Neuro reading Flashcards
1
Q
What are paraphasic errors?
A
Inappropriately substituted words
2
Q
How can you test comprehension?
A
Mike was shot by John. Is John dead?
3
Q
What are the 6 components of testing language?
A
- Spontaneous speech
- Comprehension
- Naming
- Repetition
- Reading
- Writing
4
Q
What are the four components of Gerstmann’s syndrome?
A
- Calculations
- Right-left confusion
- Finger agnosia (naming fingers)
- Agraphia
5
Q
What is apraxia?
A
Inability to follow a motor command that is not due to a primary motor deficit or a language impairment
6
Q
Apraxia may indicate a lesion where?
A
language area and adjacent structures of the dominant hemisphere
7
Q
What is anosognosia?
A
a deficit of self-awareness, a condition in which a person with some disability seems unaware of its existence
8
Q
How can you test perseveration? What type of pathology is this indicative (lesion where)?
A
Draw alternating sequence.
Frontal release sign
9
Q
What is abulia, and what sort of pathology is it indicative of?
A
Slow responses
Frontal release sign
10
Q
What is red desaturation, and what does it test for?
A
Compare between eyes a red colored object. If color diminishes or changes, suspect CN II dysfunction
11
Q
What is optokinetic nystagmus, and how is it tested?
A
Normal nystagmus elicited by moving a striped piece of paper in front of the pt
12
Q
What is the jaw jerk reflex, and what is being tested?
A
Tapping on a slight open jaw. If jaw moves, UMN sign
13
Q
Why is hearing loss almost always caused by peripheral nerve lesions?
A
Projects bilaterally to the corticies
14
Q
Fasiculation are a LMN or UMN sign?
A
LMN
15
Q
Lesions of the motor cortex produce tongue weakness on the ipsilateral or contralateral side?
A
contralateral
16
Q
Where is the best place to inspect for LMN fasciulations? (3)
A
intrinsic hand muscles
thigh
Shoulder girdle
17
Q
How long do UMN lesions take to manifest?
A
hours to weeks
18
Q
What does toe tapping or hand tapping test?
A
FIne motor movements
19
Q
Proximal weakness is more suggestive of what sort of pathology?
A
Myopathy
20
Q
Rate 0-5 reflexes
A
0 = none 1 = trace, or only seen with reinforcement 2 = Normal 3 = brisk 4 = nonsustained clonus 5 = sustained clonus
21
Q
True or false: reflexes rated 1-3 are only abnormal if they are asymmetric
A
True
22
Q
What is the crossed adduction sign of the legs?
A
tapping the medial aspect of the knee elicits adduction of the opposite leg
23
Q
What is the interpretation if one foot has a downgoing babinski, and the other has no response?
A
No response side is considered abnormal
24
Q
Name the spinal level tested: biceps
A
C5, C6
25
Name the spinal level tested: brachioradialis
C6
26
Name the spinal level tested: triceps
C7
27
Name the spinal level tested: Patellar
L4
28
Name the spinal level tested: achilles
S1
29
How do you elicit the abdominal cutaneous reflexes?
Lightly brushing either side of the umbilicus
30
What is the bulbocavernosus reflex? How do you perform it for males and females respectively?
contraction of the rectal sphincter in response to pressure on the bulbocavernosus muscle
- Males = squeeze the glans
- Females = traction on the foley cath
31
What are the four major frontal release signs?
Graps
Snout
Root
Suck
32
What is myerson's sign?
Positive glabellar tap
33
When is a glabellar tap considered positive?
Only in continuous (should eventually extinguish in the normal pt)
34
What is the palmomental reflex?
Scraping hypothenar eminence causes contraction of ipsilateral mentalis muscle (may be normal in some people)
35
What spinal levels are being tested with the abdominal cutaneous reflexes?
ABove umbilicus = T8-T10
| Below = T10-T12
36
What spinal level is being tested with the cremasteric reflex?
L1-L2
37
What spinal level is being tested with the anal wink
S2-S4
38
What spinal level is being tested with the bulbocavernosus reflex?
S2-S4
39
Dysdiadochokinesia is a sign of what sort of pathology (where is the lesions)?
Cerebellar
40
What is the difference between truncal and appendicular ataxia?
- Appendicular = affects movements of the appendages, and is indicative of cerebellar hemispheres
- Truncal = affects proximal musculature, and is suggestive of lesions to the vermis
41
FNF and other cerebellar tests, rely on what senses?
- Cerebellar coordination
- Position sense
- visual pathways
- UMN and LMNs
- Basal ganglia
42
If the Romberg test is abnormal with eyes open, where is the lesion?
Cerebellum
43
What is circumduction in the context of gait?
Moving in circular paths when trying to move in a straight line
44
What is the forced gait test?
walk on heels, toes, sides of feet
45
What is gait apraxia, and what conditions is it seen in?
Pt able to carry out all motor movements of gait while supine, but can't actually walk.
NPH or frontal disorders
46
Where is vibratory testing done on the foot?
Lateral aspect of the ball of the foot
47
What is graphesia testing (what neurological area)?
Cortices
48
What is stereognosis testing (what neurological area)?
Cortex
49
How can you improve motor / sensory testing in patients with hemineglect?
Turn head and attention toward affected side
50
Absences of the Doll's eyes reflex in an awake and comatose pt mean what respectively?
```
Awake = normal
unconscious = Brainstem lesion
```
51
What is the COWS mnemonic for the caloric stimulation testing?
Cold opposite, warm same
52
What does decerebrate vs decorticate posturing indicate in terms of localization?
```
Decorticate = lesion above the midbrain
Decerebrate = below midbrain
```
53
What is triple flexion, and what does it indicate?
Flexion of the hip and knee, with dorsiflexion at the ankle.
Spinal cord intact (it's a spinal cord mediated reflex)
54
What is involved with the apnea test, and what does it indicate?
pull off ventilator, and check for spontaneous breathing while monitoring pH, PCO2, PO2. If no spontaneous breathing occurs, despite appropriate changes in the above, consider brain death
55
True or false: brain death is a clinical diagnosis
True
56
What is conversion disorder and somatization disorder?
```
Conversion = psych produced sensory or motor deficits
Somatization = psych produce somatic symptoms
```
57
What do saccadic eye movement in a pt with a coma indicate?
Locked in syndrome, or pseudocoma
58
What is the hoover test?
palpate opposite gastrocnemius when asking pt to lift contralateral leg. Gastroc should constrict if true weakness
59
Why is midline change of vibratory sense across skull or sternum not physiologic?
Bone will readily conduct to other side
60
True or false: a headache that is always on the same side warrants imaging
True--r/o vascular malformation
61
What are ophthalmoplegic migraines?
Migraines where eyes are paralyzed in some way
62
Lesions to the temporal lobe optic radiations will produce what sort of visual field defect?
Contralateral homonymous quadrantanopia ("pie in the sky")
63
What is the role of the superior colliculus and pretectal of the brain?
Directing attention toward visual stimuli
64
What is the fissure that separates the occipital lobe?
Calcarine fissure
65
What sort of visual field defect is associated with a superior and inferior occipital lobe lesion respectively?
Inferior lobe = superior vision and v.v.
66
What are the three basic channels of information processed in the occipital lobe?
Motion
Form
Color
67
Negative visual disturbances are usually a lesion where? Positive?
```
Negative = visual pathways
Positive = eye itself
```
68
Occipital lobe seizures will produce what symptoms?
pulsating colored lights or moving geometric shapes
69
Where do formed visual hallucinations come from?
Inferior temporo-occipital visual association cortex
70
What are the common causes of visual hallucinations (besides psych)?
- drug withdrawl
- narcolepsy
- Midbrain ischemia
- CJD
71
Visual hallucinations are often caused by what?
Release phenomena--hallucinations appear in the field of visual loss
72
What is Bonnet syndrome?
Visual hallucinations in elderly people as a result of impaired vision
73
Extinction when testing confrontation by field is a sign of what?
neglect
74
Monocular scotoma are generally caused by what?
Primary eye pathology
75
Pie in the sky visual field defect places the lesion where?
Temporal lobe (optic radiation)
76
Pie on the floor visual field defect places the lesion where?
Parietal lobe (optic radiation)
77
Lesions of the entire optic radiation produces what sort of visual field defect?
Contralateral homonymous hemianopia
78
Why is there macular sparing with some lesions of the optic cortex?
Such a large portion
79
Concentric visual loss is suspicious for what pathology?
Increased ICP
80
What is amaurosis fugax? What does the work up involve?
Transient ischemia attack of eye
| Just like regular TIA
81
What are the classic s/sx of optic neuritis?
eye pain (wwo movement) and monocular visual disturbance
82
What is the red desaturation effect seen in optic neuritis?
Duller color to red in affected eye
83
What is the general prognosis for optic neuritis?
Full recovery over 6-8 weeks
84
Which CNs exit via the cerebellopontine angle? (3)
VII
VIII
IX
85
What are the CNs that exit through the superior orbital fissure?
III
IV
VI
V1
86
Which foramen do CN V2 and V3 exit?
```
V2 = rotundum
V3 = ovale
```
87
Which CNs exit the jugular foramen?
IX
X
XI
88
Where does CN XII exit?
Hypoglossal canal (just in front of the foramen magnum)
89
Why is unilateral hearing loss never a CNS issue?
Tracts cross multiple times
90
How do the symptoms of cerebellopontine angle tumors progress (think CNs affected)?
Slight imbalance, unilateral hearing loss or tinnitus
CN V next with decreased sensation
CN VII next with facial weakness
91
Which presents with immediate nystagmus following the dix-hallpike maneuver? Which one does not fatigue?
Central for both (delay of 2-5 seconds for peripheral)
92
Which type of vertigo has vertical nystagmus: central or peripheral?
Central
93
Prominent nystagmus in the absence of vertigo is characteristic of central or peripheral vertigo?
Central
94
What is the major difference between vestibular neuritis and BPPV?
Vestibular neuritis is a monophasic illness, resulting in several days of intense vertigo and sometimes a feeling of unsteadiness that can last from weeks to months
95
What is the role of transtympanic gentamicin?
Ablate the vestibular function of affected ear
96
What is the common cause of central vertigo?
Vertebrobasilar ischemia/infarct
97
What causes the hoarseness associated with pancoast tumors?
CN IX involvement
98
What is glossopharyngeal neuralgia, and what are the s/sx?
Like trigeminal neuralgia, but produces severe ear and throat pain
99
What are glomus tumors?
Tumors arising along the path of CN IX that resemble carotid bodies histologically, but have no known function. Tumors cause impairments of CN IX, X, and XII
100
What is the term used to describe the voice of pts with vocal cord paralysis?
Breathiness
101
What is pseudobulbar affect?
Lesions to nuclei of the corticobulbar pathway, causing laughter, crying or other emotions, without the pt actually feeling the expressed emotion
