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109 Cards in this Set
- Front
- Back
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Q. The 3 roles of pain?
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Protection
Prevention Healing |
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Q. The mental status examination helps classify a disorder as what 4 possible things?
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1. Confusional state
2. Dementia 3. Cognitive disturbance (apraxia, amnesia) 4. Psychiatric illness |
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Q. Rate resistance strength 0-5? Characterise each.
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0=no contraction, 1-trace, 2-w/o gravity, 3-against gravity, 4-with resistance, 5-normal strength
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Q. Astereognosis?
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Inability to identify object placed in hand
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Q. Agraphesthesia?
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Inability to identify number written in hand
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Q. Allesthesia?
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misplaced location of tactile stimulation
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Q. Extinction?
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Visual or tactile stimulus is lost when applied bilaterally.
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Q. Tactile agnosia?
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Inability to determine identity from shape
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Q. Constructional Apraxia where is the lesion located?
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Lesion in Parietal Lobe Association Area
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Q. Muscle stretch or deep tendon reflexes: Graded as follows
+4 +3 +2 +1 0 |
+4 pathological hyperreflexic
+3 hyperreflexic +2 normal +1 hyporeflexic 0 absent reflex |
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Q. A Positive Babinski?
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Patient flexes the toes TOWARD the PLANTAR SURFACE
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Q. Where is the lesion located in adults with positive Babinski?
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**adults with an UMN lesion
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Q. Primitive Reflexes:
Grasp? Suck? Snout? Glabellar? |
Grasp: stroking side of patient’s palm
Suck: involuntary sucking movements after stimulation of lips Snout: gently tapping the lips and results in their protrusion Rooting: stimulation of lips causes them to move toward stimulus. Glabellar: tapping forehead: causes patient to blink normally only 2-3 times |
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Q. Primitive reflexes show up in adults with what?
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Overlying frontal lobe dysfunction: normally inhibited by cortex: FRONTAL RELEASE SIGN
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Q. CT and MRI are angled
several degrees Up or DOWN? |
UPWARD to include entire brain
in fewer slices and to decrease X-ray exposure to the eyes |
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Q. CT is better at imaging what in the brain?
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STROKES & TRAUMA
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Q. MRI is better at imaging what in the brain?
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TUMORS & LESION OF WHITE MATTER
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Q. What 4 conditions are CONTRAINDICATED in LUMBAR PUNCTURE?
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1. Suspected INTRACRANIAL MASS lesion
2. Local Infection 3. COAGULOPATHY, Clotting factor deficiencies. 4. Suspected SPINAL CORD MASS lesion |
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Q. Where is the LUMBAR PUNCTURE made?
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L3-4, L4-5
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Q. 1. What color will the lumbar puncture fluid be?
2. What will the pressure not exceed? 3. WILL THERE BE RBCs in lumbar puncture? |
1. Clear or colorless
2. NOT EXCEED 180-200 3. NO |
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Q. If there is bloody cerebral spinal fluid, what will we want to distinguish between?
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CNS hemorrhage & traumatic tap
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Q. Delirium?
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Is a deficit of ATTENTION
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Q. Dementia?
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is a deficit of MEMORY
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Q. What distinguishes between delerium and dementia?
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TIME COURSE
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Q. Acute confusional Signs and Symptoms of Delerium?
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Signs: Disorientation to time, place, person, CHANGE IN PERSONALITY
SXM: Frank psychosis: Delusion Hallucinations Paranoia |
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Q. Frank psychosis: 3 SXM and what disease?
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1. Delusion
2. Hallucinations 3. Paranoia DX: Delerium |
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Q. Clinical Management of the Delusional Patient?
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Mini mental exam: 30 point scale
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Q. What is the normal score for the mini mental status exam?
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24 or higher
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Q. Confusion?
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A state of impaired attention, implies adequate arousal to perform mental status tests of this ability
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Q. Lethargy?
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A state in which arousal, though diminished, is spontaneously maintained or requires only light stimulation to get them to focus (say verbal only)
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Q. Obtunded?
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Decreased arousal with some response to touch or voice
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Q. Stupor?
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Severely impaired arousal with some response to vigorous stimuli
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Q. Delirium?
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A state of confusion with periods of agitation and sometimes hypervigilance, irritability, and hallucinations typically with alternating periods of depressed level of arousal
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Q. Aphasia?
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language disorder
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Q. Dysarthria?
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Articulation disorder
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Q. Treatment for Wernikes?
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100mg of Thiamine
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Q. Long term Wernickes?
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IRREVERSIBLE
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Q. Apraxia?
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Inability to perform previously learned tasks despite intact motor/sensory functions
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Q. What drug reaction will you see with Alcohol?
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Dysarthria (bad coordination)
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Q. What is an important sign in ENCEPHALOPATHY?
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Asterixis: (FLAPPING TREMOR) of the outstretched hands and feet. Usually due to increased glutamine in CSF
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Q. What does hypertension lead to in the brain?
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BRAIN EDEMA
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Q. Meningitis is the LEADING CAUSE OF WHAT?
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CONFUSIONAL STATE
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Q. Non-communicating hydrocephalus?
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BLOCKAGE in the ventricles
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Q. Communicating hydrocephalus?
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Too much CSF
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Q. Normal pressure hydrocephalus is the most common cause of what? What is preserved?
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1. GAIT ABNORMALITY.
2. LANGUAGE IS PRESERVED. |
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Q. What is the classic SXM triad in normal pressure hydrocephalus?
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1. Urinary Incontinence
2. Gait Disturbance 3. Dementia |
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Q. This condition MUST have BILATERAL involvement of the HIPPOCAMPUS?
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Alzheimers Disease
HIppocampus is responsible for memory forming |
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Q. 2 Cause of Acute Amnesia?
Are they able to incorporate new memories during episode? When full consciousness returns will they be able to form new memories? |
1. Trauma & Hypoxia
2. NO 3. YES |
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Q. Who is at more risk for hypoxic amnesia?
Is retrograde amnesia associated with Hypoxia? |
1. Pts in COMA.
2. YES |
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Q. What are the 2 diagnostic criteria for dementia?
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1. Impaired social or occupational function.
2. Impaired memory, plus one or more of the following cognitive function impairments |
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Q. Frontotemporal dementia includes what disease?
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PICKS disease
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Q. Clinical findings in Alzheimers Disease?
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Personality Change: Apathetic, Impulsive
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Q. Will the personality change in multi-infarct dementia?
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NO
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Q. Naturopathic treatment for dementia?
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Gingko Biloba 70mg/ long term
Centella |
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Q. Pain caused by traction, displacement, inflammation, vascular spasm, or distention of pain-sensitive structures LOCATED 2 places?
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1. Within Cranial Vault
2. Extracranial structures |
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Q. 3 Structures not usually sensitive to pain?
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1. Brain parenchyma itself,
2. Most of the dura, 3. Regions of the bony skull |
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Q. Subacute headaches occur when?
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Occur over weeks and months
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Q. Chronic headaches occur when?
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Occur over years
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Q. 1 Prodromal Sxms seen in headaches?
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Scotomas in visual fields
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Q. When is pain most common in cluster headahce?
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Most common DURING SLEEP
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Q. What relieves a patients headache who has a CRANIAL MASS?
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Less Pain with STANDING
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Q. What exacerbates a patient with a headahce who has a SUBDURAL HEMATOMA?
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NO OBVIOUS CAUSE
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Q. In Subarachnoid Hemorrhage 75% of cases will see a RUPTURE of WHAT?
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Rupture of BERRY ANEURYSM
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Q. Patient presents with extremely tender CRANIAL ARTERIES. OCCLUSION of the OPHTHALMIC ARTERY and BLINDNESS IS A COMPLICATION. Name the disease?
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GIANT CELL ARTERITIS
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Q. Headaches due to a MASS LESION have what type of pain? Is it Better or Worse in the morning?
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1. Dull & Steady in NATURE
2. Usually maximal in the MORNING |
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Q. Patient presents with throbbing HA, unilateral and having vomitting?
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Chronic Headache
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Q. What area of the face is post herpetic neuralgia worse over?
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V1=Top right forehead
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Q. Patient presents with UNILATERAL headahce (ALWAYS), often PRESSURE BEHIND EYE?
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Cluster Headache
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Q. Patient presents with UNILATERAL headahce, which starts in OCCIPITAL REGION?
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Migraine
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Q. What are the 5 phases of a migraine?
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Prodromal Phase
1. Aura 2. Headache Phase 3. Sleep Resolution 4. Recovery Phase |
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Q. Spontaneus Nystagmus is DAMAGE to what?
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VESTIBULAR NUCLEI
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Q. Nystagmus Testing helps determine what?
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Brain stem integrity in comatose patients
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Q. Vertigo Definition?
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Illusion of bodily or environmental movement often described as spinning, rotating or moving per patient
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Q. SXM of CEREBELLAR ATAXIA?
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WIDE BASED GAIT & TANDEM GAIT
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Q. SXM of HYPOTONIA?
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Defective postural maintenance & Limbs become PENDULAR and Oscillatory
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Q. SXM of SENSORY ATAXIA?
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STEPPAGE GAIT
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Q. Cause of Benign Positional Vertigo?
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Head Trauma, Debris in endolymph
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Q. Acute Peripheral Vestibulopathy SXM?
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Acute Labyrinthitis with NO HEARING LOSS
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Q. What type of hearing loss is in Menieres Disease?
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SENSORINEURAL HEARING LOSS
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Q. Otosclerosis has what type of hearing loss?
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CONDUCTIVE HEARING LOSS
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Q. What type of hearing loss is Cerebellopontine Angle Tumors?
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UNILATERAL HEARING LOSS
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Q. What is a treatment in benign Vertigo?
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EPLEYS MANEUVER
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Q. Syncope Definition?
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Transient self limited loss of consciousness
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Q. Signs and SXM of SYNCOPE?
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LOSS of POSTURAL TONE
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Q. What is the most common cause of SYNCOPE?
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CARDIAC SYNCOPE
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Q. Sudden onset of visual symptoms is usually due to what?
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Vascular in Origin
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Q. Oculomotor Nerve is responsible for what 3 things?
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1. Movement UP and IN, 2. EYELID MOVEMENT, 3. PUPILLARY CONSTRICTION
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Q. Trochlear Nerve is responsible for what?
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DOWN MOTION
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Q. Abducens Nerve is responsible for what?
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OUTWARD MOTION
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Q. Hemispheric Lesions have deviation where?
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Deviation of both eyes TOWARD the side of LESION
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Q. Brainstem Lesion have deviation where?
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Deviation AWAY from the Lesion
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Q. Central Scotoma def?
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Loss of vision in CENTER of visual field
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Q. Bitemporal Hemianopsia def?
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Pressure on OPTIC CHIASM by PITUITARY TUMOR
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Q. Strabismus is due to?
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Imbalanced MUSCULAR DEVELOPMENT or Strength
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Q. IMPORTANT: Papilledema Def?
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BILATERAL and PAINLESS
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Q. IMPORTANT: OPTIC Papillitis Def?
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UNILATERAL and PAINFUL
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Q. Horners Syndrom 3 Signs and SXM?
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1. Small Pupil Miosis
2. Ptosis (Drooping Eyelid) 3. Anhydrosis of facial Skin (Dry Skin) |
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Q. Direct Response Pupillary Reflexes?
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Constriction of pupil in SAME EYE of shining light
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Q. Consensual Response Pupillary Reflexes?
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Constriction of pupil in OPPOSITE EYE of shining light
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Q. Occulomotor damage produces what type of response?
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Produces CONSENSUAL RESPONSE, but NO DIRECT RESPONSE IN AFFECTED EYE
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Q. What are the 3 actions of ACCOMADTION?
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1. Convergence of eyes
2. Pupillary Constriction 3. Lens Thickening |
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Q. Saccades Def?
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RAPID Conjugate eye movements
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Q. Is Optic Neuritis Painful or Painless?
Can you shine a light in this patients eye? |
1. PAINFUL
2. NO, cant shine a light in their eye |
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Q. Is Anterior Ischemic Optic Neuropathy Painful or Painless?
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PAINLESS
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Q. What can Giant Cell Arteritis lead to?
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INFARCTION OF OPTIC NERVE
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Q. What is the major finding in MYATHENIA GRAVIS?
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Major FINDING is WEAKNESS**
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Q. What are the SXM of detached retina?
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EMERGENCY SITUATION!
Shade coming down over eye |
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Q. Good supplement to detox LIVER?
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NAC & Glutathione
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Q. Good supplements for Anti-inflammatory action?
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Quercitin & Vitamin A
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