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CLTM 1
Board exam questions
| Question | Answer |
|---|---|
| Loss of pupillary reflexes indicates: | Loss of brainstem function. |
| Doll's eye reflex | Oculocephalic: Performed by holding a patients eye open while turning head side to side. Positive: Eyes move in opposite direction of head. Indicates intact brainstem function. |
| Negative Doll's eye reflex: | Oculocephalic reflex- Negative reflex: Eyes move in the same direction as the head. Indicates severe brainstem disfunction. |
| What type of test uses cold water squirted into the earl canal? What 2 types of results can the test have? | Cold caloric testing: 1. Produces a beating nystagmus toward the stimulated ear-Positive reflex; brainstem function is present. 2: Produces no eye movement; Reflex absent- brainstem is impaired. |
| Dysarthia meaning: | Abnormal speech articulation |
| The Babinski reflex response: | Upgoing big to and/or fanning of all toes when the sole of the foot is stroked with a blunt object from the heel towards the toes. |
| What 3 questions need to be answered to be considered oriented x3? | Name, place, date. |
| 4 aspects of the neuro exam that help to determine brain death: | 1: Pupillary reflex (fixed/ dilated), 2: Cold caloric testing (absent), 3: Oculocephalic reflex (absent), 4. Response to painful stimuli. |
| In decerebrate posturing, the arms will: | Stiffen and extend at the patients side, wrists will flex. |
| In decorticate posturing, the arms will: | Flex over chest and rotate inward. |
| Stereognosis: | Ability to recognize objects by touch. |
| Graphesthesia: | Ability to recognize numbers and letters 'written' on skin by sensation of touch. |
| What is the first-line treatment for absence epilepsy? | Ethosuximide (Zarontin) |
| What is the first-line treatment for infantile spasms? | ACTH- Adrenocorticotropic hormone. Vigabatrin is used when pt is ACTH resistant. |
| What are antiseizure med options for focal onset seizures? | Carbamazepine (Tegretol), Gabapentin (neurontin), Lacosamide (Vimpat) |
| The first line antiseizure medication options for GTCs are: | Carbamazepine (Tegretol), Ethotoin (Peganone), Phenytoin (Dilntin), Primidone (Mysoline), |
| Describe hemispherectomy and its indications: | Large parts of 1 hemisphere are exercised and the other 2 hemispheres are diconnected from one another. Usually done on kids with refractory epilepsy due to extensive damage in 1 hemisphere. (ex: struge-weber, rasmussen's) |
| What drug is one of the oldest antiseizure meds, still used and is a long-acting sedative drug with anticonvulsant action? | Phenobarbital |
| What type of seizure is the anitseizure med Oxcarbazapine used for? (Trileptal) | All types of focal seizures. |
| The first line antiseizure medication option for juvenile myoclonic epilepsy is: | Valproic acid |
| What antiseizure med is used to treat seizures that occur in temporal lobe? | Carbamazepine (Tegretol, Carbatrol, Epitol, Equetro) |
| Indications for corpus callostomy: | Refractory generalized seizures resistant to AEDs, causing cognitive decline. (Ex: Lennox-Gastaut) |
| What are some EEG changes associated with normal aging? | Slow PDR, Increased temporal slowing, Bursts of generalized RDA during drowse, Diffuse lower voltage. |
| Trace discontinu which appears in a 42 week conceptional age neonate is normal or abnormal? | Abnormal; Trace discontinu is the defining feature of quiet sleep first emerging around 28 weeks PMA. By 37-40 weeks, Trace alternant fully replaces dinscontinu. |
| What is the recommended minimum length of cEEG recording for neonates at high risk for seizure? | 24 hours; continuing until seizure free for 24 hours |
| When monitoring neonates, modified placement of which electrodes allows the best visualization of background activity? | Frontal electrodes. Neonate lack cerebral activity in extreme frontopolar regions Fp3/Fp4 are sometimes used instead of Fp1/Fp2. |
| At what age do most kids reach 8hz PDR: | 3 years old. |
| What is the most common cause of seizure in neonates? | Hypoxic-ischemic encephalopaathy (HIE) |
| What is the fastest growing epilepsy population? | The elderly. |
| At what conceptional age do active (REM) and quiet (non-REM) stages of sleep begin to emerge in the EEG of neonates? | 30-32 weeks. At this age, wakefulness and active sleep may be differentiated electrographically from quiet sleep, but much is still considered transitional. |
| What is the duration of a sleep-wake cycle for a term infant? | Pre term: <35 weeks; 30-50 min, Pre term >35 weeks; 50-65 min, Full term: 3-4 hours |
| What are behavioral states in neonates? | Awake, Asleep;active sleep, quiet sleep, Transitional sleep, Indeterminate sleep, Sleep-wake cycling |
| What disorder is known for "disappearing tumors"? | Primary central nervous system lymphoma |
| When is a lumbar puncture contraindicated? | When a brain tumor mass is suspected. Increased ICP can cause fatal herniation. |
| what is a type of brain tumor often associated with chronic seizures that becomes progressively refractory to AEDs? | Oligodendroglioma; Slow growing, infiltrative, and rare neoplasm found in temporal lobe. |
| What is Wilson's disease and what are the possible EEG findings? | Abnormal copper metabolism causing a progressive disorder characterized by ataxia, choreoathetosis, dystonia and dysarthria. EEG may show gen async or focal slow waves, especially in cases of liver disease. |
| What is Struge-Weber syndrome? How is it characterized? What does EEG show? | Congenital, port wine stain, angiomas on brain (same side as birth mark), EEG shows asymmetric alpha and focal abnormalities. |
| Agnosia | The inability to process sensory info typically with loss of ability to recognize objects, persons, shapes, smells or sounds, w/ no significant memory loss. Associated with brain injury or neuro illness. |
| Anosmia | Loss of sense of smell with inability to perceive odor. |
| Apraxia | Inability to execute a voluntary motor movement despite being able to demonstrate normal muscle function. Caused by injury to the brain, especially superficially to the posterior parietal cortex. |
| Ataxia | Lack of voluntary coordination of muscle movements that include gait abnormalities that is related to dysfunction of the nervous system |
| Locked-in syndrome | Complete paralysis of all muscles except the eyes. Conscious and awake. Caused by damage to the pons/ brainstem |
| ESES: Electrical Status Epileptics of Sleep | Continuous spike/wave during non REM. Associated with Landau-kleffner syndrome |
| What are lacunar infarcts and where are they found? | Small infarcts that form cysts as they age, found on CT or MRI in arterioles of the thalamus, internal capsule, pons and cerebellum |
| Todd's paralysis | Temporary postictal paralysis contralateral to the seizure origin and may affect speech and vision. |
| What new seizure term replaces "hyper motor" and indicates agitated thrashing or leg pedaling movements? | Hyperkinetic |
| Gelastic seizures | A rare type of seizure that involves a sudden outburst or inappropriate and unusual episode of laughter or crying. Associated with Hypothalamic Harmatomas. |
| What is the most common cause of temporal lobe epilepsy? | Mesial temporal sclerosis |
| What new seizure term replaces "psychic" and refers to cognitive impairment (de ja vu, aphasia, hallucinations)? | Cognitive |
| A seizure type characterized by bursts of crying with or without feelings of sadness is called? | Dacrystic |
| A seizure characterized at the onset by alterations of systems controlled by the autonomic nervous system | Autonomic seizure |
| Childhood absence epilepsy: Onset, sz type, activation, first-line medication? | Onset: -8yo, female predominence, sz type: 3hz s/w, activation: HV, Meds: lamotrigine, valproate, ethosuximide |
| Juvenile absence epilepsy: Onset, sz types, activations? | Later age onset than CAE. Onset: 8-20y/o, Sz type: typical absence, 80% also have GTCs, activation: HV |
| Age of onset and sz type for childhood epilepsy with centrotemporal spikes | Onset: 3-14y/o (peak 8-9yo), Sz type: Frontoparietal opercular features such as hemifacial clonic mvmnts, laryngeal symptoms, articulation difficulty, hypersalivation |
| Describe the sz type and interictal EEG finding in Panayiotopoulos syndrome | Sz type: Focal autonomic sz involving nausea, retching, or vomiting. Interictal finding: multifocal high voltage repetitive spikes or sharp waves. 60% have occipital spikes |
| Describe the sz type and interictal EEG finding in childhood occipital epilepsy (Gastaut type) | Sz type: Visual phenomena described as small colored circles followed by ipsi head or eye deviation. Interictal: Occ spikes or s/w discharges. Might only be seen in sleep. 20% may have coexisting frontal, centrotemporal, or gen s/w discharges. |
| Describe the age of onset and sz type in Dravet syndrome | Onset: Usually 1st year of life, typically 6 months, some occur at 2y/o. Sz types: Focal or gen. First sz is febrile in 60% of pts. Hemiclonic is common. May also develop atypical absence, myoclonic and atonic sz |
| Describe the age of onset, sz types and interictal finding in JME | Onset: 8-25y/o, Sz types: All have myoclonic sz most often occurring after wake. Most have GTCs (over 90%), 1/3 have typical absence sz. Interictal findings: 3.5-6hz gen s/w, poly s/w discharges. |
| Age onset, initial clinical presentation and sz type in landau-Kleffner syndrome | Onset: 2-8y/o (peak 5-7y/o), Clinical presentation: Aphasia, sz or both. Sz types: infrequent and nocturnal. 20-30% dont have sz. when sz are present it might be focal, atypical absence or atonic |
| Age of onset, sz type, EEG finding in Lennox-Gastaut: | Onset: 1-7y/o (peak 3-5y/o), sz types: Multiple types of intractable sz, Tonic sz in sleep or upon wake. EEG: Slow s/w (<2.5) and paroxysmal fast activity |
| Age of onset, sz type and EEG finding in West syndrome | Onset: 3-12 months, Sz type: infantile spasms (epileptic spasms), EEG findings; Hypsarrhythmia. Ictal EEG shows high voltage low wave followed by low amp fast activity and voltage attenuation. |
| Acquired verbal auditory agnosia, language regression, EEG abnormalities and sz are associated with what disorder? | Landau-Kleffner Syndrome. 20-30% of patients dont have sz |
| 1* This EEG during sleep was recorded from a patient with which of the following; | A. JME B. CAE C. CSWS D. Lennox (Gen paroxysmal fast activity in sleep) |
| Astatic: | A sudden loss of erect posture without specifying sz type (could be atonic, myoclonic, tonic sz) |
| Epileptiform discharges that occur more than once per min but less than 1 every 10 sec would be quantified as: | Frequent |
| What does BIRDS stand for? | Brief potentially ictal rhythmic discharges |
| What is SUDEP? | Sudden unexpected death in epilepsy. Excludes death from status |
| What is the definition of an electrographic sz? | Epileptiform discharges averaging >2.5hz for >= 10 sec (>25 discharges in 10 sec) or any pattern with definite evolution lasting >= 10 sec |
| What is a scotoma? | A small spot of vision loss (blind spots) |
| What is the definition of "marked" EEG asymmetry? | 1hz greater in frequency or 50% amplitude difference in hemispheres |
| Mirror focus phenomenon: | The concept that an actively discharging epileptiform region may induce similar behavior in a homologous site. (secondary epileptiform foci develop in contra hemisphere) |
| Epigastric aura: | A rising sensation in the abdomen at sz onset associated w temporal sz |
| What do you call the ethical principle that medical professionals actions should promote good by having the welfare of the pt as the main goal? | Principle of beneficence |
| QEEG: | Quantitative EEG: Trend analysis. detects sz based on amp, frequency, rhythmicity and asymmetry (EX: persyst) |
| What are coup and contrecoup injuries? | Coup: Same side of impact Contrecoup: opposite side of impact |
| A deficit in one visual field indicates a lesion where? | Contralateral occipital lobe (or optic pathway posterior to optic chiasm) |
| HIE | Hypoxic ischemia encephalopathy- major cause of morbidity and mortality among newborns, with acute and chronic consequences. High risk for sz |
| ICH | Intracranial hemorrhage- early neurological deterioration and periodic discharges on cEEG are associated with poor outcome. Primary causes: HTN, cerebral amyloid angiopathy, bleeding diathesis |
| ICP | Intracranial pressure- Measures pressure via parenchymal or ventricular device |
| Nonconvulsive sz | More common than convulsive sz in children. EEG characteristics: Interical discharges, LPDs, absence of sleep arc and no stimulus reactivity. Greatest risk is TBI |
| Electrographic status epilepticus | Electrographic sz for >= 10 continuous minutes or for a total duration of >= 20% of any 60 min recording. |
| BIRDs | >hz frequency and >=0.5 to < 10 sec. Evolves or is similar to the patients IEDs or is sharply contoured. Not consistent with a known normal pattern. No definite clinical correlate. |
| SAH | Subarachnoid hemorrhage-bleeding into the subarachnoid space. Symptoms: severe headache, can be followed by sz, LOC, and/or vomiting. Most common; ruptured aneurysm |
| TBI | Traumatic brain injury. At least half of sz in patients with severe TBI are subclinical |
| SIRPIDs | Stimulus-induced rhythmic periodic or ictal-appearing discharges. Includes all SI patterns. Common in critically ill patients |
| What EEG findings are seen in intraventricular and subarachnoid hemorrhage? | Diffuse slowing and generalized, frontal predominant rhythmic delta (formerly FIRDA) |
| Rasmussen's Encephalitis | Rare inflammatory neuro disease. Affects mostly children/young adults. Typically affects one hemisphere. Frequent severe sz. Pharmacoresistant epilepsy. Progressive loss of motor/speech skills and hemiparesis w unihemispheric brain atrophy |
Created by:
hannahhenderson