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(2) MS: Neurological Conditions 🩺 > S1_L1-2: Approach to Diagnosis & Neuro Exam > Flashcards

S1_L1-2: Approach to Diagnosis & Neuro Exam Flashcards

1
Q

Signs/Symptoms of increased intracranial pressure (IICP) in NON-INFANTS

A

Headache, vomiting, papilledema, lateral rectus palsy (diplopia with internal squint), altered sensorium (deterioration in the level of consciousness), and Cushings Triad (↑ BP, ↓ Pulse, ↓ Respirations)

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2
Q

Signs/Symptoms of meningeal irritation

A

Headache, nuchal (neck) rigidity, Brudzinski’s Sign, Kernig’s Sign

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3
Q

Signs/Symptoms of increased intracranial pressure (IICP) in INFANTS

A

Bulging fontanel, separation of sutures, and rapid enlarging head size (Hydrocephalus)

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4
Q

What is the Normal Respiratory Rate (Breaths per minute)?

A

12-20 breaths per minute

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5
Q

Explain how to perform the Brudzinski’s Sign.

A

Patient is in supine and the examiner flexes the patient’s neck.

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6
Q

What is the expected findings in a (+) Brudzinski’s Sign?

A

Patient will involuntarily flex hip and knee. (+) wincing pain

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7
Q

Explain how to perform the Kernig’s Sign.

A

Patient is supine and the examiner flexes the patient’s hip, then extends the knee.

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8
Q

What is the expected findings in (+) Kernig’s Sign?

A

Patient feels an excruciating pain.

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9
Q

What is a secondary tumor of the brain?

A

A tumor that grows outside the CNS

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10
Q

What is a primary tumor of the brain?

A

A tumor that grows within the CNS

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11
Q

Type/Distribution of MASS LESION

A

Focal

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12
Q

Type/Distribution of PERIPHERAL NEUROPATHY

A

Diffuse

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13
Q

Type/Distribution of MULTIPLE SCLEROSIS

A

Multi-focal

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14
Q

Type/Distribution of NUTRITIONAL ENCEPHALOPATHY

A

Diffuse

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15
Q

A neurologic illness with a bulbar onset manifests with?

A

Swallowing and speech problems

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16
Q

Diagnostic test that is MORE SENSITIVE to mass lesions, strokes, brain abscess, and demyelinating disease COMPARED TO A CT SCAN?

A

Magnetic Resonance Imaging (MRI)

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17
Q

It is a cortical electrodiagnostic study

A

Electroencephalogram (EEG)

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18
Q

It is used to detect myopathies

A

Muscle Biopsy

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19
Q

Ancillary procedure for hypokalemic paralysis

A

Serum Potassium

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20
Q

The GOLD STANDARD of Angiograms

A

Digital Subtraction Angiogram / Catheter Angiogram

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21
Q

Angiogram that is NON-INVASIVE?

A

Magnetic Resonance Angiogram

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22
Q

Angiogram that is the MOST ACCURATE BUT INVASIVE?

A

Catheter Angiogram / Digital Subtraction Angiogram

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23
Q

Diagnostic test used to detect TB of the spine?

A

Spine X-ray

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24
Q

Medical term for TB of the spine?

A

Pott’s Disease

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25
Q

What is the Transcranial Doppler Ultrasound (Ultrasonography) used for?

A

Stroke, Hydrocephalus

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26
Q

What is the purpose of the ancillary procedure: Serologic Test

A

It is used to identify the different types of bacteria or virus causing the infection

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27
Q

Diagnostic test for Myoneural Junction (Neuromuscular Junction) Disorders?

A

Nerve Stimulation Studies (NSS)

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28
Q

Components of the Cushings Triad?

A

↑ BP, ↓ Pulse (Bradycardia), and ↓ Respirations

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29
Q

What are the prominent bladder signs?

A

Bowel or bladder incontinence, constipation, dysuria, and no bowel movement.

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30
Q

A lesion that is bilateral and often presents with a symmetrical deficit is in the level of the _____?

A

Spinal cord

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31
Q

TRUE OR FALSE: The cerebrum is responsible for fine movements.

A

False

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32
Q

TRUE OR FALSE: Cerebellar affectation presents with incoordinated movements. It does not present with weakness.

A

Both statements are true.

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33
Q

Cause of Amyotrophic Lateral Sclerosis (ALS)

A

Degenerative

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34
Q

Cause of Alzheimer’s Disease, Dementias

A

Degenerative

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35
Q

Cause of Myasthenia Gravis

A

Immunologic, autoimmune

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36
Q

Cause of Spina Bifida

A

Congenital / Developmental

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37
Q

Cause of subarachnoid hemorrhage

A

Trauma / neurotrauma

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38
Q

Cause of Hyponatremia

A

Toxic / metabolic

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39
Q

Cause of brain abscess

A

Infection

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40
Q

Cause of Stroke

A

Vascular / Circulatory problem

Source: Merritt’s Neurology, 14th ed.
Due to cerebral ischemia or hemorrhage. It strikes “out of the blue” and manifests as hemiparesis or other focal brain signs

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41
Q

Cause of Arteriovenous Malformation (AVM)

A

Congenital / Developmental

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42
Q

Cause of B1, B6, B12 Defiency

A

Nutritional

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43
Q

What is the most common vascular / circulatory problem?

A

Stroke

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44
Q

Cause of Parkinson’s Disease

A

Degenerative

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45
Q

Cause of Landry-Guillain-Barre Syndrome

A

Demyelinating and autoimmune

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46
Q

Cause of meningitis

A

Infection

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47
Q

Cause of intracerebral hemorrhage

A

Trauma / neurotrauma

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48
Q

Cause of aneurysm

A

Congenital / Developmental

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49
Q

TRUE OR FALSE: In a spinal cord lesion, there are normal findings above the level of the lesion.

A

True

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50
Q

TRUE OR FALSE: Atrophy occurs with time in a peripheral nerve lesion.

A

True

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51
Q

Other name for Bilateral Pyramidal Tract Signs

A

Pathologic Reflexes

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52
Q

Cause of Craniostenosis

A

Congenital / Developmental

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53
Q

Cause of hypercalcemia

A

Toxic / metabolic

54
Q

Cause of Encephalitis

55
Q

What is a tumor?

A

A tumor is an abnormal enlargement or proliferation of cells.

56
Q

Cause of Multiple Sclerosis

A

Demyelinating and immune

57
Q

Cause of epidural and subdural hematomas

A

Trauma / neurotrauma

58
Q

Onset of trauma

59
Q

Onset of degenerative disease (slowly progressive)

60
Q

Onset of intoxication

Alcohol, exposure to poison or chemicals

61
Q

Onset of mass lesions

62
Q

Onset of infections

63
Q

Onset of vascular diseases

64
Q

Onset of nutritional disorder/lesion

E.g. lack of thiamine, lack of pyridoxine

65
Q

Onset of metabolic diseases

66
Q

Onset of acute demyelinating disease

67
Q

Type/Distribution of VASCULAR DISEASE

68
Q

Type/Distribution of Metastasis

Multiple Tumors

A

Multi-focal

69
Q

Type/Distribution of Metabolic Encephalopathy

70
Q

What does a focal type/distribution of lesion mean?

A

The lesion is restricted to one area

71
Q

What does a multi-focal type/distribution of lesion mean?

A

Lesion is present in multiple areas

72
Q

Type/Distribution of a demyelinating disease

A

Multi-focal

73
Q

Type/Distribution of Toxic Encephalopathy

74
Q

Diagnostic Test for Fractures

A

Skull X-Ray

75
Q

Diagnostic Test for Guillain-Barre’s Syndrome

A

Nerve Stimulation Studies (NSS)

76
Q

Diagnostic Test for Seizures

A

Electroencephalogram (EEG)

77
Q

Diagnostic Test for Aneurysm

78
Q

Diagnostic Test for Dermatomyositis

A

Total Creatine Phosphokinase (CPK)

79
Q

Diagnostic Test for Subarachnoid Hemorrhage

A

Lumbar Puncture

80
Q

Diagnostic Test for Myasthenia Gravis

A

Nerve Stimulation Studies (NSS)

81
Q

Diagnostic Test for Arteriovenous Malformation (AVM)

82
Q

Diagnostic Test for Polymyositis

A

Total Creatine Phosphokinase (CPK)

83
Q

Diagnostic Test for Neuropathies

A

Nerve Stimulation Studies (NSS)

84
Q

In performing Babinski sign, we use the (1) end of the key to strike the (2) aspect of the end of the foot going (3) towards the (4).

A
  1. Pointed
  2. Lateral
  3. Upwards
  4. Big toe/Great toe
85
Q

Normal Response of Babinski Sign is —–. Abnormal Response of Babinski Sign is —–.

A

Normal: Plantarflexion (flexion) of all toes
Abnormal: Extension of big toe and flexion / fanning of small toes

86
Q

TRUE OR FALSE: Babinski sign is present during the first year of life.

A

True. Reason: The corticospinal tract is not myelinated until the end of the first year of life. (Source: Snell)

87
Q

A +++ grade in DTR / MSR indicates:

A

Increased reflex

88
Q

Which segments are tested in the Brachioradialis reflex?

89
Q

TRUE OR FALSE: Deep tendon reflex is more accurate than muscle stretch reflex.

90
Q

TRUE OR FALSE: In DTR, reflex muscle contraction mediated by the upper motor reflex arc.

A

False. It is mediated by the lower motor reflex arc.

91
Q

Hyperreflexia is caused by a (1), while hyporeflexia is caused by a (2).

A
  1. Upper motor neuron lesion
  2. Lower motor neuron lesion
92
Q

Cause of cerebral contusion / concussion

A

Trauma / Neurotrauma

93
Q

Cause of Post-infectious and postvaccinal encephalomyelitis

A

Immunologic and demyelinating (neurologic or infectious in nature)

94
Q

Arrange the components of a neurological examination (USUAL PRACTICE) in chronological order.
(1) Motor system
(2) Gait
(3) Cranial nerve exam
(4) Coordination / Cerebellar
(5) Sensory system
(6) Mental Status exam
(7) Reflexes

A

(6) Mental Status exam
(3) Cranial nerve exam
(1) Motor system
(4) Coordination / Cerebellar
(7) Reflexes
(5) Sensory system
(2) Gait

95
Q

What is the tool used for sensory examination to check for equal sensations on the body?

A

Wartenberg Pin-Wheel

96
Q

Name the sensory limb and the motor limb of the corneal reflex.

A

Sensory: Ophthalmic division of Trigeminal nerve
Motor: Facial nerve

97
Q

Differentiate the affected areas of the face between stroke and bell’s palsy.

A

Stroke: Lower half of face
Bell’s Palsy: Whole half of face

98
Q

TRUE OR FALSE: Air conduction is longer than bone conduction.

99
Q

Rinne’s Test and Weber’s Test are used to examine which cranial nerve?

A

Vestibulocochlear, Cranial nerve VIII

100
Q

Shoulder shrug tests the (1) and head rotation tests the (2).

A
  1. Trapezius muscle
  2. Sternocleidomastoid muscle (Contralateral)
101
Q

In a hypoglossal affectation, where is the tongue protruding/pushing?

A

Towards the weak / affected side

102
Q

Fasciculations are (1) that are present in (2) and (3).

A
  1. Muscle twitches
    2-3. Amyotrophic Lateral Sclerosis & Lower Motor Neuron disease
103
Q

Semipurposeful flowing movements that flit from one part of the body to another. Chaotic or unpredictable movements. Swift grimaces and sudden movements of the head or limbs are examples of this condition.

Present in Huntington’s disease

104
Q

Wild, flinging/flailing movements that represent large amplitude proximal movements.
Rare form of involuntary movement confined to one side of the body.

A

Hemiballismus

105
Q

Brief, sudden shock-life jerks, muscular contractions of a portion of a muscle, an entire muscle, or a group of muscles.
Patients with this condition can have seizures.

106
Q

Slow, sinuous, “snakelike”, writhing movements in distal limbs (fingers and toes).
Piano like movements in fingers & toes.

107
Q

Alternating pronation-supination: Ask the patient to pronate and supinate the forearms rapidly.

This is a test for?

A

Dysdiadochokinesia

108
Q

This test assesses unilateral hearing loss (conductive or sensorineural)

A

Weber’s Test

109
Q

Eyebrow elevation, forehead wrinkling, eye closure, smiling, cheek puff, and whistling
can be used to examine which cranial nerve?

A

Facial nerve, cranial nerve VII

110
Q

When testing this cranial nerve, the symmetry of nasolabial folds is examined at rest and at motion

A

Facial nerve, cranial nerve VII

111
Q

We test the visual fields by —–.

A

Confrontation

112
Q

Diagnostic test for muscle disease

A

Total Creatine Phosphokinase (CPK)

113
Q

Diagnostic test for CNS infections (e.g. meningitis, encephalitis)

A

Lumbar puncture

114
Q

TRUE OR FALSE: In papilledema, there’s clear disk margins, visible blood vessels, and double vision.

115
Q

Frequent, Maintained/Sustained contraction of both agonist & antagonist muscles, frequently causing twisting & repetitive movements/abnormal postures. May present like a mannerism.

116
Q

TRUE OR FALSE: When mapping a region of sensory loss, move from the affected area into the normal region

116
Q

Steady resistance through the entire movement of a joint. An example is Parkinson’s disease

117
Q

Diminished tone, suggests LMN disease
But may be observed acutely following UMN disease, such as stroke

A

Flaccidity

118
Q

Clasp-knife reaction: When passive movement of a joint is attempted, —-produces resistance. The muscles, on stretching, suddenly give way due to neurotendinous organ-mediated inhibition.

A

Spasticity
Source: Snell

119
Q

tone which is also velocity dependent but predictably increases with increased speed of movement and decreases at lower speeds

120
Q

When asked to flex the neck, the whole body flexes except the neck

A

(+) neck rigidity

121
Q

Segment/s of knee reflex

A

L2, L3, L4

122
Q

Slow movements accompanied by tremors

A

Bradykinesia with tremors

123
Q

Extremity tone indicative of UMN problem

A

Hypertonia

124
Q

Assessing upper extremity strength and looking for pronator drift is part of which neuro exam?

A

Motor System

125
Q

TRUE OR FALSE: CN VIII is affected in Bell’s Palsy along with CN VII.

126
Q

Test for perception/conduction of air or bone

A

Rinne’s Test

127
Q

TRUE OR FALSE: Distal sensorimotor deficit is present in a peripheral nerve problem.

128
Q

TRUE OR FALSE: Examples of Inferior frontal lobe disease are meningioma/tumors that cause unilateral anosmia

129
Q

TRUE OR FALSE: Gag reflex is checked by stimulating lateral pharyngeal wall on each side

A

FALSE. Posterior pharyngeal wall

(2) MS: Neurological Conditions 🩺 (12 decks)

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