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Surgery and other stuff > Neuro reading > Flashcards

Neuro reading Flashcards

1
Q

What are paraphasic errors?

A

Inappropriately substituted words

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2
Q

How can you test comprehension?

A

Mike was shot by John. Is John dead?

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3
Q

What are the 6 components of testing language?

A
  1. Spontaneous speech
  2. Comprehension
  3. Naming
  4. Repetition
  5. Reading
  6. Writing
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4
Q

What are the four components of Gerstmann’s syndrome?

A
  1. Calculations
  2. Right-left confusion
  3. Finger agnosia (naming fingers)
  4. Agraphia
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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

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6
Q

Apraxia may indicate a lesion where?

A

language area and adjacent structures of the dominant hemisphere

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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

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8
Q

How can you test perseveration? What type of pathology is this indicative (lesion where)?

A

Draw alternating sequence.

Frontal release sign

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9
Q

What is abulia, and what sort of pathology is it indicative of?

A

Slow responses

Frontal release sign

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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

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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

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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

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13
Q

Why is hearing loss almost always caused by peripheral nerve lesions?

A

Projects bilaterally to the corticies

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14
Q

Fasiculation are a LMN or UMN sign?

A

LMN

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15
Q

Lesions of the motor cortex produce tongue weakness on the ipsilateral or contralateral side?

A

contralateral

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16
Q

Where is the best place to inspect for LMN fasciulations? (3)

A

intrinsic hand muscles
thigh
Shoulder girdle

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17
Q

How long do UMN lesions take to manifest?

A

hours to weeks

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18
Q

What does toe tapping or hand tapping test?

A

FIne motor movements

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19
Q

Proximal weakness is more suggestive of what sort of pathology?

A

Myopathy

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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
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21
Q

True or false: reflexes rated 1-3 are only abnormal if they are asymmetric

A

True

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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

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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

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24
Q

Name the spinal level tested: biceps

A

C5, C6

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25
Q

Name the spinal level tested: brachioradialis

A

C6

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26
Q

Name the spinal level tested: triceps

A

C7

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27
Q

Name the spinal level tested: Patellar

A

L4

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28
Q

Name the spinal level tested: achilles

A

S1

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29
Q

How do you elicit the abdominal cutaneous reflexes?

A

Lightly brushing either side of the umbilicus

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30
Q

What is the bulbocavernosus reflex? How do you perform it for males and females respectively?

A

contraction of the rectal sphincter in response to pressure on the bulbocavernosus muscle

  • Males = squeeze the glans
  • Females = traction on the foley cath
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31
Q

What are the four major frontal release signs?

A

Graps
Snout
Root
Suck

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32
Q

What is myerson’s sign?

A

Positive glabellar tap

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33
Q

When is a glabellar tap considered positive?

A

Only in continuous (should eventually extinguish in the normal pt)

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34
Q

What is the palmomental reflex?

A

Scraping hypothenar eminence causes contraction of ipsilateral mentalis muscle (may be normal in some people)

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35
Q

What spinal levels are being tested with the abdominal cutaneous reflexes?

A

ABove umbilicus = T8-T10

Below = T10-T12

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36
Q

What spinal level is being tested with the cremasteric reflex?

A

L1-L2

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37
Q

What spinal level is being tested with the anal wink

A

S2-S4

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38
Q

What spinal level is being tested with the bulbocavernosus reflex?

A

S2-S4

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39
Q

Dysdiadochokinesia is a sign of what sort of pathology (where is the lesions)?

A

Cerebellar

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40
Q

What is the difference between truncal and appendicular ataxia?

A
  • Appendicular = affects movements of the appendages, and is indicative of cerebellar hemispheres
  • Truncal = affects proximal musculature, and is suggestive of lesions to the vermis
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41
Q

FNF and other cerebellar tests, rely on what senses?

A
  • Cerebellar coordination
  • Position sense
  • visual pathways
  • UMN and LMNs
  • Basal ganglia
42
Q

If the Romberg test is abnormal with eyes open, where is the lesion?

A

Cerebellum

43
Q

What is circumduction in the context of gait?

A

Moving in circular paths when trying to move in a straight line

44
Q

What is the forced gait test?

A

walk on heels, toes, sides of feet

45
Q

What is gait apraxia, and what conditions is it seen in?

A

Pt able to carry out all motor movements of gait while supine, but can’t actually walk.

NPH or frontal disorders

46
Q

Where is vibratory testing done on the foot?

A

Lateral aspect of the ball of the foot

47
Q

What is graphesia testing (what neurological area)?

A

Cortices

48
Q

What is stereognosis testing (what neurological area)?

A

Cortex

49
Q

How can you improve motor / sensory testing in patients with hemineglect?

A

Turn head and attention toward affected side

50
Q

Absences of the Doll’s eyes reflex in an awake and comatose pt mean what respectively?

A 
Awake = normal
unconscious = Brainstem lesion
51
Q

What is the COWS mnemonic for the caloric stimulation testing?

A

Cold opposite, warm same

52
Q

What does decerebrate vs decorticate posturing indicate in terms of localization?

A 
Decorticate = lesion above the midbrain
Decerebrate = below midbrain
53
Q

What is triple flexion, and what does it indicate?

A

Flexion of the hip and knee, with dorsiflexion at the ankle.

Spinal cord intact (it’s a spinal cord mediated reflex)

54
Q

What is involved with the apnea test, and what does it indicate?

A

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
Q

True or false: brain death is a clinical diagnosis

A

True

56
Q

What is conversion disorder and somatization disorder?

A 
Conversion = psych produced sensory or motor deficits
Somatization = psych produce somatic symptoms
57
Q

What do saccadic eye movement in a pt with a coma indicate?

A

Locked in syndrome, or pseudocoma

58
Q

What is the hoover test?

A

palpate opposite gastrocnemius when asking pt to lift contralateral leg. Gastroc should constrict if true weakness

59
Q

Why is midline change of vibratory sense across skull or sternum not physiologic?

A

Bone will readily conduct to other side

60
Q

True or false: a headache that is always on the same side warrants imaging

A

True–r/o vascular malformation

61
Q

What are ophthalmoplegic migraines?

A

Migraines where eyes are paralyzed in some way

62
Q

Lesions to the temporal lobe optic radiations will produce what sort of visual field defect?

A

Contralateral homonymous quadrantanopia (“pie in the sky”)

63
Q

What is the role of the superior colliculus and pretectal of the brain?

A

Directing attention toward visual stimuli

64
Q

What is the fissure that separates the occipital lobe?

A

Calcarine fissure

65
Q

What sort of visual field defect is associated with a superior and inferior occipital lobe lesion respectively?

A

Inferior lobe = superior vision and v.v.

66
Q

What are the three basic channels of information processed in the occipital lobe?

A

Motion
Form
Color

67
Q

Negative visual disturbances are usually a lesion where? Positive?

A 
Negative = visual pathways
Positive = eye itself
68
Q

Occipital lobe seizures will produce what symptoms?

A

pulsating colored lights or moving geometric shapes

69
Q

Where do formed visual hallucinations come from?

A

Inferior temporo-occipital visual association cortex

70
Q

What are the common causes of visual hallucinations (besides psych)?

A
  • drug withdrawl
  • narcolepsy
  • Midbrain ischemia
  • CJD
71
Q

Visual hallucinations are often caused by what?

A

Release phenomena–hallucinations appear in the field of visual loss

72
Q

What is Bonnet syndrome?

A

Visual hallucinations in elderly people as a result of impaired vision

73
Q

Extinction when testing confrontation by field is a sign of what?

A

neglect

74
Q

Monocular scotoma are generally caused by what?

A

Primary eye pathology

75
Q

Pie in the sky visual field defect places the lesion where?

A

Temporal lobe (optic radiation)

76
Q

Pie on the floor visual field defect places the lesion where?

A

Parietal lobe (optic radiation)

77
Q

Lesions of the entire optic radiation produces what sort of visual field defect?

A

Contralateral homonymous hemianopia

78
Q

Why is there macular sparing with some lesions of the optic cortex?

A

Such a large portion

79
Q

Concentric visual loss is suspicious for what pathology?

A

Increased ICP

80
Q

What is amaurosis fugax? What does the work up involve?

A

Transient ischemia attack of eye

Just like regular TIA

81
Q

What are the classic s/sx of optic neuritis?

A

eye pain (wwo movement) and monocular visual disturbance

82
Q

What is the red desaturation effect seen in optic neuritis?

A

Duller color to red in affected eye

83
Q

What is the general prognosis for optic neuritis?

A

Full recovery over 6-8 weeks

84
Q

Which CNs exit via the cerebellopontine angle? (3)

A

VII
VIII
IX

85
Q

What are the CNs that exit through the superior orbital fissure?

A

III
IV
VI
V1

86
Q

Which foramen do CN V2 and V3 exit?

A 
V2 = rotundum
V3 = ovale
87
Q

Which CNs exit the jugular foramen?

A

IX
X
XI

88
Q

Where does CN XII exit?

A

Hypoglossal canal (just in front of the foramen magnum)

89
Q

Why is unilateral hearing loss never a CNS issue?

A

Tracts cross multiple times

90
Q

How do the symptoms of cerebellopontine angle tumors progress (think CNs affected)?

A

Slight imbalance, unilateral hearing loss or tinnitus
CN V next with decreased sensation
CN VII next with facial weakness

91
Q

Which presents with immediate nystagmus following the dix-hallpike maneuver? Which one does not fatigue?

A

Central for both (delay of 2-5 seconds for peripheral)

92
Q

Which type of vertigo has vertical nystagmus: central or peripheral?

A

Central

93
Q

Prominent nystagmus in the absence of vertigo is characteristic of central or peripheral vertigo?

A

Central

94
Q

What is the major difference between vestibular neuritis and BPPV?

A

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
Q

What is the role of transtympanic gentamicin?

A

Ablate the vestibular function of affected ear

96
Q

What is the common cause of central vertigo?

A

Vertebrobasilar ischemia/infarct

97
Q

What causes the hoarseness associated with pancoast tumors?

A

CN IX involvement

98
Q

What is glossopharyngeal neuralgia, and what are the s/sx?

A

Like trigeminal neuralgia, but produces severe ear and throat pain

99
Q

What are glomus tumors?

A

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
Q

What is the term used to describe the voice of pts with vocal cord paralysis?

A

Breathiness

101
Q

What is pseudobulbar affect?

A

Lesions to nuclei of the corticobulbar pathway, causing laughter, crying or other emotions, without the pt actually feeling the expressed emotion

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