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Clinical Medicine > Neuro- Diagnostic methods > Flashcards

Neuro- Diagnostic methods Flashcards

1
Q

Common signs of upper motor neuron lesion

A

weakness/ paralysis
increased muscle tone
increased reflex strength & + Babinkski sign
muscle mass maintained

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2
Q

Possible cause of upper motor neuron lesions?

A

Stroke (contralateral symptoms), cord section

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3
Q

where is the lesion in an upper motor neuron

A

above the anterior horn cell in the spinal cord or above the nuclei of the cranial nerve

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4
Q

what happens to tone in an upper motor neuron lesion?

A

increased (spasticity) +/- clonus

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5
Q

what happens with muscle weakness in upper motor neurons?

A

all muscle groups of the lower limb- more marked in the flexor muscles. in the upper limb, weakness is more marked in the extensors

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6
Q

fasciculations in the upper motor neuron lesions?

A

absent

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7
Q

wasting? what happens in a upper motor neuron lesion?

A

appears late, mainly because of disuse

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8
Q

damage to several discrete nerves (not contiguous)

A

multiple mononeuropathy

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9
Q

damage to multiple diffused nerves

A

polyneuropathy

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10
Q

damage to a nerve root?

A

radiculopathy

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11
Q

damage to motor nerves can show up as?

A

weakness, but also cramps, fasciculations, muscle wasting

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12
Q

damage to large sensory fibers can show up as?

A

damage to the ability to feel vibrations and touch- especially in the hands and feet
* leads to stocking glove distribution of numbness, loss of reflexes, loss of position sense (makes it hard to coordinate complex movements)

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13
Q

damage to small fibers without myelin sheaths interferes with the ability to? what else can happen with this type of damage?

A

interferes with the ability to feel pain/temp
it can causes neuropathic pain

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14
Q

damage to autonomic nerves can cause?

A

excess sweating, heat intolerance, blood pressure fluctuations, and GI symptoms

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15
Q

most neuropathies affect?

A

motor, sensory and autonomic systems

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16
Q

what two nerve types are predominantly effected with neuropathy?

A

motor and sensory

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17
Q

most neuropathies are?

A

length dependent meaning the farthest nerve endings in the feet are where symptoms develop first or are worse

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18
Q

most common cause of single nerve injury?

A

physical injury (trauma)

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19
Q

leading cause of polyneuropathy in the US?

A

Diabetes

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20
Q

what is the major difference between PNS disorders vs stroke

A

Time frame is important
* PNS disorders slowly progressive compared to stoke

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21
Q

Herniation at the L3-L4 disc; L4 nerve root would have pain where? Numbness? weakness? atrophy? what reflex would be diminished?

A

Pain: lower back, hip, posterolateral thigh, anterior leg
numbness: Anteromedial thigh and knee
weakness: quadriceps
atrophy quadriceps
reflexes: knee jerk diminished

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22
Q

Herniation at the L4-L5 disc; L5 nerve root would have pain where? Numbness? weakness? atrophy? what reflex would be diminished?

A

Pain: Above sacroiliac joint, hip, lateral thigh and leg
numbness: lateral leg, first three toes
weakness: dorsiflexion of great toe and foot; difficulty walking on heels; foot drop (may occur)
atrophy: minor or nonspecific
reflexes: changes uncommon in knee and ankle- posterior tibial reflex diminished or absent

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23
Q

Herniation at the L5-S1 disc; S1 nerve root would have pain where? Numbness? weakness? atrophy? what reflex would be diminished?

A

pain: over sacroiliac joint, hip, posterolateral, thigh and leg to heel
numbness: back to calf, lateral heel, foot and toes
weakness: plantar flexion of foot and great toe may be affected; difficulty walking on toes
atrophy: Gastrocnemius and soleus
reflexes: Ankle jerk diminished or absent

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24
Q

when do people with back pain need an MRI?

A

if they have a history of cancer
if they have back pain and fever or concern for infection
objective extremity weakness
loss of bowel or bladder control

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25
Q

weakness of the legs, saddle anesthesia, urinary retention, loss of reflexes, loss of rectal tone +/- low back pain?

A

Cauda Equina syndrome

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26
Q

What type of diagnostic imaging should you get for Cauda Equina syndrome?

A

MRI

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27
Q

Rare condition in which a person’s immune system attacks the peripheral nerves

A

gullain-Barre syndrome

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28
Q

what is key to diagnosis of Gullain-Barre syndrome?

A

Absent reflexes

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29
Q

what methods can you use to DIAGNOSE Guillan-Barre?

A

Electrophysiological studies (Nerve conduction studies)
- CSF analysis

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30
Q

Management of Guillan-Barre? what is first line?

A

Plasmapheresis or IVIG

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31
Q

temporary weakness or facial paralysis on one side of the face resulting from dysfunction of cranial nerve VII- most common cause of facial paralysis

A

Bells palsy

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32
Q

bells palsy vs stroke? how can you tell the difference?

A

the key is the forehead! is there wrinkling when you ask patient to raise eyebrow?
if wrinkles are present, think stroke
if no wrinkles- it is likely Bells

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33
Q

how do you treat bells palsy?

A

no treatment is really required
however you can give steroids (prednisone) to reduce inflammation are associated with good facial functional recovery

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34
Q

Autoimmune disease affecting skeletal muscles leading to fluctuating weakness and fatigue?

A

myasthenia gravis

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35
Q

what is the pathophysiology of Myasthenia gravis?

A

antibodies block acetylcholine receptors at post-synaptic neuromuscular junction.
since acetylcholine can’t bind, it is more quickly broken down by acetylcholinesterase

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36
Q

what is considered a mild form of myasthenia gravis?

A

limited to eye muscles

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37
Q

what is considered a severe form of myasthenia gravis?

A

it affects many muscles (including breathing in severe forms)

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38
Q

what types of diagnostic testing can be done to diagnose myasthenia gravis

A

fatigue test
ice test or sleep test
tensilon
serologic screening
Electrophysiologic testing
thyroid panel, thoracic imaging

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39
Q

treatments for myasthenia gravis?

A

acetylcholinesterase inhibitors
immunosuppressants
thymectomy

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40
Q

what is considered acts of daily living during stroke recovery?

A

transfers, bathing, positioning, dressing, feeding, toileting, grooming

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41
Q

What is considered instrumental activities of daily living during stroke recovery?

A

shopping, meal prep, use phone, drive, money management, emergency aid, use of safety precautions

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42
Q

What is the peak of neurologic recovery during a stroke?

A

the first 3 months of stroke

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43
Q

what is considered secondary prevention for stroke?

A

CHD (anti-platelet therapy) hypertension control, lipid lowering therapy, exercise, smoking cessation

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44
Q

what is on the stroke risk assessment?

A

pain assessment
bowel and bladder functional assessment (LOOK FOR DYSURIA)
mobility and need for assistance
risk of DVT
hx of anti-platelet or anticoagulation tx
psychosocial assessment (holistic assessment by social worker)
emotional support

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45
Q

what should you start once a stroke patient is medically stable?

A

rehab therapy (mobilize the patient)

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46
Q

what does mobilizing a stroke patient reduce the risk of?

A

DVT/ pulmonary embolism,

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47
Q

what is standardized evaluation tool that can be used for stroke evaluation? when should you do the evaluation? What does that evaluate?

A

NIHSS
Assess within the first 24 hours of stroke

this helps asses probability of outcome (recovery) determine appropriate level of care and develop optimal interventions

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48
Q

a score of <6 on the NIHSS signifies what? A score >16 signifies what

A

<6= good recovery
>16= death or severe disability

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49
Q

what is the standardized tool to asses for function after a stroke?

A

FIM

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50
Q

what does the functional assessment of stroke rehabilitation include?

A

arousal, attention, cognition
balance
circulation (particularly w/ position change)
gait
pain
ROM
muscle performance
motor function

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51
Q

difference between inpatient and outpatient rehab?

A

inpatient rehab is more aggressive- pt. must meet criteria for aggressive therapy

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52
Q

what is the pathophysiology behind Multiple Sclerosis?

A

Destruction of myelin sheath slows then stops the conduction of nerve impulses- this happens progressively

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53
Q

What symptoms of MS contribute to the patients perception of overall health?

A

Pain
unsteady gait
fatigue(most common and chronic disabling symptom)

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54
Q

what is the current- McDonald Diagnostic Criteria?

A

At least 2 attacks with objective clinical evidence of at least 1 lesion, plus dissemination in space shown on MRI, or two or more MRI lesions consistent with MS, plus positive CSF finding or second clinical attack

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55
Q

What is the preferred method to evaluate MS non-invasively? What characteristic is preferred to make a diagnosis?

A

MRI (gadolinium enhanced)
three characteristic lesions (white patches) are preferred to make diagnosis

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56
Q

what is another method of diagnosing MS? What would you expect to see?

A

cerebrospinal fluid (CSF)
increased IgG & oligoclonal bands
* oligoclonal immunoglobulin bands positive in CSF, negative in serum

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57
Q

1st clinical episode consistent w/ a demyelinating etiology, suggestive of MS

A

Clinically Isolated Syndrome

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58
Q

incidental brain or spinal cord MRI findings suggestive of MS, in an asymptomatic patient lacking history, symptoms or signs of MS

A

Radiologically Isolated syndrome (RIS)

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59
Q

characterized by partial or total recovery after attacks
it is the most common and treatable form of MS. This is characterized by exacerbations where new symptoms can appear and old ones resurface or worsen

A

relapsing-remitting MS

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60
Q

A relapsing-remitting course which become steadily worse. Attacks and partial recoveries continue to occur. in the early phases the person may still experience a few relapses but after a will they merge into a general progression

A

secondary- progressive MS

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61
Q

progressive from onset; symptoms generally do not remit. Onset is typically in the late thirties or early forties and men are likely as women to develop this form and the initial disease activity is in the spinal cord, not the brain

A

primary-progressive MS

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62
Q

This form of MS follows a progressive course from onset, punctuated by relapses. There is a significant recovery immediately following a relapse but between relapses there is gradual worsening of symptoms

A

Progressive Relapsing MS

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63
Q

what are the most important factors for predicting worse clinical outcome in MS?

A

poor relapse recovery
high burden of disease on MRI
New T2 lesions on MRI
Spinal cord lesions

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64
Q

What therapy should be started early in the course of MS?

A

Disease modifying therapy

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65
Q

what is the benefit of disease modifying therapy?

A

Decrease the relapse rate
reduce disability progression
slow the accumulation of lesions on MRI

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66
Q

how is diet implicated in MS?

A

patients that maintained a low fat-vegetable based diet were much more likely to be free of MS relapses

omega 3 fatty acids are also associated with significant reductions in the frequency & severity of relapses

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67
Q

what are some uses of CT?

A

useful for certain types of brain injuries
lesions due to cancer
identify brain swelling or bleeding (hemorrhage)
show structural brain changes from diseases such as Alzheimers or schizophrenia
ventricles
intracranial masses
calcification

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68
Q

why choose CT over MRI?

A

no magnet, so safer for people with implanted hardware
not as much detail as MRI- but much faster study. Useful for identifying stroke or other acute conditions

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69
Q

what does bone show up as on a CT scan?

A

white

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70
Q

what does Air show up as on a CT scan?

A

black

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71
Q

what does the brain show up as on a CT scan?

A

gray

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72
Q

what does blood show up as on a CT scan?

A

white

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73
Q

what are advantages to CT?

A

can change slice thickness and angulation
fast
inexpensive
widely available

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74
Q

what are disadvantages to CT?

A

radiation
contrast dye

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75
Q

what is a CT angiogram useful for?

A

Helpful for visualizing blocked blood vessels (accounts for 90% of strokes)
aneurysms (ballooning {thinning} of vessel walls)
trauma to vessels
vasculitis
pre-op planning

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76
Q

what should you consider before ordering a CT angiogram?

A

Consideration for patient’s renal function since dye is processed through the kidneys
Need IV access

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77
Q

if you want to rule out a hemorrhagic stroke (brain bleed in about 10% of strokes) what might you consider ordering?

A

Non-contrast CT

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78
Q

What does a non-contrast CT have good have sensitivity for?

A

bone, blood and air

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79
Q

if you get someone with stroke-like symptoms that started less than 4 hours ago, and you get a negative non-contrast CT (no hemorrhagic stroke) what drug can you give that would be lifesaving?

A

tPA (tissue plasminogen activator

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80
Q

what happens to a patient who has a hemorrhagic stroke if given tPA?

A

you will cause them to die quickly

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81
Q

what is often the gold standard for evaluating stroke, brain tumors and other brain/spinal cord pathology?

A

MRI

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82
Q

what are some advantages to MRI?

A

soft tissue contrast resolution superior to CT
smaller lesions missed on CT can be picked up w/ MRI
multiplanar views
more info on blood flow w/out use of contrast
no radiation
less artifact

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83
Q

what are some disadvantages to MRI?

A

Length of time
claustrophobia

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84
Q

what imaging modality should you consider for a head injury when evaluating for foreign body?

A

radiography

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85
Q

what are the uses for radiography? what do certain parts of the body show up as?

A

useful for the Skull, neck, sinuses
bones=white
soft tissue= black/gray

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86
Q

what are some advantages to radiography? what is a disadvantage?

A

readily available
foreign bodies, some fractures
Disadvantage= low sensitivity

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87
Q

what are some uses for ultrasound?

A

carotid artery patency
newborn screening

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88
Q

what are some advantages of ultrasound?

A

portable
no radiation
portable

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89
Q

what are some disadvantages to ultrasound?

A

operator dependent
can’s use for brain after fontanelles have been closed

90
Q

what imaging modality is a dynamic X-ray?
You inject contrast material into subarachnoid space and then monitor real-time flow to see if abnormalities appear
usually paired with a CT to better evaluate?

A

myelography

91
Q

what are some advantages of myelography?

A

-used for disk herniations and to rule out spinal cord compressions
- useful if patient can’t get an MRI

92
Q

disadvantages of myelography?

A

invasive procedure
radiation exposure

93
Q

Functional studies evaluate which two systems?

A

CNS & PNS

94
Q

what functional studies evaluate the CNS?

A

EEG, MEG, fMRI, PET

95
Q

what functional studies evaluate the PNS?

A

PET, EMG, NCS

96
Q

What imaging modality measures brain waves (electrical activity of neurons)
frequency from different brain areas provide data as to what is occurring?

A

Electroencephalography (EEG)

97
Q

EEG can detect issues such as?

A

seizure disorders
sleep disorders
changes to electrical activity from brain tumors, infection. brain damage, dementia (only electrical activity, often not diagnostic)

98
Q

what imaging modality measures the magnetic field from neuron electrical activity?

A

MEG

99
Q

what is the difference between the MEG and EEG?

A

in EEG the electrodes are placed on the scalp while he MEG uses a dewar that has multiple sensor coils (do not touch patients head

100
Q

benefit of MEG?

A

can identify the precise locations where seizures arise

101
Q

what are some uses of MEG?

A

used for pre-operative planning and in epilepsy surgery has shown promise in identifying autistic children by studying auditory processing
identifying cognitive defects in alzheimers, psychiatric disorders and head injury

102
Q

disadvantages of MEG?

A

much more expensive (thousands of dollars) than EEG (hundred of dollars) or fMRI (fewer thousands than MEG)

103
Q

which imaging modality can detect changes in blood flow and oxygen levels that arise from brain activity?

it also uses the magnetic field of the scanner to affect the magnetic nuclei of hydrogen atoms, so they can be measured and converted into images?

A

fMRI

104
Q

What is a key difference between the MRI and the fMRI?

A

MRIs display anatomic structure and fMRIs measure metabolic function

105
Q

what are the calculations for fMRI aimed at determining?

A

how the amount of oxygenated blood flow changes (more oxygenated blood in one part of the brain = more activity)

106
Q

what are some benefits and uses of fMRI?

A

no radiation
useful for assessing: brain activity
finding brain abnormalities
creating pre-surgical brain maps

107
Q

which imaging modality uses a small amount of radioactive tracer (similar to glucose) that is injected into a vein and the scanner take a picture of where glucose is being used in the brain?

A

Position emission tomography (PET)

108
Q

when is a PET imaging modality useful?

A

useful primarily for cancer evaluation- tracer accumulates within the malignant cells because of their high rate of glucose metabolism
also:
to detect and highlight tumors and diseased tissue
measure cellular and or tissue metabolism
show blood flow
evaluate patients who have seizure disorders that don’t respond to therapy
patients with certain memory disorders,
determine brain changes following injury, or drug abuse

109
Q

which imaging modality measures muscle response or electrical activity in response to a nerve’s stimulation of the muscle?
it also measures the electrical activity of muscle during rest, slight contraction and forceful contraction

A

Electromyography (EMG)

110
Q

when is EMG useful?

A

used to help detect location of neuromuscular abnormalities
-numbness, weakness, inflammation, etc)
helps find where the lesion is

111
Q

what imaging modality is a measurement of the amount of speed of conduction of an electrical impulse through a nerve? this modality can determine nerve damage and destruction, and often performed at the same time as EMG

A

Nerve Conduction Study

112
Q

progressive neurodegenerative conditon that causes death of the upper motor neuron and lower motor neuron

A

Amyotrophic Lateral Sclerosis (ALS)

113
Q

Classically presents as asymmetric progressive weakness in one limb that progresses over time to involve other limbs?

A

ALS

114
Q

What LMN deficit would be seen in ALS?

A

muscle atrophy, fasciculations- tongue fasciculations are classic

115
Q

What UMN deficit would be seen in ALS?

A

brisk reflexes, clonus, upgoing toes (babinski) jaw jerk, spastic speech, Hoffman’s sign

116
Q

what are the four regions of the body that could be affected in ALS?

A

bulbar, cervical, thoracic, lumbar

117
Q

what would provide a probable diagnosis of ALS?

A

UMN or LMN in 2 of 4 regions of the body
LMN may be determined by EMG only

118
Q

what is the prognosis of ALS after diagnosis

A

2-3 years

119
Q

what could cause a myasthenia crisis?

A

physiologic stress, surgery or medication

120
Q

X-linked disorder in dystrophin leads to nearby absence of protein?

A

Duechenne Muscular dystrophy

121
Q

What are some signs of of DMD?

A

Signs: Proximal leg weakness causing falls and walking problems
waddling gait
calf pseudohypertrophy (fat replaces muscle)
gower’s sign (inability to rise from seat on the ground without hands)

122
Q

what is the benefit of steroids in DMD?

A

mobility improves cardiac and respiratory function

123
Q

what are considered primary headache disorders?

A

tension type-headache
migraine headache
trigmeminal autonomic cephalgias

124
Q

what is the most prevalent type of primary headache?

A

tension-type

125
Q

what is the true range of glucose?

A

there is not true normal range of glucose

126
Q

what is the gold standard for diagnosing Bacterial meningitis?

A

Culture

127
Q

if getting a result and it is a gram-negative cocci in pairs what should you think of?

A

Neisseria meningitidis

128
Q

if getting a result and it is a gram-positive cocci in pairs what should you think of?

A

strep pneumo

129
Q

symptoms of bacterial meningitis

A

fever
headache
photophobia
irritability
vomiting
altered mental status
seizures

130
Q

what is the classic triad for bacterial meningitis?

A

fever, neck stiffness, headache

131
Q

Recurrent episodes of headache associated with other symptoms?

A

Nausea+/- vomiting
photophobia or phonophobia and or osmosphobia (scent hypersensitivity)
GI symptoms (delayed digestion, diarrhea, constipation)
neck pain

132
Q

inherited disorder of sensory processing- currently though to be a disorder or the central nervous system (and not to be a vascular disorder)

A

migraine

133
Q

to diagnose a migraine with aura, the patient must have one of the following symptoms

A

visual
sensory
speech and/or language
motor-motor symptoms may last up to 72 hours
brainstem
retinal

134
Q

what is the most common trigeminal autonomic cephalgias?

A

Cluster headache

135
Q

what is known as the suicide headache?

A

cluster

136
Q

shorter lasting attacks
unilateral
intense pain in the trigeminal distribution- most often in the ophthalmic branch
ipsilateral cranial autonomic symtpms

A

trigeminal autonomic cephalgias

137
Q

with a migraine headaches need to last? what are some criteria for a migraine without aura

A

4-72 hours
unilateral location
pulsating quality
moderate to sever pain
aggravation by or causing routine physical activity
nausea and or/vomiting
photophobia and phonophobia

138
Q

attacks tend to surround typical times of the day- often soon after sleep onset, midmorning, midafternoon
attacks tend to be seasonal- often spring and fall

A

cluster

139
Q

which headaches are unilateral? bilateral?

A

Cluster is always unilateral
tension type is bilateral
migraines can be unilateral, usually bilateral in children and adolescents

140
Q

what is the typical duration of each headache?

A

migraine- 4-72 hours
tension type- 30 minutes to 7 days
cluster 15 minutes-3 hours

141
Q

what imaging modality is the imaging of choice (if not contraindicated) to rule out secondary causes of headache?

A

MRI

142
Q

What headache type is most common primary headache disorder associated with medication overuse headache?

A

migraine

143
Q

what is the most common cause for spontaneous sudden acute headache?

A

Subarachnoid hemorrhage

144
Q

urge to move legs, most often after a period of inactivity; “creepy crawly sensation” “bugs all over me” “electrical sensation” gets better when they move around
causes sleep disturbance

A

Restless leg syndrome

145
Q

what are some of the pathogenesis of RLS?

A

Iron deficiency
Dopaminergic deficiency
thalamic issue
peripheral pathology

146
Q

what should you check in suspected RLS?

A

always check Iron levels
review medications- first gen. antihistamines, antipsychotics, antidepressants

147
Q

what are some protective factors in parkinson’s?

A

smoking, caffeine, exercise/ aerobic

148
Q

Depletion of dopamine in the substansia nigra results in disruption of communication from the basal ganglia to the motor cortex

A

Parkinson’s disease

149
Q

what are cardinal motor features in parkinson’s

A

tremor: resting, asymmetric, pill rolling
Rigidity: lead pipe, cogwheeling
bradykinesia (akinesia)
postural instability

150
Q

in order to make a diagnosis of parkinson’s the patient must have?

A

bradykinesia on exam plus tremor and/or rigidity

151
Q

what imaging can be done in the evaluation of parkinson’s? what does it show?

A

DAT scan- shows density of health dopamine neurons

152
Q

how do you get a definitive diagnosis of parkinson’s?

A

Autopsy

153
Q

what are some non-motor symptoms of parkinson’s

A

olfactory dysfunction
sleep disturbances
Fatigue
cognitive changes/ dementia
mood disorders
autonomic symptoms: orthostatic hypotension, constipation, urinary syptoms, sexual dysfunction

154
Q

degenerative changes in caudate, putamen, globus pallidus, temporal and frontal lobes

A

Huntington’s disease

155
Q

when can a diagnosis for huntington’s disease be made?

A

when chorea (dance like movements) are seen

156
Q

high number of CAG repeats leads to instability during replication, so the next generation, likely to have a high number of CAG repeats, which can lead to more severe diseases or earlier onset

A

Huntingtons diease

157
Q

what are some indications for lumbar puncture?

A

subarachnoid hemorrhage
CNS infection/ meningitis (most common)
many disorders affecting the nervous system (Guillan-Barre, MS)
Certain types of cancer
excess CSF in the brain

158
Q

how is the diagnosis of a subarachnoid hemorrage usually made?

A

diagnosis is usually made by CT scan or blood in CSF

159
Q

when is a lumbar puncture contraindicated?

A

in the presence of infection in the tissues near the puncture site
in the presence of pailledema (increased cranial pressure)
in coagulopathy or decreased platelet count

160
Q

what positions can you place the patient for lumbar puncture?

A

Lateral recumbent position (lying on their side)
Sitting position (if difficult entry, start seated then move to lateral recumbent position)

161
Q

which position for a lumbar puncture has an increased risk of post lumbar puncture headache?

A

Sitting position

162
Q

tuffier’s line is located?

A

superior iliac crest intersection (L4)

163
Q

where should the needle be inserted during a lumbar puncture? What about in children

A

L3/L4 or L4/L5
in children the spinal cord ends at L3, insertion L4/L5 or L5/S1

164
Q

what should you get if you cannot find the right place to insert the needle during a lumbar puncture?

A

Fluoroscopy

165
Q

what are some lumbar puncture complication?

A

post lumbar puncture headache (#1 complication)
back pain
traumatic tap
dry tap
referred LE pain
cerebral herniation
infection

166
Q

what is the cause of a lumbar puncture headache? what is it related to?

A

it is due to the leakage of CSF through the dural puncture site, leaking faster than CSF reproduced
-directly related to the size of the needle

167
Q

what causes macroscopic blood in CSF? secondary to improper needle placement?

A

traumatic tap

168
Q

how do you compare a traumatic tap vs. subarachnoid hemorrhage?

A

Clot formation in one of the tube favors traumatic tap

169
Q

what is considered abnormal lab results for CSF analysis?

A

> 250mmH20

170
Q

what should you begin to think about in patients with WBC > 1000

A

bacterial meningitis

171
Q

what should you think about in patients with <100 WBC’s/ mm3`

A

Viral meningitis

172
Q

what would a traumatic do the the white blood cell count?

A

cause an artificial rise

173
Q

if RBCs decrease in subsequent tubes, think?

A

traumatic tap

174
Q

if RBCs constant in subsequent tubes, think?

A

intracranial bleed

175
Q

elevated protein level (100-1000mg/dl) without an accompanying decreased cell count

A

Guillain-Barre syndrome

176
Q

increased immunoglobulin levels and oligoclonal bands (increased number of antibodies)

A

Multiple sclerosis

177
Q

lymphocytosis in CSF can be seen in?

A

viral, fungal and tuberculosis CNS infections

178
Q

what would you see in glucose levels for bacterial infections? Viral infections?

A

Lowered CSF glucose in bacterial
normal glucose levels in virus

179
Q

90% of the cause of bacterial meningitis is?

A

streptococcus pneumoniae
Neisseria meningitis

180
Q

the most common cause of acute septic (viral) meningitis is?

A

enteroviruses

181
Q

what is the most rapid and accurate test for the presumptive diagnosis of acute bacterial meningitis?

A

gram stain

182
Q

key complication of bacterial meningitis

A

hearing loss

183
Q

the culture done from lumbar puncture is usually accomplished from tube #?

A

4

184
Q

Aphasia (receptive, expressive)
right sided weakness
right side sensory distubance

A

Left MCA

185
Q

Left side weakness
neglect
left side sensory disturbance

A

Right MCA

186
Q

paralysis/ sensory loss of the leg/foot
urinary incontinence
paresis of the proximal arm
abulia
flat affect
akinetic mutism

A

ACA stroke

187
Q

peripheral (cortical)
homonymous/ hemianopsia
memory deficits
Central (penetrating)
sensory loss (thalamus)
CN III palsy with contralateral hemiplegia

A

PCA stroke

188
Q

the dizzy paitent–> vertigo
“drunk” oscillopsia
lightheaded/ fainting—> cardiovascular
key signs/symptoms

A

Cerebellar/Vestibular Strokes
(PICA, AICA, SCA)

189
Q

What is the workup for ischemic stroke/ TIA

A

Imaging of vasculature (MRA) and carotid (US)
cardiac telemetry and echo
blood pressure control
cholesterol: LDL and HDL
etc.

190
Q

difference between absence and complex partial seizure?

A

look at the timing, complex partial seizures tend to last longer

191
Q

what is the 1st, 2nd and 3rd line agent for acute seizures (but pt is not currently seizing)

A

lorazepam

192
Q

what can be first line in kids with complex seizures?

A

carbamazepine

193
Q

proximal muscles affected should hint to?

A

muscular disorders

194
Q

when to image for headaches?

A

new onset headaches in older people or significant worsening or change in pattern
-thunderclap headache
-continuous headache
-pulsatile tinnitus
-associated neurologic symptoms
-jaw claudication
-positional headache
-older onset

195
Q

Aphasia
apraxia
agnosia
problems with memory

A

cortical signs

196
Q

movement disorders
changes in posture or tone
gait abnormalities
tremors

A

Sub-cortical signs

197
Q

motor, sensory, temperature and pain lost; vibration/position intact

A

anterior cord syndrome

198
Q

motor impairment of upper more than lower extremities

A

central cord syndrome

199
Q

loss of fine, vibratory and position sensation; preserved motor function

A

posterior cord syndrome

200
Q

ipsilateral paralysis, loss of proprioception, touch, and vibration; contralateral loss of pain and temp

A

brown-sequard (hemicord) syndrome

201
Q

a reflexic bladder, bowel and lower extremities; sacral reflexes can be preserved; reduced rectal tone and perirectal sensation

A

conus medullaris syndrome

202
Q

sensory loss, with flaccid weakness; sacral reflexes abnormal or absent

A

cauda equina syndrome

203
Q

what happens to GABA and acetylcholine levels in Huntington’s disease?

A

The levels decrease

204
Q

What area of the brain is responsible for movement of the body as a whole?

A

The primary motor cortex

205
Q

A tumor or destruction of the this area would result in widespread paralysis

A

the primary motor cortex

206
Q

what area of the brain coordinates movements of the hands?

A

the premotor area (anterior to the primary motor cortex)

207
Q

A tumor or other destructive agent in this area leads to uncoordinated movement and non-purposeful hand movement called motor apraxia. It may also affect the complex activities related to speech, voluntary eye movement and head rotation.

A

Anterior to the primary motor cortex (premotor area)

208
Q

what is immediately posterior to the primary motor cortex?

A

the primary sensory cortex

209
Q

Destruction to the primary motor cortex would result in?

A

loss of sensation

210
Q

what is immediately superior to Broca’s area?

A

regions for personality and memory storage

211
Q

Middle cerebral artery lesions are associated with?

A

contralateral motor and sensory deficits of the face, arms and legs (face and arm deficits are more pronounced than the leg)

212
Q

anterior cerebral lesions are associated?

A

Leg weakness greater than arm weakness, mild contralateral cortical sensory deficits and dyspraxia

213
Q

internal carotid occlusion causes symptoms similar to? what else may it include?

A

Middle Cerebral artery
may also include ipsilateral ocular symptoms

214
Q

branch occlusion of the vertebrobasilar system can cause? what symptoms could that include?

A

cerebellar, sensory and cranial nerve symptoms
findings may include dizziness, vertigo, diplopia, ataxia, cranial nerve palsies and limb weakness

215
Q

A positive Babinski reflex is an indication that?

A

the corticospinal tract has been transected

216
Q

Where does the corticospinal tract originate? where does it terminate? what does it control?

A

originates in the frontal love and terminates in the ventral horn of the spinal cord
controls the contralateral side of the body with the majority of fibers crossing the medulla

217
Q

damage to this nerve root may cause tingling primarily on the medial surface of the arm, into the lateral hand into the fourth and fifth digits. may also cause dysfunction of the hand

A

C8

218
Q

damage to this nerve root may cause neck and upper shoulder numbness and pain

A

C4

219
Q

damage to this nerve root may cause deltoid and shoulder numbness and pain, biceps tendon reflex may be diminished

A

C5

220
Q

damage to this nerve root can cause numbness and tingling down the arm into the thumb, with weakness in the bicep muscle and diminished brachioradialis tendon reflex

A

C6

221
Q

damage causes numbness and pain down the affected arm but into the middle finger, triceps reflex may also be diminished

A

C7

Clinical Medicine (5 decks)

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