Term
| Which CN are involved in taste? |
|
Definition
CN V - somatosensory sensations (hot peppers)
CN VII, IX, X - Regular Taste |
|
|
Term
| What type of taste loss is observed with Bell's Palsy? |
|
Definition
| Loss of anterior 2/3rd of tongue |
|
|
Term
| What type of taste lost is observed with CN IX disruption? |
|
Definition
| loss of taste posterior 1/3 of tongue |
|
|
Term
| Which meds can cause loss of taste? |
|
Definition
|
|
Term
| If there is a diminished gag reflex or disturbed swallowing, what CN is affected? |
|
Definition
|
|
Term
| If there is asymmetric rise of the uvula, which CN is affected? |
|
Definition
|
|
Term
| A lesion of which CN causes drooping shoulder, muscle atrophy, weakened or limited elevation of the shoulder or arm, scapula winging? |
|
Definition
|
|
Term
| A lesion of which CN causes flaccid paralysis of tongue and atrophy, as well speech difficulties? |
|
Definition
|
|
Term
| What CN is involved with Ramsey Hunt syndrome? |
|
Definition
|
|
Term
| How do you tx Ramsey Hunt Syndrome? |
|
Definition
| Anti-virals, steroids, and adequate pain control |
|
|
Term
| What neurological syndrome causes tingling, pain and vesicles, can decrease hearing (on affected side) and cause nausea or loss of balance? |
|
Definition
|
|
Term
| What is the difference between Bell's Palsy and a Central Lesion? |
|
Definition
Bell's Palsy affects the entire 1/2 of the face causing facial weakness/paralysis.
Central lesions causes facial weakness/paralysis but SPARES the forehead (wrinkles across) |
|
|
Term
| What is the treatment for Bell's Palsy? |
|
Definition
- Most often complete recovery - 80%
- Prednisone burst
- Acyclovir
- If no improvement in 2 weeks refer to ENT eval |
|
|
Term
| If a pt presents with aural pain, numbness on 1/2 of the face, impaired taste and auditory hyperacusis as well as facial paresis affecting entire 1/2 of face (including forehead)? |
|
Definition
|
|
Term
| What is the cause of tic Douloureux or trigeminal neuralgia? Which vessel is affected most often? |
|
Definition
Microvascular compression of the sensory fibers of the trigeminal root by a blood vessel
MC vessel involved - Superior Cerebellar Artery |
|
|
Term
| If a patient presents with unilateral sharp, electric-like pains lasting seconds or minutes along the trigeminal nerve branch(es) of the lower 2/3 of face that seems to occur with eating or drinking, what condition is suspected? |
|
Definition
| Tigeminal Neuralgia (Tic Douloureux) |
|
|
Term
| What is the treatment for trigeminal neuralgia (Tic Douloureux)? |
|
Definition
| Carbemazepine, phenytoin, or baclofen |
|
|
Term
| What are the MC causes of CN VI palsy? |
|
Definition
| Trauma, microvascular disease, and basal intercranial neoplasms |
|
|
Term
| What is bilateral CN VI palsy an indication of? |
|
Definition
|
|
Term
| If the pt presents with an affected eye that at rest is adducted and cannot abduct, what CN is suspected? What test should you get if a pt presents this way? |
|
Definition
|
|
Term
| If a pt presents with complaints of vertical diplopia, and on exam has an elevated gaze with one eye at rest, and the elevation is made more pronounced with head tilting to the affected side, what condition should you suspect? |
|
Definition
|
|
Term
| What muscle is affected in CN IV palsy? |
|
Definition
|
|
Term
| What is the MC cause of CN IV palsy? |
|
Definition
|
|
Term
| What muscle is affected in CN VI palsy? |
|
Definition
|
|
Term
| What are the three components of Horner's Syndrome? |
|
Definition
Ipsilateral ptosis, anhydrosis and miosis
(Lid drooping, lack of sweating and pupil contraction) |
|
|
Term
| What nerves are affected with Horner's syndrome? |
|
Definition
| cervical sympathetic nerves |
|
|
Term
| How is the diagnosis of Horner's syndrome confirmed? |
|
Definition
| Infusion of 10% cocaine - findings of normal pupil (unaffected) dilated more than Horner's pupil (affected) indicates Horner's syndrome |
|
|
Term
| How can Horner's syndrome and CN III palsy be differentiated? |
|
Definition
Horner's syndrome - ptosis and SMALL pupil ipsilateral
CN III - ptosis and LARGE pupil ipsilaterally |
|
|
Term
| If CN III palsy is suspected, but the pupil is spared, what underlying conditions may be causing the disruption? |
|
Definition
|
|
Term
| If a pt has an eye that is abducted at rest, and cannot look up, look down, or adduct their gaze with that eye, what condition do you suspect? What other physical finding might also be indicative of this condition? |
|
Definition
CN III Palsy
Myadriac (Dilation) Pupil |
|
|
Term
| What type of visua deficit is seen with a pituitary tumor? What other symptoms may be present? |
|
Definition
Bitemporal Hemianopsia
HA
Endocrine Sx - galactorrhea, amenorrhea, acromegaly etc. |
|
|
Term
| What is papilledema an indicator for, especially when found bilaterally? |
|
Definition
| Indicator of increased ICP |
|
|
Term
|
Definition
|
|
Term
| What are the most common causes of bilateral vision loss? |
|
Definition
Papilledema
Pituitary Tumor
Occipital Cortex Lesion |
|
|
Term
| What artery is affected by giant cell arteritis? |
|
Definition
| External Carotid Artery at the superficial temporal artery |
|
|
Term
| What can Giant Cell arteritis lead to? |
|
Definition
| blindness due to inflammation extending to the ophthalmic artery |
|
|
Term
| If a pt presents with jaw pain and tenderness while chewing and tenderness over the temporal artery, what condition should you suspect? |
|
Definition
|
|
Term
| What is the tx for Giant Cell Arteritis? |
|
Definition
|
|
Term
| What nerve is affected in optic neurtitis? |
|
Definition
|
|
Term
| What disease is often a cause of optic neuritis? |
|
Definition
|
|
Term
| What visual disturbances are caused by optic neuritis? |
|
Definition
| scotomata, visual loss unilaterally |
|
|
Term
| If a pt complains of sudden unilateral vision loss, and the physical exam findings include unilateral optic disc swelling, with blurring of margins and the pupils are slow to react, what condition should you suspect? |
|
Definition
|
|
Term
| What is the tx for Optic Neuritis? |
|
Definition
|
|
Term
| What is the MC cause of amaurosis fugax or TMVL (transient monocular vision loss)? |
|
Definition
| Ischemic, cardiac or cerebrovascular problems |
|
|
Term
| What are the most common causes of secondary dysfunction of CN I? |
|
Definition
Sinus Infection
URI
Head Injury
Meds |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| hallucination of fecal odor |
|
|
Term
| What types of CA most often cause metastases to the brain (cerebellar tumors)? |
|
Definition
|
|
Term
| What type of cerebellar tumor MC presents in childhood and is highly malignant? |
|
Definition
|
|
Term
| What is a possible treatment for an Astrocytoma? |
|
Definition
|
|
Term
| What are the clinical presentations of a cerebellar tumor? |
|
Definition
| HA, nausea, dizziness, loss of coordination or balance, lethargy, confusion, disorientation, nystagmus |
|
|
Term
| What chromosome carries the gene for Friedreich's ataxia? |
|
Definition
|
|
Term
| What part of the CNS and PNS is affected by Friedreich's ataxia? |
|
Definition
Posterior columns
lateral corticospinal tracts
Peripheral nerves
(spinal cord becomes thin, myelin sheath is destroyed, distal axons die back) |
|
|
Term
| If a pt presents with symptoms that began with gait ataxia and progressed to arm ataxia as well as sensory loss and weakness and appears kyphotic and has clubfoot, what condition would you suspect? |
|
Definition
|
|
Term
| On physical exam, what findings will help confirm Friedreich's ataxia? |
|
Definition
position and vibratory sense - reduced
Rhomberg - Positive
Nerve Conduction - slowed
Echo - cardiomyopathy |
|
|
Term
| What cells are affected by alcohol abuse? |
|
Definition
|
|
Term
| What are the symptoms of alcohol cerebellar degeneration? |
|
Definition
gait ataxia
tremor
alcohol related neuropathy |
|
|
Term
| What causes Wernicke's encephalopathy? What type of pts are MC affected? |
|
Definition
Thiamine deficiency
Alcoholics |
|
|
Term
| What is the classic triad of Wernicke's encephalopathy? |
|
Definition
gait ataxia
ophthalmoplegia
Confusion |
|
|
Term
| How is Wernicke's encephalopathy diagnosed? |
|
Definition
| Administer Thiamine 100mg IV and resolution of symptoms should occur if they are caused by Wernicke's Encephalopathy |
|
|
Term
| If a pt has sudden attacks of vertigo lasting briefly (seconds) that are triggered by laying down, sitting up or turning the head, what condition should you suspect? |
|
Definition
|
|
Term
| How is BPPV diagnosed? treated? |
|
Definition
Dx- Dix-Hallpikes
Tx - Epley Maneuver |
|
|
Term
| Is BPPV a peripheral or central disorder? |
|
Definition
|
|
Term
| Is Meinere's a peripheral or central disorder? |
|
Definition
|
|
Term
| Is an Acoustic Neuroma a peripheral or central disorder? |
|
Definition
|
|
Term
| Is Gentamycin ototoxicity a peripheral or central disorder? |
|
Definition
|
|
Term
| Is alcohol intoxication a peripheral or central disorder? |
|
Definition
|
|
Term
| Is Wernicke's Encephalopathy a peripheral or central disorder? |
|
Definition
|
|
Term
| Is MS a peripheral or central disorder? |
|
Definition
|
|
Term
| Is alcoholic cerebellar degeneration a peripheral or central disorder? |
|
Definition
|
|
Term
| Is TIA/stroke a peripheral or central disorder? |
|
Definition
|
|
Term
| Is cerebellar ataxia a peripheral or central disorder? |
|
Definition
|
|
Term
What is the difference in symptoms accompanying vertigo in central vs peripheral lesions?
Onset?
Exacerbation of Vertigo?
Symptoms Intermittent or Constant?
Accompanying Symptoms?
Neurological Signs? |
|
Definition
Central -
SLOW onset
Vertigo NOT exacerbated by head movement (constant)
Symptoms have no relief
Ataxia and Nystagmus
HAVE other NEUROLOGICAL signs
Peripheral -
ACUTE Onset
Vertigo Exacerbated with Movement
Symptoms are INTERMITTENT
Tinnitus, Aural fullness
NO other neurologic findings |
|
|
Term
| What is the pathophysiology of Myasthenia Gravis? |
|
Definition
| less functioning ACh receptor = less conduction |
|
|
Term
| If a pt complains of not being able to brush their hair without fatigue, has an increase in fatigue throughout the day, and you notice asymmetric ptosis, what condition do you suspect? |
|
Definition
|
|
Term
| Are sensation or reflexes affected by Myasthenia Gravis? |
|
Definition
|
|
Term
| How is Myasthenia Gravis diagnosed? |
|
Definition
Blood = ACh receptor antibodies detected
"Tensilon Test" - Edrophonium (short-acting cholinesterase inhibitor) given and transient weakness should improve dramatically |
|
|
Term
| What is the treatment for Myasthenia Gravis? |
|
Definition
Anticholinesterase drugs
Pyridostigmine
*Use steroids if pts don't respond well to Pyridostigmine* |
|
|
Term
| What are the symptoms of tetanus? What is the MC exposure? |
|
Definition
Muscle tone increase, spasms, rigidity (tetany)
MC exposure - contaminated wounds |
|
|
Term
| What are the symptoms of botulism poisoning? |
|
Definition
| Bilateral - Weakness, diplopia, ptosis, dysphagia paralysis, may progress to affect respiration |
|
|
Term
| What is the MC cause of botulism poisoning? |
|
Definition
| canned food that is contaminated with the toxin |
|
|
Term
| What type of peripheral neuropathy distribution is typical of diabetic neuropathy? Which type of sensation is the first to go? |
|
Definition
| Stocking and Glove; Vibratory first to go |
|
|
Term
| What are some common manifestations of diabetic autonomic neuropathy? |
|
Definition
| Exercise Intolerance, dizziness, Hypoglycemic indicators (lack of sweating and shaking), orthostatic hypotension, gastric atony, bladder dysfunction, ED |
|
|
Term
| In Guillain-Barre syndrome, what is the MC complaint? |
|
Definition
| symmetrical weakness beginning in the legs |
|
|
Term
| In guillain-Barre is the weakness/paralysis in an ascending or descending pattern? |
|
Definition
|
|
Term
| If a pt presents with sudden onset weakness in the legs that seems to be worsening, now they can barely walk and on physical exam there are absent achille's tendon reflex as well as elevated protein levels in the CSF and a demyelination pattern on their Nerve conduction study, what condition should you suspect? |
|
Definition
|
|
Term
| What nerve roots are MC affected by herpes zoster reactivation? |
|
Definition
|
|
Term
| If there is a herpes zoster reactivation suspected and the lesion is located on the tip of the nose, what NEEDS to be done urgently? |
|
Definition
| Referral to ophtho!!! This indicates an ophthalmic disease division. |
|
|
Term
| How is herpes zoster reactivation treated? |
|
Definition
Antivirals - Acyclovir, Valcyclovir
Pain Relief |
|
|
Term
| How is post-herpetic neuralgia treated? |
|
Definition
| Gabapentin or amitriptyline |
|
|
Term
| What part of the spinal cord does the polio virus attack? |
|
Definition
|
|
Term
| If a pts presents with a hx of fever, myalgias, URI and GI sx plus is experiencing weakness in the legs, what condition should you suspect, especially if they are unvaccinated? |
|
Definition
|
|
Term
| Which disease has transient sx of paresthesia, gait disorders, focal weakness, visual blurring, diplopia, vocal slurring and is MC in women? |
|
Definition
|
|
Term
| What is the MC type of MS? |
|
Definition
|
|
Term
| How are acute relapses of MS treated? |
|
Definition
| Prednisone 60 day with taper |
|
|
Term
| What is given to MS pts to help with long-term immune suppression to help slow the course of the disease? |
|
Definition
|
|
Term
| What is given to help with muscle spasticity seen with MS? |
|
Definition
|
|
Term
| What MS subtype is the MC initial course? |
|
Definition
|
|
Term
| Which subtype of MS is described as unpredictable relapses followed by periods of no new signs of the disease? |
|
Definition
|
|
Term
| Which subtype of MS is described as having the greatest amount of disability, may include new neurologic symptoms and worsening cognition? |
|
Definition
|
|
Term
| Which type of MS is described as a rapid decline that occurs continually without clear attacks? |
|
Definition
|
|
Term
| Which type of MS is described as pts who from the onset of MS symptoms have a steady neurologic decline but also suffer from superimposed attacks? |
|
Definition
|
|
Term
| What is the isolated peripheral neuropathy that affects the trigeminal nerve, causing palsy? |
|
Definition
|
|
Term
| What is the isolated peripheral neuropathy that affects the radial nerve? |
|
Definition
|
|
Term
| What is the isolated peripheral neuropathy that affects the median nerve? |
|
Definition
|
|
Term
| What is the isolated peripheral neuropathy that affects the ulnar nerve? |
|
Definition
|
|
Term
| What is the isolated peripheral neuropathy that affects the lateral femoral cutaneous nerve? |
|
Definition
|
|
Term
| What is the isolated peripheral neuropathy that affects deep peroneal nerve? |
|
Definition
| Compartment syndrome (EMERGENCY) |
|
|
Term
| What is the isolated peripheral neuropathy that affects posterior tibial nerve? |
|
Definition
|
|
Term
| What is a "classic finding" of ALS? |
|
Definition
|
|
Term
| Does ALS affect the intellect? |
|
Definition
|
|
Term
| If a pt presents with UMN and LMN deficits, and symptoms including limb fatigue, weakness, but with normal sensations, what condition should be suspected? |
|
Definition
|
|
Term
| What spinal pathway is affected in ALS? |
|
Definition
| Corticospinal (peripheral limb sx) and corticobulbar (difficulty chewing and swallowing) |
|
|
Term
| If a pt presents with complaints of acute onset bowel and bladder dysfunction, saddle anesthesia, and variable motor and sensory loss in the lower extremities, what condition is suspected? |
|
Definition
|
|
Term
| What is the treatment for cauda equina syndrome? |
|
Definition
| URGENT referral to neurosurgeon, MRI |
|
|
Term
| What is the treatment for ALS? |
|
Definition
| NO cure, but riluzole slows the progression of the disease |
|
|
Term
| What is the cause of epidural spinal cord compression? |
|
Definition
| tumor pressing on dural sac |
|
|
Term
| If a patient presents with back pain especially at night, focal thoracic spine tenderness, weakness and radicular sensory defects, with abnormalities on the neurological exam, what condition should you suspect? |
|
Definition
| Epidural spinal cord compression |
|
|
Term
| What is the treatment for epidural spinal cord compression? |
|
Definition
| TRUE Oncologic ER - rapid tx required to avoid permanent impairment (delay of only few hour can cause permanent impairment) |
|
|
Term
| If a patient has had a major spinal cord trauma and they have diminished motor strength, fine touch, positional sense and vibratory sense on one side of the body (below the trauma) and on the other side they have a loss of pain and temperature sensation, what condition do you suspect? What has occurred in reference to the spinal cord? |
|
Definition
| Brown-Sequard Syndrome - partial spinal cord resection |
|
|
Term
| If a pt has had a major spinal cord trauma and they have immediate bilateral paralysis and loss of all sensation below the site of the injury, what type of injury has occurred to the spinal cord? |
|
Definition
| Total spinal cord transection |
|
|
Term
| Identify which lesion, UMN or LMN, the sign or symptom implies - Hyporeflexia? |
|
Definition
|
|
Term
| Identify which lesion, UMN or LMN, the sign or symptom implies - Hyperreflexia? |
|
Definition
|
|
Term
| Identify which lesion, UMN or LMN, the sign or symptom implies - Hypotonia (flaccidity)? |
|
Definition
|
|
Term
| Identify the type of dysfunction that causes Rigidity. |
|
Definition
| extrapyramidal/basal ganglia dysfunction |
|
|
Term
| What term describes a stiffness or inflexibility that persists throughout the ROM due to muscle contraction? |
|
Definition
|
|
Term
| Identify which lesion, UMN or LMN, the sign or symptom implies - Spasticity? |
|
Definition
|
|
Term
| What motion is spasticity increased greater with in the arms? in the legs? |
|
Definition
arms - flexor muscles
legs - extensor muscles |
|
|
