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aan Flashcards

1
Q

Cardinal Signs of Parkinson’s

A

Postural instability
Resting Tremor
Cogwheel rigidity
Bradykinesia

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2
Q

CSF findings in MS

A

Mild Pleocytosis w/ low PMN’s
NL glucose
NL to mildly elevated proteins
ie WBC 20, PMN 5%, Glucose 75, Protein 80
ie CSF study mostly normal, look for IgG oligoclonal bands

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3
Q

What is the recommendation for a person that encounters a concussion through a contact sport?

A

D/c play for today, evaluate prior to the next game

Must be asymptomatic at rest w/o medication

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4
Q

Pt is able to draw geometric shapes, but cannot draw specific animals and all attempts at drawing an animal look the same

A

Semantic Problem - lost the sense of what makes animals unique. Defect in dominant lateral temporal lobe. Associate with Alzheimer’s
Being able to draw shapes suggest corticospatial is intact (non dominant parietal lobe)

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5
Q

What is a good medication for a female of child bearing age with a generalized seizure disorder

A

Lamotrigine - just titrate up slowly to avoid Stevens Johnson
Avoid valproic acid and phenytoin - birth defects
Topiramate is a good choice but may have cognitive side effects

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6
Q

Pt has syx similar to migraine, but is not responsive during episodes and is fatigued after. She has no memory of the event

A

Give lamotrigine - effective in simple and complex seizures

These AOC are suggestive of temporal lobe epilepsy

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7
Q

Syx of ICA dissection

A 
Horner syndrome (ipsi ptosis, anoscoria) +
Contra hemiparesis (varying levels)
Stroke like syx in a younger pt following a trauma, or can be seen in elderly
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8
Q

Pt has loss of L superior corner of visual field in both eyes. Where is the lesion?

A

R temporal

“pie in the sky” visual loss indicated lesion w/in the Meyer loop of the temporal lobe

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9
Q

DM pt with neuropathy is highly suggestive of also having?

A

nephropathy OR retinopathy - if they have neither the cause may not be related to their DM
Symmetric sensory neuropathy

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10
Q

3 cardinal findings in brain death

A
  1. Unresponsiveness
  2. Absence of Brainstem reflexes
  3. Apnea
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11
Q

Glove and stocking parathesia + Proximal and distal muscle weakness x nmonths
+ slowed nerve conduction velocity + elevated protein in CSF

A

Chronic inflammatory Demyelinating polyneuropathy (CIDP)

Chronic form of Guillain-Barre. Can look similar but months vs weeks

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12
Q

Compare Becker and Duchenne muscular dystrophy

A

Both are X-linked

BMD progresses at a much slower late, so suspect DMD in a young pt

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13
Q

What syx is expected in a small fiber peripheral neuropathy?

A

Loss of temperature sensation

Pain and temperature are perceived through the small fibers (hence burning pain and parathesia)

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14
Q

Debilitating HA triggered by weather changes

A

Migraine w/o aura

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15
Q

Pt has defect in facial recognition. Where is the lesion?

A

Prosopagnosia

b/l inferior occipitotemporal cortex (fulsiform gyrus

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16
Q

Conductive aphasia + R homonymous hemianopsia + vomitting

A

Intracerebral hemorrhage of the L temporal and parietal lobe

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17
Q

Middle aged man has night terros and vivid dreams

A

REM sleep behavior disorder (RBD)
Associated with onset of neurodegenerative disorders (approx 10 years later); Parkinson’s, Lewy Body
Loss of motor atonia during sleep causing pts to act out their dreams

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18
Q

Expressive aphasia (lack of fluency, intact comprehension, intact awareness)

A

Dominant frontal cortex

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19
Q

Dementia pt has bradycardia, be suspicious for which med?

A

Donepezil

cholinesterase inhibitor

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20
Q

IDD w/ long narrow face, prominent ears, large body habitus, low muscle tone, macroorchidism

A

Fragile X syndrome

mutation in FMR1

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21
Q

Medical management of ischemic stroke

A

tPA w/in 4 hours of syx onset (if BP <185/110)
ASA 24 hours later
Heparin for long term

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22
Q

Pt has neck pain and Horner syndrome after a chiropracter appointment. What study does she need?

A

MRA

Look for Carotid or vetebral dissection

23
Q

Which MS treatment is associated with increased risk of depression

A

IF Beta

24
Q

Pt has general weakness the morning after working out and a large dinner

A

Check Sr K+
Hyper or Hypokalemic periodic paralysis
AD, K+ can be normal between attacks

25
Q

Most common cause of sporadic encephalitis in the US

A

HSV 1
MRI reveals lesion in frontal and temporal
CSF PCR is highly sensitive

26
Q

Postural tremor

A

Essential tremor

AD

27
Q

Tx for Wilson’s dz

A

Penicillamine

28
Q

Pt has numbness stiffness, unsteady gait, stocking decrease in sensation, beefy red tongue

A

B12 deficiency

Glossitis is a good clue

29
Q

AMS, dysconjugate gaze, intermittent nystagmus, wide-based unsteady gait

A

Wernicke encephalopathy

Give thiamine

30
Q

Difficulty w/ elbow flexion, forearm supination, numbness over the lateral aspect of forearm

A

Musculocutaneous n.

C7 alone would not affect the biceps or brachialis

31
Q

Pathophys of optic neuritis

A

Demyelination of the optic n.
Myelin is made by:
CNS - oligodendroglial cells
Peripheral - Schwann cells

32
Q

Pt reports multiple episodes slowly progressive arm numbness lasting approx 30 minutes

A

Migraine aura

Typically progress over 15-30 minutes

33
Q

Pt reports a single episode of arm numbness that started aburptly

A

TIA

34
Q

Pt reports episodes of arm numbness lasting 2-3 minutes

A

Seizure

35
Q

What Ab titer is useful in a pt with optic neuritis to r/o causes other than MS?

A

anti-aquaporin 4
Present in neuromyelitis optica
Usually aggressive and does not respond to MS therapies. Needs more aggressive immunosuppresion

36
Q

Following a URI, pt has acute severe pain around the shoulder followed by weakness and atrophy of the muscles in the arm

A

Parsonage-Turner syndrome (idiopathic brachial plexopathy)
Typically unilateral, can cause minimal sensory loss
Tx - symptomatic for pain and PT

37
Q

Where is the lesion in a pt with dysarthria, R arm weakness, R facial weakness?

A

Left pons
Dysarthria-clumsy hand syndrome
CT reveals lesions in the contralateral pons or internal capsule

38
Q

Decreased Biceps reflex is associated with a disc herniation at?

A

C5-C6
5 6 pick up sticks
C5 nerve passes above C6 vertebrae

39
Q

Pt has episodes of LOC x seconds and falls with brief tonic stiffening of all four extremities and axial arching

A

Get orthostatic BP’s to evaluation for syncope

The tonic episodes w/o a post-ictal state is common in syncope

40
Q

Pt report episodes of a curtain descending over her R eye. Which vessel is involved?

A

R Internal carotid a.

Amaurosis fugax = TIA of the retina in the area of the opthalmic a.

41
Q

Pt has sensory defects and weakness in thumb abduction and flexion. Where is the lesion?

A

Median n. at the forearm

CTS would explain weak thumb abduction but not flexion (flexor pollicis longus is inn proximal to the CT)

42
Q

Pt has hemiballism (abn large amplitude flailing) due to ICH. Where is the hemorrhage?

A

Subthalamic nucleus
Part of the basal ganglia responsible for inhibition of movement
Contralateral hemiballism

43
Q

Where is DBS placed in a PD pt?

A

Subthalamic nucleus

Helps to reduce tremors

44
Q

Most appropriate migrane prophylaxis med for a pt with insomnia

A

Amitriptyline - can help with insomnia
Topiramate - causes renal stones
Propanaolol - contra in asthma
Valproic acid - teratogen, hepatotoxic

45
Q

Most common neuropathy of pregnancy?

A

CTS
Begins in 3rd trimester, resolves after delivery
due to edema
Compression of median nerve
Pain and sensory loss of thumb, index and middle finger

46
Q

Pt continues to seize after 2 doses of lorazepam. Now what?

A

Give fosphenytoin

47
Q

What is a good anti-emetic for a PD pt?

A

Ondansetron - least DA blocking properties (vs. metoclopramide, prochlorperazine, promethazine, trimethobenzamide)

48
Q

Pt has weakness of brachioradialis and inability to extend wrist and fingers. Sensory loss over dorsum of hand

A

Compression of radial nerve at the humerus

49
Q

Migraine pt has short term memory impairment lasting less than 24 hours

A

Transient global amnesia

Reassurance

50
Q

Pt has worse HA of his life, but CT is negative. Now what?

A

LP

RBC’s suggests SAH

51
Q

Acute onset of unilateral onset of sensorineural hearing loss

A 
Acoustic trauma (altitiude, flying)
If it doesn't get better - image for a Schwanoma
52
Q

A pt that required ACLS is now comatose with involuntary rapid muscle jerks. Why?

A

Myoclonus due to cerebral anoxia
Usually a poor prognosis
Need an EEG to r/o status epilepticus and labs

53
Q

Teenager w/ HA and impaired upward gaze, lid retraction

A

Pineal gland tumor (parinaud syndrome)

Compresses dorsal midbrain

54
Q

Pt with cauda equina syndrome urgently need?

A

Surgical decompression to prevent further neurologic compromise

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