Neuro 1

Question 1

What is dysarthria

Answer 1

Condition in which the muscles you use for speech are weak or you have difficulty controlling them

Question 2

What is apraxia

Answer 2

Apraxia is a motor disorder caused by damage to the brain (specifically the posterior parietal cortex), in which the individual has difficulty with the motor planning to perform tasks or movements when asked, provided that the request or command is understood and he/she is willing to perform the task

Question 3

What is aphasia

Answer 3

A language disorder that affects a person’s ability to communicate

Question 4

What is catatonia

Answer 4

A behavioral syndrome marked by an inability to move normally

Question 5

What is Keppra

Answer 5

Levetiracetam

Question 6

Damage to what part of the brain causes hemispatial neglect

Answer 6

Non-dominant parietal cortex

Question 7

Damage to dominant parietal cortex causes what?

Answer 7

Gerstmann syndrome = agraphia (inability to write), acalculia (inability to calculate), finger agnosia (inability to distinguish fingers), left-right disorientation

Question 8

What is the reticular activating system

Answer 8

Located in the midbrain

Mediates consciousness and alertness

Question 9

Damage to basal ganglia causes what?

Answer 9

♣ Resting tremor, chorea, athetosis

Question 10

Damage to lateral cerebellum causes what?

Answer 10

♣ Occurs with chronic alcohol use

♣ Intention tremor, limb ataxia

Question 11

Damage to medial cerebellum causes what?

Answer 11

♣ Truncal ataxia, dysarthria

Question 12

Damage to PPRF causes what?

Answer 12

♣ Eyes look away from side of lesion

Question 13

What are the 4 midline columns in the brainstem and presentation of damage to each

Answer 13

• Motor pathway (corticospinal tract) – Contralateral weakness
• Medial lemniscus – loss contralateral proprioception/vibration
• Medial longitudinal fasciculus – Ipsilateral intranuclear ophthalmoplegia
• Motor nucleus and nerve – Ipsilateral CN motor loss (3, 4, 6, 12 – midline motor divide into 12)

Question 14

What are the 4 lateral (side) columns in the brainstem and presentation of damage to each

Answer 14

• Spinocerebellar pathway – Ipsilateral ataxia
• Spinothalamic – Contralateral pain/temp sensation loss
• Sensory nucleus of CN 5 – Ipsilateral pain/temp loss in face
• Sympathetic pathway – Ipsilateral Horner’s syndrome

Question 15

Blood supply of medial and lateral midbrain

Answer 15

Posterior cerebral artery

Question 16

Blood supply of medial and lateral pons

Answer 16

Medial = basilar
Lateral = AICA

Question 17

Blood supple of medial and lateral medulla

Answer 17

Medial = anterior spinal
Lateral = PICA

Question 18

Parts of brain most vulnerable to ischemic damage

Answer 18

Cerebellum
Neocortex
Hippocampus
Watershed areas (between ACA and MCA; MCA and PCA)

Question 19

What is hydrocephalus

Answer 19

increased CSF leading to ventricular dilation (+/- increased ICP)

Question 20

What is pseudotumor cerebri

Answer 20

♣ Aka idiopathic intracranial HTN

♣ Increased intracranial pressure without hydrocephalus

Question 21

Presentation of pseudotumor cerebri

Answer 21

• Headache, diplopia, papilledema

* Lumbar puncture shows increased opening pressure with headache relief

Question 22

Describe migraine HA

Answer 22

♣ Usually 4 – 72 hours
♣ Unilateral pulsing, throbbing headache
♣ Associated with nausea, photophobia, phonophobia, and aura

Question 23

Tx of migraine HA

Answer 23

Triptans

Question 24

Describe tension HA

Answer 24

♣ Usually 4 – 6 hours
♣ Bilateral headache with constant, steady pain (non-throbbing)
♣ Usually in frontal or occipital lobe
♣ No throbbing, no photophobia, no phonophobia, no aura

Question 25

Tx of tension HA

Answer 25

NSAIDs, Acetaminophen

Question 26

Describe cluster HA

Answer 26

♣ 15 min – 3 hours ♣ Repetitive (often occur daily at the same time) ♣ Unilateral, non-throbbing heading ♣ Excruciating pain, usually perioribital ♣ Associated with lacrimation, rhinorrhea, and Horner syndrome (ptosis and miosis, not anhidrosis)

Question 27

Tx of cluster HA

Answer 27

100% O2, sumatriptan

Question 28

Presentation of fetal hydantoin syndrome

Answer 28

o Caused by exposure to anticonvulsants (e.g. Phenytoin and Carbamazepine) o Midfacial hypoplasia, microcephaly, cleft lip and palate, digital hypoplasia, hirsutism, and developmental delay

Question 29

Presentation of fetal alcohol syndrome

Answer 29

o Midfacial huypoplasia, microcephaly and stunted growth | o CNS damage may manifest as hyperactivity, mental retardation, or learning disability

Question 30

What will you see in motor function, pain & temp, and vibration & proprioception in Brown Sequard syndrome

Answer 30

Contralateral loss of pain and temp (beginning 2 levels below lesion) Ipsilateral motor and vibratory/proprioception

Question 31

What are the nerve roots of the reflexes?

Answer 31

* Biceps and brachioradialis reflexes = C5, C6 (“pick up sticks”) * Triceps reflex = C7, C8 (“lay them straight”) * Achilles reflex = S1, S2 (“buckle my shoe”) * Patellar reflex = L3, L4 (“kick the door”) * Cremasteric reflex = L1, L2 (“testicles move”) * Anal wink reflex = S3, S4 (“winks galore”)

Question 32

Describe acute intermittent porphyria

Answer 32

♣ Deficiency of Porphobilinogen (PBG) deaminase • THINK: Acute intermittent = guys hollering “damn” (deam-inase) intermittently at A CUTE pretty big girl (PBG) walking by ♣ Symptoms – 5 P’s • Painful abdomen, Port wine colored urine (due to increase PGB), Polyneuropathy, Psychological disturbances, Precipitated by drugs (CYP450 inducers), alcohol, and starvation

Question 33

Describe disorder of the splenium of the corpus collusum in the dominant occupital lobe

Answer 33

Can write but can't read You read with the occipital lobe but write with broca's area. So if dominant occipital lobe is damaged, you need to get reading info from the R side of the brain but can't if the corpus collosum is damaged. But Broca's is still intact so you can still write

Question 34

Tx of status epilepticus

Answer 34

- IV Benzo (e.g. Diazepam, Lorazepam) - Phenytoin - IV Phenobarbital

Question 35

What is Keppra

Answer 35

Levetiracetam

Question 36

What is Lyrica

Answer 36

Pregabalin (anticonvulsant; GABA analog)

Question 37

What is Versed

Answer 37

Midazolam

Question 38

What is Depakote

Answer 38

Valproate

Question 39

What is Fioricet

Answer 39

Caffeine, Acetaminophen, Butalbital Used for tension or muscle contraction HA

Question 40

What is Addison's disease

Answer 40

♣ Primary adrenal insufficiency problem of the adrenal gland - Aka Addison disease • Most commonly due to autoimmune destruction of adrenal gland Presentation: o Lack of cortisol = Weakness, fatigue, weight loss o Lack of aldosterone = hypotension, hyponatremia, hyperkalemia o Increased ACTH = skin hyperpigmentation (due to POMC)

Question 41

What is AED

Answer 41

Automated external defibrillator Portable device that checks the heart rhythm and can send an electric shock to the heart to try to restore a normal rhythm

Question 42

What is a bulbar palsy

Answer 42

Refers to a range of different signs and symptoms linked to impairment of function of the cranial nerves IX, X, XI and XII, which occurs due to a lower motor neuron lesion in the medulla oblongata or from lesions of the lower cranial nerves outside the brainstem Symptoms: dysphagia (difficulty in swallowing), difficulty in chewing, nasal regurgitation, slurring of speech, difficulty in handling secretions, choking on liquids, dysphonia (defective use of the voice, inability to produce sound due to laryngeal weakness), dysarthria (difficulty in articulating words due to a CNS problem)

Question 43

Describe presentation of Myasthenia gravis

Answer 43

Autoantibody against post-synaptic ACh receptor Clinical features: ♣ Ptosis, diplopia, weakness ♣ Worsens with muscle use

Question 44

Cause of MS

Answer 44

o Due to autoimmune demyelination of CNS | o Most often affects women in 20s-30s

Question 45

Presentation of MS

Answer 45

``` ♣ Charcot triad of symptoms SIN: • Scanning speech • Intention tremor, Incontinence, Internuclear ophthalmoplegia • Nystagmus ♣ Hemiparesis, hemisensory symptoms ```

Question 46

Diagnosis of MS

Answer 46

``` o MRI gold standard ♣ Periventricular plaques (areas of oligodendrocyte loss and reactive gliosis) o Lumbar puncture ♣ Increased protein ♣ Oligoclonal IgG bands ```

Question 47

Describe ALS

Answer 47

o Aka Lou Gehrig disease o Damage to anterior motor horn and lateral corticospinal tract o Presents with both UMN and LMN deficits o Lack of sensory impairment distinguishes from syringomyelia o Caused by defect in superoxide dismutase (O2- H2O2)