Neuro

Question 1

MSE (4) (ORAL)

Answer 1

Orientation
Recall
Attention
Language

Question 2

UMN S/S

Answer 2

Atrophy of disuse, arms flexed, legs extended.  
Stronger flexors > extensors upper 
Stronger extensors > flexors lower 
Increased/spastic tone
Coordination limited 
Reflexes 
Plantar: up (dorsi flex)
Deep: increased clonus
Superficial: absent

Question 3

LMN S/S

Answer 3

Atrophy, fasciculations

Weak
Decreased tone
Coordination limited
Reflexes
Plantar: down (plantar flex)
Deep: decreased
Superficial: absent

Question 4

asterixis

Answer 4

brief jerky downward mvts of the wrist when patient extends both arms with wrist dorsiflexed, palms forwards, eyes closed

Question 5

Tics

Answer 5

non-voluntary contractions of single muscles or groups of muscles, suppressive, associated with a sense of relief

Question 6

Myoclonus

Answer 6

sudden rapid muscle jerk, may be focal

Question 7

athetosis

Answer 7

repetitive, involuntary, slow, sinuous, writhing, especially severe in hands

Question 8

dystonia

Answer 8

prolonged/sustained muscle contraction

Question 9

Tremor

Answer 9

rhythmic semi-rhythmic oscillating movements, can be fast or slow. Both against and antagonist muscles simultaneously activated. Coarse = insignificant (cold/fatigue). Fine = UMN lesion, or other

Question 10

Chorea

Answer 10

“Dance” = fleeting random involuntary movements that affect multiple joints may be fluid or jerky and carrying in quality

Question 11

Hemiballismus

Answer 11

Violent flinging movement of half the body

Question 12

seizure automatisms

Answer 12

stereotyped semi-purposeful movements, repeated eye blinking, tonic or clonic motor activity

Question 13

Location of lesion for:
Spasticity
Flaccidity
Rigidity

Answer 13

Spasticity = UMN 
Flaccidity = LMN 
Rigidity = extrapyramidal

Question 14

Rhyme song to recall myotomes… ‘___ pick up sticks…’

Answer 14

C5, C6 pick up sticks (biceps)
C6, 7, 8, lay them straight (triceps)
L3, L4, kick the door (quad)
S1, S2, buckle my shoe (ankle plantar flexion)

Question 15

What are the 4 lobes of the cerebral cortex and what do they control

Answer 15

•	Frontal 
Personality, behaviour, emotion 
Broca’s – motor speech 
Precentral gyrus 
(primary motor) 

• Parietal
Sensation
Postcentral gyrus (primary sensory)

• Temporal
Hearing taste smell
Wernicke’s

• Occipital
Visual

Question 16

Function of cerebellum

Answer 16

• Motor coordination
• Equilibrium
• Balance
• Voluntary movement and muscle tone
• Does not initiate movement, but coordinates and smooths it

Question 17

What does the extrapyramidal system control? What are the structures (general)?

Answer 17

• Basal ganglia
• Subcortical motor system
• Brain stem and spinal cord
• All movement outside of pyramids
• Gross automatic movements like: arm swinging, walking

Question 18

What does the thalamus do?

Answer 18

relay station

Question 19

Hypothalamus neuro function?

Answer 19

• Temperature, HR, BP, sleep
• Pituitary gland
• Coordinates ANS and emotional status

Question 20

What are the components of the brainstem?

Answer 20

• Midbrain: most anterior of the brain stem, merges into thalamus hypothalamus
• Pons: enlarged area containing ascending and descending fibre tracts
• Medulla: continuation of spinal cord. CN XIII to XII. Pyramidal decussation.

Question 21

What does the posterior (dorsal) column transmit?

Answer 21

vibration
fine touch (stereognosis)
proprioception (position)

Question 22

What does the spinothalamic tract do? lateral vs anterior

Answer 22

• Pain and temperature – lateral thalamic tract

* Crude touch – anterior spinothalamic tract

Question 23

What are the UMN?

Answer 23

corticospinal, corticobulbar, extra pyramidal tracts. (MS, CVA)

Question 24

What are the LMN?

Answer 24

PNS, cell body in grey matter of spinal cord then extends to muscle (ALS, polio)

Question 25

DTR has 5 components to function. What are they?

Answer 25

``` Afferent limb Efferent limb Synapse in the cord Neuromuscular junction Competent muscle ```

Question 26

Where do CN I and II originate form?

Answer 26

cerebrum

Question 27

Where do CN III to XII originate from?

Answer 27

diencephalon and brainstem

Question 28

Movement disorders (8)

Answer 28

* Paralysis * Fasciculations * Tic * Myoclonus * Intention tremor * Rest tremor * Chorea: sudden, rapid, jerky, purposeless * Athetosis: slow, twisting, writhing, continuous movement resembling a snake

Question 29

Spastic hemiparesis gait

Answer 29

o arm stuck, leg extended, circumducts to walk | o UML, CVA, trauma

Question 30

cerebellar ataxia gait

Answer 30

o Wide-based gait, staggering. o Positive Romberg sign o ETOH, cerebellar tumour, MS

Question 31

parkinsonian (festinating) gait

Answer 31

o Stooped posture, trunk pitched forwards o Short shuffling steps o Hesitates to initiate walking and has difficulty stopping

Question 32

scissors gait

Answer 32

o Knees crossed, or are in contact | o MS

Question 33

steppage or foot drop

Answer 33

o Slapping quality o Weakness of tibia, LMN lesions o Charcot, Polio

Question 34

waddling gait

Answer 34

o Weak hips | o Muscular dystrophy, hip dislocation

Question 35

short leg gait

Answer 35

o Discrepancy > 2.5 cm | o Congenital dislocated hip

Question 36

What is cerebral palsy?

Answer 36

* Mixed group of neuromotor disorders of infancy and childhood * Results from damage to cerebral cortex caused by a developmental defect

Question 37

What is muscular dystrophy?

Answer 37

* Chronic progressive wasting of skeletal musculature | * Duchenne’s

Question 38

What is hemiplegia?

Answer 38

* Damage to corticospinal tract, above pyramids, UML, contralateral * CVA

Question 39

Parkinsonism

Answer 39

* EPS tract defect in the Basal Ganglia * Loss of dopamine * Triad: tremor, rigidity, akinesia * Slow monotonous speech, diminutive writing, flat affect, excessive saliva, less eyelid blinking

Question 40

Paraplegia

Answer 40

* LMN damage | * First DTR absent, then reappear gradually, then spastic  prevailing extensor tone

Question 41

What sensory loss does spinal cord hemisection (brown squared) result in?

Answer 41

* Loss of pain and temperature sensation on the contralateral side, starting one to two segments below the level of the lesion * Loss of vibration sensation and positive discrimination on the ipsilateral side below the level of the lesion * Meningioma, neurofibroma, MS, cervical spondylitis

Question 42

What loss of function does thalamus or cortex lesion result in?

Answer 42

* ALL modalities, contralateral side, head to toe * Vascular occlusion * Cortex: also loss of graphesthesia, stereognosis, recognition of shapes and weights, finger finding…

Question 43

Speech disorders: Dysphonia Dysarthria Aphasia

Answer 43

Dysphonia – hoarse/whisper Dysarthria – distorted, poor articulation Aphasia – defect in comprehension - Global – spontaneous speech absent or reduced to stereotypical words - Broca’s – expressive – speech mostly nouns and verbs – word searching. Auditory and reading intact. - Wernicke’s – receptive aphasia