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ASCM > Neuro review > Flashcards

Neuro review Flashcards

1
Q

Chronic vs acute onset - give 2x2 etiological examples

A

Acute - vascular, seizure

Chronic - inflammatory, dymyelinating, mass

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2
Q

Anatomic diagnosis

A

relates the history and clinical exam to knowledge of neuroanatomy

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3
Q

Syndromic diagnosis

A

based on clusters of recognizable symptoms and signs

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4
Q

Regions of anatomic localization:

A

muscle, neuro-muscular junction, peripheral nerve, nerve root, ant. horn (or dorsal?), spinal cord, brainstem, cerebellum, sub-cortical brain, cortical brain

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5
Q

Neurologic exam -step 1

A

mental status - orientation and language

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6
Q

CN I (brief)

A

olfactory - detection of smell/discrimination of smells, no noxious stimuli

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7
Q

CN II (brief)

A

optic-acuity, visual fileds by confrontation, blind spot, fundoscopy

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8
Q

CN III, IV, VI (brief)

A

oculomotor, trochlear, abducens, PERLA, extra-ocular movements “H”, eyelid position

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9
Q

V (brief)

A

trigeminal - V1,2,3, sensation, corneal, motor for masseter, temporalis, pterygoids

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10
Q

VII (brief)

A

facial - facial muscles, lower vs upper with frontalis, taste

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11
Q

VIII (brief)

A

vestibulocochlear - threshold of detection, whisper +/- masking, weber and rinne tests

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12
Q

IX (brief)

A

glossopharyngeal - sensory arc of gag reflex

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13
Q

X (brief)

A

Vagus- elevation of palate, motor gag reflex, phonation

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14
Q

XI (brief)

A

Accessory - sternocleidomastoid, trapezius

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15
Q

XII (brief)

A

Hypoglossal - protrusions of tongue (ipsalateral deviation represents weak side)

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16
Q

CN D’s

A 
III Diplopia
IV Diplopia
V Decreased facial sensation
VI Diplopia
VIII Deafness and Dizziness
IX Dysarthria and dysphagia
X Dysarthria and dysphagia
XI Decreased strength in neck and shoulders
XII Dysarthria and Dysphagia
17
Q

Neurologic Exam:

A
  1. mental status
  2. CNs
  3. Motor exam
  4. Sensory exam
  5. Cerebellar exam and gait
  6. GCS (Glascow coma scale)
18
Q

Motor exam

A
  1. Bulk
  2. Tone
  3. Power
  4. Fine motor skills
  5. Presence of drift
  6. Deep tendon reflexes and plantar responses
19
Q

Sensory exam

A
  1. Basic modalities - light touch, temp, pinprick
  2. vibration, proprioception, two point discrimination
  3. Cortical sensory testing (if primary modalities are intact): stereognosis, graphesthesia, sensory neglect/inattention
20
Q

Cerebellar and gait:

A
  1. Finger to nose, heel to shin, diadochokinesis = rapid alternating movements
  2. Assess speech - rate, flow and force
  3. Ocular movements; coarse nystagmus, overshoot
  4. Gait - ataxia, wide based
  5. Stance - rhomberg sign (really measure proprioception)
21
Q

Neurosurgical emergencies

A
  1. Raised ICP

2. Progressive Neurological Deficits

22
Q

Raised ICP - causes

A
  • Hydrocephalus
  • Mass Lesion (5)
    (hematoma)
    (Tumour)
    (Abscess)
    (Trauma/contused brain)
    (Inflammation)
23
Q

Progressive Neurological Deficits

(rapid or relentless/subacute vs. acute) - causes

A 
Rapid or relentless/sub-acute:
- space occupying lesions
- spinal cord compression
Acute neurological deficits:
- Subarachnoid hemorrhage due to aneurysm
24
Q

Clinical features of Increased ICP

A 
Headache
Nausea/Vomiting
Drowsiness
Ocular Palsies
Papilledema
25
Q

Neurological causes of vision loss:

A

lesions of the optic nerve (ischemia or demyelnation)

26
Q

Homonymous hemianopia:

A

due to post chiasmal lesion in the optic pathway - may present as unilateral vision loss as patient only notices loss on side where temporal vision is lost (bumping into things etc.)

27
Q

etiology suggested by sudden onset of unilateral vision loss (+/- pain):

A

ischemia - non-arteritic anterios ischemic optic neuropathy and retinal transient ischemic attack are painless
- anterior ischemic optic neuropathy secondary to giant cell arteritis associated with headache, scalp tenderness, jaw or tongue caludication

28
Q

Aetiology of visual loss with gradual onset, worsens over days and subsequently improves:

A

Inflammatory - optic neuritis

29
Q

Unilateral pain that is exacerbated by eye movement:

A

Optic neuritis

30
Q

Chronic, progressive loss of visions suggests:

A

possible compressive lesion of the optic nerve - tumour

31
Q

Hx for visions loss:

A

O-W, FIFE
location: which eye? is the entire field of vision affected (superior vs. inferior, temporal vs. nasal)
Associated symptom:
GI - nausea or vomiting with eye pain
HEENT - Headache? halos around lights, redness in eyes, floaters, flashes of light, curtain or shadow obscuring vision?
Neuro - Other neuro symptoms: focal numbness or weakness, speech or swallowing difficulties, difficulty with balance, dizziness or vertigo, hearing problems, double vision
Pmh - Previous injury to head or to eye? hx of htn or high cholesterol, DM?Smoking?
Fmx- family members with vision loss

32
Q

Diplopia (defn)

A

Double vision - single object in field appearing twice

33
Q

Diplopia (where is the lesion? where is it not?)

A
  • central lesions in brainstem or cerebellum
  • weakness in one or more extraocular muscles (lesion in nerve innervating or disease of muscle itself)
  • diseases affecting neuromuscular transmission (myastenia gravis)
    Generally - presence of diplopia negates the possibility of a lesion in the supratentorial compartment
34
Q

Specific Hx of diplopia (8)

A
  1. binocular vs monocular diplopia: does it resolve or persist when patient closes one eye () neurological lesions cause binocular, while monocular are usually ocular/opthalmic (e.g. corneal deformities) or psychogenic.
  2. Horizontal vs vertical diplopia: are images side by side or on top of each other. If horizontal ask whether worsened (ex. image separation increases) with viewing near objects (medial rectus paresis) or far objects (lateral rectus paresis).
  3. Worse when looking to left or right? Binocular, horizontal diplopia that is worse when looking to right and when viewing far objects suggest right CN VI palsy (lateral rectus muscle)
  4. Worse when looking down and in - like going down stairs - vertical diplopia made worse by down and in suggests CN IV palsy (superior oblique muscle)
  5. Does a specific head posture or gaze eliminate the diplopia? patient with CN IV palsy will tilt head away from lesions to eliminate or reduce diplopia.
  6. Any significant fluctuation in double vision? Worse at end of day or after prolonged use of eye? Dramatic fluctuation or fatiguability, esp. accompanied by ptosis, susgests neuromuscular junction disorder such as myasthenia gravis
  7. Recent or remote head trauma - fracture of orbital floor can lead to hematoma and/or entrapment of soft tissue and extraocular muscles restricting downward movement of eyes. Head trauma can also cause CN IV palsy.
  8. Vascular risk factors - microvascular ischemia as a cause of isolated ocular motor nerve palsies in older patients.

ASCM (6 decks)

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