus , primary auditory cortex
  2. wernickes area , superior temporal gyrus
  3. arcuate fasciculus
  4. broca’s area , left inferior frontal
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24
Q

what links written words with language

A

angular gyrus

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25
Q

what is anosmia mean

A

loss of smell

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26
Q

what is dysguesia

A

altered taste

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27
Q

what are common path for cranial number 1 (olfactory nerve) sumptomatic and asymptomatic

A

symp: post viral , head trauma

asymptomatic: alzheimer’s , parkinson’s

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28
Q

what CN deals with
– Visual acuity
– Visual fields
– Ophthalmoscopy
– Pupillary reactivity
(afferent limb)
– Color perception

A

cn II: optic

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29
Q

what mm goes with CN IV: trochlear N

A

superior oblique mm

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30
Q

what mm does the motion for CN VI: abducens N

A

lateral rectus MM

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31
Q

what exam do you do for CN III, IV and VI

A

extraocular movements , ptosis

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32
Q

what mm do the motion for CN III: oculomotor

A

superior rectus

inferior rectus

medial rectus

inferior oblique

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33
Q

when you are doing the swinging flashlight test what is the direct response and consensual response

A

the direct response is shine light into pupil and look for constriction

consensual response is look for opposite pupil constriction

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34
Q

if you do the swinging flash light test and there is no direct response what is the problem

A

problem with ipsilateral optic never

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35
Q

if you do the swinging flashlight test and there is no consensual response what can be the 3 problems

A

problem with opposite optic nerve , ipsilaterla parasympathetic of CN 3 or pupillary constrictor mm

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36
Q

what CN is

– Muscles of mastication (chewing)
– sensation of the face, conjunctiva, sinuses

A

CN V: trigeminal nerver

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37
Q

what is the exam for CN V: trigeminal

A

corneal reflex

strength of jaw

facial sensation

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38
Q

what 2 CN does the corneal reflex test and what are u doing and looking for

A

CN V and VII

touch cornea gently with cotton swab and look for eye lid blinking

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39
Q

what CN is this

– Muscles of facial expression, stapedius
– Lacrimal glands (tearing)
– Taste of anterior 2/3 of tongue

A

CN VII: facial

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40
Q

what is the exam for CN VII: facial

A

show teeth , wrinkle forehead, close eyes tight

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41
Q

if there is a central lesion for CN VII what does that mean

A

lower half of face weak on the contralateral side (stroke)

if there is a right sided lesion then the left half od the lower face will be weak bc it crosses

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42
Q

if there is a peripheral lesion for CN VII: facial what does tha mean

A

entire half of face weak on the ipsilateral side

bell’s palsy

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43
Q

what is the exam for CN VIII: vestibulochoclear nerve

A

hearing to finger rubs or tuning fork

eye movements , nusyagmus

head thrust

dix hall pike

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44
Q

what cn is this

– Sensation/taste from posterior 1/3 tongue, back of the throat
– Motor nerve elevates pharynx, contributes to gag
– Parasympathetics to parotid

A

CN XI: glossopharyneal nerve

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45
Q

what CN is this

– Motor nerve innervating muscles of pharynx, larynx, tongue,
smooth muscles
– Major autonomic nerve - parasympathetic efferent

A

CN X: vagus nerve

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46
Q

what is the exams for CN XI and X

A

palatial elevation

gag reflex

taste

swallowing

assessment of speech

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47
Q

what 2 mm does the CN XI: accessory n inn

A

SCM and traps

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48
Q

what CN INN the tongue MM

A

CN XII: hypoglossal n

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49
Q

what are the 3 different tones

A

flaccidity

rigidity

spasticity

50
Q

what is flaccidity define as

A

little resistance to passive movement

51
Q

what tone is steady muscular tension that is equal in degree in opposing mm groups

A

rigidity

52
Q

what tone is sustained increase in tension of a mm when it is passively lengthened

A

spasticity

53
Q

which tone is speed dependent

A

spasticity

54
Q

what brain strucutre has to do with rigidity

A

BG

55
Q

atrophy, pseudohypertrophy these are consider what in the motor exam

A

bulk

56
Q

what 2 things do you check in the motor exam

A

bulk and tone

57
Q

what are the 5 upper motor neuron signs

A
  • stiffness , spasticity
  • weakness in pyramidal pattern ( flexor strong in UE and extensors stronger in LE )
  • hyperreflexia

-pathological reflexes

  • babinskis
58
Q

what are the 4 lower motor neuron sign

A

-•Weakness, muscle atrophy,
fasciculations, cramps.
•NO SENSORY INVOLVEMENT
•NO PAIN
•Hypoactive reflexes

59
Q

what grade of power is partial arc of movement with gravity eliminated

A

2

60
Q

what grade of power is full arc against gravity and some added resistance

A

4

61
Q

what number is it if the reflex is normla

A

2+

62
Q

what do you rate a clonus reflex

A

4+

63
Q

what is a Series of rhythmic involuntary muscle
contractions induced by sudden passive stretching of
a muscle

A

clonus (UMN lesion)

64
Q

is hoffmann sign UMN or LMN and what finger do you do it on

A

UMN and middle

65
Q

what is the babinski sign

A

extensor plantar response

66
Q

when is the babinski sing abnormal

A

when the toes goes up (except in babies)

67
Q

what tract is pain and temperature

A

lateral spinpthalamic tract

68
Q

what tract is light touch

A

ventral spiniothalamic tract

69
Q

what tract is vibration and proprioception

A

DCML

70
Q

what part of the neurologic exam do you – Screen for distal/proximal gradient, asymmetry,
dermatomes

A

V. sensation

71
Q

what is one of the more earliest signs of dorsal column disease

A

romberg sign

72
Q

when sit he romberg sign positive

A

when pt is able to stand with his feet together while his eyes are open but sways or falls when they are closed

73
Q

when is the romberg sign included during the neurologic exam

A

sensory or coordination exam

74
Q

when during the neurologic exam do you test the function of the cerebellum, basal ganglia, and related connections.

A

VI. coordination exam

75
Q

disorders of the coordination exam manifest as what 5 things

A

imbalance
incoordination
ataxia
dusdiadochokinesia
abnormal movements

76
Q

what 2 coordination test assess for dysmetria and intention tremor

A

finger nose finger test and heel to shin test

77
Q

what does rapid alternation movements test for

A

dysdiadochokinesia

78
Q

define station

A

attitude or manner of standing , including posture

79
Q

what does fiat assess

A

width of the base , arm swing , pelvis rotation , height of step and symmetry

80
Q

MRI, CT, myelography, angiography,
perfusion, DAT are all examples of what

A

neuro imaging

81
Q

electroencephalography (EEG),
electromyography (EMG), nerve conduction studies,
evoked potentials these are examples of what

A

neurophysiology

82
Q

– Inflammatory and infectious conditions, including
meningitis, encephalitis, multiple sclerosis
– Subarachnoid hemorrhage
– Pseudotumor cerebri (idiopathic intracranial
hypertension): high opening pressure
– Cancer involving meninges

what is a diagnosis of these things

A

lumbar puncture

83
Q

lumbar puncture inject what medications

A

chemotherapy , anesthesia

84
Q

what levels of the spinal cord does the lumbar puncture go in at and into what space

A

L4/L5

epidural

85
Q

what is normla measure pressure for lumbar puncture ____ mm H2O

A

80-200

86
Q

what are some complications for lumbar puncture

A

post LP HA

bleeding

infection

back pain

87
Q

what are 5 advantages of computed tomography

A

– Emergency diagnosis of acute conditions (stroke, trauma).
Blood easily seen.
– Quick and readily available
– Only option for those with contraindications to MRI
– Visualization of bone (skull)
– High resolution of vascular structures

88
Q

what are disadvantages of computed tomography

A

radiation exposure and poor visualization of BS

89
Q

what is hyper dense on a CT

A

calcium and bone

90
Q

what is hypodense (dark) on CT

A

CSF, fat

91
Q

is white matter or grey matter darker on CT

A

white

92
Q

is blood hyper dense or hypodense on CT

A

hyper dense

93
Q

on a CT , stroke , edema , fluid and air are ____

A

hypodense

94
Q

what are the 3 advantages of MRI

A

no radiation exposure

much higher resolution

unmarred by bony artifact

95
Q

what are 3 disadvantages of MRI

A

some contraindications (pacemaker)

can’t assess bone

long acquisition time

96
Q

what is the test of choice for imaging most central nervous system disease/lesions

A

MRI

97
Q

what choice of imaging would you do for these … infarcts, hemorrhages, vascular malformations,
aneurysms, tumors, degenerative disorders,
contusions, demyelination (MS), epilepsy,
infections

A

MIR

98
Q

can an MRI be done with or without contrast material (gadolinium)

A

yes

99
Q

MRI: delusion weighted imaging is ___ in acute stroke

A

bright

100
Q

what is an injection of 5-25 mL of radiopaque dye into
subarachnoid space via lumbar puncture.

A

myelography

101
Q

myelography is combined with what to allow for visualization of subarachnoid space

A

CT scanning

102
Q

what are the 4 things that myelography evaluates for

A

spinal stenosis , cord arteriovenous malformation , tumor and abscess

103
Q

what do you usually do instead of a myelography

A

MIR

104
Q

what is injection of dye into cranial arteries (via
catheterization from femoral artery)

A

conventional angiography

105
Q

what can you visualize with a conventional angiography

A

occlusion , dissections , primary angiitis , aneurysms , vascular malformations

106
Q

conventional angiography is. an intra arterial injection of ___

A

thrombolytic

107
Q

what is interventional for conventional angiography

A

clot removal , stenting , angioplasty , coils and glue

108
Q

what measure brain electrical activity thru scale electrodes

A

EEG

109
Q

what does an EEG evaluate for

A

seizures , brain death , encephalopathy , dementia , coma

110
Q

what is a Recording of electrical activity in central
sensory pathways produced by visual (VEP),
auditory (BAEP), or sensory (SSEP) stimulation

A

evoked potential

111
Q

what does VEP evoked potentials mean

A

alternation checkerboard pattern

112
Q

what is BAEP (auditory) evoked potientials mean

A

auditory clicks thru earphones

113
Q

what does SSEP ( sensory) evoked potential mean

A

electrical stimuli applied to peripheral nerves

114
Q

what do you use for Diseases of muscle, nerve, neuromuscular junction

A

EMG (electromyography) and NCV ( nerve conduction velocities)

115
Q

what is an Insertion of a small needle
into individual muscles and recording of motor unit
potentials at rest and with activity

A

electropgyogrpahy

116
Q

what is an Electrical
stimulation over nerves with recording of sensory
and motor nerve potentials and velocities

A

nerve conduction velocities

117
Q

what will an axonal neuropathic show for an eMG and NCV

A

decreased amplitudes on NCV , abnormal spontaneous activity on EMG

118
Q

what will a demyelinating neuropathies show on a EMG and NCV

A

slowed condution

119
Q

what will a myopathies show on an EMG and NCV

A

normal NCV , small duration , low amplitude potentials

120
Q

what does myasthenia gravis show on an EMG and NCV

A

abnormalities on repetitive nerve stimulation

121
Q

what does this describe

– Increased tone
– Hyperreflexia
– No atrophy

A

UMN

122
Q

what does this describe

– Decreased/normal tone
– Hyporeflexia
– Atrophy

A

LMN

NEUROMUSCULAR (15 decks)

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