Flashcards in Quiz 2 - Neuro I Deck (59)
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1
the frontal lobe contains the? which is what?
the frontal lobe contains the:
Primary motor area
PRECENTRAL GYRUS
2
the parietal lobe contains the ? which is what?
primary sensory area
POSTCENTRAL GYRUS
3
The cerebellum is attached to the brain stem by?
3 cerebellar peduncles
4
what are gyri? fissures? and sulci?
gyri - buldges
fissures - large indentations
sulci - small indentations
5
which CNs are sensory, motor or mixed?
CN I, II, VIII - sensory
CN III, IV, VI, XI, XII - motor
CN V, VII, IX, X - mixed
6
Which tracts decussate, what do they sense, where do they cross over?
ASCENDING:
spinothalamic tract (pain/temp) - cross immediately.
posterior column (proprioception) - cross at junction of spinal cord and brain stem
7
stepwise approach to the neurologic patient?
Where is the lesion?
Location, singular or multifocal (metastatic dx, ms, multiple diseases)?
is it confined to the nervous system or is it part of a systemic disorder?
what part of the nervous system is affected?
What is the lesion? (tumor, infection, hemorrhage)
8
What is the importance in asking for neurological history?
essential in order to localize symptoms
may need family member support in teasing out the ONSET
9
in PMhx - what different systems do we need to assess and why? what about environmental?
cardio - htn, cvd - assesses stroke risk
neuro - previous stroke? TIAs? psychiatric illness
endocrine - DM
hepatobiliary - liver!! could disrupt metabolism, causing systemic issues
trauma - TBI? MVA? Concussions?
systemic issues - CA? may be metastasis
HEAVY METALS - issue for neuro complaints (not something to jump to first)
10
in FHx - what are important question to ask?
alzheimers?
parkinsons?
CVD?
11
what are the important SHx questions to assess?
smoking**, alcohol, drugs
sexual hx (neurosyphilis)
diet (gluten)
hobbies (exposure to heavy metals, solvents)
12
What ROS questions should be considered in the neurological patient?
Are you experiencing ANY PAIN?
HEENT
headaches, visual changes, dizziness
NEURO
tremor, weakness/sensory loss, LOC
13
what mental status acronym is important to know and what does it stand for? this test is also known as?
FOGS
1. Family story of memory loss
2. Orientation - time, month, day, year
3. General Information - president of the US?
4. Spelling - spell the word "world" forwards and backwards
this is your mini mental status exam (MMSE)
14
if you see hyper-reflexia where is your lesion
upper motor neuron
15
if you see hypo-reflexia where is the lesion?
lower motor neuron
16
what is the 3rd most common cause of death and most common cause of neurological disability - how do they present depending on supply? how do they present - generally?
cerebrovascular accident (STROKE)
anterior supply (2/3 of the brain, internal carotid) - unilateral sxs
posterior supply (1/3 of the brain, vertebrobasilar) - unilateral or bilateral, more likely to affect consciousness
generally, present SUDDENLY; CONTRALATERAL limbs, facial paralysis; confusion; h/a
17
What are the different types of stroke? what are their ssx?
ISCHEMIC TYPES (80%)
- thrombic, MOST COMMON - atherosclerotic plaques, sites of turbulent blood flow, slower onset (24-48 hrs), tend to occur at NIGHT, noticed upon waking - NO H/A, PAIN OR FEVER!!
- emobolic, SUDDEN ONSET, RAPID onset of symptoms, HEADACHE may precede neurologic defect (weakness) - AFIB, huge preceding factor.
- lacunar - ataxia, DM, poorly controlled HTN
- transient ischemic attack - usually precedes stroke onset by a few days/months, mini strokes, last less than an hour - DO NOT CAUSE BRAIN DAMAGE, bigger stroke is coming - WARNING SIGN
HEMORRHAGIC TYPES (20%)
- intracerebral hemorrhage - generally due to HTN - ssx: H/A, Nausea, Impairment of consciousness
- subarachnoid Hemorrhage - SUDDEN sever H/A with LOC, severe neurological deficits
18
How do you DX stroke?
BIG THING YOU WANT TO KNOW - USUALLY CLINICAL!
F - facial droop, smile, asymm?
A - arm drop, pronator drift
S - speech difficulties - repeat simple sentence
T - timing, if all above are positive - 911** likelihood of stroke is HIGH - when did they notice onset? family member may be helpful?
while waiting - assess vitals (take BP), O2 saturation (pulse ox - if losing o2 percentage, put on oxygen mask while waiting for transport).
NIHSS - typically done in the hospital, grade stroke for severity. How to ID in primary care.
Imaging - CT, done first to exclude hemorrhage. MRI done second, smaller infarcts.
IF TIME? Bedside glucose.
19
What are the different types of stroke? what are their ssx?
ischemic (80%)
- thrombic, MOST COMMON - slower onset (24-48 hrs), tend to occur at NIGHT, noticed upon waking - NO H/A, PAIN OR FEVER!!
- emobolic, SUDDEN ONSET, RAPID onset of symptoms, HEADACHE may precede neurologic defect (weakness) - AFIB, huge preceding factor.
- lacunar - ataxia, DM, poorly controlled HTN
- transient ischemic attack - usually precedes stroke onset by a few days/months, mini strokes, last less than an hour - DO NOT CAUSE BRAIN DAMAGE, bigger stroke is coming - WARNING SIGN
hemorrhagic (20%)
- intracerebral hemorrhage - generally due to HTN - ssx: H/A, Nausea, Impairment of consciousness
- subarachnoid Hemorrhage - SUDDEN severe H/A with LOC, severe neurological deficits
20
How do you DX stroke?
BIG THING YOU WANT TO KNOW - USUALLY CLINICAL!
F - facial droop, smile, asymm?
A - arm drop, pronator drift
S - speech difficulties - repeat simple sentence
T - timing, if all above are positive - 911** likelihood of stroke is HIGH - when did they notice onset? family member may be helpful?
while waiting - assess vitals (take BP), O2 saturation (pulse ox - if losing o2 percentage, put on oxygen mask while waiting for transport).
NIHSS - typically done in the hospital, grade stroke for severity. How to ID in primary care.
Imaging - CT, done first to exclude hemorrhage. MRI done second, smaller infarcts.
IF TIME? Bedside glucose.
21
How do you DX stroke?
BIG THING YOU WANT TO KNOW - USUALLY CLINICAL!
F - facial droop, smile, asymm?
A - arm drop, pronator drift
S - speech difficulties - repeat simple sentence
T - timing, if all above are positive - 911** likelihood of stroke is HIGH - when did they notice onset? family member may be helpful?
while waiting - assess vitals (take BP), O2 saturation (pulse ox - if losing o2 percentage, put on oxygen mask while waiting for transport).
NIHSS - typically done in the hospital, grade stroke for severity. How to ID in primary care.
Imaging - CT, done first to exclude hemorrhage. MRI done second, smaller infarcts.
IF TIME? Bedside glucose.
22
which CN is helpful in assessing a frontal lobe lesion?
CN I tested - change in personality may also be present
23
what are key tests, assessing upper motor neuron weakness?
Drift of Upper Extremity
- hands in front, palms up held flat 15-30 seconds. (+), palm rotates in and pronate midline
Hand Grasp and Toe Dorsiflexion
- weakness is commonly seen in UMN lesion
24
what are the two tests for meningeal irritation and how are they performed?
kernig
- (+) straightening of lower extremity causes low back pain
brudzinski
- (+) - supine pt, passively flex pt's head, hips will involuntarily flex
25
what is "bedside glucose"?
this is a neurological diagnostic procedure done because blood sugar dysregulation can mimic neurological conditions since glucose is the brain's food supply
26
what imaging is ordered for neurological cases?
CT - used acutely
MRI - more specific, not acute
Lumbar puncture - last option
27
Dementia affects mainly
memory
28
Delirium affects mainly
attention
29
Delirium affects mainly
attention
30
How does dementia present?
slow and gradual
usually permanent
initially unimpaired, until severe
no immediate need for medical attention
31
How does delirium present?
sudden onset
reversible
attention is greatly impaired
variable level of consciousness
Immediate need for medical attention
- both of these are worse in the evening
32
delirium is typically caused by ___, often ___, most common in ___
acute illness
reversible
MC in the elderly
33
SSX of delirium
difficulty focusing, fluctuating consciousness, confusion, personality changes
34
what is required for dx of delirium?
acute change in cognition
difficulty focusing
plus 1 of the following
- altered level of consciousness
- disturbance of consciousness
35
What does "I WATCH DEATH" stand for? Helps with dx of delirium
infectious
withdrawal
acute metabolic disorder
trauma
CNS path
hypoxia
deficiencies
endocrinopathies
acute vascular
toxins
heavy metals
36
What does "I WATCH DEATH" stand for? Helps with dx of delirium
infectious
withdrawal
acute metabolic disorder
trauma
CNS path
hypoxia
deficiencies
endocrinopathies
acute vascular
toxins
heavy metals
37
What are the 5 most common types of dementia
Alzheimer's Disease
Vascular Dementia
Lewi Body Dementia/Parkinson' Disease
HIV-associated Dementia
Frontotemporal Dementia
38
what is commonly the first sign of dementia?
short-term memory loss
39
what do you need for dx of dementia?
history - MSE
PE - complete neuro exam
40
What labs would be ordered for dementia?
TSH
B12
CBC
LFTs
HIV/RPR - if suspected
41
what imaging would be ordered for dementia?
CT - acute
MRI - nonacute
42
what is the diagnostic criteria for dementia?
Requires ALL 3 of the following:
- cognitive sxs that interfere with the ability to complete daily activities (with 2 of the following: amnesia, language dysfxn (aphasia), can't recognize faces (agnosia), impaired reasoning (apraxia), changes in personality)
- obvious decline from previous
- sxs not explained by psychiatric etiology
43
what is the diagnostic criteria for dementia?
Requires ALL 3 of the following:
- cognitive sxs that interfere with the ability to complete daily activities (with 2 of the following: amnesia, language dysfxn (aphasia), can't recognize faces (agnosia), impaired reasoning (apraxia), changes in personality)
- obvious decline from previous
- sxs not explained by psychiatric etiology
44
what is the most common cause of dementia (60-80%)
Alzheimer's Disease
- elderly (>65)
45
what is the most common cause of dementia (60-80%)
Alzheimer's Disease
- elderly (>65)
46
which genetic incidence is highly correlated with Alzheimers and occurs by the age of 35
Trisomy 21 - Down's Syndrome Patients
47
what protein is pathopneumonically deposited in Alzheimer's brain, when is this formed, during the processing of _____?
protein beta-amyloid
formed during APP
amyloid precursor protein processing
-inappropriate deposition of this in the brain causes degeneration
48
what two proteins contribute to the processing of amyloid precursor protein (APP)
presenilin 1 & 2
49
what two proteins contribute to the processing of amyloid precursor protein (APP)
presenilin 1 & 2
50
what is the most common risk factor for alzheimer's disease
advanced age
51
what is the most common risk factor for alzheimer's disease
advanced age
52
what is the first sign of alzheimer's disease?
loss of short term memory
53
What are required for the Dx of Alzheimer's (KNOW)
Dementia - clinically dx'd vis MSE
deficits in > 2 areas of cognition
gradual onset, progressive memory and cognitive decline
no disturbance of consciousness
onset after age 40, most after 65
no systemic/brain disorders present
54
what is the 2nd most common dementia among the elderly? what are common etiologies
Vascular Dementia
for this one, think vascular diseases - HTN, DM, Smoking, Hyperlipidemia
55
What is characteristic of Lewy Body Dementia
gait instability occurs early
quick onset tremor, occurs late
symmetric
fluctuating cognitive function - aka, hallucinations, sleep disorders, etc
56
What is characteristic of Parkinson's Disease Dementia
motor symptoms more severe
motor precedes cognitive symptoms by up to 10-15 years
57
which form of dementia tends to occur in younger individuals?
HIV-associated Dementia
58
which dementia affects personality, behavior and usually language function, more?
Frontotemporal Dementia
- occurs 55-65 (younger)
59
