Neuro

Question 0

Romberg Sign

Def’n, Seen In?

Answer 0

Swaying of the body when eyes are closed and feet are placed close together.

SEEN IN:
- Tabes Dorsalis (due to 3ry Syphilis)

Question 1

Positional Testing

Performance (2 steps), Evaluation (2), Uses?

Answer 1

TEST:
Patient sits on table w head turned to side, ready to lie down ->
Dr supports head as patient LIES DOWN.

EVAL:

• What Dr sees in patient’s EYES
• What patient feels

USES:
- Dx of Nystagmus

Question 2

Ataxia (Sensory, Cerebellar, Vestibular)

Answer 2

Lack of muscle coordination when voluntary movement is attempted.
SENSORY ATAXIA: Problem with ascending tracts or parts of brain
that interpret sensory info. Loss of balance
when eyes are closed, in dark, etc..
CEREBELLAR ATAXIA: Problem with Cerebellum. Irregular,
unstable + uncoordinated movements.
VESTIBULAR ATAXIA: Problem with vestibular canals.
Loss of balance.

Question 3

Cerebellar Ataxia

Mech, Seen In?

Answer 3

MECH:
- Cerebellar atrophy

SEEN IN:
- Ataxia-Telangiectasia

Question 4

Friedrich’s Ataxia

Def’n, Lesion Locations (2),
Inher, Genetics, Mech (4 steps),
Pres (6), Prognosis (2)?

Answer 4

Degenerative disorder of Cerebellum + SC (multiple tracts).

• Cerebellum (-> Ataxia)
• SC tracts (-> everything else)

AR.

Gene that encodes Frataxin- trinucleotide repeat expansion (GAA).

MECH:
Loss of Frataxin -> Fe BUILDUP -> Free Radical damage ->
Mitochondrial impairment.

PRES:
- Kyphoscoliosis in childhood

• Nystagmus
• Dysarthria
• Staggering gait
• Frequent falling
• Pes Cavus + “hammer toes”

PROG:

• Wheelchair-bound within a few years
• Hypertrophic Cardiomyopathy = cause of death

Question 5

Paresthesia

Def’n?

Answer 5

Abnormal sensation on skin of numbness, tingling, tickling, pricking or burning (eg “pins + needles”).

Question 6

UMN Damage

Lesion Location, Pres?

Answer 6

Lat Corticospinal tract.

PRES: * “Everything UP!” *
Hypertonia, hyperreflexia, spasticity, Babinski sign present.

Question 7

LMN damage

Lesion Location, Pres, Seen In (2)?

Answer 7

Ant Motor horn.

PRES: * “Everything DOWN / DEPRESSED!” *
Atrophy /↓muscle mass, hypotonia, hyporeflexia,
flacidity, fasciculations (twitching) + fibrillations.

SEEN IN:
- Polio + Werdnig-Hoffman Dz

Question 8

Athetosis vs Chorea (OPPOSITES)

Lesion Location, Def’n (vs), Seen In?

Answer 8

Basal Ganglia.

Slow writhing movements (esp of fingers) THINK: snakelike vs
Sudden jerky purposeless movements.

SEEN IN: Huntington’s Dz

Question 9

Dystonia vs Myoclonus (OPPOSITES)

Def’n (vs)?

Answer 9

Sustained muscle contractions (eg writer’s cramp) vs

Sudden brief muscle contractions (eg hiccups, jerks).

Question 10

Tremor

3 Types?

Answer 10

• Essential / Postural tremor
• Resting tremor
• Intention tremor

Question 11

Essential / Postural Tremor

Def’n, Inher, Pres, RX?

Answer 11

ACTION tremor. Worsens when holding posture.

AD.

PRES: Often self-medicate with alcohol, which↓tremor

RX: b-blockers

Question 12

Resting Tremor

Pres, Seen In?

Answer 12

PRES: Most noticeable DISTALLY.

SEEN IN:
- Parkinson’s (“pill-rolling” tremor)

Question 13

Intention Tremor

Lesion Location, Def’n?

Answer 13

Cerebellum.

Slow zigzag motion when pointing at a target.

Question 14

Paralysis

2 Types incl Def’n + Mech + Causative Bugs?

Answer 14

• Flaccid Paralysis:↓muscle tone -> weakness + paralysis.
  No release of STIM (Ach) signals at NMJs.
  C botulinum (botulinum toxin)
• Spastic Paralysis:↑muscle tone. Excessive contraction + rigidity.
  No release of INHIB (GABA, Glycine) signals in SC.
  C tetani (tetanospasmin toxin)

Question 15

Asterixis

Def’n, Seen In (2)?

Answer 15

“Flapping” / jerking tremor of hands when outstretched +
when wrists extended.

SEEN IN:

• Wilson Disease
• Ammonia toxicity

Question 16

Hemiballismus

Location Affected, Def’n, Etiology, Mech (2 steps), Seen In (Epi)?

Answer 16

CONTRALAT Subthalamic Nucleus.

Wild flinging movements of half the body (1 arm +/- 1 leg).

ET: Destruction of Subthalamic Nucleus due to HEM (ie Htn, Lacunar Stroke).

MECH:
Destruction of CONTRALAT Subthalamic Nucleus ->
Loss of INHIB of Thalamus thr Globus Pallidus (Internal Segment)

SEEN IN: Hypertensive patients

Question 17

Tetany

Def’n, MCC?

Answer 17

Involuntary muscle contractions caused by↑A.P frequency in nerves that supply them.

MCC = Hypocalcemia

Question 18

Tetanus

Location Affected, Causative Bug, Mech, Pres (3)?

Answer 18

Renshaw cells in SC.

CB = C tetani (tetanospasmin = toxin)

MECH = Blockage of GABA + Glycine release from Renshaw cells in SC.

PRES:

• Spastic / Tetanic paralysis
• Trismus (lockjaw)
• Risus Sardonicus