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PCM 4 FINAL TEST EVER > Neurologic procedures > Flashcards

Neurologic procedures Flashcards

1
Q

What spinal level do you perform a lumbar puncture?

A

L4-L5

Below L2 which is the end of the spinal cord

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2
Q

What should the CSF pressure normally be?

A

Less than 25-30 cm

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3
Q

What should you do before performing a spinal tap?

A

CT scan… unless meningitis is suspected

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4
Q

What needle do you use for lumbar puncture?

A

short bevel

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5
Q

What is considered low spinal pressure and what are some causes?

A

Below 7 cm

  • Hypoproduction
  • Distal to occlusion
  • Spinal fluid leak
  • Spinal cord tumor
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6
Q

What is considered high spinal pressure and what are some causes?

A

Above 25-30

  • Hyperproduction
  • Proximal to occlusion
  • Malabsorption of spinal fluid
  • Obesity- pseudo tumor cerebri
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7
Q

Xanthochromic

A

The color of CSF due to old blood pigments… subarachnoid hemorrhage

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8
Q

At what point will CSF become cloudy?

A

If greater than 200 WBC or 400 RBC

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9
Q

Elevated neutrophils means?

A

Bacterial infection

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10
Q

Elevated lymphocytes means?

A

Viral infection

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11
Q

Elevated monocytes/macrophages means?

A

Chronic condition

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12
Q

Things measured in spinal fluid analysis?

A

Glucose- CSF lags one hour behind blood glucose, never lower than 80% of blood glucose)
Protein
Culture and sensitivity
Special tests (oligoclonal bands)

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13
Q

What is the epidural space?

A

A potential space that contains no fluid or blood- only access to the nerve roots and disc material

It is accessible to nerve roots- medications can remain outside the spinal canal

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14
Q

How does EEG brain maping work?

A

Helps locate focuses of function or dysfunction by converting digitial signals to color and 3D images

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15
Q

When are x-rays most useful?

A

To screen for fracture

- Want to see all 7 cervical vertebrae plus T1… follow lines all the way down

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16
Q

How does a CT scan work?

A

Gives a 3D view of the body- rotates an x-ray beam around the pt, imaging the body in a series of slices

Adding cameras adds more slices, heat, and radiation

More radiation is = to more than 100 chest xrays

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17
Q

When do you use a CT?

A

To view

  • Hemorrhages
  • Spinal fractures
  • Kidney stones

Needs IV contrast

  • Abscess
  • Tumor
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18
Q

How does a PET scan work

A

Inject FDG into patient –> metabolism of FDG in the glucose pathway gives off positron + gamma radiation

Cancer cells use more glucose than normal cells and emit more gamma radiation

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19
Q

What shows up the most on MRI?

A

Things with a lot of water

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20
Q

How does an MRI work?

A

Protons wobble in alignment with magnetic fields of varying intensity, frequency of wobble is proportionate to strength of individual magnetic field

A brief radio signal whose soundwaves frequency equals the frequency of wobble of certain protons, knocks those protons out of alignment

When radio signal ceases, protons snap back into alignment with magnetic field, emitting a radio signal of their own that announces the presence of a specific tissue

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21
Q

How do T2 weighted images appear?

A

CSF is bright

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22
Q

How do T1 weighted images appear?

A

CSF is dark

23
Q

Fluid-Attenuated Inversion Recovery

A

T2-weighted image with spinal fluid blanked out

- Shows edema and gliosis to be hyperintense

24
Q

When is an MRI useful?

A
  • Tumor
  • Soft tissue surrounded by bone
  • Sclerotic lesions in brain tissue (M.S.)
  • Vascular lesions
  • When there is edema or excess fluid (meningitis)
25
Q

When is a spinal tap useful?

A
  • Meningitis
  • Degenerative neurologic conditions (MS, ALS)
  • Diseases suspected to alter spinal fluid pressure or circulation
26
Q

Where is the lesions if presenting with bitemporal hemianopia?

A

Around the pituitary gland

27
Q

Causes for when a pupil doesn’t react to light

A
  • Blindness
  • Optic neuritis (sometimes due to MS)
  • Optic nerve tumor
28
Q

Causes for when a pupil remains dilated

A

Adie’s pupil

A u/l dilated pupil may be a CN III due to

  • herniation of the ipsilateral cerebral hemisphere
  • strokes, diabetes, migraine

If due to ischemia inside the brain- pupil is spared

If due to lesions outside the brain (tumor, herniation)- pupil is not spared

29
Q

Ptosis is injury to what muscle?

A

Levator palpebrae superioris

30
Q

Horner’s Syndrome

A

Due to damage of the sympathetic nervous system.
Ptosis- weakness in Mueller’s muscle
Miosis
Anhydrosis

31
Q

How do you test CN IV?

A

Have patient look down and in

Serves the c/l superior oblique muscle

32
Q

CN VI serves which muscle?

A

ipsilateral lateral rectus muscle

33
Q

What does CN VII supply

A

Motor- muscles of facial expression

  • Taste of anterior tongue
  • Lacrimation and salivation
34
Q

Central vs peripheral CN VII palsy

A

Peripheral- hits the facial nerve after it has left the pons

  • BOTH the upper and lower facial muscles on that side are impaired
  • -> Bell’s Palsy

Central- lesion is in the pons or upper brain stem

  • ONLY the lower facial muscles are impaired
  • May be bc the lower facial muscles receive innervation from BOTH SIDES of the motor strip in the frontal lobes

MUST KNOW

35
Q

Double cross of the cerebellum

A

Cerebellum coordinates movements of the SAME SIDE because the “double cross” of cerebellar efferents-
cross over in the brainstem (traveling to c/l thalamus and motor cortex) and then cross again in the medulla

MUST KNOW

Therefore, L cerebellum problems effects your L leg

36
Q

Why do strokes or hemorrhages that extend to one cerebral hemisphere cause rapid death?

A

Brain stem is damage and blocks the fourth ventricles CSF flow

37
Q

What does Romberg test?

A

Posterior columns and cerebellum

38
Q

What 3 functions does upright posture require?

A
  1. Vision
  2. Cerebellum
  3. Posterior columns
39
Q

Grading of strength

A 
Severe weakness
0/5- absolutely no movement in a group
1/5- minimal, or "flicker" of movement
2/5- minimal horizontal movement, but no movement against gravity
3/5- some movement against gravity

Moderate weakness
4/5- moderate strength against gravity and some resistance
5/5- normal contraction

40
Q

Quadriplegia

A

Disease of the upper or mid cervical spine, or both of the corticospinal tracts of the brain stem

41
Q

Hemiplegia

A

Disease of one cerebral hemisphere or one side of the brainstem along the corticospinal tract

42
Q

Paraplegia

A

Disease of the spinal cord in the thoracic or high lumbar regions

43
Q

Causes of weakness of one arm

A

Cervical spine disease or the brachial plexus, or some strokes

44
Q

Causes of weakness of one leg

A

Lumbar spine disease or the lumbar sacral plexus

- Rarely a stroke- anterior cerebral artery infarct

45
Q

Grading of DTRs

A 
0- no reflex
1- diminished reflex
2- average reflex
3- increased reflex, but only one beat
4- increased reflex with clonus- 2 or more beats

A reflex of 0 is usually pathologic, but a reflex of 4 is always pathologic

46
Q

Normal and abnormal plantar reflex

A

Normal- Flexion of the big toe

Abnormal- extensions of the big toe –> Babinski sign

47
Q

Upper motor neuron signs

A

Problem in brain or spinal cord

- Increased reflexes, spasticity, only delyated atrophy of muscles, Babinski signs

48
Q

Lower motor neuron signs

A

Problem in motor neuron, NMJ, muscle iteself

- Decreased reflexes, atrophy within weeks, sometimes fasciculations, no Babinski signs

49
Q

Decreased DTRs can be caused by?

A 
Diabetes mellitus
Hypothyroidism
vitamin B12 deficiency
Exposure to heavy metals or some organic chemicals
Auto immune disease
50
Q

Increased DTRs can be caused by?

A

Lesions of the corticospinal tracts, especially in the spinal cord or brain stem

51
Q

Hemiplegic gait

A

With circumduction- inability to bring the leg all the way in

52
Q

Spastic gait

A

Limited ability to bend at the hips and knees

53
Q

Fenistating gait

A

Slow with the first steps,t then faster and faster, and out of control- in Parkinson’s disease

PCM 4 FINAL TEST EVER (8 decks)

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