Neuro

Question 1

Obtunded

Answer 1

dull & slow

will response appropriately

Question 2

Stuporous

Answer 2

unresponsive to normal stimuli

aroused with strong stimuli

Question 3

Comatose

Answer 3

Unconsciousness w/ no arousal

Question 4

Head tilt vs head turn

Answer 4

Tilt
• Vestibular

Turn
• forebrain

Question 5

Leaning

Answer 5

vestibular

Question 6

Wide based stance

Answer 6

Vestibular

Cerebellar

Question 7

De-cerebrate rigidity

Answer 7

Extension of all 4 legs + Opisthotonus
• Brainstem lesion

Assoc’d stupor or coma
– w/o might be C1-C5 lesion!

Question 8

Opisthotonus

Answer 8

dorsiflexion of head/neck

Question 9

De-Cerebellate Rigidity

Answer 9

Opisthotonus + rigid thoracic limbs + hip flexion

indicates Acute Cerebellar lesion

Question 10

Schiff-Sherrington posture

Answer 10

Pelvic limbs flexed normally
w/ Thoracic limbs spastic, in rigid extension.

• indicates Severe spinal injury (no prognostic significance)
  • T3-L3 UMN lesion
• loss of ascending inhibition from bordering cells in spinal cord to thoracic limbs –> hypertonicity
• Thoracic = neuro normal
• Pelvic = UMN paresis/plegia + CP deficits

Question 11

Sensory Ataxia

Answer 11

loss of proprioceptive pathway
• incoordination
• crossing over
• knuckling

Question 12

Vestibular Ataxia

Answer 12

loss of vestibular pathway
• Head tilt
• Leaning
• wide based stance

Bilateral –> Wide swaying of head side to side

Question 13

Cerebellar ataxia

Answer 13

Loss of cerebellar mediation
• Wide based stance
• dysmetria (hypermetria)
• intention tremor

– no scuffing/knuckling

Question 14

Intention tremors

Answer 14

Coarse Tremor, Low frequency
• worsens w/ movement & goal-diretion
• cerebellar dysfunction

Question 15

Physiologic Tremor

Answer 15

Fine Tremor, fast
• ↑ w/ weight-bearing
• not aggravated w/ movement

Caused by:

• Hypothermia
• Weakness
• ↑ catecholamines (physiologic/pathologic)
• Metabolic dz (hypoglycemia)
• Peripheral neruopathy
• drugs

Question 16

Parkinsonian Tremor

Answer 16

Resting Tremor (constant), Medium frequency
• improves w/ movement
• head-bobbing

• Dobermans w/ Droperidol

Question 17

myoclonus

Answer 17

Rhythmic jerking of a muscle group

• hiccups
• canine distemper virus infection

Question 18

Myotonia

Answer 18

delayed relaxation of muscle after voluntary contraction

• percussion of myotonic muscle –> dimple appearance

Question 19

What is the main differentiation btwn ataxia & paresis?

Answer 19

Muscle strength

Question 20

Reflex scale

Answer 20

0 = absent
1 = hyporeflexive
2 = normal
3 = hyperreflexive
4 = hyperreflexiv w/ clonus 
        • repeated flex/extension of join in response to a single stimuli

Question 21

Seizure

Answer 21

Paroxysmal brain dysfunction
- excessive hypersynchronous neuronal discharge

• A sign, not a disease!

Question 22

Epilepsy

Answer 22

Recurrent seizures due to intracranial dz
1 - Primary
2 - Familial
3 - Secondary = structural lesion
4 - Cryptogenic = probable lesion, but can’t see it yet
5 - Reactive epilepsy = metabolic, toxin, inflamm

Question 23

Components of seizure

Answer 23

Prodrome
Aura
Ictus
Post-ictal period

Question 24

Prodrome

Answer 24

characteristic behavior prior to onset

Question 25

Aura

Answer 25

• Stereotypic behavior
• autonomic activity
• unusual psychic events

Question 26

Ictus

Answer 26

• Involuntary muscle tone
• Autonomic signs
• Abnormal sensation

Question 27

Post-ictal

Answer 27

• disoriented
• ataxia
• weakness
• inappropriate U/D
• excessive hunger/ thirst
• agression
• blindness
• sensory/motor abnormalities

Question 28

Generalized seizures

Answer 28

1 - Grand mal (Clonic-tonic)

2- Petit mal (Absence) - mild

Question 29

Partial seizures

Answer 29

Simple partial
• conscious w/ focal motor activity

Complex
• unconscious w/ focal motor activity
• Psychomotor
     - abnormal sensory / behavioral activity
     - limbic/occipital

Question 30

Cluster seizures

Answer 30

2+ in 24hrs

Question 31

Status epilepticus

Answer 31

Lasting > 5 mins
OR
3+ seizures w/o return to normal consciousness between

Question 32

Seizure pathophysiolgy

Answer 32

1 - Neurotransmitter disorder
• GABA = inhibitory NT
• Glutamate = excitatory NT

2 - Ion channelopathy
• Excessive Na
• Blocked K
• Altered Ca flow