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Clinical Flashcards

1
Q

Frontal lobe

A

Inhibition
Higher level func
Problem solving

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2
Q

Parietal lobe

A

Sensory

Attention

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3
Q

Temporal lobe

A 
Memory
Emotion
Olfaction
Hearing
Spatial awareness
Hippocampus
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4
Q

occipital lobe

A

Vision

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5
Q

Cerebellum

A

Motor corrd and regulation

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6
Q

Brainstem

A

Midbrain- eyes, ears, primit motor
Pons- eat, hear, balance
Medulla- vagus, resp

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7
Q

PNS vs CNS

A

PNS can regenerate
Benign tumours
Schwann myelin

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8
Q

CSF cycle

A

Choroid plexus produc in ventricles. 500ml per day

Arachnoid granulation in sub arach space abs CSF into venous blood. After ventricle IV.

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9
Q

Dorsal and ventral horns

Grey matter cols

A

Dorsal- has DRG, sensory afferents

Ventral- motor efferents

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10
Q

grey matter

A

Cerebral cortex
Nuceli
Horns

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11
Q

White matter

A

Association fibres
Commisural fibres x CC
Projection fibres down SC

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12
Q

Funiculi

A

Dorsal- DCML (split into gracile and cuneate)
Lateral- lat CST
Ventral- ventral CST

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13
Q

defins

A

Ataxia- loss vol musc coord
Apraxia- loss purposeful movem
Dysdiadochokinesia- diffic in repetit movem
Paresis- musc weakness
Chorea- invol spasms and rigidity of limbs and face (eg HD degen corpus striatum)

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14
Q

Spina bifida

A

Fail of usually LS neural fold fusion. Incompl NT closure. Vertebral arch not grow normally. Meningeal herniation.
Occulata- fail L5/S1 arch fus. 25% popn. Hidden. Hair tuft.
Cystica- myelomeningocoele- neural tiss and meninges herniate= neural issues and infec risk.
Meningocoele- only meninges herniate.
Lipomeningocoele

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15
Q

Hydrocephalus

A

Head expans due to accum of CSF in brain ventricles.
Mx- shunt to jugular V or peritoneum.
Communicating- external block eg scarring arachnoid grans
Non comm- internal ventric blockage.

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16
Q

LP

A

L3/4 level of hip crests
Passed end of SC at L1/2
Lower down in a baby

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17
Q

Substantia gelatinosa

A

Tip dorsal horn

Nociception

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18
Q

SNS

A

Efferents from T1 to L2

Synapse with sympathetic chain

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19
Q

Glia

Supp, nourish, insulate, remove waste

A

Astrocyte- supp, nutrit, BBB, env maint, nt remov, K buffer
Oligodendrocyte- insulate
Microglia- immune resp by phagoc and APC

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20
Q

BBB

A

Tight junc
Bm
Astrocyte feet
T cells can cross

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21
Q

inhib nt’s

A

GABA

Glycine

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22
Q

L dopa

A

Can x BBB

AADC enz forms dopamine, carbidopa inhibs this peripherally to prev vessel effects. But it cant x BBB.

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23
Q

transverse foramen

A

Conts vertebral V and A. Artery not C7.

Arth comp may cause vertigo as disrupt vertibrobasillar circ.

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24
Q

Fontanelles

A

Allow squeeze and tiss fluid exc during birth

If breech deliv too fast then brain damage.

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25
disc prolpase
Comm L4/5 or L5/S1 Post prolpapse can cause paraplegia Lat prolapse inv N roots
26
carotid sheath
Extension of neck musc fascia | Conts- carotid As, IJV, vagus
27
SC BS
Anterior spinal A | 2x post spinal A
28
Cerebral A embolus
Isch Lack O, lack gluc, build up K Infarcted brain
29
haemorrhage types
Extradural- arterial blood Subdural- venous blood Subarachnoid- arterial blood
30
Phasic Rs
Eg tough Rs | Adapt fast
31
Sensory agnosia
One side of body no sensation or pain | Parietal lobe, thalamus, or int capsule lesion.
32
Glove and stocking periph neurop
Demyelination Axon degen Due to eg vasc dis, AI, infec, degen etc.
33
dorsal root and col lesions
Tabes dorsalis syphillis Vit B12 defic dorsal col degen Get loss of light touch and conc proprio, sensory ataxia and pos rhomberg. Stick and stamp gait.
34
syringomyelia
ST tracts affected. Central canal cavity/syrinx. Loss of pain and temp. Bilat.
35
reflex
R, afferent neurone, synpase, efferent, effector | Deep tendon reflexes are examined.
36
pain fibres
C slow dull small unmyelinated- mech, thermo, chem A delta fast sharp large myelinated- mech and thermal only Ligand gated TRPV1 Ca channel lat ST tract Mechano and desc inhibition (PAG, LC) via SG
37
periph sensitisation
Tiss damage and inflamm resp causes more prim afferent activ. Can lead to central sensitisation (excess gluatamate), wind up, and RF expansion or allodynia. Hyperalgesia- incr pain at normal thresh. Allodynia- pain from non painf stim, and in areas with no stim.
38
Neuropathic pain
``` Neuronal origin No specif dis or site of damage Burn, elec, parasthesia, shooting Allodynia and hyperalgesia VGNa upreg and new afferent format (aberrant plasticity= phantom limb) ```
39
CRPS
Trigger eg trauma, frac, surg, stroke, MI Contin pain, allodyn, hyperalg after. Symps- sensory, vasomotor, oedema, motor, trophic. Stages- acute, dystrophic, atrophic.
40
Motor unit
An alpha MN and the muscle fibres it innervates
41
proprioceptors
Muscle spindle- musc str Tendon organ- contractile tension Jnt Rs- jnt movem Skin- skin str
42
LMN
Cell body in SC or CN nuclei, innervates skel musc. Periph patt. Signs- weakness, wasting, hypotonia, decr reflexes, fascuculation, musc contractures. Causes- trauma, periph neurop, MND
43
UMN | Pyramidal and extra pyramidal paths
Cell body in cerebral cortex of brainstem nuc. Stay in CNS. Signs often widespread eg mono/hemiparesis Signs- clasp knife, hypertonia, hyperreflexia, clonus, pos babinski, weakness, pronator drift, loss abdo reflexes. Causes- stroke, SC inj.
44
PD Degen dopaminergic neurones SN Disrup nigrostriatal causes more inhib ad reduced activation Dop direct path- SN ot D1R stims movem Dop indirect path- SN to D2R prevents inhib so stims movem.
``` Hypertonia eg lead pipe, cog wheel Hypokinesia/bradykinesia Pill rolling resting tremor Coord is good Immobile face Flexed posture Festinating gait, reduced arm swing, unsteady on changing direc, difficulty stopping. Sign often unilat initially on contralat side to basalg ganglia inv ```
45
PD mx
Levo dopa. Causes dyskinesia LT. Dop agonists MAO inhibs Deep brain stim
46
cerebellar ataxia
Nystagmus Poor coord Dysarthria Tremor Hypotonia Broad base staggering gait. Unbalanced heel to toe walk. Incr arm swing. Cerebellar damage causes fall TOWARDS the lesion.
47
DANISH
``` Dysdiadochokinesia/dysmetria Ataxic gait Nystagmus Intention tremor Slurred speech Hypotonia ```
48
Cerebellar eye signs
Slow jerky persuits with catch up saccades. Dysmetria of saccades- overshoot when fixing Nystagmus- maximal on gaze TOWARDS lesion.
49
PASTRIES | Causes of cerebellar dysfunc
``` Post fossa tum Alc MS Trauma Rare Inherited eg friedreichs ataxia Epil meds eg carbamazepine, phenytoin tox Stroke ```
50
Cerebellum lobes
Ant paleo- maint gait Post neo- posture and motor skill modulation Floculonodular archi- maint balance Vestibulo- balance Spino- error correc Cerebro- motor planning and learning
51
Basal ganglia | Movem control and planning
``` Caudate nuc Putamen Globus pallidus Substantia nigra Subthalamic nuc ```
52
Huntingtons chorea
Striatum degen of inhib | Invol spasm and rigidity
53
diplopia
Cornea and lens prob- eg cataract Eye musc- MG N prob or their BS- MS, DM Brain- CVA, SOL
54
Conductive hear loss
Blockage Rupt tympanic OM fluid Otosclerosis
55
sesnory hear loss
Hair cell destruc eg moise, physical | Hair cell death eg tox
56
neural hear loss
Spiral ganglion dam eg acoustic neuroma Age Tinnitus Auditory neuropathy
57
Memory
Declarative- cortex | Non declarative eg motor, emot- cerebellum and BG
58
Brocas aphasia
Makes sense but not fluent. | Thoughts to words.
59
wernickes aphasia
Fluent but nonsense | Lang comprehension.
60
Speech path
Ear to W to B to motor
61
AD ix
Bloods- FBC, UE, LFT, CRP, gluc, Ca, TFT, B12, folate Urine MSE and MMSE (under 9 sev, 10-18 mod, 19-23 mild) MRI head- gen atrophy, esp hippocampus SPECT
62
AD pathol
``` Senile amyloid plaques nf hyperP tau tangles Reduc nt’s Loss synpases Neurone death, cortical atrophy ```
63
AD px prog
Mem, judgem, interest Loss func, confus, agit, disinhib, hallucin and delusion Weak, cant eat, incontin, loss speech
64
AD mx
AChE inhibs eg galantamine, rivastigmine, donepezil. For mild to mod. S/e eg headache, GI, seix, urin reten, bradyc, SJS NMDA antag eg memantine. Severe. S/e eg drowsy, constip, headache, SOB, hallucin, confus, gait.
65
epilepsy
``` Excess neurone activ in brain Partial seiz- one hemis Generalised- crosses CC Simple- retain awareness Complex- loss awareness, physic strange behav Tonic clonic with post ictal Atonic Myoclonic musc jerking Ansence ```
66
Emerg epil mx
ABCDE Over 5 mins give midazolam pre hosp In hosp IV loraz and phenytoin
67
Dementia defin
Acq global impair of intellect, reason and personality without impairm of conciosness. Eg AD, vasc, lewy body, picks.
68
ICP
Normal 5-15mmHg RICP is over 20 for over 5 mins Compensation- reduc BV, reduc CSF, brain atrophy. Vasc mechs maint BF at ICP under 60.
69
SOL
Brain deformation Midline displ Internal herniation
70
stroke defin
Sudd events producing a disturb of CNS func due to vasc dis. Abrupt loss focal brain func lasting over 24hrs or causing death. Due to either spont haemorr into brain or inadeq BS (embol, thromb). Includes SAH.
71
Stroke categs
-Infarct 85%- Embol most comm (AF, carotid atheroma, ath plaque thrombus, aneur) Thrombosis over atheromatous plaque. -Haemorrhage 15%- IC 10- HTN dam, charcot bouchard, amyloid depos, inher, RICP. subarach 5- berry aneur, br pts of circle willis. Thunderclap, sentinel headache, LOC, rap die.
72
Neuro hx
HPC- headache, motor, sensory, bal, gait, mem, vsion, seix, wl, impair cog. PMH- epil, stroke, surg, trauma. Chronic dis. HTN etc. Soc hx incl recreat drugs, occup, alc, smok, env. MSE MMSE
73
Sleep disorders
Insom- anx cortex overactive, excess stim to reticular format. Narcolepsy- loss orexinergic neurones to RF, loss vis sys input. Sleep apnoea- airway comp. chemoR to thalamus cuases sudd wake.
74
conc disorders
Brain death- wide cortic and bstem dam. Coma- same but disord EEG, unarousable, unresp, no sleep wake cyc. PVS- wide cortic dam, var EEG, some spont eye open, bstem reflexes, sleep wake cycle. Locked in synd- basilar or pontine A lesion. Can move eyes somet.
75
alt conc
Cortical func eg metab disturb. Press RICP Lesion eg infarct.
76
Delerium
Acute confus state, fluc arousal, disorient, hallucin. | RFs- eld, dementia, infec, hip frac.
77
RICP causes
Oedema- hypox, trauma, enceph, tum, hypoNa, water intox, infarct SOL- tum, haemorr, trauma, abcess. Hydroceph- obstruc or not. Blood flow- venous outflow obstruc, vasodilat eg acidosis, venous sinus thrombosis.
78
herniation
Subfalcine- CG Tentorial- uncus Tonsillar- cerebellar tonsils through FM. CONING.
79
Gen neural exam
``` Abn movem Posture Meningism Tone, reflex Lateralising signs Pupil reflex and fundosc AVPU, GCS Bstem tests ```
80
Decerebrate
Arm ext, flex wrist Upper BS dam Worse
81
decorticate
Flex elbow | CST damage
82
GCS
Eye- none, pain, verbal, spont Verbal- none, incomp, inapp, confused, orient Move- none, ext to pain, flex, withdraw, loc, obeys
83
neuro ix
Bloods incl pH, lactate, cult, endoc Imaging- CT, MRI CSF EEG
84
TIA defin
Focal distrub brain func Presumed vasc origin Resolves compl in 24hr
85
stroke hx
Onset, prog Neuro- locat, modalities, pos vs neg Other- headache, seiz, vom, drowsy, cardiac Atyp- delerium, confus, collapse, incontin.
86
Stroke ix
``` GLUC ECG Bloods CXR CT MRI Carotid US Echo ```
87
stroke mx
``` Thrombolysis in 3hr/ectomy Endovasc interven Anticoag if not Tlysis Rehab Tx HTN, chol, DM Carotid surg ```
88
spinal cord BS
Ant spinal A- most comm occluded (aorta dis, surg, vasculitis, sickle, hypot, TIA, disc hern) 2x post spinal As 21 pairs segm As A of adamkeiwicz
89
Spinal isch px
Acute pain Spinal shock LMN init, then UMN Loss pain and temp
90
RICP symps
Headache- worse on lying or bend forw. Worse in morn. NV Loss vis Alt mental state
91
RICP signs
Papilloedema- blurr disc margins CN III palsy- ptosis, dilat, down and out CN VI palsy- cant abduct Loss vastibulo occular reflex- normal tow cold. Confus, impair cognit, reduc GCS UMN signs Decort or decerebrate posturing Biots resp Cushings reflex- cushings triad- irreg resp, bradyc, HTN.
92
Hydroceph
Excess produc- choroid plex papilloma Block flow- spina bif, sten, clot, SOL Disrup abs- oblit arachnoiditis post bleed/trauma
93
Normal press HC triad
Dementia UI Gait abn
94
HC mx
VP or VA shunt | Decomp craniectomy
95
extradural haemorr
Arterial Btw skull and dura High impact Init regain conc then decline
96
Subdural haemorr
``` Venous Btw dura and arachnoid Acute/sub acute/chronic Can spread beyond sutures but lim by dural reflecs. Crescent CT, acute brighter ```
97
SAH
Arterial Btw pia and arachnoid Trauma or psont (aneur/AVM) Thunderclap, neck stiff, vom, photophob.
98
Base skull frac
Periorb ecchymosis Mastoid ecchymosis CSF rhinorr CSF otorr

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