Neurology Flashcards
(153 cards)
1
Q
What does TIPSS stand for?
A
T- tumor I- injury P- psychological disorders S- stroke S- sepsis
2
Q
What does AEIOU stand for?
A
A- alcohol E- epilepsy I- insulin O- opium U- uremia
3
Q
What are some concerning symptoms of the nervous system?
A
- Headache - Dizziness or vertigo - Generalized, proximal, or distal weakness - Numbness or paresthesias - Abnormal or loss of sensations (vision, hearing, speech) - Loss of consciousness, syncope, or near-syncope - Seizures - Tremors or involuntary movements - Changes in mood - Changes in sleep - Alcohol/ drug use
4
Q
What are the 3 fundamental questions you should know about your patient’s stroke?
A
- What area of the brain? 2. Ischemic or hemorrhagic? 3. If ischemic, thrombus or emboli?
5
Q
What are the warning signs of a stroke?
A
SUDDEN = Stroke - Sudden numbness/ weakness - Sudden confusion, trouble speaking or understanding - Sudden trouble seeing - Sudden trouble walking, dizziness, or loss of balance/ coordination - Sudden severe headache
6
Q
Syncope
A
- what were the doing before syncope? - standing or sitting? - any warning signs? - could you hear voices? - how long did it last? - was the onset/offset, fast or slow? - any palpitations before? - any hx of heart disease? - who witnessed it? - did you loose continence? - did you get hurt during the episode?
7
Q
Name the types of syncope
A
Vasovagal Hypovolemia Valsalva Reduced cardiac output Hypoxia Pulmonary emboli Anemia Hypoglycemia TIA Anxiety
8
Q
Name the types of seizures
A
- Simple/Partial Focal Seizure 2. Complex Focal Seizure 3. Partial Generalized Seizure 4. Tonic-Clonic or Grand Mal Seizure 5. Absence Seizure 6. Myoclonic Seizure 7. Myoclonic Atonic Seizure (drop attack) 8. Pseudo-seizure
9
Q
Simple/Partial Seizure
A
Focal or unilateral seizure without loss of consciousness Types: - Jacksonian - Sensory - Autonomic - Psychiatric
10
Q
What is a Jacksonian (simple/partial seizure)?
A
- unilateral, no loss of consciousness - tonic, then clonic - unilateral, starts in one part of body, then moves to another part on the same side
11
Q
What is a Sensory (simple seizure)?
A
- unilateral, no loss of consciousness - numbness or tingling - simple visual, auditory or olfactory hallucinations such as flashing lights, buzzing or odors
12
Q
What is autonomic (simple seizure)?
A
- unilateral, no loss of consciousness - funny feeling feeling in epigastrium, - nausea - pallor, flushing - lightheadedness
13
Q
What is a psychiatric simple seizure?
A
- unilateral, no loss of consciousness - anxiety or fear - feeling of familiarity or unreality - dreamy states
14
Q
Complex Partial Seizure
A
- unilateral seizure - impairment of consciousness - temporary confusion and HA - may remember aura but rest is amnesic - may or may not start with autonomic or psychic symptoms (if do, called aura) - Automatisms may develop (smacking lips, chewing, walking about)
15
Q
Partial Generalized Seizure
A
- focal seizure that becomes generalized - Resemble tonic-clonic - Has an aura - Unilateral neurologic deficit
16
Q
Tonic Clonic or Grand Mal Seizure
A
- Bilateral - Lose consciousness suddenly, stiffen into tonic extensor rigidity. - Breathing stops, cyanosis - Clonic phase follow (rhythmic muscular contractions) - Breathing resumes with excessive salivation - Injury: tongue biting and incontinence may occur - Postictal- confusion, drowsiness, HA, fatigue and temporary focal deficits - No remembrance of aura or seizure
17
Q
Absence or Petite Mal Seizure
A
- Bilateral - Sudden brief lapse of consciousness, with momentary blinking, staring or movements of lips and hands but no falling - Petit mal 10 sec and some postictal confusion) - No aura recalled
18
Q
Myoclonus Seizure
A
- Bilateral - Sudden brief rapid jerks involving trunk or limbs - Variable postictal state
19
Q
Atonic Seizure (drop-attack)
A
- Bilateral - Sudden LOC with falling but no movements - Either prompt return to normal or brief/ mild confusion
20
Q
Pseudo-seizure
A
- Bilateral - No neuroanatomic pattern - Variable postictal
21
Q
What is the most common type of seizure for ages 12-20?
A
Idiopathic Trauma Drug and Alcohol withdrawal
22
Q
What is the most common type of seizure for ages 20-35?
A
Trauma Alcoholism Brain Tumor
23
Q
What is the most common type of seizure for ages 35+?
A
- Brain tumor - Cerebrovascular disease - Metabolic disorders: Hyponatremia, Hypoglycemia, Hepatic failure, Uremia - Alcoholism
24
Q
What is a likely diagnosis for: Transient monocular blindness, lasting a few days to weeks
A
retro-bulbar neuritis
25
What is the likely diagnosis for: New onset of blurred vision or unexplained change in normal acuity
Diabetes
26
What is the likely diagnosis for: Tinnitus and vertigo
Meniere's disease
27
Nystagmus- definition
rhythmic oscillation of the eye (like a tremor of the eye) - Horizontal (occurs when looking to the side) - Vertical (occurs when looking down) - Rotary (turns in a circle when looking straight)
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Nystagmus- causes
- Impairment of vision early in life - Disorders of labyrinth and cerebellar system - Drug toxicity
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Aphonia
loss of voice from disease affecting larynx or nerve supply
30
Dysphonia
- Difficulty speaking because of impaired function. - Secondary to impaired function of the vocal cords or respiratory disease (CN X)
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Dysarthria
- Difficulty in articulating words. - Impaired movement of the palate, tongue or lips - usually due to CNS lesions - Difficulty pronouncing “t” “m” “l” “g” (Parkinosnism)
32
Aphasia
- Loss of production or comprehension of spoken and/or written language - cerebral hemisphere damage usually left side - Two types: fluent (Wernicke's) and non-fluent (Broca's)
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Wernicke's v. Broca's Aphasia
Wernicke's- fluent- can hear the voice or read the print, but doesn't understand the meaning. Can't get message out Broca's- non-fluent- can't produce language (spoken or written) Leave out words or really slow speech
34
What are possible causes of numbness and paresthesias?
- Nerve root compression due to herniated disc - Anemia (pernicious) B-12 deficiency - Peripheral neuropathies - Metabolic: hypocalcemia, hypomagnesium - Hyperventilation syndrome - Medications (i.e. digoxin, heavy metal poisoning)
35
What are possible causes of intermittent weaknesses or paralysis?
- Think of myasthenia gravis - Hypokalemia - TIA
36
What are possible causes of persistent weakness or paralysis?
- Sequela of stroke - Peripheral neuropathies - Diabetic neuropathy - Demyelinating disease such as MS - Connective tissue disorder such as polymyositis - Muscular dystrophies
37
What can altered mood be attributed to?
- Alcohol and/or drugs - Depression - Dementia related to alcoholism, HIV, AIDS, or syphilis
38
Lethargic Patient
- appears drowsy but opens the eyes and looks at you, responds to questions, and then falls asleep.
39
Obtunded Patient
- opens the eyes and looks at you, but responds slowly and is somewhat confused. - Alertness and interest in the environment are decreased.
40
Stuporous Patient
- arouses from sleep only after painful stimuli. - Verbal responses are slow or even absent. - lapses into an unresponsive state when the stimulus ceases. - minimal awareness of self or the environment.
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Comatose Patient
- remains unarousable with eyes closed. - no evident response to inner need or external stimuli
42
Circumstantiality speech
- indirect and delayed speech - excessive use of detailsthat have no connection to the point
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Derailment speech
- shifts topics with no apparent relation between the topics
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Flight of ideas speech
- accelerated change of topics in a very fast but generally coherent manner
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Incoherent speech
- incomprehensible speech - illogical
46
Confabulation speech
- fabrication of facts to hide memory impairment
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Delusions
- false, fixed beliefs that are not shared by other members of the person’s culture
48
Illusions
- misinterpretations of real stimuli
49
Hallucinations
- subjective external stimuli the patient hears or sees that others don’t hear or see - auditory (schizophrenia) - visual (drug withdrawal, fever) - olfactory - gustatory, taste - tactile
50
Affect
The observable mood of a person expressed through their facial expression, body movements and voice - flat affect: lack of facial movement - does their affect reflect their mood?
51
What to asses in the patient's speech?
- Quantity of speech: silent, excessive? - Rate: fast, slow? - Loud: loud, soft? - Articulation: speaking clearly? - Fluency: involves the rate, flow and melody of speech
52
When are speech hesitancy seen?
aphasia from strokes
53
When are monotone inflections seen?
schizophrenia or severe depression
54
What is circumlocution?
when words or phrases are substituted for the work a person can’t remember ex. “what you write with” for “pen”
55
Paraphasias
when words are malformed “I write with a den”, wrong “I write with a branch” or invented “I write with a dar”
56
How to test for CN I?
CN I: Olfactory Occlude each nostril and test different smells
57
How to test for CN II?
CN II: Optic Snellen eye chart or hand-held card; inspect fundi; screen visual fields by confrontation
58
How to test for CN II & III?
CN III: Oculomotor; CN II: Optic Inspect size and shape of pupils; test reactions to light and near response
59
How to test for CN III, IV & VI?
CN III: Oculomotor CN IV: Trochlear CN VI: Abducens Test extraocular movements in 6 cardinal directions of gaze; lid elevation; check convergence
60
How to test for CN V?
CN V: Trigeminal Palpate temporal and masseter muscles while patient clenches teeth; test forehead, each cheek, and jaw on each side for sharp or dull sensation; test corneal reflex
61
How to test for CN VII?
CN VII: Facial Assess face for asymmetry, tics, abnormal movements. Ask patient to raise eyebrows, frown, close eyes tightly, show teeth (grimace), smile, puff both cheeks
62
How to test for CN VIII?
CN VIII: Vestibulocochlear or Acoustic Test hearing, lateralization, and air and bone conduction
63
How to test CN IX and X?
CN IX: Glossopharyngeal CNX: Vagus Assess if voice is hoarse; assess swallowing. Inspect movement of palate as patient says “ah.” Test gag reflex, warning patient first.
64
How to test for CN XI?
CN XI: Spinal Accessory Assess strength as patient shrugs shoulders up against your hands. Note contraction of opposite sternocleidomastoid, and force as patient turns head against your hands.
65
How to test for CN XII?
CN XII: Hypoglossal Ask patient to protrude tongue and move it side to side. Assess for symmetry, atrophy.
66
What to look for when examining the motor system?
- Observe body position - involuntary movements (tremors, tics, fasciculations) - Inspect muscle bulk; note any atrophy - Assess muscle tone — flex and extend the arm and the lower leg for residual tension → slight resistance to passive stretch
67
How to grade muscle strength?
0- no muscular contraction 1- barely detectable 2- move body part without gravity 3- move body against gravity 4- move against gravity and some resistance 5- move against full resistance without fatigue
68
What is spastic tone? A common cause?
- upper motor neuron or corticospinal tract systems at any point from the cortex to the spinal cord - cause: stroke
69
What is rigid tone? A common cause?
- basal ganglia system- constant state of resistance; resists passive movement in any direction - Cause: parkinson
70
What is flaccid tone? Common causes?
- lower motor neuron at any point from the anterior horn cell to the peripheral nerves, loss of tone, limb floppy - causes: stroke, spinal cord injury, Gillian Barre
71
What is paratonia? A common cause?
- sudden loss or increase in tone. bilateral, usually frontal - cause: dementia
72
What is a tic? Common causes?
- normal movements of muscle groups such as winking or grinning that occur involuntarily and seemingly inappropriately. - Causes: Tourette’s, medications like amphetamines and phenothiazines
73
What is dystonia? Common causes?
- dystonic movements, involves large portions of the body including the trunk - causes: medications like phenothiazines, primary torsion dystonia, and spasmodic torticollis
74
What is athetosis? Common causes?
- slow, twisting movements commonly involving the face and distal extremities, associated with spasticity - causes: cerebral palsy
75
What is chorea? Common causes?
- brief, rapid, jerking movements - don't repeat themselves, move around - involves: face, head and arms - Causes: Sydenham’s chorea (with RF) and Huntington’s disease
76
What is a tremor? Types of tremors?
-oscillating movements caused by involuntary contraction of muscle groups Types: - Resting or static tremor - Postural tremor - Intentional or essential tremor
77
Resting/static tremor. Cause?
- Disappears with voluntary movement - Pill rolling with Parkinsonism
78
Postural tremor? Cause?
- When actively maintaining a posture - Fine motor tremors of hyperthyroidism or anxiety
79
Intentional/essential tremor? Cause?
- Absent at rest, only present with movement - Cause: Multiple sclerosis
80
Romberg test
- Patient stands with feet together and eyes open, then with eyes closed for 30–60 seconds without support - Loss of balance when eyes closed is a positive test
81
Pronator Drift test
- Patient stands for 20–30 seconds with both arms straight forward, palms up, and eyes closed; tap arms briskly downward - Pronation and downward drift of the arm is a positive test
82
What types of sensations should be tested to see if the spinothalamic tract is intact?
Pain: dull and sharp Light touch: with a cotton ball
83
The shoulder is correlated to what spintothalamic tact?
C4
84
The inner/outer aspect of the forearm is correlated to what spintothalamic tact?
C6, T1
85
The thumb/pinky is correlated to what spintothalamic tact?
C6, C8
86
The front of the thighs is correlated to what spintothalamic tact?
L2
87
The medial/lateral aspects of the calves is correlated to what spintothalamic tact?
L4, L5
88
The little toe is correlated to what spintothalamic tact?
S1
89
How to test proprioception?
hold the big toe by its sides between your thumb and index finger, pull it away from the other toes, and move it up then down. Ask the patient to identify the direction of movement.
90
Stereognosis
place a key or familiar object in the patient’s hand and ask the patient to identify it
91
Graphesthesia
outline a large number in the patient’s palm and ask the patient to identify the number - if unable to identify, there is a lesion on the sensory cortex
92
Two-point discrimination
- using two ends of an opened paper clip, or two pins, touch the finger pad in two places simultaneously; ask the patient to identify 1 touch or 2 - start close together and move out until the patient can identify two points. Record in mm, should be
93
Point localization
lightly touch a point on the patient’s skin and ask the patient to point to that spot
94
Extinction
touch an area on both sides of the body at the same time and ask if the patient feels 1 spot or 2 - if they can't feel it, the damage is on the contralateral side of the brain
95
Asterixis
- motor disturbance marked by intermittent lapses of an assumed posture as a result of intermittency of sustained contraction of groups of muscles - seen in liver failure - hold palms flat ("stop" with hands) and they will flap their hands
96
Meningeal signs
- neck mobility- limited, stiff - Brudzinski’s sign- from lying position, will involuntarily flex their hip/knee, when you bend their neck - Kernig’s sign- inability to straighten leg
97
What needs to be assessed on stuporous or comatose patients?
- ABC’s - level of consciousness - pupillary response - ocular movements - posture and muscle tone
98
Reflex Grading Scale
4+ Very brisk- hyperactive, with clonus 3 + Brisker than average, not a disease process 2+ Average, normal 1+ Somewhat diminished 0 No response
99
What cord level is the biceps reflex?
C5-6
100
C5-6 corresponds to what reflex?
Biceps, supinator, brachioradialis reflex
101
What cord level is triceps reflex?
C6-7
102
C6-7 corresponds to what reflex?
Triceps reflex
103
What cord level is supinator/brachioradialis reflex?
C5-6
104
What cord level is knee reflex?
L2-4
105
What cord level is ankle reflex?
S1
106
L2-4 corresponds to what reflex?
Knee reflex
107
S1 corresponds to what reflex?
Ankle reflex
108
Where would a clonus reflex be most likely seen?
Ankle reflex
109
What cord level is abdominal reflex?
Upper: T8-10 Lower: T10-12
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What cord level is plantar reflex?
L5-S1
111
What cord level is anal reflex?
S2-4
112
T8-10 corresponds to what reflex?
Upper abdominal reflex
113
T10-12 corresponds to what reflex?
Lower abdominal reflex
114
L5-S1 corresponds to what reflex?
Plantar Reflex
115
S2-4 corresponds to what reflex?
Anal reflex
116
Babinski: how to test? Abnormal? Indication?
Test: stroke lateral aspect of foot, ankle to toes Abnormal: toes fan out Indication: Corticospinal (pyramidal) tract disease
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Oppenheim: how to test? Abnormal? Indication?
Test: Stroke anterior medial tibial muscle Abnormal: toes fan out Indication: Corticospinal (pyramidal) tract disease
118
Gordon: how to test? Abnormal? Indication?
Test: Firmly squeeze calf muscles Abnormal: toes fan out Indication: Corticospinal (pyramidal) tract disease
119
Hoffman: how to test? Abnormal? Indication?
Test: Flick distal phalanx of middle or index finger Abnormal: Clawing of fingers and thumb Indication: Corticospinal (pyramidal) tract disease
120
Kernig: how to test? Abnormal? Indication?
Test: Raise leg straight or flex thigh on abdomen, then extend knee Abnormal: Resist straightening of leg, causes pain Indication: Meningeal irritation
121
Brudzinski: how to test? Abnormal? Indication?
Test: Flex chin on chest, watch hips and knees Abnormal: Resistance and pain in neck, with flexion of hips and knees Indication: Meningeal irritation
122
Symptoms of peripheral neuropathy?
- Paresthesia- tickling, tingling, burning, pricking, or numbness - Loss of position or vibratory sense - Motor weakness in extremities - Loss of deep tendon reflexes - Unsteadiness of gait
123
What are some possible causes of motor peripheral neuropathy?
- Lead poisoning - Guillian-Barre syndrome (moves feet up) - Acute intermittent porphyria - Hypoglycemia
124
What are some possible causes of motor/sensory neuropathy?
- Carcinoma - Lymphoma - Anemia - Chronic liver disease - Multiple myeloma (plasma cell cancer)
125
What are some possible causes of sensory peripheral neuropathy?
- Diabetes - Alcoholism - Heavy metal exposure (arsenic) - Hypothyroidism
126
What type of sensory loss is this?
Peripheral neuropathy
127
What type of sensory loss is this?
Transection of the spinal cord
128
What type of sensory loss is this?
Individual Nerve loss
129
What type of sensory loss is this?
Cortex
130
How will upper motor neuron disease affect:
- muscle tone
- muscle mass
- movement
- reflexes
* muscle tone- increase/spastic
* muscle mass- atrophy from disuse
* movement- weakness or paralysis
* reflexes- hyperreflexia, ankle clonus, positive Babinski
131
What are some upper motor neuron dieases?
* cerebral cotext lesion
* brainstem lesion
* spinal cord lesion
* basal ganglia lesion
* cerebellar lesion
132
What are motor and sensory findings for cerebral cortex lesions?
How will the deep tendon reflexes change?
Motor: contralateral upper motor neuron weakeness and spasiticity
Sensory: contralateral sensory loss of the limbs and tunk on the same side as the motor deficits
DTR: Greater
133
What are motor and sensory findings for brainstem lesions?
How will the deep tendon reflexes change?
Motor: weakness and spasticity on contralateral side and CN deficits
Sensory: Variable. No typical sensory findings
DTR: Increase
134
What are motor and sensory findings for spinal lesions?
How will the deep tendon reflexes change?
Motor: weakness and spasicity on both sides causing paraplegia or qudraplegia
Sensory: Dermatomal sensory deficity on trunk, bilaterally at the level of the lesion and sensory loss from tract damage below the lesion
DTR: increased
135
What are motor and sensory findings for basal ganglia lesions?
How will the deep tendon reflexes change?
Motor: slowness of movement, rigidity and tremor
Sensory: No affect
DTR: normal or decreased
136
What are motor and sensory findings for cerebellar lesions?
How will the deep tendon reflexes change?
Motor: hypotoniaa, ataxia, nystagmus
Sesory: no affected
DTR: normal or decreased
137
What is an example of a cerebral cotext lesion?
Cortical stroke
138
What is an example of a brainstem lesion?
brainstem stroke
acoustic neuroma
139
What is an example of basal ganglia lesion?
Parkinson's
140
What is an example of a cerebellar lesion?
Cerebellar stroke
Brain tumor
141
How will lower motor neuron affect:
- muscle tone
- muscle mass
- movement
- reflexes
* Muscle tone: decreased or lost, flaccid
* Muscle mass: atrophy from disuse
* Movement: weakness or paralysis corresponding to the damage in the spinal segment. Will fasticulate (twitch)
* Reflexes: hypo-reflexia, negative Babkinski
142
What are motor and sensory findings for anterior horn cell lesions?
How will the deep tendon reflexes change?
* Motor: weakness and atrophy in segmental or focal pattern and twitching
* Sensory: intact
* DTR: decreased
143
What are motor and sensory findings for spinal root/nerve lesions?
How will the deep tendon reflexes change?
* Motor: weakness and atrophy in a root innervated pattern. Some fasticulations
* Sensory: corresponding dermatomal sensory deficits
* DTR: decreased
144
What are motor and sensory findings for one peripheral nerve lesion?
How will the deep tendon reflexes change?
* Motor: Weakness and atrophy in a peripheral nerve distribution sometimes with fasciculations
* Sensory: Weakness and atrophy in a peripheral nerve distribution sometimes with fasciculations
* DTR: decreased
145
What are motor and sensory findings for many peripheral nerve lesions?
How will the deep tendon reflexes change?
* Motor: Weakness and atrophy more distal than proximal, sometimes with fasciculations
* Sensory: Sensory deficits, commonly in stocking-glove distribution
* DTR: decreased
146
What are motor and sensory findings for neuro-muscular junction lesions?
How will the deep tendon reflexes change?
* Motor: Fatigability more than weakness
* Sensory: intact
* DTR: normal
147
What are motor and sensory findings for muscle lesions?
How will the deep tendon reflexes change?
* Motor: weakness, usually more proximal than distal
* Sensory: intact
* DTR: normal or decreased
148
What are lower motor neuron diseases?
* anterior horn cell lesion
* spinal root and nerve lesion
* peripheral nerve lesion(s)
* neuro-muscular junction lesion
* muscle lesion
149
How will toxic-metabolic coma affect:
- respirations
- pupils
- LOC
* Respirations: regular or cheynes-stokes
* Pupils: pinpoints from opitates/cholinergic, unreactive
* LOC- change after pupils change
150
How will a structural coma affect:
- respirations
- pupils
- LOC
* Respirations: cheynes-stokes
* Pupils: unequal, unreactive to light fixed
* LOC: change before pupils change
151
Decorticate (Flexor Response)
* Arms flexed tight to the sides with elbows, wrists, and fingers flexed
* Feet plantar flexed
* Implies destructive lesion of corticospinal tracts
152
Decerebrate (Extensor Response)
* Arms are extended by the sides, forearms pronated, wrists and fingers flexed
* Legs stiffly extended at the knees
* Feet plantar flexed
* Posture may occur spontaneously or in response to external stimuli
* Associated with brain stem damage
* May be a result of severe metabolic disorders such as hypoxia, hypoglycemia
153
Oculocephalic Reflex
* aka Dolls eyes
* Move the head quickly to one side and then the other
* Intact brainstem: head turned, eyes move toward the opposite direction
