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CPD III > Quiz 2- Neurological Disorders > Flashcards

Quiz 2- Neurological Disorders Flashcards

1
Q

Lobes of the brain and their functions

A 
Frontal - speech
Parietal - sensory
Temporal - auditory
Occipital - vision
Cerebellum - proprioception, fine muscle mvmnt
Brain stem - midbrain, pons, medulla
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2
Q

gyri

A

bulges

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3
Q

sulci

A

small indentations

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4
Q

fissures

A

large indentations

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5
Q

cerebellar disorders

A 
ataxia
decreased tendon reflexes
asthenia (muscles tire more easily than normal)
tremor
nystagmus
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6
Q

Ascending pathway: spinocerebellar tract

A

unconscious proprioception
tracts come from the same side and do not cross
ipsilateral sx

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7
Q

Ascending pathway: spinothalamic tract

A

pain, temp, light touch
crosses over
loss of pain-temp contralaterally

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8
Q

Spinal cord comprised of

A

grey matter- neuronal cell bodies and synapses

white matter - ascending and descending tracts

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9
Q

Descending Tracts (Motor): Corticospinal Pathway

A

Upper Motor Neuron (UMN): pathway from brain to spinal cord before synapse
Lower Motor Neuron (LMN): postsynaptic pathway from spinal cord to periphery (peripheral nerve)

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10
Q

Damage to a UMN causes

A
  • hypertonia or spasticity
  • decreased motor control and inability to perform fine motor movements
  • reflexes can be spastic
  • (+) Babinski
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11
Q

Damage to a LMN causes

A
  • decreased tone (hypotonia)
  • decreased strength (weakness)
  • decreased reflexes in affected areas
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12
Q

Within the CNS a bundle of pathway axons is known as

A

a tract

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13
Q

Outside the CNS (in the peripheral nerves, which connect the CNS with skin, muscles and other organ systems) a bundle of pathway axons are called

A

a nerve

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14
Q

Superior Sagittal Sinus

A

Spinal fluid drains here

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15
Q

Cavernous Sinus

A

Drains the eye; potential source into the brain of infx from eye or face

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16
Q

Transverse Sinus

A

Runs by the ear: may become involved in inner ear infx

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17
Q

for ROS in regards to HEENT make sure to ask __________?

A

Headache?
Visual changes?
dizziness

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18
Q

for ROS in regards to neuro make sure to ask______?

A 
Tremor?
Weakness or sensory loss?
LOC?
Motor dysfunction
Speech or swallowing concern
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19
Q

mental status exam includes________?

A 
FOGS
F: family story of memory loss
O: orientation to time
G: general info
S: spelling
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20
Q

what are the two types of MSE?

A

Mini Mental Status Exam (MMSE)- shorter

Montreal Cognitive Assessment (MoCA)- spatial info

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21
Q

key motor tests:

A

-Drift of upper extremity (and lower if necessary)
Have pt. close eyes and hold arms horizontally forward, palm up for 15-30 sec
If +, hand will drop and rotate in (if neurological problem pronator muscles with override supinator muscles)

-Hand grasp and toe dorsiflexion
Weakness is commonly seen in upper motor neuron lesion
Cross hands, have pt. grasp index and middle fingers
Move toe and foot against resistance

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22
Q

We all need 2 out of the following 3 senses to maintain balance

A

Vision
Vestibular sense
Proprioception

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23
Q

We all need 2 out of the following 3 senses to maintain balance

A

Vision
Vestibular sense
Proprioception

*Rhomberg test
+ test is when pt sways when eyes are closed (either vestibular or proprioception defect)

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24
Q

A + Babinski indicates a lesion where?

A

UMN lesion

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25
Q

What are the tests to rule out meningeal irritation?

A

Kernig
(+) -> pain in low back on straightened lower extremity)
Brudzinski
(+) -> flexion of the head results in marked neck pain and involuntary flexion of the hip and lower extremities

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26
Q

Basic labs to consider for neurological problems?

A

CBC
CMP
TSH
Bedside glucose

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27
Q

Additional labs to consider for neurological problems?

A

Celiac (anti-gluten Abs, TTG)
Heavy metal testing (whole blood, hair analysis, urine with and without provocation)
Environmental testing for solvents, pesticides, etc

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28
Q

Top 3 imaging to order for neurological disorders?

A

Lumbar puncture
CT
MRI

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29
Q

stroke that involves the anterior artery supply typically have

A

unilateral involvement

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30
Q

stroke that involves the posterior supply typically have

A

unilateral or bilateral

more likely to affect consciousness (LOC)

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31
Q

risk factors for stroke

A 
Prior stroke
Older age
Family history of stroke
Alcoholism
Male sex
Hypertension
Cigarette smoking
Hypercholesterolemia
Diabetes
Use of certain drugs (eg, cocaine, amphetamines)
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32
Q

Ischemic stroke

A

thrombotic
embolic
lacunar
TIAs

33
Q

embolic stroke

A

quicker onset
during day
H/A may precede neurological deficit

34
Q

thrombotic stroke

A

slower onset, “evolving stroke” - unilateral neurologic dysfunction often beginning in one arm and then spreading ipsilaterally
occurs at night, usu noticed upon waking
extends w/out H/A

35
Q

lacunar stroke

A

Pure motor hemiparesis
Pure sensory hemianesthesia
Ataxic hemiparesis

36
Q

how to dx for a stroke?

A

clinical - FAST (facial drooping, arm drop, speech difficulties, timing (if all the above occur, call 911)
imaging - CT (1st), MRI (2nd)
bedside glucose testing - to r/o hypoglycemia

37
Q

ddx for stroke

A 
Hypoglycemia
Postictal paralysis
Hemorrhagic stroke
Migraine
Tumor
Systemic condition: Guillian Barre, Bell’s Palsy
syncope
38
Q

types of hemorrhagic stroke

A

intracerebral hemorrhage

subarachnoid hemorrhage

39
Q

definition of intracerebral hemorrhage

A

Focal bleeding from a blood vessel in the brain parenchyma

40
Q

causes of intracerebral hemorrhage

A 
HTN (most common)
less common
Arteriovenous Malformations (AVMs)
Aneurysm
Trauma
Brain tumor
Bleeding disorder
41
Q

ssx of intracerebral hemorrhage

A

focal neurological deficit wi
H/A
nausea
impairment of consciousness

42
Q

definition of subarachnoid hemorrhage

A

sudden bleeding into the subarachnoid space

43
Q

cause of subarachnoid hemorrhage

A

ruptured aneurysm

44
Q

ssx of subarachnoid hemorrhage

A

sudden severe H/A with LOC

severe neurologic deficitis

45
Q

dx of subarachnoid hemorrhage

A

non-contrast CT

if neg, follow with lumbar puncture (to r/o meningitis)

46
Q

broad differences between ischemic and hemorrhagic stroke

A

hemorrhagic stroke is more severe, sudden onset and more often involves LOC

47
Q

both dementia and delirium are characterized by disordered thinking, but they differ in

A

dementia- affects memory, progressive

delirium- affects attention, usu reversible if can remove cause

48
Q

delirium
caused by
prognosis
incidence

A

acute illness or drug toxicity, or dehydration
often reversible
more common in elderly (if in young ppl, usu due to drug use or life threatening systemic disorder)

49
Q

SSX of delirium

A

Difficulty focusing, maintaining or shifting attention
Fluctuating consciousness
Disorientated to time and sometimes to place
May have hallucinations, delusions, and paranoia
Confusion
Changes in personality or affect

50
Q

want to rule out DDX in order to arrive at delirium (it’s a tricky one to arrive at). What’s the nemonic for a DDX?

A 
I WATCH DEATH
Infectious
withdrawal
acute metabolic disorder
trauma
CNS pathology
Hypoxia
Deficiencies 
Endocrinopathies
Acute vascular
Toxins
Heavy metals
51
Q

which 3 things must be present to dx delirium?

A
  • acute change in cognition that fluctuates throughout the day
  • inattention (difficulty focussing or following what is said)
  • plus one of the following (disturbance of consciousness or an altered level of consciousness or disorganized thinking)
52
Q

labs/imaging for delirium

A 
First Set:
CT or MRI
Tests for suspected infection (CBC, Blood Cultures, UA)
Chest film
Electrolytes
BUN
Creatinine
Plasma glucose
Blood levels of any drugs
Urine drug screen
53
Q

PE for delirium

A

vitals, neurologic exam, hydration status

54
Q

prognosis for delirium

A

Delirium due to certain conditions typically resolves with treatment but resolution may be slow
For up to 2 yr after a delirium event: risk of further decline is increased

55
Q

dementia
caused by
prognosis

A

caused by anatomic changes in the brain

irreversible

56
Q

dementia most often results from which neurologic progressive diseases?

A 
Alzheimer’s Dementia
Vascular Dementia
Lewy Body Dementia and Parkinson Disease Dementia
HIV-associated Dementia
Frontotemoral Dementia
57
Q

SSX of dementia

A

Impairs cognition globally
Onset is gradual
Short-term memory loss may be the first sign
Personality and behavioral disturbances may develop early or late
Motor and other neurological deficits (occur at different stages depending on the type of dementia)
Incidence of seizure is increased
Psychosis in 10%

58
Q

early stage of dementia

A

Recent memory is impaired
May have progressive difficulty with independently doing ADLs (balancing checkbook, remembering where they put things, etc.)
May have agnosia, apraxia, aphasia
May have beginning of personality changes

59
Q

intermediate stage of dementia

A

Inability to learn and recall new info
Memory of remote events reduced but not lost
May need help with basic ADLs (bathing, eating, dressing, toileting)
Loss of sense of time and place
Are ambulatory but often get lost and are at risk of falls due to confusion

60
Q

late stage of dementia

A

Cannot walk, feed themselves, or do any other ADLs
May become incontinent
May be unable to swallow
End-stage usually results in coma or death, usually from infection

61
Q

dx for dementia

A

Requires all of the following:
Cognitive or behavioral (neuropsychiatric) symptoms interfere with the ability to function at work or do usual daily activities.
These symptoms represent a decline from previous levels of functioning.
These symptoms are not explained by delirium or a major psychiatric disorder.
And cognitive or behavioral impairment should have ≥ 2 of the following:
Impaired ability to acquire and remember new information (amnesia)
Language dysfunction (aphasia)
Visuospatial dysfunction (agnosia; eg, inability to recognize faces or common objects)
Impaired executive function, including reasoning, handling of complex tasks, and/or judgment (apraxia)
Changes in personality, behavior, or comportment.

62
Q

Alzheimer’s disease caused by

A

beta-amyloid deposits and neurofibrillary tangles

63
Q

genetic component of Alzheimer’s- which loci is involved that is also implicated in Down syndrome?

A

21 (amongst others)

64
Q

best predictor of AD?

A

age

65
Q

what finding is directly related to severity of dementia?

A

number and distribution of neurofibrillary tangles

66
Q

risk factors for AD

A 
Advanced age
Family history (esp. if seen in 1st deg. relatives)
ApoE genotype
Trisomy 21 (AD develops in all patients by age 35 because of increased deposition of β-amyloid)
67
Q

SSX for AD

A

Early, intermediate and late stages (see Dementia in general)
Loss of short term memory is typically the first sign
Increasing forgetfulness (can’t remember words, names, disorganization of bills and medications, burnt pots on the stove)
Increasing repetitiveness
Asking the same question over and over or having the same conversation minutes after it was completed
Behavioral sxs become common
Suspicious or paranoid behavior
Agitation, yelling, wandering

68
Q

DDX for AD

A

The absence of motor deficits helps to differentiate AD from most other dementias
However, as AD progresses, Parkinsonism can become evident making differentiating AD from Lewy body dementia more difficult

69
Q

Traditional Criteria for Dx includes all of the following:

A

Dementia established clinically and documented by a formal mental status examination
Deficits in ≥ 2 areas of cognition
Gradual onset and progressive worsening of memory and other cognitive functions
No disturbance of consciousness
Onset after age 40, most often after age 65
No systemic or brain disorders that could account for the progressive deficits in memory and cognition

+really know this

70
Q

AD
labs
PE
imaging

A

no standard labs
neuro exam
CT or MRI (may show loss of volume)

71
Q

Vascular dementia

A

due to cerebral infarction

2nd most common cause of dementia in elderly

72
Q

vascular dementia is the most common in those with vascular risk factors of

A 
HTN
hyperlipidemia 
DM
smoking
several strokes
73
Q

SSX of vascular dementia

A

similar to other dementias
Exaggeration of deep tendon reflexes (UMN lesion)
Extensor plantar response (Babinski response)
Gait abnormalities
Weakness of an extremity
Hemiplegias
Pseudobulbar palsy with pathologic laughing and crying

74
Q

DX
history
imaging

A

hx: reveals history of stroke
imaging: CT and MRI may show multiple BL infarcts

75
Q

Lewy Body Dementia is characterized by

A

cellular inclusions called lewy bodies in the cytoplasm of cortical neurons

76
Q

Parkinson Disease Dementia is typically characterized as a

A

movement disorder but dementia can form late in the disease. Dementia is from lwey bodis in the substantia nigra

77
Q

comparing and contrasting Lewy Body Dementia with Parkinson Disease Dementia

A

Lewy Body Dementia- cognitive and extrapyramidal (gate) sxs usu begin within 1 year of each other
Parkinson Disease Dementia- cognitive sxs don’t begin until 10-15 years after motor sxs, psychiatric sxs (hallucinations, delusions) less frequent than Lewy Body Dementia

78
Q

what is the definitive dx for Lewy Body Dementia and Parkinson Disease Dementia?

A

autopsy samples of brain tissue

CT and MRI not helpful except to rule out other conditions

79
Q

what’s the thing that differentiates HIV-associated dementia from all other forms of dementia?

A

Unlike almost all other forms of dementia, tend to occur in younger people

CPD III (7 decks)

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