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346 Cards in this Set
- Front
- Back
constant flexion of all limbs
|
position of comfort
|
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bell palsy's
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unilateral CN 7 palsy
|
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Pathway of center of gravity
|
1. extremely smooth movement
2. has vertical displacement of 2 inches 3. has side to side displacement of 2 inches 4. will make a "figure 8" in space |
|
gait cycle
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stance phase 40%; swing phase 60%
1. heel contact 2. foot flat 3. mid stance 4. heel off 5. toe off (right after this, the leg goes into swing phase (last 40% of cycle)) |
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step length
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distance between right and left foot after one step
|
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stride length
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distance between 2 placements of the same foot
|
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vertical displacement when walking
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2 inches
|
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Manual muscle exam (range of motion)
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0- total paralysis
1- palpable or visible contraction 2-active movement- full ROM, eliminated w/ gravity 3-active movement- full ROM against gravity (not resistance) 4-moderate resistance 5-full resistance, normal strength |
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Paralyses
|
1-quadriceps paralysis
2-ankle dorsiflexion (L4 lesion tibialis anterior mm); patient has foot drop; patient uses steepage gait 3-flaccid hemiplegia (stroke patient); patient's leg moves in semicircular fashion 4-Trendelendurg gait (gluteus medius paralysis); patient's pelvis drops on side opposite the lesion; associated w/ abductorsof leg |
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Charcot-Marie_Tooth
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Peroneal nerve disease
|
|
compass gait
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jerky walking movement; represents walking if person had sticks for legs w/ pelvic rotation
|
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Tibiofemoral angle
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important in lateral displacement
|
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Parkinson's Disease
|
Shuffling gait
T for tremor (resting) R for rigidity A for akinesia P for posture instability ( most important to PM &R) |
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Multiple sclerosis
|
intention tremor
|
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Scissors gait
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associated with cerebral palsy and spastic diplegia
|
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Cerebral palsy
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cerebrum defect of multiple cause; occurs before during or after birth; patient talks a lot and has difficult use of limbs
|
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Becker
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Xp21
A qaulitative abnormality in dystrophin proteins molecular weight benign |
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Duchenne
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1. lack of dystrophin
2. gower sign 3. pseudohypertrophy (big fatty calves) 4. Late walker (3-6) with stumbling 5. Stop walking at about 10 y/o 6. Spine develops sclerosis, osteoporosis after loss of walking ability 7. death: pneumonia and proximal weakness |
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Muscular dystrophy
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associated with wide limb gait
|
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autonomic dysreflexia
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1-vasomotor response to the noxious stimuli below the level of injury
2-occurs in patient's w/ an injury at T6 or above 3-noxious stimuli- bladder distension, blocked catheter, overfilled drainage bags, UTI, stones 4-signs &symptoms- migraine headache, incr BP, flushing, diaphoresis above level of injury, goosebumps |
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Treatment of autonomic dysreflexia
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1- have person sit upright
2- in and out cath disimpactation -> slowly remove noxious stimuli 3-monitor BP, give Ca channel blocker to prevent stroke |
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Alzheimers Disease is a complication of patient w/ above T6 injury when given anesthesia. Should use....
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1-general anesthesia + halothane
or 2-local nerve block or 3-spinal anesthesia |
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patient w/ altered sensorium after being dehydrated w/ peripheral LM symptoms and MCV of 101
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symptoms are due to pernicious anemia
|
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most common cause of adult disabilities
|
stroke
|
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which should you check for before treating a quadiplegic w/ headaches
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none of the above
|
|
phantom pain is
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psychogenic pain
|
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anti-spasticity meds are indicated in stroke patients with
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all of the above
|
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which is not true with Guillan Barre syndrome
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axonal neuropathy predominates
|
|
25 year old female w/ spinal cord injury
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tell her that fertility will be normal and menses will return within 6 mths
|
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shortened pedicles secondary to
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abnormal posterior development ....
|
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running back w/ transient quadriplegia
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due to spinal stensosis
|
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which is seen w/ vascular claudication but not with neurologic claudication
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early onset of pain w/ walking uphill
|
|
phase of a motor unit
|
is related to collateral nerve sproat conduction
|
|
pain does not travel in which of the following
|
A alpha and B fibers
|
|
Brown sequard syndrome is seen with
|
fracture dislocation of L3
|
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Patient with ASIA A classification spinal cord injury w/ fever
|
do urinalysis and blood culture first
|
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sexual intercourse
|
requires 5 METS
|
|
the gate control theory of pain explains all of the following except
|
the anti-inflammatory response
|
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what ASIA scale is a female mobile with a walker
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Class D
|
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Leading cause of spinal cord injury in women
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motor vehicle collision
|
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which is not seen in pain
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changes in lymphatic clearing
|
|
the outcome of stroke rehab is affected by
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all of the following
|
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which is not a component autonomic hyperreflexia
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history of headaches
|
|
autonomic dysreflexia is seen woth spinal cord injuries of level
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above T6
|
|
parasympathetic supply to the bladder
|
S2-4
|
|
Which is contraindication to Tx w/ tPA
|
distant history of gastritis
|
|
in spinal injury above the level of T6
|
body temp varies w/ ambient temp
|
|
7 yr old boy
|
1.non-communicating hydrocephalus
2. radiosensitive 3. pineal region 4.Perinaud's syndrome |
|
25 yr old w/ HIV and ring enhancing lesion
|
1. CNS lymphoma
2. cerebral toxoplasmosis |
|
25 yr old w/ HIV and nonenhancing mass
|
low grade glioma
|
|
Treatment for AV malformation
|
1. surgical excision
2. anti-convulsants |
|
Brainstem glioma
|
1. radiation therapy and steroid TX
2. rarely treated w/ surgery 3. causes increased ICP late 4. causes CN signs on the same side of mass 5. may be biopsied when well circumscribed 6.cause crossed CN and corticospinal tract dysfxn |
|
cervical spine x-rays in trauma
|
1. should include C7-T1
2.flex-extension film is part of series 3. x -ray of cervical spine may be supplemented by CT scan |
|
associated w/ communicating hydrocephalus
|
1. chronic meningitis
2. sarcoidosis 3. |
|
Duchenne Erb Palsy
|
1. Weakness of the biceps mm
2. the arm hangs limp at the side and the biceps jerk is lost |
|
Tx for convexity meningioma
|
1. steroids are used to reduce vasogenic edema
2. complete excision w/ dural attachment is pallative (possible) |
|
anterior cord syndrome
|
loss of motor, pinprick, temp
|
|
for patient w/ trauma where is injury
|
at level where strength first decreases
|
|
heel strike phase of gait
|
pretibial muscles
|
|
no hypotension seen in
|
autonomic hyperreflexia
|
|
autonomic hyperdysreflexia seen in which injuries
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above T6
|
|
intial spinal cord injury workup
|
UA and cultures
|
|
the most common metabolic complication of.....
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hypercalcemia
|
|
central cord syndrome
|
due to hyperextension of cervical spine
|
|
spinal cord vascular supply
|
mid-thoracic region vulnerable to ischemia
|
|
phantom pain included all:
|
gate control, massage, rarely severe, narcotics
|
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injury above T6 affect on temp
|
varies with ambient temp, associated with autonomic dysreflexia
|
|
the effects of exercise training include all except
|
increased minute ventilation
|
|
pain sensation is transmitted via
|
A delta and C fibers
|
|
in terms of cardiac rehab the patients goal are measured in metabolic equivalents (METS)= which of the following is true?
|
5-7 METS adequate for most sedentary jobs
|
|
ASIA B
|
sensory sparing, no motion
|
|
what does not affect microscopic changes and pain
|
increased lymphatic clearance
|
|
most common cause of spinal cord injury in the US
|
motor vechicle accidents
|
|
what influences the outcome of stroke rehab
|
all the above
psychologic rxn to disability severity of apralysis aprexia visual perceptual disturbance |
|
ASIA A
|
complete loss
|
|
ASIA C
|
motor <3/5
|
|
ASIA D
|
motor >3/5
|
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ASIA E
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normal
|
|
what does SACH stand for
|
solid, ankle, cushion, heal
|
|
Fracture dislocation of L3
|
True-spastic paralysis below lesion
True-contralateral loss of pain and tempbelow lesion True- ipsilateral loss of proprioception below lesion False-horizontal hemisection of spinal cord |
|
incorrect statement regarding stroke
|
AV malformations seldom bleed before 40
|
|
Child who develops episodes of staring and is doing poorly in school
|
Petit mal or absence seizures
TX ethosuxemide spikes-assoc w/ slow waves, spike at 3 sec |
|
Adult has aura with seizure
|
partial complex seizure
|
|
Lateral pontine syndrome
|
Anterior inferior cerebellar artery
cant move eye to rt or left diplopia to left whole face paresis left pontine gaze center and CN VII- can close right eye |
|
Multiple sclerosis
|
sudden vertigo, loss of balance, convergence preserved, corneal reflex lost, MRI T2 weighted,
|
|
ALS
|
progressive weakness, dysphagia, dysarthria, tongue fasicculations, anterior.ventral horns, no sensory deficits
|
|
huntingtons chorea
|
tongue protusion
striatum/caudate triplet repeat CAG on chr 4 no intention tremor depression ldopa can induce chorea in Huntingtons patient |
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tonic clonic seizures
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boy with loss of concentration for last couple yrs, aura, and shrill cry, incontinence
LP- w/ xanthochromia |
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MCA UMN versus LMN
|
if entire side of face affected then LMN, if lower face then contralateeral UMN (cortex)
|
|
medulloblastoma
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child, HA in morning, unsteady gait,
location-right cerebellar hemisphere DOES NOT have decreased visual acuity at onset |
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l'arbre (m.)
|
tree
|
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Syringomyelia
|
B/L loss of pain and temp in cape and arm distribution
central spinal cord cavitation No CN palies |
|
B/L MLF syndrome
|
monocular abduction
nystagmus mouth drooling 20-40 lesion in brainstem normal convergence remission and exacerbations |
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lateral meduallary syndrome
|
PICA
difficulty swallowing horners decreased CN 9, 10 |
|
lesion involving the left inferior cerebellar peduncle would explain which symptoms
|
left sided ataxia and dysmetria
|
|
degeneration of the substantia nigra and presence of Lewy bodies are associated with
|
Parkinson
|
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dystonia disorders of the basal ganglia manifests with all of the following except
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intention tremors
|
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lesion of subthalamus nucleus is associated with
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contralateral hemiballismus
|
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blood supply to internal capsule
|
lenticulostriate arteries
|
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if more than one tract is involved (sensory, visual, motor) where is the lesion
|
posterior limb of the internal capsule bc thats where all the tracts are together
|
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Broca aphasia lesion location
|
left inferior frontal gyrus
|
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1. The minimum cerebral perfusion pressure suggested in the tx of most pts with severe traumatic brain injury is:
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a. 60mm Hg
|
|
2. In pts with decerebrate rigidity
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a. There is upper pontine damage.
|
|
3. In hyperventilation one expects to achieve:
|
a. A reduction in cerebral edema.
|
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4. In pts with decorticate rigidity:
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a. There is upper midbrain damage
|
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10. A 10 year old child presents with short stature and symptoms of raised ICP. CT of the head shows calcified cystic suprasellar mass. The most likely dx is:
|
a. Craniopharyngioma
|
|
9. The tx of pts with glioblastoma multiforme is:
|
a. Surgery, radiation, and chemotherapy
|
|
8. A 32 year old male presents with weakness of the right limbs. MRI of the brain shows a homogenously enhancing left frontal mass compatible with meningioma. The tx is:
|
a. Surgery
|
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7. Appropriate initial radiological study in a pt with acute traumatic brain injury is:
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a. CAT scan of the head without contrast.
|
|
6. A 35 year old pt passed out after he was assaulted and struck in the head. He then regained consciousness, however, in the ER, he became comatose with dilated sluggishly reactive left pupil and mild right hemiparesis. The most likely dx is:
|
a. Left epidural hematomas
|
|
5. In the tx of pts with raised intracranial pressure:
|
a. ICP of 20mm Hg is threshold value for tx
|
|
4. In pts with decorticate rigidity:
|
a. There is upper midbrain damage
|
|
13. Regarding metastatic brain tumors:
|
a. Surgery is recommended for solitary metastasis at favorable sites
|
|
14. A seven-year-old patient presents with headache, nausea, vomiting and incoordination, MRI of the brain reveals midline cerebellar mass. The differential diagnosis includes:
|
a. A and C (where A = medulloblastoma and C = ependymoma)
|
|
15. Regarding Medulloblastomas:
|
a. Treatment is surgery and radiation therapy to the Craniospinal axis.
|
|
12. Regarding Hemangioblastomas:
|
a. B and C (where B = the tumors are frequently cystic with mural nodule and C = the lesions can coexist with congenital cysts in the pancreas, kidneys and liver)
|
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26. The proper width of a doorway to allow transit of a power wheelchair without turning is at least
|
a. 36 inches
|
|
27. In the management of the neurogenic bowel, bissacodyl (Dulcolax) tablets and suppositories are
|
a. Colonic stimulants that stimulate and enhance the gastrocolic reflex and thereby induce peristalsis in the colon
|
|
28. Which surgical option would be most appropriate for a patient with rheumatoid arthritis who has severe uncontrollable knee pain and loss of function?
|
a. Hemiarthroplasty
|
|
29. A 65-year-old woman describes a 6-year history of progressive pain and stiffness in her left knee, right hip and distal fingers. Plain radiographs of her left knee and right hip demonstrate osteophytes and asymmetric joint space narrowing with subchondral bony sclerosis. The most likely diagnosis is
|
a. osteoarthritis
|
|
11. Brain stem gliomas: DROPPED
|
a. Peak age is the sixth decade
b. The tumors are frequently cystic with mural nodule c. The lesions can coexist with congenital cysts in the pancreas, kidneys, and liver d. Are more common in adults |
|
25. A 50 year old male experiences the worst headache of his life. His neck is stiff and he has photophobia. He is alert and he has no focal neurological deficit. CT Head shows subarachnoid hemorrhage and cerebral angiogram shows aneurysm of right internal carotid artery bifurcation.
|
a. Hydrocephalus is a possible complication
|
|
24. Astereognosis is associated with a lesion of the contralateral:
|
a. Parietal lobe
|
|
23. The spinal cord in adults usually terminates at:
|
a. Upper border of L3
b. Lower border of L1 |
|
22. Oligodendrogliomas
|
a. Are often calcified
|
|
21. Acute subdural hematomas
|
a. Has a mortality rate of 50% to 60% in several series
|
|
20. In a patient with traumatic brain injury, a risk factor for developing post traumatic seizures is
|
a. Glasgow Coma Scale 11
|
|
19. The predominant features of the Cushing Reflex observed in patients with raised intracranial pressures are
|
a. Hypertension and brachycardia
|
|
18. Brachycephaly is premature closure of
|
a. Sagittal suture
|
|
17. Neurological deficits involving the lower extremities are more frequently seen in patients with
|
a. Myelomeningocele
|
|
16. The most common location of colloid cyst in the brain is in:
|
a. Third ventricle
|
|
A 69 year old patient has a right parietal lobe lesion on CT scan of the head. He has a left sided hemi neglect syndrome. Which of the following will be correct?
|
B. He will have a cortical sensory deficit with astereognosis on the left hand
|
|
11. A 71 year old patient presents with inability to communicate and gait difficulties. His CT scan of the head reveals an infarction of the left frontal cortical and subcortical regions. Which of the following is correct?
|
C. He has occlusion of the left middle cerebral artery cortical branches
|
|
10. A 60 year old diabetic patient presents with sudden onset of ptosis of the left eye, diplopia on looking to her right side and a fixed dilated left pupil Which of the following is correct?
|
A. She has a lesion of the left Oculomotor nerve
|
|
9. A 38 year old patient presents with recurrent episodes of twitching of the left side of his face and clonic jerking of his left arm lasting five minutes each time. He is fully conscious during these episodes. Which of the following is likely?
|
E. He most likely has an irritative right frontal lobe focal lesion
|
|
8. A 23 year old young woman presents with diplopia on looking laterally on either side. She had an episode of optic neuritis at the age of 18 years from which she totally recovered. She is diagnosed as having internuclear ophthalmoplegia at this visit. Which of the following findings is most likely?
|
A. She will have preserved convergence
|
|
7. A 65 year old patient presents with decreased pain and temperature of both his legs up to his mid calves and absent ankle jerks (reflexes). He also has distal weakness of both his feet. Which of the following is most likely?
|
D. He most likely has peripheral neuritis
|
|
6. A patient has a tumor compressing the spinal cord at the left T4 level of the thoracic cord resulting in Brown Sequard's syndrome. Which of the following is correct?
|
C. The patient will have a sensory level with loss of pain and temperature on the right side of his body below T6
|
|
5. A patient is found comatose with gaze deviation to the right side and inability to move the left side of his body. The tone on the left side is flaccid and the reflexes are depressed. The left plantar reflex is extensor (Babinski's response). Which of the following is correct?
|
C. The patient will have tonic gaze deviation to the side injected with ice cold water
|
|
4. A patient is found comatose with weakness of all extremities (quadriplegia), small pin point pupils, respiratory difficulties and absent oculo vestibulo cephalic reflex. Which of the following is most appropriate?
|
E. The patient most likely has a pontine hemorrhage causing his comatose state
|
|
3. A patient presents with left sided hemiparesis, hemisensory deficit and homonymous hemianopsia. Which of the following is correct?
|
B. The patient will have accompanying left sided central facial weakness involving the left lower part of the face
|
|
2. A patient presents with sudden onset of inability to speak and right sided weakness. He can follow commands but cannot repeat or spontaneously produce any words. Which of the following is correct?
|
B. The patient has a lesion involving the left inferior frontal gyrus and the corticospinal tract
|
|
1. A patient presents with weakness of the right side of the face and left side of the body. Which of the following is correct?
|
D. The patient will have a lesion involving the right pons
|
|
Proper width of a doorway to allow transit of a power wheelchair without turning
|
30 inches
|
|
In the management of the neurogenic bowel, dulcolax tablets and suppositories are
|
contact irritants that act directly on the colonic mucosa to produce peristalsis throughout the colon
|
|
Which surgical option would be most appropriate for a patient with rheumatoid arthritis who has severe uncontrollable knee pain-
|
arthrodesis arthrodesis is surgically inducing ossification between two joints to relieve intractable pain/ pain refractory to meds
|
|
Sixty five yo woman describes a six year history of progresssive pain and stiffness in her left knee right hip and distal fingers. Plain radiographs of her left knee and right hip have osteophytes and asymmetric joint space narrowing with subchondral sclerosis...most likely diagnosis
|
osteoarthritis
|
|
Which of the hollowing prosthetic knee mechanisms provide good swing phase control at variable cadences and low energy expenditure.
|
hydraulic
C-leg = microprocessor in knee joint. For above knee amputation. Allows walking on uneven terrain. Provides good stance and swing, and allows walking at variable speeds |
|
Unilateral above knee amputee ambulates at his usual comfortable pace. His additional energy expenditure per minute as compared to a normal individual is
|
None? This is wrong challenge
Below Knee = Speed is 36% slower; Expends 40% more energy Above Knee = Speed is 43% slower; Expends 89% more energy |
|
A circumducted gait in a man with an above knee amputation is most likely due to
|
inadequate socket suspension
Circumduction is circular motion of a limb. More precisely, it is mov’t of limb in a conical fashion such that the distal end moves in an arc. Poor socket suspension in above-knee prosthetic can result in circumduction |
|
Multidisciplinary approach in chronic pain management include all of the following except
|
Recreational therapy so pharmacotherapy, behavioral therapy and patient education
Chronic pain may be managed by pharmacotherapy, behavioral therapy, and patient education. NOT recreational therapy |
|
Factors not involved in chronic neuropathic pain.
|
Not mediated by glutamate and nt interfacing with the nmda receptors...(right answers...peripheral nervous system sensitization, central nervous system sensitization, poorly managed acute pain)
|
|
Which of the following is the most important factor influencing your selection of a preferred treatment
|
safety
Most important factor when selecting a DOC is safety |
|
Person who steps on a thumb tack and reacts by taking his foot off utilizes..
|
... Large diameter peripheral nerve a-fibers
|
|
Thrombotic stroke...
|
Happens during sleep
Thrombotic strokes tend to occur over night or early morning because blood pressure is low at these times. Not high enuff to overcome flow barriers set up by thrombi |
|
Management of this patient would include the following except...
|
urgent reduction of bp
|
|
Cushing reflex
|
bradycardia and hypertension due to increased intracranial pressure
|
|
Modifiable risk factor for thrombotic stroke is.
|
htn
Modifiable risk factors are: HTN, DM, smoking, hyperlipidemia Non-modifiable risk factors are: age, sex, fam history, race |
|
Patients most likely to benefit from phrenic nerve pacemakers following traumatic spinal cord injuries are those with.
|
... c1 quadriplegia
Phrenic nerve is C3, 4 and 5. Damage above brachial plexus (C5-T1) leads to quadriplegia and respiratory failure |
|
Indications for diaphragmatic pacing include
|
phrenic nerve lesion
|
|
Successful semen collection using electroejaculation will generally not be successful in spinal cord injured males with absence of function in
|
t10-12
|
|
The americans with disability act was passed in order to
|
ensure that workers with disabilities have equal access in the work environment
|
|
Individuals with spinal cord injury are generally considered to be at risk for autonomic dysreflexia if their injury level is above
|
...t6
Autonomic dysreflexia/ hyperreflexia seen in spinal cord injuries especially above T6. Due to dumping of NE into circulation. Result is hypertension (SBP > 300mmHg), diaphoresis, flushing/ facial erythema, goose bumps, nasal stuffiness, intense headaches. SBP goes up over 40mmHg from normal – this should raise suspicion for autonomic dysreflexia. Seen in bladder and bowel distension. Also in conditions like multiple sclerosis. Can occur days to years after spinal cord injury. So pt w/ h/o spinal cord injury presenting w/ severe headaches, facial redness, HTN – think autonomic dysrefleixa Treat by catheterization of bladder to remove stimulus Add vasodilators like sublingual nitrates and oral clonidine |
|
Acupuncture is described as reducing pain through neuromodulation. Through what mechanism is neuromodulation theorized to reduce pain
|
Endogenous endorphins and enkephalins
Neuromodulation reduces pain by the following mechanisms: - Stimulate cortical descending inhibitory pathways - Production of endogenous endorphins and enkephalins - Gate ctrl mech = stimulation of large diameter fiber stimulates substantia gelatinosa to inhibit activation of transmitter cells; therefore, no transduction of pain. |
|
A 22yo female sustains a spinal cord injury, resulting in c5 quadriplegia. She is admitted to a spinal cord injury rehabiliation unit one month postinjury. She reports that she missed her menstrual period while in the acute care unit. Her pregnancy test is negative. You advise that...
|
Her menstrual period should return in a year
|
|
Strength needed to regain walking ability
|
Need 3/5 strength to regain walking ability
|
|
Wide gaits
|
Muscular dystrophy – wide-limb gait
-Alcoholics – wide-based gait |
|
charcot Maries Tooth
|
Charcot-Marie-Tooth – bilateral foot drop due to demyelination of peroneal nerve
|
|
Central cord syndrome
|
-Central cord syndrome is a disorder of gray matter and crossing STTs. There is weakness in upper extremities greater than that in lower extremities. During recovery, function returns to lower extremities first. Causes include trauma, syringomyelia, tumors, anterior spinal artery ischemia, contusion injury
|
|
what determines gait
|
determinants of gait include pelvic rotation, pelvic tilt, knee flexion in stance phase, foot and knee mechanisms, lateral displacement of pelvis (tibiofemoral angle important in that)
|
|
one complete gait cycle
|
-one complete gait cycle includes the stance phase of one leg and the swing phase of that same leg
|
|
A 7 year old boy presents with headaches and vomiting over a 2 week period, followed by lethargy and ataxia. Examination shows impairment of pupillary reflexes, impairment of convergence, paralysis of upward gaze and papilledema. Which of the following may likely be true?
|
d) Non-communicating hydrocephalus is usually associated. a) A tumor here is usually radiosensitive. a) A pineal region tumor is likely. b) The patient has Perinaud’s Syndrome.
|
|
A 25 year old HIV+ patient presents with an 8 week history of progressive left-sided headaches and weakness of the right arm. CT scan shows a single enhancing periventricular brain mass. Which of the following may be true?
|
a) CNS lymphoma is most likely.
a) Cerebral toxoplasmosis is most likely. a) A primary brain tumor. b) A lymphoma. c) A metastatic tumor. |
|
A 25 year old HIV+ patient presents with a 12 month week history of progressive left-sided headaches and weakness of the right arm. CT scan shows a solitary nonenhancing mass. Which of the following may be true?
|
e) A low grade glioma is most likely.
|
|
Which of the following is a good treatment for an arteriovenous malformation?
|
a) Surgical excision
b) Anti-convulsants |
|
Which of the following may likely be true regarding a brainstem glioma?
|
a) Is usually treated with radiation therapy and steroids.
e) Are rarely treated with surgery. d) Causes increased ICP late. c) Usually causes cranial nerve signs on the same side of the mass. c) Usually cause crossed cranial nerve and corticospinal tract dysfunction. a) May be biopsied when well-circumscribed. |
|
Which of the following may be correct about cervical spine x-rays in trauma?
|
c) Should include C7-T1.
e) X-rays of the cervical spine may be supplemented by CT scan. e) A x-ray alone is adequate to clear the C-spine b) The flex-extension film is a routine x-ray that is part of the series. |
|
Which of the following are associated with communicating hydrocephalus?
|
e) Chronic meningitis
c) Sarcoidosis |
|
Which of the following are true regarding treatment for a convexity meningioma?
|
e) Steroids are used to reduce vasogenic edema.
c) Complete excision with the dural attachment is usually palliative. c) Complete excision with the dural attachment is usually possible. |
|
Duchenne-Erb Palsy results from injury to the 5th and 6th cervical roots, the upper trunk or the upper and middle trunks of the brachial plexus. Which of the findings below could be caused by this?
|
e) Weakness of the biceps muscle
c) The arm hangs limp at the side and the biceps jerk is lost |
|
A 15 year old presents with early morning headache, vomiting and papilledema, initiated by changes in position and straining, progressing over three years. CT scan shows a mass in the right frontal lobe. Which of the following may be true?
|
d) Surgery radiation and chemotherapy are the best treatment.
|
|
A 25 year old man is struck on the right side of the head with a softball which causes a swelling on the head. The patient begins having severe headaches, lethargy and vomiting several hours later. The patient is taken to the ECA where a skull x-ray shows a skull fracture that crosses the middle meningeal groove. Which of the following may be true?
a) The patient should be followed as an outpatient |
b) The patient likely has an epidural hematoma.
b) CT scan and admission seem appropriate. c) A follow-up skull x-ray is usually necessary. |
|
Which of the following deficits may likely occur in a patient with an incomplete lesion due to acute spinal cord compression at T12?
|
b) Motor deficit in the legs with sacral sparing
|
|
Which of the following deficits may likely occur in a patient with an incomplete lesion due to acute spinal cord compression at T8?
|
a) A T10 sensory level
|
|
Which of the following deficits may likely occur in a patient with an incomplete lesion due to acute spinal cord compression at T10?
|
A L1 sensory level
|
|
Which of the following deficits may likely occur in a patient with an incomplete lesion due to acute spinal cord compression at T6?
|
a) A T8 sensory level.
|
|
Which of the following may be considered good treatment for increased intracranial pressure?
|
Glycerol
Hyperventilation Barbituates Mannitol |
|
Which of the following may be true regarding increased ICP?
|
e) Is relieved by head elevation
|
|
Which of the following may cause increased ICP?
|
Subarachnoid hemorrhage
|
|
Which of the following are classic signs of increased ICP?
|
b) Is associated with hypertension
|
|
A patient presents with a GCS of 11 after a head injury with a left dilated and fixed pupil, serosanguineous drainage from the nose, a right hemiparesis, a left periorbital ecchymoses, withdrawal to pain and eye opening to voice. Which of the following may be true?
|
d) The patient has confused speech.
b) The patient has inappropriate words. |
|
A patient presents with a GCS of 9 after a head injury with a left dilated and fixed pupil to direct and consensual light, serosanguineous drainage from the nose and a left hemiparesis. Which of the following may be true?
|
a) The patient has a right brainstem compression.
d) The patient has a third nerve palsy. |
|
A patient is in a coma after a head injurt with a left fixed and dilated pupil to direct light which dilates when light is shown into the right eye. Which of the following may likely be true?
|
b) The patient has an afferent pupillary defect.
|
|
Which of the following may be treated with lumbar puncture?
|
b) Communicating hydrocephalus
e) Pseudotumor cerebri |
|
Which of the following are true regarding treatment for a malignant astrocytoma?
|
a) Radiotherapy is usually given.
b) Chemotherapy is usually administered. c) Complete excision when possible is recommended. |
|
Which of the following are true regarding meningiomas?
|
b) Are excised with their dural attachment.
a) Rarely invade the brain. c) Are rarely malignant. e) Are more common in the elderly. c) Are most frequently parasagittal. |
|
The meningomyelocele often presents in the lumbrosacral region at birth. What is most likely to be true regarding lumbosacral meningomyeloceles?
|
d) Are repaired to prevent meningitis.
a) Are usually associated with bowel and bladder dysfunction. b) Frequently require a shunt placement for hydrocephalus. c) Are usually repaired at birth. |
|
Meralgia paresthetica:
|
b) Is worsened by extension movement of the hips
b) May be bilateral |
|
Which of the following are associated with non-communicating hydrocephalus?
|
Dandy Walker cyst
b) Arnold Chiari malformation c) Colloid cyst |
|
An obese young 24 year old female presents with a two month history of headache, blurred vision and vomiting. On examination, she is found to have bilateraly sixth nerve palsies, 20/400 vision, papilledema, a pulse of 50 and blood pressure of 180/100, but no other neuro findings. CT shows non-communicating hydrocephalus. Which of the following may be true?
|
a) The patient has pseudotumor cerebri.
c) A lumbar puncture may reduce ICP. |
|
An obese young 14 year old female presents with a two month history of headache, blurred vision and vomiting. On examination, she is found to have 20/40 vision, a pulse of 72 and blood pressure of 180/100, but no other neuro findings. CT shows dilated lateral, third and fourth ventricles. Which of the following may be true?
|
b) A ventriculoperitoneal shunt is appropriate.
|
|
An obese young 24 year old female presents with a two month history of headache, blurred vision and vomiting. On examination, she is found to have bilateraly sixth nerve palsies, 20/400 vision, papilledema, a pulse of 50 and blood pressure of 180/100, but no other neuro findings. CT shows a CPA mass and obstructive hydrocephalus. Which of the following may be true
|
a) The sixth nerve palsy may be a localizing sign.
b) The patient has increased intracranial pressure. c) A lumbar puncture should not be performed. d) All of the above. |
|
A 65 year old patient presents with progressive, severe, early morning headaches over 2-3 years duration, worsened by positional changes and straining, associated with vomiting and other symptoms of increased ICP. Which of the following is most likely to be associated with this history?
|
b) Meningioma
|
|
A patient presents with progressive, severe, early morning headaches over 1-2 years duration, worsened by positional changes and straining, associated with vomiting and other symptoms of increased ICP. Which of the following is most likely to be associated with this history?
|
a) A colloid cyst
|
|
A 35 year old patient presents with progressive, severe, early morning headaches over 10-12 years duration, worsened by positional changes and straining, associated with vomiting and other symptoms of increased ICP. Which of the following is most likely to be associated with this history?
|
a) Benign astrocytoma
|
|
A patient presents to the ECA after being struck with a hammer in the parietal area. The patient complains of headache and neck pain. His pulse is 50, BP is 180/110 and there is an open depressed skull fracture of 10 mm on x-ray. Which of the following may be true?
|
d) Surgery should be performed emergently.
|
|
A patient presents with sudden throbbing paind behind the right eye and blurred vision. On examination, the patient has a stiff neck, subhyloid hemorrhages and a right ptosis. Which of the following may likely be true?
|
c) The patient has a third nerve palsy.
e) The patient has involvement of V1 in the cavernous sinus. a) The patient has a posterior communicating artery aneurysm. b) He has involvement of the right third cranial nerve. c) The patient has a subarachnoid hemorrhage. d) All of the above. |
|
A patient presents to the ECA after being struck with a hammer in the parietal area. The patient complains of headache and neck pain. His pulse is 50, BP is 180/110 and there is an open depressed skull fracture of 1 mm on x-ray. Which of the following may be true?
|
a) Surgical treatment is not usually needed with such a small lesion.
|
|
A patient presents to the ECA after being struck with a hammer in the parietal area. The patient complains of headache and neck pain. His pulse is 50, BP is 180/110 and there is an obvious open depressed skull fracture of 1 cm. Which of the following may be true?
|
a) Surgical treatment is recommended.
b) The patient should have a CT scan. c) Antibiotics are usually given. d) All of the above. e) None of the above. |
|
The ulnar nerve supplies which of the following muscles?
|
d) The flexor carpi ulnaris
|
|
Video 1
|
Video # 1
Difficulty standing on narrow base Ataxic gait, brisk reflexes on left; drift on left; past-pointing Nystagmus on horizontal gaze Vestibular pathway T2 weighted MRI to diagnose Diagnosis: Multiple sclerosis CSF: Myelin basic protein with oligoclonal bands Management: Corticosteroids and interferon |
|
Video 2
|
66 yo patient with diplopia, sudden onset, difficulty walking
Facial weakness, right ptosis, right pupil 4 cm fixed, increased left tone Brisk reflexes left, finger-to-nose, heel-to-shin ataxia on left, left weakness Right midbrain lesion Right CN III weakness that caused ptosis Midbrain lesion in right red nucleus UMN weakness, right cerebral peduncle Occlusive lesion of basilar artery Management: Sedation, anticonvulsant |
|
Video 3
|
9 yo; progressive gait difficulty, not able to walk after 5 months
Extreme lordosis, rapid movement decreased on right Trouble with hip flexon, Decreased left tone; plantar extension right foot Dystonia Basal ganglia disorder; all except intention tremor Degeneration of substantia nigra: Parkinson’s (is this really a 9 yo kid?!) Tripliate repeat: Huntington’s Degeneration of Caudate: Huntongton’s Lesion of subthalamic nucleus: Contralateral hemibalismus |
|
Video 4
|
14 yo with hx of fever, sore throat, flattened left NLF
Left eye does not close completely, left forehead does not wrinkle, hypotonic Polyradiculopathy Peripheral nerve dysfunction Bilateral LMN VII dysfunction Dx: Nerve conduction study CSF: 5 cells lymphs, 50% glucose, 150% protein Acute infectious polyradiculopathy (Guillain-Barre) Management: Immunosuppression, immwar/cyclosporine |
|
Case 1
|
Sudden onset vertigo, falling to the right
Dx with MRI of brain Unequal pupils: Sympathetic involvement Decreased corneal response: Right descending V nucleus and tract Occlusive vascular disease, right PICA |
|
case 2
|
54 yo male with PMH HTN; left sided weakness
Altered mental status; bp 230/120 Conjugate deviation of eyes: Destructive lesion of right cerebral hemisphere Right cerebral hemorrhage with uncal herniation CT scan with hyperdensity of right basal ganglia CT scan with hyperdensity of right basal ganglia Tonic deviation of left eye to the left Minimal movement of the right eye when irrigating left ear (cold caloric response) |
|
case 3
|
15 yo right-handed female; staring spells
Poor academic performance Test: Hyperventilation to evoke seizure EEG “B” |
|
case 4
|
32 yo HIV patient, headaches 2-3 weeks, fever
Decreased appetite, nuchal rigidity, diplopia when looking to left Chronic CNS infection Left CN III (except) Loss of venous pulsation: Papilledema Large ventricles: Enhanced sulci on CT CSF: TB positive with acid-fast stain |
|
case 5
|
45 yo male, weakness
Distal neuropathy Myotonic muscular dystrophy Dx with EMG: “Dive-bomber” potentials |
|
Lesion of superior temporal gyrus
|
Wernicke’s aphsia, unintelligible jargon, neologisma, paraphrasing
|
|
Video 1
|
Video # 1
Difficulty standing on narrow base Ataxic gait, brisk reflexes on left; drift on left; past-pointing Nystagmus on horizontal gaze Vestibular pathway T2 weighted MRI to diagnose Diagnosis: Multiple sclerosis CSF: Myelin basic protein with oligoclonal bands Management: Corticosteroids and interferon |
|
Video 2
|
66 yo patient with diplopia, sudden onset, difficulty walking
Facial weakness, right ptosis, right pupil 4 cm fixed, increased left tone Brisk reflexes left, finger-to-nose, heel-to-shin ataxia on left, left weakness Right midbrain lesion Right CN III weakness that caused ptosis Midbrain lesion in right red nucleus UMN weakness, right cerebral peduncle Occlusive lesion of basilar artery Management: Sedation, anticonvulsant |
|
Video 3
|
9 yo; progressive gait difficulty, not able to walk after 5 months
Extreme lordosis, rapid movement decreased on right Trouble with hip flexon, Decreased left tone; plantar extension right foot Dystonia Basal ganglia disorder; all except intention tremor Degeneration of substantia nigra: Parkinson’s (is this really a 9 yo kid?!) Tripliate repeat: Huntington’s Degeneration of Caudate: Huntongton’s Lesion of subthalamic nucleus: Contralateral hemibalismus |
|
Video 4
|
14 yo with hx of fever, sore throat, flattened left NLF
Left eye does not close completely, left forehead does not wrinkle, hypotonic Polyradiculopathy Peripheral nerve dysfunction Bilateral LMN VII dysfunction Dx: Nerve conduction study CSF: 5 cells lymphs, 50% glucose, 150% protein Acute infectious polyradiculopathy (Guillain-Barre) Management: Immunosuppression, immwar/cyclosporine |
|
Case 1
|
Sudden onset vertigo, falling to the right
Dx with MRI of brain Unequal pupils: Sympathetic involvement Decreased corneal response: Right descending V nucleus and tract Occlusive vascular disease, right PICA |
|
case 2
|
54 yo male with PMH HTN; left sided weakness
Altered mental status; bp 230/120 Conjugate deviation of eyes: Destructive lesion of right cerebral hemisphere Right cerebral hemorrhage with uncal herniation CT scan with hyperdensity of right basal ganglia CT scan with hyperdensity of right basal ganglia Tonic deviation of left eye to the left Minimal movement of the right eye when irrigating left ear (cold caloric response) |
|
case 3
|
15 yo right-handed female; staring spells
Poor academic performance Test: Hyperventilation to evoke seizure EEG “B” |
|
Video 1
|
Video # 1
Difficulty standing on narrow base Ataxic gait, brisk reflexes on left; drift on left; past-pointing Nystagmus on horizontal gaze Vestibular pathway T2 weighted MRI to diagnose Diagnosis: Multiple sclerosis CSF: Myelin basic protein with oligoclonal bands Management: Corticosteroids and interferon |
|
case 4
|
32 yo HIV patient, headaches 2-3 weeks, fever
Decreased appetite, nuchal rigidity, diplopia when looking to left Chronic CNS infection Left CN III (except) Loss of venous pulsation: Papilledema Large ventricles: Enhanced sulci on CT CSF: TB positive with acid-fast stain |
|
Video 2
|
66 yo patient with diplopia, sudden onset, difficulty walking
Facial weakness, right ptosis, right pupil 4 cm fixed, increased left tone Brisk reflexes left, finger-to-nose, heel-to-shin ataxia on left, left weakness Right midbrain lesion Right CN III weakness that caused ptosis Midbrain lesion in right red nucleus UMN weakness, right cerebral peduncle Occlusive lesion of basilar artery Management: Sedation, anticonvulsant |
|
Video 3
|
9 yo; progressive gait difficulty, not able to walk after 5 months
Extreme lordosis, rapid movement decreased on right Trouble with hip flexon, Decreased left tone; plantar extension right foot Dystonia Basal ganglia disorder; all except intention tremor Degeneration of substantia nigra: Parkinson’s (is this really a 9 yo kid?!) Tripliate repeat: Huntington’s Degeneration of Caudate: Huntongton’s Lesion of subthalamic nucleus: Contralateral hemibalismus |
|
case 5
|
45 yo male, weakness
Distal neuropathy Myotonic muscular dystrophy Dx with EMG: “Dive-bomber” potentials |
|
Lesion of superior temporal gyrus
|
Wernicke’s aphsia, unintelligible jargon, neologisma, paraphrasing
|
|
Video 4
|
14 yo with hx of fever, sore throat, flattened left NLF
Left eye does not close completely, left forehead does not wrinkle, hypotonic Polyradiculopathy Peripheral nerve dysfunction Bilateral LMN VII dysfunction Dx: Nerve conduction study CSF: 5 cells lymphs, 50% glucose, 150% protein Acute infectious polyradiculopathy (Guillain-Barre) Management: Immunosuppression, immwar/cyclosporine |
|
Case 1
|
Sudden onset vertigo, falling to the right
Dx with MRI of brain Unequal pupils: Sympathetic involvement Decreased corneal response: Right descending V nucleus and tract Occlusive vascular disease, right PICA |
|
case 2
|
54 yo male with PMH HTN; left sided weakness
Altered mental status; bp 230/120 Conjugate deviation of eyes: Destructive lesion of right cerebral hemisphere Right cerebral hemorrhage with uncal herniation CT scan with hyperdensity of right basal ganglia CT scan with hyperdensity of right basal ganglia Tonic deviation of left eye to the left Minimal movement of the right eye when irrigating left ear (cold caloric response) |
|
case 3
|
15 yo right-handed female; staring spells
Poor academic performance Test: Hyperventilation to evoke seizure EEG “B” |
|
case 4
|
32 yo HIV patient, headaches 2-3 weeks, fever
Decreased appetite, nuchal rigidity, diplopia when looking to left Chronic CNS infection Left CN III (except) Loss of venous pulsation: Papilledema Large ventricles: Enhanced sulci on CT CSF: TB positive with acid-fast stain |
|
case 5
|
45 yo male, weakness
Distal neuropathy Myotonic muscular dystrophy Dx with EMG: “Dive-bomber” potentials |
|
Lesion of superior temporal gyrus
|
Wernicke’s aphsia, unintelligible jargon, neologisma, paraphrasing
|
|
Lesion of left occipital lobe: Splenium of corpus callosum
|
Alexia: Right-sided homonymous hemianopsia
|
|
Lesion of right parietal lobe
|
Denial/non-recognition of body parts
|
|
Epidural hematoma
|
Dilated, fixed pupil:
|
|
1. Meningitis
|
1. Stiff neck
2. Kernig 3. Photophobia 4. Brudzinski 5. Eyeball tenderness |
|
Normal CSF
|
1. Normal CSF: Opening pressures is 150-200, clear and colorless, glucose is ½ - 2/3 of the blood drawn out, protein is 15-45 and cells are 0-5
|
|
Acute pyogenic meningitis
|
4. Acute pyogenic menin: high temps, OP is very high 300-500, CSF is cloudy, low glucose, high protein, high count of WBCs (polys), lactate > 35. smear and culture give positive results in 80% of people who have not been treated with ABs.
|
|
1. Dorsal column – medial meniscus system
|
a. Carries information from Ipsilateral side. Cross at medulla.
b. Carries position (joint sense), vibration, 2 point discrimination (requires calipers), and deep touch i. Does it feel the same of different? c. Made up of the fasciculus gracilis (lower limbs) and fasciculus cuneatus (upper limbs). These tracks synapse in their respective nuclei in the medulla. They decussate as the medial meniscus in the medulla and synapses in the VPL (of the thalamus) |
|
2. Ventral/Dorsal spinocerebellar fasciculus ????
|
a. Large joint proprioceptions: large coordinated movements.
b. Touching the tip the nose with a finger – checking right cerebellar track c. Heal to shin d. Tandem walk – in the vermis, therefore cant localize in a hemisphere e. Rapid alternating movements (RAM) – dysdiakokinesia |
|
3. Lateral funiculus
|
a. Spinothalamic tract
i. Contralateral pain and temp. ii. Fibers from periphery synapse at the dorsal horn cross over via ventral white commissure then ascend to thalamus (VPL) |
|
4. Brown-Sequard syndrome
|
a. Ipsilateral loss of DC, Coordinated movements, CST, LMN, Spinothalamic tract
b. Pain and temp opposite side absent c. Sensory dissociation spinal cord lesion |
|
5. Final common pathway: α – Motor neuron
|
a. Lesions of ventral horn to muscle – LMN signs
i. Hypotonia, flaccid paralysis, hyporeflexia, atrophy, fasciculations ii. Ipsilateral signs |
|
6. Breast, lung, and prostate cancer metastasis
|
cause lytic lesions in vertebrae compression fractures of vertebrae which compresses the spinal cord.
|
|
7. Corticospinal tract
|
a. Fine motor movements
b. Lesion anywhere above ventral horn upper motor neuron signs i. Paralysis paresis, spasticity, hyperreflexia, Babinski sign c. Location in spinal cord is lateral. |
|
8. Subacute combined degeneration
|
a. Vitamin B12 deficiency caused by atrophic gastritis (pernicious anemia), nutritional (alcoholics, strict vegetarians), ABs to intrinsic factor
b. Lose DC, CST, dorsal horn bilaterally (symmetric lesion) i. Positive Romberg sign w/no DC. Alcoholic cerebellar disease can look the same way, but they stumble and sway with their eyes open. Also get a peripheral neuropathy. Definition is impairment of sensation in a stocking-glove distribution. 1. My hands are numb, can cut them off with an axe and wouldn’t feel it. He does have sensation in his feet. Therefore not peripheral neuropathy. Spinal cord ends at L1-L2. The axon to the feet is very long (longest axons are affected first with nutritional deficiencies). c. Source of Vitamin B12 are leafy vegetables. |
|
9. Polio
|
a. Anterior horn disease (LMN signs)
b. Signs: muscle weakness and fever (Ipsilateral) i. Hyporeflexia, spasticity, hypotonia. |
|
10. Amyotrophic lateral sclerosis (Lou Gehrig’s disease)
|
a. CST, anterior horn cells
i. UMN and LMN signs together 1. Spasiticity, atrophy, hypereflexia, 2. Uselessness of hand, foot drop, muscle cramps, fatigue ii. Cranial nerves that are motor nuclei are affected except 3,4,6. iii. They are awake and alert of what’s going on around them. They are trapped in a body. |
|
An old lady has new onset (a year after something) 1/5 strength and proprioception spared. (*note nothing was said about fine touch*)
|
think the answer is anterior cord syndrome
|
|
Pt with C2 lesion has been on a vent for a year, what are options:
|
choices were maintain on vent, ween off vent,....
I think the answer was E which was to do nerve conduction to screen for a phrenic pacemeaker |
|
football player gets hit on the field and starts to complain of tingling in arms in right more than left. what do you do?
|
answer choices were: walk him off field, take helmet off, and other stuff.
The one I thought was right: Stabilize the neck |
|
Which is good for increased intercranial pressure?
|
Mannitol
|
|
Obese 14 yo female 2 month history 20/400 vision. Which is true?
|
LP can be performed
|
|
ECA baseball injury with sluggish right pupil? Likely?
|
Uncal hernia
|
|
GCS 9 serosaguinous drain from nose what is true?
|
Its likely a third nerve injury
|
|
Cervical x ray should?
|
Include the head and neck when indicated
|
|
Lesion at or above T6 likely causes?
|
Autonomic Hyperreflexia (or Dysreflexia)
|
|
7 y/o vomits over two weeks likely diagnosis?
|
Perinaud syndrome
|
|
Perinaud syndrome
|
It is a cluster of abnormalities of eye movements and pupil dysfunction, characterized by:
1. Paralysis of upgaze: Downward gaze is usually preserved. This vertical palsy is supranuclear, so doll's head maneuver should elevate the eyes, but eventually all upward gaze mechanisms fail. 2. Pseudo-Argyll Robertson pupils: Accommodative paresis ensues, and pupils become mid-dilated and show light-near dissociation. 3. Convergence-Retraction nystagmus: Attemps at upward gaze often produce this phenomenon. On fast up-gaze, the eyes pull in and the globes retract. The easiest way to bring out this reaction is to ask the patient to follow down-going stripes on an optokinetic drum. 4. Upper Eyelid retraction (Collier's sign) 5. Conjugate down gaze in the primary position: "setting-sun sign". Neurosurgeons will often see this sign most commonly in patients with failed ventriculoperitoneal shunts. It is also commonly associated with bilateral papilledema. It has less commonly been associated with spasm of accommodation on attempted upward gaze, pseudoabducens palsy (also known as thalamic esotropia) or slower movements of the abducting eye than the adducting eye during horizontal saccades, see-saw nystagmus and associated ocular motility deficits including skew deviation, oculomotor nerve palsy, trochlear nerve palsy and internuclear ophthalmoplegia. |
|
What is true regarding brain stem glioma?
|
Increase intercranial pressure is found late
|
|
What is truth regarding meningioma?
|
Most frequently occur in parasaggital region
|
|
5 y/o with progressive headaches for two months and incoordination with a CT scan showing a mass in the vermis. What is true?
|
Gross resection, radiation, chemotherapy are best survival
|
|
55 y/o with morning HA ,vomiting, papilledema initiated by change of postion over 3 years?
|
Rarely malignant tumor
|
|
The truth regarding glioblastoma?
|
May be multicentric
|
|
Myelomeningocele at birth?
|
Is associated with bowel dysfunction
|
|
Which is associate with communicating hydrocephalus?
|
Sarcoidosis
|
|
Pt has sudden throbbing pain behind right eye and blurred vision. Examination shows stiff neck, subhyloid hemorrhage and right ptosis. What is true?
|
It can be caused by V1 cavernous sinus
|
|
Which is associated with normal pressure hydrocephalus?
|
Ataxia, dementia and incontinence
|
|
Incomplete Spinal Syndrome with variable loss of motor, pinprick and temperature, & sensation but propioception spared?
|
Brown Sequard Syndrome
|
|
Excessive knee flexion in below knee amputee due to?
|
Flexion contracture
|
|
Good treatment for arteriovenous malformation?
|
Surgical excision
|
|
In analyzing fit and alignment of ischial prosthesis the…?
|
Ishium SHOULD be continuous in the flare (careful not to pick the option that says it should NOT)
|
|
Suprcondylar prothesis provides?
|
Increased mediolateral stability
|
|
Pain sensation travels via?
|
Aδ and C fibers
|
|
Pain does not travel in what fibers?
|
Aα and B fibers
|
|
All the following modalities used for treatment is explained by gate control theory except?
|
Anti- inflammatory meds
|
|
Right stump dressing provide all EXCEPT?
|
Causes stump edema via choke phenomena
|
|
To lock the elbow in an above elbow prothesis which is the movement of the arm?
|
Shoulder extension
|
|
Indications for diaphragmatic pacing include?
|
C2 tetraplegia with denervation injury to C3, C4, C5
|
|
VIDEO 1:
|
61yo DM male, sudden onset of weakness on the right side of face. (Dx: occlusion of AICA)
|
|
This patient demonstrates facial weakness, which of the following statements is correct?
|
c. the lesion will involve the right facial nerve nucleus or nerve
|
|
52. If the lesion at the region causing the facial weakness also involved the motor tract, which of the following statement would be correct?
|
b. there would be initial flaccidity/hyporeflexia and later spasticity/hyperreflexia of the left side of the body
|
|
53. Which of the following ocular findings is likely to be present in this patient?
|
e. he will have diplopia on attempted gaze to the left side
|
|
54. Which of the following etiological factors is likely in this patient?
|
d. ischemic occlusion in the territory of the basilar artery
|
|
55. Which of the following radiological findings is most likely in this patient on initial presentation?
|
d. the CT scan will show multiple hyperintense lesions periventricularly on T2 images
|
|
56. Factors that predispose to vascular cerebral disease include all of the following except:
|
c. chronic use of aspirin
|
|
57. Factors that cause cerebral demyelination lesions include all of the following except:
|
d. Guillen-Barre syndrome (acute infectious demyelinating polyradiculopathy)
|
|
VIDEO 2:
|
71yo AAF in a wheelchair. She has only motor deficits, no sensory. (Dx: ALS)
|
|
58. The patient most likely has which of the following disorders?
|
a. motor neuron disease (amyotropic lateral sclerosis)
|
|
59. The tongue fasciculations indicate:
|
e. bilateral hypoglossal nuclear lesions
|
|
60. Involvement of the anterior horn cell will explain all the following findings except:
|
a. spasticity/hyperreflexia of extremities
|
|
61. Presentation of deep tendon reflexes in the presence of marked anterior horn cell involvement can best be explained by which of the following statements?
|
c. simultaneous involvement of the upper motor neurons
|
|
62. The most important diagnostic study to confirm this disorder is
|
e. electromyogram showing giant polyphasics and fibrillation potentials
|
|
63. All the following statements are true of this disorder except
|
d. only females are involved, particularly over the age of 50yrs
|
|
64. The infantile form of the disorder will manifest with all of the following except
|
b. preserved deep tendon reflexes
|
|
VIDEO 3:
|
17yo AAF who has had difficult speaking (Dx: MS)
|
|
65. The speech problem in this patient can best be attributed to
|
a. dyasthria denoting cerebellar dysfunction
|
|
66. The vertical nystagmus
|
d. lesion involving the vestibular nucleus or its projections
|
|
67. The absent right corneal reflex is due to
|
e. lesion involving the right trigeminal nerve
|
|
68. All of the following findings are compatible with a lesion of the right lateral medulla except
|
a. right sided hemiparesis
|
|
69. The clinical course with remission of symptoms suggests
|
c. multiple sclerosis
|
|
70. The most useful investigative finding in making the diagnosis would be
|
b. T-2 MRI of brain demonstrating periventricular white matter lesions
|
|
VIDEO 4:
|
28 yo left handed female who has uncontrollable movements (Dx: Huntington’s)
|
|
71. The major findings are consistent with dysfunction
|
d. caudate nucleus
|
|
72. The biochemical problem is
|
a. decreased acetylcholine and GABA synthesis
|
|
73. The most likely etiology is
|
e. Huntington’s Disease
|
|
74. The following observations are true except:
|
c. there is degeneration of the substantia nigra
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75. Basal ganglia disorder are characterized by all of the following except
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b. ataxia
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76. Hemiballismus is seen accompanying lesions that involve
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a. subthalamic nucleus
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CASE 1:
A 16yo patient presents with episodes of “loss of consciousness” for two years. These episodes are characterized by an aura of vertigo, followed by loss of consciousness, generalized tonic and clonic movements, sometimes accompanied by urinary incontinence, each episode lasting for 2-3 mins, and followed by confusion and drowsiness for several minutes. This particular presentation was because of a similar witnessed episode, which however, was followed by server headache, photophobia and a stiff neck. His examination revealed nuchal rigidity; normal vital signs and some drowsiness. No focal deficit was observed. The optic discs were shapr and normal on fundoscopic examination |
77. Which of the following tests would be most helpful?
a. xrays of the skull b. lumbar puncture c. MRI of C-spine d. CT of the head e. b and d are correct |
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78. Which of the following findings is likely in the CSF
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c. xanthocromic fluid, RBC-50,000, WBC-135, protein-105, glucose-65
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79. The findings are consistent with which of the following etiological factors?
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d. acute subarachnoid hemorrhage
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80. Which of the following conditions is likely to have caused seizures in this patient?
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e. arteriovenous malformation of the brain with rupture into the subarachnoid space
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81. What would you do next?
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d. order an MRI and MRA of the brain, after stabilizing anticonvulsant levels
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The patient’s loss of consciousness is most consistent with which EEG:
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C (the EEG is not in the supplement packet – however it has large spikes indicating some seizures preceded by low amplitude activity)
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CASE 2:
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A 43yo black female, who is presently on methadone and has abused cocaine in the past, present with sudden, serve headache, diplopia and ptosis of the left eye. The left pupil is fixed and dilated.
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83. The patient most likely has
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b. ruptured of leaking Berry aneurysm
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84. The following statement(s) will apply
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a. The patient’s diplopia will be maximal on looking to the right
b. The patient will have an exotropia (outward deviation) c. The patient will not be able to look upwards with the left eye d. The patient is likely to have nuchal rigidity e. all of the above |
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85. The most definitive test would be
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a. a 4-vessel angiogram (internal carotid and vertebrals)
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86. Appropriate management should not include
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c. administration of thrombolytics (tpa)
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87. Which of the following conditions is likely in this patient?
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b. left cerebellar hemispheric astrocytoma
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88. The papilledema can be associated with all of the following findings except
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e. unilateral dilation of the left lateral ventricle due obstruction of the foramen of Munro
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89. The head tilt is most likely due to
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d. cerebellar tonsilar herniation
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90) Which investigation is contraindicated?
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Lumbar puncture
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CASE 3:
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65 y/o with known HTN black male presents 1 hour of sudden onset of 2 sided weakness, gaze deviation to the right side and slurring speech. His physical examination is otherwise normal except blood pressure 170/88.
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91) All should be done except..?
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Spinal tap
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92) What is CT likely to reveal?
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Normal with no lesion
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93) Gaze deviation is likely due to?
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Destructive right cerebral lesion involving projection from FEF (remember, if it’s a cortical lesion, the eyes look TO the lesion; right FEF eyes look to the right)
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94) Speech problem is likely due to ?
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Involvement of right corticobulbar tract in hemisphere
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95) Most important complication of tPA therapy is?
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Intracerebral hemorrhage
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CASE 4:
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A 25 y/o HIV + patient presents with headache progressively worsening over 3 weeks, fever, and episode of generalized seizure
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96) A CT scan of the head reveals mild to moderate ventricular enlargement without mass effect. What factor is likely cause of cranial nerve problems?
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Brain Stem encephalitis
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98) What test would be most helpful?
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Cryptococcal antigen in CSF
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99. An MRI reveals several ring enhancing lesions with mild edema. Initial treatment also includes
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c. treatment for toxoplasmosis
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100. The findings in the lower extremities can best be studied by
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a. nerve conduction velocities of peripheral nerves in lower extremities
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interpret coma scale
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Severe, with GCS ≤ 8
Moderate, GCS 9 - 12 Minor, GCS ≥ 13. |
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interpret coma scale
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Severe, with GCS ≤ 8
Moderate, GCS 9 - 12 Minor, GCS ≥ 13. |
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function of oculomotor nerve
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It controls most of the eye's movement, constriction of the pupil, and maintains an open eyelid
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