intro to neurology

Question 1

what are important associated symptoms to ask about during HPI

Answer 1

headache, numbness, pins and needles, cold or warmth, weakness, unsteadiness, stiffness or clumsiness,N/V, visual disturbances, altered consciousness

Question 2

what are the different portions of a neurological exam

Answer 2

mental status
cranial nerve
motor system
sensory system
coordination and gait
reflex testing

Question 3

what is within the mental status exam

Answer 3

general appearance and behavior
speech
mood and affect
thought and perception
cognition: MMSE
Judgement and insight

Question 4

what is MMSE

Answer 4

Mini-mental state exam

Question 5

what is assessed within the MMSE?

Answer 5

orientation
registration
attention and calculation
recall
language

Question 6

what are the cranial nerves

Answer 6

1. olfactory
2. optic
3. oculomotor
4. Trochlear
5. trigeminal
6. Abducens
7. Facial
8. Vestibulochochlear
9. glossopharyngeal
10. vagus
11. Accessory
12. Hypoglossal

Question 7

what type of scale is muscle strength graded on for a neurologic exam

Answer 7

0-5 scale

0 is no muscle contraction
5 is muscle can move the joint it crosses through a full ROM against gravity as well as against full resistance

Question 8

what is assessed during sensory neurologic exam

Answer 8

touch
pain
deep pain
temperature
joint position sense
vibration sense
two-point discrimination

Question 9

what is stereognosis test

Answer 9

object identification with eyes closed

Question 10

what is graphesthesia test

Answer 10

ability to feel/identify a number being traced in their palm

Question 11

what used to assess coordination in the neurologic exam

Answer 11

rapid alternating movements

(first with hands and then with feet)

Question 12

what is diadochokinesia

Answer 12

ability to perform RAM (rapid altenating movements)

Question 13

what is dysdiadochokinesis

Answer 13

slow, irregular, clumsy, movements

Question 14

how is the gait evaluated

Answer 14

walk across the room, turn and come back
walk heel-to-toe in a straight line (tandem walking)
walk on their toes in a straight line
walk on their heels in a straight line
hope in place on each foot
do shallow knee bend
rise from a sitting position

Question 15

what is a hemiplegic gait

Answer 15

abnormal gait: affected leg is held extended and internally rotated, the foot is inverted and plantar flexed and leg moves in circular direction at hip (circumducation)

Question 16

what is a diplegic gait

Answer 16

abnormal gait: slow and stiff with legs crossing in front of eachother (scissoring) - often with CP, used to be called spastic gait

Question 17

what is a cerebellar ataxic gait

Answer 17

abnormal gait: wide-based and may be associated with staggering/reeling as in drunkness

Question 18

what is a sensory ataxic gait

Answer 18

abnormal gait: wide based, the feet are slapped onto the floor, a patient may watch their feet

Question 19

what is a neuropathic or steppage gait

Answer 19

abnormal gait: inability to dorsiflex foot, often due to peroneal nerve lesion. results in exaggerated elevation hip/knee to allow foot to clear floor

Question 20

what is a dystrophic gait

Answer 20

abnormal gate; pelvic muscle weakness produces lordotic/waddling gait (with trendelenberg tilt)

Question 21

what is parkinsonian gait

Answer 21

abnormal gate; flexed posure, starts are slow, steps are small and shuffling, there is reduced arm swing, and involuntary acceleration may occur

Question 22

what is festination gait

Answer 22

another name for parkinsonian gait

Question 23

what is a choreic gait

Answer 23

abnormal gait: jerky and lurching yet falls are supprizingly rare

Question 24

what is a apraxic gait

Answer 24

abnormal gait; difficulty initiating walking and may appeared to be glued to the floor. once started, gait is slow and shuffling. however no difficulty performing same leg movements when lying and not bearing weight

Question 25

what is a antalgic gait

Answer 25

favoring one leg over other to avoid pain (limp)

Question 26

how are reflexes graded

Answer 26

on a scale 0-4+

Question 27

what reflexes do we assess?

Answer 27

biceps, brachioradialis, achilles, triceps, patellar and plantar

Question 28

what is GCS

Answer 28

glasgow coma scale

Question 29

what is being assessed during CSF labs

Answer 29

appearance
total protein
glucose
cell count (WBC and there should be NO RBCs)
opening pressures

Question 30

what are the indications for lumbar puncture

Answer 30

CNS infection, concern for meningitis
suspected on Subarachnoid hemorrhage
unexplained seizure/SE
intrathecal chemotherapy/contrast
thoraco-abdominal aortic aneurysm repair
idiopathic intracranial hypertension (pseudotumor cerebri)

Question 31

when are LPs contraindicated

Answer 31

infection in tissue near puncture site
space occupying lesion, especially brain abscess
anticoagulation
thrombocytopenia with PLT
complete spinal block
non-communicating hydrocephalus

Question 32

what labs are used for strokes

Answer 32

CBC, ESR/CRP, serum glucose (HGB A1C), lipids (LDL, HDL, triglycerides)

Question 33

what are the indications for CT

Answer 33

stroke, tumor, trauma, dementia, SAH

Question 34

what is CT better at assessing than MRI

Answer 34

acute bleeds

Question 35

what is MRI indicated for

Answer 35

stroke
tumors
trauma
dementia
Multiple Sclerosis
Infections
Seizures

Question 36

when is MRI indicated over CT scan

Answer 36

pregnancy and MRI is more sensitive than CT in detecting certain structural lesions such as tumors and vascular abnormalities
better contrast between white and grey matter

Question 37

what is a DW-MRI

Answer 37

diffusion weighted MRI - detect stroke within an hour of onset with high specificity

Question 38

what do DW-MRI discriminate between

Answer 38

Cytotoxic (strokes) and Vasogeneic dema (cerebral lesions)

Question 39

what is a PET scan

Answer 39

positron emission tomography
may demonstrate function brain abnormalities for structural abnormalities

Question 40

what are the indication for PET scans

Answer 40

medical refractory epilepsy and evaluations for surgery
dementia
gradng fliomas
can provide early confirmatory evidence in huntingtons disease

Question 41

what are the different types of angiography used for neurologic cases

Answer 41

formal cerebral angiography
Ct angiography
MR angiography

Question 42

what are the indications for angiography

Answer 42

acute stroke to evaluate for LVO
intracranial aneurysms/AVMs/Fistulas
SAH - evaluating for above etiology
venous sinus thrombosis
space occupying lesions

Question 43

when are fibrillation potentials and positive waves found on EMG

Answer 43

typically found in denervated muscle as in myopathic disorders and especially in inflammatory disorders like polymyositis

Question 44

what do fasiculation potentials seen in EMG mean

Answer 44

they reflect spontaneous activation of individual motor units characteristic of neuropathic disorders especially involving anterior horn cells as in ALS

Question 45

what are myotonic discharges in EMG

Answer 45

high frequency discharges of potential from muscle fibers that wax and wane in amplitude and frequency as in myotonic dystrophy and myotonia congenita

Question 46

what do myopathic disorders show on EMG

Answer 46

increase incidence of small, short duration, polyphasic motor units in affected muscles

Question 47

what do neuropathic disorders show on EMG

Answer 47

number of units activated during a maximal contraction is reduced and units fire faster than normal

Question 48

What are Evoked potentials

Answer 48

visual, auditory and somatosensory

Question 49

when are evoked potentials indicated

Answer 49

detection of lesion in MS
evaluating efficacy of treatment in MS
detection of lesions in other CNS disorders
assessment and prognosis after CNS trauma/hypoxia
intraoperative monitoring
evaluation of visual/auditory acuity