Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
146 Cards in this Set
- Front
- Back
|
CSF does NOT give nutritional support to the s.c. but does do what 4 things?
|
Provides mechanical support
Buffer venous pressure changes Assist in Ionic regulation of CNS Acts as lymphatics for the CNS |
|
|
Memory + Learning =
|
Temporal Lobe
|
|
|
Speech + Language =
|
Frontal Lobe
|
|
|
Visual =
|
Parietal and Occipital Lobes
|
|
|
What are a few characteristics of a frontal lobe lesion?
|
Aphasia, Bladder incontinence and mood changes
|
|
|
What lobe involves disorders of the special senses?
|
Temporal lobe
-Because the primary auditory centers are in the temporal lobe |
|
|
A dysfunction of the higher cortical region would manifest as?
|
Language deficits
|
|
|
What sign will present with a cortical disorder?
|
Agraphesthesia
|
|
|
Higher cortical dysfunction can cause what?
|
Agraphesthesia
|
|
|
Higher cortical dysfunction results in what 3 things?
-other than agraphesthesia |
Complex sensory loss, Language deficit, and Astereognosis
|
|
|
What higher cortical system helps drive memory and learning and is located deep to the temporal lobe?
|
Limbic system
|
|
|
Where is broca's speech?
|
Frontal lobe
|
|
|
All of the following are related to an UMNL except?
Increased DTR, Spastic paralysis, Positive Babinski, Atrophy |
Atrophy
|
|
|
Disturbances of motor activities such as hemiballismus and choreathatosis indicate a problem where?
|
Basal ganglia
|
|
|
Rombergs sign is a test for?
|
Cerebellum
|
|
|
Dysmetria, dysdiadochokinesia and incoordination result from a lesion where?
|
Cerebellum
|
|
|
If a person cannot stand without swaying, even with their eyes open, the problem is most likely where?
What about if the eyes are closed? |
Cerebellum
Dorsal Column |
|
|
Cerebellar disorders include all the following except: intention tremor, disdiadochokinesia, walking smoothly, dysmetria
|
Walking smoothly
|
|
|
Conjugate gaze is accomplished through multiple cranial nerves. What two portions of the brainstem are involved in integrating these activities?
|
Mesencephalon (midbrain) and Pons
|
|
|
If a patient presents with hyperreflexia, spastic paresis, and deviation of the tongue on protrusion, to the side opposite the hyper-reflexia, the lesion is likely located where?
|
Medulla
|
|
|
Which cranial nerve does not have its nucleus in the pons?
4, 5, 6, 7, 8 |
4
|
|
|
The trigeminal nerve nucleus responsible for motor activity is located where in the neuraxis?
|
Pons
|
|
|
The nuclei responsible for cardioregulatory functions are located where in the neuraxis?
|
Medulla
|
|
|
The nucleus of which CN is located outside of the CNS?
|
1 and 2
|
|
|
The nucleus of which CN is located in the midbrain and is motor only?
1, 2, 3, 4 |
4
|
|
|
CN V has nuclei located in?
|
Pons, medulla, cervical cord
|
|
|
Which CN is not located in the medulla?
7, 9, 10, 11 |
7
|
|
|
Which CN nucleus is located in the midbrain?
4, 5, 6, 7 |
4
|
|
|
A lesion that involves loss of pain and temp on the R of the body and dilation of the pupil with the L eye down and turned outward. There is also ptosis of the eyelid. Where is the lesion located?
|
L midbrain
|
|
|
What is the only CN nucleus that is in all three parts of the brain stem?
|
Trigeminal CN V
|
|
|
Expansion of the central canal of the s.c. will likely first disrupt with s.c. pathway?
|
Lateral spinothalamic
|
|
|
In traumatic lesions to the s.c., the area that suffers greatest injury is?
|
The central gray
|
|
|
At what point in the cord does UMN stop and become LMN?
|
Anterior Horn cells
|
|
|
Temp is mediated by?
|
Lateral spinothalamic tract
|
|
|
MM contraction is mediated by?
|
corticospinal tract
(pyramidal < decussate in medulla) |
|
|
Dermatomal sensory loss, flaccid weakness and depressed reflexes indicate a lesion where?
|
Nerve root
|
|
|
Fasciculations are seen with lesions in which two?
|
Nerve root and peripheral nerve
|
|
|
All of these terms go with a nerve root lesion except?
Radiculopathy, Dermatome, Myotome, Myelopathy |
Myelopathy
|
|
|
MS =
|
demyelinating of the PNS
|
|
|
Your pt complains of increasing weakness of muscles, especially of the jaws during a meal. The lesion is likely where?
|
Neuromuscular junction
|
|
|
What mm are most rapidly impacted by NMJ ds?
Intrinsic mm of the hands, mm of face, eyes and jaw, the erector spinae, suboccipital mm |
MM of face, eyes, and jaw
|
|
|
NMJ lesions are characterized by which of the following?
-Proximal symmetric weakness that is better with exercise -Distal symmetric weakness that is better w/ exercise -Proximal symmetric weakness that is worse with exercise -Distal symmetric weakness that is worse with exercise |
Proximal symmetric weakness that is worse with exercise
|
|
|
Having a pt sustain an upward gaze is a good test for a lesion where?
|
NMJ
|
|
|
Which ds is assoc w/ a NMJ lesion?
|
MG
|
|
|
Which of of the following indicates a NMJ lesion?
-Gets worse w/ ex -Decreased contractility of mm w/ prolonged active use -No sensory changes -All of the above |
All of above
|
|
|
Which receptors show a marked reduction on the postsynaptic membrane?
|
ACH receptors
|
|
|
A marked reduction in the number of ACH receptors on the NMJ results in a dx of which NMJ ds?
|
MG
|
|
|
Which of the following are possible cause(s) of NMJ ds?
-Autoimmune -Sensory loss -Inherited |
Autoimmune and inherited
|
|
|
Which of the following is NOT a possible cause of NMJ ds?
-Virus -Sensory loss -Genetic -Autoimmune |
Sensory loss
|
|
|
NM ds is caused by all of the following except:
-familial -dairy -chromosomal -genetic |
dairy
|
|
|
A pt walks into your office and complains to you about his quick fatigue after performing daily activities. In fact he feels like he has to take a nap right after he completes any activity. What possible ds might the pt be displaing?
|
NMJ ds
|
|
|
Your pt is complaining of his weight-lifting routine getting shorter and shorter. This "plate-head" figures he's just getting stronger and doesn't need to work-out long and hard. He tell's you he is also feeling very weak after his gym routine but after he rests, he feels like he can do it again. What is wrong with the "plate-head"?
|
Suffers from a NMJ ds
|
|
|
MG is?
|
Ds of unknown cause
|
|
|
A pt with MG would present w/ the following symptoms?
|
Weakness during continued activity, but strength returns after a period of rest
|
|
|
Which of the following includes a hereditary disorder that has an affinity for proximal mm w/o sensory changes?
|
Myopathy
|
|
|
What is a characteristic of a myopathic lesion?
|
Weaker mm
|
|
|
Which is a myopathic lesion?
-MS -Alzheimer's -Duchenne's -Gordie Howe |
Duchenne's
|
|
|
What is an important factor in myopathic lesions?
|
Family hx
|
|
|
Which is NOT a characteristic of myopathic lesion?
-Sensory changes -Proximal symmetric weakness -Normal to decreased tone -Normal to decreased reflexes |
Sensory changes
|
|
|
Which is not assoc w/ myopathic lesions?
-Asymmetric mm weakness -Loss of sensation -Intact cutaneous reflexes |
Loss of sensation
|
|
|
Which is a myopathic lesion?
-MS -MD -Polio -Parkinsons |
MD (muscular dystrophy)
|
|
|
What relieves its blood supply from the anterior cerebral artery?
|
Corpus collosum
|
|
|
The anterior limb of the internal capsule receives its blood supply from which artery?
|
Anterior cerebral
|
|
|
The sensory homunculus for the fascial region receives its blood supply from what major artery?
|
MCA
|
|
|
Strokes frequently occur in the posterior limb of the internal capsule. What artery perfuses this region?
|
MCA
|
|
|
The CN nuclei responsible for lateral gaze for the R eye and R sided facial mm control receive their bloos supply from which major artery?
|
Basilar A
|
|
|
The aterior spinal artery is generated from branches off which of the following?
|
Vertebrobasilar artery
|
|
|
Which of the following are located in the posterior limb of the internal capsule?
|
Thalamic formation for somatosensory information, corticospinal tract, corticobulbar tract
|
|
|
Five steps in making a Dx
|
SHAFE
Syndrome Hx and physical exam Anatomic dx (localize lesion) Functional dx Etiological dx (whats occuring at perticular anatomy) |
|
|
Location of CN I, II
|
Brain
|
|
|
CN located in Midbrain
|
Midbrain
CN III, IV, V |
|
|
CN located in Pons
|
Pons
CN V, VI, VII, VIII |
|
|
CN located in Medulla
|
Medulla
CN VIII, IV, X, XI, XII |
|
|
CN located in C/S
|
CN V, VI
|
|
|
Cortex:
Sensory Motor Special |
Sensory = complex loss, astereognosia, agraphesthesia, visual spatial disorder
Motor = Variable Special = decreased language, decreased intellectual function |
|
|
Cerebellum:
Blood supply Sensory Motor Special |
BS = VBA
Sen = incoordination and clumsiness Mot = Intention tremor, dysmetria, dysdiodochokinesia Spe = possible brain stem involvement |
|
|
UMNL
|
-Hyperreflexia
-Spastic paralysis -mm weakness -Babinski -Hypertonia -Clasp knife response |
|
|
LMNL
|
-CNS or PNS
-Hyporeflexia -Atrophy |
|
|
Nerve root/radicular lesion:
|
-Dermatomal sensory loss
-Usually asymmetric -Myotomic hyporeflexia -Atrophy -Fasciculations/flaccid weakness -Pain |
|
|
NMJ:
|
-Autoimmune is inherited
-Sensory, no change -Motor = proximal symmetric weakness (worsens w/ exercis, late in the day, normal tone and reflexes Spe = effects mm of eyes, jaw, and face |
|
|
Myopathic lesion
Sensory Motor Special |
Sen: none
Mot: proximal symmetric weakness, no atrophy, no fasciculations, decreased tone and reflexes Spe: family Hx |
|
|
Lateral corticospinal (pyramidal):
|
-Info = motor signals from pre-central gyrus
-Decussation = caudal to medulla (columns to medial meniscus) -Test = myotome strength |
|
|
Dorsal columns
|
-info = 2 pt discrimination, light touch, vibration, proprioception
-decussation = medulla, dorsal column nuclei |
|
|
Lat spinothalamic
|
-info = pain, temp, crude touch
-dec = ventral white commissure, 2 levels above |
|
|
Cervical spondylosis occurs mostly at?
|
C4, C5, C6
|
|
|
If the pt has vascular compromise of the postero lateral spinal column (dorsal horn and dorsal columns) which modality is lost?
|
All sensory modalities
|
|
|
Posterolateral spinal arteries come from
|
VBA
|
|
|
The vermis of the cerebellum is essential for balance mechanisms and maintaining the upright posture. This structure receives its arterial blood supply from what vessel?
|
VBA
|
|
|
Carotid arteries deliver arterial blood to all aspects of the cerebral hemisphere except
|
???? Posterior 1/3 ?????
Not positive but I think |
|
|
The cause of the weakness is best deteremined?
|
After the disorder has been localized
|
|
|
Damage to the anterior spinal artery will result in deficits in all but which of the following?
|
Vibration below level of lesion
|
|
|
Gain disorders with imbalance of station and no mm?
|
Cerebellum
|
|
|
W/ damage to the dorsal horn at C6 which sensation will likely be spared in that dermatome?
|
None
|
|
|
Organophosphate toxicity will cause which of the following?
|
Acute of subacute motor weakness
|
|
|
Three tests checking cerebellar fx
|
Heel to shin, finger to now, rombergs, gait
|
|
|
The pt presents complaining of some difficulty maintaining his balance. In addition u notice on this intake paperwork, the writing seems course ad unsteady. When he extends his hand to shake yours, you notice shaking that worsens as he reaches out towards you. What is the likely location of lesion?
What is this movement called Which side will the pt fall to? |
cerebellum
intention tremor The side of lesion |
|
|
Your pt presents w/ his spuse at your office. she tells u that for the last few days, the pt doesn't seem to understand what she says to him and his responses make no sense. She also tells you his speech seems to be slurred. The pt has a hx of coronary artery ds, vascular ds in the lower extremity and the L/S xrays u took 3 yrs ago demonstrate atherosclerotic chnages in the abdominal aorta. Assuming the pt has had a vascular event what artery is involved that will explain the problems the pt is experiencing?
|
MCA
|
|
|
Bony components of the spinal canal?
|
2 pedicles, 2 lamina, vb
|
|
|
bony components of the IVF
|
2 bodies, 2 pedicles, set of z joints
|
|
|
Symptoms of the VB insufficiency are referred to as the Ds and Ns. List 5 symptoms
|
Dizziness, Dysphasiz, Disarthria, Diploplia, Nausea, Nystagmus, Numbness, Ataxia
|
|
|
The pt has developed hoarseness in addition to weakness and hyperreflexia in the R upper and lower extremities. Also identified on exam is failure of palatal elevation on the L. Where is the likely level of lesion?
|
CN lesion plus long tract sign = brainstem; probably in the medulla
|
|
|
An extramedullary anterior cord lesion will that impacts the R lateral spinothalamic pathway will effect fibers from which extremity first?
|
L Lower extremity
|
|
|
5 peripheral nerves
|
-Median
-Radial -Ulnar -Femoral -Peroneal |
|
|
3 different demyelinating ds
|
MS
ALS Guillan-barre syndrom |
|
|
With increased intracranial pressure, what CN will be first affected?
|
As the pressure increases it begins to press down on the tentorium, which begins to press down on CN II
|
|
|
Which sensory exam diff with LMNL, peripheral neuron ds?
|
LMN = dermatomal/myotomal pattern
Peripheral = territorial, usually distal |
|
|
Causes of myopathic disorders?
|
Typically hereditary
|
|
|
Causes of NMJ disorders?
|
destruction of Ach receptors on post synaptic membrane, auto-immune Dx, anti-cholinergic drugs
-exasterbated through prolonged activity or exercise |
|
|
3 functions of CSF?
|
1) shock absorption/mechanical support
2) electrolyte buffer/ venous pressure buffer 3) CNS lymph system/ ionic regulation of CNS |
|
|
Anterior cerebral artery supplies?
|
cortically the anterior 3/4 of the frontal lobe including the medial orbital fissure, frontal lobe, 4/5 of the corpus callosum and the aterior limbe of the internal capsule
|
|
|
MCA supplies?
|
Cortical branches = cortex and white matter of lat/inf frontal lobe, cortex and white matter of parietal lobe, superior temporal lob es and insula, face and upper extremity
Deep penetrating branches = putamen, part of head and body of caudate nucleus, posterior limb of the internal capsule, corona radiata |
|
|
PCA supplies?
|
Interpeduncular branches = cortex and white matter of the lat/inf frontal lobe, cortex and white matter of the parietal lobe, superior temporal lobes and insula. Face and upper extremity
|
|
|
Cerebral emboli
|
80% released from carotid bifurcation
20% are from the heart |
|
|
Battle Sign
|
Basilar fracture of the skull extending posteriorly damaging the sigmoid sinus, tissue behind the ear and over the mastoid process becomes boggy and discolored
|
|
|
Clinical effects of concussion
|
Immediate LOC
Suppression of reflexes Transient arrest of respiration Brief bradycardia Fall in BP |
|
|
4 complaints with post concussion syndrome
|
1) headaches = central symptom, general or localized
2) dizziness = not true vertigo, dizzy or light headed 3) intolerance = to noise, crowds, emotional excitement 4) restlessness = inability to concentrate, very tense |
|
|
Lhermite's sign = ?
|
Reports electric shock/like sensations down the spine upon neck flexion caused by cervical spndylogenic ds, intermedullary lesions
|
|
|
PAG 3 in cerebrovascular accident
|
1) thrombus
2) embolus 3) hemorrhagic |
|
|
2 processes cause arenchymal change with stroke
|
1) ischemia
2) hemorrhage |
|
|
Risk factors for stroke?
|
-HTN
-Smoking -Increased age -HRT ds -Diet -Obesity -Sedentary life style -Anemia -Dehydration -Diabetic |
|
|
3 types of generalized seizures
|
Convulsing = tonic, clonic, or tonic-clonic (grand mal)
Non-Convulsive = Absense (petit-mal) Juvenile = Myoclonic and epilepsy, infantile spasm, atonic |
|
|
Characteristics of tonic-clonic
|
-Pt often senses the approach
-Half of cases have some type of MVT before LOC w/ no memory of it -Half ar out of the blue -Initial flexion of trunk, opening mouth and eyelids, upward deviation of the eyes, arms elevated/abducted, hands pronated |
|
|
Characteristics of absence seizures
|
-Brief/sudden interruption of consciousness
-90% have a burst of fine clonic MVT of facial mm, eyelids, or fingers at rate of 3/5 -Pt do not fall -Briefly stop talking and fail to respond -High frequency in adolescent females |
|
|
Partial seizures
|
1. simple (w/o LOC or psychic change)
2. complex (w/ impared consciousness) -benign as simple partial progressing to LOC -impairment of consciousness upon onset |
|
|
Common partial seizure pattern
|
Seizure is a product of demonstrable facial lesion or EEG abnormality in cerebral cortex or diencephalons
-Simple = partial sensory-motor cortex, simple partial-frontal lobe |
|
|
Pain sensitive cranial structures
|
1) skin, subcutaneous tissue, mm, skull periosteum
2) eye, ear, nasal cavity, paranasal sinus 3) intracranial venus sinus, paricavernous structures 4) dura at base of brain, arteries w/in dura, pia, and arachnoid, anterior and mca and internal carotid |
|
|
Early signs and symptoms of MS
|
-Unilateral
-Weakness -Incoordination -Paresthesia -Positive LHermitte's sign -B/L babinski -Cerebellar ataxia -Optic neuritis |
|
|
Areas of CNS primarily affected by MS
|
-Optic nerve, brain
-Brain: scattered patches below surface -Optic nere and chiasm (rarely optic tract) -S.C. where pia veins are next to or w/in white matter |
|
|
ALS vs. MS
|
ALS = mm wasting, fasciculation, sensory involvement, males over 50
MS = Pyramidal weakness, optic neuritis, sensory loss, brainstem dysfunction |
|
|
Common parkinson
|
-1 million pt in america
-1% of pop over 65 -familial tendency 5% -asians 1/2 - 1/3 -blacks 1/4 |
|
|
Clinical features of parkinsons
|
-tremor (resting)
-rigidity -akinesia -postural reflexes -66% gone before signs and symptoms appear -expressionless face -stooped posture |
|
|
Pathological changes in partkinsons
|
-loss of pigmented cells in substantia nigra
-decreases melanin in cells -increased eosinophilic granules - lewy bodies -neuronal loss in mesencephalic formation -slight neuronal loss, lewy bodies in sympathetic ganglia |
|
|
S and S of Guillan-Barre
|
-mild respiratory of GI infection preceeding s and s
-paresthesia and slight numbness in fingers and toes -symmetrical weakness -proximal and distal extremities involved (usually lower extremities first) |
|
|
Diff dx problems w/ GBS-
|
-distinguish GBS from acute spinal cord ds marked by sensorimotor paralysis
-acute lesion of cord where DTR in intially lost -early transient urinary retention -cervical myelopathy |
|
|
Duschenne muscular dystrophy features: progressive mm weakness and
|
-affects only boys, skeletal mm are destroyed by dystrophin protein
-age 3-6 -can later affect hrt and lungs -Belker type MD features: inherited mm wasting Ds -begins in 2nd or 3rd decade of life -males -mm of hips and shoulders are weakened |
|
|
Posterior limb of the Internal Capsule
|
-Thalamic radiation
-Corticospinal tract -Corticobulbar tract |
|
|
Basal ganglia has what
|
-Corpus striatum: caudate and putamen
-substantia niagra -globus pallidus |
|
|
Consensual reflex is performed by what and where?
|
Performed by Edinger Westphal nucleus
In the midbrain |
|
|
Anterior limb of the Internal Capsule
|
Genu: corticobulbar pathway
Posterior limb: corticospinal pathway |
|
|
Caudate
|
Extrapyramidal activity
|
|
|
Movement of involuntary nature:
|
Basal ganglia
|
|
|
Putamen and globus pallidus form what?
|
the lentiform nucleus
|
|
|
Lateral ventricles produes?
|
CSF
|
|
|
CSF flow is based on respiratory rate. What happens when u breath in it ?
|
Decreases the pressure
|
|
|
Obstruction of CSF flow b/w cranial vault and cord = ?
|
Hydrocephalus
|
|
|
What is the communication b/w the 2 hemispheres?
|
Corpus Callosum
|
