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CPD Spring Term > Quiz 2 - Neuro I > Flashcards

Quiz 2 - Neuro I Flashcards

1
Q

the frontal lobe contains the? which is what?

A

the frontal lobe contains the:

Primary motor area
PRECENTRAL GYRUS

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2
Q

the parietal lobe contains the ? which is what?

A

primary sensory area

POSTCENTRAL GYRUS

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3
Q

The cerebellum is attached to the brain stem by?

A

3 cerebellar peduncles

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4
Q

what are gyri? fissures? and sulci?

A

gyri - buldges
fissures - large indentations
sulci - small indentations

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5
Q

which CNs are sensory, motor or mixed?

A

CN I, II, VIII - sensory
CN III, IV, VI, XI, XII - motor
CN V, VII, IX, X - mixed

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6
Q

Which tracts decussate, what do they sense, where do they cross over?

A 
ASCENDING:
spinothalamic tract (pain/temp) - cross immediately.

posterior column (proprioception) - cross at junction of spinal cord and brain stem

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7
Q

stepwise approach to the neurologic patient?

A

Where is the lesion?
Location, singular or multifocal (metastatic dx, ms, multiple diseases)?
is it confined to the nervous system or is it part of a systemic disorder?
what part of the nervous system is affected?
What is the lesion? (tumor, infection, hemorrhage)

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8
Q

What is the importance in asking for neurological history?

A

essential in order to localize symptoms

may need family member support in teasing out the ONSET

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9
Q

in PMhx - what different systems do we need to assess and why? what about environmental?

A

cardio - htn, cvd - assesses stroke risk
neuro - previous stroke? TIAs? psychiatric illness
endocrine - DM
hepatobiliary - liver!! could disrupt metabolism, causing systemic issues
trauma - TBI? MVA? Concussions?
systemic issues - CA? may be metastasis

HEAVY METALS - issue for neuro complaints (not something to jump to first)

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10
Q

in FHx - what are important question to ask?

A

alzheimers?
parkinsons?
CVD?

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11
Q

what are the important SHx questions to assess?

A

smoking**, alcohol, drugs
sexual hx (neurosyphilis)
diet (gluten)
hobbies (exposure to heavy metals, solvents)

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12
Q

What ROS questions should be considered in the neurological patient?

A

Are you experiencing ANY PAIN?

HEENT
headaches, visual changes, dizziness

NEURO
tremor, weakness/sensory loss, LOC

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13
Q

what mental status acronym is important to know and what does it stand for? this test is also known as?

A

FOGS

  1. Family story of memory loss
  2. Orientation - time, month, day, year
  3. General Information - president of the US?
  4. Spelling - spell the word “world” forwards and backwards

this is your mini mental status exam (MMSE)

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14
Q

if you see hyper-reflexia where is your lesion

A

upper motor neuron

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15
Q

if you see hypo-reflexia where is the lesion?

A

lower motor neuron

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16
Q

what is the 3rd most common cause of death and most common cause of neurological disability - how do they present depending on supply? how do they present - generally?

A

cerebrovascular accident (STROKE)

anterior supply (2/3 of the brain, internal carotid) - unilateral sxs

posterior supply (1/3 of the brain, vertebrobasilar) - unilateral or bilateral, more likely to affect consciousness

generally, present SUDDENLY; CONTRALATERAL limbs, facial paralysis; confusion; h/a

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17
Q

What are the different types of stroke? what are their ssx?

A

ISCHEMIC TYPES (80%)

  • thrombic, MOST COMMON - atherosclerotic plaques, sites of turbulent blood flow, slower onset (24-48 hrs), tend to occur at NIGHT, noticed upon waking - NO H/A, PAIN OR FEVER!!
  • emobolic, SUDDEN ONSET, RAPID onset of symptoms, HEADACHE may precede neurologic defect (weakness) - AFIB, huge preceding factor.
  • lacunar - ataxia, DM, poorly controlled HTN
  • transient ischemic attack - usually precedes stroke onset by a few days/months, mini strokes, last less than an hour - DO NOT CAUSE BRAIN DAMAGE, bigger stroke is coming - WARNING SIGN

HEMORRHAGIC TYPES (20%)

  • intracerebral hemorrhage - generally due to HTN - ssx: H/A, Nausea, Impairment of consciousness
  • subarachnoid Hemorrhage - SUDDEN sever H/A with LOC, severe neurological deficits
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18
Q

How do you DX stroke?

A

BIG THING YOU WANT TO KNOW - USUALLY CLINICAL!
F - facial droop, smile, asymm?
A - arm drop, pronator drift
S - speech difficulties - repeat simple sentence
T - timing, if all above are positive - 911** likelihood of stroke is HIGH - when did they notice onset? family member may be helpful?

while waiting - assess vitals (take BP), O2 saturation (pulse ox - if losing o2 percentage, put on oxygen mask while waiting for transport).

NIHSS - typically done in the hospital, grade stroke for severity. How to ID in primary care.

Imaging - CT, done first to exclude hemorrhage. MRI done second, smaller infarcts.

IF TIME? Bedside glucose.

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19
Q

What are the different types of stroke? what are their ssx?

A

ischemic (80%)

  • thrombic, MOST COMMON - slower onset (24-48 hrs), tend to occur at NIGHT, noticed upon waking - NO H/A, PAIN OR FEVER!!
  • emobolic, SUDDEN ONSET, RAPID onset of symptoms, HEADACHE may precede neurologic defect (weakness) - AFIB, huge preceding factor.
  • lacunar - ataxia, DM, poorly controlled HTN
  • transient ischemic attack - usually precedes stroke onset by a few days/months, mini strokes, last less than an hour - DO NOT CAUSE BRAIN DAMAGE, bigger stroke is coming - WARNING SIGN

hemorrhagic (20%)

  • intracerebral hemorrhage - generally due to HTN - ssx: H/A, Nausea, Impairment of consciousness
  • subarachnoid Hemorrhage - SUDDEN severe H/A with LOC, severe neurological deficits
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20
Q

How do you DX stroke?

A

BIG THING YOU WANT TO KNOW - USUALLY CLINICAL!
F - facial droop, smile, asymm?
A - arm drop, pronator drift
S - speech difficulties - repeat simple sentence
T - timing, if all above are positive - 911** likelihood of stroke is HIGH - when did they notice onset? family member may be helpful?

while waiting - assess vitals (take BP), O2 saturation (pulse ox - if losing o2 percentage, put on oxygen mask while waiting for transport).

NIHSS - typically done in the hospital, grade stroke for severity. How to ID in primary care.

Imaging - CT, done first to exclude hemorrhage. MRI done second, smaller infarcts.

IF TIME? Bedside glucose.

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21
Q

How do you DX stroke?

A

BIG THING YOU WANT TO KNOW - USUALLY CLINICAL!
F - facial droop, smile, asymm?
A - arm drop, pronator drift
S - speech difficulties - repeat simple sentence
T - timing, if all above are positive - 911** likelihood of stroke is HIGH - when did they notice onset? family member may be helpful?

while waiting - assess vitals (take BP), O2 saturation (pulse ox - if losing o2 percentage, put on oxygen mask while waiting for transport).

NIHSS - typically done in the hospital, grade stroke for severity. How to ID in primary care.

Imaging - CT, done first to exclude hemorrhage. MRI done second, smaller infarcts.

IF TIME? Bedside glucose.

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22
Q

which CN is helpful in assessing a frontal lobe lesion?

A

CN I tested - change in personality may also be present

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23
Q

what are key tests, assessing upper motor neuron weakness?

A

Drift of Upper Extremity
- hands in front, palms up held flat 15-30 seconds. (+), palm rotates in and pronate midline

Hand Grasp and Toe Dorsiflexion
- weakness is commonly seen in UMN lesion

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24
Q

what are the two tests for meningeal irritation and how are they performed?

A

kernig
- (+) straightening of lower extremity causes low back pain

brudzinski
- (+) - supine pt, passively flex pt’s head, hips will involuntarily flex

25
Q

what is “bedside glucose”?

A

this is a neurological diagnostic procedure done because blood sugar dysregulation can mimic neurological conditions since glucose is the brain’s food supply

26
Q

what imaging is ordered for neurological cases?

A

CT - used acutely
MRI - more specific, not acute
Lumbar puncture - last option

27
Q

Dementia affects mainly

A

memory

28
Q

Delirium affects mainly

A

attention

29
Q

Delirium affects mainly

A

attention

30
Q

How does dementia present?

A

slow and gradual
usually permanent
initially unimpaired, until severe
no immediate need for medical attention

31
Q

How does delirium present?

A 
sudden onset
reversible
attention is greatly impaired
variable level of consciousness
Immediate need for medical attention
  • both of these are worse in the evening
32
Q

delirium is typically caused by ___, often ___, most common in ___

A

acute illness
reversible
MC in the elderly

33
Q

SSX of delirium

A

difficulty focusing, fluctuating consciousness, confusion, personality changes

34
Q

what is required for dx of delirium?

A 
acute change in cognition
difficulty focusing
plus 1 of the following
- altered level of consciousness
- disturbance of consciousness
35
Q

What does “I WATCH DEATH” stand for? Helps with dx of delirium

A 
infectious
withdrawal
acute metabolic disorder
trauma
CNS path
hypoxia
deficiencies
endocrinopathies
acute vascular
toxins
heavy metals
36
Q

What does “I WATCH DEATH” stand for? Helps with dx of delirium

A 
infectious
withdrawal
acute metabolic disorder
trauma
CNS path
hypoxia
deficiencies
endocrinopathies
acute vascular
toxins
heavy metals
37
Q

What are the 5 most common types of dementia

A 
Alzheimer's Disease
Vascular Dementia
Lewi Body Dementia/Parkinson' Disease
HIV-associated Dementia
Frontotemporal Dementia
38
Q

what is commonly the first sign of dementia?

A

short-term memory loss

39
Q

what do you need for dx of dementia?

A

history - MSE

PE - complete neuro exam

40
Q

What labs would be ordered for dementia?

A 
TSH
B12
CBC
LFTs
HIV/RPR - if suspected
41
Q

what imaging would be ordered for dementia?

A

CT - acute

MRI - nonacute

42
Q

what is the diagnostic criteria for dementia?

A

Requires ALL 3 of the following:

  • cognitive sxs that interfere with the ability to complete daily activities (with 2 of the following: amnesia, language dysfxn (aphasia), can’t recognize faces (agnosia), impaired reasoning (apraxia), changes in personality)
  • obvious decline from previous
  • sxs not explained by psychiatric etiology
43
Q

what is the diagnostic criteria for dementia?

A

Requires ALL 3 of the following:

  • cognitive sxs that interfere with the ability to complete daily activities (with 2 of the following: amnesia, language dysfxn (aphasia), can’t recognize faces (agnosia), impaired reasoning (apraxia), changes in personality)
  • obvious decline from previous
  • sxs not explained by psychiatric etiology
44
Q

what is the most common cause of dementia (60-80%)

A

Alzheimer’s Disease

- elderly (>65)

45
Q

what is the most common cause of dementia (60-80%)

A

Alzheimer’s Disease

- elderly (>65)

46
Q

which genetic incidence is highly correlated with Alzheimers and occurs by the age of 35

A

Trisomy 21 - Down’s Syndrome Patients

47
Q

what protein is pathopneumonically deposited in Alzheimer’s brain, when is this formed, during the processing of _____?

A

protein beta-amyloid

formed during APP
amyloid precursor protein processing

-inappropriate deposition of this in the brain causes degeneration

48
Q

what two proteins contribute to the processing of amyloid precursor protein (APP)

A

presenilin 1 & 2

49
Q

what two proteins contribute to the processing of amyloid precursor protein (APP)

A

presenilin 1 & 2

50
Q

what is the most common risk factor for alzheimer’s disease

A

advanced age

51
Q

what is the most common risk factor for alzheimer’s disease

A

advanced age

52
Q

what is the first sign of alzheimer’s disease?

A

loss of short term memory

53
Q

What are required for the Dx of Alzheimer’s (KNOW)

A 
Dementia - clinically dx'd vis MSE
deficits in > 2 areas of cognition
gradual onset, progressive memory and cognitive decline
no disturbance of consciousness
onset after age 40, most after 65
no systemic/brain disorders present
54
Q

what is the 2nd most common dementia among the elderly? what are common etiologies

A

Vascular Dementia

for this one, think vascular diseases - HTN, DM, Smoking, Hyperlipidemia

55
Q

What is characteristic of Lewy Body Dementia

A

gait instability occurs early
quick onset tremor, occurs late
symmetric
fluctuating cognitive function - aka, hallucinations, sleep disorders, etc

56
Q

What is characteristic of Parkinson’s Disease Dementia

A

motor symptoms more severe

motor precedes cognitive symptoms by up to 10-15 years

57
Q

which form of dementia tends to occur in younger individuals?

A

HIV-associated Dementia

58
Q

which dementia affects personality, behavior and usually language function, more?

A

Frontotemporal Dementia

- occurs 55-65 (younger)

59
Q

patient ptc with dementia, urinary incontinence and a gait disturbance that is termed “magnetic gait” - characteristic of this disorder - what is it?

A

Normal Pressure Hydrocephalus

CPD Spring Term (6 decks)

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