Neuro Review Flashcards
How many cranial nerves are there?
12
How many spinal nerves are there?
31
What are specialized cells that monitor changes in the internal and external enviroment?
Sensory Receptors
What is a small mass of nervous tissue consisting of neuronal cells bodies in the PNS?
Ganglia
What are the 3 basic functions of the nervous system?
Sensory (afferent)
Integrative (information process)
Motor (efferent)
What are the two types of cells that make up the nervous tissues? What do they provide?
Neurons- Unique functions
Neuroglia - support, nourishment and protection of neurons
What are the parts of the cell body?
Cell body
Dendrites
Axon
Axon Terminals
What are Structural Classes of Neurons?
Multipolar
Bipolar
Unipolar
What neuron class has several dendrites and one axon? Most common type in the brain and spinal cord.
Multipolar
What neuron class has one dendrite and one axon?
Bipolar
What neuron class has a fused dendrite and axon? Sensory neuron of spinal nerves
Unipolar
What neuron class is this?
Bipolar
What neuron class is this?
Unipolar
What neuron class is this?
Multipolar
What are sensory neuron functions?
Convey impulses into the CNS
What are motor neuron functions?
Convey impulses from CNS through PNS to muscles or glands
What are interneurons (integrative) neuron functions? Where are they located?
Transmit impulses between neurons (sensory and motor)
Located within CNS
What neuron cell is responsible for support, nourishment and protection. Critical for homeostasis of interstitial fluid around neurons?
Neuroglia
What are the types of neuroglia?
Astrocytes Oligodendrocytes Microglia Ependymal Schwann Satellite
What neuroglia types are found in the CNS?
Astrocytes
Oligodendrocytes
Microglia
Ependymal
What neuroglia are found in the PNS?
Schwann and Satellite
Which neuroglia form the blood brain barrier?
Astrocytes
Which neuroglia produce myelin in the CNS?
Oligodendrocytes
Which neuroglia protect CNS cells from disease?
Microglia
Which neuroglia form CSF in the ventricles?
Ependymal
Which neuroglia produces myelin in the PNS?
Schwann
Which neuroglia support cells in PNS ganglia?
Satellite
What are gaps in the myelin along the axon?
Nodes of Ranvier
What are the two types of collection of nervous tissues?
Ganglion
Nucleus
What collection of neuronal cell bodies are found in the PNS?
Ganglia
What collection of neuronal cell bodies are found in the CNS?
Nucleus
What are the type of axon bundles?
Nerve
Tract
What are a bundles of axons found in the PNS?
Nerve
What are a bundle of axons found in the CNS?
Tract
What are the two matters that make up the spinal cord and brain?
White and grey matter
Which matter contains primarily myelinated axons?
White matter
Which matter contains cell bodies, dendrites, unmyelinated axons, axon terminals and neuroglia?
Grey matter
Where is the white and grey matter located in the spinal cord?
White matter surrounds a centrally located grey matter (H or butterfly)
Where is the white and grey matter in the brain?
Grey matter in thin cortex that surrounds the white matter.
What is action potential?
Communication between neurons
What are required to enact action potential?
A resting membrane potential
Ion Channels
What is a charge difference across cell membrane (polarization)?
Resting membrane potential
What allows ions to move by diffusion from high to low concentration?
Ion Channels
What are the two types of ion channels?
Leakage
Gate
What is the process of the initial event or stimulus?
- Resting membrane triggered to become more permeable to Na+
- Na+ entering reaches threshold
- An action potential arises(all or nothing response)
What is the threshold required for action potential?
-55 mv
What are the 2 main phases of action potential?
Depolarizing and repolarizing
What action potential phase is when enough Na+ enters a cell and membrane potential rises and becomes positive?
Depolarizing
What action potential phase is when enough K+ leave a cell and the membrane potential is returned to a resting value?
Repolarization
What action potential phase is (-70 ~ 0 ~ +30 mv)
Depolarizing
What action potential phase is (+30 ~ 0 ~ -70 mv)
Repolarization
What are the two types of nerve impulse conductions?
Continuous
Saltatory
Which type of conduction is the slower form associated with unmyelinated axons.
Continuous
Which type of conduction is fast associated with myelinated axons, Nodes of Ranvier that allow impulses to leap?
Saltatory
What is synaptic transmission?
Communication from neurons to other neurons or effectors
What are the main components of synapse?
Presynaptic neuron
Synaptic cleft
Postsynaptic neuron
What component of synapse is the sending neuron and releases neurotransmitters?
Presynaptic neuron
what is the space between neurons in the synaptic transmission?
Synaptic cleft
What is the receiving neuron that has receptors that bind to the neurotransmitter?
Postsynaptic neuron
In the presynaptic neuron, increased Ca2+ concentration causes what to happen?
Exocytosis
What is released into the synaptic cleft after exocytosis?
Neurotransmitters
Neurotransmitters act as a chemical trigger open ion channels in what?
Postsynaptic neuron
Neurotransmitters are removed from the cleft how?
Diffusion
Destruction by enzymes
Reuptake into presynaptic cell
What are the types of neurotransmitters?
Acetylcholine Amino Acids Modified amino acids Neuropeptides Nitric oxide
Neurotransmitters bind to what in the postsynaptic neuron
Ligand-gated channels
What are forms of acetylcholine neurotransmitters?
Stimulatory (skeletal)
Inhibitory (cardiac)
What are examples of amino acids?
Glutamate
Aspartate
gamma aminobutyric acid (GABA)
Glycine
What are examples of modified amino acids?
Norepinephrine
Dopamine
Serotonin
What are the two systems of the nervous tissue?
Central Nervous System
Peripheral Nervous System
What nervous system is responsible for thoughts, emotions and memories?
Central Nervous System
What are the subcategories of the Peripheral Nervous System?
Somatic
Autonomic
Enteric
Sensory neurons of the SNS do what?
Convey info to CNS from head, body wall, limbs and special senses
Motor neurons in the SNS do what?
Conduct impulses to the skeletal muscles (voluntary control)
Sensory neurons of the ANS do what?
Convey information from visceral organs to the CNS
Motor Neurons of the ANS do what?
Conduction impulses to smooth/cardiac muscles and glands (involuntary control)
Autonomic Nervous System motor neurons are divided into what two subcategories?
Sympathetic and Parasympathetic
What subcategory of the ANS motor neurons is for fight or flight?
Sympathetic
What subcategory of the ANS motor neurons is rest and digest?
Parasympathetic
The Enteric Nervous System is known as what?
Brain of the gut
Sensory neurons of the ENS do what?
Monitor chemical change in the GI tract and stretching of walls
Motor neurons of the ENS do what?
regulate contractions, acid secretion and endocrine cell secretions
Enteric Nervous System is an involuntary or voluntary control?
Involuntary
What are the structures that protect the spinal cord?
Vertebral Column
Vertebral Ligaments
Meninges
Cerebrospinal Fluid
What are the three layers of connective tissue that make up the meninges
Dura
Arachnoid
Pia
Which layer of the meninges is the outer layer and is a tough dense connective tissue?
Dura mater
What layer is the middle layer of the meninges, resembles a spider web and extends into the subarachnoid space?
Arachnoid mater
What layer of the meninges is thin and delicate that adheres to the spinal cord and the brain and contains blood vessels?
Pia mater
What is the space between the arachnoid and pia matter that is filled with CSF?
Subarachnoid space
What space is between the vertebra and (above) dura mater that is made up of fat and helps with cushioning and protection?
Epidural space
The spinal cord is on average what length?
16-18 inches
The spinal cord extends from the ___________ to the ____________.
Medulla oblongata
Second Lumbar vertebra (L2)
What are the two grooves in the spinal cord that divide it into hemispheres?
Anterior median fissure
Posterior median sulcus
The spinal cord has how many spinal nerves?
31 pairs
What are roots in the spinal cord? What are the different roots?
Two bundles of axons that connect each spinal nerve to to a segment of the cord.
Posterior and Anterior
Posterior spinal roots contain what?
Sensory axons which conduct nerve impulse from sensory receptors to into the CNS
Anterior spinal roots contain what?
Motor neurons (autonomic and somatic) which conduct nerve impulses from the CNS to effectors.
What are the plexuses that make up the spinal cord?
Cervical (C1-C5)
Brachial (C5-T1)
Lumbar (L1-L4)
Sacral (L4-S4)
What are the main functions of white matter in the spinal cord?
A tract that serves as highways for nerve impulses
What are the main functions of grey matter in the spinal cord?
Receives and integrates incoming and outgoing information and is a site for integration of reflexes.
Grey matter is subdivided into what?
Left and Right regions called horns that are relative to their location (anterior, lateral and posterior)
The posterior grey horn does what
contains cell bodies and axons of interneurons as well as axons of incoming sensory neurons.
The anterior grey horn contains
cell bodies of somatic motor neurons that provide impulses for contraction of muscles.
The lateral grey horn is only present where? And contains what?
Thoracic and upper lumbar segments
Contains cell bodies of the autonomic motor neuron that regulates cardiac/smooth muscle and glands.
White matter consists of two tracks, what are they?
Sensory and Motor
Sensory tracts direction is
ascending, spinothalamic tract
Motor tracts direction is
descending, corticospinal tract
Spinal nerves are a part of what nervous system?
Peripheral Nervous System
What is the breakdown of the spinal nerves?
8 cervical 12 thoracic 5 lumbar 5 sacral 1 coccyx
What root does sensory information go through the spinal cord?
Dorsal root
What root does motor information go through in the spinal cord?
anterior root
What are the spinal nerve layers
Endoneurium (wraps axons)
Fascicles (bundle of axons)
Perineurium (wraps Fascicles)
Epineurium (wraps Perineuriums of multiple fascicles or the entire spinal nerve)
Cervical plexus supplies what areas
posterior head, neck, upper shoulder and diaphragm.
Brachial plexus supplies what?
Upper limbs, some neck and shoulder muscles
Lumbar plexus supplies what
abdominal wall, external genitals and parts of the lower limb
Sacral plexus supplies what
Buttocks, perineum and most of the lower limbs
Brain protections is done by what parts?
Cranium Meninges - Dura - Arachnoid - Pia
The brain is supplied with blood from what structure?
Circle of willis
The circle of willis consists of what structures
Internal carotids
Vertebral artery
Anterior/posterior communicating arteries
The brain consist of what percent of the body’s weight and requires how much of the body’s oxygen supply?
2% of weight
20% of oxygen
Infarction happens when
the brain is deprived of oxygen for 4 or more minutes.
What lipid soluble materials are able to pass into the blood brain barrier?
O2
CO2
Alcohol
Anesthesia
What type of fluids cushions the brain
Cerebrospinal Fluid
Where does CSF circulate
subarachnoid space, central canal and ventricles of the brain
Where is CSF produced?
Choroid plexuses
Where is CSF reabsorbed?
arachnoid villi
What are the major parts of the brain?
Brain stem
Diencephalon
Cerebellum
Cerebrum
What does the brain stem contain?
medulla oblongata
pons
midbrain
Where does the medulla oblongata lie on the brain stem?
inferior aspect
What does the diencephalon contain
thalamus
hypothalamus
pineal gland
Where does the cerebellum lie and what are it’s functions?
posterior and inferior to the cerebrum
balance, equilibrium and coordination
What is the largest, most superior part of the brain?
Cerebrum
Medullary rhythmicity areas that regulate breathing are located in
medulla oblongata grey matter
posterior medulla oblongata nuclei are associated with
touch
pressure
vibration
proprioception
Medulla oblongata contains nuclei associated with which cranial nerves?
VIII-XII
What is part of the brain stem is known as the bridge and connects the right and left sides of the brain?
Pons
The pons contain nuclei associated with which cranial nerves?
V-VIII
What part of the brain stem connects the pons to the diencephalon?
Midbrain
The midbrain consists of what parts
Cerebral peduncles
Substantia nigra
red nuclei
The midbrain contains nuclei associated with which cranial nerves?
III-IV
What part of the diencephalon has major sensory relay center, contributes to motor functions and plays a role in consciousness?
Thalamus
What part of the diencephalon is responsible for homeostasis?
Hypothalamus
What part of the diencephalon is a part of the endocrine system and is responsible for the secretion of melatonin and sets the body’s biological clock?
Pineal gland
The cerebellar cortex is what type of matter?
Grey matter
What is the structure in the brain that has a tree like appearance of white and grey nuclei?
Cerebellum
What part of the brain receives a wide range of sensory inputs and compares actual movements to intended ones?
Cerebellum
What divides the cerebrum into right and left cerebral hemispheres?
longitudinal fissure
What part of the cerebrum connects the right and left hemispheres?
Corpus Callosum
What 3 areas comprise the basal ganglia?
Globus pallidus
putamen
Caudate nucleus
What does the basal ganglia assist with
motor control, emotions, behavior, executive function
The folds of the cerebrum are called
Gyri or gyrus
The shallow grooves of the cerebrum are called
sulci or sulcus
Each cerebrum hemisphere has how many lobes?
4
The 4 lobes of each cerebrum hemisphere are
frontal
parietal
temporal
occipital
The central sulcus separates the frontal and parietal lobes is the divide between what
precentral gyrus
postcentral gyrus
The precentral gyrus is the primary area for what?
motor
The postcentral gyrus is the primary area for
somatosensory area
Posterior to the primary somatosensory area areas do what
store memories of past sensory experiences
Premotor areas do what
generate nerve impulses causing a specific group of muscles to contract in specific sequence.
What is a ring structure on the inner border of the cerebrum and floor of the diencephalon?
Limbic system
The limbic system is referred to as the __________ as it plays a role in the pain, pleasure, anger, affection and behavior?
emotional brain
IRT to the brain and body, lateralization means
one side of the brain controls the other side of the body
All sensory and motor pathways cross where
CNS
The left hemisphere of the brain is responsible for what type of skills?
language
numerical
scientific
reasoning
the right hemisphere of the brain is responsible for what type of skills?
spatial and pattern recognition
emotional content of language
generating images of sight, sound, taste and smell
Somatic Nervous System Pathways
Sensory and Motor
What nervous system is voluntary, it’s motor pathway has one neuron from CNS to effector and releases ACH neurotransmitter?
Somatic Nervous System
What are the three neurons in the somatic sensory pathway?
Cell body #1 in dorsal root ganglion
Cell body #2 in the spinal cord or brainstem
Cell body #3 in the thalamus to post central gyrus
What are two examples of a somatic sensory pathway
Posterior column- medial lemniscus pathway
Spinothalamic Pathway
-Lateral spinothalamic tract
-Anterior
The medial lemniscus pathway senses what
touch
pressure
vibration
conscious proprioception
The anterior spinothalamic pathway senses
Light touch, deep pressure
The lateral spinothalamic pathways senses
pain sensation and temperature sensation
The Somatic Motor pathways signals come from
Upper motor neurons
basal ganglia
cerebellum
sensory neurons or interneurons via reflexes
What corticospinal tract pathway neuron originates in the primary motor cortex and synapes with a lower motor neuron of appropriate spinal level?
Upper motor neuron
What corticospinal tract pathway neuron exits the spinal ventral root to the muscle for movement
Lower Motor Neuron
What nervous system is an unconscious/involuntary system with two divisions that controls viscera and releases norepinephrine and acetylcholine?
Autonomic Nervous System
What are the two divisions of the autonomic nervous system?
Sympathetic and Parasympathetic
What is the motor pathway of the ANS
Series of two neurons from CNS to the effector
what is dual innervation?
Most viscera supplied with nerves of both symp and parasymp divisions
Sympathetic and Parasympathetic have what effects in contrast to each other?
Antagonistic
How does the sympathetic and parasympathetic effect Heart rate?
S- stimulates
P- inhibits
How does the sympathetic and parasympathetic effect Digestive organs?
S- inhibits
P- Stimulates
What two motor neurons does the ANS pathway have?
Preganglionic and postganglionic
Preganglionic path is
neuron from CNS to neuron in autonomic ganglion
Post ganglionic path is
from cell body in ganglion to effector
Where do sympathetic preganglionic nerves reside?
cell bodies in the lateral grey horn of spinal cord segments T1-L2.
What is often referred to as the thoracolumbar division?
Sympathetic preganglionic neurons in the T1-L2
What is the path of the sympathetic preganglionic neurons
axons emerge from spinal cord via anterior root and pass through ventral roots of spinal nerves
Where does most synapse occur with postganglionic neurons?
sympathetic trunk ganglion
How many post ganglionic neuron cell bodies can synapse with a single preganglionic axon?
20 or more
What are the abdominal arteries the prevertebral ganglia follow along?
celiac
superior mesenteric
inferior mesenteric
Parasympathetic preganglionic neurons cell bodies are located where?
Brainstem - CN III, VII, IX, X
Spinal cord - S2-S4
What nerves carry 80% of all parasympathetic nerve impulses?
Vagus
Where do parasympathetic post ganglionic neurons reside?
terminal ganglia
Parasympathetic nerves cause what kind of effects?
precise, localized
What are the sympathetic effects on the autonomic nervous system?
FIGHT OR FLIGHT increase HR, contraction and BP dilate pupils and airways Dilate vessels to muscles, heart, liver and adipose tissue Constrict vessels to nonessential organs Mobilize nutrients for energy
What is the parasympathetic effect on the autonomic nervous system?
SLUDD
Salivation Lacrimation Urination Defecation Digestion
What are the types of Headaches
Tension Cluster Migraine Post Traumatic HA Medication Overuse
What headache is bilateral, often daily, described as vice like and may present with hypertonicity of neck muscles
Tension
What is the treatment of tension HAs?
NSAIDS
Tylenol
What HAs usually affect middle aged men, present with unilateral pain around the temple/eye, occur in 15-3 hours episodes and horner’s syndrome?
Cluster
What is horner’s syndrome?
ptosis
miosis
anhidrosis
What is the treatment for cluster HAs?
Oxygen 100% 15 mins
SubQ sumatriptan 6mg, 12 mg in 24 hr period
Oral zolmitirptan 2.5mg, 10mg in 24 hr period
What HAs have a gradual buildup of throbbing HA, last several hours, may have Aura, associated with nausea and vomiting and family history?
Migraine
Treatment for migraine
rest in dark area Analgesic/NSAID Sumatriptan -oral, 25/50/100 mg -subQ, 6mg up to 12 in 24hrs Zolmitriptan -2.5mg up to 10 in 24 hrs
What are some migraine prophylaxis? What indicates use?
Needed when migraines occur 2-3 times per month Antihypertensives -Propanolol- 40mg - 160mg Antidepressants -Amitryptyline 10mg - 20-50mg Anticonvulsants -Topiramate 100-200mg/day Symptomatic treatment -Antiemetic-promethazine 12.5-25mg q4-6h
What is the pathophysiology of a seizure?
An abnormal, excessive, hypersynchronous discharge from an aggregate of CNS neurons
What type of seizure is identified by how much cortical involvement occurs?
Partial or focal seizure
What type of focal seizures are there?
Focal w/ and w/o impaired awareness
What is the difference between focal w/ and w/o impaired awareness?
Patient appears to be awake but not in contact with others, does not respond normally and has no recollection of what occurred during seizure with impaired awareness.
What automatisms may a patient exhibit during a focal seizure?
Facial grimacing Gesturing Lip smacking Chewing Repeating words or phrases
Generalized Seizures involve how much of the brain?
Entire brain
What is the most common type of generalized seizure?
tonic-clonic seizure (grand mal)
What does tonic mean?
Muscle stiffening
What does clonic mean?
Rhythmic jerking
What are other types of generalized seizures?
absent
clonic
atonic (w/o tone)
What is the phase after a seizure that the patient is somnolence, confused with HAs, no recollection and Todd’s paralysis?
Postictal Phase
What is Todd’s paraylsis?
Weakness of the limbs
What is the only definitive way to diagnosis a seizure?
Video EEG
Treatment of Seizure
First aid
- Clear area
- maintain airway
- Start IV
- Blood work
Diazepam 5mg IV/IM Q5-10M, do not exceed 30mg
Medevac
What is a condition that a single seizure last greater than 5 mins or 2 or more seizures during the postictal phase?
Status eplilepticus
What is a condition that a single seizure last greater than 5 mins or 2 or more seizures during the postictal phase?
Status eplilepticus
What is the treatment for status eplilepticus?
Diazepam 5mg IM/IV Q5-10m, do not exceed 30mg
Valproic acid 30mg/kg
Correct possible underlying issue
Intubate
What are the two major branches of internal carotid arteries?
Anterior and middle cerebral artery
Two verterbral arteries fuse to become _______ that create the __________.
Basilar Artery
Vertebral-basilar arteries
What are the two types of strokes?
Hemorrhagic
Ischemic
What are the two types of Ischemic Strokes?
Transient ischemic attack (TIA)
Cerebral Vascular Accident (CVA)
What is an acute neurologic injury that occurs in the result of interrupted blood flow to the brain?
Stroke
What type of stroke is caused by a ruptured blood vessel causing bleeding into the brain and lack of cerebral blood flow?
Hemorrhagic
What type of stroke is from a blockage of a blood vessel causing lack of cerebral blood flow?
Ischemic
What are the percentages of types of strokes?
80% ischemic, 20% hemorrhagic
What are the subtypes of Ischemic Strokes?
Thrombotic
Embolic
Systemic hypoperfusion
What stroke is caused by and obstruction of an artery due to a blockage that forms in the vessel? (atherosclerosis)
Thrombotic
What type of stroke is caused by and obstruction of an artery due to a blockage from debris that has broken off from a distal area?
Embolic
What type of stroke is caused by a lack of brain flow due to decreased systemic blood flow? (hypovolemia)
Systemic hypoperfusion
What is defined as a transient episode of neurologic dysfunction caused by focal brain, spinal cord or retinal ischemia without acute infarction and may be reversible?
Transient Ischemic Attack (TIA)
What is defined as a neurologic dysfunction caused by focal brain, spinal cord or retinal ischemia with infarction of central nervous system tissue?
Cerebral Vascular Accident
What is the only way to determine TIA vs CVA?
MRI
What is the FASTER mneumonic?
Face-drooping or numbness on one side
Arms- one limb being weaker or more numb
Stability- steadiness on feet
Talking- slurring, garbled, nonsensical words,
Eyes- visual changes
React- MEDEVAC immediately, note time of symptoms
What are two subtypes of hemorrhagic or intracranial hemorrhagic stroke (ICH)
Intracerebral Hemorrhage
Subarachnoid hemorrhage
What are the initial interventions for ischemic stroke?
Maintain oxygenation > 94%
Elevate head to 30 degrees
When should you lower blood pressure for a stroke patient?
Only if Bp is 220/120, lower by 15%.
What drug is given to stroke patients to reduce BP?
Labetalol
10-20mg IV, same or double dose every 10-20 mins, max is 150mg
What medication may be given with MO guidance?
Aspirin 325mg
What is the hallmark symptom of restless leg syndrome?
unpleasant or uncomfortable urge to move legs that is transiently relieved with movement, usually deep sensation.
What is the treatment for restless leg syndrome?
Ferrous Sulfate, after labs
325mg x3 day for 3-6 months
Avoid aggravating drugs/substances
Increase exercise
Leg massages
At what Glasgow Coma Scale must you intubate?
Less than 8, intubate
What is a reversal for opioids?
Naloxone IV, IM, SubQ
.4-2mg repeat doses 2-3 mins
What is the most common type of cranial trauma?
Linear fracture (75%)
What cranial trauma injury has a high likelihood of infection?
Open fracture
What are the thin areas of the skull susceptible to fractures?
Temporal
Nasal Sinuses
What are signs of a basilar skull fracture?
Battle signs
raccoon eyes
hemotympanum
CSF rhino/otorrhea
What is cushings triad?
Bradycardia
Hypertension
Respiratory irregularity
What can be given for osmotic therapy in a patient with ICP
Mannitol 1g/1kg IV
7.5% hypertonic NaCl 250 bolus
What occurs in 85% of patients with a skull fracture?
Arterial injury, usually middle meningeal artery
What is a classic presentation of an epidural hemorrhage?
Immediate LOC, lucid interval
What is the clinical presentation for subdural hematoma?
Acute presents in 1-2 days
Chronic -15 days or more
What is the clinical presentation of a Subarachnoid Hemorrhage?
Thunder Clap
Nucal rigidity
What are the mortality rates for the types of hematomas?
subdural - 60%
subarachnoid-51 %
What are the most common reasons for a spinal cord injury?
MVA 47%
Falls 23%
Violence 14%
Sports 9%
Treatment of spinal cord injury?
ABCs
C-Spine
Foley if bladder paralysis
Sedate if needed
What medication may be given for spinal cord injury with MO consult?
Methylprednisolone 125mg IM/IV Q4-6H prn
What is the NEXUS Criteria (NSAID)
Used to determine need for x-ray N-focal neurological deficit S-Midline spinal tenderness A-Altered mental status I-Intoxicated D-Distracting injuries
What causes radiculopathy?
Lumbar disk herniation
What are the most common disks affected in radiculopathy?
L5-S1 (90%)
What is a medical emergency in herniated disk injury that could present with saddle sensation?
Cauda equina syndrome
During a straight leg test, what is the sign that occurs with worsening pain with the manuever?
Lasegue’s Sign
What is the clinical presentation for cauda equina?
Pain/n/t in lower back, down 1 or both legs
foot drop
bowel/bladder control
problems with sex
What can cause cauda equina?
Herniated disk
Infection or inflammation
Cancer
Spinal Stenosis
What is the treatment for carpal tunnel syndrome?
Modify hand activity, affected wrist in splint for up to 3 months.
Steroids or NSAIDs
Refer is sxs persist more than 3 months
What are the test for carpal tunnel syndrome?
Tinel’s
Phalan’s
What is the lower motor neuron CN affected in Bell’s palsy?
VII
What is the clinical presentation of bell’s palsy?
Abrupt onset of unilateral face paralysis
ipsilateral restriction of eye closure
tearing or eye dryness
bell’s phenomenon
What is the difference between bell’s palsy and stroke?
Stroke-no paralysis of the forehead
Treatment of bell’s palsy
Protect/lubricate eye
Steroid-Prednisone 60mg x7 days then taper 5 days
Antiviral-Valacyclovir 1000mg 3x/day x7 days
What are the possible etiologies of Meningitis?
Bacterial
Fungal
Spirochete
What are common bacterial etiologies for meningitis?
Streptococcus pneumonia
Neisseria Meningitides
Listeria Monocytogenes
What are common viral etiologies for meningitis
enterovirus
herpes simplex virus
West nile virus
Differential between meningitis and encephalitis?
Meningitis-cerebral function usually intact
Encephalitis-usually associated with AMS
Two test for meningitis
Brudzinski
Kernig
What is the treatment of meningitis?
Ceftriaxone 2g IV Q12H
Vanc
Dexamethasone .15mg/kg IV Q6H
Acyclovir for HSV suspect
Meningitis contact prophylaxis treatement?
Ciprofloxacin 500mg X1
What are the types of chronic pain?
Nociceptive
Neuropathic
Centralized
What are the stages of Nonrapid eye movement (NREM) sleep?
1 light
2 less aware, deeper
3 deepest sleep stage
What are medication treatments for insomnia?
Melatonin 3-5mg PO
Trazodone 50mg po
Vistaril 25-50 mg po
Diphenhydramine 25-50 mg po
What are the two types of vertigo?
Peripheral
Central
Which type of vertigo is associated with tinnitus and hearing loss?
Peripheral
What is the test that will help determine peripheral vs central vertigo?
Dix Halpike
