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Internal Medicine Bates > The Nervous System > Flashcards

The Nervous System Flashcards

1
Q

Lumbar puncture performed at

A

L3-L4/ L4-L5 vertebral interspace

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2
Q

Corticospinal (pyramidal) tract

A
  • voluntary movement and integrated skilled/delicate movement
  • can also inhibit muscle tone
  • cross in the medulla region
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3
Q

Basal ganglia system function

A

Maintain muscle tone

Control gris automatic movements(walking)

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4
Q

Cerebellar system

A

Motor activity
Maintain equilibrium
Control posture

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5
Q

Upper motor neuron damage

A
  • if above crossover →affects opposite side
  • if below the crossover→ipsilateral side
  • ↑ muscle tone
  • ↑ deep tendon reflexs
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6
Q

Damage to lower motor neuron

A
  • affects the ipsilateral side
  • muscle weakness and paralysis
  • ↓or absent muscle tone and reflexes
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7
Q

Diabetic patient with sharp, shooting or burning (dysesthesia)foot pain

A

Small nerve fiber neuropathy(spinothalamic tract)

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8
Q

Diabetic patient with numbness and tingling/loss of sensation in the foot

A

Large fiber neuropathy (posterior column)

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9
Q

No impairment in pain, touch and position but can’t appreciate size shape and texture of the object( fine discrimination)

A

Lesion in sensory cortex

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10
Q

Loss of piston and vibration but other senses preserved

A

Point if damage is Posterior column

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11
Q

Waist down paralysis and hyperactive reflex’s in legs with crude and light touch preserved

A

Severe traverse damage to spinal cord

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12
Q

Ankle reflex

A

S1

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13
Q

Knee reflex

A

L2-4

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14
Q

Supinator(brachioradialis) reflex

A

C5-6

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15
Q

Biceps reflex

A

C5-6

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16
Q

Triceps reflex

A

C6-7

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17
Q

Upper Abdominal reflex

A

T8-10

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18
Q

Lower ab reflex

A

T10-12

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19
Q

Creamasteric reflex

A

L1-2

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20
Q

Plantar reflex

A

L5 and S1

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21
Q

Anal reflex

A

S2,3,4

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22
Q

“Worst headache of my life” and instantaneous onset

A

Subarachnoid hemorrhage

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23
Q

Severe headache and neck stiffness

A

Meningitis

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24
Q

Dull headache, ↑with cough and sneezing, reoccur in same location

A

Mass lesions due to brain tumor or abcess

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25
Q

Woman using hormonal contraceptive, thunderclap headache, fever stiff neck

A
  • maybe stroke

- check for papilledema and focal neurologic sign

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26
Q

Feeling light headed, weak in the legs, about to faint

A

Presyncope

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27
Q

Causes of presyncope

A
  • Vasovagal simulation
  • Arrhythmias
  • Changes in bp
  • Orthostatic hypotension
  • Other medication
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28
Q

Vertigo with diplopia, dysarthria or ataxia

A

Central causes:

  • suspicious for vertebrobasilar TIA or stroke or
  • posterior fossa tumor or
  • migraine with brahmarshi aura
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29
Q

Proximal limb weakness, symmetric, intact sensation

A
  • myopathies from alcohol
  • glucocorticoid
  • polymyositis, dermatomyositis
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30
Q

Proximal asymmetric weakness associated with bulbar symptoms

A

Myasthenia gravis

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31
Q

Proximal asymmetric weakness and worsen with effort(friable) associated with bulbar symptoms

A

Myasthenia gravis

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32
Q

Bilateral distal weakness with sensory loss

A

Polyneuropathy in diabetes

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33
Q

Pattern of stockinng then glove sensory loss

A

Polyneuropathy from diabetes

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34
Q

Multiple patchy area of sensory loss in different limbs

A

Mononeuritis multiplex in diabetes and AR

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35
Q

Prodrome of nausea, diaphoresis,pallor(unpleasant event), vagally mediated hypotension with slow onset and offset

A

Vasovagal syncope

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36
Q

Syncope onset and offset are sudden

A

Reflecting loss and recovery of cerebral perfusion →syncope from arrhythmias

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37
Q

Tonic -clinic motor activity, bladder/bowel incontinence, postical state, and tongue biting and bruising of limbs may occur

A

Generalized seizures

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38
Q

Low frequency unilateral resting tremor, rigidity, and bradykinesia

A

Parkinson disease

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39
Q

High frequency, bilateral, upper extremity tremor that occur with limb movement and sustained posture and subsides when relaxed

A

Essential tremor

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40
Q

Unpleasant sevaon of legs especially at night, gets worse with rest and improve with movement

A

Restless leg syndrome

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41
Q

Risk factors for women having a stroke

A
  1. Preeclampsia
  2. Autoimmune collagen vascular disease
  3. Gestational diabetes
  4. Pregnancy induced hypertension
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42
Q

Visual field cuts and contralateral hemiparesis and sensory deficit

A

Occlusion of middle cerebral artery

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43
Q

Aphasia

A

Occlusion of left middle cerebral artery

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44
Q

Left hemineglect

A

Occlusion of right middle cerebral artery

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45
Q

Warning signs of stroke

A
  • FAST

- beyond FAST

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46
Q

Modifiable risk factors of ischemic stroke

A
  1. Hypertension
  2. Smoking
  3. Dyslipidemia
  4. Diabetes
  5. Weight, diet, nutrition
  6. Physical inactivity
  7. Alcohol use
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47
Q

Disease specific risk factors of ischaemic stroke

A
  1. Atrial fibrillation
  2. Carotid artery disease
  3. Obstructive sleep apnea
48
Q

Diagnosis delirium

A

Using CAM algorithm (4 features- MIDC)

Requires1 and 2 and either 3 or 4

49
Q

2 screening questions for depression

A
  1. Depressed mood?

2. Anhedonia?

50
Q

Otic disc shows bulging and blurred margins

A

Papilledema

51
Q

Optic disc shows pallor

A

Optic atrophy

52
Q

Fundoscopy shows optic cup enlargement

53
Q

Prechiasmal /anterior defects→scotoma, unilateral total blindness causes:

A

Causes:

  • glaucoma
  • retinal emboli→ischemia
  • optic neuritis (w/ poor visual acuity)
54
Q

Bilateral hemianopsia

A

Lesion at optic chiasm←pituitary tumor

55
Q

Homonymous hemianopsia/ quandrantanopsias with normal visual aquity

A

Postchiasmal lesion in the occipital/parietal←stroke

56
Q
  1. Large pupil reacts poorly to light/ anisocoria worsens in light
  2. If with ptosis and ophthalmoplegia also present
    a. Person awake
    b. Comatose
A
  1. Large pupil→abnormal pupillary constriction→CNlll palsy
  2. a) intracranial aneurym
    b) transtentorial herniation
57
Q

Both pupil react to light and anisocoria worsens in darkness

A

Smaller pupil→abnormal dilation→horner syndrome and simple anisocoria

58
Q

Nystagmus is seen in

A
  1. Cerebellar disease w/ gait ataxia and dyarthria
  2. Vestibular disorder
  3. Internuclear ophthalmoplegia
59
Q

Difficulty clenching the jaw

A

Masseter weakness

60
Q

Difficulty moving the jaw to the opposite side

A

Lateral Pterygoid weakness

61
Q

Jaw deviation during opening

A

Weakness on the deviating side

62
Q
  1. Unilateral weakness of temporal and masseter muscle

2. Bilateral weakness

A
  1. CN V pontine lesion

2. Bilateral hemispheric disease

63
Q

Corneal reflex Blinking absent in both eyes

64
Q

Absent blinking and sensorineural hearing loss

A

Acoustic neuroma

65
Q

Drooping in upper and lower face(unilateral/bilateral), hyperacusis, increase or dec in tearing

A

Peripheral injury to CN VII →Bells palsy (affects ipsilateral side)

66
Q

Vertigo with hearing loss and nystagmus

A

Meniere disease

67
Q
  1. Hoarse voice

2. Nasal voice

A
  1. Vocal chhod paralysis

2. Paralysis of the palate

68
Q

One side of the palate fails to rise and with the uvula pulled to the normal side

A

Unilateral lesson of CN X

69
Q

Unilateral absence of gaf reflex

A

Lesion if CN IX

70
Q

Any muscle weakness with atrophy and fasciculation

A

Peripheral nerve disorder

71
Q

Should droop and scapula is displaced downward and laterally

A

Trapezius muscle paralysis

72
Q

Difficulty raising head of the pillow

A

Bilateral weakness of SCM

73
Q

Difficulty raising head of the pillow

A

Bilateral weakness of SCM

74
Q

Tongue atrophy and fasciculation present in

A

In:

  • amyotrophic khayal sclerosis
  • past polio
75
Q

CN used for articulation

A

CN V, VII, IX, X, and XII

76
Q

Unilaterally cortical lesion→tongue presentation

A

Protruded tongue deviates away from the cortical lesion

77
Q

CN XII lesion presentation

A

Protruded tongue deviates to the weak side

78
Q

Marked floppiness in a handshake

A

Hypotonia/flaccidity→ peripheral motor disorder

79
Q

Spasticity

A
  • Velocity depend, ↑tone that worsen at the at extreme ranges
  • central corticospinal tract disease
  • rate dependent
80
Q

Rigidity

A

↑resistance throughout the range of motion

Not rate dependent

81
Q

Increased bulk with diminshed strength→pseudohypertrophy seen in

A

Duchenne muscular dystrophy

82
Q

Flexion of the elbow

A

Biceps and brachioradialis- C5,6

83
Q

Extension of elbow

A

triceps- C6,7,8

84
Q

Wrist extension

A

Extensor carpi radialis Longus and brevis- C6,7,8, radial nerve

85
Q

Grip strength

86
Q

Finger abduction

A

C8,T1 upbeat nerve

87
Q

Opposition of the thumb

A

C8, T1 and median nerve

88
Q

Flexion at the hip

A

L2,L3, LA→Iliopsoas

89
Q

Hip adduction

A

Adductors→ L2,3,4

90
Q

Hip abduction

A

Gluteus medius and minimus→L4,5, S1

91
Q

Knee extension

A

L2,3,4 (quadriceps)

92
Q

Knee flexion

A

L4,5, S1, S2 (hamstring)

93
Q

Dorsiflexion

Plantar flexion

A
  1. L4, L5 (tibialis anterior)

2. S1 (gastrocnemius)

94
Q

Features of cerebellar disease

A

Dysarthria, nystagmus, ataxia, hypotonia

95
Q

Test to assess coordination

A
  1. Rapid alternating movement
  2. Point to point movement
  3. Gait
  4. Stance
96
Q

Cerebellar disease

A
  1. Dysdiadochokinesis
  2. Dysmetria
  3. Past pointing with eyes closed
  4. ataxia
  5. Difficulty hoping
  6. +ve Romberg test wether eyes are open/ closed →cerebellar ataxia
  7. Test pronator drift→arm return to original position but overshoots
97
Q

Corticospinal tract damage

A
  1. Inability to heel walk

2. Pronator drift→ lesson in contralateral hemisphere

98
Q

Distal leg weakness

A

Difficulty Walking on toes

99
Q

Test proximal leg weakness

A
  1. Difficulty in shallow knee bend

2. Difficulty in rising from during position without atm support

100
Q

dorsal column disease

A 
\+ve Romberg's test→ ataxia
Loss of vibration
Loss of position
Asrereognosis
Agraphanesthesia
Impaired 2 point discrimination
101
Q

Evaluate sensory system

A
  1. Test pain and temp (spinothalamic tract)
  2. Position and vibration (posterior dorsal col)
  3. Light touch (both)
102
Q

Asymmetric distal sensory loss (stoking glove)

A

Diabetic(alcoholism) polyneuropathy

103
Q

Causes Dorsal column diseases include

A
  1. Tabes dorsalis
  2. Multiple sclerosis
  3. Vit B12 deficiency
104
Q

Lesion in serenity cortex presents:

A
  1. Asrereognosis
  2. Agraphanesthesia
  3. Impaired 2 point discrimination
  4. Inability to localize points
  5. Extinction of stimulus contralateral to damage cortex
105
Q

Lesion in descending corticospinal tract

A
  1. Hyperreflexia

2. Upper motor neurons disease: weakness, spasticity/ +ve Babinski sign( L5, S1)

106
Q

Lesion of nerve root, nerve, plexuses/peripheral nerve presents

A
  1. Hyperreflexia

2. Lower motor neuron disease: weakness, atrophy, and fasciculation

107
Q

Reflexes and their innervation

A 
Biceps reflex→  C4, C5
triceps reflex→ C6, C7
Brachioradialis → C5, C6
Patellar reflex→ L2,3,4
Achilles reflex's→ S1
108
Q

When do you test for clonus?

A

-Only when reflexes are hyperactive

109
Q

Meningitis signs

A
  1. Nuchal rigidity (spinal nerves)
  2. Brudzinski ( femoral nerve)
  3. Kernig sign (sciatic nerve)
110
Q

What is asterixis?

A

Brief nonrhythmic flexion of the hands and fingers followed by recovery

111
Q

And what is the cause of asterixis?

A

metabolic encephalopathy,→Abnormal functioning of diencephalic motor centers→impairs muscle tone and posture→in liver disease, hypercapnia and uremia

112
Q

Arousal pathway

A
  • ascending reticular activating system of the brainstem→thalamus→cortex
113
Q

Approach to comatosed patient

A
  1. Assess and stabilise ABC
  2. establish patients level of consciousness
  3. Neuro exam
  4. Interview relatives fir history
114
Q

Cardinal don’ts

A
  1. Don’t dilate pupil

2. Don’t flex neck

115
Q

Neuro exam for comatosed patient

A
  1. Resp rate, rhythm, pattern
  2. Pupil light reaction
  3. Check for gaze preference
  4. Check oculocephalic reflex (doll eye movement)
  5. Oculovestibular reflex
  6. Check posture and tone
  7. Further exams
116
Q

Brainstem damage

A
  • absent doll eye movement/ oculocephalic reflex

- no oculovestibular reflex

Internal Medicine Bates (5 decks)

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