Neurological

Question 1

Anterior spinal cord injury

Answer 1

Caused by ischemic injury to the anterior aspect of spinal cord due to occlusion of anterior spinal artery, which is most commonly occur as a consequence of non traumatic process, although it can be traumatic. The anterior two-thirds of the spinal cord contains corticospinal and spinothalamic tracts, which are affected in this syndrome.

Question 2

Brown-Sequard cord injury

Answer 2

Result of a hemicord lesion (i.e damage or impairment to the left or right side of the spinal cord).

Question 3

Central cord injury

Answer 3

The most common type of incomplete spinal cord injury, accounting for ~10% of all spinal cord injuries.

Most often occurs in older persons with degenerative disk disease; however, it may also be seen in younger persons who sustain trauma to the cervical spine, typically after an athlete spears another with their head, or a diving injury.

Question 4

Autonomic Dysreflexia

Answer 4

Question 5

Cerebral perfusion pressure is calculated

Answer 5

CPP = MAP - ICP

Question 6

Increasing ICP is most easily seen with what clinical change?

Answer 6

Changing level of consciousness

Question 7

What is Doll’s eyes reflex? What does it indicate?

Answer 7

Ability to stay fixed on a point when head is turned (eyes move opposite of head direction)

Absence indicates midbrain/pons injury

Question 8

What is Brudzinski’s sign? What does it indicate?

Answer 8

A stiff neck that causes knees/hips to bend when neck is flexed.

Meningitis or subarachnoid hemorrhage

Question 9

A trauma patient with hypotension, normal HR, and pink/dry skin may have what type of shock?

Answer 9

Neurogenic/spinal shock

Question 10

Signs of uncal herneation include

Answer 10

(1) Abnormal posture and poor GCS. There may be pupillary dilation and loss of light reflex due to direct compression of the oculomotor nerve.

Question 11

What is a transcalvarial herneation?

Answer 11

(4) The brain herneates through an open skull fracture (or surgical site)

Question 12

What is a cingulate (subfalcine) herneation?

Answer 12

(3) The brain (frontal lobe) is scraped under part of the falx cerebri, the dura mater at the top of the head between the two hemispheres of the brain.

This can cause abnormal blood flow, leading to a dangerous increase in ICP

Question 13

Vomiting from a head injury is due to increased pressure on what structure?

Answer 13

The area postrema in the medulla oblongata

Question 14

Normal cerebral perfusion pressure is

Answer 14

70-90 mmHg

Question 15

Normal ICP is

Answer 15

0-10 mmHg

Question 16

What two “electrolytes” are most important to maintain in a head-injured patient

Answer 16

glucose and sodium

Question 17

Cushing’s triad typically has what findings?

Answer 17

Bradycardia

Hypertension / wide pulse pressure

Abnormal respiratory pattern

Question 18

An epidural hematoma usually involves what type of blood vessel

Answer 18

Arteries

Question 19

A subdural hematoma usually involves what type of blood vessels?

Answer 19

Veins

Question 20

A subarachnoid hematoma typically involves what type of blood vessels?

Answer 20

Arteries

Question 21

Usual presentation for a subarachnoid hemorrhage is

Answer 21

Sudden, severe headache

Question 22

Usual presentation for an epidural hematoma is

Answer 22

Loss of consciousness followed by a lucid period

Question 23

What is Babinski’s reflex? What does it indicate?

Answer 23

• Plantor extensor reflex
• Is present/absent, not normal/abnormal
• Indicates upper motor neuron (brain stem) injury (age >2)

Question 24

Bell’s Palsy affects what cranial nerve?

Answer 24

CN VII

Question 25

How does Bell's palsy differ from acute CVA?

Answer 25

Bell's Palsy always affects upper and lower face without other symptoms. CVA affects lower face with other, associated symptoms.

Question 26

What cranial nerves controls eye movement, pupil dilation, and pupil accomodation?

Answer 26

CN III (oculomotor) CN IV (trochlear) CN VI (abducens)

Question 27

What cranial nerve transmits visual informaition?

Answer 27

CN II (optic)

Question 28

What cranial nerve controls the sense of smell?

Answer 28

CN I (olfactory)

Question 29

What cranial nerve controls facial sensation and chewing?

Answer 29

CN V (trigeminal)

Question 30

What cranial nerve controls movement of the facial muscles?

Answer 30

CN VII (facial)

Question 31

What cranial nerve controls hearing and position/balance?

Answer 31

CN VIII (vestibulocochlear)

Question 32

What cranial nerve controls taste and salivation?

Answer 32

CN IX (glossopharyngeal)

Question 33

What cranial nerve controls the ability to swallow, as well as parasympathetic innervation to much of the body?

Answer 33

CN X (vagus)

Question 34

What cranial nerve controls the ability to raise the shoulders and turn the head?

Answer 34

CN XI (accessory)

Question 35

What cranial nerve controls the ability to move the tongue?

Answer 35

CN XII (hypoglossal)

Question 36

What is Guillan-barre syndrome and how does it typically present?

Answer 36

Acute inflammatory demyelinating polyneuropathy - an infectous process of the peripheral nervous system that causes ascending paralysis

Question 37

What is myasthenia gravis and how does it typically present?

Answer 37

An autoimmune disorder that destroys acetylcholine receptors in postsynaptic neuromuscular junctions, causing transient weakness and fatigue

Question 38

Mydriasis is

Answer 38

excessive pupil dilation

Question 39

Miosis is

Answer 39

excessive pupil constriction

Question 40

How does decorticate posturing present, and what does it indicate?

Answer 40

Flexor posturing Damage to cerebral hemispheres, thalmus, or midbrain

Question 41

How does decerebrate posturing present, and what does it indicate?

Answer 41

Extensor posturing Damage to midbrain, brainstem, or cerebellum

Question 42

Progression from decorticate to decerebrate posturing often indicates

Answer 42

uncal (1) or tonsillar (6) herneation