The Nervous System Flashcards
1
Q
Lumbar puncture performed at
A
L3-L4/ L4-L5 vertebral interspace
2
Q
Corticospinal (pyramidal) tract
A
- voluntary movement and integrated skilled/delicate movement
- can also inhibit muscle tone
- cross in the medulla region
3
Q
Basal ganglia system function
A
Maintain muscle tone
Control gris automatic movements(walking)
4
Q
Cerebellar system
A
Motor activity
Maintain equilibrium
Control posture
5
Q
Upper motor neuron damage
A
- if above crossover →affects opposite side
- if below the crossover→ipsilateral side
- ↑ muscle tone
- ↑ deep tendon reflexs
6
Q
Damage to lower motor neuron
A
- affects the ipsilateral side
- muscle weakness and paralysis
- ↓or absent muscle tone and reflexes
7
Q
Diabetic patient with sharp, shooting or burning (dysesthesia)foot pain
A
Small nerve fiber neuropathy(spinothalamic tract)
8
Q
Diabetic patient with numbness and tingling/loss of sensation in the foot
A
Large fiber neuropathy (posterior column)
9
Q
No impairment in pain, touch and position but can’t appreciate size shape and texture of the object( fine discrimination)
A
Lesion in sensory cortex
10
Q
Loss of piston and vibration but other senses preserved
A
Point if damage is Posterior column
11
Q
Waist down paralysis and hyperactive reflex’s in legs with crude and light touch preserved
A
Severe traverse damage to spinal cord
12
Q
Ankle reflex
A
S1
13
Q
Knee reflex
A
L2-4
14
Q
Supinator(brachioradialis) reflex
A
C5-6
15
Q
Biceps reflex
A
C5-6
16
Q
Triceps reflex
A
C6-7
17
Q
Upper Abdominal reflex
A
T8-10
18
Q
Lower ab reflex
A
T10-12
19
Q
Creamasteric reflex
A
L1-2
20
Q
Plantar reflex
A
L5 and S1
21
Q
Anal reflex
A
S2,3,4
22
Q
“Worst headache of my life” and instantaneous onset
A
Subarachnoid hemorrhage
23
Q
Severe headache and neck stiffness
A
Meningitis
24
Q
Dull headache, ↑with cough and sneezing, reoccur in same location
A
Mass lesions due to brain tumor or abcess
25
Woman using hormonal contraceptive, thunderclap headache, fever stiff neck
- maybe stroke
| - check for papilledema and focal neurologic sign
26
Feeling light headed, weak in the legs, about to faint
Presyncope
27
Causes of presyncope
- Vasovagal simulation
- Arrhythmias
- Changes in bp
- Orthostatic hypotension
- Other medication
28
Vertigo with diplopia, dysarthria or ataxia
Central causes:
- suspicious for vertebrobasilar TIA or stroke or
- posterior fossa tumor or
- migraine with brahmarshi aura
29
Proximal limb weakness, symmetric, intact sensation
- myopathies from alcohol
- glucocorticoid
- polymyositis, dermatomyositis
30
Proximal asymmetric weakness associated with bulbar symptoms
Myasthenia gravis
31
Proximal asymmetric weakness and worsen with effort(friable) associated with bulbar symptoms
Myasthenia gravis
32
Bilateral distal weakness with sensory loss
Polyneuropathy in diabetes
33
Pattern of stockinng then glove sensory loss
Polyneuropathy from diabetes
34
Multiple patchy area of sensory loss in different limbs
Mononeuritis multiplex in diabetes and AR
35
Prodrome of nausea, diaphoresis,pallor(unpleasant event), vagally mediated hypotension with slow onset and offset
Vasovagal syncope
36
Syncope onset and offset are sudden
Reflecting loss and recovery of cerebral perfusion →syncope from arrhythmias
37
Tonic -clinic motor activity, bladder/bowel incontinence, postical state, and tongue biting and bruising of limbs may occur
Generalized seizures
38
Low frequency unilateral resting tremor, rigidity, and bradykinesia
Parkinson disease
39
High frequency, bilateral, upper extremity tremor that occur with limb movement and sustained posture and subsides when relaxed
Essential tremor
40
Unpleasant sevaon of legs especially at night, gets worse with rest and improve with movement
Restless leg syndrome
41
Risk factors for women having a stroke
1. Preeclampsia
2. Autoimmune collagen vascular disease
3. Gestational diabetes
4. Pregnancy induced hypertension
42
Visual field cuts and contralateral hemiparesis and sensory deficit
Occlusion of middle cerebral artery
43
Aphasia
Occlusion of left middle cerebral artery
44
Left hemineglect
Occlusion of right middle cerebral artery
45
Warning signs of stroke
- FAST
| - beyond FAST
46
Modifiable risk factors of ischemic stroke
1. Hypertension
2. Smoking
3. Dyslipidemia
4. Diabetes
5. Weight, diet, nutrition
6. Physical inactivity
7. Alcohol use
47
Disease specific risk factors of ischaemic stroke
1. Atrial fibrillation
2. Carotid artery disease
3. Obstructive sleep apnea
48
Diagnosis delirium
Using CAM algorithm (4 features- MIDC)
| Requires1 and 2 and either 3 or 4
49
2 screening questions for depression
1. Depressed mood?
| 2. Anhedonia?
50
Otic disc shows bulging and blurred margins
Papilledema
51
Optic disc shows pallor
Optic atrophy
52
Fundoscopy shows optic cup enlargement
Glaucoma
53
Prechiasmal /anterior defects→scotoma, unilateral total blindness causes:
Causes:
- glaucoma
- retinal emboli→ischemia
- optic neuritis (w/ poor visual acuity)
54
Bilateral hemianopsia
Lesion at optic chiasm←pituitary tumor
55
Homonymous hemianopsia/ quandrantanopsias with normal visual aquity
Postchiasmal lesion in the occipital/parietal←stroke
56
1. Large pupil reacts poorly to light/ anisocoria worsens in light
2. If with ptosis and ophthalmoplegia also present
a. Person awake
b. Comatose
1. Large pupil→abnormal pupillary constriction→CNlll palsy
2. a) intracranial aneurym
b) transtentorial herniation
57
Both pupil react to light and anisocoria worsens in darkness
Smaller pupil→abnormal dilation→horner syndrome and simple anisocoria
58
Nystagmus is seen in
1. Cerebellar disease w/ gait ataxia and dyarthria
2. Vestibular disorder
3. Internuclear ophthalmoplegia
59
Difficulty clenching the jaw
Masseter weakness
60
Difficulty moving the jaw to the opposite side
Lateral Pterygoid weakness
61
Jaw deviation during opening
Weakness on the deviating side
62
1. Unilateral weakness of temporal and masseter muscle
| 2. Bilateral weakness
1. CN V pontine lesion
| 2. Bilateral hemispheric disease
63
Corneal reflex Blinking absent in both eyes
CN V
64
Absent blinking and sensorineural hearing loss
Acoustic neuroma
65
Drooping in upper and lower face(unilateral/bilateral), hyperacusis, increase or dec in tearing
Peripheral injury to CN VII →Bells palsy (affects ipsilateral side)
66
Vertigo with hearing loss and nystagmus
Meniere disease
67
1. Hoarse voice
| 2. Nasal voice
1. Vocal chhod paralysis
| 2. Paralysis of the palate
68
One side of the palate fails to rise and with the uvula pulled to the normal side
Unilateral lesson of CN X
69
Unilateral absence of gaf reflex
Lesion if CN IX
70
Any muscle weakness with atrophy and fasciculation
Peripheral nerve disorder
71
Should droop and scapula is displaced downward and laterally
Trapezius muscle paralysis
72
Difficulty raising head of the pillow
Bilateral weakness of SCM
73
Difficulty raising head of the pillow
Bilateral weakness of SCM
74
Tongue atrophy and fasciculation present in
In:
- amyotrophic khayal sclerosis
- past polio
75
CN used for articulation
CN V, VII, IX, X, and XII
76
Unilaterally cortical lesion→tongue presentation
Protruded tongue deviates away from the cortical lesion
77
CN XII lesion presentation
Protruded tongue deviates to the weak side
78
Marked floppiness in a handshake
Hypotonia/flaccidity→ peripheral motor disorder
79
Spasticity
- Velocity depend, ↑tone that worsen at the at extreme ranges
- central corticospinal tract disease
- rate dependent
80
Rigidity
↑resistance throughout the range of motion
| Not rate dependent
81
Increased bulk with diminshed strength→pseudohypertrophy seen in
Duchenne muscular dystrophy
82
Flexion of the elbow
Biceps and brachioradialis- C5,6
83
Extension of elbow
triceps- C6,7,8
84
Wrist extension
Extensor carpi radialis Longus and brevis- C6,7,8, radial nerve
85
Grip strength
C7,8, T1
86
Finger abduction
C8,T1 upbeat nerve
87
Opposition of the thumb
C8, T1 and median nerve
88
Flexion at the hip
L2,L3, LA→Iliopsoas
89
Hip adduction
Adductors→ L2,3,4
90
Hip abduction
Gluteus medius and minimus→L4,5, S1
91
Knee extension
L2,3,4 (quadriceps)
92
Knee flexion
L4,5, S1, S2 (hamstring)
93
Dorsiflexion
| Plantar flexion
1. L4, L5 (tibialis anterior)
| 2. S1 (gastrocnemius)
94
Features of cerebellar disease
Dysarthria, nystagmus, ataxia, hypotonia
95
Test to assess coordination
1. Rapid alternating movement
2. Point to point movement
3. Gait
4. Stance
96
Cerebellar disease
1. Dysdiadochokinesis
2. Dysmetria
3. Past pointing with eyes closed
4. ataxia
5. Difficulty hoping
6. +ve Romberg test wether eyes are open/ closed →cerebellar ataxia
7. Test pronator drift→arm return to original position but overshoots
97
Corticospinal tract damage
1. Inability to heel walk
| 2. Pronator drift→ lesson in contralateral hemisphere
98
Distal leg weakness
Difficulty Walking on toes
99
Test proximal leg weakness
1. Difficulty in shallow knee bend
| 2. Difficulty in rising from during position without atm support
100
dorsal column disease
```
+ve Romberg's test→ ataxia
Loss of vibration
Loss of position
Asrereognosis
Agraphanesthesia
Impaired 2 point discrimination
```
101
Evaluate sensory system
1. Test pain and temp (spinothalamic tract)
2. Position and vibration (posterior dorsal col)
3. Light touch (both)
102
Asymmetric distal sensory loss (stoking glove)
Diabetic(alcoholism) polyneuropathy
103
Causes Dorsal column diseases include
1. Tabes dorsalis
2. Multiple sclerosis
3. Vit B12 deficiency
104
Lesion in serenity cortex presents:
1. Asrereognosis
2. Agraphanesthesia
3. Impaired 2 point discrimination
4. Inability to localize points
5. Extinction of stimulus contralateral to damage cortex
105
Lesion in descending corticospinal tract
1. Hyperreflexia
| 2. Upper motor neurons disease: weakness, spasticity/ +ve Babinski sign( L5, S1)
106
Lesion of nerve root, nerve, plexuses/peripheral nerve presents
1. Hyperreflexia
| 2. Lower motor neuron disease: weakness, atrophy, and fasciculation
107
Reflexes and their innervation
```
Biceps reflex→ C4, C5
triceps reflex→ C6, C7
Brachioradialis → C5, C6
Patellar reflex→ L2,3,4
Achilles reflex's→ S1
```
108
When do you test for clonus?
-Only when reflexes are hyperactive
109
Meningitis signs
1. Nuchal rigidity (spinal nerves)
2. Brudzinski ( femoral nerve)
3. Kernig sign (sciatic nerve)
110
What is asterixis?
Brief nonrhythmic flexion of the hands and fingers followed by recovery
111
And what is the cause of asterixis?
metabolic encephalopathy,→Abnormal functioning of diencephalic motor centers→impairs muscle tone and posture→in liver disease, hypercapnia and uremia
112
Arousal pathway
- ascending reticular activating system of the brainstem→thalamus→cortex
113
Approach to comatosed patient
1. Assess and stabilise ABC
2. establish patients level of consciousness
3. Neuro exam
4. Interview relatives fir history
114
Cardinal don'ts
1. Don't dilate pupil
| 2. Don't flex neck
115
Neuro exam for comatosed patient
1. Resp rate, rhythm, pattern
2. Pupil light reaction
3. Check for gaze preference
4. Check oculocephalic reflex (doll eye movement)
5. Oculovestibular reflex
6. Check posture and tone
7. Further exams
116
Brainstem damage
- absent doll eye movement/ oculocephalic reflex
| - no oculovestibular reflex
