Neuro Flashcards
(122 cards)
1
Q
All CNS lesions
A
Ipsilateral
2
Q
Question asked
A
Is there is a neurologic problem?
Where is the neurologic problem?
What is the neurologic problem?
3
Q
Increased ICP
Most defective finding
A
Papilledema
4
Q
Type of lesion
Focal
A
Mass lesion
Infarction
Hematoma
5
Q
Type of lesion
Multi focal
A
Multiple tumors, abscess
MS
6
Q
Type of lesion
Diffuse
A
Toxic (metab encephalopathy)
Peripheral neuropathy
Myopathy
7
Q
Is there is neurological problem?
3 findings
A
Meaningeal irritation
Increased intracranial pressure
Focal neurologic deficits
8
Q
Irritation of the meninges by meningitis, subarachnoid hemorrhage, drugs and increase intracranial pressure
A
Meaningeal irritation
9
Q
With the patient supine and the limbs extended, passively flex the neck
A
Brudzinski sign
10
Q
Positive brudinzki sign
A
Flexion of the hips
11
Q
With the patient supine, passively flex the hip to 90 degrees while the knee is flexed about 90 degrees
A
Kernig sign
12
Q
Patient cannot place the chin on the chest
A
Nuchal rigidity
13
Q
If patient with meningitis is awake
A
Sign are always positive
14
Q
But if patient with meningitis has decreased level of consciousness
A
No positive signs
Obtunded that he cannot produce protective reflexes
15
Q
Most common cause of meningitis
A
Infection
16
Q
If patient has fever, automatically do the test for Meaningeal signs
A
CNS infection is always a differential diagnosis
17
Q
Physical and neurological examination
A
Mental status exam - cerebral hemisphere
Cranial nerves - brainstem
Motor- corticospinal
Cerebellar - always ipsilateral
Reflexes - pathologic, superficial, deep tendon
Sensory - spinothalamic, posterior columnar
Meningeal signs
21
Q
Central nervous system
Brain
Supratentorial
A
Diencephalon
Cerebral hemispheres
Thalamus
Basal ganglia
22
Q
Central nervous system
Brain
Infratentorial
A
Brainstem
Cerebellum
23
Q
Peripheral nervous system
Can best diagnose posterior fossa problems
A
MRI
24
Q
Localize
A
What specific part
25
Q
Lateralize
A
Right or left
Midline or diffused
Ipsilateral or contralateral
26
Q
Symptoms that manifest contralateral to the lesion
A
Hemi paresis
Hemi sensory deficits
27
Q
Symptoms that manifest ipsilateral to the lesion
A
Cerebellar problem
Cranial nerve deficits
Impaired position sense, vibration sense
28
Sudden onset
Within minutes, hours, days, weeks
29
Sudden onset
Cerebral infarction
Thrombolic
| Embolism
30
Sudden onset
Cerebral hemorrhage
Most common cause is HPN
31
Subacute onset
More than 2 weeks but less than 3 months
32
Chronic onset
More than 3 months
33
Chronic onset
Neoplasm
Malignant
Glioblastoma
Patient will die after 6 months
34
Chronic onset
Neoplasm
Benign
Meningioma
Tumor will present for many years
35
Chronic onset
Abscess
Temporal nobe
| Cerebellum
36
Chronic onset
Manifest within 6 months
Subdural hematoma
37
Chronic onset
Remnant of TB infection
Granuloma and cyst
38
Examination of cerebral function
Between frontal and parietal
Central sulcus
39
Examination of cerebral function
Between frontal and temporal
Lateral fissure
40
Examination of cerebral function
Sensory, cortical level function
Parietal
41
Examination of cerebral function
Vision
Occipital
42
Examination of cerebral function
Audition and memory
Temporal
43
Objective evidence of cerebral dysfunction
Seizure
44
Level of consciousness
Inability to maintain a coherent stream of thought or action
Diffuse infusion to brain
Confusion
45
Level of consciousness
Ability to sort out and stratify the many sensory inputs and potential motor output
Attention
46
Level of consciousness
Most common cause of confusion
Metabolic/ toxic derangement
47
Level of consciousness
Confusional state with excess sympathetic activity
Delirium
48
Most common cause of delirium
Febrile sates and dehydration
49
Level of consciousness
Ability to respond verbally and fending off
Drowsiness
Ask the sleeping pattern
50
Level of consciousness
Lethargy
Incomplete arousal to noxious stimuli
No response to verbal commands
Motor response purposeful
Stupor
51
Level of consciousness
Obtunded
Primitive and disorganized motor responses to noxious stimuli
No response to attempts at arousal
Light coma
52
Level of consciousness
Absence of response to noxious stimuli
Deep coma
53
Glasgow Coma Scale
Eye opening
4- spontaneous
3- verbal
2- painful
1- no response
54
Glasgow Coma Scale
Verbal
```
5- oriented and talks
4- disoriented and talks
3- inappropriate words
2- incomprehensible sounds
1- no response
```
55
Glasgow Coma Scale
Motor activity
```
6- verbal command
5- localizes pain
4- withdraws from pain
3- decorticate
2- decerebrate
1- no response
```
56
Full outline of unresponsive scale
Eye response
Motor
Brainstem reflex
Respiration
57
Mental status
Orientation
Time
Place
Person
58
Mental status
Attention
Ask patient to count backwards from 100 by 7
| Stop after 5 correct answers
59
Mental status
Registration
Name 3 objects
| Ask patient to repeat 3 objects
60
Mental status
Complex task
Give patient 3 step command
61
Mental status
Repetition
Repeat a sentence
62
Mental status
Recall
Usually dates
63
Recall
Type of memory
Recent
Remote
Immediate
64
Mental status
Reading
Follow written commands
65
Inability to understand the meaning
Agnosia
66
Types of agnosia
Trace letters/numbers on skin and palm with fingertips
Agraphesthesia/ agraphognosia
67
Types of agnosia
Inability to recognize faces in person or in photos
Prosopagnosia
68
Agraphognosia lesion
Contralateral parietal
69
Prosopagnosia lesion
Right or bilateral inferomedia temporo occipital region
70
Types of agnosia
Inability to locate , identify and orient one's body parts
Autotopagnosia/ asomatognosia
71
Types of agnosia
Inability to be aware of his own bodily defect
Anosognosia
72
Ask patient to draw symmetrical figures
Seen in right parietal lesion
Unilateral neglect
Left sided hemispatial inattention
73
Sensory extinction, sensory inattention
| Touch patient on one or both sides
Inattention to double simultaneous cutaneous stimuli
74
Inattention to double simultaneous cutaneous stimuli
Lesion
Right Parietal (common) / left parietal lesions
75
Word agnosia and word blindness
| Left parietal lesion
Dyslexia and alexia
76
Inability to perform a voluntary act even though the motor, sensory, and mental status are intact
No motor weakness
Apraxia
77
Testing the apraxia
Instruct to do different tongue movement
Bucco-facial apraxia
If verbal instruction fails, try miming
78
Testing the apraxia
Ask the patient to demonstrate sequential acts
Ideomotor apraxia
79
Testing the apraxia
Draw geometric figures
Constructional apraxia
80
Testing the apraxia
Also know as Bruns apraxia
C3 and C4 commonly in right parietal lesion
Gait apraxia
81
Communication
Left hemisphere
Invest words and meaning
82
Communication
Right hemisphere
Prosody of speech (intonation, melody, pauses and phrasing)
83
Inability to understand or express words as symbols for communication even though the primary sensorimotor pathway to receive and express language and mental status are relatively intact
Aphasia
84
Types of aphasia
Need mo ito kabisaduhin nasa trans
85
Types of aphasia
Brocas
```
Can understand
Motor
Non fluent
Expressive
Left posterior inferior frontal operculum
```
86
Types of aphasia
Wernicke's
Sensory
Receptive
Fluent
87
Types of aphasia
Conduction
Posterior parasylvian area
88
Types of aphasia
Frontally and superiorly toward stratum
Trans cortical motor
89
Types of aphasia
Parietal + temporal + thalamocortcial circuit
Trans cortical sensory
90
Types of aphasia
Entire parasylvian area
Global
91
Clinical manifestation of frontal lobe,
Bilateral hemiplegia ( quadriplegia)
Spastic bulbar (pseudobulbar palsy)
Decomposition of gait and sphincter incontinence
Inability to solve complex problem (prefrontal)
92
Clinical manifestation of temporal lobe
Korsakoff amnestic defect
Apathy and placidity
Hypermetamorphosia ( hypersexuality, hyperorality)
93
Clinical manifestation of parietal lobe lesion
Dysgraphia
Dyscalculla
Finger agnosia
94
Clinical manifestation of occipital lobe lesion
Loss of topographic memory and visual orientation
Hallucinations
Homonym outs hemianopsia
95
Made up of bags of small muscle fibers (intrafusal) has afferent and efferent axons that maintain constant tension
Muscle spindle
96
Only have efferent axons
Skeletal (extrafusal)
97
Pulls the perimysium and stretches the muscle spindle
Extension of joint
98
Relaxation of muscle spindle
Flexion of the joint
99
To maintain stretch sensitivity
JE- muscle spindle lengthens
| JF- muscle spindle contracts
100
Reflexes
Upper ext- biceps and triceps
| Lower ext - quads (knee jerk) and triceps surae reflex (ankle jerk)
101
Short convex sides
Taylor tomahawk hammer
102
Biceps reflex
C5, C6
103
Triceps reflex
C6-8
104
Patellar reflex, femoral nerve
L2-L4
105
Achilles reflex, tibial nerve
L5-S2
106
Lesion of various site of reflex arc
LMN lesion
Myopathy
Paralysis
107
Lesion of various site of reflex arc
LMN lesion
Denervation atrophy
108
Lesion of various site of reflex arc
Dorsal root lesion
Loss of sensation
109
Lesion of various site of reflex arc
Dorsal root lesion
LMN lesion
Myopathy
Absence of MSR
110
Superficial reflexes
Abdominal reflexes upper quadrant
T8T9
111
Superficial reflexes
Abdominal reflex lower quadrant
T11-T12
112
Superficial reflexes
Abdominal reflex
Beevor sign
| Scrape skin toward umbilicus
113
Superficial reflexes
Cremasteric reflex
L1-L2
114
Superficial reflexes
Involves tapping the nail or flicking the terminal phalanx of the middle or ring finger
Hoffman's
Positive when there's flexion of terminal phalanx of thumb
Lesion in corticospinal tract
115
Superficial reflexes
Most important component: dorsiflexion of big toe and fanning of the rest
Babinski reflex
Corticospinal tract lesion
UMN paralysis
116
Superficial reflexes
Diagnostic reflex similar to the babinski reflex
To identify lesion of pyramidal tract
Chaddoks reflex
117
Superficial reflexes
Dorsiflexion of the big toe elicited by irritation downward of the medial side of the tibia
Oppenheim's reflex
Lesion in pyramidal tract
118
Non localizing primitive reflex
Stroke proximodistally over the patients thenar eminence
Palmomental reflex
119
Non localizing primitive reflex
With patients eyes closed, tap philtrum several times
Snout relfex
120
Non localizing primitive reflex
Stroke patient palm from the hypothenar eminence toward junction of third and index finger
Grasp reflex
121
Non localizing primitive reflex
With patients eye closed stroke his lip from the center of the crevice to the sides
Sucking relfex
132
Increased ICP
Lateral rectus palsy secondary to abducens nerve
Diplopia with internal squint
133
Diplopia with internal squint
Test
Ask patient to look at one finger and move the finger to the right patent will see double vision
134
Increased ICP
Hypertension
Localized collection of pus
Bulging fontanelle
Separation of sutures
Rapid enlarging head size
135
Increased ICP
Very obvious
Shortened walking hours
Drowsiness
Deterioration in level of consciousness
