Clinical - Block 1

Question 1

Consciousness

Answer 1

Awake and Aware

Question 2

Wakefulness

Answer 2

Arousal and ability to open eyes

Question 3

Awareness

Answer 3

Experience of thoughts, emotions and memories

Question 4

What lesion most commonly causes locked-in syndrome?

Answer 4

Lesion of bilateral ventral pons

Question 5

Cortex injury does not usually cause. . .

Answer 5

loss of consciousness

Question 6

Locked in syndrome

Answer 6

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

Question 7

Damage to what can result in chronic neuropathic pain?

Answer 7

Thalamus

Question 8

Function of midbrain:

Answer 8

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

Question 9

Function of pons:

Answer 9

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

Question 10

Function of medulla:

Answer 10

Blood pressure, breathing, GI motility, Ingestion, Equilibrium

Question 11

What are the parts of the forebrain?

Answer 11

Cerebral cortex, basal ganglia, thalamus

Question 12

Vegetative state

Answer 12

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

Question 13

In coma, what might you have?

Answer 13

spinal reflexes

Question 14

When are you awake but not aware?

Answer 14

Vegetative state

Question 15

Corneal reflex tests. . .

Answer 15

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.

Question 16

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

Answer 16

Forehead!

Question 17

Weber test:

Answer 17

Hold tuning fork on middle of head

Question 18

Rinne test:

Answer 18

Check air to bone conduction

Question 19

Stroke (central facial weakness):

Answer 19

Can still raise eyebrows

Question 20

Bell’s Palsy:

Answer 20

Cannot raise eyebrows

Question 21

Peripheral facial weakness:

Answer 21

whole side of face is lateral/weak

Question 22

Where are things louder in the weber test?

Answer 22

Conductive hearing loss - louder in affected ear

Sensorineural loss - louder in unaffected ear

Question 23

Where will the tongue deviate when you stick it out?

Answer 23

To the affected side/weak side of CN XII

Question 24

What is the “clasp knife” tone?

Answer 24

Spastic, clonus

• One direction, better with repetition, worse with speed
• UMN problem, pyramidal

Question 25

What is the "lead pipe" tone?

Answer 25

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

Question 26

What happens in pronator drift?

Answer 26

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.

Question 27

What is the grading system for strength?

Answer 27

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

Question 28

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

Answer 28

Large fibers - Dorsal columns | Small fibers - Spinothalamic tract

Question 29

Positive Romberg means. . .

Answer 29

Lost proprioception!

Question 30

What cranial nerves for the biceps reflex?

Answer 30

C5-6

Question 31

Brachioradialis reflex?

Answer 31

C6-7

Question 32

Triceps reflex?

Answer 32

C7-8

Question 33

Patellar reflex?

Answer 33

L3-4

Question 34

Achilles reflex?

Answer 34

S1-2

Question 35

What can hyperreflexivity mean?

Answer 35

Brain lesion, spinal cord lesion!

Question 36

Where do corticospinal tracts (descending) cross?

Answer 36

- 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]

Question 37

What are the two somatosensory ascending tracts?

Answer 37

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

Question 38

When do the spinothalamic tracts cross?

Answer 38

Almost immediately after entering the spinal cord

Question 39

When do the dorsal column-medial lemniscus tracts cross?

Answer 39

When they reach the level of the medulla

Question 40

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

Answer 40

Rostral pons

Question 41

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

Answer 41

Trochlear nerve

Question 42

What does the brain use all of its energy for?

Answer 42

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

Question 43

What is the function of astrocytic endsheaths?

Answer 43

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

Question 44

When is the pentose phosphate pathway used?

Answer 44

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

Question 45

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

Answer 45

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

Question 46

What is the formula for CMR-G?

Answer 46

(A-V) F/W

Question 47

Glucose metabolism formula:

Answer 47

1 glucose + 6O2 = 6CO2 + 6H2O

Question 48

Where is low glucose metabolism seen?

Answer 48

Alzheimers brains

Question 49

When eyes are stimulated, what increases?

Answer 49

Blood flow, glucose use and oxygen availability

Question 50

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

Answer 50

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

Question 51

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

Answer 51

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

Question 52

What is ischemia?

Answer 52

Local anemia due to lack of blood flow

Question 53

What is infarction?

Answer 53

Severe ischemia leading to cell death or necrosis

Question 54

What is a thrombus?

Answer 54

Clot that forms in place where it blocks blood flow

Question 55

What is an embolus?

Answer 55

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

Question 56

What syndromes affect supratentorial structures?

Answer 56

Middle cerebral artery syndrome & Anterior Cerebral Artery syndrome

Question 57

What syndromes affect posterior fossa structures?

Answer 57

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

Question 58

What does acetazolamide do?

Answer 58

Inhibits CA (carbonic anhydrase) - helps reduce CSF production

Question 59

What does furosemide (Lasix) do?

Answer 59

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

Question 60

What does ouabain do?

Answer 60

Inhibits Na/K/ATPase - helps reduce CSF production