Clinical - Block 1 Flashcards Preview

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Flashcards in Clinical - Block 1 Deck (60):
1

Consciousness

Awake and Aware

2

Wakefulness

Arousal and ability to open eyes

3

Awareness

Experience of thoughts, emotions and memories

4

What lesion most commonly causes locked-in syndrome?

Lesion of bilateral ventral pons

5

Cortex injury does not usually cause. . .

loss of consciousness

6

Locked in syndrome

Everything is normal in brain except you cannot move (quadraplegia) except maybe blink or move eyes

7

Damage to what can result in chronic neuropathic pain?

Thalamus

8

Function of midbrain:

Vertical eye movements, pupil control, posture, locomotion, non-rapid eye movement, level of arousal

9

Function of pons:

Conjugate horizontal eye movements, posture, rapid eye movements, facial expressions

10

Function of medulla:

Blood pressure, breathing, GI motility, Ingestion, Equilibrium

11

What are the parts of the forebrain?

Cerebral cortex, basal ganglia, thalamus

12

Vegetative state

Not aware but:
-Has sleep-wake cycles, opens eyes
-May smile, grimace, reflexively grip hand
-Does not feel pain or pleasure
-Not aware of self or others

13

In coma, what might you have?

spinal reflexes

14

When are you awake but not aware?

Vegetative state

15

Corneal reflex tests. . .

CN V - wiping cotton on eye of coma patient to look for response of nerve. CN V will detect sensation and CN VII will control the blink reflex.

16

What will be spared in a central lesion (stroke)?

Forehead!

17

Weber test:

Hold tuning fork on middle of head

18

Rinne test:

Check air to bone conduction

19

Stroke (central facial weakness):

Can still raise eyebrows

20

Bell's Palsy:

Cannot raise eyebrows

21

Peripheral facial weakness:

whole side of face is lateral/weak

22

Where are things louder in the weber test?

Conductive hearing loss - louder in affected ear
Sensorineural loss - louder in unaffected ear

23

Where will the tongue deviate when you stick it out?

To the affected side/weak side of CN XII

24

What is the "clasp knife" tone?

Spastic, clonus
-One direction, better with repetition, worse with speed
-UMN problem, pyramidal

25

What is the "lead pipe" tone?

-Rigid in every direction
-Basal ganglion may be damaged, extrapyramidal
-Both flexion and extension is difficult (ex: Parkinson's disease)

26

What happens in pronator drift?

If UMN weakness, fingers flex, arm pronates, drifts downward. If patient has had a stroke, they will have fingers that flex and arm that slowly drops.

27

What is the grading system for strength?

5 - cannot overcome
4 - can overcome
3 - antigravity only
2 - not antigravity
1 - feel or see
0 - no movement

28

What tract has large fibers and what tract has small fibers?

Large fibers - Dorsal columns
Small fibers - Spinothalamic tract

29

Positive Romberg means. . .

Lost proprioception!

30

What cranial nerves for the biceps reflex?

C5-6

31

Brachioradialis reflex?

C6-7

32

Triceps reflex?

C7-8

33

Patellar reflex?

L3-4

34

Achilles reflex?

S1-2

35

What can hyperreflexivity mean?

Brain lesion, spinal cord lesion!

36

Where do corticospinal tracts (descending) cross?

-Axons from motor cortex (UMN) descend on the same side of the brain until the level of the SPINOMEDULLARY JUNCTION
-This is where the fibers cross to the opposite side and continue to descend through the spinal cord until they reach the lower motor neuron on that side [crosses at lower medulla]

37

What are the two somatosensory ascending tracts?

1. Spinothalamic tract (pain and temperature)
2. Dorsal Column-Medial Lemniscus System (discriminatory touch and position sense)

38

When do the spinothalamic tracts cross?

Almost immediately after entering the spinal cord

39

When do the dorsal column-medial lemniscus tracts cross?

When they reach the level of the medulla

40

When does the spinothalamic and dorsal column-medial lemniscus tracts start to travel together to the thalamus (and then onto the sensory cortex)?

Rostral pons

41

What CN has the longest path as it exits the brainstem?

Trochlear nerve

42

What does the brain use all of its energy for?

-Membrane depolarization & repolarizatio
-NT release & uptake
-NT synthesis & metabolism
-Ion pumping
-"Housekeeping Activities"

43

What is the function of astrocytic endsheaths?

They cover blood vessels.
-While neuron is firing, astrocyte is sensing what is going on (energy level used) and responding by sending signal to vessel to dilate or constrict to regulate the flow of blood and nutrients

44

When is the pentose phosphate pathway used?

In ketone breakdown
-Most active in newborn
-It requires vitamin B1 (thiamine) for its transketolase
-Alcoholics deficient in VB1 can get Wernicke-Korsakoff syndrome!

45

What does pos. and neg. CMR-G indicate?

+ = brain is using glucose (more glucose going in than out)
- = brain is producing glucose (more glucose going out than in)

46

What is the formula for CMR-G?

(A-V) F/W

47

Glucose metabolism formula:

1 glucose + 6O2 = 6CO2 + 6H2O

48

Where is low glucose metabolism seen?

Alzheimers brains

49

When eyes are stimulated, what increases?

Blood flow, glucose use and oxygen availability

50

What is the Glucose and Oxygen use in coma and epilepsy?

Low CMRG & Low CMRO2 in Coma
High CMRG & High CMRO2 seen in Epilepsy (neurons firing out of control)

51

Glucose and O2 in person who is drowning, AD and Strong anesthetic?

Drowning - CMRG same or higher, CMRO2 low
AD - Low CMRG & Low CMRO2
Strong anesthetic - Low CMRG & Low CMRO2

52

What is ischemia?

Local anemia due to lack of blood flow

53

What is infarction?

Severe ischemia leading to cell death or necrosis

54

What is a thrombus?

Clot that forms in place where it blocks blood flow

55

What is an embolus?

Clot that forms in one location and travels to the brain where it blocks blood flow.

56

What syndromes affect supratentorial structures?

Middle cerebral artery syndrome & Anterior Cerebral Artery syndrome

57

What syndromes affect posterior fossa structures?

Lateral Medullary syndrome (PICA), Medial medullary syndrome (anterior spinal artery) and Weber's syndrome (superior alternating hemiplegia - posterior cerebral artery affecting midbrain)

58

What does acetazolamide do?

Inhibits CA (carbonic anhydrase) - helps reduce CSF production

59

What does furosemide (Lasix) do?

It blocks the Na/K/2Cl pump & is often used to treat children with over production of CSF (& congestive heart failure!!) - helps reduce CSF production

60

What does ouabain do?

Inhibits Na/K/ATPase - helps reduce CSF production