Neuro History and Pysical Exam II St FU PA prog. 2005
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| Upper Motor Neuron Lesion can results ins/s?: (name 5) | Were is the Motor Neuron lesion?...:
1 Spastic paralysis.
2 Little muscle atrophy.
3 No fibrillation or faciculation.
4 Hyper reflexive (early sign).
5 Positive Babinski.
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| Fibrillation is?: | Muscle movement of small motor units, can't see with eyes.
What is it called?
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| Faciculations are? | Uncoordinated, Uncontrollable twitching of a muscle group.
What is it called?
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| Cranial Nerve involvement of a Brain-stem Lesion, can include what signs and symptoms?(4) | In a brain-stem lesion indicates involvement of what nerves(s)?.............
1 Diplopia,
2 Dysarthria,
3 Facial Muscle Weakness,
4 Increased DTR's or hyper reflexive,
In a Brainstem Lesion indicates involvement of what?
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| Brainstem Level lesion were do the symptoms occur? | CN defect on one side of the body,.... motor effects contralateral extremities...were is the lesion.
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| Sensory relay and integration center of the brain... name it... | Thalamus ....whats it do?
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| Thalamus pain syndrome | Can perceive pain, but can't locate the pain. Name the condition:
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| peripheral nerve lesion were? | Ipsilateral manifestation... were is the nerve nlesion possible?
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| Lesion:LMN,..list motor defects (5) | 1 Atrophy is significant, 2 Babinski is negative, 3 faciculation's and fibrillations, 4 flaccid paralysis, 5 hypo reflexia
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| Ulnar nerve defect..describe: | Claw hand, can not finger abduct.
...What nerve is defective?
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| Median nerve defect describe: | Thumb oppositionis weak..... What nerve is defective?
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| Radial nerve defect... describe: | "Saturday night palsy" ...no stop sign... weak arm extension..What Nerve?
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| Peroneal nerve defect | Foot drop.... week dorsiflexion.
What nerve is defective?
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| Cerebellum and basal ganglia lesions result in: | Motor movement deficiencies were in the brain C_____and B____ is the lesion?
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| Awkwardness of intentional movements indicate: | Cerebellar dysfunction _____ of intentional movements
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| Dysmetria: symptom and PE test? | Difficulty gauging distance in physical exam..... use the pint 2 point test... to indicate what?
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| dysdiadochokinesia is ? | Inability to perform rapid alternating movements is called what?
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| Nystagmus how is it described? (4) | This eye condition is described by: 1 fast or slow, 2 plane,3 field of gaze 4 unilateral or bilateral
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| Nystagmus | make tremor or beating in eyes tested EOM's can be horizontil or Vertical
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| Nystagmus is it always pathological? | A rhythmic tremor at extreme eyes position is nonpathological for a few small beats. But can be pathological if more.
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| Ataxia 6 s/s name 1 | Awkwardness in posture and gate
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| Ataxia 6 s/s name another | Fall to same side as disease
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| Ataxia 6 s/s nameanother | Poor ordination of movements one of 6 symptms that macke up a catagory of symptoms
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| Ataxia 6 s/s name another clur bigins with dys.. | Dysmetria is one of 6 signs of what catagory of symptoms?
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| Ataxia 6 s/s name another | dysdiadochokinesia
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| Ataxia 6 s/s name another | Irregularly... spaced............. words
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| Intention tremor define: | What kind of Tremor? Tremor only when performing a task gets... worse when hand gets closer to object
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| Positive Romberg is | Patient standstill with eyes open but sways one eyes are closed ......... test is called?
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| 1) vision, 2) equilibrium(or vestibular ) 3 proprioception.....Help do what? | To keep balance you need to of the following three senses
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| Ataxia :six components: | Awkwardness posture and gate, coordinated movements, fall to same side as disease, dysmetria, dysdiadochokinesia, ..... irregularly..... spaced.................... words
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| Basal ganglia location | Deep within the cerebral hemispheres is located B_______
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| Basal ganglia involvement:(3) | 1)Movement.. 2)cordination.. 3)cognition,,,, ,With part of the brain is involved with?
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| Three cardinal signs of Parkinson's disease | Tremor... rigidity.. bradykinesia whatdisease are these 3 a sign of?
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| Parkinson's disease tremor called: | Pill rolling tremor ....what disease?
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| Parkinson's rigidity.. name 4 components | What disease includes: involuntary increased muscle tone.... Cog wheel rigidity..... flexed posture... mask face....
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| Parkinson's disease movements name 4: | Slow involuntary movements...... difficulty initiating movement... reduced arm swinging..... turns as a unit... what disease?
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| Parkinson's disease... what secondary cause of injury are you worried about? | Falls, tell the patient to pick up rugs.... what disease do you think of?
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| Parkinson's gait (8) s/s: | 1) stooped posture...2) Head + neck forward 3) hips and knees slightly flexed..4) arms flexed at elbows,,,5) lean into first step( difficult to initiate)...6) steps short in shuffling....7) no arms swinging...8) turns as one unit......What Dx?
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| Parkinson's patients in an emergency... what? | Patient can temporarily returned to normal during an emergency. Who?
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| The Greek word for dance? | Chorea means what?
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| What is chorea? | Describes involuntary movements of arms legs and face. What's it called if it's danced like?
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| Name three diseases associated with Chorea | Sydenham's chorea...2)Huntington's chorea...3) Athetosis... categorized as?
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| Sydenhams's chorea, common name and etiology? | St. Vitus's dance is caused by strep infection that leads to rheumatic fever what is other name?
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| Huntington's chorea is it genetic? | Autosomal dominant disease with chorea
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| Huntington's disease starts at | Symptoms start at 35 years or older, in this autosomal dominant disease.
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| Huntington's disease to the debilatation at? | Incapacitated in 15 to 20 years after onset what autosomal disease?
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| Chorea movements described as____in Huntington's disease | Piano playing motion of the fingers and facial grimace as are the beginning movements of what disease?
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| Symptoms of Huntington's disease are caused by significant reduction of what two principal neuro transmitters? | Acetylcholine GABA if these two are reduced what disease of the basal ganglia can it be??.... clue this disease is partly characterized by an increase in the availability of dopamine
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| Huntington's chorea show degenerative changes in what part of the brain? | The basal ganglia structures of the brain degenerate in what disease? This disease also can result in severely shrunken brain and enlarged ventricles.
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| Primary complaints of patients with Huntington's disease are (2) | Acute personality changes and involuntary movements(or rigidity) are two primary complaints of what disease of the basal ganglia?
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| Pain and temperature follow what to nerves tract? | Spinal thalamic tract ... what type of messages carried
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| Unconscious proprioception... what track? | Spinal cerebellar tract.... what message does itcarry?
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| Pain and temperature pathway enters the spinal cord where does that cross over ? | Almost immediately on entering the spinal column this crosses over contralaterally... what message?
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| What message is carried by the posterior columns? | Proprioception, stereognosis (conscious) and vibration ........are carried up what tract?
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| Spinal thalamic does it carry unconscious proprioception? | No.... unconscious proprioception is not carried out the spinal thalamic
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| Motor cortex messages travel to the medulla were it crosses over, then down through the UMN to synapse with the LMN through what tract? | Cortical spinal tract..... where does the message originate?...dos it cross over? were?
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| Proprioception, stereognosis, and vibration.... crossover contralaterally ?.... if so where? | The posterior columns, which carry proprioception stereognosis, and vibration Cross contralaterally at the medulla
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| Where does the spinocerebellar tract cross contralaterally? | This tract does not cross contralaterally at all... it is the only one.. what's its name?
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| Hypoosmia ..name 6 conditions that may have this | MS. Alzheimers, Parkinaons, Dm , Obesity ,pernicious anemia may have a reduced ability to smell what is this called?
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| Anosmis is | can't smell
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| Bilateral anosmis is caused by | URI, Polyps, allergies
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| A specific form of disc edema resulting from Increased Inter Cranial Pressure is called? | Papilledema .. what can cause it?
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| You look into the pt. eyes and see the disc margins are obscured .. what is it called? | papilledema the disc is swollen and the disc margins are...
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| during PE on Pupil is diated and fixed to light, there is a lateral deviation of the one eye and Ptosis what CN may be involved? | CN III paralysis what are the 3 symptoms?
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| A pt comes in and they have an upper lid dropping and one eye ( same side and ptosis)is constricted but reacts to light whats wrong? what nerve(s) | Horners Syndrome ( ok the have lose of sweating on half their face). A tumor in the apex of their lung may impinging on the cervical sympathertic trunk nerves ( NOT Occular Nerves)
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| What nerve is the trauma Nerve? | CN IV travels a long distance from the brain to the eye in locations that make CN 4 vunerable to injury ...whats CN 4 's nick name?
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| Pt has both pupils large BUT reactive to light .. what did they injest??? | If a pt takes LSD,cocaine or amphetamines.... what will happen to their pupils?
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| Pt has one large unreactive pupil are you worried? | Yikes Blown Pupil! Someting serious is impinging on CN III The Ocular motor nerve. It may be an intercranial hemorrage .... Whats it look like????
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| Pt has a mid positon but fixed pupil are you worried ? | Mid brain damage can cause this s/s of the pupil
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| Both my pupils are dialated and fixed what s my problem 3 or 4reasons | If I eat Belladonna, Tricyclic anti depressant, not getting O2 to my brain ... or I am dead my pupils will be....
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| miotic pupil | tiny constriced pupil
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| anterior 2/3 of tounge taste..what nerve?? | CN VII facial nerve
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| horizontal uncrossed diplopia ( or eyes dont line up Horizontally ( Look at pat's eyes) ) | palsy of CN VI (Abducens).
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| Peripheral CN VII lesion ..what S/S? | Both eye and mouth palsy on one side ...were the lesion??
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| CN VII central lesion ( up by motor cortex) s/s? | Disruption to just part of the face , such as eye or half the mouth not both
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| If my voice is hoarse and lost my gag reflex what nerve are you interested in? | CN X (Vagus) can be tested by listening to the voice and checking the gag reflex
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| If you loose innervation to a muscle over a period of time what do you notice on PE? | Mucle atrophy ... one possible cause?
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| the pt stick out an atrophic tongue with fasiculations. You ask them to open wide and notice the uvula pulling towards the rt and the tounge pushing to the left ... were is the problem | the left ( help need to verify this) cotical lesion ofCN XII
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| Vasovagal Syncope | Faint or swoon due to the slowness of the vagus nerve which transmits signal from the aortic arch baroreceptors , immeadtalty FOLLOWING a stressfull event in wich BP spiked high. BP drops too fast for the body to compinsate
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| What is the "suicide" headache? | Cluster headache .. whats its nick name
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| What are the 3 primary headaches? | Migraine Cluster Tension are promary or secondary headaches?
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| What six signs assocated with cluster HA? | conjunctival injectionn 2) tearing 3) rhinorrhea or congestion 4) ptosis 5) contricted pupil 7) edema of eyelid what head ache..???
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| Coup- counter coup what head injury? | Subdural Hematoma often what injury??
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| Tearing of bridging veins from the cotex to one of the draining sinuses is what injury? | Subdural hematoma ...where is the blod from??
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| Worst heqad ache of their life... what? | Sub arachnoid hemorrhage
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| Older people usually dont get this headinjury ... why? | epidural hemorrhage because their dura layer is stuck to their skull tightly
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| Thunderclap head ache is ... | Subarachnoid headache " worst head ache of ny life " and ____ ____!
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| a pt arives unconsious whilw waiting fot the CT he wakes up and is lucid do you relax? | No can still have an epidural hematoma and be haveing a " classic lucid interval"
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| Boozers, babies and biddies are prone to what hematoma? | Subdural hemotomas ..people prone to when they have a little dry brain in a big skull, Coup- counter-coup
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| headachOne Tx for the suicide HA is a calcium channel blocker write a script: | Verapamil 120-1200 mg q day is good for what Head Ache?
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| Cluster HA to TX ,other then CCB ,what else to TX | Sub Q sumatriptan, prednisone 60-80mg poq day,, antidepressants,,,SSRI's.. BUT O2 NRB mask the best
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| what HA (s) can have Nausa, Photophobia and phonophobia? | Migraine ..AND Chronic Tension headache!!! have what 3 symptoms in common?
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| how many days a year to classify a HA as a chronic tension headach? | 180day/year of a tension HA is...
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| How many days a month to classify a tension head ache as a chronic tension HA? | at least 15 days / month for the last 6 months makes a tension HA...?
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| Unconscious Proprioception what tract and were does it Cross ? | The Spinocerebellar tract doe not cross over but it carries what sence?
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| The cortico spinal tract crosses contralaterally were? What does it carry? | This tract carrys Motor signals and crosses at the junction of the brainstem and spinalcord
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| The Spinalthalmic tract crosses contralaterly were? | With in 1-2 vertebre of entering the spinal coard Pain Temperature and light tough cross contralterly name that tract.
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| Pain Temperature and light tough cross contralterly name that tract. | Spinalthalamic tract carries what signals?
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| Posterior colums carry what sensations? | Vibration, consious proprioception and stereogenisis are carried on what tract?
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| Do the posterior colums cross contralatery were? | at the junction of the brain stem and spine this carrier of vibration sence is what?
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| My right leg is weak from the hip to my toes, All my senses there are diminished . on PE my Left DTR's in the leg are Hyperflexia whats your Dx? | UMN Left side possibly L Ant. CA
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| Were is the lesion? I have no vision in my right eye | Rt optic nerve 100% damage .. what happend to my vision?
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| My left optic track is 100% dammaged what will happen to my vision ? | Both my eyes have lost the right half of vision ...were's the lesion?
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| I have a pituitary gland tumor and develope Bitemporal Hemianopia. what my vision like ? | Each eye is blide in the lateral half
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| Optic chiasm impinged by an pituitary tumor 100% what happend to my vision? | Bitemporal hemianopia (can't see the later half ,either eye) weres the lesion? what might couse it?
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| Signs of Spino-cerebellar Disease | Ataxia TremorDecomposition of movement Dysdiadokinesis,Dysarthria and scanningNystagmus,Hypotonia, Romberg Sign
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| CRANIAL NERVE III PALSY | sudden onset unilateral ptosis wheres the Lesion?
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| vertical diplopia, which is manifest as the Pt tries to read. There may be an inability to look down and in. Pt has a head tilt contralateral to the affected superior oblique muscle. The chin is often tucked downwards as well.. what Lesion? | CRANIAL NERVE IV PALSY what symptoms?
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| The patient will present with horizontal uncrossed diplopia which worsens at distance and in either right or left gaze. The patient will have an abduction deficit in the involved eye What Lesion? | CRANIAL NERVE VI PALSY ?
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| ptosis, pupillary miosis and facial anhidrosis | HORNER'S SYNDROME
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| TONIC PUPILunequal pupil sizes, and frequently of decreased vision at near. Cause? | Trauma most common cause of a tonic pupil. Other causes associated with tonic pupils include viral illness, diabetes, syphilis and giant cell arteritis. When the etiology cannot be identified, particularly in young females, the condition is
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| Amaurosis Fugax Lesion ? were? | Impingment of the opthalmicartery by tumor,emboli atherosclerosis, (sickle cell , temporal arterioitis
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| Amaurosis Fugax symptoms? | painless, monocular loss of vision, may be total or sectorial. This is a traditional blackout of the pt’s vision.Can occur in isolation, antecedent, or crescendo +is unprovoked and unpredictable. Vision loss secs to hours. opthalmic artery whatsitcalled?
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| Decorticate Rigidity ( hands at the core of the body) signals what lesions or conditions? | Lesion of the corticospinal tract within or near the cerebral hemisphere ... what position of rigidity??
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| Decerebrate Rigidity ( elbows straight and stiff) sign of what?? | Lesion in the diecephalon ,midbrain or pons or metabolic disorders like hypoxia, hypoglycemia
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| Big toe Backwards with Babinski.... what 3 B's ? | Babys.. Bombed... Bad Brains what test ?... Whats Positive???
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| Pt presses against the wall with arms extended.. you notice one scapula bowing out whats this called?? | Scapular Winging ...how to test??
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| Pt presses against the wall with arms extended.. you notice one scapula bowing out whats the nerve involved? | Long thoracic nerve is involoved with Scaplular Winging .. How to test?
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| Pt presses against the wall with arms extended.. you notice one scapula bowing out whats muscles involved? | Serratus anterior muscle/trapezius are innervated by the Long thoracis wich involes Scapular winging ...How to test?
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| Were`doe the spinal cord end? | L2 ....What ends here?
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| Were would you do a spinal tap? | L3-L4 is below the spinal cord .. do what procedure here?
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| Pt walks across the room like one leg is " going up a step" or lifting knee high then slapping the foot on the ground . What kind of Gait?.. What Nerve??? | Common peroneal nerve problem cause "Steepage Gait" because the pt cant dorsiflex the foot
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| What disease? days or weeks after : Flu, cold, GI virus,Mono, Viral Hept. campylobacteriosis,rarley: surgery and vaccination? Hint : body attacks it's self , damage to periph. nerves?? | Guillain Barre Syndrime .... what are precipitating events?
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| What test for Guillain Barre? (3) | LP, EMG, NCV ... are 3 tests for what Autoimmune disorder??
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| Battle sign, Racoon eyes make you think of what??? (image of a battling racoon) | Epidural Hematoma .. name 2 signs
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