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Clinical Medicine > Neuro > Flashcards

Neuro Flashcards

1
Q

All CNS lesions

A

Ipsilateral

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2
Q

Question asked

A

Is there is a neurologic problem?
Where is the neurologic problem?
What is the neurologic problem?

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3
Q

Increased ICP

Most defective finding

A

Papilledema

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4
Q

Type of lesion

Focal

A

Mass lesion
Infarction
Hematoma

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5
Q

Type of lesion

Multi focal

A

Multiple tumors, abscess

MS

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6
Q

Type of lesion

Diffuse

A

Toxic (metab encephalopathy)
Peripheral neuropathy
Myopathy

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7
Q

Is there is neurological problem?

3 findings

A

Meaningeal irritation
Increased intracranial pressure
Focal neurologic deficits

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8
Q

Irritation of the meninges by meningitis, subarachnoid hemorrhage, drugs and increase intracranial pressure

A

Meaningeal irritation

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9
Q

With the patient supine and the limbs extended, passively flex the neck

A

Brudzinski sign

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10
Q

Positive brudinzki sign

A

Flexion of the hips

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11
Q

With the patient supine, passively flex the hip to 90 degrees while the knee is flexed about 90 degrees

A

Kernig sign

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12
Q

Patient cannot place the chin on the chest

A

Nuchal rigidity

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13
Q

If patient with meningitis is awake

A

Sign are always positive

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14
Q

But if patient with meningitis has decreased level of consciousness

A

No positive signs

Obtunded that he cannot produce protective reflexes

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15
Q

Most common cause of meningitis

A

Infection

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16
Q

If patient has fever, automatically do the test for Meaningeal signs

A

CNS infection is always a differential diagnosis

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17
Q

Physical and neurological examination

A

Mental status exam - cerebral hemisphere
Cranial nerves - brainstem
Motor- corticospinal
Cerebellar - always ipsilateral
Reflexes - pathologic, superficial, deep tendon
Sensory - spinothalamic, posterior columnar
Meningeal signs

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21
Q

Central nervous system

Brain

Supratentorial

A

Diencephalon
Cerebral hemispheres
Thalamus
Basal ganglia

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22
Q

Central nervous system

Brain

Infratentorial

A

Brainstem

Cerebellum

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23
Q

Peripheral nervous system

Can best diagnose posterior fossa problems

A

MRI

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24
Q

Localize

A

What specific part

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25
Q

Lateralize

A

Right or left
Midline or diffused
Ipsilateral or contralateral

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26
Q

Symptoms that manifest contralateral to the lesion

A

Hemi paresis

Hemi sensory deficits

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27
Q

Symptoms that manifest ipsilateral to the lesion

A

Cerebellar problem
Cranial nerve deficits
Impaired position sense, vibration sense

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28
Q

Sudden onset

A

Within minutes, hours, days, weeks

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29
Q

Sudden onset

Cerebral infarction

A

Thrombolic

Embolism

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30
Q

Sudden onset

Cerebral hemorrhage

A

Most common cause is HPN

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31
Q

Subacute onset

A

More than 2 weeks but less than 3 months

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32
Q

Chronic onset

A

More than 3 months

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33
Q

Chronic onset

Neoplasm

Malignant

A

Glioblastoma

Patient will die after 6 months

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34
Q

Chronic onset

Neoplasm

Benign

A

Meningioma

Tumor will present for many years

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35
Q

Chronic onset

Abscess

A

Temporal nobe

Cerebellum

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36
Q

Chronic onset

Manifest within 6 months

A

Subdural hematoma

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37
Q

Chronic onset

Remnant of TB infection

A

Granuloma and cyst

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38
Q

Examination of cerebral function

Between frontal and parietal

A

Central sulcus

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39
Q

Examination of cerebral function

Between frontal and temporal

A

Lateral fissure

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40
Q

Examination of cerebral function

Sensory, cortical level function

A

Parietal

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41
Q

Examination of cerebral function

Vision

A

Occipital

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42
Q

Examination of cerebral function

Audition and memory

A

Temporal

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43
Q

Objective evidence of cerebral dysfunction

A

Seizure

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44
Q

Level of consciousness

Inability to maintain a coherent stream of thought or action
Diffuse infusion to brain

A

Confusion

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45
Q

Level of consciousness

Ability to sort out and stratify the many sensory inputs and potential motor output

A

Attention

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46
Q

Level of consciousness

Most common cause of confusion

A

Metabolic/ toxic derangement

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47
Q

Level of consciousness

Confusional state with excess sympathetic activity

A

Delirium

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48
Q

Most common cause of delirium

A

Febrile sates and dehydration

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49
Q

Level of consciousness

Ability to respond verbally and fending off

A

Drowsiness

Ask the sleeping pattern

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50
Q

Level of consciousness

Lethargy
Incomplete arousal to noxious stimuli
No response to verbal commands
Motor response purposeful

A

Stupor

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51
Q

Level of consciousness

Obtunded
Primitive and disorganized motor responses to noxious stimuli
No response to attempts at arousal

A

Light coma

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52
Q

Level of consciousness

Absence of response to noxious stimuli

A

Deep coma

53
Q

Glasgow Coma Scale

Eye opening

A

4- spontaneous
3- verbal
2- painful
1- no response

54
Q

Glasgow Coma Scale

Verbal

A 
5- oriented and talks
4- disoriented and talks
3- inappropriate words
2- incomprehensible sounds
1- no response
55
Q

Glasgow Coma Scale

Motor activity

A 
6- verbal command
5- localizes pain
4- withdraws from pain
3- decorticate
2- decerebrate
1- no response
56
Q

Full outline of unresponsive scale

A

Eye response
Motor
Brainstem reflex
Respiration

57
Q

Mental status

Orientation

A

Time
Place
Person

58
Q

Mental status

Attention

A

Ask patient to count backwards from 100 by 7

Stop after 5 correct answers

59
Q

Mental status

Registration

A

Name 3 objects

Ask patient to repeat 3 objects

60
Q

Mental status

Complex task

A

Give patient 3 step command

61
Q

Mental status

Repetition

A

Repeat a sentence

62
Q

Mental status

Recall

A

Usually dates

63
Q

Recall

Type of memory

A

Recent
Remote
Immediate

64
Q

Mental status

Reading

A

Follow written commands

65
Q

Inability to understand the meaning

A

Agnosia

66
Q

Types of agnosia

Trace letters/numbers on skin and palm with fingertips

A

Agraphesthesia/ agraphognosia

67
Q

Types of agnosia

Inability to recognize faces in person or in photos

A

Prosopagnosia

68
Q

Agraphognosia lesion

A

Contralateral parietal

69
Q

Prosopagnosia lesion

A

Right or bilateral inferomedia temporo occipital region

70
Q

Types of agnosia

Inability to locate , identify and orient one’s body parts

A

Autotopagnosia/ asomatognosia

71
Q

Types of agnosia

Inability to be aware of his own bodily defect

A

Anosognosia

72
Q

Ask patient to draw symmetrical figures
Seen in right parietal lesion
Unilateral neglect

A

Left sided hemispatial inattention

73
Q

Sensory extinction, sensory inattention

Touch patient on one or both sides

A

Inattention to double simultaneous cutaneous stimuli

74
Q

Inattention to double simultaneous cutaneous stimuli

Lesion

A

Right Parietal (common) / left parietal lesions

75
Q

Word agnosia and word blindness

Left parietal lesion

A

Dyslexia and alexia

76
Q

Inability to perform a voluntary act even though the motor, sensory, and mental status are intact
No motor weakness

A

Apraxia

77
Q

Testing the apraxia

Instruct to do different tongue movement

A

Bucco-facial apraxia

If verbal instruction fails, try miming

78
Q

Testing the apraxia

Ask the patient to demonstrate sequential acts

A

Ideomotor apraxia

79
Q

Testing the apraxia

Draw geometric figures

A

Constructional apraxia

80
Q

Testing the apraxia

Also know as Bruns apraxia
C3 and C4 commonly in right parietal lesion

A

Gait apraxia

81
Q

Communication

Left hemisphere

A

Invest words and meaning

82
Q

Communication

Right hemisphere

A

Prosody of speech (intonation, melody, pauses and phrasing)

83
Q

Inability to understand or express words as symbols for communication even though the primary sensorimotor pathway to receive and express language and mental status are relatively intact

A

Aphasia

84
Q

Types of aphasia

A

Need mo ito kabisaduhin nasa trans

85
Q

Types of aphasia

Brocas

A 
Can understand
Motor
Non fluent
Expressive
Left posterior inferior frontal operculum
86
Q

Types of aphasia

Wernicke’s

A

Sensory
Receptive
Fluent

87
Q

Types of aphasia

Conduction

A

Posterior parasylvian area

88
Q

Types of aphasia

Frontally and superiorly toward stratum

A

Trans cortical motor

89
Q

Types of aphasia

Parietal + temporal + thalamocortcial circuit

A

Trans cortical sensory

90
Q

Types of aphasia

Entire parasylvian area

A

Global

91
Q

Clinical manifestation of frontal lobe,

A

Bilateral hemiplegia ( quadriplegia)
Spastic bulbar (pseudobulbar palsy)
Decomposition of gait and sphincter incontinence
Inability to solve complex problem (prefrontal)

92
Q

Clinical manifestation of temporal lobe

A

Korsakoff amnestic defect
Apathy and placidity
Hypermetamorphosia ( hypersexuality, hyperorality)

93
Q

Clinical manifestation of parietal lobe lesion

A

Dysgraphia
Dyscalculla
Finger agnosia

94
Q

Clinical manifestation of occipital lobe lesion

A

Loss of topographic memory and visual orientation
Hallucinations
Homonym outs hemianopsia

95
Q

Made up of bags of small muscle fibers (intrafusal) has afferent and efferent axons that maintain constant tension

A

Muscle spindle

96
Q

Only have efferent axons

A

Skeletal (extrafusal)

97
Q

Pulls the perimysium and stretches the muscle spindle

A

Extension of joint

98
Q

Relaxation of muscle spindle

A

Flexion of the joint

99
Q

To maintain stretch sensitivity

A

JE- muscle spindle lengthens

JF- muscle spindle contracts

100
Q

Reflexes

A

Upper ext- biceps and triceps

Lower ext - quads (knee jerk) and triceps surae reflex (ankle jerk)

101
Q

Short convex sides

A

Taylor tomahawk hammer

102
Q

Biceps reflex

A

C5, C6

103
Q

Triceps reflex

A

C6-8

104
Q

Patellar reflex, femoral nerve

A

L2-L4

105
Q

Achilles reflex, tibial nerve

A

L5-S2

106
Q

Lesion of various site of reflex arc

LMN lesion
Myopathy

A

Paralysis

107
Q

Lesion of various site of reflex arc

LMN lesion

A

Denervation atrophy

108
Q

Lesion of various site of reflex arc

Dorsal root lesion

A

Loss of sensation

109
Q

Lesion of various site of reflex arc

Dorsal root lesion
LMN lesion
Myopathy

A

Absence of MSR

110
Q

Superficial reflexes

Abdominal reflexes upper quadrant

A

T8T9

111
Q

Superficial reflexes

Abdominal reflex lower quadrant

A

T11-T12

112
Q

Superficial reflexes

Abdominal reflex

A

Beevor sign

Scrape skin toward umbilicus

113
Q

Superficial reflexes

Cremasteric reflex

A

L1-L2

114
Q

Superficial reflexes

Involves tapping the nail or flicking the terminal phalanx of the middle or ring finger

A

Hoffman’s

Positive when there’s flexion of terminal phalanx of thumb
Lesion in corticospinal tract

115
Q

Superficial reflexes

Most important component: dorsiflexion of big toe and fanning of the rest

A

Babinski reflex

Corticospinal tract lesion
UMN paralysis

116
Q

Superficial reflexes

Diagnostic reflex similar to the babinski reflex
To identify lesion of pyramidal tract

A

Chaddoks reflex

117
Q

Superficial reflexes

Dorsiflexion of the big toe elicited by irritation downward of the medial side of the tibia

A

Oppenheim’s reflex

Lesion in pyramidal tract

118
Q

Non localizing primitive reflex

Stroke proximodistally over the patients thenar eminence

A

Palmomental reflex

119
Q

Non localizing primitive reflex

With patients eyes closed, tap philtrum several times

A

Snout relfex

120
Q

Non localizing primitive reflex

Stroke patient palm from the hypothenar eminence toward junction of third and index finger

A

Grasp reflex

121
Q

Non localizing primitive reflex

With patients eye closed stroke his lip from the center of the crevice to the sides

A

Sucking relfex

132
Q

Increased ICP

Lateral rectus palsy secondary to abducens nerve

A

Diplopia with internal squint

133
Q

Diplopia with internal squint

Test

A

Ask patient to look at one finger and move the finger to the right patent will see double vision

134
Q

Increased ICP

Hypertension
Localized collection of pus

A

Bulging fontanelle
Separation of sutures
Rapid enlarging head size

135
Q

Increased ICP

Very obvious
Shortened walking hours
Drowsiness

A

Deterioration in level of consciousness

Clinical Medicine (6 decks)

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