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Neurology > Neuro3 - Clinician > Flashcards

Neuro3 - Clinician Flashcards

1
Q

inability to see on the medial side of the eye

A

Nasal hemianopsia

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2
Q

disruption of axonal flow, no discontinuity of nerve, complete recovery in hours to weeks

A

neuropraxiaa

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3
Q

axonal disruption, recovery incomplete, march of recovery 1-2mm/day

A

axonotmesis

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4
Q

anatomic dsruption of the nerve, recovery always incomplete, no recovery without surgical repair

A

neurontmesis

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5
Q

wrist drop - due to compression of radial nerve -> inability to extend fingers ; prognosis w partial nerve palsy > 80% recovery, with complete nerve palsy < 40%

A

Radial nerve palsy

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6
Q

foot drop - due to fibular nerve compression -> numbness, tingling in the top of the foot or the outer part of the upper or lower leg, slapping gait, toes drag while walking, weakness of the ankles or feet ; prognosis w partial nerve palsy > 80% recovery, with complete nerve palsy < 40%

A

Peroneal nerve palsy

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7
Q

involves C2 ; involves lesser and greater occipital nerves ; upper neck, back of the head and behind the eyes ; Tx - OMT, injection, neurectomy ;

A

Entrapment neuropathy - Occipital neuritis / neuralgia

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8
Q

causes - muscular or osseous (cervical rib, clavicle) ; also called scalenus anticus syndrome ; Dx - stick em up hand raise for 3-5 mins or compression test will help dx ; Sx - vascular and or nerve entrapment ; Tx - section muscle, remove 1st rib, OMT

A

Thoracic outlet syndrome

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9
Q

commonly called carpal tunnel syndrome ; causes - trauma, repetitive use ; diagnositc testing ; conservative treatment, surgical treatment (traditional open procedure, endoscopic procedure, retinaclotome) - cut the carpal ligament

A

Median nerve compression

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10
Q

used to dx median nerve compression (carpal tunnel syndrome)

A

Tinels and Phalanx sign

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11
Q

tardy ulnar palsy ; etiology - trauma, repetitive use ; Dx - signs (can use tinnels sign), symptoms, ; Tx - first try non-surgical tx then surgical treatment (nerve decrompression, decompresion with epicondylectomy, decrompression with transposition

A

Cubital tunnel syndrome

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12
Q

lateral femoral cutaneous nerve problem ; etiology - trauma, ingunal surgery, rapid weight loss, pendulous abdomen ;

A

Meralgia Paresthetica

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13
Q

Secreted by ciliary epithelium (from ciliary body) -> posterior chamber -> anterior chamber -> trabecular meshwork -> canal os schlemm -> venous drainage of the eye ;

A

Circulation of Aqueous Humor

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14
Q

ciliary body houses choroid plexus which secretes aqueous humor 2ul/min -> pressure is generated by fluid production and relieved by reabsorption -> trabecular meshwork resistance to outflow creates a pressure of 15mmHg -> intraocular pressure maintains shape of the eye ; if defective -> too much pressure -> luxation of lens -> glaucoma

A

Eye anterior chamber aqueous pressure

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15
Q

highest density of photoreceptors

A

Fovea

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16
Q

many axons and no room for photo receptors

A

Optic disk

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17
Q

more sensitive to light -> allow us to see in dim light and monochromatic ; Scotopic vision ; photopigment is RHODOPSIN, more sensitive, slower response ; lowest density in the fovea and highest density in the periphery

A

Rods

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18
Q

color vision in bright light -> enable us to see detail-visual acuity ; Photopic vision ; photopigment is CONE PIGMENT, less sensitive, quicker response ; blue (short wavelength), green, & red (long wavelength) ; highest density in the fovea, lowest density in the periphery

A

Cones

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19
Q

rods to see by starlight ; amacrine cells connect the rods to cone cells

A

Scotopic vision

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20
Q

rods and cones in moonlight ; rods and cones connect to each other using gap junctions

A

Mesopic vision

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21
Q

cones for brighter than moonlight

A

Photopic vision

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22
Q

light photon hits an Opsin in a cone or rod -> activates a transducin (G protein) -> activate cGMP-PDE -> amplify and activate 100s - 1000s of cGMP which hydrolize with PDE -> decreased levels of cGMP -> less binding of Na+ by cGMP -> Na+ channels close -> cell hyperpolarizes reducing release of glutamate at terminal ; increased light = decrease in membrane potential and DECREASE in glutamate

A

Response to light

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23
Q

decreased light = increased membrane potential -> increased glutamate ; oposite process of response to light ;

A

Response to dark

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24
Q

the adaptation of eyes to a level of light ; balance between breakdown and replenishment of pigments (several seconds) ; balance of excitation and inhibitoin by neighboring receptors - contrast detection mechanism (several milliseconds) ; pupilary light reflex

A

adaptation to light

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25
Q

the amount of time it takes for the eyes to fully adapt to dark and have full sensitivity ; visual pigments fully replenished ; slow (20-30 mins)

A

adaptation to dark

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26
Q

no red pigment cones ; X-linked

A

Protanopia

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27
Q

no green pigment cones ; X-linked

A

Deuteranopia

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28
Q

no blue pigment cones ; Chromosome 7

A

Tritanopia

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29
Q

back of the eye -> retinal pigment epithelium -> rods or cones -> outerlimiting membrane, outer nuclear layer-cell bodies (rods and cones) -> outer plexiform layer, inner nuclear layer -> inner plexiform layer -> ganglion cell layer -> nerve fiber layer -> inner limiting membrane (basal lamina) -> vitreous humor

A

Layers of the retina

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30
Q

contrast detection in black and white -> optic neurons have on center and off center sensors which fire at the same rates if they are receiving the same amount of light but if the on center portion recieves no light and the off center portion recieves light, the transmittion changes by increasing firing of the off center portion (the same is true for the opposite) -> therefore where there is “shade” change it appears darker than where there is not - you notice the edges of things

A

Image processing at the retina

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31
Q

connect the rod cells to the cone cells in scotopic cells ;

A

amacrine cells

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32
Q

are involved in transmitting the on center / off center information

A

Bipolar / horizontal optic cells

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33
Q

image -> optic nerve II -> optic chiasm (right & left visual fields separated) -> optic tract wraps around cerebral peduncles -> LGN (some fibers also go to the superior colliculi - pretectal area) -> geniculocalcarine tract (Meyer’s Loop) -> optic radiations -> cortex

A

Visual pathway

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34
Q

found in the lateral geniculate nuclesus (LGN) ; recieve input from large retinal ganglion cells, larger receptive field, detection of motion and location

A

magnocellular layers (1,2)

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35
Q

found in the LGN - input from small retinal ganglion cells, smaller receptive field, detection of color and form

A

parvocellular layers (3-6)

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36
Q

recieves visual data from both eyes and is organized into layers ; projects data to the geniculocalcarine tract (Meyer’s Loop) -> optic radiations -> cortex

A

Lateral Geniculate Nuclesu (LGN)

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37
Q

provides motor nerves to muscles of facial expression (temporal, zygomatic, buccal, mandibular, and cervical branches), stapedius tendon/muscle (stapedial branch) and partial inervation to the digastric muscle (digastric nerve), sensory nerves to the anterior 2/3 of the tongue (chordae tympany), and sensory to external auditory canal/part of the auricle (posterior auricular branch), autonomic innervation to lacrimal glands (via the greater superficial petrosal branch), and salivatory glands (via the chordae tympany)

A

Cranial Nerve 7 - Facial Nerve

38
Q

facial expression

A

thalamic nuclei

39
Q

corneal reflex - nvoluntary blinking of the eyelids elicited by stimulation of the cornea (such as by touching or by a foreign body), or bright light, though could result from any peripheral stimulus

A

trigeminal nuclei

40
Q

stapedial reflex -

A

acoustic nuclei

41
Q

blink reflex

A

visual system - nulei

42
Q

stimulates lacrimal gland

A

greater superficial petrosal branch

43
Q

stimulates salivary glands and provides tastes to anterior 2/3 of tongue

A

chordae tympani

44
Q

stimulates the stapedial tendon (protects ear from loud sounds

A

Stapedial branch

45
Q

transient episode of nerve damage with no distrucption of nerve or nerve sheath

A

Neuropraxia

46
Q

distruption of the neuronal axon but maintenance of the myelin sheath

A

axonotmesis

47
Q

the nerve and ner sheath are distrupted

A

neurotmesis

48
Q

nerve is cut or crushed & distal axon skeleton disintegrates / axon membrane breaks apart (24rs) - > neurolemma remains and proximal axon grows at 1mm /day (96 hrs)

A

wallerian degeneration

49
Q

Idiopathic - Bell’s Palsy, Melkerson-Rosenthal Syndrome ; Traum - surgical trauma, temporal bone fracture, facial trauma ; Infections - lyme disease (bilateral), herpes zoster oticus, acute or chronic supprative otitis media, malignant otitis externa, syphils, meningitis, rubella, mono, other infections ; Neoplasm - neuroma, meningioma, central CNS or parotid malignancy ; Most common - Bells, operative, diabetes,

A

Etiology of VII paralysis

50
Q

shirmer tear test - filter paper to lower lids to compare tear production over fixed time ;

A

Greater superficial petrosal nerve test

51
Q

stapedial acoustic reflex test ; when sound is over 7-9 decibels (sound travels through 8th nerve) then the (7th nerve acoustic nuclei is activated) stapedial nerve causes thension in the stapedius muscle to dull the sound

A

Nerve to stapedius test

52
Q

salivary flow test - cannulate Whartons ducts to collect salivary production over fixed time ; electrogustometry - measure amount of electricity needed to stimulate the tongue sensation comparing sides

A

Chordae tympany nerve test

53
Q

Sign - good tone, intact upper face, presence of spontaneous smile, neurologic deficits ; DX - CVA, trauma

A

Supranuclear facial nerve lesion

54
Q

Signs - involvement of the 6th and 7th cranial nerves, corticospinal tract signs ; DX - vascular or neoplastic, polio, MS, encephalitis ;

A

Nuclear facial nerve lesion

55
Q

Signs - involvement of vestibular and chochlear portions of CN 8, CN7 particularly taste, lacrimation and salivation may be altered, CN 5 and later CN9, 10, 11 may become impaired ; DX - neurioma, meningioma, fracture, cholesteatoma, arachnoid cysts

A

Angle facial nerve lesion

56
Q

Signs - facial paralysis, hyperacusis, alteraion of lacrimation, salivation and taste, ; Dx - herpes zoster oticus, fracture, bells palsy, cholesteatoma, neurinoma, AV malformation, meningioma

A

Geniculate ganglion facial nerve lesion

57
Q

Signs - facial paralysis, alteration in salivation and taste, lacrimation intact ; Dx - bells palsy, cholesteatoma, fracture, infection

A

tympanomastoid facial nerve lesion

58
Q

Signs - facial paralysis (usually a branch is spared), salivation, and tates intact, deviation of jaw to normal side ; DX - trauma, tumor, parotid carcinoma, pharingeal carcinoma

A

extracranial facial nerve lesion

59
Q

treat with steroids and acyclovir if bells palsy ; injury - treat with nerve reanastamosis ; otitis - treat with myringotomy, mastoidectomy, nerve decompression ; avoid complications of paralysis - early (tape eyes closed and artificial tears), late (trasorrhaphy or gold weights to upper lids) - muscle atrophy - stretch and facial muscles in front of mirror, physical therapy ; reconstruction - nerve grafting, cross face graft, facia sling

A

Tx of facial paralysis

60
Q

stria cascularis of the spiral ligament -> chochlear ducts -> sccule -> endolymphatic duct -> endolymphatic sac -> reabsorbed

A

Endolymph circulation

61
Q

transverse temporal gyrus ; highest frequencies are medial and lowest frequencies are lateral

A

Tonotopic organization

62
Q

inner hair cells - make up 90% of CN 8 auditory afferents - efferents modulate afferents ; outer hair cell (type II) -> afferents and efferents of CN 8 efferents controled contraction of outer hair cells ; part of cochlear selectivity mechanism

A

Auditory afferents and efferents

63
Q

attached to neck of stapes ; mudulates transmission of low frequencies stimulated in response to loud noise

A

Stapedius muscle

64
Q

attached to handle of malleus ; modulates tension on the tympanic membrane and overall transmission ; stimulated by noise, fright, facial touch, vocalization ;

A

tensor tympany muscle

65
Q

BInaural information is present at superior olivary nucleus and lateral lemniscus ; spiral ganglion -> cochlear nuclei -> ipsilateral and contralateral superior olivary nucleus -> up lateral lemniscus -> inferior colliculus (where there is clrosing of information again) -> medial geniculate nucleus -> lprimary auditory cortex

A

Auditory neural pathway

66
Q

to discern where a sound is coming from this structure recieves information from both ears ; uses cues such as tone, frequency, timeshift

A

superior olivary nucleus

67
Q

left hemisphere processes language meaning ; right hemisphere processes the prosity of sound (what the tone of the voice or quality of the sound means)

A

right hemisphere vs left hemisphere auditory processing

68
Q

difficulty understnading meanding convayed by tone of voice

A

Sensory aprosodia

69
Q

difficulty conveying meanding through tone of voice

A

motor aprosodia

70
Q

STATE OF CONSCIOUSNESS (most important part of neurologic exam), pattern of breathing/vital signs, eye exam (pupils, ocular movements, fundoscopic), motor/sensory examination, reflexes ;

A

Coma evaluation

71
Q

state in which the patient is not fully alert and tends to drif to sleep when not stimulated ; if stimulated will respond and stay awayke

A

Lethargy / Somnolence

72
Q

acute confusional state, is severe confusion that develops quickly, and often fluctuates in intensity. It is a common neuropsychiatric syndrome with a core feature of acute onset, meaning it has been present from hours to days, but not months or years.

A

Delerium

73
Q

unresponsiveness except to vigorous, noxious and repeated stimuli ; nail bed pressure, sternal rub

A

Stupor / Obtundation

74
Q

state in which the patient is completely unarousable ;

A

Coma

75
Q

a generalized term for al subjects who survive for prolonged periods following severe brain injury with-out recovering any manifestations of the “content of consciousness” ; akinetic mutism, coma vigil, apallic state ;

A

Chronic vegetative state

76
Q

lesion in the MIDbrain subthalamic region ; patient is silent, alert-looking immobility seen in individuals in which sleep-wake cycles have returned but evidence for mental activity remains entirely absent ;

A

Akinetic mutism

77
Q

lesion in the FOREbrain region ; patient is silent, alert-looking immobility seen in individuals in which sleep-wake cycles have returned but evidence for mental activity remains entirely absent ;

A

Coma Vigil

78
Q

lesion is bilateral and diffuse cortical degeneration that sometimes follows anoxia, head injury or encephalitis ; means “no cortex” ; patient is silent, alert-looking immobility seen in individuals in which sleep-wake cycles have returned but evidence for mental activity remains entirely absent ;

A

Apallic state

79
Q

a condition of paralysis of all four extremities and lower cranial nerves that may or may not be associated with imparired conciousness but has an intact “content of consciousness” ; Lesion is also called ventral pontine syndrome or de-efferented state ;

A

Locked-in Syndrome

80
Q

Minimum of 3 points (BAD), Maximum of 15 points (normal) ; Best motor Response - 6 obeys, 5 localizes, 4 withdraws, 3 abnormal flexion, 2 extensor response, 1 None ; Verbal Response - 5 oriented, 4 confused conversant, 3 inappropriate words, 2 incomprehensible sounds, 1 None ; Eye Opening - 4 spontaneous, 3 to speech, 2 to pain, 1 none ; Milld (80%) 13-15 ; Moderate (10%) 9-12 ; Severe (10%) < 9

A

Glascow Comma Scale

81
Q

represents metabolic encephalopathy ; is an abnormal pattern of breathing characterized by progressively deeper and sometimes faster breathing, followed by a gradual decrease that results in a temporary stop in breathing called an apnea. The pattern repeats, with each cycle usually taking 30 seconds to 2 minutes

A

Cheney stokes respiratory

82
Q

caused by: DKA, lesion in the midbrain ; is an abnormal pattern of breathing characterized by deep and rapid breaths at a rate of at least 25 breaths per minute. Increasing irregularity of this respiratory rate generally is a sign that the patient will enter into coma

A

Central neurogenic hyperventilation

83
Q

caused by lesion in the pons ; is an abnormal pattern of breathing characterized by deep, gasping inspiration with a pause at full inspiration followed by a brief, insufficient release.

A

Apneustic breathing

84
Q

a breathing pattern in which a closely grouped series of respirations is followed by apnea. The activity is associated with a lesion in the lower pontine region of the brainstem.

A

Cluster breathing

85
Q

breathing is irregularly irregular ; is caused by damage to the medulla oblongata due to strokes or trauma or by pressure on the medulla due to uncal or tentorial herniation.

A

Biot’s breathing

86
Q

occurs when the cerebral perfusion pressure is reduced from increased intracraneal pressure -> brain signals for increased systolic blood pressure -> widened pulse pressure and bradycardia (if you see tachycardia = grave sign) ; will also see decreased respiratory rate at first but if intracraneal pressure rises too much then you will see increased respiratory rate ;

A

Cushings phenomenon

87
Q

parasympathetics -> constrict pupil (afferents from CN2 enter midbrain and efferents from CN3 leave midbrain) ; sympathetics -> dilate pupil (afferents are psychosensory and efferents travel down brainstem to lower cervical area ; damage in any of these pathways may cause changes

A

Pupillary examination

88
Q

are bilateral small pupils that constrict when the patient focuses on a near object (they “accommodate”), but do not constrict when exposed to bright light (they do not “react” to light) ;

A

Argyll Robertson pupil

89
Q

relative afferent pupillary defect (RAPD) is a medical sign observed during the swinging-flashlight test whereupon the patient’s pupils constrict less (therefore appearing to dilate) when a bright light is swung from the unaffected eye to the affected eye. The affected eye still senses the light and produces pupillary sphincter constriction to some degree, albeit reduced. ; a lesion of the optic nerve

A

Marcus Gunn pupil

90
Q

is the combination of drooping of the eyelid (ptosis) and constriction of the pupil (miosis), sometimes accompanied by decreased sweating of the face on the same side ; lateral medullary syndrome

A

Horners syndrome

91
Q

metabolic abnormality is the most likely cause of ____________

A

Most likely cause for coma

Neurology (6 decks)

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