Term
| Name the modalities of diagnostic imaging. |
|
Definition
Radiography (XR)
Computed Tomography (CT)
Magnetic Resonance Imaging (MRI)
Ultrasound (US)
Nuclear Medicine (NM)
Interventional Radiology (IR) |
|
|
Term
| Name the advantages and disadvantages of XR (plain films) |
|
Definition
Advantages: Fast, relatively inexpensive, and availible everywhere.
Disadvantages: uses ionizing radiation, provides limited info regarding soft tissues. |
|
|
Term
| A patient on x-ray has what appears to be an open physis. What does this indicate? |
|
Definition
|
|
Term
| What are the x-ray findings of arthritis? |
|
Definition
Joint space narrowing
Sclerosis
Osteophytes
Subchondral cysts |
|
|
Term
| Name the common types of fractures (Slide 22 of Introduction to Radiology) |
|
Definition
Transverse
Spiral
Oblique
Comminuted
Segmental |
|
|
Term
|
Definition
| Joint surfaces are no longer congruent, but some contact remains. |
|
|
Term
| Name the four kinds of bone lesion descriptions. (Slide 29 in Introduction to Radiology slideshow). |
|
Definition
Sclerotic
Blastic
Lytic
Expansile |
|
|
Term
| What are the four considerations of mental status? |
|
Definition
Alert, Aware, Attentive
Language function
Orientation
Memory |
|
|
Term
A colloid cyst in the 3rd ventricle could cause this disorder. How would this present on a mental status exam?
also can be seen in CJD and encephalitis lethargica. |
|
Definition
Akinetic mutism
Patient appears alert, but would not reply or move. |
|
|
Term
A "de-efferenting" lesion of the ventral pons can cause this syndrome. Destroys the decending corticospinal tract.
What part of the brain is spared in this syndrome? (allows for full consciousness) |
|
Definition
"Locked in" syndrome.
The tectum tegmentum of the dorsal brain stem (reticular activating system is here, allowing for full alert aware consciousness.) |
|
|
Term
This area can have a lesion with expressive aphasia
how does this disorder present?
What are some synonyms for this disorder? |
|
Definition
Broca's area
neoflogisms (nonsense words), anomia (don't know what objects are), non-fluent speech, and mutism (if severely devistated)
non-fluent aphasia, anterior aphasia |
|
|
Term
This area of the brain can have a lesion with receptive aphasia.
How does this disorder present?
what are some synonyms for this disorder? |
|
Definition
Wernike's area
fluent speech, but not on topic. Cannot respond to commands such as "show me your right foot." Can initiate a proper conversation, but cannot carry it on.
fluent aphasia, posterior aphasia |
|
|
Term
Damage of the arcuate fasiculus can cause this disorder.
How does this present? |
|
Definition
Conduction aphasia
Is fluent and can respond to commands, but cannot correcctly respond to verbal requests such as (say the word, "house") |
|
|
Term
| what is the most common (but not exclusive) cause of aphasias? |
|
Definition
|
|
Term
| What are the 3 components of orientation? |
|
Definition
| Person (who they are), Place (where they are), Time (when they are) |
|
|
Term
| What are 2 tests of memory during a mental status exam? |
|
Definition
Digit span (serial 7 subtractions) for immediate recall
3 object recall (house, boat, car) for store and retrieve function. |
|
|
Term
What is the function of the non-dominant (usually the right) parietal lobe?
What occurs when lesions occur here? |
|
Definition
sense of spatial orientation.
Body agnosia (patients don't recognize half of their body), Dressing apraxia (cannot dress themselves; don't know up, down, left and right!), and constructive apraxia (cannot build 3 dimensional objects with blocks or sticks). |
|
|
Term
What are the syndrome is associated with damage to the dominant parietal lobe?
How does this disorder present? |
|
Definition
| Gerstmann syndrome (R-L dissociation, acalculia, agraphia without expressive aphasia, and finger agnosia) |
|
|
Term
| What would be the damage in a patients brain if they had sensory discimination graphesthesia, asterognosis, barognosia, poor 2 point discrimination, and/or extinction. (see page 112 of notebook 2) |
|
Definition
| contralateral parietal lobe damage. |
|
|
Term
What are disorders involved with temporal damage?
How do they present? |
|
Definition
Hippocampal memory loss (common with Alzheimer's disease).
Kluver-Bucy syndrome (with bi-temporal lesions), presents with hyper-oral, hyper-sexual tendencies. |
|
|
Term
| What are some common manifestations of frontal lobe injuries? |
|
Definition
Apathy , abula (lack of will power), akinesia. The 3 A's can look like depression.
contralateral motor defects
expressive aphasia
akinetic melody (smooth, repetitive motion) |
|
|
Term
| Name the four patterns of weakness and how they manifest. |
|
Definition
1. Neuropathic-distal muscle weakness (weakness with ankle dorsiflexion).
2. Myopathic-proximal muscle weakness (shoulder weakness).
3.Cerebral weakness-hemiparesis; contralateral to lesion.
4. Spinal chord weakness-paresis or paraplegia. (Must be distinguished from an artery occlusion supplying the leg homonculus.) |
|
|
Term
| A 63 y.o. type 2 diabetic has difficulty raising her leg. You think this could be one of two things. The two things are what and how can they be distinguished? |
|
Definition
Can be a spinal chord problem affecting L2,3, and 4 or acute femoral neuropathy.
If the patient can adduct the leg, this patient has acute femoral neuropathy (adductors supplied by the obturator nerve which has L2, L3, and L4 components but does not supply the quads). |
|
|
Term
A 22 year old football player presents with a dislocated shoulder. What nerve is in danger of trauma, and how can this be diagnosed via clinical presentation?
What can result if this dislocated shoulder is not treated? |
|
Definition
The axillary nerve is in danger. Dx clinically if the deltoid is weak (axillary neuropathy).
Adhesive capsulitis can result w/o therapy. |
|
|
Term
| Which muscle is most severely affected in carpal tunnel syndrome? |
|
Definition
| Abductor pollicis brevis. |
|
|
Term
| A 33 year old male weight lifter presents with wrist drop and weak supination. However, you note that the patient has 5/5 muscle strength when flexing at the elbow at 90 degrees of pronation. Also, the triceps are spared. You have ruled out CNS reasons, and suspect what? |
|
Definition
| entrapment of the posterior interosseous nerve (radial nerve branch) at the arcade of Frohose. This is called posterior interosseous syndrome. |
|
|
Term
| A 26 year old male presents with left sided foot drop in your office. He says it started a few days ago after an intense workout, including lots of squats. Spinal nerves appear to be intact. You suspect what? |
|
Definition
| Peroneal nerve neuropathy |
|
|
Term
A 42 year old female presents with weakness of her shoulder girdle. She does not have any eye droopiness, double vision or other cranial manifestations. An injection of edrophonium does not relieve the weakness of her shoulder girdle. This is most likely:
What is this disorder commonly associated with? |
|
Definition
Lamberd-Eten syndrome (not mysthenia gravis)
Commonly associated with malignancy. |
|
|
Term
| A 42 year old type 2 diabetic female presents with a decreased sense of vibration sense and cold sense in her hands and feet, but has no loss of sensation on her shoulder. This indicates that she has what disorder? |
|
Definition
| Peripheral neuropathy (glove and stocking neuropathy) |
|
|
Term
A 54 year old male heavy smoker is experiencing sensory loss (pain and temperature) of the right side of his face, as well as similar sensory loss on the left side of his body. You suspect that this is some kind of infaction...
Name where the infarction MOST LIKELY occurred and what the name of the syndrome is due to this infaction. |
|
Definition
Possibly a right sided medullary infarction (occlusion of the vertebral artery most commonly, followed by PICA) causing Wallenberg Syndrome (lateral medullary syndrome)
The spinal nucleus of the 5th nerve and the substantia gelatinosa. |
|
|
Term
A patient who is recovering from a traumatic fall just recently regained sphincter tone and is under observation at the hospital. He fell from a ladder onto a raised beam on his left side at about the level of T9. On physical exam he has a positive Babinski sign on his left side, negative on his right. He also has almost complete anesthesia around the area of his umbilicus, complete loss of tactile sensation along his left leg, and has lost the ability to feel pain and temperature in his right leg.
Name this disorder and the spinal tracts that experienced damage.
If he had fallen and hit himself at around the level of C6, what syndrome might develop as well? |
|
Definition
This is Brown-Sequard syndrome.
Ipsilateral UMN signs (Left corticospinal tract).
Ipsilateral loss of tactile sensation (Left dorsal column).
Contralateral loss of pain and temperature (Left spinothalamic tract).
Loss of sensation around the umbilicus (Left anterior horn)
Horner's syndrome |
|
|
Term
| A 54 year old chronically hypertensive female presents with very pronounced sensory loss on the right side of her face and equally pronounced sensory loss along the left side of her body. When asked to distinguish a golf ball from a ping-pong ball, the patient could do so. She could also identify a quarter from a dime in her hands. Extinction was absent. This is most likely. |
|
Definition
| Hemorrage affecting the right VPL and VPM. |
|
|
Term
Damage to the parietal lobe can cause what syndrome?
What symptoms are associated with this syndrome? |
|
Definition
Gherstmann's syndrome
Dysgraphia/agraphia
Dyscalculia/acalculia
Finger agnosia (unique)
Left-right disorientation |
|
|
Term
| A 67 year old female complains of an inability to hold things and the onset of general clumsiness with objects. An arm drift test is positive. An action tremor that does not worsen with continued movement. She also had difficulty touching her nose with her eyes closed. What is the patients diagnosis, and where exactly is the problem? |
|
Definition
| This is paresis caused by a contralateral parietal lesion or ipsilateral cerebellar lesion. Sensory feedback is impaired. |
|
|
Term
| True or false: the Rhomberg test is a test of cerebellar function. |
|
Definition
| False: it is a proprioreceptive test! |
|
|
Term
| What is the most common cause of sensory ataxia? |
|
Definition
|
|
Term
| A patient presents with a decorticate posture (extended leg, flexed arm on same side) and walks with a strange circumduction of the upper extremity. What kind of gait is this? |
|
Definition
|
|
Term
| A patient presents with two "stiff" (fully extended) legs and walks without much fluidity. This is most likely |
|
Definition
|
|
Term
| A patient presents with both arms in full flexion and a "scissoring gait". This is most likely: |
|
Definition
| Spastic diparetic gait due to cerebral palsy |
|
|
Term
| A "waddling gait" in patients with muscular dystrophy usually indicates: |
|
Definition
| Myopathic weakness (pelvic girdle specifically) |
|
|
Term
|
Definition
Lateral rectus (abducens nerve)
Superior Oblique (trochlear nerve)
All others (oculomotor nerve) |
|
|
Term
| A right optic tract lesion would cause: |
|
Definition
| Left homonymous hemianopsia |
|
|
Term
| A right temporal lobe lesion that destroys the inferior portion of the optic radiation in Meyers loop. This indicates a: |
|
Definition
| left sided superior quadrantanopia |
|
|
Term
| A right sided parietal lobe lesion of the optic tract will cause: |
|
Definition
| Left-sided inferior quadrantanopia |
|
|
Term
| If damage occurs to the occipital lobe or optic tract, but the occipital pole is spared, what is the result? |
|
Definition
| hemianopsia/quadrantanopsia with central vision sparing |
|
|
Term
What muscle and nerve is tested with:
looking away
Looking up and away
Looking down and away
looking up and in
looking down and in
looking in |
|
Definition
lateral rectus (abducens nerve)
Superior rectus (oculomotor nerve)
Inferior rectus (oculomotor nerve)
Inferior oblique (oculomotor nerve)
superior oblique (trochlear nerve)
medial rectus (oculomotor nerve) |
|
|
Term
| what is the most common trigeminal division that experiences nuralgia? |
|
Definition
|
|
Term
Peripheral damage to the 7th cranial nerve would cause what?
Central damage (due to stroke) to this same nerve would cause what? |
|
Definition
full ipsilateral facial weakness (p129 in notebook 2).
contralateral lower face weakness. |
|
|
Term
| A 45 year old patient presents with with right sided facial ptosis, lack of sweating, eyelid drooping, ear pain, sound sensitivity and vesicles around the pinna of the ear. This is most likely caused by: |
|
Definition
| Ramsey-Hunt syndrome type II |
|
|
Term
| Name the 5 main parameters that must be present for a patient to be considered comatose |
|
Definition
Level of responsiveness
Motor function observed in its entirety
Respiratory patterns
Eye movements
Pupils |
|
|
Term
| which areas of the brain may be suppressed in a truly comatose patient? |
|
Definition
The reticular activating system bilaterally
bilateral cortical suppression (see slide 3) |
|
|
Term
Pressure on the right supraorbital notch causes flexion of the left arm and extention of the left leg (de-corticate posture). This indicates:
How might this progress? |
|
Definition
Damage to the right cerebral cortex
May progress to the other side of the body if this damage is due to a herniation (herniation syndrome) |
|
|
Term
| in response to pressure on the supraorbital area, a comatose patient flexes both of his arms and extends both of his legs; this indicates |
|
Definition
| Lesion at the thalamus, internal capsule and/or the cerebral cortex above the red nucleus. |
|
|
Term
A bi-lateral decerebrate posture looks like what?
What does this indicate? can this progress further? |
|
Definition
Arm extention and wrist flexion (going for your guns).
Further progression of herniation syndrome to the area just above the vestibular nucleus. Can progress further to below the vestibular nucleus and cause flaccid paralysis. |
|
|
Term
Name the respiratory patterns and describe them and their etiology.
Which two can support a patient without respiratory assistance? |
|
Definition
Cheyne-Stokes Respirations- "creshendo-apnea" pattern. Very recognizable. Indictive of bilateral cortical suppression.
Central neurogenic hyperventilation-very fast, short breaths. Indicates pons damage.
Apneustic Breathing, cluster breathing and ataxic breathing are agonizable breathing and need to be intubated or the pt. will not respirate.
Cheyne-Stokes and central neurogenic hyperventilation can sustain a patient on their own. |
|
|
Term
| Roving eye movements indicate what? |
|
Definition
|
|
Term
| To test a comatose patient, you move their head to the left and observe their eyes move to the right. What test is this called, and what does it indicate? |
|
Definition
This is the "doll's eyes" test.
Indicates a functional vestibulooccular reflex is present (vestibular nucleus, inner ear function, pontine gaze center, etc. are all working). |
|
|
Term
A comatose patient is tested for vestibulooccular function by placing cold water in their right ear. What way do you expect them to look if their function is in tact?
In a conscious patient? |
|
Definition
Expect looking to the right.
In a conscious patient, COWS: expect looking to the left. |
|
|
Term
| True or false: a nystagmus is present ONLY in conscious patients. |
|
Definition
| True; requires cortical function. |
|
|
Term
| A comatose 78 year old female has pinpoint pupils. Just from this finding, we can expect to see: |
|
Definition
| A pontine hemorrage; sympathetics interrupted. Parasympathetic overdrive |
|
|
Term
A comatose 88 year old male presents with a left blown pupil. Just from this, we should look for:
what is the pathology of this morphology? |
|
Definition
An uncal herniation
presses on lateral 3rd nerve which can interrupt the parasympathetics coming from the nucleus of Edinger-westphal which travel with the 3rd nerve.
Sympathetic overdrive. |
|
|
Term
An unconscious male of unknown age presents with cheyne-stokes respiration, a pupillary reflex, negative doll's eye test, negative caloric test, and a de-corticate posture with reaching towards stimulation.
What is the probable area of the brain that is affected?
What should you look for? |
|
Definition
bi-lateral cerebral cortex shutdown.
Look for organic causes, head trauma, or infection. |
|
|
Term
An unconscious female of unknown age presents with cheyne-stokes respiration, a pupillary reflex, negative doll's eye test, negative caloric test, and a de-corticate posture without reaching towards stimulation.
What is the probable area of the brain that is affected?
What should you look for?
|
|
Definition
| bi-cortical suppression with brainstem damage above the red nucleus and vestibular nucleus. |
|
|
Term
| another name for the indentation of a cerebral peduncle. |
|
Definition
|
|
Term
| What is the primary cause of progressive multifocalencephalopathy (PML) and what must be present? |
|
Definition
John Cunningham virus (a type of polyomavirus) (JC virus)
Must be immunosuppressed. |
|
|
Term
What is the most common etiologic agent of bacterial meningitis in adults?
In HIV patients? |
|
Definition
Streptococcus pneumoniae
Cryptococcus |
|
|
Term
| Which type of protozoan causes hemorragic encephalitis and looks more like a viral infection with lab results? |
|
Definition
|
|
Term
| Name a virus and bacteria that causes hemorragic encephalitis |
|
Definition
| HSV-I and bacillus anthracis |
|
|
Term
| Name the clinical features of parkinsonism |
|
Definition
Bradykinesia
Rigidity
Resting tremor
Dystonic movement (with a dopamine drug overdose) |
|
|
Term
| If lewy bodies are fuond in the midbrain, what does this indicate? |
|
Definition
| Idiopathic Parkinson's disease |
|
|
Term
| misfolding of alpha-synuclein protein can cause: |
|
Definition
Parkinson's disease
Dementia with Lewy bodies
Multisystem atrophy |
|
|
Term
| Tau protein misfolding causes? |
|
Definition
Frontotemporal dementia
Progressive supranuclear palsy
Corticobasal degeneration |
|
|
Term
| B-amyloid protein misfolding causes what disease? |
|
Definition
|
|
Term
What is the largest cause of Parkinson's disease?
What are risk factors for this form of parkinsonism? |
|
Definition
Cerebrovascular/disconnection
Hypertension
Diabetes
Cigarette smoking
Alcoholism
Cardiac disease
This is technically a small vessel disease |
|
|
Term
| Name the ways to cause motor system dysfunction |
|
Definition
deplete dopamine (substantia nigra damage)
cerebrovascular disease (break connections)
direct degenerative disease of basal ganglia
|
|
|
Term
| What class of drugs can induce a drug form of parkinsonism? |
|
Definition
| Neuroleptics and atypical antipsychotics |
|
|
Term
| What is the typical age of oncet in idiopathic parkinson's disease? |
|
Definition
| Both sexes equally, onset 40-70 years with peak at 60y.o. |
|
|
Term
What finding would make a diagnosis of parkinson's clinically possible?
What makes it probable? |
|
Definition
One of the following:
Assymetric rest tremor
Assymetric rigidity
Assymetric bradykinesia
postural reflexes lost
Two of the above make it a probable diagnosis |
|
|
Term
| What must be present for the diagnosis of Parkinson's disease |
|
Definition
Two of the following:
Assymetric rest tremor
Assymetric rigidity
Assymetric bradykinesia
postural reflexes lost
With a response to Parkinson's drugs! |
|
|
Term
How many substantia nigra neurons are present in a young person?
How many in a typical 80y.o.
in in IPD patient? |
|
Definition
|
|
Term
| What situations all but exclude the diagnosis of parkinson's disease? |
|
Definition
Drug exposure
Ceerbellar signs
Corticospinal tract signs
Eye movement abnormalities (except upward)
Severe dysautonomia
Early dementia or gait disturbance
Hx of encephalitis
Evidence of severe subcortical white matter disease |
|
|
Term
| What % of parkinson's patients have an alternate dx postmortem? |
|
Definition
|
|
Term
| What percent of patients have dementia with parkinson's disease? |
|
Definition
|
|
Term
| What are the complications of long term treatment? |
|
Definition
Drugs wear off
Dyskinesia (take too much drug!)
On-Off periods
Dopamine unresponsive |
|
|
Term
| what are the 3 clincal stages of Parkinson's disease and how are they characterized? |
|
Definition
Honeymoon period-excellent early response to dopamine treatment.
Transition phase-diminished benefit toward end of dose cycle.
Complex response and fluctuation phase-end of dose akinesia, peak dose dyskinesias, on-off periods (freezing unrelated to dose) |
|
|
Term
| What are the adverse effects seen with dopamine agonists? |
|
Definition
| Impulse control dysfunction-e.g. compulsive gambling and hypersexuality |
|
|
Term
| What two drugs are often given together to treat early idiopathic parkinson's disease (IPD)? |
|
Definition
|
|
Term
| What is the "end of the road" treatment for IPD that trumps pharmacological intervention? |
|
Definition
| Surgical intervention such as "deep brain stimulators" |
|
|
Term
| Which two types of dementia account for about 96% of all dementia? |
|
Definition
Alzheimers disease
Vascular dementia |
|
|
Term
| During what age group is the detection of dementia usually the hardest to find? |
|
Definition
|
|
Term
| What is the first area to be affected in AzD? |
|
Definition
| The superior temporal sulcus |
|
|
Term
| What percent of familial alzheimer's disease is due to mutations of APP? |
|
Definition
|
|
Term
| True or false: all patients with a mutation of APOE develop alzheimers. |
|
Definition
|
|
Term
| What are the pathogenic causes of AzD? Name the genetic and non-genetic causes |
|
Definition
Genetic:
APP gene
Presenillin 1 and 2
Down's syndrome
Other late onset genes
Apolipoprotein E
Nongenetic:
Toxins
Viruses
Prions
Trauma |
|
|
Term
| What form of APOE when present in a person increases their risk of AzD? What is the relative risk? |
|
Definition
heterozygous APOE-4=3x
homozygous APOE-4=8x |
|
|
Term
| What percent of people have headaches at least once a year? |
|
Definition
|
|
Term
| What is the difference between primary and secondary headaches? |
|
Definition
Primary=idiopathic
Secondary=symptomatic of another problem |
|
|
Term
| Name 4 kinds of primary headaches and 2 types of secondary headache |
|
Definition
Primary: Migrane, tension, cluster, misc.
Secondary: extracranial or intracranial |
|
|
Term
| What are the red flags and what are the underlying problems in the diagnosis of headache? |
|
Definition
Sudden onset-subarachnoid hemorrage
Worsening pain headache-mass lesion, subdural hematoma, medication overuse.
Headache with systemic illness-Meningitis, encephalitis, systemic infection, collagen vascular disease, arteritis. |
|
|
Term
| How do subarachnoid hemorrages commonly present? |
|
Definition
| "Worst headache of my life!" |
|
|
Term
What is the sensitivity of a CT for a subarachnoid hemorrage if done in the first 24 hours?
What can be done if negative but still suspicious? What will you see? |
|
Definition
95%
Lumbar puncture-look for xanthochromia; blood in spinal tap. |
|
|
Term
A patient presents with a headache described as throbbing pain located in the temporofrontal area. The patient also describes neurological manifestations and intermittent jaw claudictaion. This is most likely:
What is the selectivity of this condition?
What are the 3 best tests for this condition?
How is this a medical emergency? |
|
Definition
Temporal arteritis
Selective for arteries with ample elastin.
Elevated Sedimentation Rate (ESR), C-reactive protein (CRP) and as a last resort a temporal artery biopsy.
May cause loss of vision. |
|
|
Term
| What percent of migranes present with an aura? |
|
Definition
|
|
Term
What percent of the population is affected by migranes?
What percent of all headaches in adults are migranes?
What is the typical age of onset? What percent have a family history? |
|
Definition
10-15%
10-20%
15-35 years old. 70% have family history |
|
|
Term
| What is the most common trigger of migranes? |
|
Definition
|
|
Term
| If a patient is on estrogen therapy and has classic (aura presenting) migranes, what are they at a higher risk for? |
|
Definition
|
|
Term
What gender predominantly experiences cluster headaches?
When do they tend to occur?
What are the clinical findings?
What is one treatment possibility? |
|
Definition
Men
More severe pain than a migrane, but shorter duration.
Commonly occurs in the middle of the night. Can wake someone up!
Causes ipsilateral tearing, nasal symptoms, eyelid edema, facial sweating, miosis/ptsis, and restlessness.
100% O2 helps idiopathically. |
|
|
Term
| What is the most common type of primary headache in adults? |
|
Definition
| Tension-type headaches (50% of all) |
|
|
Term
| Differentiate between petit mal and gand mal seizures. |
|
Definition
petit mal=smaller; absense or staring seizures
Grand mal=tonic clonic seizures |
|
|
Term
| What brain activity is seen in a partial seizure, generalized tonic-clonic seizure, and a generalized absense seizure? |
|
Definition
Partial-left frontal and left temporal activity
GTC-Full heavy activity of all areas, with a gradient of activity from the tonic, to the clonic, to the coma stages.
GAS-Constant, large regular wave activity of all areas. |
|
|
Term
What is the incidence and prevalence of seizures?
What is the prevalance of recurrent seizures |
|
Definition
1 in 10, 1 in 118
1 in 100 |
|
|
Term
| What is the age distribution of seizures? |
|
Definition
| Bimodal; less than 1 and greater than 60. |
|
|
Term
| How are seizures characterized medically? |
|
Definition
| Classified based on their EEG findings, not by clinical appearance. |
|
|
Term
| What type of seizure is the only type with an aura? |
|
Definition
|
|
Term
| What type of seizure commonly presents with oral automatisms? |
|
Definition
| Temporal (partial) seizures |
|
|
Term
| What type of diet helps reduce seizures in epileptics? |
|
Definition
| Atkin's diet (carbohydrate restriction) |
|
|
Term
| What are other ways to treat seizures without medication or diet? Hint: use a more invasive method. |
|
Definition
Vagus Nerve Stimulator (VNS)
Epilepsy surgery |
|
|
Term
| For those that get epilepsy surgery, what % become seizure free afterwards? |
|
Definition
|
|
Term
| What are the physical modalities/agents used in rehabilitation? |
|
Definition
Heat
Cold
Water
Pressure
Sound
EMR
Electrical currents |
|
|
Term
| What are the rles of physical modalities in rehab? |
|
Definition
Modify inflammation and healing
Relieve pain
Alter collagen extensibility
Modify muscle tone |
|
|
Term
| What are the general contraindications and precautions for physical agents in rehab? |
|
Definition
Pregnancy
Malignancy
Impaired sensation
Impaired mental status
pacemaker |
|
|
Term
| What are the uses of hydrotherapy in physical rehab? |
|
Definition
| Help heal wounds, exercise w/ joint decompression, superficially heat or cool, reduce pain, and edema control |
|
|
Term
| What is one physical rehab method that can treat Reynaud's disease and complex regional pain syndrome? |
|
Definition
| warm to cold switches in hydrotherapy. |
|
|
Term
| Which physical rehab method is falling out of favor because of constant exposure to radiation by the practitioner? |
|
Definition
|
|
Term
| What parameters of ultrasound therapy cause increased penetration? |
|
Definition
| Decreased frequency and increased intensity |
|
|
Term
What are alternative ways to administer a drug superficially without the risk of injection?
What form must the drug be in for these routes? |
|
Definition
Phonophoresis or iontophoresis
Drug needs to be in a compound form |
|
|
Term
What are the types of UV rays, and how deep does each penetrate?
What are the special characteristics of each? |
|
Definition
UVA is long wave, deepest penetration
UVB= produces skin erythemia (medium pen.)
UVC-Short wave (germicidal) |
|
|
Term
| How oes transcutaneous electrical stimulation (TENS) work to reduce pain? |
|
Definition
| Stimupates A fibers which "close the gate" on pain. |
|
|
Term
| What treatment is best for nerve impingements and herniations? |
|
Definition
|
|
Term
| Which physical medicine treatment is best for treating edema? |
|
Definition
|
|
Term
| True or false: ALS presents ASYMETRICALLY |
|
Definition
|
|
Term
A 21 year old male presents with progressive weakness in his left and right legs. Reflex testing reveals hyporeflexia in both of these limbs, with normal responses in the others. He has no fever, relatively symmetric weakness, and mild sensory involvement. You also note that he seems to have some slight facial nerve involvement. Lab results show an abnormal CSF profile and an electrophysiologic exam shows evidence of demyelination. This is:
What is the etiology of this disorder?
Is the disorder self-limiting?
What is the incidence, predominant gender, and age of onset?
|
|
Definition
Gillian Barre Syndrome
autoimmune type II hypersensitivity (molecular mimicry)
Self limited-12 weeks.
Occurs mostly in young men, incidence is about 1.3:100,000 |
|
|
Term
| What organism is most blamed for the molecular mimicry seen in Gillian Barre syndrome? |
|
Definition
|
|
Term
a spastic disarthria indicates what type of ALS?
What is the prognosis? |
|
Definition
Indicates a bulbar form of this disease.
Better prognosis. |
|
|
Term
What are the common clinical findings of Gillian Barre syndrome?
What finding is diagnostic? |
|
Definition
Reflexes disappear
Facial muscles affected (facial dysplasia)
Normal muscle bulk, but weak.
autonomic dysfunctions
albuminocytological dissociation- absense of immune cells in CSF, but increased protein levels *This is diagnostic |
|
|
Term
| With neurotoxic marine poisoning, what is blocked? |
|
Definition
| Voltage gated Na+ channels |
|
|
Term
| What is the most common marine poison? |
|
Definition
|
|
Term
What percent of patients with DMD have a frameshift mutation of their dystrophin gene?
What percent have a NEW mutation?
|
|
Definition
|
|
Term
| What is the etiology of Myasthenia gravis? |
|
Definition
| Autoimmune type II disorder against nicotonic ach receptors on the post-synaptic membrane. |
|
|
Term
| What is the most common disorder of the neuromuscular junction? |
|
Definition
|
|
Term
| Removal of what organ can help alleviate Myesthenia gravis? |
|
Definition
|
|
Term
| What are the most affected muscles in Myesthenia gravis? |
|
Definition
Levator palpebrae
Extraocular muscles
Muscles of facial expression
neck muscles
bulbar muscles
proximal limb muscles |
|
|
Term
| What is the most common associated disorder with myesthenia gravis? |
|
Definition
|
|
Term
What is the etiology of Lamber-Eaton Myasthenic Syndrome (LEMS)?
What does this syndrome most commonly occur with?
What age group/background tends to get this disorder? |
|
Definition
autoimmune disease against presynaptic voltage gated Ca++ chanels.
Commonly occurs with a small cell lung cancer.
greater than 40 years old. Smoker. |
|
|
Term
| What are the differences between Lambert-Eaton syndrome and Myasthenia gravis clinically regarding the initial presentation, progression, effect of exercise, commonly associated tumors, deep reflexes, autonomic disturbances, autoantibodiy in serum, and the repetitive nerve stimulation (RNS) test? |
|
Definition
LE: limb muscle weakness, limbs to face, improves weakness, small cell lung carcinoma, absent, present, antibody against calcium chanels, incremental response.
MG: Ocular weakness, craniocaudal, worsens weakness, thymic tumors, intact, absent, AchR antibody, decremental response. |
|
|
Term
| What are the 3 main kinds of botulism and how are they acquired? |
|
Definition
Classic (food borne)-ingest toxin
Infant botulism-ingest spores
Wound botulism-wond with clostridium botulinum or intravenous drug use. |
|
|
Term
| What is the most common clinical presentation of botulinism? |
|
Definition
| Decending limb weakness with autonomic dysfuncction. |
|
|
Term
What is the etiology and clinical presentation of polymyositis?
What is the age of onset and its association with other disorders?
How can it be differentiated from ALS and PND? |
|
Definition
inflammatory disorder.
Characterized by weakness (proximal to distal, with fatigue), normal sensation and normal tendon reflexes.
less than 20 years, associated with other CT disorders.
Elevated creatine kinase (test for elevated inflammation) |
|
|
Term
| Why does chronic alcoholism cause ataxia? |
|
Definition
|
|
Term
| What ethnicity and gender tends to have more agressive MS? |
|
Definition
|
|
Term
What are the 4 types of MS and which is most common? What do the progressions of each type show?
What type does our current drug regimen attempt to fix most? |
|
Definition
| Relapsing-remitting (most common, drug focus), secondary progressive (first relapsing, then constant progression), primary progressive (constantly progressing) and progressive-relapsing (relapsing and progressing evenly). |
|
|
Term
At what MS EDSS score does a patient have that cannot walk 500 meters without sitting?
using a cane?
Walker support? |
|
Definition
|
|
Term
What are the common signs of Group A streptococcus infection?
What does it appear as histologically? |
|
Definition
Painful
No gas
Usually erythema with lymphangitis
Generally well demarcated
toxic
rapid
gram + Cocci in chains |
|
|
Term
What is a very common finding for an S. Aureus infection?
What does it appear like? |
|
Definition
Always seems to produce an abscess.
Appears as small clusters and small chains "grape like" |
|
|
Term
What bacteria causes toxic epidermal necrolysis in children?
what does this look like? |
|
Definition
S. aureus
Looks like child abuse! |
|
|
Term
| What organism causes "hot tob folliculitis"? |
|
Definition
|
|
Term
| What condition predisposes people to necrotizing cellulitis? |
|
Definition
|
|
Term
| What bacteria tends to cause Fournier's Gangrene? |
|
Definition
| Strep or mixed anaerobe infection |
|
|
Term
| What condition can be caused by a perforated bowel during surgery? |
|
Definition
|
|
Term
| What bacteria is a serious threat due to a human bite? |
|
Definition
|
|
Term
A common bacterial infection acquired via a puncture wound through a shoe is:
treat with? |
|
Definition
pseudomonas
cephalosporin |
|
|
Term
Most common vector borne disease |
|
Definition
|
|
Term
What are the 3 stages of lyme's disease?
What treatment is best post infection? |
|
Definition
Stage 1: Erythemia migrans
Stage 2: disseminated infection
Stage 3: persistant infection.
dooxycycline |
|
|
Term
True or false: there is no test to know if someone has been truly cured of lyme's disease. |
|
Definition
|
|
Term
What disease can deer ticks spread besides lymes disease? |
|
Definition
|
|
Term
Which organism discussed in class is NOT treated with doxycyclin? |
|
Definition
|
|
Term
| What type of stroke is most common? |
|
Definition
| Ischemic-specifically a cerebral thrombosis |
|
|
Term
Which areas of the brain are particularly vulnerable to global ischemia?
|
|
Definition
Hippocampus-pyramidal cell layer
Cerebral cortex: purkinje cell layer
cerebellar cortex |
|
|
Term
| What percent of patients with SLE get the characteristic "butterfly" rash? |
|
Definition
|
|
Term
| What is the sex incidence and age incidence of SLE? |
|
Definition
9:1 females to males
Peak age of onset is in the 3rd decade |
|
|
Term
What are the 4 most common (in order of most to least) clinical features of SLE?
What are the 3 most common manifestations? |
|
Definition
Arthritis or arthralgia
Skin involvement
Nephritis
Fever
Fatigue
Fever
Anorexia (weight loss as a result) |
|
|
Term
| What organ has the highest involvement in SLE? |
|
Definition
| Joints (diffuse arthralgia) |
|
|
Term
| What is the order of color change in reactive hyperemia? |
|
Definition
| White, blue and then red (reactive hyperemia) |
|
|
Term
What is a common cardiovascular manifestiation of SLE?
What can be seen in the heart of an SLE patient? |
|
Definition
pericarditis
Leman Sach's lesions |
|
|
Term
| What is a major complication of long term steroid use? |
|
Definition
|
|
Term
True or false: lupus anticoagulants can lead to a hemorragic stroke.
What can these cause? |
|
Definition
False. This is a misnomer. These proteins actually cause coagulation.
Can cause spontaneous abortions
|
|
|
Term
| What is another name for chronic-cutaneous lupus? |
|
Definition
|
|
Term
| Name 6 acquired connective tissue diseases. |
|
Definition
Rheumatoid arthritis
Systemic lupus
scleroderma
polymyositis/dermatomyositis
polyarteritis Nodosa
Sjogren's syndrome |
|
|
Term
| What are the localized forms of scleroderma? |
|
Definition
Morphea (single or multiple plaques)
Linear scleroderma (usually along a dermatome, looks like a burn). |
|
|
Term
| What are the manifestations of eosinophilic fasciitis? |
|
Definition
inflammation and induration of the skin and subQ tissues usually of distal extremities
Raynaud's is absent
peripheral eosinophilia and hyper IgG.
Histologic Dx by deep wedge biopsy of skin; will see inflammation in all layers!
Tends to resolve spontaneously |
|
|
Term
What is the most common internal manifestation of scleroderma?
What might be seen in the lungs?
|
|
Definition
esophageal pathology and wide mouthed diverticulum
May see a low O2 diffusing capacity in the lungs (lots of inflammation). |
|
|
Term
| Describe the clinical course of diffuse systemic sclerosis |
|
Definition
Increased skin and increased risk of new internal organ involvement early in diffuse SS.
Slowly improving skin change is typical.
In later disease new visceral involvement is reduced, but still may occur. |
|
|
Term
| Describe the clinical course of limited scleroderma |
|
Definition
Insidious progression of skin involvement
Visceral involvement delayed for many years. |
|
|
Term
what age group is at highest risk for dermatomyositis?
females or males?
What genes are associated? |
|
Definition
4th to 5th decade
F:M=2:1
HLA-BR3 and BRW-52 |
|
|
Term
| What are the individual criteria for polymyositis and dermatomyositis and how do you distinguish one from the other? |
|
Definition
nIndividual Criteria
1.1. Muscle biopsy evidence of myositis
2.2. increase in serum skeletal muscle enzymes
3.3. Characteristic EMG pattern
4.4. Symmetric proximal muscle weakness
5.5.Typical rash of dermatomyositis
nDiagnostic Criteria
nPolymyositis
Definite:all of 1-4
Probable:any 3 of 1-4
Possible:any 2 of 1-4
nDermatomyositis
Definite:5 plus any 3 of 1-4
Probable:5 plus any 2 of 1-4
Possible:5 plus any 1 of 1-4
|
|
|
Term
| What tends to be the lethal complications of dermatomyositis and polymyositis? |
|
Definition
| Pulmonary, cardiac or systemic complications |
|
|
Term
What is the pathopneumonic test for Sjrogen's syndrome?
What antibodies are present in this syndrome?
What are the systemic symptoms of this syndrome? |
|
Definition
Schirmer's filter paper test; less than 5ml of tears in 5 mins.
Lip biopsy is the "gold standard"
ANA and anti-SS-A/SS-B
skin vasculitis, fatigue and cognitive loss. |
|
|
Term
What spinal nerves go to each of these nerves, and what muscles does each innervate?
Genitofemoral nerve
Lateral femoral cutaneous
Obturator nerve
Femoral nerve
superior gluteal nerve |
|
Definition
Genitofemoral nerve-L1, L2 supplies the cremaster in males
Lateral femoral cutaneous nerve-L2, L3 cutaneous innervation only.
Obturator nerve (L2-L4) Obturator exernus, adductors.
Femoral nerve (L2-L4) iliopsoas, pectineus, sartorius, quadriceps femoris
superior gluteal nerve (L4, L5, S1) |
|
|
Term
| How would a person with a lesion of the superior gluteal nerve walk? Describe why they would walk this way. |
|
Definition
| Trendelianberg gait-ipsilateral gluteus medius is out, thus during contralateral swing phase the ipsilateral side cannot contract to provide clearance of the contralateral foot. Therefore, the patient must lean to the ipsilateral side so that the leverage from his/her trunk can get the contralateral leg to swing forward. Looks lop-sided. |
|
|
Term
| IS a hemorragic or ischemic stroke more accutely damaging (shows more stroke signs acutely)? |
|
Definition
| Hemorragic; takes up more space. |
|
|
Term
| What form of communication is MOST possible with aphasia? |
|
Definition
| Music, can usually sing along to a familiar song. |
|
|
Term
| A recent stroke patient should be on what kind of diet? |
|
Definition
| Need a pureed diet. dysphagia is common. |
|
|
Term
| What is a long-term stroke prevention method for patients with atrial fibrillation? |
|
Definition
| long-term anticoagulant therapy. |
|
|
Term
| What is common just after a stroke occurs? |
|
Definition
Increased blood pressure (decreased perfusion)
Increased blood glucose
contralateral lower facial droop. |
|
|
Term
| What is the lowest % level of protein and the lowest number of kcals of fat that a human can theoretically have before they starve? |
|
Definition
35% of total fed body protein
20,000-25,000kcal or about 2.2Kg of fat. |
|
|
Term
| How many grams of glucose does the brain use a day? |
|
Definition
|
|
Term
| Which fuel is unusable by muscle? |
|
Definition
| None, all macronutrients are usable by muscle in some way shape or form. |
|
|
Term
| What component of the TCA cycle must be periodically replaced by metabolizing glucose, even in a severely starved state? |
|
Definition
|
|
Term
| When does ketone usage really start to kick in and play an energy role? |
|
Definition
| 2-4 days of starvation (intermediate fast) |
|
|
Term
| What is the minimum intake of a macronutrient that can be used to ward off starvation? |
|
Definition
|
|
Term
| What energy sources does muscle use when exercising based on the time period of the strenuous exercise? |
|
Definition
seconds=creatinine phosphate
minutes=glycogen to glucose to lactic acid
minutes to hours=glucose to CO2
Many minutes to hours=Fatty acids to CO2 |
|
|
Term
| Why might carb loading be a bad idea for a wrestler? |
|
Definition
| Lots of water weight, may miss weight class |
|
|
Term
| What does an athlete aim to do just before the start of an event regarding his or her insulin and blood glucose levels? |
|
Definition
| Want to keep insulin low, but blood glucose moderate to high if possible. |
|
|
Term
| What is the golden standard in assessing the physical function of a patient with RA? |
|
Definition
| Health Assessment Questionnare. |
|
|
Term
| True or false: In an RA patient, if IL-1 is blocked this will inhibit TNF and IL-6 as well. |
|
Definition
|
|
Term
How do DMARDS function in treating RA?
Does this help everyone? |
|
Definition
They are antibodies that act against cytokines such as TNF or IL-1.
No, although a DMARD may be great against TNF and work well in a pt. that has RA principally driven by overproduction of TNF, it will have no effect on another patient's RA if it is driven more by IL-6. No way to tell which is which before treatment currently. |
|
|
Term
| What is the most specific test for Rheumatoid arthritis? |
|
Definition
| CCP antibody is much more specific than Rh factor (96% specific, 78% sensitive) |
|
|
Term
| When does RA typically manifest itself? When is its peak? |
|
Definition
| usually starts at around age 20-40, peak is age 50-60 |
|
|
Term
| Where DOESNT rheumatoid arthritis typically affect? |
|
Definition
| The lower spine (lumbar region) |
|
|
Term
What would be a necessary condition to check with RA affecting the atlantoaxial joint?
When might an x-ray be indicated on such a patient?
How does RA predispose a person to this condition? |
|
Definition
Check for c1-c2 subluxation
before surgery
Pannus formation at the synovial joint between C1 and the transverse ligament, causing distruction of the transverse ligament, dens or both. |
|
|
Term
What manifestation in the lungs can one see with spondolytis?
What about in the lower spinal chord?
What is an important factor in keeping ankalosing spondolytis patients healthy? |
|
Definition
Upper lobe fibrosis
Cauda equina syndrome.
Need to keep them active |
|
|
Term
| What drugs should be avoided in anokalizing spondolytis? |
|
Definition
Radiotherapy
Corticosteroids
Gold & Antimalarials
Narcotics, analgesics and muscle relaxants |
|
|
Term
| What MHC-II protein makes AS not only more likely, but more severe in a patient? |
|
Definition
|
|
Term
| What is the primary function of HLA antigens? |
|
Definition
| HLA antigens help in presentation mainly to CD8 lymphocytes |
|
|
Term
| What are the risk factors for hyperuricemia? |
|
Definition
| diuretics, hypertensive patients, obesity and post-menopausal women. |
|
|
Term
| True or false: an increasing tider of B-27 antigen indicates increasing severity of AS. |
|
Definition
| False. If you have it you have it. |
|
|
Term
| with a positive B27, what is one disorder which can cause spondolysis? |
|
Definition
|
|
Term
| What is the composition of crystals in gout, psuedogout and milwaukee shoulder? |
|
Definition
urate crystals
Calcium phosphate crystals
hydroxyapetite crystals |
|
|
Term
| What is the most common type of fracture caused by osteoporosis? |
|
Definition
|
|
Term
| What are the normal, low bone mass, osteoporosis and severe osteoporosis scores of the BMDT scoring classification? |
|
Definition
Normal=-1
Low bone=-1 to -2.5
Osteoporosis=-2.5 or less
Severe=-2.5 or less with fragility fractures |
|
|
Term
What are the effects of SERMs in osteoporosis treatment?
What doesn't it help? |
|
Definition
Act like estrogen in some places, not in others
decrease bone turnover
increase bone mineral density
decrease risk of vertebral fractures
Doesn't help prevent hip or other non-vertebral fractures |
|
|
Term
| What is the most common pharmacological agent for treating osteoporosis? |
|
Definition
|
|
Term
| Describe the PRICES approach to basic injury rehab. |
|
Definition
Protection
Rest
Ice
Compression
Elevation
Support |
|
|
Term
Name the common sports injuries in these areas:
Foot
Ankle
Knee
Hip
Hand
Wrist
Elbow
Shoulder |
|
Definition
Foot-Plantar fasciitis
Ankle-Acute ankle sprain
Knee-Acute knee sprain and patellofemorla pain syndrome
Hip-Trochenteric bursitis
Hand-Maletfinger, triggerfinger
Wrist-DeQuervain's tendinitis
Elbow-epicondylitis
Shoulder-rotator cuff injury, impingement syndrome, biceps tendinitis |
|
|
Term
What is important to rule out with an x-ray in young patients with plantar fasciitis?
What about a bone scan in a patient with very persistent pain? |
|
Definition
Sever's disease (calcaneal apophysitis)
Check for a stress fracture |
|
|
Term
| What is a good, non-drug way of treating plantar fasciatis? |
|
Definition
|
|
Term
When should an X-ray be taken for an acute ankle sprain in adults?
What about kids? |
|
Definition
Patient is older than 50
Patient is unable to bear weight on foot for 4 steps
Bone tenderness at the posterior edge of the distal 6cm of either the tibia or fibula, or tenderness at the navicular or base of the 5th metatarsal.
in children, grade I sprains may need an xray to rule out epiphyseal injury |
|
|
Term
| When should an x-ray of the knee be taken in an acute knee sprain? |
|
Definition
Ottawa knee rules
Pt is older than 55 years
Tenderness at head of fibula
isolated patellar tenderness
inability to flex 90 degrees
inability to transfer weight for 4 steps. |
|
|
Term
| Which syndrome accounts for up to 50 of all of the overuse syndromes of the knee? |
|
Definition
| Patellofemoral pain syndrome |
|
|
Term
Describe two point gait
Three point gait
Four point gait |
|
Definition
One crutch and opposite LE move together, followed by opposite crutch and LE.
Both crutches and involved LE advance together, then the uninvolved LE is advanced forward.
One crutch is advanced and put on the floor, followed by the opposite LE. The remaining crutch is then advanced before the second LE is moved forward. (maximum stability) |
|
|
Term
| When assending the stairs or decending the stairs with an assistive device, which foot goes forward in each scenario? |
|
Definition
Ascent-uninvolved always goes first followed by crutches.
Decent-Crutches and the involved LE go first.
"Up with the good, down with the bad" |
|
|
Term
| Which artery, if disrupted, can cause avascular necrosis of the head of the femur? |
|
Definition
| The femoral circumflex artery |
|
|
Term
| Where are extracapsular fractures of the hip located? |
|
Definition
| At the intertrochanteric area |
|
|
Term
| What is the strongest area of the hip region? |
|
Definition
| The sacroiliac complex; the interosseous SI ligaments act as suspension bars. |
|
|
Term
| Why might binding the hips in a hemorragic pelvic injury be good? |
|
Definition
| Reduce bleeding by up to 25%. Huge decrease in mortality. |
|
|
Term
| If looking at an anterioposterior X ray image of the inominate region and the lesser trochanter of the femur is seen, what does this indicate? |
|
Definition
| Lower extremity external rotation. |
|
|
Term
| At what age is the femoral head soley supplied by 1 source? |
|
Definition
|
|
Term
| True or false: Mortality generally stays the same with a hip fracture even if 48 hours pass without treatment. |
|
Definition
| False. Treat ASAP to lower mortality. |
|
|
Term
| How is a knee dislocation different from a patella dislocation? |
|
Definition
Knee=high energy dislocation with lots of soft tissue disruption.
Patellar dislocation is much less severe. |
|
|
Term
| What is one of the most common orthopedic fractures? |
|
Definition
|
|
Term
| Which has a higher level of risk regarding osteonecrosis, an ankle fracture, or a talus fracture? |
|
Definition
|
|
Term
| Why are Jone's fractures problematic? |
|
Definition
| They are in a watershed area |
|
|
Term
| In an open fracture, what is the first step in treating the patient? |
|
Definition
| Deliver lots of antibiotics. |
|
|
Term
| what serves as a "check-reign" for the dens of the axis? |
|
Definition
The transverse ligament of the atlas.
|
|
|
Term
| What factors indicate an unstable fracture of the cervical spine? |
|
Definition
Canal compromise
posterior ligament disruption |
|
|
