Week 2 Neuro

Question 1

Cerebellar disorders

Answer 1

Ataxia, decreased tendon reflexes, asthenia, tremor, nystagmus

Question 2

Spinal cord: ascending tracts

Answer 2

Pain-temp, proprioception, light touch

Question 3

Spinothalamic tract

Answer 3

Pain-temp, light touch. Crosses over to other side then ascends to thalamus and cerebral cortex on opposite side.
*lesion in this tract –> loss of pain-temp sensation contralaterally, below level of lesion.

Question 4

Damage to upper motor neurons

Answer 4

Hypertonia/spasticity, decreased motor control, spastic reflexes, +Babinski

Question 5

Damage to lower motor neuron

Answer 5

Hypotonia, weakness, decreased reflexes in affected areas

Question 6

+ Babinski

Answer 6

UMN lesion. Abnormal dorsiflexion of great toe and fanning of other toes

Question 7

Gray matter

Answer 7

Neuronal cell bodies and synapses

Question 8

White matter

Answer 8

Ascending: sensory info to brain

and descending: motor instructions from brain

Question 9

Spinocerebellar tract

Answer 9

Does NOT cross the spinal cord therefore ipsilateral symptoms. Receives afferent from periphery.

Question 10

Spinothalamic tract

Answer 10

Crosses spinal cord immediately, therefore contralateral sxs

Question 11

Descending tracts

Answer 11

Extends from motor area of cerebral cortex through brain stem, cross at medial lemniscus, synapse in anterior horn of spinal cord
UMNs and LMNs

Question 12

UMN

Answer 12

Pathway from brain to spinal cord before synapse. Do not directly stimulate target muscle

Question 13

LMN

Answer 13

Post synaptic pathway from spinal cord to periphery. Directly stimulate target muscle

Question 14

Diencephalon

Answer 14

All structures with “thalamus”: thalamus, hypothalamus, epithalamus, subthalamus.
Connects endocrine with nervous and limbic systems

Question 15

Disorders of basal ganglia

Answer 15

Parkinsonism: tremors (degeneration of this and substantia nigra)
Chorea: sudden, jerky, purposeless movements
Athetosis: slow writhin, snake like movements
Hemiballismus: Wild flail of one arm

Question 16

Review of sys questions for neurological patient

Answer 16

Pain
HEENT: HA, vision chnages, dizziness
Neuro: tremor, weakness or sensory loss, LOC, motor dysfunction, speech/swallowing issue

Question 17

Mental status exam

Answer 17

Family hx of memory loss
Orientation
General info
Spelling

Question 18

Cranial nerves

Answer 18

CN 7: have them smile to test for stroke

Question 19

Basic labs

Answer 19

CBC, CMP, TSH, bedside glucose

Lumbar puncture, CT, MRI

Question 20

Ischemic stroke

Answer 20

Due to thrombosis (or emboli, lacunar, TIA)

Sxs: embolic– acute onset, during day, headache precedes neuro deficit
Thrombotic–slower onset, during night, without headache/pain/fever
Lacunar–hemiparesis

Question 21

Risk factors for stroke

Answer 21

Prior stroke, age, male, smoking, cocaine, family history

Question 22

Labs for ischemic stroke

Answer 22

1st: CT
2nd: MRI
3rd: bedside glucose testing

Question 23

Hemorrhagic stroke

Answer 23

Intracerebral and subarachnoid. 20% of strokes

Question 24

Intracerebral hemorrhage

Answer 24

Usu HTN (trauma, brain tumor)
Sxs: headache, nausea, impairment of consciousness 

Severe presentation!

Question 25

Subarachnoid hemorrhage

Answer 25

Usu ruptured aneurysm Sxs: sudden, severe headache with LOC, severe neurologic deficits, seizures

Question 26

Delirium

Answer 26

Sudden, days-weeks, due to infection/dehydration/drugs, reversible, poor attention May be changes in personality, confusion

Question 27

Dementia

Answer 27

Slow, progressive, LOC not impacted Etiology: Alzheimer's, vascular, Lewy Body, Parksinson Dz, HIV assoc dementia, frontotemporal dementia

Question 28

How to diagnose dementia?

Answer 28

History w mental status, PE with complete neuro, TSH/B12/CBC/LFT/HIV, CT/MRI Requires: 1. Cognitive or behavioral changes (aphasia, agnosia, apraxia) 2. Decline 3. Rule out delirium

Question 29

Alzheimer's Disease

Answer 29

Beta amyloid deposits and neurofibrillary tangles (tau) and Ach def. Must be >40yrs to be diagnosed. Half of people >85 yrs. Risk factors: age, family history, trisomy 21

Question 30

To diagnose Alzheimer's Dz

Answer 30

``` Dementia established clinically Deficits in > 2 areas of cognition Gradual onset and progressive worsening of memory No disturbance of consciousness Onset after 40, most after 65 yrs No systemic or brain disorders ```

Question 31

Risk factors for vascular dementia

Answer 31

HTN, DM, hyperlipidemia, smoking, strokes

Question 32

Vascular dementia signs and symptoms

Answer 32

Exaggerated DTRs, gait abnormalities, hemiplegias History: of stroke(s)!

Question 33

Lewy body dementia

Answer 33

Lewy bodies in cytoplasm of cortical neurons. Cognitive and extra pyramidal Sxs within one year. Rigidity of axial muscles with gait instability, symmetrical deficits, tremors

Question 34

Parksinson Dz Dementia

Answer 34

Motor Sxs then 10-15years later cognitive Sxs. Psychiatric Sxs uncommon Definitive diagnosis requires autopsy