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Clinical Medicine LAB - Professor Sample > Psych II > Flashcards

Psych II Flashcards

1
Q

CTA vs MRA: CTA ?

A

Often used after questionable MRA findings

Also used in acute settings

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2
Q

CTA vs MRA: own notes ?

A

facial droop , slurred speak, not orientated in time - stroke! CT brian is neg. and this is NL with acute stroke ( esp. hemorrhagic cause it is to early to see the blood light up)

BP is to high so not a TPA candidate

MRI and MRA or carotid and circle of willis

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3
Q

What is better at detecting blood within 24-48 hours , CT or MRI ?

A

CT

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4
Q

EEG results ?

A

Collection of fluid in an area will cause activity to be damped in that lead

Lesions in cerebral cortex will cause high-voltage abnormal waves

Generalized seizures- widespread electrical activity

Absence seizures- characteristic spike and wave pattern

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5
Q

What is a EMG ?

A

Electrode is placed in the skin to measure electrical activity if the skeletal muscle

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6
Q

EMG results: Polymyositis ?

A

Small, spontaneous wave forms caused by hyperirritability of the muscle

  • *muscle that is hyper-irritable
  • *
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7
Q

Mitochondrial Tests are for ?

A

Mitochondrial Myopathies

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8
Q

When is ENG used ?

A

Differentiate between organic versus psychogenic vertigo

Differentiate between peripheral and central vertigo

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9
Q

What is NL about pineal gland and coccoid plexus ?

A

calcified pineal gland and coccoid plexus - this is NL

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10
Q

When is EMG used ?

A

Can differentiate between primary muscular disorders and neurologic muscular weakness

Used in patients with muscle weakness

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11
Q

EEG
 Brain Waves: Alpha waves abnormal with ?

A

alpha coma caused by destructive process in the pons, seen in pts with hypoxic brain injury (unresponsive)

Abnormal to see these in patients that are awake

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12
Q

General Guidelines: dementia ?

A

Non-con MR ( extend of dementia)

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13
Q

EEG
 Brain Waves own notes ?

A

coma with prominent with T and D waves = again someone in a coma who has wakeful periods and stay in these waves ( eyes opening and we still see these waves then this is a worse prognosis cause the brains till thinks it is asleep )

Spindle coma!?

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14
Q

but if i get headache alot ___________ then do a MRI - more chronic

A

over months

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15
Q

EMG results: ALS ?

A

Reduced muscle activity with spontaneous contractions; NL with stimulation

** ALS - problem with lateral nerve and they dont worse anymore , the muscle is fine just the signal is not getting to the muscle **

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16
Q

What is better for acute problem, CT or MRI ?

A

CT evaluate for acute facial trauma , acute neurologic dysfunction, suspected subarachnoid hemorrhage

it is quick and easy and give you alot of info better then MRI ( superior to MRI in wrist 24 hours if blood is suspected)

make sure to do a Cr/ BUN before a CT

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17
Q

What is better for trauma CT or MRI ?

A

CT, rapid acquisition

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18
Q

General Guidelines: Headache, acute ?

A

non-con CT

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19
Q

EMG results: Muscle injury ?

A

Decreased electrical activity and amplitude

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20
Q

Imaging the Head/Brain: midline ?

A

Middle of the brain should be in the middle of the head

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21
Q

Indications for Head CT ?

A 
Trauma
Acute Stroke
Suspected SAH or ICH
Headache
Sensory or motor loss
Sinuses
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22
Q

EEG
 Brain Waves: Alpha waves prominent with ?

A

Prominent with relaxation, disappear with attention ( this is normal)

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23
Q

General Guidelines: Headache, chronic ?

A

MR

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24
Q

What is the Tilt-table Test ?

A

Provokes vasopressor syncope

Induces orthostatic hypotension

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25
Q

CT brain is normally at wha angle ?

A

oblique

**not straight across it is more of an oblique angle **

**slicing head at oblique angle and patient i standing **

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26
Q

When is a Tilt-table Test used to evaluate for ?

A

Tachyarrhythmias

Overmedication for heart disease or HTN

Hyper-reactive vagal activity

Vasomotor instability
-POTS (postural orthostatic tachycardia syndrome )

**list headed alot or head racing when standing up **

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27
Q

CT contrindications and risks ?

A

pregnancy

radiation to fetus

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28
Q

When is EEG used ?

A

Evaluating for epilepsy

After trauma - see if there is brian activity

Determine cerebral death in comatose pt

Cerebral lesions localization

**below a voltage for a certain amount of time then they can said that there is brain death **

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29
Q

What is the big star fish ?

A

suprasellar cistern and 4th ventricle

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30
Q

Imaging the Brain: what are you evaluating for ?

A

Evaluate the suprasellar cistern and the quadrigeminal plate cistern

Evaluate the ventricles.
Are they midline and symmetric?

Can fill with blood or pus

Can you see the “smile” and the pentagon?

**expect to find the pineal gland and the coccoid plexus here in their view

big one - starfish - super cellar cistern and 4th ventricle **

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31
Q

Evoked Potential Studies Results: Sensory ?

A

Spinal cord injury

Peripheral nerve injury

CVA

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32
Q

CT Angiogram (CTA) what is it ?

A

Problem solving technique, NOT a screening method EXCEPT for dissection or acute CVA where CT is negative.

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33
Q

Acetylcholine Receptor Antibody (AChR Ab) what is it ?

A

Antibody test

Binding vs. Blocking ABS

Modulating ABS

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34
Q

What are Evoked Potential Studies ?

A

Similar to EEG

Focus on changes that occur when brain is stimulated

Doesn’t require any pt participation

35
Q

Blood in the subdural space ? own notes ?

A

under the dura then it just seeps into the brain - diffuse bleeding that seeps out if it is not big enough to shift midline

36
Q

What is ENG ?

A

Evaluate for nystagmus by measuring electrical changes around the eye

Makes a recording of eye movement at rest, with head movement, and with stimuli

The direction, velocity, and degree can be recorded

Mosby’s pg. 584

**measure electrical changes around they eye to see of there is nystagmus ( hard to tell if it is horizontal or vertical ) but this can tell you what type og nystagmus the patient is having

organic versus psychogenic vertigo **

37
Q

Imaging the Head/Brain: midline - any shift represents ?

A

mass effect

38
Q

Gomori stain uses ?

A

Muscle bx

39
Q

General Guidelines: cancer ?

A

MR

40
Q

CS#3

An 80 year old female is brought in by daughter for dizziness. She states that she feels completely off balance and cannot walk. On exam you note she has an abnormal finger-to-nose test (ataxia).

What do you do?

A

CT scan

is an old brain cause it is aptly and it is symmetrical

all dark spaces get larger

CT normal then call nureo, check Cr and order a CTA ( make sure vasculartur is okay with Cr)

41
Q

EEG 
Brain Waves: Theta waves ?

A

Seen in sleep, slow waves

Abnormal in awake adult

42
Q

CS #2

A 12 year old boy was playing soccer and was struck in the side of the head by another boy’s knee. There was a brief LOC initially. Now is complaining of headache, nausea, and light sensitivity.

What do you do?

A

get a non con CT - cause LOC, and sxs, photosensitive and N and he has pain

lenticular shape - epidural - soft tissue swelling as well

this is a brain window

43
Q

Evoked Potential Studies Results: Auditory ?

A

Acoustic neuroma

Auditory nerve damage

Deafness

44
Q

When do you want to pick CT ?

A

Best for sizing coils and treatment plans for AVMs

No contrast in an acute setting unless looking for brain abscess or tumor

Acute (within 48 hours)

45
Q

The septum between the lateral ventricles should NOT deviate more than _ mm from midline

A

5

**lateral ventricle are a good place to start

draw line down an they should be symmetric **

46
Q

CS #1

A 2 year old fell off of the couch and hit his forehead on the hardwood floor. He has a small bruise there. Mother is concerned because he cried then he fell asleep.

What do you ask?

A

no V and no LOC, fell off cough onto hardwood floor,

no V and cried is good and no LOC is all good - injury is in the forehead ( best place, better thn back of head)

2 yo this is better

REASSURE!! do not radiate this little kid!

47
Q

Imaging the Head/Brain windows ?

A

different window

C - bone window

A and B - brain windows

bone window is a better view of the bone

“soft tissue edema outside the tissue”

slide 29

48
Q

CTA vs MRA: MRA ?

A

Easier to read

Better contrast between tissues

Intracranial vascular stenosis

Aneurysms

PTs who are NOT acutely ill

if not emergent ( takes alot of time and requires patient coorporation)

49
Q

Diverse group of disorders that result from abnl mitochondrial DNA
?

A

Mitochondrial Myopathies

50
Q

General Guidelines: seizure ?

A

Non-con CT ( make sure no big area of edema or bleed causing the siezure)) THEN CT or MR with

more for new onset siezure contrast

51
Q

Caloric Study: Normal results ?

A

Cold water: nystagmus away from ear being irrigated

Warm water: nystagmus toward the ear being irrigated

**fast and a slow part of the nystagmus **

52
Q

Electromyography aka ?

A

EMG

53
Q

ABS MS own notes ?

A

Each is ther but the receptor are gone so the AP does not get generated

less receptors to pick up Each and at first it works fine but with repetitive movement ( development of weakness occurs cause not enough receptor)

talking and face starts to droop

early they are fine but it gets worse

thigh weakness - walking around fine and then all the sudden thigh weakness

54
Q

What is a Penumbra ? own notes.

A

black area where the vessel has been occluded

dead tissue is dead - never get it back

penumbra - will potential die as well if you do not reverse the ischemic event ( catch it early enough)

pic rt - ischemia to long and the brain died in that penumbraa area

TIME IS BRAIN!!

55
Q

CT Angiogram (CTA) own notes ?

A

carotid dissection, dissection of arterial aneurysm or posterior circulation stroke , - start with regular w/o CT brain to not miss something else and this is fine ( still vomitting) then check Cr and then run CTA

problem solving technique

dizzy, V and ataxia, no trauma, woke up 68 yo and feeling fine and then sudden got dizzy and things are spinning and now vomitting, not ficial drop, little unstable gait, little nystagmus horizontal - think stroke in the posterior ( vertigo and ataxia usually posterior issue)

56
Q

Evoked Potential Studies: response and potentials ?

A

Visual-evoked responses

Auditory brainstem-evoked potentials

Somatosensory-evoked responses

**i cant hear out of my left ear , nothing wrong physically and there is no tumor and they still can’t tear

so this test does not lie - they can tell if brain is responding to it or not

used in babies to tell them if they can smell or hear or see

good test cause no participation from the patient **

57
Q

When are Evoked Potential Studies used ?

A

Evaluate specific areas of the brain cortex that are stimulated by the eyes, ears or sensory nerves

Identify histrionic or malingering patients who complain of sensory deficits

58
Q

sudden acute worse head ache of my life - sub arachnoid hemorrhage - first do a ?

A

non contract CT

59
Q

General Guidelines: coma ?

A

Non-con CT

60
Q

When is AChR Ab used ?

A

To diagnose MG

61
Q

EEG 
Brain Waves: Delta waves ?

A

Slowest, largest amplitude

Generated in deep meditation and dreamless sleep

62
Q

EEG during the test ?

A

Supine position

Allow pt to move every 5 minutes ( if they are awake - not continuously though)

+/- photostimulation
can trigger seizures or abnormal brain activity

+/- hyperventilation
can trigger seizures or abnormal brain activity

+/- sleep

Takes 45 min- 2 hrs

63
Q

EEG 
Brain Waves: Beta waves ?

A

Small, observed in all age groups

Irregular, occur with attention

64
Q

Evoked Potential Studies Results, what is abnormal ?

A

Prolonged latency is abnormal

65
Q

General Guidelines: Acute trauma ?

A

Non-con CT

66
Q

ABS: MS - ____________________ cause myasthenia fatigue

A

Repeated movements

67
Q

Acetylcholine Receptor Antibody (AChR Ab) resources ?

A

Harrison’s Ch. 386

Mosby’s pg.22

68
Q

ENG results ?

A

Different patterns of nystagmus correspond to various pathologies

Will allow differentiation between central or peripheral cause.

69
Q

Antibody tests: Myasthenia gravis - ___ combines with ____ at the NM junction

A

ACh

AChRs ( receptors)

70
Q

Mitochondrial Myopathies can mimic __ pr present with ___ dysfunction

A

Can mimic MG or present with CNS dysfunction

  • *this is a fuzzy area that mimic things like MS ( mitochondrial myopathies mimic disorders and they cause neurologic or muscular dysfunction)
  • *
71
Q

What is a Caloric study ?

A

Irrigation of the EAC with hot or cold water induces nystagmus

72
Q

ABS: MS - Antibodies destroy receptor sites for the ___

A

ACh

73
Q

Blood in the epidural space ? own notes ?

A

blood in epidural space - dura is pushed down but the dura is attached still where the suture lines are but the blood pushed down the cerebrum in a symmetrical way

nice lenticular space

74
Q

Electronystagmography aka ?

A

ENG

75
Q

EMG results: other ?

A 
MD
Guillan-Barre
MG
Nerve injury
MS
Diabetic neuropathy
76
Q

Electroencephalography aka ?

A

EEG

77
Q

what is an EEG ?

A

Graphic recording of the electrical activity of the brain

78
Q

When do you want to pick MRI ?

A

Chronic or subacute

Best for seeing AVMs

Better for cancer

more chronic problems

79
Q

Caloric Study: Abnormal results ?

A

Labyrinth is diseased or CN VIII is not functioning then there will be no nystagmus induced

80
Q

General Guidelines: stroke ?

A

Non-con CT ( make sure its not hemorrhagic)

F/U MRA or CTA

81
Q

Imaging the Brain :Symmetry ?

A

Compare left and right side

Do they look alike?

**the right side is smaller - in a accident and atrophy of the brian on one side **

82
Q

Evoked Potential Studies Results: Visual ?

A

Demyelinating disease

Optic nerve damage

Occipital lobe tumor or CVA

83
Q

Mitochondrial Myopathies Gomori stain shows ?

A

characteristic “ragged red fibers” - if you are looking for a mitochondrial myopothay

84
Q

EEG pre-test ?

A

+/- medications

Sometimes sleep time should be shortened

No sedatives before the test
No fasting
No caffeine

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