Jhusom Neurology Precede Exam Flashcards

Front 1

NAME & DEFINE:

3 major features of Parkinson's

Back 1

1. Bradykinesia - slowed movement
2. Hypokinesia - reduced amplitude
3. Dysrhythmia - loss of rhythm

Front 2

HOW:

Could one enhance a Parkinsonian rest tremor?

Back 2

By distracting the patient (making them subtract 3s, for example)

Front 3

NAME:

The 4th cardinal component of Parkinsonism

Back 3

"Loss of Postural Reflexes" = postural instability not caused by issues with cerebellum, vision, vestibular system, etc .... can use a "pull test" to assess

Front 4

NAME:

A possible consequence of levodopa treatment in advanced Parkinson's patients

Back 4

Can develop a levodopa induced dyskinesia ... which is choreiformic in nature

Front 5

WHERE:

Would you place an implant for DBS?

Back 5

Subthalamic nucleus (STN) implant

Front 6

NAME:

Events favoring an Epileptic Seizure vs. a Psychogenic Non-Epileptic Seizure (PNES)

Back 6

EPILEPTIC SEIZURES
--aura
--brief duration (1-2 mins)
--post-ictal confusion
--abnormal posturing
--amnesia for the event
--incontinence
--events arising from sleep
--self injury (lateral tongue biting)
--eyes open at the onset of the event

PNES
--specific nontraditional triggers (aka not photic stimulation or hyperventilation)
--event occurs in waiting or examination room
--histrionic behavior during exam
--rapid cognitive post-ictal recovery
--ability to induce seizure
--presence of fibromyalgia, chronic pain, chronic fatigue

Front 7

EXPLAIN:

When light is shined on the left eye, that eye constricts. When the light is swung to the right eye, the right eye dilates.

Back 7

Indicates a right afferent pupillary defect

Front 8

WHAT:

Causes obstructive sleep apnea

Back 8

Narrowing of the airway leading to obstruction of air flow during sleep

Front 9

HOW:

Does the modified Mallampati 2 Classification System predict risk of sleep apnea

Back 9

By relating tongue size to pharyngeal size

Front 10

NAME:

3+/5 medical associations with sleep apnea

Back 10

1. Increased age
2. Obesity
3. Craniofacial/soft tissue abnormalities
4. Endocrine Disorders
5. Hypothyroidism

Front 11

NAME:

Possible hypersomnias to consider in a patient if sleep disordered breathing is not present

Back 11

Idiopathic hypersomnia
Narcolepsy

Front 12

WHAT:

Scores on an Epworth Sleepiness Scale indicate excessive daytime sleepiness?

Back 12

10+ = excessive sleepiness
18+ = severe sleepiness

Test is out of 24 (8 situations rated 0-3)

Front 13

NAME:

Current gold standard for evaluating sleep fragmentation and determining etiology

Back 13

Polysomnography (PSG)

Front 14

WHAT:

Is a normal Apnea/Hypopnea index

Back 14

<5/hour

Front 15

NAME:

Things to question a patient about when he/she present with sleep compaints

Back 15

--Sleep hygiene (bedtime, rise, caffeine, meds, exercise, distractions)
--h/o insomnia
--head trauma
--hallucinations
--sleep paralysis
--cataplexy

Front 16

WHAT:

Parts of sleep does patients with restless leg syndrome have difficulty with

Back 16

Both initiating sleep and maintaining sleep

Front 17

NAME:

Conditions known to make restless leg syndrome worse

Back 17

Iron Deficiency!
Kidney disease
Pregnancy

**patients with RLS are associated with an increased risk of depression/anxiety which is relevant as >>>most anti-depressants make RLS worse<<<

Front 18

STATE:

Prevalence/Demographics of restless leg syndrome

Back 18

2.5-10% in western industrialized countries

Equal rates between boys and girls

More common post-puberty in women (potentially due to increased risk of iron deficiency

Front 19

STATE:

How the following causes of leg discomfort would present differently from RLS
1. Nocturnal leg cramps
2. Peripheral neuropathy
3. Arthritic or muscle pains
4. Peripheral vascular disease

Back 19

1. unilateral, sudden onset
2. no relieved by movement, accompanied by additional neuropathic sx like numbness/tingling/pain
3. tends to be stiffness brought on by immobility, so can be relieved by movement, but would be seen at any time of day and particularly worse in the morning
4. discomfort made worse by movement

Front 20

WHAT:

Are the following tests best used for:
1. PSG
2. MSLT
3. MWT

Back 20

1. Sleep apnea
2. Diagnose excessive sleepiness or REM problems
3. Used to determine the success of therapy helping excessive daytime sleepiness

Front 21

HOW:

Long does it take to realign the circadian rhythm to night shift work

Back 21

5-6 days (~90 minutes per day)

Front 22

DEFINE:

Zeitgebers

Back 22

Factor in the environment with a periodicity capable of synchronizing the endogenous circadian rhythm into a 24-hour cycle

Front 23

HOW:

Much less sleep do night-shift workers get compared to daytime working peers

Back 23

10 hours less per week

Front 24

WHAT:

Percentage of patients admitted to the EMU have both PNES and epileptic seizures

Back 24

5-15%

Front 25

WHAT:

Is the effect of stress on the following:
1. MS
2. Memory
3. Cortisol

Back 25

1. Sometimes linked to exacerbations (additionally stress management has shown significant reduction in enhancing lesions)
2. Negatively affects consolidation of short/long term memory, spatial memory, navigation
3. Increases corisol

Front 26

WHAT:

Brain volume changes are observed in stress and under what situations do they reverse

Back 26

Stress assocaited with decreased volume of hippocampus and amygdala

--> decrease in cortisol levels reverses hippocampal atrophy

--> whereas adding cortisone decreases recall

Front 27

WHAT:

Percentage of medical students experience
1. burnout
2. SI

Back 27

1. 50%
2. 10%

Front 28

WHAT:

Do the following tests assess
1. Life Orientation Test
2. Pearlin's Personal Mastery Scale
3. Rosenberg Self-Esteem Scale

Back 28

1. optimism - favorable expectations
2. mastery - belief in bringing about desired outcomes
3. self-esteem - evaluation of self-worth

Front 29

HOW:

Can one increase optimism

Back 29

Best Possible Scenario mental imaging

Front 30

WHAT:

Genetic factor is related to increased psychological resources

Back 30

Oxytocin receptor gene (OXTR)

Front 31

DEFINE:

Eustress

Back 31

A positive/adaptive response to a stressor

Front 32

HOW:

1. Many deaths per year are the result of misdiagnosis?

2. Much does one's risk of death increase with a misdiagnosis

Back 32

1. 40-80k

2. 2-5 times

Front 33

WHAT:

Percentage misdiagnosis rate is consistently found at necropsy

Back 33

50%

Front 34

STATE:

With regards to mental status changes, what is the differential for a (1) Chronic/Slowly Progressive Course vs. (2) an Acute/Subacute Progression

Back 34

1. think neurodegenerative disorders (dementia)

2. consider toxic vs. metabolic vs. infectious vs. medications

Front 35

DESCRIBE:

The two major types of aphasia and what region of the brain is responsible for each

Back 35

1. Expressive aphasia = Broca's (think broken speech, can't get words outs) ... also described as a nonfluent aphasia >>>> FRONTAL LOBE <<<<

2. Receptive aphasia = Wernicke's (think word salad, lots of random words) ... also described as fluent aphasia >>>> PARIETAL LOBE <<<<

Front 36

DEFINE:

Dysarthria

Back 36

Motor dysfunction leading to aphasia (thus is a "secondary aphasia")

Front 37

DEFINE:

Apraxia

Back 37

Inability to follow a motor command (not due to primary motor disorder or language impairment)

Front 38

NAME & DEFINE:

Frontal Release Signs

Back 38

Are patterned behavior reflexes present in infancy that are normally inhibited in adulthood by the frontal lobe ... but reappear after damage

Include: snout reflex, root reflex, palmomental reflex

Front 39

LOCALIZE:

CN abnormality

Back 39

= above spinal chord

Front 40

LOCALIZE:

CN + ipsilateral deficit

Back 40

= supranuclear (eg stroke)

Front 41

LOCALIZE:

CN + contralateral deficit

Back 41

= brainstem (eg stroke, tumor)

Front 42

LOCALIZE:

CN V-VIII + contralateral deficit

Back 42

= cerebellopontine angle (eg tumor)

Front 43

LOCALIZE:

Unilateral CN IX-XI abnormality

Back 43

= jugular foramen (tumor)

Front 44

LOCALIZE:

Unilateral CN III, IV, V, VI abnormality

Back 44

= cavernous sinus

Front 45

NAME:

Disorders associated with hyposmia

Back 45

Dementia, Parkinson's dz, B12 deficiency

Front 46

HOW:

Would you diagnose conversion disorder in a patient with anosmia

Back 46

Anosmia to ammonia is due exclusively to CN V

Front 47

DIAGNOSE:

Unilateral anosmia

Back 47

Suspect subfrontal tumor

Front 48

LOCALIZE:

Tunnel Vision (pt reports the same size area of perception regardless of how far from the testing screen the examination is performed)

Back 48

Conversion Disorder

Front 49

LOCALIZE:

Bitemporal loss

Back 49

Lesion at chiasm

Front 50

LOCALIZE:

Bilateral Visual Field loss

Back 50

= AT or POSTERIOR to chiasm

Front 51

LOCALIZE:

Unilateral Visual Field loss

Back 51

= ocular, retinal, optic nerve, or conversion

Front 52

LOCALIZE:

Afferent pupillary defect

Back 52

= optic nerve lesion anterior to chiasm

Front 53

LOCALIZE:

Bilateral small pupils that reduce in size when the patient focuses on a near object, but do not constrict when exposed to bright light

Back 53

-- accomodate but do not react

AKA Argyll Robertson (prostitute's) pupil

= midbrain lesion, specific for neurosyphilis (also diabetes???)

Front 54

DIAGNOSE:

32 yo otherwise healthy female with one abnormally dilated pupil which does not constrict in response to light, loss of deep tendon reflexes, and abnormalities of sweating

Back 54

= Adie's Syndrome

Thought to be the result of a viral or bacterial infection that causes inflammation and damage to neurons in the ciliary ganglion, an area of the brain that provides parasympathetic control of eye constriction

Front 55

DIAGNOSE:

Upgaze difficulties on EOM exam

Back 55

= stroke, or progressive supranuclear palsy

Latter = Progressive supranuclear palsy (PSP) is a rare brain disorder that causes serious and progressive problems with control of gait and balance, along with complex eye movement and thinking problems. One of the classic signs of the disease is an inability to aim the eyes properly

Front 56

DIAGNOSE:

Ptosis, EOM fatigue on EOM exam

Back 56

= neuromuscular

Front 57

DIAGNOSE:

EOM difficulties, optic neuritis on EOM exam

Back 57

= MS

Front 58

DIAGNOSE:

CN III Palsy

Back 58

= potentially ...
--aneurysm
--diabetic ophthalmoplegia
--ophthalmoplegic migraine

Front 59

NAME:

Roles of each CN V branch

Back 59

V1 = ophthalmic = forehead and corneal sensation/reflex

V2 = maxillary = infraorbital, palatal and upper teeth sensation

V3 = mandibular = chin, lower teeth, tongue sensation

Also facial sensation/muscles of mastication

Front 60

DISTINGUISH:

CN IV vs. X lesion

Back 60

CN IV = asymmetric palate elevation

CN X = asymmetric uvula deviation

Front 61

DISTINGUISH:

CN XII UMN vs. LMN lesion

Back 61

UMN = tongue away from lesion, weak, hyper gag reflex

LMN = tongue towards lesions, weak, fasculations

Front 62

DISTINGUISH:

Spasticity
Rigidity
Cogwheeling
Myotonia
Dystonia

Back 62

Spasticity = increased tone w/ sudden release
Rigidity = increased tone throughout range
Cogwheeling = intermittent catch
Myotonia = delay in muscle relaxation after activation
Dystonia = simultaneous activation of against/antagonist

Front 63

WHEN:

Would one see hypotonia

Back 63

With a LMN insult

Front 64

WHEN:

Would one see spasticity

Back 64

With UMN lesion

Front 65

WHEN:

Would one see dystonia

Back 65

With extrapyramidal abnormalities

Front 66

WHEN:

Would one see myotonia

Back 66

With myotonic muscular dystrophy

Front 67

WHEN:

Would one see rigidity

Back 67

With abnormalities to the extrapyramidal pathways, basal ganglia

Front 68

WHAT:

Is suggested by proximal vs. distal weakness

Back 68

Proximal = myopathy
Distal = peripheral neuropathy

Front 69

NAME:

Signs consistent with an UMN vs. LMN lesion

Back 69

UMN = weakness, NO acute atrophy, NO fasiculations, INCREASED reflexes, INCREASED tone

LMN = weakness, YES atrophy, YES fasiculations, DECREASED reflexes, DECREASED tone

Front 70

NAME:

Nerve and Dorsal Root of deltoid muscle

Back 70

axillary nerve, C5

Front 71

NAME:

Nerve and Dorsal Root of biceps muscle

Back 71

musculoskeletal nerve, C6

Front 72

NAME:

Nerve and Dorsal Root of triceps muscle

Back 72

radial nerve, C7

Front 73

NAME:

Nerve and Dorsal Root of brachioradialis muscle

Back 73

radial nerve, C6

Front 74

NAME:

Nerve and Dorsal Root of extensor carpi ulnaris muscle

Back 74

posterior interosseous nerve (branch of radial), C7

Front 75

NAME:

Nerve and Dorsal Root of extensor digitorium muscle

Back 75

radial nerve, C7

Front 76

NAME:

Nerve and Dorsal Root of dorsal interosseous muscle

Back 76

ulnar nerve, T1

Front 77

NAME:

Nerve and Dorsal Root of abductor pollicus brevis muscle

Back 77

median nerve, T1

Front 78

NAME:

Nerve and Dorsal Root of iliopsoas muscle

Back 78

lumbosacral plexus/femoral nerve, L1 L2

Front 79

NAME:

Nerve and Dorsal Root of hamstrings muscle

Back 79

sciatic nerve, S1

Front 80

NAME:

Nerve and Dorsal Root of tibialis anterior muscle

Back 80

deep peroneal nerve, L4 L5

Front 81

NAME:

Nerve and Dorsal Root of gastrocnemius muscle

Back 81

tibial nerve, S1

Front 82

NAME:

The dermatome corresponding to the following
Deltoid
Thumb
Index Finger
Small Finger
Nipple
Umbilicus
Great Toe
Lateral Foot

Back 82

Deltoid = C5
Thumb = C6
Index Finger = C7
Small Finger = C8
Nipple = T4/5
Umbilicus = T10
Great Toe = L5
Lateral Foot = S1

Front 83

DESCRIBE & DIAGNOSE:

Apraxic gait
Ataxic gait
Short steps w/ reduced arm swings
Spastic gait
Steppage gait
Waddling gait

Back 83

Apraxia = difficulty initiating gait = NPH
Ataxia = broad based and uncoordinated = cerebellar
Short steps = Parkinson's
Spastic = scissor like = bilateral UMN
Steppage = high knees, slap foot = peroneal palsy, L5 lesion
Waddling = pelvic/shoulder rotation = myopathy or muscular dystrophy

Front 84

WHAT:

Does no response to an attempt to elicit a plantar reflex indicate

Back 84

Unfortunately nothing ... patient could be normal, or could have super severe neuropathy or could have severe weakness

Front 85

NAME:

Functions controlled by the cerebellar midline vs. hemispheres

Back 85

Midline = tandem walking, hammer toe, shin scrape

Hemispheres = rapidly alternating movements, finger-nose-finger, limb ataxia

Front 86

NAME:

Focus areas of Physical Therapy

Back 86

transfers, gait, balance, wheelchair management, strengthening, functional mobility

also coma stimulation?

Front 87

NAME:

Inappropriate physical therapy consults

Back 87

--if patients are already focusing at baseline/premorbid level
--if pt is medically unstable
--if patient is sedated
--if pt is scheduled for OR within a few days

Front 88

NAME:

Focus areas of Occupational Therapy

Back 88

Maximize independence in ADLs and instrumental ADLs including interventions like splinting, self-care, home management training, cognitive retraining, adaptive equipment training

Front 89

WHEN:

Would the following be indicated
Helmet
Resting Hand Splint
Multipodus Boot
Elbow Extension Splint

Back 89

Helmet = hemicraniectomy
Resting Hand Splint = prolonged flaccidity, or increased tone, or hemiplegia/neglect
Multipodus Boot = flaccidity >1wk, or increased tone
Elbow Extension Splint = increased tone

Front 90

NAME:

Inappropriate OT consults

Back 90

--patient unable to participate because they are ... medically unstable ... on bedrest w/out splinting needs ... in coma without splinting needs
--patient scheduled for surgery soon
--patient already independent

Front 91

NAME:

The types of conditions evaluated by Speech Language Pathology

Back 91

many! swallowing, speech, language, cognitive, tracheostomy, alternative communication, voice disorders

Front 92

NAME:

Phases of a swallow

Back 92

oral phase --- pharyngeal phase --- esophageal phase

Front 93

NAME:

Most likely origins of dysphagia

Back 93

71% = brainstem lesions
14% = unilateral hemisphere lesions

Front 94

NAME:

Slippery slope consequences of dysphagia

Back 94

Upper airway obstruction
Aspiration pneumonia (NOTE: 20-50% mortality rate)
Dehydration
Death

Front 95

STATE:

What should happen to CVA pts with regards to SLP

Back 95

ALL CVA pts --> need swallow screen before initiating PO diet/meds

3 oz screen administered by doctors/nurses

Consult SLP as appropriate

Front 96

NAME:

The gold standard for evaluating swallowing function

Back 96

Videofluoroscopic Swallow Study ... AKA Modified Barium Swallow