FSBPT – Neuro: Questions With Expert-Approved
Solutions
Epidural hematoma Right Ans - b/w skull and dura
PET Right Ans - positron emission tomorgraphy- uses radioisotopes
injected/inhaled and measure with gamma ray detector system. Good for
cerebral blood flow and brain metabolism
EEG Right Ans - electroencephalography- brain e- activity (ex: seizures)
Can help localize intracranial lesions b/c of dec activity there
Evoked potentials/responses Right Ans - sensory stim (visual, aud, SS)
used to evoke responses (visual, aud, somatosens)
echoencephalogram (US Doppler techniques) Right Ans - reflected
ultrasonic waves are recorded for analyzing flow, plaques and
tumors/hematomas Similar to an echocardiogram where they use US sound
waves to take dimensions of the heart
lumbar puncture Right Ans - inserting a spinal needle below L1/2 to: w/
draw CSF (contains pro, glucose, Ig, cells), ICP analysis, injecting contrast
medium, treating cancer/meningitis. Complications: severe HA (laying down
makes it better), infectional, hematoma, herniation of the uncas (through
foramen magnum?)
normal CSF Right Ans - clear and colorless.
vol 50-100mL in child, 100-150 in adult.
Pressure is 10-100 mm H2O in kids, 100-200 adults.
Proteins 15-50mg/dL in adults, up to 100 in kids
pathologic CSF Right Ans - changes in color, RBC, elevated WBCs, high
proteins
insertional activity (EMG) Right Ans - increased burst of AP with insertion
of needle in denervated mms
,denervated mms (LMN injury) EMG characteristics Right Ans - incr
insertional activity, dec MU potentials, large MUs
fibrillations vs. fasciculations Right Ans - spontaneous invol contractions of
individual mm fibers (seen in complete denervation) vs. most of the mm fibers
(visible to the naked eye) (seen in incomplete denervation)
decreased conduction velocities are seen in __ __ __ (diseases) Right Ans -
CMT, GBS, CIDP (chronic inflamm demyel polyneurop).
All demyelinating neuropathies
Also seen in focal peripheral n compression (ie disc)
meningitis Right Ans - from flu, pneumonia, e coli if bacteria, or from a
virus. Tx: antiB, positioning, PROM, fluid/elect balance
encephalitis Right Ans - severe brain inflammation
etiology- arboviruses or influeza, sinusitis, otitis, prion-caused (ex: mad cow
disease)
brain abcess Right Ans - signs: CN 2/6 deficits, HA, fever
can be an extension of an infection (meningitis, post-TBI)
AIDS Right Ans - ADC- AIDS dementia complex
Motor deficits- ataxic, weak, tremor, loss fine coord
Periph neuropathy
thrombus vs. embolism Right Ans - stationary vs. traveling
CVA risk factors Right Ans - atherosclerosis, HTN, cardiac disease,
DM/metabolic syndrome, TIAs
how long it takes for irreversible brain dmg Right Ans - 4-6 min
ACA (ant cerebral a syndrome) Right Ans - Supplies ant 2/3 of medial
cerebral cortex
UE is more spared (b/c UE is located more laterally in the motor homunculus)
Contralat hemiplegia and sensory loss. HHemianopsia.
Possible apraxia
,Lesions proximal to the anterior communicating produce min deficits d/t
collateral circulation
MCA syndrome Right Ans - Supplies lateral cerebral cortex, BG, internal
capsule.
UE more effected
Contralat hemiplegia and sensory loss. HHemianopsia (these are the same as
ACA)
*this is the most common one, and so most peoples legs are spared, but the
arm is non-functional
VB artery Right Ans - Arises from the subclavian artery.
vertebral portion supply medulla and cerebellum
basilar a supplies pons and terminates as the PCA
VB Artery Syndrome Right Ans - A broad term including Medial and Lateral
(wallenberg's) syndrome, Basilar a syndrome, medial inf pontine syndrome
and PCA syndrome.
Basilar artery syndrome Right Ans - BS S+S (HR, RR changes etc) and PCA
S+S (b/c basilar a terminates as the PCA)
OR locked in syndrome which occurs when lesion is at the level of the pons
So bad b/c there is no collateral circulation
locked-in syndrome Right Ans - quadriplegic, lower bulbar paralysis (CN 5-
12), can blink
Midbrain Syndrome Right Ans - Multiple syndromes encompassed
Ex: Weber's -Contralat hemiplegia, ipsilateral CN 3 dysfunction
Medial Inferior Pontine Syndrome vs. Lateral Right Ans - Medial occludes
paramedian branch of basilar a vs. the AICA in Lateral (which lies more
posterior/inf, so affects lower CNs).
The pons houses CN nuclei for vision and hearing
Both: ipsilaterally: ataxic, nystagmus, cant gaze to side of lesion
Medial: ipsilat diplopia (CN 2, 3, 4, 6), contralat hemiparesis (weakness) and
sensation loss (b/c DC/medial lemniscus and CS tracts lay medially in the
pons)
, Lateral: ispilat vertigo, face paralysis, deaf/tinitis, contralat P+T loss (b/c
ST/anterolat system is lateral in the pons) - affects CN 7 + 8
Hemiparesis vs. hemiplegia Right Ans - hemiparesis is weakness of one
side of the body
hemiplegia is total paralysis on one side
Medullary Syndrome (Medial vs. Lateral) Right Ans - Medial Medullary
Syndrome - ipsilat paralysis of 1/2 tongue, contralat hemiplegia and impaired
sensation (last 2 are the same as medial inf pontine syndrome)
Lateral Medullary Syndrome - Wallenburg's - contralat loss of P+T (same
lateral inf pontine syndrome), ispilat cerebellar symptoms, loss of P+T to just
face, sensory loss
PCA syndrome Right Ans - supply midbrain, temporal lobe, diencephalon,
posterior 1/3 of cortex (occipital lobe)
Contralat sensory loss, invol mvmts, transient hemiparesis, homonymous
hemianopsia (makes sense b/c post brain does sensory, anterior does motor)
6 Stages of Recovery s/p CVA (similar to Chedoke McMaster) Right Ans - 1.
flaccid
2. emerging spasticity/hyperreflexic/synergies
3. vol mvmt possible in strong synergies
4. can isolate some joint movements, decline in spasticity
5. increasing voluntary control of movements, lacking coordination still
6. control and coordination near normal
dominant vs. non-dominant hemispheres Right Ans - L- usually dominant
side, Brocas, if damaged examine for expressive aphasia
R- usually non-dom, Wernikes, if damaged examine for perceptual
defeicits/fluent aphasia/conductive apahsia
left hemisphere lesion behavior (R hemi) Right Ans - slow, cautious,
hesitant, insecure
give frequent feedback, dont underestimate ability to learn
ex: Debbie- had L injury b/c dmg to Broca's area. Very slow and cautious and
insecure.
Solutions
Epidural hematoma Right Ans - b/w skull and dura
PET Right Ans - positron emission tomorgraphy- uses radioisotopes
injected/inhaled and measure with gamma ray detector system. Good for
cerebral blood flow and brain metabolism
EEG Right Ans - electroencephalography- brain e- activity (ex: seizures)
Can help localize intracranial lesions b/c of dec activity there
Evoked potentials/responses Right Ans - sensory stim (visual, aud, SS)
used to evoke responses (visual, aud, somatosens)
echoencephalogram (US Doppler techniques) Right Ans - reflected
ultrasonic waves are recorded for analyzing flow, plaques and
tumors/hematomas Similar to an echocardiogram where they use US sound
waves to take dimensions of the heart
lumbar puncture Right Ans - inserting a spinal needle below L1/2 to: w/
draw CSF (contains pro, glucose, Ig, cells), ICP analysis, injecting contrast
medium, treating cancer/meningitis. Complications: severe HA (laying down
makes it better), infectional, hematoma, herniation of the uncas (through
foramen magnum?)
normal CSF Right Ans - clear and colorless.
vol 50-100mL in child, 100-150 in adult.
Pressure is 10-100 mm H2O in kids, 100-200 adults.
Proteins 15-50mg/dL in adults, up to 100 in kids
pathologic CSF Right Ans - changes in color, RBC, elevated WBCs, high
proteins
insertional activity (EMG) Right Ans - increased burst of AP with insertion
of needle in denervated mms
,denervated mms (LMN injury) EMG characteristics Right Ans - incr
insertional activity, dec MU potentials, large MUs
fibrillations vs. fasciculations Right Ans - spontaneous invol contractions of
individual mm fibers (seen in complete denervation) vs. most of the mm fibers
(visible to the naked eye) (seen in incomplete denervation)
decreased conduction velocities are seen in __ __ __ (diseases) Right Ans -
CMT, GBS, CIDP (chronic inflamm demyel polyneurop).
All demyelinating neuropathies
Also seen in focal peripheral n compression (ie disc)
meningitis Right Ans - from flu, pneumonia, e coli if bacteria, or from a
virus. Tx: antiB, positioning, PROM, fluid/elect balance
encephalitis Right Ans - severe brain inflammation
etiology- arboviruses or influeza, sinusitis, otitis, prion-caused (ex: mad cow
disease)
brain abcess Right Ans - signs: CN 2/6 deficits, HA, fever
can be an extension of an infection (meningitis, post-TBI)
AIDS Right Ans - ADC- AIDS dementia complex
Motor deficits- ataxic, weak, tremor, loss fine coord
Periph neuropathy
thrombus vs. embolism Right Ans - stationary vs. traveling
CVA risk factors Right Ans - atherosclerosis, HTN, cardiac disease,
DM/metabolic syndrome, TIAs
how long it takes for irreversible brain dmg Right Ans - 4-6 min
ACA (ant cerebral a syndrome) Right Ans - Supplies ant 2/3 of medial
cerebral cortex
UE is more spared (b/c UE is located more laterally in the motor homunculus)
Contralat hemiplegia and sensory loss. HHemianopsia.
Possible apraxia
,Lesions proximal to the anterior communicating produce min deficits d/t
collateral circulation
MCA syndrome Right Ans - Supplies lateral cerebral cortex, BG, internal
capsule.
UE more effected
Contralat hemiplegia and sensory loss. HHemianopsia (these are the same as
ACA)
*this is the most common one, and so most peoples legs are spared, but the
arm is non-functional
VB artery Right Ans - Arises from the subclavian artery.
vertebral portion supply medulla and cerebellum
basilar a supplies pons and terminates as the PCA
VB Artery Syndrome Right Ans - A broad term including Medial and Lateral
(wallenberg's) syndrome, Basilar a syndrome, medial inf pontine syndrome
and PCA syndrome.
Basilar artery syndrome Right Ans - BS S+S (HR, RR changes etc) and PCA
S+S (b/c basilar a terminates as the PCA)
OR locked in syndrome which occurs when lesion is at the level of the pons
So bad b/c there is no collateral circulation
locked-in syndrome Right Ans - quadriplegic, lower bulbar paralysis (CN 5-
12), can blink
Midbrain Syndrome Right Ans - Multiple syndromes encompassed
Ex: Weber's -Contralat hemiplegia, ipsilateral CN 3 dysfunction
Medial Inferior Pontine Syndrome vs. Lateral Right Ans - Medial occludes
paramedian branch of basilar a vs. the AICA in Lateral (which lies more
posterior/inf, so affects lower CNs).
The pons houses CN nuclei for vision and hearing
Both: ipsilaterally: ataxic, nystagmus, cant gaze to side of lesion
Medial: ipsilat diplopia (CN 2, 3, 4, 6), contralat hemiparesis (weakness) and
sensation loss (b/c DC/medial lemniscus and CS tracts lay medially in the
pons)
, Lateral: ispilat vertigo, face paralysis, deaf/tinitis, contralat P+T loss (b/c
ST/anterolat system is lateral in the pons) - affects CN 7 + 8
Hemiparesis vs. hemiplegia Right Ans - hemiparesis is weakness of one
side of the body
hemiplegia is total paralysis on one side
Medullary Syndrome (Medial vs. Lateral) Right Ans - Medial Medullary
Syndrome - ipsilat paralysis of 1/2 tongue, contralat hemiplegia and impaired
sensation (last 2 are the same as medial inf pontine syndrome)
Lateral Medullary Syndrome - Wallenburg's - contralat loss of P+T (same
lateral inf pontine syndrome), ispilat cerebellar symptoms, loss of P+T to just
face, sensory loss
PCA syndrome Right Ans - supply midbrain, temporal lobe, diencephalon,
posterior 1/3 of cortex (occipital lobe)
Contralat sensory loss, invol mvmts, transient hemiparesis, homonymous
hemianopsia (makes sense b/c post brain does sensory, anterior does motor)
6 Stages of Recovery s/p CVA (similar to Chedoke McMaster) Right Ans - 1.
flaccid
2. emerging spasticity/hyperreflexic/synergies
3. vol mvmt possible in strong synergies
4. can isolate some joint movements, decline in spasticity
5. increasing voluntary control of movements, lacking coordination still
6. control and coordination near normal
dominant vs. non-dominant hemispheres Right Ans - L- usually dominant
side, Brocas, if damaged examine for expressive aphasia
R- usually non-dom, Wernikes, if damaged examine for perceptual
defeicits/fluent aphasia/conductive apahsia
left hemisphere lesion behavior (R hemi) Right Ans - slow, cautious,
hesitant, insecure
give frequent feedback, dont underestimate ability to learn
ex: Debbie- had L injury b/c dmg to Broca's area. Very slow and cautious and
insecure.
