NEURO BLOCK 1 Flashcards
1
Q
What does the word lancinating mean
A
Knife like radicular pain
2
Q
What is diplopia
A
Double vision
3
Q
What is dysphagia
A
Difficulty swallowing
4
Q
What is parasthesia
A
Burning, tingling, pricking
5
Q
What is dyskenesia
A
Involuntary movements
6
Q
What is the cerebellar portion of your brain responsible for
A
Coordinated movements
```
When lesions are here it causes
Altered coordination
Abnormal equilibrium
Dizzyness, vertigo
Tremors
~~~
7
Q
Thunderclap head ache, or “worst head ache of my life… think
A
Subarachnoid Hemorrhage
8
Q
Sudden blindness think..
A
Amaurosis fugax/ hypoperfusion to the retinal circulation
9
Q
Back pain worse at night, think..
A
Cancer
10
Q
Loss of bowel or urinary control think..
A
Cauda equina
11
Q
What are the criteria for a focused physical neuro exam
A
General impression Mental Status Cranial nerves Motor System Reflexes Sensory Coordination Gait
12
Q
A score of less than 24 on a mini mental status exam indicates..
A
Cognitive D/o
13
Q
List the Cranial nerves
A
Olfactory Optic Oculomotor Trochlear Trigeminal Abducens Facial Vestibulocochlear (auditory) Glossopharyngeal Vagus Spinal Hypoglossal
14
Q
Decreased muscle tone is most commonly a sign of what..
A
Decreased tone is most commonly due to lower motor neuron or peripheral nerve disorders.
15
Q
How are DTRs graded
A
4/4: hyperactive +/- clonus 3/4: exaggerated response 2/4: “normal” 1/4: diminished response 0/4: absent reflexes
16
Q
How is strength graded
A
0 = no movement 1 = flicker or trace of contraction but no associated movement at a joint 2 = movement with gravity eliminated 3 = movement against gravity but not against resistance 4– = movement against a mild degree of resistance 4 = movement against moderate resistance 4+ = movement against strong resistance 5 = full power
17
Q
What is the motor, reflex, and sensation for C5
A
Motor: deltoid
Reflex: biceps reflex
Sensation: Lateral upper arm
18
Q
What is the Motor, Reflex, sensation for C6
A
Motor: Wrist extension
Reflex: Forarm reflex
Sensation: radial side of forearm and hand (first two digits)
19
Q
What is the motor, reflex, and sensation for C7
A
Motor: wrist flexion
Reflex: tricep tendon
Sensation: middle of palm and middle finger
20
Q
What is the motor, reflex, and sensation for C8
A
Motor: finger flexion
Reflex: none
Sensation: Ulnar side of forearm and had ( last two digits)
21
Q
What is the motor, reflex, and sensation for L4
A
Motor: tibialis anterior
( foot inversion)
Reflect: patellar tendon
Sensation: medial side of the foot
22
Q
What is the motor, reflex, and sensation of L5
A
Motor: extensor digitorum longus
Reflex: none
Sensation: middle of the food
(Majority of toes)
23
Q
What is the motor, reflex, and sensation for S1
A
Motor: peroneus longus and brevis (Foot eversion) Reflex: Achilles’ tendon Sensation: Lateral portion of foot (Pinky toe)
24
Q
What is babinski sign
A
with upper motor neuron lesions above the S1 level of the spinal cord, a paradoxical extension of the toe is observed, associated with fanning and extension of the other toes
25
What is the palmomental response
A primitive reflex
Contraction of mentalis muscle ipsilateral to a scratch stimulus diagonally applied to the palm
26
T4-5 dermatomes is where
Across the nipple line
27
T 10 dermatomes is where
Umbilicus
28
What nerve root moves the trapezius
C3-4
29
What is the most important part of a neuro exam
Observation of gait
30
What platelet count is a C/I for lumbar puncture
A count less than 20,000
31
When should warfarin be stopped prior to lumbar puncture
4-5 days prior
32
When should ticlopidine or Clopidogrel be stopped prior to Lumbar puncture
D/c 14 and 7 days respectively
33
What is the landmark for a Lumbar o puncture
L3-4
34
What is the principle complication of lumbar puncture
Headache
35
Tx approach to headache caused by lumbar puncture
Analgesics, caffeine or epidural blood patch
36
Are there any C/I to EEG
No
37
What are the 4 Indications for CT in neuro
Stroke or Sub Arac Hem
Tumor ( -/+ contrast)
Trauma
dementia
(Detect atrophy, hydrocephalus)
38
What is the definition of contrast nephropathy
A rise in serum creatinine of at least 0.5 mg/dL within 48 h of contrast administration is often used as a definition of contrast nephropathy
39
When should Creatinine testing be done for CT
Age >60
History of “kidney disease” as an adult, including tumor and transplant
Family history of kidney failure
Diabetes mellitus treated with insulin or other prescribed medications
Hypertension
Paraproteinemia syndromes or diseases (e.g., myeloma)
Collagen vascular disease (e.g., SLE, scleroderma, rheumatoid arthritis)
Solid organ transplant recipient
40
The American college of Radiology recommends GFR assessment with MRI on what criteria
Must be obtained within 6 weeks before MRI if:
A history of renal disease (including solitary kidney, renal transplant, renal tumor)
Age >60 years
History of hypertension
History of diabetes
History of severe hepatic disease, liver transplant, or pending liver transplant; for these patients, it is recommended that the patient’s GFR assessment be nearly contemporaneous with the MR examination.
41
What is a pet scan
Positron emission tomography
Functional imaging study
Demonstrates perfusion and metabolic activity
42
What is the use of Myeolgrpahy
Inject contrast through LP needle to visualize subarachnoid space
Evaluate degree of cord compression, AVMs, epidural abscesses, and tumors
43
Are sensory neurons afferent or efferent
Afferent
44
Are motor nuerons afferent or efferent
Efferent
45
Where is the development of the CNS and PNS
CNS is from the neural tube (Brian and spinal cord)
PNS is from the neural crest
46
At what week of fetal development does the Nervous system begin
Week 3
47
What is the first step in neural plate development
Thickening of the ectoderm
48
What happens after the ectoderm thickens in NS plate development
The neural plate folds inward forming a longitudinal groove or neural groove.
49
What are the 3 layers of the neural tube
The outer layer (marginal layer) cells develop into white matter.
The middle layer (mantle layer) cells develop into gray matter.
The inner layer (ependymal layer) cells eventually form the:
- Lining of the central canal of the spinal cord
- Ventricles of the brain.
50
White matter develops from…
The marginal layer of the neural tube
51
Gray matter develops from
The mantle layer of the neural tube
52
The lining of the central canal of the spinal sword and the ventricles of the brain develop from ..
The ependymal layer of the nueral tube
53
What does the nueral crest give rise to
Dorsal/posterior root ganglia of spinal nerves
Spinal nerves
Ganglia of cranial nerves.
Cranial nerves
Ganglia of the ANS
Adrenal medulla
Meninges
54
When does nueral tube closure happen ( at what week/ days )
26-28 days post conception
55
What are the 3 major neural tube defects
Anencephaly, Encephalocele, Menigomyelocele
56
What is anencephaly
Failure of the anterior neuropore to close.
Cranial bones fail to develop and brain degenerates
1:1000
2 to 4x more common in females than males
57
What is myleomenigiocele
AKA Spina bifida
Failure of the posterior neuropore to form.
Most commonly in the sacrolumbar region (80%)
58
What supplements can be added to reduce the RSK of neural tube deficits
Folic acid ( 0.4 mg q day) (one month prior to conception)
High risk? (4mg q day) (3 months prior to conception)
59
What are the 4 major parts of the Brain
Brain stem
Cerebellum
Diencephalon
Cerebrum
60
What are the 3 parts of the brain stem
Medulla
Pons
Midbrain
61
What are the two major parts of the diencephalon
Thalmus and the Hypothalmus
62
What is the connection between R and L hemispheres of the brain
The corpus Callosum
63
Destruction of the motor and pre motor cortex of the frontal lobe leads to..
Spastic paresis
64
Destruction of the frontal eye field of the frontal lobe leads to..
Ipsilateral deviation of the eyes
65
Where is brochas speech area located
In the posterior frontal gyrus of the dominant hemisphere
66
What are the results of damage to the prefrontal cortex
Destruction of the anterior 2/3 results in deficits in concentration, orientation, abstracting ability, judgment, and problem solving.
Destruction in other areas may cause loss of initiative, inappropriate behavior, gait apraxia, sphincteric incontinence.
Destruction of the orbital portion results in inappropriate social behavior such as use of obscene language or urinating in public
67
What is the result of damage to the primary auditory cortex in the temporal lobe
Loss of hearing (cortical deafness)
68
Where is wernickes speech area located
Posterior part of the superior gyrus of the temporal lobe
69
Where is meyers loop located and what happens if it is damaged
In the temporal lobe, and Interruption results in contralateral homonymous superior quadrantanopia (pie in the sky)
70
Where are the olfactory bulb, tract, and primary cortex located
In the temporal lobe, responsible for smell
71
Where is the hippocampal cortex located
In the temporal lobe
Bilateral lesions result in inability to consolidate short-term memory into long term memory.
72
What is prosopagnosia
Inability to recognize faces
A function of the inferiomedial occipitotemporal complex
73
What is asterognosis
The ability to ID objects by feel only
| Close eyes and ID an object by touch
74
Where is the sensory cortex located
In the parietal lobe
75
What is the result of damage to the superior parietal lobe
Destruction results in contralateral astereognosis and sensory neglect
76
What is the result of damage to to the inferior parietal lobe
Leads to topographic memory loss, anosognosia, construction apraxia, dressing apraxia, contralateral sensory neglect, and contralateral hemianopia or lower quadrantanopia
77
What is the most common transmitter at postganglionic sympathetic neurons
NE
78
What is the major inhibitory NT of the brain
GABA
79
What is the major inhibitory NT of the spinal cord
Glycine
80
What is the major excitatory NT of the brain
Glutamate
81
What is the single most common finding in aphasia pts
Anomia ( a deficit of naming)
82
What is non fluent aphasia
Brocas
83
What is fluent aphasia
Wernickes
84
Neglect is a sign of..
Cortical D/o of the right frontal or parietal lobes
85
What are the components of the basal ganglia
the globus pallidus
The Putamen make up the lentiform nucleus and combined with the
The caudate nucleus
make up the corpus straitum
86
What is the function of the basal ganglia
Coordianate muscle aditivo y
87
Damage to the basal ganglia results in..
Damage to the basal ganglia results in uncontrollable shaking (tremor), muscular rigidity (stiffness), and involuntary muscle movements.
(All Parkinson’s criteria eg: Cogwheel stiffness)
Parkinson’s:
dopamine-producing neurons of the basal ganglia degenerate
Huntington’s disease:
damage to the corpus striatum
88
What is the “master control for the ANS”
Hypothalmus
Also controls the pituitary gland
89
What is the epithalmus
The pineal gland
90
What are the 5 structures that make up the limbic system
```
Amygdala
Cingulate Gyrus
Midbrain Raphae
Locus Ceruleus
Hippocampus
```
91
What is the function of the limbic cortex
Emotion, eating, and reproduction
92
What is the function of the amygdala
Chief role in the memory of emotional experiences
| Central role in behavioral responses to fear
93
What is the role of the hippocampus
Integrator of incoming novel and unpleasant stimuli.
Connects w/ temp. lobe closely
May predict the next event based on what has already happened.
94
What are the 3 functions of the cerebellum
Sensory perception
Coordination
Motor control
95
Do lesions in the cerebellum lead to paralysis
No
Instead they cause feedback D./o
Posture
Equilibrium
Motor Learning
Like ataxias
96
What is the difference between the pyramidal and extra pyramidal functions of the midbrain
Tracts responsible for movement pass through here
Pyramidal:
Voluntary movements
Extrapyramidal:
Involuntary movements
Posture/adjustments/coordination
97
Where is the RAS located and what is its function
The pons Contains the RAS and controls respirations
Is the Consciousness center
98
Where does the spinal cord extend to (what vertebra)
L1-2
99
Gray matter in the spinal cord is what
Nerve cell bodies
100
White matter in the spinal cord is what
Mylienated nerves
101
Where do Upper motor nuerons originate
In the cortex and Brain stem
102
Where do Lower motor nuerons originate
Begin in the anterior horn of the spinal column
103
In the spinal cord:
The anterior root has what kind of fibers
The posterior root has what kind of fibers
Anterior: motor (efferent)
Posterior: sensory (afferent)
104
What is the function of the coticospinal tract
Voluntary motor activity
105
What is the function of the spinothalamic tract
Pain, temp, light/crude touch, pressure
106
What is the function of the dorsal columns of the spinal tract
Fine touch, 2 point discrimination, and proprioception
107
How do the spinthalamic tract and dorsal column ascend up the spinal cord
Spinothalamic: enter and cross midline immediately
Ascend to the thalamus in the spinothalamic tract, on opposite side
Dorsal columns: Sensory impulses ascend up the same side as fibers enter the cord
Fibers cross the midline at medulla
108
Cord lesions of the corticospinal tract produce
Ipsilateral S/s
109
Cord lesions of the dorsal columns produce
Ipsilateral S/s
110
Cord lesions of the spinothalamic tract produce
Contralat s/s
111
What is the blood flow through the circle of Willis
1. Internal carotid artery
2. Vertebral artery
3. Cavernous sinus
4. Carotid canal
5. Anterior cerebral artery
6. Posterior cerebral artery
112
Poor circulation in the anterior cerebral artery affects what area
The lower limb area of the motor cortex
113
Poor perfusion to the middle cerebral artery has effects where
Affects the face and upper limb
are of the motor cortex
Also affects the dominant language hemisphere
Occlusion of either the ACA or MCA may lead a devastating stroke
114
Poor profusion to the basilar artery has effects where r
Leads to both Left and Right PCA
Occlusion of the vertebrobasilar system leads to “drop attacks”
Complete occlusion results in blindness
115
What are the 4 vessels that make up “posterior circulation:” of the brain
The superior cerebellar artery
The posterior inferior cerebellar artery
The anterior inferior cerebellar artery
And the basilar artery
116
What are the 3 layers of the meninges
Dura mater: outermost layer
Arachnoid mater: lies above the subarachnoid space
Pia mater: the delicate inner layer that directly covers the brain
117
Where is CSF secreted from
Secreted by choroid plexus, absorbed in subarachnoid space
118
What is an encephaloele
Nueral tube defect
Anterior pore defect
Least common of the 3 NTD
Classification is based on location
Occipital is the most common encephalocele
119
What is the function of the ANS
Regulates glands, smooth muscle, cardiac muscle
Sympathetic: fight or flight
Fibers exit spinal cord at T1-L2
Parasympathetic: Restorative, conserve energy
Fibers exit through CN III, VII, IX, X, and S2-S4 to gut and bladder
Hypothalamus provides the master control for ANS
