Intro to Neurology

Question 1

What grade is a normal reflex

Answer 1

2+, Active Response

Question 2

What is a hemiplegic gait

Answer 2

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

Question 3

What is a diplegic gait

Answer 3

slow and stiff with legs crossing in front of each other (scissoring)

Question 4

What type of patient do you normally see a diplegic gait

Answer 4

Cerebral Palsy

Question 5

What is a cerebellar ataxic gait

Answer 5

wide based and may be associated with staggering/reeling as in drunkeness

Question 6

What is a sensory ataxic gait

Answer 6

wide based, the feet are slapped onto the floor, and patient may watch his feet

Question 7

What is a neuropathic (steppage) gait

Answer 7

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

Question 8

What is a dystrophic gait

Answer 8

Pelvic muscle weakness produces lordotic/waddling gait (with Trendelenberg tilt)

Question 9

What is the Parkinsonian (Festinating) gait

Answer 9

Flexed posture, starts are slow, steps are small and shuffling, there is reduced arm swing, and involuntary acceleration (festination) may occur

Question 10

What is a Choreic gait

Answer 10

jerky and lurching yet falls are suprisingly rare

Question 11

What is a Apraxic gait

Answer 11

Difficulty initiating walking and may appear to be glued to the floor. Once started, gait is slow and shuffling. However, no difficulty performing leg movements when lying down and not bearing weight

Question 12

What is an Antalgic gait

Answer 12

Favoring one leg over other to avoid pain (limp)

Question 13

What is the normal color of CSF

Answer 13

clear/colorless (champagne colored tap)

Question 14

Why are there no RBC’s in CSF

Answer 14

Because of the blood brain barrier

Question 15

How do you differentiate glucose levels in viral meningitis vs. bacterial?

Answer 15

Viral Meningitis glucose is normal, Bacterial Meningitis it is low (<45 mg/dL)

Question 16

What WBC predominantly shows in viral meningitis

Answer 16

Lymphocytes

Question 17

What WBC predominantly shows in bacterial meningitis

Answer 17

Neutraphils

Question 18

What are contraindications for doing an LP

Answer 18

-Infection in tissue near puncture site (L4)
-Space occupying lesion, especially brain abscess
-Anticoagulation
-Thrombocytopenia with PLT#<50K
-Complete spinal block
-Non-communicating hydrocephalus

Question 19

What are indications for doing an LP

Answer 19

-CNS infection, concern for meningitis
-Suspected SAH
-Unexplained seizures/SE
-Intrathecal chemotherapy/contrast
-Thoraco-abdominal aortic aneurysm repair
-Idiopathic intracranial hypertension (psuedotumor cerebri)

Question 20

What are the labs to diagnose stroke?

Answer 20

CBC
Inflammatory markers (ESR/CRP)
Serum glucose
Lipids

Question 21

What is the usefulness of CT in diagnosing neurological conditions

Answer 21

• progressive neurologic disorders
• focal neuro deficits with suspected lesions
• elvated ICP
• patients with suspected stroke/head injuries

Question 22

What imaging modality is better at detecting an acute bleed

Answer 22

CT, because it is better at differentiating from other cause (bleed)

Question 23

Indications to order a CT for neurologic conditions

Answer 23

• Stroke
• Tumor
• Trauma
• Dementia
• SAH

Question 24

What is within the grey matter of the brain?

Answer 24

cell bodies

Question 25

What is within the white matter of the brain?

Answer 25

nerve fibers

Question 26

Does MRI or CT provide better contrast of white/grey matter?

Answer 26

MRI

Question 27

Indications for MRI in neurological disorders?

Answer 27

- Stroke - Tumors - Trauma - Dementia - Multiple Sclerosis - Infections - Seizures

Question 28

Why is MRI useful in diagnosing dementia

Answer 28

more sensitive in identifying abnormal white matter signal and associated atrophy

Question 29

Why is MRI useful in diagnosing MS

Answer 29

It is possible to detect lesions in cerebral white matter or cervical cord. Can use GAD to distinguish between lesions of different ages. (Identifying lesions are critical to proper diagnosis)

Question 30

Why is MRI useful in diagnosing a brain infection

Answer 30

Very sensitive in detecting white matter edema likely attributing to earlier detection of cerebrites/abscess

Question 31

How quickly can DW-MRI Sequencing detect an acute stroke

Answer 31

Within an hour of onset with high specificity

Question 32

What is DW-MRI Sequencing used for

Answer 32

to discriminate between cytotoxic (strokes) and vasogenic edema (cerebral lesions)

Question 33

What are the indications for a PET scan in neurological disorders

Answer 33

- Medical refractory epilepsy and evaluation for surgery - Dementia - Grading gliomas - Confirmatory evidence of Huntington's disease

Question 34

Types of Angiography in Neurology

Answer 34

- Formal Cerebral Angiography - CT Angiography - MR Angiography

Question 35

What are the indications for angiography in neurology

Answer 35

- Acute stoke to evaluate for LVO - Intracranial aneurysms/AVM's/Fistula's - SAH - Venous sinus thrombosis - Space occupying lesions

Question 36

What are the indications for EMG's

Answer 36

When you suspect diagnosis such as: - myopathic disorders (especially in inflammatory disorders like polymyositis) - ALS - Muscular dystrophies

Question 37

Indications for Evoked Potentials (EP)

Answer 37

- Detection of lesions in MS - Evaluating efficacy of treatment in MS - Lesion detection in CNS disorders - Assessment of trauma/hypoxia - Intraoperative monitoring - Evaluation of visual/auditory acuity (not first line)

Question 38

What are the types of evoked potentials

Answer 38

Visual, Auditory, and Somatosensory