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Neurology > Step 1 Q Bank review > Flashcards

Step 1 Q Bank review Flashcards

1
Q

What layers does a needle pass through in a spinal tap?

A

skin –> superficial fascia –> deep fascia –> supraspinus ligament –> interspinous ligament –> ligamentum flavum –> epidural space –> dura –> arachnoid –> subarachnoid space

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2
Q

Where does the spinal cord end?

A

usually L1-2

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3
Q

where are lumbar punctures done?

A

L4-5 interspace; subarachnoid space

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4
Q

where is spinal anesthesia given?

A

into the subarachnoid space (local anesthesia given into CSF in subarachnoid space)

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5
Q

Effects of benzodiazepines v. barbiturates on GABAa receptor

A

benzodiazepines increase frequency of GABAa channel opening
whereas
barbiturates increase duration of GABAa channel opening

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6
Q

How do benzodiazepines work?

A

potentiate the effects of GABA at GABA receptor

  • -> antianxiety effect
    • increase frequency of GABAa channel opening
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7
Q

How do barbiturates work?

A

increase duration of GABAa channel opening

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8
Q

What are some names of benzodiazepines?

A

lorazepam, alprazolam, diazepam

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9
Q

What are some things associated with generalized anxiety disorder (GAD)?

A
  • excessive worry about life events
  • may be associated with:
    - muscle tension
    - impaired concentration
    - autonomic arousal
    - restlessness
    - insomnia
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10
Q

How might you begin treatment of GAD (generalized anxiety disorder)?

A

may begin with benzodiazepines such as lorazepam

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11
Q 
Naegleria fowleri
What is it? 
sx?
How is it acquired?
dx?
treatment?
prognosis?
A
  • primary amebic meningoencephalitis (PAM): severe prefrontal headache, nausea, high fever, often altered sense of smell
  • acquired from diving into warm, freshwater lakes
  • amoebae enter brain through cribriform plate during forceful diving
  • dx: motile trophozoites in CSF, culture on plates seeded with gram neg bacteria; amebae will leave trails
  • treatment: amphotericin B (rarely successful)
  • often fatal
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12
Q

Acanthamoeba

  • disease/locale
  • onset and prognosis
  • form/transmission
  • dx
  • treatment
A
  • disease/locale: keratitis; GAE - granulomatous amaebic encephalitis in immunocompromised patients
  • insidious onset but progressive to death
  • form/transmission: free-living amebae in contaminated contact lens solution (airborne cysts); not certain for GAE - inhalation or contact with contaminated soil or water
  • diagnosis: star-shaped cysts on biopsy; rarely seen in CSF; culture on plates seeded with gram neg bacteria - amebae leave trails
  • treatment:
    - for keratitis - topical miconazole and propamidine isethionate
    - GAE: sulfadiazine (rarely successful)
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13
Q 
CNI 
name
type 
function 
results of lesion
A

olfactory
sensory
smells
results of lesions: anosmia (inability to perceive odor)

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14
Q 
CNII
name
type 
function 
results of lesion
A

optic
sensory
sees
results of lesions: visual field deficits (anopsia), loss of light reflex with III
** only nerve to be affected by MS (multiple sclerosis)

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15
Q 
CNIII
name
type 
function 
results of lesion
A 
oculomotor
motor
fxn: 
- innervates medial rectus, superior rectus, inferior rectus, inferior oblique (extraocular muscles); adduction (MR) most important
- raises eyelid (levator palpebrae superioris)
- constricts pupil (sphincter pupillae)
- accommodates (ciliary muscle) 
results of lesion: 
- diplopia, external strabismus (eyes are not properly aligned with each other)
- loss of parallel gaze
- ptosis (eyelid droop)
- dilated pupil
- loss of light reflex with 2
- loss of near response (accomodation)
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16
Q 
CNIV
name
type 
function 
results of lesion
A 
trochlear
motor 
function - superior oblique depresses and aBducts eyeball (makes eyeball look down and out) 
- intorts
result of lesions: 
- weakness looking down w/ adducted eye
- trouble going down stairs
- head tilts away from lesioned side
17
Q 
CNV
name
type 
function 
results of lesion
A 
trigeminal 
mixed 
*ophthalmic (V1) 
fxn: general sensation (touch, pain, temp) of forehead/scalp/cornea
lesion: loss of those sensations
loss of blink reflex w/ VII
*maxillary (V2) 
fxn: general sensation of palate, nasal cavity, maxillary face, maxillary teeth
lesion: loss of those sensations
*mandibular (V3) 
fxn: general sensation of anterior 2/3 of tongue, mandibular face, mandibular teeth 
& motor to muscles of mastication (temporalis, masseter, medial and lateral pterygoids) and anterior belly of digastric, mylohyoid, tensor tympani, tensor palati 
lesion: 
- loss of those sensations
- weakness in chewing
- jaw deviation toward weak side

trigeminal neuralgia - intractable pain in V2 or V3 territory

18
Q 
CNVI
name
type 
function 
results of lesion
A 
abducens
motor 
lateral rectus - aBducts eyeball
result of lesion: 
- diplopia 
- internal strabismus
- loss of parallel gaze 
- "pseudoptosis"
19
Q 
CNVII
name
type 
function 
results of lesion
A 
facial 
mixed
fxn: 
- muscles of facial expression
- motor to posterior belly of digastric, stylohyoid, stapedius
- salivation (submandibular, sublingual glands)
- taste (anterior 2/3 of tongue/palate)
- tears (lacrimal gland) 
result of lesions: 
- corner of mouth droops
- cannot close eye
- cannot wrinkle forehead
- loss of blink reflex
- hyperacusis
- Bell's palsy - lesion of nerve in facial canal
- alteration or loss of taste (ageusia)
- eye dry andred
20
Q 
CNVIII
name
type 
function 
results of lesion
A 
vestibulocochlear
sensory 
fxn: hearing, angular acceleration (head turning), linear acceleration (gravity) 
result of lesion: 
- sensorineural hearing loss
- loss of balance
- nystagmus
21
Q 
CNIX
name
type 
function 
results of lesion
A 
glossopharyngeal 
mixed 
fxn: 
- sense of pharynx, carotid sinus/body
- salivation (parotid gland) 
- taste and somatosensation of posterior 1/3 of tongue 
- motor to one muscle - stylopharyngeus 
results of lesions: 
- loss of gag reflex with X
22
Q 
CNX
name
type 
function 
results of lesion
A 
vagus
mixed
fxn: 
- muscles of palate and pharynx for swallowing except tensor palati (V) and stylopharyngeus (IX) 
- all muscles of larynx (phonates) 
- sensory of larynx and laryngopharynx
- sensory of GI tract - to GI tract smooth muscle and glands in foregut and midgut 
results of lesion: 
- nasal speech
- nasal regurgitation 
- dysphagia
- palate droop
- uvula pointing away from affected side
- hoarseness/fixed vocal cord
- loss of gag reflex with IX
- loss of cough reflex
23
Q 
CN XI
name
type 
function 
results of lesion
A 
spinal accessory 
motor 
head rotation to opposite side (SCM) 
elevates and rotates scapula (trapezius) 
weakness turning head to opposite side 
shoulder droop
24
Q 
CN XII
name
type 
function 
results of lesion
A

hypoglossal
motor
fxn:
- tongue movement (styloglossus, hypoglossus, genioglossus, intrinsic tongue muscles - palatoglossus is by X)
results of lesion:
- tongue pointing toward same (affected) side on protrusion

Neurology (10 decks)

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