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PANCE review > Neuro > Flashcards

Neuro Flashcards

1
Q

What makes up the brainstem (top to bottom)?

A

midbrain, pons, medulla

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2
Q

Myelination is done by what type of cells?

A

Schwann cells in PNS

Oligodendrocytes in CNS

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3
Q

_______ is communication between brain and thoracic and abdominal viscera.

A

Vagus nerve (CN X)

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4
Q

Describe pathway of corticospinal tract.

A

R motor cortex -> cross at medullary pyramids -> anterior horn -> L side muscle

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5
Q

Symptoms of Lower motor neuron lesion

A 
weakness/paralysis
flaccidity
diminished reflexes
fasciculations (twitches)
muscle atrophy
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6
Q

Symptoms of Upper motor neuron lesion

A

weakness/paralysis
spasticity
increased reflexes
Babinski’s sign

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7
Q

What is an abnormal Babinski?

A

stroke bottom of adult foot and big toe goes up

*normal during infancy

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8
Q

clonus

A

repetitive, rhythmic contraction of muscle when it is stretched (commonly ankle)

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9
Q

What are two sensory pathways and what signals do they transmit?

A

Posterior columns: proprioception, discrimination, vibration

Spinothalamic: pain and temp

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10
Q

Where does each sensory pathway decussate?

A

Posterior columns: medulla

Spinothalamic: immediately in spinal cord

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11
Q

Trace pathway of proprioception, vibration, and discrimination sensation from left side to body to brain.

A

L body -> posterior spinal cord -> posterior column -> cross at medulla -> medial lemniscus -> R thalamus

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12
Q

If pain/temp sensation loss on left side of body, then where is possible lesion?

A

right spinal cord or right thalamus

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13
Q

What pathology destroys an entire half of the spinal cord?

A

Brown-Sequard Syndrome

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14
Q

C6 dermatome

A

thumb

lateral arm

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15
Q

C7 dermatome

A

digits 2 and 3

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16
Q

C8 dermatome

A

digits 4 and 5

medial arm

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17
Q

Dermatome that runs back of calf to lateral foot

A

S1

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18
Q

Dermatome that runs down posterior arm and hand

A

C7

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19
Q

Dermatome that runs down shin to top of foot

A

L5

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20
Q

Which cranial nerves exit from each division of brainstem?

A

2-4 midbrain
5-8 pons
9-12 medulla

  • Olfactory and vision pathway don’t go to brainstem
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21
Q

Effects of optic nerve lesion

A

blindness in one eye, other eye unaffected

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22
Q

Effects of left optic tract lesion

A

blindness in right hemisphere of each eye

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23
Q

Which cranial nerves innervate the extraocular muscles?

A

CN III, IV, VI

IV: superior oblique
VI: lateral rectus
III: all the rest (IO, SR, IR, MR)

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24
Q

Effects of complete CN III lesion

A

ipsilateral eye is “down and out”
dilated pupil
ptosis (drooping eyelid)

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25
Q

Cranial nerves involved in pupillary light reflex

A

oculomotor (CN III) - allows eyes to constrict with light

optic (CN II) - allows consensual response if CN III intact

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26
Q

Signs of Horner’s Syndrome

A

ptosis
miosis (constricted pupil)
anhidrosis (loss of sweating)

  • loss of sympathetic pathway to face and eyes
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27
Q

_____ is only cranial nerve to project contralaterally.

A

CN VI

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28
Q

What are functions of cranial nerves that innervate the face (sensory and motor)?

A

CN V sensory: 3 branches - ophthalmic, maxillary, mandibular
CN VII motor: chewing muscles

  • both involved in corneal reflex
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29
Q

Bell’s Palsy vs Cerebral stroke

A

Bell’s Palsy: CN VII lesion, paralysis of entire ipsilateral face

Stroke: UMN lesion, facial droop on contralateral side but forehead unaffected

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30
Q

Lesion affecting CN VIII that causes unilateral hearing deficit?

A

acoustic neuroma (or vestibular schwannoma)

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31
Q

What is the vestibulo-ocular reflex?

A

vision steady while head rotates side to side

“doll’s eye” test in coma patient to determine if brainstem intact

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32
Q

What nerve may be damaged if absent gag reflex?

A

CN IX (glossopharyngeal)

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33
Q

If when patient says “ahhh” uvula deviates to the left, then where is the lesion?

A

Right side of CN X (vagal)

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34
Q

How is CN XI tested?

A

test strength of shoulder shrug and head rotation (trapezius and SCM muscles)

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35
Q

How is CN XII tested?

A

“stick out your tongue”

tongue will deviate toward lesion side

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36
Q

Effects of cerebellar lesion

A

“Errors of rate, range, force, and direction”

IPSILATERAL ataxia, intention tremor, nystagmus, vertigo

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37
Q

Effects of basal ganglia lesion

A

CONTRALATERAL chorea, resting tremor, akinesia, rigidity

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38
Q

Pathophysiology of Parkinson’s

A

shortage of dopamine due to degeneration of substantia nigra (midbrain)

motor regions of cerebral cortex inhibited

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39
Q

Hallmark signs of Parkinson’s

A

bradykinesia
resting tremor
lead-pipe or cogwheel rigidity
shuffling, hunched-over gait

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40
Q

Main treatment of Parkinson’s

A

L-Dopa

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41
Q

Side effects of anti-Parkinson meds

A

Hallucinations, Schizophrenia (too much dopamine)

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42
Q

dementia vs delirium

A

delirium is an acute change in mental status

dementia is progressive decline in cognitive function

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43
Q

CT/MRI results of Parkinson’s

A

NORMAL; used to r/o other causes

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44
Q

Lewy Bodies may be seen on an autopsy of the brain in…

A

Parkinson’s disease
Dementia with Lewy bodies
Alzheimer’s disease

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45
Q

Risk factors of cerebral aneurysm

A 
Smoking
ETOH
HTN
Obesity
PCOS
Marfan syndrome
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46
Q

A ruptured cerebral aneurysm (

Berry aneurysm) is common cause of ___________.

A

subarachnoid hemorrhage

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47
Q

How to manage a cerebral aneurysm?

A

Known aneurysms monitored:
BP control
Cholesterol control
F/U imaging

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48
Q

Location of cerebral vs epidural vs subdural vs subarachnoid hemorrhages

A

cerebral - within parenchyma or ventricle
epidural - btwn dura and skull
subdural - btwn dura and arachnoid mater
subarachnoid - btwn arachnoid and pia mater

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49
Q

Which brain bleed most often caused by trauma?

A

epidural

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50
Q

Severe headache “The Worst Headache of my life!” lasting hours to day =

A

subarachnoid hemorrhage

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51
Q

Gold standard for inter-hemorrhage bleeding dx

A

Non-contrast head CT

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52
Q

How are subdural and epidural hemorrhages differentiated?

A

crescent shape bleed on CT = subdural

biconcave/rounded bleed = epidural

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53
Q

Inter-hemorrhage bleeding treatment

A 
Reduce ICP (steroids, Mannitol)
Control BP
Pain killers
Anti-seizure meds
Surgery: Craniotomy, surgical clipping, endovascular coiling
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54
Q

Risk factors of stroke/TIA

A 
Increasing age
African American, American Indian, Hispanics
HTN
Smoking
Diabetes
Oral contraception
ETOH
Afib
Heart valve issues
Endocarditis
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55
Q

2 types of stroke? Which more common?

A

Ischemic (85%)

Hemorrhagic

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56
Q

define dysarthria

A

motor speech disorder due to neurological injury

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57
Q

define apraxia

A

altered voluntary movements

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58
Q

Signs of increased intracranial pressure?

A 
Vomit w/o nausea
Headache
Papilledema
Seizures
Behavior changes
Cushing's response (HTN, bradycardia)
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59
Q

“FAST” exam to identify location and severity of stroke

A

Face: facial droop
Arms: unilateral weakness
Speech: slurred
Time: seek immediate medical attention

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60
Q

What PE exam is used to assess stroke risk?

A

Look for bruit with U/S Doppler of carotids

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61
Q

How to treat ischemic stroke?

A

Aspirin immediately
tPA within 4.5 hours
Angioplasty and stents

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62
Q

How to treat hemorrhagic stroke?

A

Surgery: clipping, coiling, hemicraniectomy

Meds: Mannitol, corticosteroids

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63
Q

Contraindications to tPA use in strokes

A 
Suspected intracranial bleed
Recent surgery
Recent head trauma
Active bleeding
Intracranial neoplasm
HTN > 185/110
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64
Q

How is TIA different than full stroke?

A
  • No brain tissue death

- Symptoms typically resolve in an hour

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65
Q

Define amaurosis fugax

A

temporary loss of vision (possible TIA or carotid stenosis)

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66
Q

DDX of altered mental status

A 
High ICP
Dehydration (or insulin overdose)
Hypoglycemia
Uremia
Hyper/hypothermia
Meningitis
Stroke/TIA
Concussion/brain injury
Meds/Drugs
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67
Q

Work up of altered mental status

A
  • Neuro exam: AAOx3, LOC, GCS
  • Pulse ox
  • Serum glucose
  • CBC
  • CMP (liver, kidney fxtn)
  • Tox screen
  • Head CT or MRI
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68
Q

Glasgow Coma Scale

A

Eye movement 1-4
Verbal response 1-5
Motor response 1-6

“less than 8 intubate”
13-15 = concussion
3 = dead

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69
Q

How to treat altered mental status from hypoglycemia?

A

IV Dextrose

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70
Q

Mother brings in 12 month old son because he is not showing signs of delayed development - poor muscle tone, has not started walking or talking, and has not been feeding well. He was born premature and at low birth weight. What is likely dx?

A

Cerebral Palsy

71
Q

Cerebral Palsy treatment

A

SYMPTOMATIC

Benzos (Diazepam)  muscle spasms
IM Botulinum toxin injection – muscles with spasticity
Antiepileptic meds – minimize seizures
PT/OT
Special ed and learning strategies
Behavior therapy and counseling
72
Q

What is the #1 risk factor for a child having CP?

A

prematurity

73
Q

Causes of dementia

A 
Alzheimer's (75%)
Brain injury
Lewy Body dementia
Hypothyroidism
Vit B12 deficiency
Lyme Disease
Neurosyphilis
74
Q

Labs to run to determine cause of dementia

A 
Vit B12
Folic acid
TSH
CRP
CBC
Electrolytes
Renal function
Liver function
75
Q

Possible medical treatment of dementia

A

Acetylcholinesterase inhibitor (Donepezil)
Antipsychotics (Risperdal)
SSRIs

76
Q

What meds can cause delirium?

A

anticholinergics

opioids

77
Q

A patient presents with very poor attention. Is this likely dementia or delirium?

78
Q

Pathology with rapid bilateral ascending paralysis =

A

Guillain-Barre Syndrome

79
Q

Signs of autonomic fiber deficit

A

Orthostatic hypotension
Changes in heart’s rate and rhythm
Fluctuating BP
Dry eyes and mouth

80
Q

Lumbar puncture results of Guillain-Barre syndrome

A

elevated proteins

no increase in WBC

81
Q

Pathophysiology of Gullain-Barre syndrome

A

rapid demyelination of peripheral nerves

  • MS is demyelination of CNS
82
Q

Gullain-Barre treatment

A

Immediate IVIG or plasmapheresis

ventilator support

83
Q

Pathophysiology of Multiple Sclerosis

A

Loss of myelin in CNS (PNS is normal)

Possibly autoimmune, infection, genetics???

84
Q

Hallmark signs of multiple sclerosis

A

Uthoff’s phenomena = worsening of sx in the heat
L’Hermitte sign = electrical sensations down spine with patient flexes neck
Optic neuritis
Bladder dysfunction

85
Q

Clinical course of MS

A

relapsing-remitting; series of normal periods with intermittent flares

86
Q

How to treat acute MS attacks?

A 
HD corticosteroids (prednisone, IV Solu-Medrol)
Plasma exchange (IVIG)
87
Q

How to slow progression of MS?

A 
Beta interferons
Monoclonal antibodies (-umab)
Vitamin D
88
Q

Pathophysiology of Myasthenia Gravis

A

Autoimmune disorder where ACh receptors are blocked by antibodies

89
Q

Patient comes in c/o increased weakness causing ptosis, diplopia, and SOB. The sx’s seem to improve with rest. There are NO sensory deficits. What must be considered?

A

Myasthenia Gravis

90
Q

How to differentiate Myasthenia Gravis and Guillain-Barre Syndrome?

A

Check reflexes and sensation

MG = normal
GBS = areflexia, loss of proprioception
91
Q

Dx testing for Myasthenia Gravis

A

Blood: ACh receptor antibodies
EMG: muscles fatigue with repetitive stimulation
CXR/CT/MRI: tumor or thymoma?

92
Q

How is Lambert-Eaton Syndrome different than Myasthenia Gravis?

A

Lambert-Eaton autoimmunity against influx of calcium (ACh receptors in MG)

Repetitive stimulation on EMG will improve symptoms (EMG causes fatigue in MG)

93
Q

Medical therapy for Myasthenia Gravis

A

Long acting anti-cholinesterase meds
Immunosuppressive drugs
Removal of thymus if thymoma

94
Q

Clinical definition of epilepsy

A

recurrent seizures; 2 or more unprovoked seizures

95
Q

2 broad categories of seizures and how they are different?

A

Generalized - involve entire brain

Partial - involve small region of brain

96
Q

Which seizures are Generalized?

A 
Grand mal
Absence
Clonic
Myoclonic
Tonic
Atonic
97
Q

Which seizures are Partial seizures?

A

Simple
Complex
Partial with secondary generalization

98
Q

simple vs complex partial seizure

A

simple - conscious

complex - impaired awareness; can’t recall event, often with aura

99
Q

Characteristics of grand mal seizure

A

unconscious
ictal cry at onset
convulsions of tonic and atonic
postictal phase after

100
Q

Seizure of only a brief loss of consciousness without loss of postural tone =

A

absence (petit mal)

101
Q

Most common epidemiology of absence seizures

A

children with epilepsy

102
Q

What is an atonic seizure?

A

sudden loss of postural tone with brief LOC

eg. head drop

103
Q

Peak incidence of febrile seizures

A

18-24 months old

104
Q

Febrile seizures management

A

Reassure parent

Tylenol

105
Q

Jacksonian March

A

seizure that spreads from distal limb to larger region

106
Q

How to determine which type of seizure a patient has?

A

EEG (electroencephalogram)

  • generalized: spikes and slow waves
  • simple partial: focal rhythmic discharges
  • complex partial: intricate spikes with slow waves
107
Q

Why do lumbar puncture for seizure?

A

to diagnose possible CNS infection

108
Q

A life-threatening neurologic disorder defined as 5 minutes or more of a continuous seizure activity or several clinical seizures without return to baseline in between

A

Status epilepticus

109
Q

Medications for status epilepticus

A

Benzos 1st line - Lorazepam

Anticonvulsants - Phenytoin

110
Q

Cardiac and non-cardiac causes of syncope

A

Cardiac: Arrhythmias, heart valves d/o, HTN, aortic dissection, cardiomyopathy

Non-cardiac: Postural hypotension, dehydration, high altitude, TIA, migraine, situational syncope (blood drawing, micturition, defecation, swallowing, coughing)

111
Q

Pathophysiology of syncope

A

global cerebral hypoperfusion

112
Q

Symptoms of syncope

A 
Pale, cold skin
Partial or complete LOC
Lightheaded
Nausea
Blurred vision
113
Q

Tilt table test

A

to elicit orthostatic syncope secondary to autonomic dysfunction

114
Q

Syncope treatment

A 
Position patient on ground, with legs slightly elevated or leaning forward with head between knees x 10-15 mi
IV access
Oxygen administration
Advanced airway techniques
Glucose administration
Pharmacologic circulatory support
Defibrillation or temporary pacing
115
Q

Epidemiology of Tourette disorder

116
Q

Symptoms of Tourette disorder

A 
Motor tics (blinking, tongue, jerking, etc.)
Vocal tics (yelling, swearing, throat clearing)
117
Q

How to rule out other conditions that may be causing tics in Tourette?

A 
EEG – if tics and seizure activity exists
MRI – brain abnormalities
TSH levels - hypothyroidism
Urine drug screen
Serum Copper – Wilson’s disease
118
Q

Treatment of Tourette disorder?

A

Deep brain stimulation
Behavioral therapy
Dopamine antagonists (fluphenazine, pimozide)
* Haloperidol is historically the drug of choice

119
Q

Definitive way to differentiate syncope from seizure?

A

EEG to pick up abnormal firing patterns in brain

120
Q

Main excitatory and inhibitory neurotransmitters in the brain

A

glutamate excitatory

GABA inhibitory

121
Q

Why is CT done before a lumbar puncture?

A

CT to look for signs of increased ICP (e.g. ventricular dilation)

LP with increased ICP can cause negative pressure in spinal canal and possible herniation

122
Q

How is equilibrium of CSF level in brain maintained?

A

choroid plexus produces it, while arachnoid granulations reabsorb it into the venous system

123
Q

_______ is caused by increased CSF in the brain.

A

hydrocephalus

124
Q

What is Cushing’s response?

A

HTN, bradycardia, and irregular respirations in response to increased ICP and/or hydrocephalus

125
Q

What is pseudotumor cerebri? How is it treated?

A

signs of elevated ICP, but brain appears normal on CT

Tx: Acetazolamide (decreases CSF production), LP shunt to decrease ICP

126
Q

Meningeal signs

A

Nuchal rigidity
Brudzinski’s sign: involuntary flexing of hip and knees when neck flexed
Kernig’s sign: flexing hip 90 degrees then extending knee causes pain

127
Q

Layers of head from skull to brain

A

bone, epidural space, dura mater, subdural space, arachnoid membrane, subarachnoid space, pia mater, brain parenchyma

128
Q

Most common offending organisms of meningitis in neonates, children, and adults?

A

Neonates: GB strep, E. coli, Listeria

Children/Adults: H flu, strep pneumo, N. meningitidis

129
Q

Viruses that cause meningitis

A

Herpes simplex
CMV
HIV

130
Q

Treatment of epidural bleed

A

Burr hole drainage

131
Q

Common organisms causing epidural and subdural abscesses

A

staph aureus

streptococcus

132
Q

Typical cause of encephalitis

A

VIRAL - HSV, enterovirus, mumps, rabies, mosquito borne (West Nile, St. Louis Encephalitis)

133
Q

Results of CSF exam for a bacterial infection

A

increased WBCs (neutrophils)
increased protein
decreased glucose

134
Q

Blood on CSF exam indicates what?

A

bright red that goes away - trauma of spinal tap

yellowish blood (xanthochromia) - subarachnoid hemorrhage

135
Q

Predominance of PMNs on lumbar puncture =

A

bacterial meningitis

136
Q

Broca’s aphasia

A

deficit in language production (both spoken and written)

preserved comprehension

137
Q

Wernicke’s aphasia

A

deficit in understanding language

“word salad”

138
Q

Effects of middle cerebral artery stroke

A

face, arm > leg deficits on contralateral side

Broca and Wernicke aphasias if left MCA

139
Q

Effects of anterior cerebral artery stroke

A

leg > arm deficits on contralateral side

lack of motivation due to frontal lobe ischemia

140
Q

Effects of posterior cerebral artery stroke

A

vision changes on contralateral side

141
Q

A pure sensory deficit can occur from infarct of _______.

142
Q

Ipsilateral CN III palsy
Contralateral hemiplegia

Location of stroke?

A

Midbrain (PCA ischemia)

143
Q

Right-sided facial numbness and weakness
Loss of right eye abduction
Left-sided hemiplegia

Location of stroke?

A

Right pontine (basilar ischemia)

144
Q

Deviation of uvula to right
Right-sided muscle weakness and loss of sensation
Signs of Horner’s syndrome

Location of stroke?

A

Left medullary stroke

145
Q

Right-sided ataxia

Location of lesion?

A

Right cerebellum

146
Q

Compression of what nerves can lead to incontinence and impotence?

147
Q

Which nerves does the patellar reflex test?

A

L3/L4 (quad muscle)

148
Q

Which nerves does the Achilles reflex test?

A

S1/S2 (gastrocnemius muscle)

149
Q

Which nerves innervate the bicep?

150
Q

Which nerves innervate the tricep?

151
Q

DDX of weakness alone with no sensory changes

A
  • Motor pathway deficit (pure motor stroke or ALS)
  • NMJ deficit (Myasthenia Gravis)
  • Muscle pathology
152
Q

Signs of ALS

A

insidious, progressive motor weakness
mix of UMN and LMN findings
NO affect on sensory pathways, eyes, bladder/bowel like MS

153
Q

shingles of CN VII that causes severe facial palsy and vesicular eruption in external auditory canal or pharynx

A

Ramsay Hunt Syndrome

154
Q

Distal sensory loss and muscle weakness in “unathletic” child may be what inherited disease?

A

Charcot Marie-Tooth

155
Q

Metabolic deficiency that can cause peripheral neuropathy

A

B12 deficiency

156
Q

Medications that cause tardive dyskinesia?

A

dopaminergic antagonists - antipsychotics

157
Q

Stroke with ipsilateral gaze preference =

A

middle cerebral artery

158
Q

Spontaneous seizure and brain bleed in previously asymptomatic young patient. Likely dx?

A

AV malformation

159
Q

Headache with “band-like” tightness

A

Tension HA

160
Q

Preventative treatment of tension headaches

A

Amitriptyline

161
Q

How are migraines differentiated from other headaches?

A

unilateral
N/V
photophobia
aura

162
Q

Abortive treatment of tension HA

A

NSAID, Tylenol, Excedrin

Toradol if in ER

163
Q

Abortive treatment of migraine HA

A

Mild: NSAID, Tylenol
Moderate: Excedrine, Triptans
Severe: Toradol, Metoclopramide, Ergotomines, Opioids

  • must treat before HA starts
164
Q

Possible prophylaxis for migraines

A

BB, CCB, Amitriptyline, SSRI, antiseizure, diet changes

165
Q

Treatment for cluster headaches

A

100% oxygen x 15 min

166
Q

What symptoms make you worry that tension HA may be a tumor?

A

new or different HA in adult
N/V
worse with exertion
signs of increased ICP

167
Q

Descending paralysis + intact sensation and mentation =

168
Q

Pathophysiology of Botulism

A

Clostridium toxins block release of ACh at NMJ

169
Q

When to do CT on head injury?

A 
GCS less than 15
Basilar fx signs
2+ vomiting
Age over 65
Amnesia over 30 min
Dangerous injury
Seizures
Neuro deficits
170
Q

Signs of basilar skull fracture?

A

Battle sign
Raccoon eyes
Hemotympanum
Otorrhea or rhinorrhea

171
Q

Signs of Alzheimer’s Dementia

A

MEMORY LOSS
impaired formation of new memories
anosognosia (lack of insight)
executive dysfunction

172
Q

Mainstay treatment of Alzheimer’s and its MOA

A

Donezepil - acetyl cholinesterase inhibitor to increase cholinergic function

173
Q

GABA analog used to treat neuropathic pain, seizures, and anxiety

A

Pregabalin (Lyrica)

PANCE review (18 decks)

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