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IPAP > Neuro Block 1 Cram > Flashcards

Neuro Block 1 Cram Flashcards

1
Q

What CNs make up the Branchiomotor Group and Tongue

Function of CN7 and issues with it will cause PT difficulty making ? noise

A

5 7 9-12

Facial expressions, taste of anterior 2/3
Difficult w/ “ma ma ma” sound

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2
Q

Motor, Sensory, Parasympathetic function of CN9

Motor, Sensory, Parasympathetic function of CN10

A

Voluntary swallow, phonation
Gag reflex, posterior 1/3 taste
Salivary glands, carotid reflex

Voluntary swallow, phonation
Ear, external auditory canal
Heart, lungs, digest, cartoid reflex

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3
Q

Together, CN9 and 10 do what functions?

Issues w/ these will give the PT difficulty making ? noises

A

Phonation, Gag reflex, palate elevation

Kuh kuh kuh sound

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4
Q

What 3 nerves make up the special sensory group?

What nerve innervates the tibialis anterior muscle?

What nerve innvervates ankle dorsiflexion

A

1, 7, 8

L4 via deep peroneal nerve

L4-5 via peroneal nerve

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5
Q

What day of development does the neural tube close?

Why is this time frame a concern?

A

Day 26-28

Women don’t know they’re pregnant until they’re 1wk late, Day 21

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6
Q

What NTD is a failure of the neuropore to close and causes cranial bones to fail tin development?

Where is this issue more commonly seen?

A

Anencephaly

1:1000 births
2-4 x F>M

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7
Q

How are NTD avoided?

What puts a PT as a high risk for NTD?

A

Folic acid
Low risk= .4mg 1mon prior
High risk= 4mg 3mon prior

Prior NTD pregnancy
Mom/Dad have NTDs

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8
Q

Frontal lobe is responsible for ?

What is the anterior 2/3 of the prefrontal cortex in charge of?

A

SPERM Behavior
Solving, Personality, Emotion, Reasoning, Motor region, Behavior

JOACS
Judgement, Orientation, Abstract, Concentration, Solving problems

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9
Q

What is the temporal lobe responsible for?

What is the parietal lobe responsible for?

A

SHOL
Short term, Hearing, Olfaction, Languag

HAI
Hemispatial, Asterognosis, Inability to copy

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10
Q

What is the occipital lobe responsible for?

What woul be the different results of a lateral and bilateral lesion in this lobe?

A

Visual processing and Shape/Color ID

Bilateral= cortical blindness
Unilateral= contralateral hemianopia of quadrantopia
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11
Q

Which NT is excitatory at neuromuscular junctions?

How does it do this effect?

A

ACh

Opens ligand gated cation channels

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12
Q

What does the lack of ACh present as?

What causes these adverse Sxs?

A

Weakness
Fatigue of skeletal muscles

Abs destroy ACh receptors at junctions

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13
Q

What hallmark of MG presents first?

What is the major inhibitory NT of the brain and spinal cord?

A

EOMs- diplopia and Ptosis

Brain= GABA
Spine= Glycine
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14
Q

UMN begin at ? and end at ?

LMN begin at ? and end at ?

A

Cortex/brain stem to anterior horn

Anterior horn to muscle fibers

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15
Q

Function of Corticospinal, Spinothalamic and Dorsal Columns

Almost all PTs w/ aphasia will also have ?

A

Corticospinal- voluntary motor
Spinothalamic- pain/temp
Dorsal- vibration, position, light touch

Agraphia

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16
Q

What is the difference between Brocas and Wernickes

A

Brocas: broken thoughts
Problem w/ language production, Impaired fluency/repetition, Preserved comprehension, R Hemiparesis

Wernicke- word salad
preserved fluency, problem w/ comprehension
R upper visual defect, PT initially unaware of problem

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17
Q

S/Sxs of compressed radial nerve

What is it AKA and how is it Tx

A

Wrist drop, weak thumb abduction and finger extension, sensory loss between thumb and index finger

AKA Saturday Night Palsy
Cock-up wrist finger splint

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18
Q

What are the 7 types of Polyneuropathy

A 
B12 deficient
Diabetic
Lyme Dz
Leprous
Autonomic
Plexopathy
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19
Q

B12 Polyneuropathy

A

Vegan, Alocholics, IBDz, Post Gastroectomy

Sx: Distal symmetry numbness starting in hands and gait instability

PE: Dec vibration sense, loss of position sense

Dx: smear for macrocytic anemia, macro-ovalocytes, hyper segmented neutrophils

Tx: 1000mcg B12 weekly x 1mon, Qmon

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20
Q

Diabetic Neuropathy

A

Sensory loss is first from hyperglycemia

TCAs
Gaba/Pregaba
SSRI/SNRI
Capsaicin

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21
Q

HIV Neuropathy

A

Neuropathy from HIV itself or from anti-viral meds
Secondary neuropathy due to Cytomegalovirus

Most common presentation= Sx encephalopathy

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22
Q

Lyme Dz

A

Bilateral facial neuropathy
Tx: Doxy or Ceftriaxone if severe
S/e: sunburn easily

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23
Q

Leprous Neuritis

A

Due to acid bast bacilli in skin
Two forms:
Lepromatous- systemic presentation, spares lungs and CNS
Tuberculoid

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24
Q

Autonomic Neuropathy

A

Generalized polyneuropathy
Anhydrosis
Tx underlying autonomic issue

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25
Q

What are the 4 hereditary polyneuropathies

A

CMT
HSAN
FAP
Refsum Dz

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26
Q

Charcot Marie Tooth Dz

A 
Slow progressive neuropathy
High steppage gait, tripping and falling
Sensory loos but NO numb/tingling
Distal weakness in legs to hands to forearms
Inverted champagne bottle legs
Tremor= conspicuous finding
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27
Q

Hereditary Sensory and Autonomic Neuropathy

A

Distal sensory loss

Recurrent osteomyelitis infxns

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28
Q

Familial Amyloid Polyneuropathy

A

Defected Transthretin gene

Sxs: PHOTN, Constipation/diarrhea, ED, impaired sweating

Cardiomyopathy leads to HF

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29
Q

Refsums Dz

A

Autosomal RECESSIVE
Earliest Sx= night blindness
Triad- peripheral neuropathy, retinitis pigmentosa, cerebellar ataxia, elevated CSF protein level
Dx- elevated phytanic acid in serum and urine
Tx- avoid lamb, beef, all fish

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30
Q

What are the 5 forms of immunologic polyneuropathy

A 
GBS
CIDP
MM
MG
Myasthenic Syndrome
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31
Q

Guillan Barre Syndrome

A

Follows infection/vaccine, usually Campylobacter infxn
Symmetric weakness of legs w/out pain (rubbery)
Slowed motor/sensory conduction
Inc CSF protein, normal count

Tx: plasmaphoresis, IV IgG

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32
Q

Chronic Inflammatory Demyelinating Polyneuropathy

A

Gradual onset and undifferentiated from GBS

Consider CIDP if longer than 9wks or > 3 relapses

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33
Q

Multiple Myeloma

A

Lytic/osteoporotic bone lesions

Sensorimotor polyneuorpathy that doesn’t reverse after Tx

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34
Q

MG Tx

A

Thymectomy

Pyridostigmine for Sx relief

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35
Q

Myasthenic Syndrome/Lambert Eaton

A 
Associated w/ small cell carcinoma
Defected P/Q type voltage gated Ca channel
Weakness in proximal limbs
Power INC w/ sustained flexion
Tx: Prednisone, Azathioprine
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36
Q

What are the 4 toxin polyneuropathies

A

Botulism
Aminoglycoside use
Tetanus
Nerve agents

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37
Q

Aminoglycoside use is c/i in ? PTs?

What two drugs does this encompass?

A

MG

Gentamycin
Streptomycin

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38
Q

How does Tetanus poisoning work?

A

Irreversible binding to cord/stem preventing release of GABA, causing inc tone, spasms and rigidity

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39
Q

Nerve agents in chemical warfare work by ? and are most commonly ?

What 4 nerve agents are similar to insecticdes like Malathion

A

Cholinesterase inhibition
Organophosphorus compounds

Sarin GB
Tabun GA
Soman GD
VX

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40
Q

What part of the nerve agent effect accounts for the major life-threatening effects?

A

Acetylcholinesterase inhibition

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41
Q

UMN lesions cause ?

LMN lesions cause ?

A 
Diffuse Weakness
Spasticity
Increased DTRs
Babinski response
Little/no muscle atrophy

Wasting/fasciculations
Loss of DTRs
Hypotonia

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42
Q

Define Hemiparetic gait

Define Paraparetic/Diplegic gait

A

Unilateral weakness and spasticity from UMN lesion, most common impairment after strokes w/ R sided weakness

Scissor gait, spasticity in LE>UP, common in strike/cerebral palsy in kids

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43
Q

Define Steppage Gait

Define Parkinsonian Gait

A

Most often seen in peripheral nerve dz (L5 if unilateral), distal LE most effected as weak foot dorsiflexors

Stooped posture and shuffling w/ pill rolling tremor, turns En Bloc (as a whole) like a statue

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44
Q

Define Apraxia

Define Choreoathetotic

A

Similar to Parkinsonian but no pill rolilng, PT appears to be glued to ground w/ difficulty turning/starting, dementia and incontinence

Hyperkinetic gait as lurching and unpredicatble motions, Huntingtons Dz,
Tardive Dyskinesia- cause of many odd stereotype gait d/os

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45
Q

Define Vestibular gait

Define Astasia/Abasia gait

A

PT falls to one side, asymmetric nystagmus

Psychogenic gait

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46
Q

MS

A

Autoimmune
Sensory loss, optic neuritis, Weak, Hyper reflexes, + babinksi, Dydiadokinesis

Dx: MRI w/ 2 regions of white matter at different times
IgG bands (oligodclonal)

Tx: flares w/ Glucocorticoids
DMARD for long term

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47
Q

Acute Disseminated Encephalomyelitis

A

Widely scattered small foci of perivenular inflammation and demyelination
(MS has large demyelinatino lesions)
Presents 1st with behavior and cognitive abnormalities
(MS presents with these late in Dz)

48
Q

ALS

A

Most common progressive motor neuron Dz
Dx requires simultaneous U/L neuron involvement w/ progressive weakness and all normal: no pain, bowel/bladder, x-rays, CSF
Tx: Riluzole- reduces glutamate to inc short term suvival
Edaracone- free radical scavenger to slow Dz progression in early/mild cases

49
Q

Poliomyelitis

A

Entrovirus transmitted through fecal-oral
Destroys anterior horns
Dxs by isolating virus in stool/NP secretions

50
Q

Poliomyelitis follows a prodromal phase that includes ? 5 things?

A

Fever

Myalgia, Malaise, URI/GI, Weakness lasting days

51
Q

What CNs are Sensory, Motor an Both

A

S- 1 2 8
M- 3 4 6 11 12
B- 5 7 9 10

52
Q

How does Amaurosis Fugax
present and what causes it?

PTs with this need to be treated as ?

A

Transient monocular blindness, “curtain coming down over an eye”
Dec blood to retina

TIA/Stroke

53
Q

S/Sxs of Optic neuritis

What is it associated w/

More severe Sxs are due to ?

Why is Dx usually delayed and how is it treated?

A

Unilateral vision loss over days and retrobulbar pain w/ EOMs

MS

Vit D

Disc looks normal, IV Methylpredinsolone

54
Q

How is GCA treated?

What type of vision loss is typical for non function pituitary tumor

A

Prednisone and Biopsy ASAP

Bitemporal hemianopsia from tumor pressing on optic chiasm

55
Q

S/Sxs of Argyll Robertson pupil

What is this Dz related w/?

A

+ accomodation w/ near vision
- reaction at all to light

Syphilis or MS

56
Q

What are the 3 most common causes of CN6 Palsy

What 3 things can also, less frequently, cause this?

Bilateral CN6 Palsy are all treated as ? until disproven

A

Trauma, Microvascular Dz, Basal intracranial neoplasms

Basal meningitis, clivus lesions and posterior fossa lesions

Inc ICP

57
Q

What is the most common cause of isolated 6th Palsy in elderly PTs?

What is the more common cause in kids/young adults and what steps need to be taken?

A

Microvascular infarction

Tumor

Order MRI

58
Q

Elderly PT presenting with CN6 Palsy regardless of DM/HTN Hx needs to have what work up done?

A

ESR, Glucose, Anti-nuclear Abs, Fluroescent treponemal Abs and Lyme Titer

No improvement in months= MRI

59
Q

Lesions of the abducens nucleus in the brainstem often produces a ?

But not always ?

A

Conjugate gaze palsy to ipsilateral side

True abduction weakness

60
Q

CN5 Trigeminal Neuralgia is AKA ?

Definition

What causes pain?

A

Tic Douloreux
Compression of sensory fibers on root by Superior Cerebellar Artery

Triggered by touch, eating, wind

61
Q

How does CN 5 Trigeminal Neuralgia seen on imaging?

How is it treated?

A

Exam, CT, MRI and arteriography are all normal

Carbemazepine (monitor LFTs and CBC for development of agranulocytosis),
Oscarbazepine- less bone marrow toxicity

Phenytoin, Baclofen

62
Q

CN8 Cochlear portion issues are seen how by Rinne ad Weber?

A

Conductive: external canal or middle ear affected
Weber lateralizes to lesion
Rinne BC>AC on side of lesion

Sensorineural- lesion in inner ear/CN8
Weber lateralizes away from lesion
Rinne- AC>BC on side of lesion, both are not good

63
Q

Pure CN9 issue is seen as ?

CN10 issue is seen as ?

CN 11 issue is seen as ?

CN12 issue is seen as ?

A

Diminished gag, difficult swallowing

Asymmetric rise of uvula

Paralyzed SCM and Trap

Tongue paralysis w/ atrophy and speech issues

64
Q

idiopathic facial paresis of the LMN is seen in ?

Who is this seen more commonly in?

A

Bells Palsy

Women and DM

65
Q

How is Bells Palsy Tx

Define Ramasy Hunt Syndrome

A

Prednisone 60mg x 5 days, followed by 5 day taper and eye protection

HSV infection as vesicular rash in ear w/ pain prodrome, loss of hearing, balance and nausea
Tx: anti-virals (Acyclovir or Famciclovir) and steroid

66
Q

Retina receive blood from retinal artery which is a branch of ?

Visual cortex is supplied by the ? which is a branch of the ?

A

Ophthalmic artery

PCA, branch of basilar artery

67
Q

If blindness onset is rapid, slow or transient then what is the cause?

A 
Rapid= vascular
Slow= inflammation, neoplastic
Transient= MS, MG, Ischemia
68
Q

How do afferent signals travel to the brain?

How are efferent signal sent for action?

A

Light through CN2, divides at chiasm and arrives at pretectal nucleus

Signal sent via CN3 to cause direct and consensual constriction

69
Q

Diplopia is the inability to maintain ?

What are the three CN2 monocular vision D/os

A

Conjugate gaze

Transient Monocular blindness
Optic neuritis
GCA

70
Q

Define the Marcus Gun Pupil

A

Afferent pupil defect from retina/optic nerve Dz

Pupil dilates to light, + consensual reflex

71
Q

What are the 3 CN2 Binocular Vision D/os

What are the 5 grades of papilledema

A

Papilledema
Pituitary tumor
Occipital cortex lesion

1- C shaped halo w/ temporal gap
2- circumferential halo
3- loss of vessels leaving disc
4- loss of vessels on disc
5- 4 criteria and loss of all disc vessels
72
Q

What are the two types of pituitary tumors?

A

Functioning- HA, galactorrhea, amenorrhea, acromegaly
Prolactoma- most common

Non-Functioning- tumor presses on chiasm causing gradual bitemporal hemianopsia

73
Q

How are pituitary tumors treated?

What can cause occipital cortex lesions?

A

Prolactoma- Bromocriptine or Carberogline
All others= surgery

Trauma, Tumor, PCA infarct leading to subtle homonymous hemianopia

74
Q

Define CN3 Palsy

What are 4 things that can cause it

A

“Down and Out”
Diplopia, Ptosis and pupil w/ down/out deviation and dilation

Aneurysm
Trauma/Tumor
Menigitis
Ophthalmoplegic migraine

75
Q

How do you reach Horners Syndrome Anisocoria

A

Anisocoria more in dark, small pupil abnormal

Dilation lag, Ptosis

10% cocaine, small pupil doesn’t dilate= Horners

If both pupils dilate symmetricaly= physiologic anisocoria

76
Q

How do you reach Adies Tonic pupil with Anisocoria

A

More in light, large pupil abnormal

Sluggish to light

0.1% Pilocarpine

Large pupil constricts= Adies

77
Q

How do you get to 3rd Nerve Palsy w. Anisocoria

A

More in light, large pupil abnormal

Ptosis/Ophthalmoplegia

78
Q

How is Horners Syndrome evaluated?

A

Preganglionic:
No brainstem Sxs= CT or MRi of neck and chest
+ Brainstem Sxs= Neuroimage head

Postganglionic- head andneck MRI

79
Q

When evaluating Horner’s Syndrome, think of what two causes?

A

Lung tumor or cartoid artery aneurysm

80
Q

If there is Ptsosis of eyelid on side of small pupil, PT has ?

If there is ptosis of eyelid on side of large pupil, PT has ?

A

Horners on that side

Partial 3rd nerve lesion on that side

81
Q

Define Adie’s Pupil

A

Parasympathetic denervation that poorly constricts to light but reacts better to accommodation

82
Q

Define CN4 Palsy

A

Diplopia

Common cause of vertical diplopia

83
Q

What is the most common cause of superior oblique palsy?

What does the eye look like?

A

Head trauma related w/ CN4 palsy

Deviates up and medially

84
Q

Who is Bells palsy seen most common in?

What preceding Sxs can hint of issue?

A

Female, DM

Max onset of paralysis in 48hrs, preceded by pain behind ears and loss of taste

85
Q

What nerve is affected by Bells Palsy?

If forehead muscles are preserved then think ?

A

CN7

Central lesion instead (stroke in cerebral hemisphere)

86
Q

Loss of ssensation of hot peppers = ?

What 3 nerves taste?

A

CN5 somatosensory sensation

7 9 10

87
Q

Bells palsy will affect taste ?

Define Paresis

A

Loss of anterior 2/3

Incomplete paralysis
“less severe weakness”

88
Q

Hypertonia means ? issue

Hypotonia means ? issue

A

Hyper= spastic- UNM lesion; rigid- extrapyramidal dysfunction

Hypo- LMN lesion or myopathy

89
Q

Corticospinal tract is AKA ?

What does this tract supply to the body?

A

Pyramidal system

Inhibition to muscle contraction

90
Q

An issue at any of what 4 locations can disturb PNS function

A 
JR PAP
Anterior Horn
Nerve Root
Limb Plexus
Peripheral Nerve
Junction
91
Q

Polyneuropathies/DM usually have what type of DTR reflexes?

All levels of ? contribute to gait

A

Loss of distal, preserved proximal

Neuroaxis

92
Q

What are three causes of Steppage/Neuropathic gait?

What causes waddle gait?

A

Sensory Neuropathy, b12, Tabe Dorsales- degeneration of dorsal columns causing interfered reflexes/movements

Myopathy, NMJ Dz, Proximal Symmetrical spinal weakness

93
Q

What PTs commonly have Tardive Dyskinesia

PTs with B12 deficiency can develop sensory ataxia and have what finding during a PE?

A

Chronic anti-psychotics
D2 dopamine blocking meds

+ Romberg

94
Q

What are 4 RFs of MS?

What are the top 3 initial Sxs of MS?

A

Genetics
Vit D deficient
EBV after early childhood
Smoking

Sensory loss
Optic neuritis
Weakness

95
Q

Define Internuclear Ophthalmoplegia and who is it seen in

A

MS Pts w/ impaired adduction of eye due to lesion in ipsilateral medial longitudinal fasciculus

96
Q

What are the 4 eye problems MS PTs can develop

How is MS and Bells palsy differentiated?

A

Optic neuritis
Diplopia
Internuclear Opthalmoplegia
CN6 Palsy

MS not associated w/ ipsilateral loss of taste or retroauricular pain

97
Q

What is the most common reason for work related disability in MS PTs?

What are the 3 parts of the Dz course?

A

Fatigue

Relapse/Remitting Dz- most common
Secondary progressive- begins as RMS then steadily deteriorates
Primary progressive- steady progression from onset

98
Q

Since there is no definitive Dx test for MS, what is the most useful tool for confirming Dx?

What is the hallmark for the Dx

A

MRI w/ contrast for enhancement

2 or more episodes of Sxs and 2 or more signs
(Sxs longer than 24hrs, white matter tracts of CNS, episodes spread by a month or longer)

99
Q

How is MS treated?

A 
Acute: Glucocorticoids
Methyprednisone 1g/day IV x 3 days
PO Prednisone 60-80mg/day x 1wk then taper
Long term=
B-interfeon (Avonex 30 mcg IM/wk)
Glatiramer 20mg SQ/day
100
Q

What meds are used for primary and secondary progressive MS?

A

Primary- Ocrelizumab

Secondary- little evidence for immuno suppression

101
Q

When does a MS Dx have favorable prognosis

How is this prognosis info gathered?

A

Optic neuritis/sensory Sxs at onset
<2 relapses in 1st year
Minimal impairment @ 5yrs

First demyelinating event w/ MRI
3 or more atypical T2 weighted lesions= 80% risk of developing after 20yrs
Normal MRI= <20% chance of developing MS

102
Q

Define ADEM

What is it’s key presenting Sx

A

Monophasic illness leading to CNS demyelination

Mild HA and drowsiness to Irritable Sxs like MS
Major Sx- optic neuritis

103
Q

How is ADEM seen on imaging?

What will lab work show?

A

MRI w/ gadolinium

Lymphocytic pleocytosis
Elevated protein
Rarely seen oligoclonal bands

104
Q

What is the prognosis and Tx for ADEM

A

IV corticosteroids shorten and lessen severity of Dz

Recovery is usually complete

105
Q

What does ALS stand for?

What do the words mean?

A

Amyotrophic Lateral Sclerosis

Amyotrophy= no muscle nourishment, atrophy

Lateral

Sclerosis- loss of fibers in lateral columns resulting in fibrillary gliosis impart a partiuclar firmness

106
Q

Who does ALS impact more and what is the median survival?

A

3-5yrs, respiratory paralysis
10% autosomal dominant
1-3/100,000
M>F

107
Q

Traumatic damage above C5 results in ?

Damage below T6 results in ?

Bowel and bladder dysfunction occurs w/ lesions above ? level

A

Respiratory insufficiency

Abdominal reflexes

Sacral

108
Q

Define High Quadriplegia

Define Low quadriplegia

Define Paraplegia

A

C1-4: Dependent for movement, wheelchair and breathing

C5-8
Partially independent
May self-transfer
Manual wheelchair and driving ability

Below T1
Independent and may be able to self ambulate short distances w/ assistance

109
Q

Where does the motor pathway cross at?

Where does sensations like pain and temp cross?

A

Medulla, goes down lateral corticospinal tract, lesions cause ipsilateral Sxs

Immediatley cross, goes up spinothalamic tract, lesions cause contralateral Sxs

110
Q

What are the two types of cord tumors?

A

Intramedullary- mostly Ependymomas, Gliomas

Extramedullary- majority of all, neurofibromas, meningiomas

111
Q

What will lab results show in PTs with spinal tumors?

A 
Xanthochromatic
Elevated proteins
N/Elevated WBC
N/Dec glucose
Quenckenstedt test- shows partial/complete block
112
Q

What causes Neurogenic Shock

A

Acute cord injury

Loss of sympathetic tone, reduced vascular resistance, HOTN, no tachy reflex

113
Q

What Dx is made via nerve and muscle biopsy?

Fasciculus gracilis belongs to what tract and only exists below what level?

A

Vasculitic
AKA Polyarteritis nodosa

Dorsal column
T6

114
Q

Define Central Cord Syndrome

Define Hemicord?Brown Sequard Syndrome w/ R sided injury

A

Absence of pain and temp in both UE

No Dorsal column in R leg
No Corticospinal in R leg
Retained Spinothalamic in L leg

115
Q

Define Posterior Cord Syndrome

Define Anterior Cord Syndrome

A

Bilateral loss of dorsal column sensations

Corticospinal and Spinothalamic tracts severed
Dorsal tract retained

IPAP (212 decks)

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