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Med Surg: Neurology Test #1
Winter Semester - 2011
129
Medical
Graduate
01/19/2011

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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
ACE I
Term
If there is a diminished gag reflex or disturbed swallowing, what CN is affected?
Definition
CN IX
Term
If there is asymmetric rise of the uvula, which CN is affected?
Definition
CN X
Term
A lesion of which CN causes drooping shoulder, muscle atrophy, weakened or limited elevation of the shoulder or arm, scapula winging?
Definition
CN XI - Accessory
Term
A lesion of which CN causes flaccid paralysis of tongue and atrophy, as well speech difficulties?
Definition
CN XII
Term
What CN is involved with Ramsey Hunt syndrome?
Definition
CN VII
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
Ramsey-Hunt Syndrome
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
Bell's Palsy
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
Indicates ICP
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
CN VI Palsy
CT Scan
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
CN IV Palsy
Term
What muscle is affected in CN IV palsy?
Definition
Superior Oblique
Term
What is the MC cause of CN IV palsy?
Definition
blunt head trauma
Term
What muscle is affected in CN VI palsy?
Definition
Lateral Rectus
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
Diabetes and HTN
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
What is papilledema?
Definition
Optic Disc swelling
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
Giant Cell Arteritis
Term
What is the tx for Giant Cell Arteritis?
Definition
Prednisone Burst
Term
What nerve is affected in optic neurtitis?
Definition
Optic Nerve
Term
What disease is often a cause of optic neuritis?
Definition
Multiple Sclerosis
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
Optic Neuritis
Term
What is the tx for Optic Neuritis?
Definition
steroids
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
What is anosmia?
Definition
absence of smell
Term
What is hyperosmia?
Definition
abnormally intense smell
Term
What is Cacosmia?
Definition
hallucination of fecal odor
Term
What types of CA most often cause metastases to the brain (cerebellar tumors)?
Definition
Lung and Breast CA
Term
What type of cerebellar tumor MC presents in childhood and is highly malignant?
Definition
Medulloblastoma
Term
What is a possible treatment for an Astrocytoma?
Definition
surgical resection
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
Chromosome 9
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
Friedreich's ataxia
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
Purkinje Cells
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
BPPV
Term
How is BPPV diagnosed? treated?
Definition
Dx- Dix-Hallpikes
Tx - Epley Maneuver
Term
Is BPPV a peripheral or central disorder?
Definition
Peripheral
Term
Is Meinere's a peripheral or central disorder?
Definition
Peripheral
Term
Is an Acoustic Neuroma a peripheral or central disorder?
Definition
Peripheral
Term
Is Gentamycin ototoxicity a peripheral or central disorder?
Definition
peripheral
Term
Is alcohol intoxication a peripheral or central disorder?
Definition
Central
Term
Is Wernicke's Encephalopathy a peripheral or central disorder?
Definition
Central
Term
Is MS a peripheral or central disorder?
Definition
central
Term
Is alcoholic cerebellar degeneration a peripheral or central disorder?
Definition
central
Term
Is TIA/stroke a peripheral or central disorder?
Definition
central
Term
Is cerebellar ataxia a peripheral or central disorder?
Definition
central
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
Myasthenia Gravis
Term
Are sensation or reflexes affected by Myasthenia Gravis?
Definition
No
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
ascending
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
Guillain-Barre
Term
What nerve roots are MC affected by herpes zoster reactivation?
Definition
Thoracic and lumbar
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
Anterior Horn Cells
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
Polio
Term
Which disease has transient sx of paresthesia, gait disorders, focal weakness, visual blurring, diplopia, vocal slurring and is MC in women?
Definition
MS
Term
What is the MC type of MS?
Definition
Secondary Progressive
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
beta-interferon (avonex)
Term
What is given to help with muscle spasticity seen with MS?
Definition
baclofen or diazepam
Term
What MS subtype is the MC initial course?
Definition
Relapsing Remmiting
Term
Which subtype of MS is described as unpredictable relapses followed by periods of no new signs of the disease?
Definition
Relapsing Remitting
Term
Which subtype of MS is described as having the greatest amount of disability, may include new neurologic symptoms and worsening cognition?
Definition
Secondary Progressive
Term
Which type of MS is described as a rapid decline that occurs continually without clear attacks?
Definition
Primary Progressive
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
Progressive Relapsing
Term
What is the isolated peripheral neuropathy that affects the trigeminal nerve, causing palsy?
Definition
Bell's Palsy
Term
What is the isolated peripheral neuropathy that affects the radial nerve?
Definition
Saturday Night Palsy
Term
What is the isolated peripheral neuropathy that affects the median nerve?
Definition
Carpal Tunnel Syndrome
Term
What is the isolated peripheral neuropathy that affects the ulnar nerve?
Definition
"funny bone" tingling
Term
What is the isolated peripheral neuropathy that affects the lateral femoral cutaneous nerve?
Definition
Meralgia paresthetica
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
Tarsal Tunnel Syndrome
Term
What is a "classic finding" of ALS?
Definition
Tongue fasiculations
Term
Does ALS affect the intellect?
Definition
NO
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
ALS
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
Cauda Equina Syndrome
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
LMN
Term
Identify which lesion, UMN or LMN, the sign or symptom implies - Hyperreflexia?
Definition
UMN
Term
Identify which lesion, UMN or LMN, the sign or symptom implies - Hypotonia (flaccidity)?
Definition
LMN
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
Rigidity
Term
Identify which lesion, UMN or LMN, the sign or symptom implies - Spasticity?
Definition
UMN
Term
What motion is spasticity increased greater with in the arms? in the legs?
Definition
arms - flexor muscles
legs - extensor muscles
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