CM Neurology Review
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| Cells that often become malignant | Glial support cells
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| How many bones are there in the skull? | 22
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| The only mobile bone of the skull | mandible, TMJ is a synovial joint
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| What technique can be used to evaluate children'ts intracranial space? | US
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| Name the three layers of the meninges from outside in | Dura Mater, Arachnoid Mater, Pia Mater
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| Describe the Pia Mater | Delicate internal layer, highly vascular, adheres to the brain
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| Which nerve hurts when you have a headache? | Cranial Nerve V
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| Where does the CSF travel? | Between the pia and arachnoid maters
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| Epidural Hematoma | Above or outside the dura mater. Usually caused by a rupture of the middle meningeal artery associated with traumaRemember the pterion?Surgical emergency
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| Subdural Hematoma | Insidious in onset, can take up to 2 weeks to develop.
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| Subarachnoid Hemorrhage | Worst headache of my life; starts with a thunderclap
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| Scalp Pneumonic | Skin, Connective Tissue, Aponeurosis, Loose areolar Tissue, Pericranium
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| Posterior Headache | C2, C3
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| Anterior to ears headache | CN V
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| Blood supply to the scalp | External carotid
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| Language, abstract thinking, perception, movement, adaptive response are possible because of ______ | our cerebral cortex
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| Outermost cells of neocortex | Pyramidal cells (shaped like pyramids)
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| Afferent fibers connecting the contralateral hemisphere of the corpus | Commissural fibers
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| Main passageway for ascending and descending fiber tracts | Internal Capsule; thalamus, basal ganglia connected through this highway
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| Information center that remains constantly informed | Basal ganglia. Has a contralateral effect on movement. (cerebellum has an ipsilateral effect)
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| When this area is destroyed, no dopamine flows to the basal ganglia | Substantia Nigra. (Extrinsic dopamine can't cross blood-brain barrier, so give L-Dopa so body can synthesize dopamine. Immediate improvement, then wears off. Used in Parkinson's Disease)
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| ______ coordinates voluntary body movement and muscle tone | Cerebellum. When you have cerebellum dysfunction, you have jerky, uncoordinated movements
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| What is the effect of cerebellum on movement? | Ipsilateral, timing and force of contraction of voluntary muscles that result in smooth, coordinated movements
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| Spinocerebellar Tract | Ascending tract, Senses unconscious proprioception, Ipsilateral, 2 neuron system, receptor to cerebellum. More than one smaller tract then routes information to the cortex
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| What makes up the diencephalon? | Thalamus and Hypothalamus
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| Thalamus | Sensory relay and integrative center. Connects with cortex, basal ganglia, hypothalamus, brainstem
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| Where do all sensory tract from the body synapse before they are directed to the cortex? (except the olfactory) | Thalamus
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| Where is the final point where information can be transferred, inserted, modified, and/or coordinated before reaching the post central gyrus? | Thalamus
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| Hypothalamus - what does it control? | Autonomic Functions "bodily needs". Regulates homeostasis, coordinates neural and endocrine functions, emotions
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| Anterior hypothalamus | Anterior hypothalamus controls parasympathetic responses
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| Posterior hypothalamus | ; Posterior hypothalamus controls sympathetic responsesPosterior hypothalamus produces two hormones that are transmitted to the posterior pituitary for release; Oxytocin, ADH
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| The amygdala is a part of the ... | limbic system. Anatomic substrate for drive-related emotional behavior and memory. Bridge between the autonomic and voluntary responses to changes in the environment
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| Amygdala | Stimulation causes many emotions, most commonly fear. Involved in signaling stimuli related to reward, fear, motivationContributes to social functions such as mating,Emotional learning
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| Hippocampus | Required for the formation of long-term memories
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| ___ affects autonomic functions regulating heart rate and blood pressure, and contributes to cognitive processing including attention. (part of the limbic system) | Cingulate Gyrus
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| Part of the brainstem, central role in bodily and behavioral alertness. | Reticular Activating System. Ascending connections affect the function of the cerebral cortex, descending connections affect bodily posture and reflex mechanisms
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| What can take out the reflective activating system? | injury, herniation of the brainstem area
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| Where do general anesthetics work their effect? | on the reticular formation. Vital in controlling respiration, cardiac rhythms, and other essential functions. Crucial for maintaining the state of consciousness. Involved in circadian rhythm, bilateral damage can lead to coma.
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| Motivation and ability to pay attention comes from | frontal lobe
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| Dominant Hemisphere | Important for important comprehension and production in language. Most people have a left-dominant hemisphere
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| The inability to use language; loss of access to the symbols that we use to represent concepts | Aphasia
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| Broca's Aphasia | Few words, written or spoken, great difficulty producing them, most important words only "telegraphic mannner", less difficulty comprehending. MOTOR
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| Wernicke's Aphasia | able to produce written and spoken words, defective in their linguistic content. Word salad. More deficient in comprehension than Broca's
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| Amnestic confabulatory syndrome | Korsakoff's Psychosis. Gray matter destruction from chronic alcohol use. Relatively intact intelligence, inability to form new memories. Make up answers as they go along.
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| Headache definition | pain or pressure registered in non-nervous tissue structures such as meninges or arteries. Brain tissue has no sensation
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| At what level does the spinal cord end? | L1-L2 for most of us; vertebral canal is longer.
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| Ascending and descending pathways are found in which matter? | white matter.
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| Where is the needle inserted for lumbar puncture? | L4-L5 vertebrae (level of the iliac crest) to avoid spinal nerves
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| Which position must a patient be in when receiving anesthesia? | upright
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| Disorder in which two sides of the vertebral arches fail to fuse during development | Spina Bifida, usually in the lower vertebrae, results in an open vertebral canal. Spectrum of disability.
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| C1-C7 exit where in relation to their corresponding vertebrae | above
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| C8 exits where? | below vertebrae C7, all other spinal nerves exit below their corresponding vertebrae
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| Posterior roots | Afferent, sensory towards CNS
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| Anterior roots | Ventral, efferent, motor, away from CNS
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| Cervical Plexi | C1-C4
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| Brachial Plexi | C5-T1
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| Lumbar Plexi | L1-L4
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| Sacral Plexi | L4-S4
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| Coccygeal Plexi | S5-Co
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| area of skin supplied by a single spinal cord level | Dermatome. On one side of the body by a single dermatome. extends around the body posterior to anterior. Carries somatic sensory information from a specific area of skin on the surface of the body. Considerable overlap between dermatomes.
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| Shoulder Dermatome | C4
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| Nipple line dermatome | T4
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| Umbilicus Dermatome | T10
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| Groin Dermatome | L1
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| Portion of skeletal muscle innervated by a single spinal cord level | myotomes. Test myotomes by assessing muscle strength
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| Motor deficit lesion location | at or above the level of the corresponding spinal nerve, all nerve roots below the lesion are affected
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| Sensory deficits | lesion is at or above the level of the affected dermatome. All nerve roots below the lesion are affected
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| recurrent laryngeal nerve | Motor innervation to almost all intrinsic muscles of the larynx. Hoarse voice with lung CA can be due to a recurrent laryngeal nerve palsy caused by pressure from the tumor
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| Impulses originate in the precentral gyrus in large cell bodies called ___________ | pyramidal cells
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| Axons pass down through the internal capsule to the ________, then to the medulla | midbrain
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| Voluntary Muscle activity: 80-90% of the axons cross over and then descend the spinal cord in the | lateral corticospinal tract
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| Voluntary Muscle activity: 10-20% descend on the same side as the | anterior corticospinal tract. Body's mechanism of preserving some function in the case of injury
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| Where do you injection IM? | Upper outer quadrant to avoid sciatic nerve
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| Where do UMN and LMN synapse? | in the ventral motor horn
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| UMN travel where? | originate in teh motor cortex or brain stem and carry impulses down the corticopsinal tracts to the anterior grey horn
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| LMN travel where? | Connect the anterior gray horn to teh muscle fibers; these are the neurons that are part of the motor units
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| UMN paralysis | spastic, tight, no atrophy, no fasiculations, hypertonic reflexes, babinski may be present
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| LMN paralysis | Flaccid, atrophy of muscles, fibrillation and fasiculations, hypotonic reflexes. Babinski absent
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| What happenes to the LMN's if the UMN cells are damaged? | LMN is freed of control and fires excessively; fires in response to reflex stimuli (hyperreflexia), fires on its own (spasticity)
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| UMN diseases | Tumors of the brain and spinal cordStrokesMultiple SclerosisMeningitisCerebral palsyALS *
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| LMN Diseases | TraumaPolio1% progress to UMNBirth injuriesMuscular DystrophiesGuillain-Barre’ syndromeCarpal Tunnel syndromeMyasthenia gravisALS *
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| __________ is a chronic, progressive, degenerative disease that attacks the lateral corticospinal tract. | Amyotrophic Lateral Sclerosis (ALS), moves from LMNs to UMNs, leads to muscle weakness, muscle wasting, hyperreflexia. Spares sensations and intellect. No cause/no cure. Lou Gehrig's Disease
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| Cerebral Palsy | Spectrum of neurological disorders that appear in infancy or early childhood that affect body movement and coordination but won't worsen over time.
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| What is the usual etiology of Cerebral Palsy? | Congenital
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| UMN damage leads to | motor disorders
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| Scissored gait is a feature of which disorder? | Cerebral Palsy.
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| ________ is a highly infectious disease caused by a virus. It invades the LMN and can cause total paralysis. | Poliomyelitis. LMN can't contract, flaccid paralysis. Initial symptoms are fever, fatigue, headache, vomiting, stiffness in the neck and pain in the limbs. Treatment is symptomatic.
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| Edward Salk made a vaccine for | Polio
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| _______ test the integrity of nerve pathways | Reflexes. Can be used to test somatic sensory and motor nerves in an unconscious patient.
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| Absent reflexes | If absent, indicates damage to sensory function, internuclear connection, or motor functionWith anesthesia reflexes disappear in predictable sequence, helping determine if patient is sufficiently sedated
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| What makes up the pyramidal system? | Basal Ganglia and Cerebellum
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| Basal Ganglia Dysfunction | Meaningless unintentional movement occurring unexpectedly. Chorea, Athetosis (snakelike), Hemiballismus (flailing movement), tremors at rest.
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| Basal Ganglia dysfunction affects which side compared to the location of the lesion? | Contralateral
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| Cerebellar Disorders | Awkwardness with intentional movement. Hypotonia, decreased DTRs, Aesthenia, Dysmetria, Dysdiadocokinesis, Intention tremor, Speech disorders, Ataxia. Pendular Reflex
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| Cerebellar Disorders affeects which side of the body in relation to the lesion? | Ipsilateral side
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| What is the progression of cerebellum destruction? | Anterior to posterior. Legs are anterior, so function destroyed first. Develop broad-based, staggering gait. Ataxia, uncontrolled leg movements. Anterior lobe syndrome
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| It’s role is to maintain a stable internal environment in conjunction with the endocrine system | Autonomic Nervous System; entirely motor. Most functions are carried out below the conscious level. Primary function is to regulate blood flow
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| Belladonna poisoning symptoms | Dilated pupils, sensitivity to light, blurred vision, tachycardia, loss of balance, headache, rash, flushing, dry mouth and throat, slurred speech, urinary retention, constipation, hallucinations, delerium, and convulsions
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| Ascending spinal tracts | Lateral spinothalamic, Anterior Spinothalamic, Dorsal Columns
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| ________ tract senses pain and temperature | Lateral Spinothalamic. 3 neuron system. Receptors in the dermis. Nerves enter spinal cord and cross over almost immediately. Lesion results in a loss of sensation contralaterally BELOW the level of the lesion
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| Senses light tough and pressure | Anterior Spinothalamic Tract. Nerves enter spinal cord adn cross over almost immediately. Lesion results in a loss of sensation contralaterally below the level of the lesion
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| Senses conscious proprioception, stereognosis, and vibration | Posterior, dorsal columns. Nerves enter spinal cord and initially travel up the same side. Cross over at junction of spinal cord and brainstem.
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| Posterior dorsal columns 1st order neuron lesion | results in loss of sensation ipsilaterally
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| 2nd or 3rd order neuron injury in posterior dorsal column | contralateral loss of sensation
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| Referred Chest pain may be felt | In the left arm
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| Referred Ureter pain may be felt | inguinal region
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| Referred Diaphragm pain may be felt | Shoulder
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| Ectopic pregnancies may refer pain to | the shoulder
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| Appendicitis may refer pain to | umbilicus
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| Most common CNS tumor in children (ages 4-8) | Medullablastoma. First signs are ataxia, stumblin, falls.
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| Fixed pupil is a result of | CN III palsy. UMN damage to occulomotor nerve. Parasympathetic fibers damaged so pupil can't constrict. Also, LMN fibers are damaged so muscles -- levator palpebrae can't work resulting in ptosis.
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| Shining a light into one eye can distinguish between damage to | CN II and CNIII damage, or damage to the brainstem
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| Which nerve controls direct pupillary light reflex? | CN II
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| Which nerve controls the consensual pupillary light reflex? | CN III
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| If pupils are non-reactive or asymmetric | it's a brainstem problem
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| Gag reflex is controlled by | CN IX and X
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| What is the importance of NPO 8-12 hours prior to surgery? | Under anesthesia, the gag reflex (CN IX and X) are inactivated. If patient vomits, then they would aspirate contents into open bronchus
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