Summative CMS 2 review

excitatory neurotransmitter

glutamate

inhibitory neurotransmitter

GABA

decorticate

flexed arms → better prognosis

hands to your CORE

decerebrate

extension and pronation→ bad prognosis

which lobe: emotions and motor

frontal

which lobe: language, hearing, smell, short term memory

temporal

which lobe: astereognosis, hemispatial + sensory

parietal

which lobe: visual

occipital

which aphasia: talks nonsense, pt unaware

wenicke's → Nickie's nonsense

which aphasia: broken speech, aware

broca's → Bro Can't talk

order of consciousness

alert → lethargic→ obtundation→ stupor→ coma

weakness, easy fatiguability, normal sensation, tongue fasciculation

ALS → need muscle biopsy

NO sensory loss

motor UMN and LMN destruction

ALS

pain/paresthesia in 1st 3 digits and radial 1/2 of 4th, worse at night

carpal tunnel syndrome → phalen and tinel

median nerve

multifocal asymmetric demyelination of white matter in CNS

MS

dawson's fingers on MRI

MS

Oligoclonal bands in CSF

MS

viral infection causing destruction of anterior horn cells

polio

ascending paralysis

GBS

unchecked excitatory impulses

tetanus → tetanus IG

symmetric descending paralysis

botulism

blockage of neuromuscular transmission at the ach post-synaptic receptors

myasthenia gravis → MC in young females

muscular weakness worse in evening, extraocular symptoms like ptosis and diplopia

MG → tensilon test (improved grip within 30 secs)

gait ataxia, ophthalmoplegia, confusion

wenicke's encephalopathy → givre thiamine

pt doesn't allow knee extension when hip is flexed

kernig's

pt resists passive flexing of chin to chest

brudzinski

MCC encephalitis in US

HSV/VZV → acyclovir

b-amyloid plaques, neurofibrillary tangles, cortical atrophy

alzheimer's

dementia with parkinsonian features, hallucinations, delusions

lewy body dementia

stepwise progression of deficits

vascular dementia → lacunar infarcts

seizure without LOC

simple partial

seizure with mild LOC and an aura

complex partial

seizure appearing as daydreaming in childhood

absence → ethosuximide

seizure >5 mins

status epilepticus → give benzos

sudden LOC, rigid and fall to ground, jerking, tongue biting, incontinence, post ictal confusion

tonic clonic seizure

tumor causing bitemporal hemianopsia

prolactinoma → bromocriptine

worst HA of my life

SA → head CT w/o contrast

POUND mnemonic for migraines

Pulsatile (throbbing)

Onset/duration (4-72 hours)

Unilateral in location

Nausea and vomiting

Disabling in intensity

migraine with aura

classic migraine

migraine without aura

common

migraine prophylaxis

Propranolol, topiramate, amitriptyline

unilateral HA with tearing

cluster → give 100% O2

prophylaxis for cluster HA

verapamil

bilateral bandlike HA

tension

saddle anesthesia, bladder/bowel dysfunction, gait disturbance

cauda equina→ stat MRI and neuro consult

discriminative touch, vibration, proprioception

posterior white column (Gracilis and cuneatus)→ crosses over at medulla so ipsilateral defects

light touch and pressure

anterior white column → crosses at spine so contralateral defects

pain and temperature

lateral spinothalamic tract → crosses at the spinal cord so contralateral defects

positive kernigs and nuchal rigidity, headache

SAH

tremor at rest, rigidity, akinesia, postural instability

parkinson's

onion peel on xray

Ewing's sarcoma

pain out of proportion s/p surgery/injury

CRPS

conjunctivitis, urethritis, oligoarticular arthritis

reactive arthritis → can't see, can't pee, can't climb a tree

chondrocalcinosis

pseudogout (CPPD) → weakly positive, birefringent rhomboid crystals

-1 to -2.5 T score

osteopenia

-2.5 T score

osteoporosis

spinal tuberculosis

Pott's disease

gold standard to acute osteomyelitis dx

open biopsy and bone aspiration

erythema migrans (bullseye), fever, fatigue, recently camped

lyme dz → doxy

amox for kids

XR: lost joint space, sclerosis, subchondral cysts, osteophytes

osteoarthritis → deformity in weight bearing joints

lower back pain worse in AM, uveitis, bamboo spine, +HLA-B27

ankylosing spondylitis → sacroilitis is hallmark

young woman, generalized pain in multiple trigger points, spared joints, anxiety/depression, memory problems

fibromyalgia → sx >3 months in 4 quadrants

salter harris..........................

....................

schmorl's nodes, poor posture, tight hamstrings, M>F

scheuermann's kyphosis

scoliosis treatment

10-25 degrees = PT and monitor

25-45 degrees = brace/PT

>45 degrees = surgery and PT

dissolution or loosening of pars interarticularis

spondylolysis

bilateral = spondylolisthesis

slipped disc

Spondylolisthesis

partial spinal cord transection

Brown-Sequard syndrome → early high dose methylpredniosolone

UMN or LMN: flaccid paralysis, weakness, decreased tone

LMN

UMN or LMN: spastic paralysis, hyperreflexia, +babinski

UMN

which hip dislocation: flexion, IR, ADDuction

posterior → fem head appears smaller on XR

which hip dislocation: mild flexion, ER, ABduction

anterior→ fem head appears larger on XR

causes of avascular necrosis

- fall/trauma

- alcoholism

- long term steroid use

MC fracture of child abuse

long bone shaft

spiral fracture is common

hair on end appearance, sunray burst apperance

osteosarcoma → mc primary bone tumor common in teens

which test: radiating pain indicates nerve root compression

spurling → axial load

head tilted toward affected side, rotated towards unaffected side, SCM lump, cranial/facial asymmetry

torticollis

what XR is used for cervical trauma pts

cross table lateral xray

young boy, limp/trendelenburg gait, mild pain, atrophy of thigh/calf/butt, leg length inequality

legg-calve Perthes disease → avasc necrosis of femoral head

activity restriction, long leg bracing, surgery

groin pain, decreased internal rotation, trendelenburg gait, kline's lines, ice cream falling off cone, pistol grip deformtiy

SCFE → progressive displacement of upper portion of femur

male adolescents!

MCC compartment syndrome

tibia fracture → fasciotomy is the tx

gradual onset pain in anteromedial aspect of distal 1/3 leg, pain with plantar flexion/inversion, pain with heel walking

shin splints → develops from exercise

unhappy triad

ACL

MCL

Meniscus

meniscal tear MOI

Knee flexion with rotational stress while weight bearing.

Most sensitive test for ACL tear

Lachman's test

PCL injury MOI

knee forced posteriorly → MVA, blow to the knee

+ valgus stress test

MCL injury

+ varus stress test

LCL injury

MC patellar dislocation

lateral

RF = excessive Q angle

why do you need to check pulses in tibiofemoral dislocations?

bc complication is popliteal artery injury → stat vascular consult

teen boy/young man athlete, pain and swelling in anterior knee

osgood schlatter

pain behind knee

patellofemoral syndrome → dull aching pain, +apprehensive and ober test

pain in the AM with 1st step

plantar fascitis

pain and tenderness over base of 5th metatarsal d/t inversion injury

jones fracture

playing sports, felt a pop, can't stand on tiptoes on affected side. positive thompson's test

achilles rupture → plantar flexion is absent→ surgical repair

aching, burning pain in lateral elbow from repeated extension, decreased pain at rest.

lateral epicondylitis → tennis elbow

aching, burning pain in medial elbow from repeated flexion

medial epicondylitis → golfer's elbow

annular ligament entrapment and radial head subluxation

nursemaid's elbow → from pulling/swinging child's arm

dislocation of radial head and fx of proximal 1/3 ulna

monteggia fracture

radial shaft fracture and dislocation of distal radioulnar joint

galeazzi fracture→ requires surgery