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29 Cards in this Set
- Front
- Back
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Define:
Dysarthria Ataxia Dystonia Damage to which portion of the CNS will tend to cause these symptoms? |
Dysarthria - speech disorder characterized by poor articulateion
Ataxia - discoordinated muscle movements Dystonia - A slow movement or extended spasm in a group of muscles Cerebellum -- Dysarthria + Ataxia Deep cerebral structures -- Dystonia |
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Attentional disorders most often arise from damage to the _________. However, sensory-specific inattention, connections from the _________ to the _________ are implicated and in hemispatial inattention, the _________ portion of the _________ lobe is implicated.
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Attentional disorders most often arise from damage to the RETICULAR FORMATION. However, sensory-specific inattention, connections from the THALAMUS to the CORTEX are implicated and in hemispatial inattention, the INFERIOR portion of the PARIETAL lobe is implicated.
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The anterior portion of the frontal lobes can be split into the dorsolateral/medial areas and the orbitofrontal areas. Damage to the former causes disorders characterized by _________ and damage to the latter causes disorders characterized by _________.
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The anterior portion of the frontal lobes can be split into the dorsolateral/medial areas and the orbitofrontal areas. Damage to the former causes disorders characterized by INDIFFERENCE (even akinetic mutism) and damage to the latter causes disorders characterized by DISINHIBITION.
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Can you name the stimulus and response of the following frontal release signs (caused by diffuse cerebral dysfxn)?
A) Grasp reflex B) Snout reflex C) Rooting reflex D) Glabellar reflex E) Palmomental reflex |
A) Forced grasp on stimulation of palm
B) Puckering of lips on tapping the lips near the midline C) Rooting -- moving mouth towards stimulus; sucking -- stimulation of palate --> sucking D) Glabellar -- tapping roof of mouth --> repeated blinking E) Palmomental -- switch of ipsilateral jaw muscles following tapping on thenar eminence |
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_________ aphasia is primarily a disorder of fluency with intact comprension. _________ aphasia is primarily a disorder of comprehension, repetition and neologisms. _________ aphasia is primarily a disorder of repetition. _________ aphasias have variable presentation but may include reduction in spontaneous speech with intact repetition (motor) or impaired auditory comprehension with fluent output (sensory). _______ aphasia involves inability to name objects in confrontation.
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BROCA'S aphasia is primarily a disorder of fluency and repetition with intact comprension (MCA stroke). WERNICKE'S aphasia is primarily a disorder of comprehension, repetition and neologisms (embolus). CONDUCTION aphasia is primarily a disorder of repetition (arcuate fasciculus stroke). TRANSCORTICAL aphasias have variable presentation but may include reduction in spontaneous speech with intact repetition (motor) or impaired auditory comprehension with fluent output (sensory) (cortex around Broca's, Wernicke's). ANOMIC aphasia involves inability to name objects in confrontation (not well-localized; encephalopathy).
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An inability to read is called ________. When associated with aphasia it is common due to a lesion in the area between the ________ and ________ lobes; when associated with agraphia it involves the dominant (left) visual cortex and the splenium of the corpus callosum due to left ___ stroke.
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An inability to read is called ALEXIA. When associated with aphasia it is common due to a lesion in the area between the TEMPORAL and PARIETAL lobes; when associated with agraphia it involves the dominant (left) visual cortex and the splenium of the corpus callosum due to left PCA stroke.
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Quickly define the terms and mention where the reside in the brain:
A) Semantic memory B) Episodic memory C) Procedural memory |
A) Body of knowledge and facts independent of a particular episode of learning -- anterior temporal lobe
B) Anterograde and retrograde memories of events -- hippocampal/diencephalic system C) Capacity to improve with repetition of a task (motor learning, specifically, refers to motor tasks) - cerebellum and basal ganglia |
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______ refers to the inability to carry out a task despite intact sensation and motor abilities. Orobuccal ***** is associated with lesions to the inferior ______ lobe and the insula and commonly accompanies ______ aphasia. Progressive, isolated limb ****** is almost diagnostic of _________ degeneration.
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APRAXIA refers to the inability to carry out a task despite intact sensation and motor abilities. Orobuccal apraxia is associated with lesions to the inferior FRONTAL lobe and the insula and commonly accompanies Broca's aphasia. Progressive, isolated limb apraxia is almost diagnostic of CORTICOBASAL degeneration.
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Quickly define and name hte location of a lesion:
A) Astereognosis B) Visual agnosia C) Prosopagnosis D) Unilateral neglect E) Dorsal and ventral visual streams |
A) Astereognosis - no ID by touch -- contralateral parietal cortex
B) Visual agnosia - no ID by sight -- occipital/splenium of CC lesions C) Prosopagnosia - no ID of faces -- temporal/occiptal lobes, often bilaterally D) Unilateral neglect - contralateral hemisphere E) Carry info from occiput to rest of brain. Dorsal: location // Ventral: ID (goes to memory centers) |
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Which is NOT one of the primary symptoms of Gerstmann's syndrome?
A) Agraphia B) Conduction aphasia C) Acalculia D) Finger agnosia E) Right-left disorientation |
B
Associated with brain lesions in the dominant (usually left) hemisphere including the angular and supramarginal gyri near the temporo-parietal junction (due to stroke or other damage). [The angular gyrus is generally involved in translating visual patterns of letter and words into meaningful information, such as is done while reading.] |
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Which is NOT one of the five main presentation of insular strokes?
A) Somatosensory deficits (pseudothalamic) B) Gustatory disorder (funny/unpleasant taste) C) Balance disorder D) Hypertensive disorder E) Hypoglycemic disorder F) Neuropsychological disorder -- aphasia, dysarthria, transient somatoparaphrenia (denying ownership of one-half of body) |
E
Hyperglycemia and loss of interest in smoking are other, rarer manifestations. |
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Which is NOT a cause of alien hand syndrome?
A) Damage to the anterior corpus callosum B) Damage to the insula C) Damage to the parietal lobe D) Corticobasal degeneration E) Creutzfeldt-Jakob disease |
B
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Define and name a few symptoms of each lesions:
A) Conus medullaris lesion B) Brown-Sequard syndrome C) Central cord lesion |
A) The conus medullaris consists of S3-5+Cocc1 roots --> incontinence, impotence and anesthesia; no radiculopathy, symmetrical, pain/temperature most affected.
B) Hemisection of cord -- loss of position/vibration/fine touch/motor ipsilateral; loss of pain/temp contralateral C) Central cord lesion -- most often at low cervical regions: picks off pain/temp @ level first, then reflexes, then motor neurons (all @ lesion), then gets the spinothalamic tract beginning at the level of the lesion and moving caudally (--> sacral sparing) |
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Explain a bit about each disorder:
A) Subacute combined degeneration B) HIV myelopathy C) Tropical spastic paraparesis |
A) B12 deficiency: degeneration of dorsal columns and pyramidal tracts (DDx w/MS) beginning in thoracic levels.
B) Causes degeneration of the dorsal columns/pyramidal pathways w/vacuolar change C) A nasty disease caused by human t-cell lymphotropic virus-1 (HTLV-1); causes pyramidal and dorsal column degeneration via an immunogenic mechanism |
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Give an example of each of the following. Which of the following is most-likely benign? Which is rarest?
A) Intramedullary tumor B) Extramedullary intradural tumor C) Extramedullary extradural tumor |
A) Rarest: ependyoma (DDx w/syringomelia -- epen. has a more rapid progression)
B) Likely benign: meningioma + neurofibroma C) Metastases |
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Neuro Exam misc. 1:
A) Define praxis, what does it test? B) Gerstmann Syndrome (agraphia, acalculia, R-L disorientation, finger agnosia) results from damage where? C) Hyperacusis means what? Damage to which cranial nerve besides VIII may cause it? |
A) Praxis -- putting an action into practice; apraxia in Parkinson's
B) Dominant (usu. left) parietal cortex C) Increased sensitivity to sound, often due to a malfxning stapedius; VII lesions can cause it. (fyi, brainstem and VIII lesions can also cause it -- and so can V lesions -- the medial pterygoid nerve innervates the tensor tympani, which dampens sounds generally during chewing) |
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Given a lesion to the right _th cranial nerve, the _____ will deviate to which side?
A) V; jaw B) X; uvula C) XII; tongue |
A) Right
B) Left C) Left |
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Tuning fork tests:
Which involves in the vertex of the cranium? Which tuning fork test involves the mastoid process? |
Weber
Rinne |
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How may one quickly assess the parasympathetic output of the vagus nerve (together, not separately)?
What pattern of muscle weaknesses is associated with UMN lesions? With myopathies? |
Observe HR change w/inspiration
UMN lesions -- weak upper limb extensors, lower limb flexors (muscles that are weaker to begin with) Myopathies -- proximal muscle weakness |
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Neuro exam misc 2 - quick definitions:
A) Cogwheel rigidity B) Gegenhalten rigidity C) Epicritic D) Jendrassik maneuver |
A) Like a ratchet (Parkinson's)
B) Stop and go rigidity (Dementia) C) Position and vibration sense (dorsal columns) D) Clasping hands to strengthen reflexes |
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Neuro exam potpourri 3 -- define:
A) Dysdiadokinesis B) Describe two quick tests to assess hypotonia C) Festinating gait D) Astasia-abasia E) Slapping gait |
A) Rapid alternating movements
B) i - push shoulders, see if one arm moves more; ii - rebound test - have patient put upward force to examiner's arms, then remove resistance -- look for arm swinging C) Gait in which the trunk is flexed, legs are flexed at the knees and hips, but stiff, while the steps are short and progressively more rapid (Parkinson's) D) Gait with swaying but no falling E) Slapping the foot against the ground w/each step to increase proprioception (as in tabes dorsalis) |
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Movement Disorder Potpourri I:
A) Define dystonia B) Ballismus is often caused by damage where in the brain? C) What characteristic do tics display with regard to conscious inhibition? D) Define dyskinesia |
A) Sustained muscle contraction twisting/turning around one joint
B) The subthalamic nucleus (it is normally inhibited by basal ganglia --> Gp Externa --| STN --> GpI --| VA/VL) loss of fxn leads to underinhibition --> hemiballismus C) Rebound -- they get worse afterward D) Involuntary mvmts seen in pts w/Parkinson's on dopaminergic Rx |
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Which is FALSE as regards essential tremor?
A) It's often inherited in an AD pattern B) It's often a sign that a patient will go on to develop Parkinson's C) It may be treated with primidone D) It may be treated with propanolol E) Deep-brain stimulation should taget the thalamic ventrointermediate nucleus |
B
Constipation + agnosia, actually, may precede the disease by 5-10 years |
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Which is NOT associated with the development of PD or Parkinsonism?
A) Herbicides/pesticide exposure B) Well water consumption C) Repeated head injury D) Antiemetics E) Promotility agents F) Multiple infarcts to the basal ganglia G) Subthalamic nucleus infarcts |
G
Infarcts in the subthalamic nucleus classically cause ballismus |
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Which is FALSE as regards corticobasal degeneration?
A) It's a Parkinson-plus syndrome B) Its onset is usually symmetric C) The characteristic early finding is apraxia D) It may transition to Alien Hand and the dystonia E) Microscopic findings: ballooned neurons and tau pathology in cortex, BG and SN |
B
Corticobasal degeneration (CBD) has a characteristic asymmetric onset |
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Which is FALSE as regards progressive supranuclear palsy (PSP)?
A) Characterized by gait disturbance and frequent falls B) Nonspecific personality changes common C) Gaze palsy, dysarthria and dysphagia are common D) Not readily treated by medications but slow progression E) Pathology: phosphorylated tau protein --> diffuse unpaired globose neurofibrillary tangles |
D
There's a rapid progression. Supranuclear palsy refers to the gaze palsy happening above the CN nuclei. Good mnemonic for this one -- imagine someone walking around obsessed with the Sony PSP (personality change, frequent falls, gaze palsy, trouble talking + eating) |
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What are a few things that differentiate Multiple System Atrophy (MSA) from PD? What is associated with each of the following types?
MSA-A MSA-P MSA-C |
Some tremor, but not clear PD presentation; rapidly progressive; no response to PD meds; brainstem atrophy on MRI sometimes.
MSA-A: Autonomic pathology MSA-P: Parkinsonian predominance MSA-C: Cerebellar predominance |
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Which is FALSE as regards Wilson's disease?
A) AD, found on chromosome 13 B) Defect in ATP7B gene, leading to no delivery of copper to ER, and copper build-up in cells C) Tremor, dystonia, ataxia and dysarthria are its cardinal manifestations D) Deposits can be seen in the eye (Kayser-Fleischer rings in Descemet's membrane) and the brain (basal ganglia, thalami) E) Treatments include copper reduction in diet, zinc, penicillamine or trientene |
A -- AR
Triethylenetetramine (copper chelation), penicillamine (copper, cysteinuria, mercury) -- chelating agents |
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Describe the difference in mechanism between GABA-A and GABA-B receptors.
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GABA-A -- chloride channels (benzos, barbituates) // GABA-B -- Gs linked to K+ channels (baclofen)
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