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328 Cards in this Set
- Front
- Back
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A patient presents w/ decreased pain nand temperature sensation over the lateral aspects of both arms
Whaere is the lesion? |
Syringomyelia
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Penlight in pts right eye produces bilateral pupillary constriction. When moved to the left eye, there is paradoxical dilatation. What is the defect?
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Atrophy of the left optic nerve.
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The patient describes a decreased prick sensation on the lateral asapect of her leg and foot. what muscular deficit can also be expected?
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Dosriflexion and eversion
common peroneal |
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An elderly woman presents w/ arthritis and tingling over the lateral digits of her right hand. What is the Dx?
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Carpal tunnel
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20 y/o dancer reports dowand plantar flexion and decreaed sensation over the back of her thigh, calf, and lateral half of her foot. What spinal nerve is involved?
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Tibial - L4,S3
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A woman inovlved in a motor vehicle accident cannot turn her head to the lft and has a right shoulder droop. What structure is damaged?
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Right XI (jugualr foramen w/ CN IX and X) innervating sternocleidomastoid and trapezius
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A man presents with one wild, flailing arm, where is the lesion?
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Contralateral subthalamic nucleus
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A patient with cortical lesion does not know that he has a disease. Where is the lesion
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Right parietal lobe
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Patient cannot protrude tongue twoard left side adn has right sided spastic paralysis. Where is the lesion?
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left medulla, CN XII
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Teen falls while rollerblading and hurts his elbow. He can't feel the medial part of his palm. Which nerve and what injury
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ulnar nerve due to broken medial condyle
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Field hocky player presents to the ER after falling on her arm during practice. X-ray shows midshaft break of the humerus. Which artery and nerve were damaged?
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Radial nerve and deep brachial artery
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Patient cannont blink his R eye or seal his lips. Mild ptosis on the right side. What is teh Dx adn which nerve is affected?
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Bells; CN VII
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Pt. complains of pain, numbness, and tingling sensation. Wasiting of the thenar eminence. What is the Dx and what nerve is affected?
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Carpal tunnel syndrome, median nerve
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In what stage of sleep would a dude have variable bp, penile tumescence, and variable EEG?
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REM
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What personality disorder would demand only the best and most famous doctor in town?
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narcissitic
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Nurse has episodes of hypoglycemia; blood analysis has no elevation in C protein
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facticious
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55 y/o businessman complains of lack of successful sexual contacts w/ women and lack of ability to reach a ful erection. two years ago he had a heart attack. What could be a cause of the problem?
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fear of sudden death during intercourse
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15 y/o girl of normal height and weight for her age has enlarged parotid glands, but no other complaints. She hides laxatives.
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bulimia
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Woman presents w/ headache, visual disturbance, galactorrhea and amenorrhea. What's the Dx?
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PRLnoma
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43y/o man w/ dizziness and tinnitis. CT has enlarged internal acoustic meatus.
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Schwaannoma
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25 y/o female presents w/ uniocular vision loss and slurred speech. Hx of weakness and parethesias that have resolved. What is the Dx?
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MS
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10 kid spaces out in class. can be a quivering of lips.
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absence seizures
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man on antidepressents and other meds has mydriasis and becomes constipated. Wha tis the cause of his symps?
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TCA
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woman on MAOI has HTN crisis after a meal, why?
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tyramine (wine or cheese)
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Astrocytes
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physical support
reapir K metab help maintain BBB GFAP is the marker |
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Ependymal cells
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inner lining of ventricles
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Microglia
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phagocytosis
originates from mesoderm Not readily discernible in Nissl stains small irrecgular nuclei andd littel cytoplasm. ameboid phagocytic cells. HIV-infected microglia fuse to form multinucleated giant cells |
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Oligodendroglia
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central myelin production
up to 30 axons myelinated. Nissle-> small nuclei w/ dark chromatin and little cytoplasm. Predominant glial in white matter. Destroyed in MS |
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Schwann cells
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peripheral myelin production
only 1 PNS. promote axonal regeneration Acoustic neuroma is an example of a schwannoma. internal acoustic meatus CN VII, VIII |
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Peripheral nerve layers
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Endoneurium invests single nerve fiber
Perineurium (permeability barrier) surrounds a fascicle of nerve fibers Epineurium (dense CT) surrounds entire nerve (fascicles and blood vessels) Perineurium- permeable barrier. must be rejoined in microsurgery for limb reattachment. |
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Meissner's corpuscle
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Small, encapsulated nerve endings found in dermis of palms, soles, and digits of skin. Involved in light discriminatory touch of glabrous (hairless) skin
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Pacinina corpuscle
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Large, encapsulated nerve endings found in deeper layers of skin at ligaments, joint capules, serous memebranes, mesenteries. Involved in pressure, course touch, vibration and tension
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Merkel's
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cup shape endings in dermis of fingertips, hair follicles, hard palate. Involved in light and crude touch.
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Inner Ear
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series of tubes in the temporal bone filled w/ perilymph (Na rich)
- cochlea, vestibule, semicircular canals. Hair cells are the sensory elements in both vestibular apparatus and cochlea Base of the cochlea picks up high-frequency sound. Apex of cochlea picks up low frequency sound |
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What is the difference between the base and the apex of the cochlea?
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base- narrow and stiff (high frequency)
Apex- wide and flexible (low frequency) |
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what should you remember about:
peri endo utricle saccule samicircular canals hearing loss |
Peri- outside the cell
Endo- inside endolymph- stria vascularis Utricle- side to side saccule- up down - use maculae to detect linear acceleration semicircular canals contain Ampullae- detect Angular acceleration Hearing loss- lose high freqency first |
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What forms the blood-brain barrier?
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Tight junctions between non-fenestrated capillary endothelial cells
Basement membrane Astrocyte processes teste-blood maternal-fetal blood |
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How do Gcose and AAs cross the BBB?
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carrier-mediated transport
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what is the difference between lipid-soluble and water-soluble substances? Polar and nonpolar?
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lipid and non-polar cross easier
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what areas of the brain are fenestrated?
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area postrema- vomiting after chemo
neurohypophysis- ADH release |
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What are the functions of the hypothalamus?
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TAN HATS
Thirst, water balance (supraoptic nucleus) Adenohypophysis Neurohypophysis Hunger (lateral nucleus) and satiety (ventromedial) Autonomic regulation (ant. hypothalamus for paras. posterior for symps), circadian (SCN) Temperature (posterior hypo regs heat. ant regs cooling) Sexual urges (septal nucleus-> w/o = rage) |
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From where do the projections of the posterios pituitary originate?
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ADH from supraoptic
Oxy from paraventricular |
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What are the functions of the thalamus?
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Major relay for ascending sensory info
LGN- visual MGN- auditory Ventral posterior nucleus, lateral part (VPL)- body senstaion (proprioception, pressure, pain, touch vibration, from the dorsal column and spinothalamic tract) Ventral post nucleus, medial part (VPM)- facial sensation Ventral ant/lateral nuclei- motor |
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What is the function of the limbic system?
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5 Fs
feeding fighting feeling fight sex |
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What is the role of the basal ganglia?
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important in voluntary movements and making postural adjustments
parkinsons is a decrease in input from the substantia nigra. (less inhibition of the inderect pathway) Direct- facilitates movement (D1) Indirect- inhibits (D2) |
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What number is the premotor area?
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6
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What number is the principal motor area?
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4
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What number is the principla sensory area?
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3,1,2
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What number is the principal visual cortex?
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17
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What number is the associative auditory cortex (wernickes)
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22
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What number is the Primary audiory cortex?
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41,42
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What number is the motor speech (Broca's) area?
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44,45
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What is the function of the frontal lobe
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Executive functions- planning, inhibition, concentration, orientation, language, abstraction, judgement, motor regulation, mood.
Lack of social judgement is most notable in frontal lobe lesion |
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What is the homunculus
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Topographical representation of sensory and motor areas in the cerebral cortex
Use to localize lesion Lower extremities are anterior cerebral- medial |
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What does the anterior cerebral artery supply?
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medial surface of the brain, leg-foot area of motor and sensory cortices
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What does the middle cerebral artery supply?
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lateral aspect of brain, trunk-arm-face area of motor and sensory cortices, Broaca and WErnickies
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What does the anterior communicating artery supply?
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most common aneurysm
visual field defects |
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What does an aneurysm of the posterior communicating artery cause?
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CNIII palsy
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What do the lateral striate supply?
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theya re division s of the middle cerebral
they are the arteries of stroke internal capsule, caudate, putamen, globus pallidus |
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What happens ina stroke of the anterior circle?
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general sensory and motor dysfunction. aphasia
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What happens in a stroke of the posterior circle
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Cranial nerve deficits (vertigo, visual deficits, coma, cerebellar deficits
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What is the function of the superior sagittal sinus?
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main location of CSF return via arachnoid granulations
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Where does the great cerebral veign branch off?
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the inferior cerebral vein
which meet up into the straight cerebral vein |
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what sinuses flow on the dorsal surface of the brain?
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superior ophthalmic vein
enters the cavernous sinus which splits the superior petrosal and inferiorpetrosal to the jugular foramen. |
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What connects the superior sagital sinus to the cavernous sinus?
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shpenoparietal sinus
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How does the ventricle system connect?
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the Lateral ventricle-> 3rd ventricle via foramen of Monro
3rd-> 4th via sylvius 4th-> subarachnoid via Luschka and Magendie |
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how many spinal nerves are there?
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31
8 cervical 12 thoracic 5 lumbar 5 sacral 1 coccygeal vertebral disk herniation most common between L5-S1 |
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Where do you do the lumbar puncture?
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between L4, 5
pia is not pierced |
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What are the layers pierced in the lumbar puncture
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Skin
Ligaments (supraspinous, interspinous, ligamentum flavum) Epidural space Dura Mater Subdural space Arachnoid Subarachnoid space- CSF |
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What is the difference between the fasiculus gracilis and the fasciculus cuneatus?
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gracilis=legs (medial)
cuneatus=arms (lateral) |
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What is the role of the Dorsal column-medial lemniscal pathway
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ascending pressure, vibration, touch, and proprioception
ascends ipsilaterally synapses in nucleus cunneatus or gracilis in the medulla contralaterally in the medial meniscus to the VPL of the thalamus |
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What is the role of the Spinothalamic tract
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pain and temperature
crosses after synapsing in the ipsilateral gray matter synapses again in VPL of the thalamus |
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What is the lateral cotricospinal tract?
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descending voluntary movements
1ry motor cortex descends ipsilaterally to the caudal medulla and decussates in the pyramidal tracts cell body of the ant. horn of hte spinal cord-> NMJ |
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How is the brachial plexus divided?
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Randy Travis Drinks Cold Beer
Roots Trunks Divisions Cords Branches |
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What is the deformity of an upper trunk lesion?
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Waiter's tip
Musculocutaneous |
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What is the deformity caused by a lower trunk lesion?
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Claw hand
ulnar |
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What comes from a Posterior cord lesion?
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wrist drop
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What deforimity comes from a axillary nerve lesion?
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deltoid paralysis
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What deformity comes from a long thoracic nerve lesion?
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winged scapula
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What comes from a radial nerve lesion?
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wrist drop
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What deformity comes from a musculocutaneous lesion?
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Difficulty flexing the elbow, variable sensory loss
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What is the deformity that comes from a median nerve lesion?
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decreased thumb fuction
pope's blessing |
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What is the deformity that comes from an ulnar nerve lesion?
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intrinsic claw hand
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What is the function of the radial nerve?
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BEST
Brachioradialis Extensors of the wrist and fingers Supinator Triceps |
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What is the function of the thenar and hypothenar muscles?
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OAF
thenar- Opponens pollicis, Abductor pollicis brevis, Flexor pollicis brevis Hypothenar- Oppones digiti, Abductor digiti, flexor digiti |
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What si the landmark for a pudendal nerve block?
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ischial spine
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What is the landmark for the appendix?
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2/3rd of the way from the umbilicus to the ant. superior iliac spine (McBurney's point)
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What is the landmark for the lumbar puncture?
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iliac crest
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C2
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posterior skull cap
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C3 Dermatome
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high turtleneck
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C4 Dermatome
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low collar shirt
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T4 Dermatome
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nipple
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T7 Dermatome
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Xyphoid
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T10 Dermatome
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umbilicus
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L1 Dermatome
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inguinal ligament
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L4 Dermatome
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kneecaps
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S2,3,4 Dermatome
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erection
penile and anal sensation |
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Where does gallbladder pain refer?
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R shoulder via the phrenic
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How is the muscle spindle controlled?
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in parallel w/ muscle fibers. Muscle stretch-> intrafusal stretch-> stimulates Ia afferent-> stimulates alpha motor neuron-> reflex muscle (extrafusal) contraction
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What is the gamma loop in muscle control?
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CNS stims gamma-> contracts the intrafusal-> increased sensitivity of reflex arc
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What is the role of the golgi tendon organ?
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monitors muscle tension; makes you drop a suitcase if you've been holding it too long.
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What are the reflexes?
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the count up
S1,2- achilles L3,4 - patellar C5,6 - biceps C7,8 - triceps babinski- UMN lesion |
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What are the primitive reflexes?
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Moro- extension of limbs
Rooting- look for the nipple Palmar- grasp objects in palms Babinski disappear in the 1st year |
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What cranial nerves lie medially at brain stem?
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3, 6, 12
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What cranial nerves start at the midbrain?
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III, IV
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What cranial nerves start at the Pons
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V, VI, VII, VIII
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What cranial nerves start at the medulla
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IX, X, XI, XII
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What is the nucleus solitarius
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Vagal nucleus
Visceral Sensory infomration (tast, baroreceptors, gut distention 7, 9, 10 |
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What is the nucleus ambiguus?
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vagal nucleus
Motor innervaion of the pharynx, larynx and upper esophagus 9, 10, 11 |
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What is the dorsal motor nucleus
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vagal nucleus
atonomic to heart, lungs and GI |
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What CN travels through the cribiform plate?
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I
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What travels through the optic canal? (3)
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II, opthalmic artery, central retinal vein
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What travels through the Superior orbital fissure? (5)
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CN III, IV, V1, VI, ophthlamic vein
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What travels through the foramen Rotundum and Ovale
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Standing Room Only
V1- S- superior orbital fissure V2- R- Foramen Rotundum V3- O- Ovale |
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What travels through the foramen spinosum?
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middle meningial artery
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What passes through the internal auditory meatus (2)
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CN VII, VIII
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What passes through the jugular foramen?
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IX, X, XI, jugular
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what passes through the hypoglossal canal?
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XII
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What passes through the foramen magnum?
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spinal roots of CN XI, brain stem, vertebral arteries
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What is the cavernous sinus?
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collection of venous sinuses on either side of the pituitary. Blood from eye and superficial cortex drains to the cavernous which drains to the internal jugular
CN II, IV, VI, V1, V2 aond postganglionic symps pass through. |
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What is cavernous sinus syndrome?
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ophthalmoplegia
ophthalmic and mandibular sensory loss |
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What ar ethe muscles of mastication?
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Close:
Masseter Temporalis Medial pterygoid Open: lateral pterygoid all innervated by V3 |
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What innervates muscles that end in glossus?
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hypoglossal
except palato- Vagus |
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What innervates muscles with palat in the name?
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innervated by vagus
except tensor veli platini (too tense; lets V handle it) |
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What is the function of the superior oblique?
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abducts, introverts, depresses
(down and in) |
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What are the functions of the eye muscles?
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LR-> temporal
Obliques-> nasal, opposite Rectus-> temporal, same (rectal sex = same sex) |
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What nucleus is responsible for pupillary contraction in response to light?
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Edinger-Westphal
CNIII constricts |
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KLM sounds
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Ka, Ka, Ka- tests palate (vagal)
La-la-la- tests tongue (glossal) Ma, Ma, Ma- tests lip (VII) |
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What are the wave forms?
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BATS Drink Blood
Beta- awake Alpha- awake- eyes closed theta- light sleep 1 sleep spindles- deep sleep 2 Delta- Deepest, non-REM; sleepwalking, night terrors, bed-wetting (slow-wave) Beta- REM- dreaming loss of motor tone, etc |
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What neurotransmitter triggers sleep?
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Serotonergic predominance of raphe nnucleus is the key to initiating sleep
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What neurotransmitter reduces REM?
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NE
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What controlse hte eye movements in REM?
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PPRF
paramedian pontine reticular formation |
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What does paradoxical sleep and desynchronized sleep refer to?
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REM sleep having the same EEG waves as bein awake
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What is the effect of Benzos on sleep?
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shorten stage 4
night terrors and sleepwalking |
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What is the role of imipramine in sleep?
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treats enuresis due to decreased stage 4
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what are the key features of REM?
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increased and variable puls, REM, increased and variable blood pressure, penile/clitoral tumescence
every 90 minutes duration increases throughout the night ACh is the principal neurotransmitter decreases w/ age |
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Neural tube defects
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elevated alpha-fetoprotein in amniotic fluid and maternal serum
Spina bifida occulta- failure of bony spiral canal to close, no structural herniation. Usually seen at lower vertebral levels. Meningocele- meninges herniate through the spnial canal defect Menigomyelocele- meninges and spinal cord herniate through spinal canal defect |
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What are the consequences of a lesion in the:
Broca's area? |
Motor aphasia w/ good comprehension
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What are the consequences of a lesion in the:
Wernicke's Area |
Sensory aphasia w/ poor comprehension
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What are the consequences of a lesion in the:
Arcuate fasciculus |
Conduction aphasia: poor repetition w/ good comprehension, fluent speech
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What are the consequences of a lesion in the:
Amygdala |
Kluver-Bucy syndrome (hyperorality, hypersex, disinhibited)
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What are the consequences of a lesion in the:
Frontal lobe |
Personality change, deficits in concentration, orientation, and judgement; may have reemergence of primitive reflexes
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What are the consequences of a lesion in the:
Right parietal lobe |
Spatial neglect syndrome
(agnosia of the contralateral side of the world) |
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What are the consequences of a lesion in the:
Reticular activating system |
Coma
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What are the consequences of a lesion in the:
Maimmillary bodies |
Wernicke-Korsakoff
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What are the consequences of a lesion in the:
Basal Ganglia |
tremor at rest, chorea, athetosis
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What are the consequences of a lesion in the:
Cerebral hemisphere |
Intention tremor, limb ataxia
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What are the consequences of a lesion in the:
Cerebellar vermis |
Truncal ataxia, dysarthria
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What are the consequences of a lesion in the:
Subthalamic nucleus |
Contralateral hemiballismus
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What is chorea?
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sudden, jerky, purposeless movements
basal ganglia lesion (huntingtons) |
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Athetosis
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Slow writhing movemetns of fingers
basal ganglia snakelike |
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What is hemiballismus?
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Sudden, wild flailing of 1 arm
Characteristic of contralateral subthalamic nucleus lesion. Loss of inhibitioin of thalamus through globus pallidus |
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What is the difference between Broca's and Wernicke's aphasia?
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Broca- nonfluent aphasia w/ intact comprehension- inferior frontal gyrus
Wernickes- fluent aphasia w/ impaired comprehension- superiro temporal gyrus Broca's is broken speech Wernicke is wordy |
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Alzheimers
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cerebral cortex degeneration
most common cause of dementia in the elderly. Associated w/ senile plaques (extracellular, B-amyloid core) and neurofibrillary tangles (intracellular, abnormally phosphorylated tau protein) genes- 1,14,19 APOE4; 10% familial 21 pApp gene |
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Picks
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dementia, aphasia, parkinsonian aspects
(intracellular aggregated tau protein) specific for the frontal and temporal lobes |
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Huntington's
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AD inheritance
chorea, dementia. Atrophy of caudate nucleus (loss of GABAergic neurons) Chromosome 4 expansion of CAG repeats C caudate A loses ACh G loses Gaba |
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Parkinson's
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Lewy bodies
depigmentation of the substantia nigra pars compacta Rare cases have been linked to eposure from MPTP contaminant in illicit street drugs. TRAP Tremor Rigidity Akinesia Postural instability you are TRAPped in your body |
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Olivopontocerebellar atrophy
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Friedreich's ataxia
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ALS
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Amyotrophic lateral sclerosis
associated w/ both LMN and UMN signs No sensory deficit |
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Werdnig-Hoffmann disease
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AR inheritance
floppy baby tongue fasciculations death at 7 months degeneration of the anterior horns |
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Polio
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LMN signs
degeneration of the ant. horns |
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Poliomyelitis
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caused by poliovirus- fecal oral
replicates in the oropharynx and small intestine before spreading through the bloodstream to the CNS where it leads to the destruction of cells in the ant. horn of the spinal cord. causes LMN destruction Sx- Malaise, headache, fever, nausea, ab pain, sore throat LMN lesions- muscle weakness, atrophy, fasciculations, fibrillation, and hyporeflexia Findings- CSF w/ lymphocytic pleocytosis w/ elevation of protein. Virus recovered from stool or throat |
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Multiple Sclerosis
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increased prevalence w/ increased distance from the equator
periventricular plaques. oligodendrocyte loss and reactive gliosis w/ preservation of axons increased protein in CSF Many pts have relapsing-remitting course Pts can present w/ optic neuritis MLF syndrome (internuclear opthalmoplegia) hemiparesis, hemisensory symps, or bladder/bowel incontinence SIN Scanning speach Intention tremor Nystagmus women in their 20s and 30s; whites B-IFN or immunosuppressant therapy |
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Progressive multifocal leukoencephalopathy
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JC virus, AIDS
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Acute disseminated encephalomyelitis
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postinfection
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Metachromatic leuckodystrophy
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lysosomal storage disease
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Guillain-Barre
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acute idiopathic polyneuritis
Inflamm and demyelination of peripheral nerves and motor fibers of ventral roots - motor more severe symmetric ascending muscle weakness in distal lower extremities Facial diplegia in 50% of cases Autonomic function may be severely affected- cardiac, HTN, hypotension) recoverey after weeks to months increased CSF protein w/ normal cell count Papilledema infections; herpes, campylobacer, inoculations, stress Respiratory support is critical plasmapheresis, IV immune globulines |
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Simple partial
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retained consciousness
motor, sensory, autonomic, psychic |
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Complex partial
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impaired consciousness
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Absense seizure
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blank stare
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Myoclonic
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quick, repetitive jerks
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Tonic-clonic
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alternating stiffening and movement
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Tonic
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stiffining
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Atonic
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drop seizures
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Epilepsy
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disorder of recurrent seizures
partial can 2rly generalize |
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What are the causes of seizures?
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kids- genetic, infection, trauma, congenital, metabolic
Adults- tumors, trauma, stroke, infection Elderly- stroke, tumor, trauma, metabolic, infection |
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Epidural hematoma
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Rupture of the middle meningeal artery
2ry to fracture of temporal bone. Lucid interval Biconvex disk |
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subdural hematoma
|
rupture of the bridign veins. Venous bleeding
delayed onset of symps elderly, alcoholics, blunt trauma, shaken baby- brain atrophy, shaking, whiplash crescent shaped hemorrhage; crosses suture lines |
|
|
Subarachnoid hemorrhage
|
Rupture of an aneurysm- berry
or an AVM. Worst headach of my life Bloody or xanthochromic spinal tap |
|
|
Parenchymal hematoma
|
HTN, amyloid angiopathy
DM and tumor |
|
|
Berry aneurysms
|
bifurcations in the circle of willis
anterior communciating artery. Rupture causes hemorrhagic stroke/subarachnoid hemorrhage. Adult polycystic kidney disease, Ehlers-Danlos syndrome, and marfans RFs- age, HTn, smoking, race |
|
|
What are the differences between UMN and LMN lesions?
|
wekness in both
atrophy, fasciculation in LMN increased reflexes and tone in UMN; decreased in LMN Babinski is + in UMN |
|
|
What are the characteristic lesions of polio and Werdnig-Hoffmann disease?
|
LMN lesiosn of anterior horns-> flaccid paralysis
|
|
|
What are the characteristic spinal cord lesions of MS?
|
white matter of cervical region. random and asymmetric
demylenation; scanning speech, intention tremor, nystagmus |
|
|
What are the characteristic spinal cord lesions of ALS?
|
combined upper and lower motor neurons signs
bilateral |
|
|
What are the characteristic spinal cord lesions of complete occulsion of ventral artery?
|
spares the dorsal columns and tract of Lissauer
|
|
|
What are the characteristic spinal cord lesions of Tabes Dorsalis?
|
degeneration of dorsal roots and dorsal columns;
impaired proprioception locomotor ataxia |
|
|
What are the characteristic spinal cord lesions of Syringomyela
|
crossing fibers of corticospinal tract damanged; bilateral loss of pain and temerature sensation
|
|
|
What are the characteristic spinal cord lesions of b12 neuropath and Friedreichs ataxia?
|
demyelination of dorsal columns and lateral corticospinal tracts
spinocerebellar tracts ataxic gait, hyperreflexia, impaired position and vibration sense |
|
|
Syringomyelia
|
Enlargement of the central canal of spinal cord
crossing fibers of the spinothalamic tract are damaged. Bilateral loss of pain and temperature sensation in upper extremities w/ preservation of touch sensation presents in pts w/ Arnold Chicari malformation Most common at C8-T1 |
|
|
Tabes Dorsalis
|
Degeneration of the dorsal columns and dorsal roots due to 3ry syphilis, resulting in impaired proprioception and locomotor ataxia. Charcot's joints, shooting pain, Argyll Robertson pupils. No DTRs.
|
|
|
What is brown-Sequard syndrome
|
Hemisection of spinal cord
1. Ipsilateral UMN signs below lesion 2. Ipsilateral loss of tactile, vibration, proprioception sense below lesion 3. Contralateral pain and temperature loss (spinothalamic tract) below lesion 4. Ipsilateral loss of all sensation at level of lesion 5. LMN signs at level of lesion. |
|
|
Horner's syndrome
|
PAM is horny
Ptosis- drooping of eyelid Anhidrosis- absence of sweating and flushing of affected side Miosis- pupil constriction - lesion of spinal cord above T1. |
|
|
What is the 3-neuron oculosympathetic pathway?
|
hypothalamus to the intermediolatereal column of spinal cord-> superior cervical ganglion, to teh pupil, smooth muscle of the eyelids, and the sweat glands of the forehead and face. Causes Horner's syndrome
|
|
|
Radial Nerve
When is the site of injury what is the deficit in motion what is teh deficien in sensation? |
Shaft of the humerus
loss of triceps, brachioradialis, and extensor carpi radialis longus-> wrist drop Posterior brachial cutaneous sensantion Posterior antebrachial cutaneous (through the supinator) |
|
|
Median Nerve
When is the site of injury what is the deficit in motion what is teh deficien in sensation? |
Supracondyle of the humerus
loss of forearm pronation, writs flexion, finger flexion and several thumb movements-> thenar atrophy passes through pronator terres |
|
|
Ulnar Nerve
When is the site of injury what is the deficit in motion what is teh deficien in sensation? |
medial epicondyle
impaired wrist flexion and adduction. impaired addduction of the thmb and the ulnar 2 fingers Loss of sensation over the medial palm and ulnar fingers passes through flexor carpi ulnaris |
|
|
Muculocutaneous Nerve
what is the deficit in motion |
Loss of function of the coracobrachialis, biceps, and brachialis
passes through coracobrachialis |
|
|
What is Erb-Duchenne Palsy
|
Tractio or tear o f the upper trunk of the bracheal plexus (blow to the sholder or trauma during delivery)
Limb hangs by side (paralysis of abductors) Medially rotated (paralysis of lateral tortators forearm is pronated (loss of biceps Waiter's tip" |
|
|
Common peroneal Nerve
When is the site of injury what is the deficit in motion what is teh deficien in sensation? |
Loss of dorsiflexion (foot drop)
deep peroneal-> ant. compartment superficial -> lateral compartment PED peroneal everts and dorsiflexes damage-> dropPED |
|
|
Tibial Nerve
When is the site of injury what is the deficit in motion what is teh deficien in sensation? |
Loss of plantar flexion. Tibial nerve innervates posterior compartment
TIP Tibial Inverts Plantarflexes can't stand on TIP toes if injured |
|
|
Femoral Nerve
When is the site of injury what is the deficit in motion what is teh deficien in sensation? |
Loss of knee extension/knee jerk
|
|
|
Obturator Nerve
When is the site of injury what is the deficit in motion what is teh deficien in sensation? |
loss of hip adduction
|
|
|
What is thoracic outlet syndrome?
|
Klumke's palsy
embyologic defect can compress subclavian artery and infereior trunk of brachial plexus 1. atrophy of thenar and hypothenar 2. Atrophy of interosseous .3 Sensory deficits on medial forearm and hand 4. no radial pulse when moving the head to the other side. |
|
|
What is the effect of a CN XII lesion?
|
tongue deviates towards the lesion
|
|
|
CN V motor lesion?
|
Jaw deviates towards the lesion
|
|
|
unilateral lesion of the cerebellum
|
fall toward the lesion
|
|
|
CN X lesion
|
uvula deviates away
|
|
|
CNXI
|
weakness turning head to contralateral side of lesion. Shoulder droop on side of lesion
|
|
|
UMN lesion of the face
|
lesion of motor cortex or connection between cortex and facial nucleus-> contralateral paralysis of lower face
|
|
|
LMN lesion
|
Ipsilateral paralysis of upper and lower face
|
|
|
Bell's palsy
|
destruction of the facial nucleus or its branchial efferent fibers
Peripheral ipsilateral facial paralysis idiopathic; gradual recovery ALexander Bell with STD AIDS Lyme Sarcoid Tumor Diabetes |
|
|
What happends in a cingulate herniation?
|
herniates under falx cerebri
can compress ant. cerebral artery |
|
|
What herniations can compress the brainstem?
|
Downward transtentoria
Uncal herniation Uncus- medial temporal lobe |
|
|
Cerebellar tonsillar herniation
|
gets pushed through the foramen magnum
|
|
|
What are the signs of an uncal herniation?
|
ipsilateral dilated pupil/ptosis from the stretching of CNIII
Contralateral homonymous hmianopia- from the compression of ipsilateral posterior cerebral artery Ipsilateral paresis- compressio of contralateral crus cerebri Duret hemorrhageds from paramedian artery rupture from the caudal displacement of the brain stem. |
|
|
How would you get right anopia?
|
R optic nerve severed before the chiasm
|
|
|
how would you get bitemporal hemianopia
|
compression of the chiasm
|
|
|
how would you get left upper quadrantic anopsia?
|
temporal lobe damage- Meyer's loop
|
|
|
How would you get left homonymous hemianopia
|
optic tract lesion after the chiasm
|
|
|
How would you get left lower quadrantic anopia?
|
Right parietal lesion
dorsal optic radiation is busted |
|
|
How would you get left hemianopia w/ macular sparing?
|
calcarine fissure lesion
|
|
|
What is internuclear ophthalmoplegia?
|
lesion in the medial longitudinal fasciculus
medial rectus plasy on attepmted lateral gaze. Nystagmus in abductin eye. Convergence is normal. MLF seen in multiple sclerosis reflex is usually something that drigeers the movement of the opposit eye meidal recturs |
|
|
What are the neurotransmitter changes in anxiety?
|
increased NE
decreasaed Gaba decreased serotonis |
|
|
What are the neurotransmitter changes in depression
|
decreaesed NE and serotonin
|
|
|
What are the neurotransmitter changes in alzheimers
|
ACh
|
|
|
What are the neurotransmitter changes in hungtingtons?
|
decreased gaba, ACH
|
|
|
What are the neurotransmitter changes in schizo?
|
increased dopa
|
|
|
What are the neurotransmitter changes in parkinsons
|
decreased dopa
|
|
|
What is orientation?
|
whether a pt is aware of him or herself as a person
do they know their name Anasognosia- unaware that one iss ill Autotopagnosia- unable to locate one's own body Depersonalization- body seems unreal or dissociated order of loss: 1st- time 2nd- place 3rd person |
|
|
What is anterograde amnesia
|
can't remember new things
|
|
|
what is Korsakoff's amnesia
|
anterograde amnesia of thiamine deficiency (bilateral destruction of the mammillary bodies
alcohol- confabulations |
|
|
What is retrograde amnesia?
|
inabliitly to remember things before an insult
|
|
|
what are the signs of Substance dependance
|
Maladaptive pattern of substance - 3 of the following:
Tolerance Withdrawal Substance taken in larger amounts or longer time than desired Persistent desire or attempts to cut down Significant energy spen obtaining, using, or recovering from a substance Important social, occupational, or recreational activities reduced due to use continued in spite of knowledge of problems. |
|
|
What are the signs of substance abuse?
|
clinically significan impairment or distress.
1. recurrent use -> failure to fulfill obligations 2. use in physically hazardous situations 3. substance-related legal problems 4. conintued use inspide of problems caused. |
|
|
What are the signs of alcohol intox?
|
disinhibition
emotional labliity slurred speech ataxia coma blackouts GGT- indicator |
|
|
What are the withdrawal signs of alcohol intox?
|
tremor, tachycardia
HTN malaise Nausea seizure delirium trememns tremulousness agitaion hallucinations |
|
|
What are the signs of opioids intox?
|
CNS depression
nausea and vomiting constipation pupillary constriction seizures |
|
|
What are the withdrawal signs of opioid intox?
|
Anxiety
insomnia sweating dilated pupils piloerection fevere rhinorrhea nausea stomach cramps diarrhea yawning |
|
|
What are the signs of amphetamines intox?
|
Psychomotor agitation, imparied judgement
pupillary dilation hyeprtension tachycardia euphoria prolonged wakefulness and attention cardiac arrhythmias delusions hallucinations fevere |
|
|
What are the withdrawal signs of amphetamine intox?
|
Crash
depression lethargy headache stomach cramps hunger hypersomnolence |
|
|
What are the signs of Cocaine intox?
|
euphoria
psychomotor agitation imparied judgement tachycardia pupillary dilation hypertension hallucinations paranoid ideations angina sudden death |
|
|
What are the signs of cocaine withdrawal?
|
postuse "crash" including severe depression and suicidality
hypersomnolence fatigue malaise severe psychological craving |
|
|
What are the signs of PCP intox?
|
Belligerence
Impulsiveness fever psychomotor agitation vertical and horizontal nystagmus tachycardia ataxia moicidality psychosis delirium |
|
|
What are the signs of PCP withdrawal?
|
reabsorption in GI tract
sudden onset of severe random, homicidal violence |
|
|
What are the signs of LSD intox?
|
Marked anxiety or depression, delusions, visual hallucinations, flashbacks, pupil dilation
|
|
|
What are the signs of Marajuana intox?
|
Euphoria
anxiety paranoid delusions slowed time impaired judgement social withdrawal increased appetitie dry mouth hallucinations |
|
|
What are the signs of barbiturates intox?
|
Low safety margin
resp depression |
|
|
What are the signs of barbituate withdrawal?
|
anxiety
seizures delirium cv collapse |
|
|
What are the signs of benzo intox?
|
Okay safety margin
Amnesia ataxia somnolence minor resp depression Addictive effects w/ alcohol |
|
|
What are the signs of benzo withdrawal?
|
Rebound anxiety, seizures, tremor, insomnia
|
|
|
What are the signs of caffeine intox?
|
Restlessness
insomnia increased diuresis muscle twitching cardiac arrhythmias |
|
|
What are the signs of caffeine withdrawal?
|
Headache
lethargy depression weight gain |
|
|
What are the signs of nicotine intox?
|
Restlessness
insomnia anxiety arrhythmia |
|
|
What are the signs of nicotine withdrawal?
|
Irritability
headache anxiety weight gain craving |
|
|
what is delirium tremens?
|
life-threeatening alcohol w/drawal syndrome that peaks 2-5 days after last drink
Autonomic hyperactivity- tachy, tremors, anxiety psychotic- hallucinations, delusions confusion Rx- benzos |
|
|
What is Wernicke-korsikoff?
|
B1 deficiency
confusion, ophtalmoplegia, ataxia. progresses to memory loss, confabulartion, personality change. Periventricular hemorrhage/necrosis especially in mammillary bodies Rx- IV B1 |
|
|
Mallory-Weiss syndrome
|
longitudinal lacerations at the gastroesophageal junction from excessive vomiting
has pain no pain in esophageal varices |
|
|
what are clues to heroine addiction?
|
track marks
risk for hepatitis, abscesses, OD hemorrhoids, AIDS and R-sided endocartidis Naloxone and naltrexone inhibit Methadone- used for heroin detox |
|
|
What is delirium
|
Rapid decrease in attention span and level of arousal
disorganized thinking, hallucinations, illusions, pisperceptions, disturbance in sleep-wake cycle cognitive dysfunction Dx- waxing and waning level of consciousness - substance use/ illniss look for anti-ACh |
|
|
Dementia
|
Gradual decrease in cognition- memory, aphasia
apraxia, agnosia loss of abstract though behavioral/personality changes, imparied judgement Dx- rule out delirium (alertness). more gradual. In elderly, depression can present as dementia irreversible |
|
|
What are the Sx of a major depressive episode?
|
SIG E CAPS
Sleep disturbance Loss of Interest Guilt or feelings of worthlessness Loss of Energy Loss of Concentration Change in Appetite/weight Psychomotor retardation Suicidal idealations prevalence- 5-12% male 10-25% female Major depressive disorder is recurrent. 2 or more episodes Dysthymia milder |
|
|
What are the sleep patterns of depressed pts.
|
decreased slow wayve, REM latency
Early-morning awakening |
|
|
What are the risk factors for suicide?
|
SAD PERSONS
Sex Age Depression Previous attempt Ethanol Rational thinking Sickness Organized plan No spouse Social support doesn't exist. |
|
|
When is electroconvulsive therapy used?
|
major depressive disorder taht is refractory to other treatment
ECT is painless and produces a seizure ECTs can cause disorientation anterograde and retrograde amnesia complications from anesthesia |
|
|
What describes a manic episode?
|
DIG FAST
Distractible Irresponsible Grandiose Flight of idease Activity and agitated Sleep isn't needed Talkative |
|
|
What is a hypomanic episode?
|
mood disturbance isn't severe enough to cause marked impairment in social or occupational functioning
|
|
|
Bipolar
|
manic- bipolar I
hypomanic- bipolar II depressed episoeds Lithiium |
|
|
Conversion disorder
|
motor or sensory symps that suggest neurologic or physical disorder- follows an acute stressor.
|
|
|
Somatoform pain disorder
|
prolonged pain that is not explained by illness
|
|
|
Body dysmorphic disorder
|
preoccupation w/ minor or imagined physical flaws
pts seek cosmetic surgery |
|
|
Pseudocyesis
|
false belief of being pregnant
|
|
|
What are the differences between 1ry, 2ry, and 3ry gain?
|
1ry- symptom does for patienst internal psychic economy
2ry- symptom gets teh patient (sympathy) 3ry- what the caretaker gets (MD and interesting case) |
|
|
What are the signs of a panic disorder?
|
Recurrent periods of intese fear and discomfort- peaks in 10 mins
Palpitations Paresthesias Abdominal distress Nausea Intense fear of dying or losing control lIght headedness Chest pain Chills Choking disConnectedness Sweating Shaking Shortness of breath Panic is decscribed in the context |
|
|
What is a phobia?
|
fear that is excessive or unreasonable
cued by presence or anticipation of a specific object or situation exposure-> anxiety Gamophobia- fear of marraige Algophobia- fear of pain Acrophobia- fear of heights Agoraphobia- fear of open places |
|
|
What is post-traumatic stress disorder?
|
person experienced or witnessed event tha tinvolved actual or threatened death or serious injury
-> intense fear, helplessness, or horror Traumatic event is persistently re-experienced as nightmares or flashbacks person persistently avoids stimuli associated w/ trauma and experiences persistent symps of increased arousal Disturbance lasts more than 1 month and causes distress or social/occupational impairment PTSD follows acute stress disoreder, which lasts 2-4 wks |
|
|
What is adjustment disorder?
|
anxiety, depression that causes impairment after a pychosocial stressor like divorse or moving
|
|
|
What is generalized anxiety disorder
|
uncontrollable anxiety unrelated to person, situation or event.
Sleep disturbance, fatigue, adn difficulty concentrating |
|
|
What is autistic disorder?
|
severe communication probs
difficulty forming relationships repetitive behavior, unusual abilities, and below-normal intelligence Rx- increase communication and social skills |
|
|
What is asperger disorder
|
milder form of autism involving problems w/ social relationships and social behavior.
normal inteligence |
|
|
what is Rett disorder
|
X-linked, in girls
loss of development and mental retard appearing at 4. hand-wringing |
|
|
what is ADHD
|
limited attention span and hyperactivity
kids are emotionally labile, and impulsive prone to accidents Methyphenidate to treat |
|
|
What is Conduct disorder
|
behavior that violates social norms
>18, diagnosed as antisocial personality disorder |
|
|
What is Oppositional defiant disorder
|
child is noncompiant in the absence of criminality
|
|
|
Tourette's
|
motor/voal tics and involuntary profanity
< 18 haloperidol to Rx |
|
|
What is seperation anxiety disorder
|
fear of loss of attachment figure leading to factitious complaints
|
|
|
Anorexia vs. Bulimia
|
anorexia- abnl eating habits, body iimage distortion, and increased exercise
severe weight loss, amenorrhea, anemia, and electrolyte disturbances can follow. seen in adolescent girls. Coexists w/ depression Bulimia- binge eating and self-induced vomitign or laxatives. Normal body weight Parotitis, enamel erosion, electrolyte disturbances, alkalosis dorsal hand calluses |
|
|
Illusion vs. delusion vs. hallucination
|
Hallucination- perceptions in the absence of external stimuli
Illusions- misinterpretations of actual stimuli Delusions- false belief not shared w/ other members of culture/subculture maintained despite obvious proof to the contrary. |
|
|
Delusion vs. loose association
|
Delusion- disorder of thought (actual idea)
loose association is a disorder in the form of though (the way ideas are tied together) |
|
|
What are the types of hallucinations?
|
Visual and auditory- schizo
Olfactory occurs as an aura of psychomotor epilepsy Gustatory- rare Tactile- formication(ants) DTs adn cocaine HypnaGOgic- Going to sleep Hypnapompic- waking |
|
|
Sleep apnea
|
person stops breathing for 10 seconds
Central- no resp effort Obstructive- lots of resp effort Obese, snoring, systemic/pulm HTN, arrhythmias, and possible sudden death Individuals may become chronically tired |
|
|
Narcolepsy
|
Disordered regulation of sleep-wake cycle
Hypnagogic or hypnopompic hallucinations nocturnal and narcoleptic sleep episodes start off w/ REM sleep Cataplexy-> loss of all muscle tone after a strong emotional stimulus Strong genetic component Rx w/ stimulants |
|
|
Schizophrenia
|
Periods of psychosis and disturbed behavior w/ a decline in functioning lasting > 6 months
1-6 monts- schizophreniform <1 month- brief psychotic disorder, stress related 1. Delusions 2. Hallucinations 3. Disorganized though 4. Disorganized or catatonic behavior Negative symps- flat affect, social w/drawal, lack of motivation, lack of speech or thought Genetic outweighs environment |
|
|
What are the subtypes of Schizo
|
Disorganized
Catatonic Paranoid Undiffed Residual Schizoaffective disorder- combined schizo and mood disorder |
|
|
What is the difference between a personality trait and a disorder?
|
trait- enduring pattern w/ a wide range of social and personal contexts
Disorder- when these traits become inflexible or maladaptive person is not aware of problems Disorder patterns must be stable by early adulthood; not diagnosed in kids |
|
|
What are the Cluster A disorders?
|
Weird
odd or eccentric- no meaningful social relationships. No psychosis Paranoid- distrust and suspiciousness; projection is main defense mechanism Schizoid- voluntary social w/drawal, limited emotional expression Schizotypal- interpersonal awkwardness, odd beliefs or magical thinking, eccentric appearance |
|
|
What are the cluster B personaltiy disorders
|
Wild
Antisocial- disregar and violatio of rights Borderline- unstable mood a nd interpersonal relationhsips, impulsive, empty Histrionic- excessive emotionality, attention seeking, sexually provocative Narcissistic- grandiosity, sense of entitlement; reacts to criticism w/ rage; may demand top physician |
|
|
Cluster C personality disorders
|
Worried
Anxious or fearful; genetic association w/ anxiety disorders Avoidant- sensitive to rejection Obsessive compulsive- preoccupation w/ order Dependant- submissive and clinging. |
|
|
What drugs are used for parkinsons?
|
BALSA
Bromocriptine- agonize dopamine receptors Amantadine- increase dopamine release L-dopa-> exog dopa Selegiline- MAO type B inhib- prevents dopa breakdown Antimuscarinic- benztropine- improves tremor and rigidity; no effect on bradykinesia |
|
|
L-dopa
|
increases dopa in brain. can cross BBB
Carbidopa prevents preipheral decarboxylase to increase bioavailability can cause arrhythmias from peripheral conversion to dopamine can cause dyskinesea w/ long term use and akinesea between doses |
|
|
Selegiline
|
selectively inhibits MAOB, increasing dopamine
adjuct w/ l-dopa can enhance adverse effects of l-dopa |
|
|
Sumatriptan
|
5HT1d agonist. Vasoconstriction. Half-life < 2 hrs
Acute migraine, cluster headaches SE causes coronary vasospasm, mild tingling can't use w/ CAD or prinzmetals |
|
|
Phenytoin
|
use-dependant blcok of Na channels
inhibs glutamate release from excitatory presynaptic neuron for tonic-clonic seizures. Class IB antiarrhythmic SE- nystagmus, ataxia, diplopia, sedation, SLE syndrome, induction of cP450 gingival hyperplasia in kids peripheral neuropathy, hirsutism megaloblastic anemia malignant hyperthermia teratogenic |
|
|
General characteristics of brain tumors
|
intracranial
few of the spinal cord kids- infratentorial adults- supratentorial 1rys rarely mets benign intracranial tumors can result in devastating clincial consequences due to compression phenomena Metastatic tumors to the brain are foudn more frequently than primary neoplasms 1ry- glioblastoma, meningioma, acoustic neuroma kids- cerebellar astrocytoma, medulloblastoma |
|
|
Glioblastoma multiforme
|
most common 1ry tumor in adults
peak in late middle-age anaplasia and pelopmorphism. vasc changes w/ endothelial hyperplasia. pseudopalisade arrangement of tumor cells- border central areas of necrosis and hemorrhage - cerebral hemisphere poor prognosis Stain w/ GFAP |
|
|
Oligodendroglioma
|
slow-growing
closely packed cells w/ large round nuclei w/ halo-> fried egg site of origin in the cerebral hemisphere tumor divides into group of cells by delecate capillary strands Foci of calcification |
|
|
Ependymoma
|
4th ventricle
peak in kids and adolescence histo by tubules or rosettes w/ cells encircling vessels or pointing toward a central lumen tumor cells demonstrate blepharoplasts, rod-shaped structures near the nucleus representing basal bodies of cilia. - papillary growths that obstruct flow of CSF and lead to hydrocephalus |
|
|
Meningioma
|
2nd most common
benign, slow growoing arachnoidal cells of meninges; external to brain cna grow into prasagittal region falx cerebri sphenoid ridge olfactory area suprasellar region histo- whorled pattern of concentric arranged cells and laminated calcified psammoma bodies frequently in women>men after 30 |
|
|
medulloblastoma
|
kid neoplasm
primitive neuroectodermal tumor malig tumor of the cerebellum can compress the 4th - sheeets of closely packed cells w/ scan tcytoplasm arranged in rosette or perivascular radiosensitive |
|
|
Neuroblastoma
|
closely related to neuroblastoma of the adrenal medulla or sympathetic ganglia
much less common than peripheral neuroblastoma amplification of the N-myc oncogene more amplification w/ worse prognosis |
|
|
Hemangioblastoma
|
most frequently in the cerebellum
von hippel lindau epo-> 2ry polycythemia Foamy cells and high vascularity are characteristic |
|
|
Neurilemmoma
|
Schwannoma- benign slowly growing encapsulated tumor arising from schwann cells
intracranial is most frequently localized to the eighth CN Antoni A- interlacing bundles Antoni B- less cellular, looser |
|
|
Neurofibroma
|
solitary or multiple tumors of peripheral nerves from schwann cell
von recklinghausen neurofibromatosis |
|
|
Mets
|
mor common
lung, breast, skin, kidney, GI, thyroid |
|
|
Pilocytic astrocytoma
|
diffulsely infiltrating glioma.
kids in posterior fossa benign rosenthal fibers- eosinophilic corkscrew mofos |
|
|
craniopharyngioma
|
most common supratentorial in kids
derived from remnants of rathke's pouch calcification |
|
|
Barbiturates
|
Facilitate GABAa action by increasing duration of Cl cahnnel opening, decreasing neuron firing
used as a sedative for anxiety, seizure, insomnia |
|
|
Benzodiazepines
|
Facilitate GABA action by increasing the frequency of Cl channel opening
MOst have long half-lives and active metabolites Clinically- anxiety, spasticity, status epilepticus (lorazepam and diazepam) detoxification- alcohol w/drawal night terrors, sleepwalking Toox- dependence, additive CNS depression effects. Less risk of resp depression and coma w/ barbs Flumazenil trates OD |
|
|
Which benzos are short acting?
|
Triazolam
Oxazepam Midazolam |
|
|
What are the toxicities of benzos?
|
sedation, tolerance, dependance
|
|
|
what are the toxicities of carbamazepine?
|
Diplopia, ataxia, blood dyscrasias, liver tox, teratogenesis
induce cP450 |
|
|
What are the toxicities of Ethosuximide
|
GI distress
lethargy headache urticaria stevens-johnson syndrome |
|
|
What are the toxicities of Phenobarbital
|
Sedation
Tolerance Dependance induction of cP450 |
|
|
What are the toxicities of Phenytoin
|
Nystagmus
diplopia ataxia sedation gingival hyperplasia hirsutism megaloblasti canemia teratogenesis SLE syndrome induction of cP450 |
|
|
What are the toxicities of valproic acid
|
GI disress, rare, but fatal hepatotoxicity (measure LFTs), neural tube defects in fetus, tremor, weight gain
|
|
|
What are the side effects of lamotrigine
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Stevens-Johnson syndrome
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What are the toxicities of Gabapentin?
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Sedation, ataxia
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What are the toxicities of Topiramate?
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Sedation, mental dulling, kidney stones, weight loss
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