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MS3 - Neurologic Care > Board Vitals: Neurology Shelf Exam > Flashcards

Board Vitals: Neurology Shelf Exam Flashcards

1
Q

What is the annual risk of dementia in an octogenarian?

A
  • 80-84: 3%

* 84-90: 8%

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2
Q

In general, what patients require antiplatelet agents?

A

Those with atherosclerosis

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3
Q

If a patient has a tonic seizure that begins with extension of the elbow, then where did the seizure likely begin?

A

Contralateral supplementary motor area

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4
Q

In addition to increased size of the lateral ventricles, those with schizophrenia can also have ___________________ on brain imaging.

A

decreased size of the prefrontal cortex and hippocampus

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5
Q

List three conditions that often are associated with spina bifida.

A
  • Latex allergy (68%)
  • Leg weakness and paralysis
  • Club foot
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6
Q

List two symptoms that can distinguish cauda equina syndrome from conus medullaris syndrome.

A
  • Symmetry: conus medullaris is symmetric while cauda equina is asymmetric
  • Incontinence: conus medullaris presents with fecal/urinary incontinence early in the disease course
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7
Q

Absent venous pulsations = _________________.

A

dural venous sinus thrombosis

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8
Q

The gluteus medius, gluteus medius, and tensor fascia latae receive innervation from the _____________ nerve.

A

superior gluteal

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9
Q

True or false: the gluteus maximus receives innervation from the superior gluteal nerve.

A

False. It receives innervation from the inferior gluteal nerve.

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10
Q

Describe canalithiasis.

A

Calcium stones can form within the semicircular canals. When this happens, positional head changes can elicit nystagmus and vertigo.

It may seem like a vertebral dissection or vestibular infarct, but the timing is usually more insidious.

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11
Q

An older guy was weight lifting and suddenly felt a headache with a droopy eyelid. What occurred?

A

Internal carotid dissection with disruption of the sympathetic nerves that travel with the internal carotid.

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12
Q

True or false: myasthenia gravis is more common in males.

A

True!

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13
Q

D2 receptors are found primarily in the __________ pathway through the basal ganglia.

A

direct

D2 receptors are inhibitory and prevent the release of GABA from the striatum.

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14
Q

If you suspect temporal arteritis, what should you do first?

A

Administer steroids

You need to treat it before getting the biopsy to prevent possible vision loss.

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15
Q

Describe essential tremor.

A
  • Often has a family history
  • Autosomal dominant pattern
  • Improves with alcohol
  • Worsens with intentional movement or specific postures
  • Typically 4 - 8 Hz
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16
Q

How can you distinguish pain due to Parkinson’s disease (as oppose to generic pain in a person with Parkinson’s)?

A

Parkinson’s pain generally improves with dopaminergic treatment.

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17
Q

_________________ is a common symptom of Parkinson’s and often predates the motor symptoms by years.

A

Constipation

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18
Q

If you’re given an MRI with a spine tumor and they ask you to differentiate between a metastasis and a meningioma, how can you decide which it is?

A

Metastases grow fast, so if the tumor is large then you would expect the patient to have other sites of growth as well. If it is a large tumor and the patient doesn’t have that many symptoms, then it is likely a meningioma.

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19
Q

Rectal biopsies are used to diagnose _______________.

A

amyloidosis

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20
Q

The autoimmune disorder that presents with anti-SSA antibodies causes what kind of nerve disorder?

A

Mixed sensorimotor neuropathy (being Sjögren’s)

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21
Q

What is the Schirmer test?

A

Used to diagnose Sjögren’s, the Schirmer test involves putting a test strip in the eyelid and seeing how far tears spread in five minutes.

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22
Q

Which migraine prophylactic raises the risk of kidney stones?

A

Topiramate (remember the cannonballs next to the kidney-shaped wheels in the Sketchy scene)

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23
Q

What is the classic story for watershed infarction?

A

A person becomes hypotensive and then develops proximal upper- and lower-extremity weakness. Think about it: the watershed area is the parietal area near the interhemispheric fissure.

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24
Q

What does NCS stand for?

A

Nerve conduction studies

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25
Q

Describe CMAP.

A

Compound muscle action potential

This is a measurement in electromyography. You place a stimulator on a motor nerve and then measure the contraction of the corresponding muscle group.

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26
Q

_______________ can sometimes present as pure sensory or pure motor deficits of the contralateral body (from head to toe).

A

Lacunar infarctions

These infarctions are small enough that they can selectively damage the motor or sensory parts of the internal capsule.

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27
Q

Other than Paget disease of the bone, _________________ can also cause an elevated alkaline phosphatase with bone manifestations.

A

osteopetrosis

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28
Q

Explain the phenomenon of pupil-sparing diabetic oculomotor nerve palsy.

A

The motor fibers of CN III travel within the central part of the nerve, while the pupillomotor fibers travel on the peripheral aspects. In diabetics, arteriolar occlusion can diminish the blood supply to the nerve. The peripheral portions stil receive oxygen but the central part doesn’t. Thus, the motor functions are knocked out but the pupil is still functional.

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29
Q

What metal toxicity can cause Parkinsonian symptoms?

A

Manganese

People with biliary excretion defects, those receiving TPN, and metal workers are at increased risk of manganese toxicity. This presents with acute-onset Parkinson’s symptoms.

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30
Q

What is the technical requirement for a Tourette’s diagnosis?

A

At least one motor and one vocal tic must be present

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31
Q

Explain the respiratory test for brain death.

A

Patients get oxygenated with 100% FiO2 for ten minutes. The ventilator is then disconnected. If no respiratory drive is observed after the patient has reached 60 mm Hg of pCO2, then the test is positive and brain death is likely.

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32
Q

What are some caveats to the brain death criteria?

A
  • Body temperature must be greater than 32º C
  • BP must be greater than 90/60
  • The absence of brain signals must not be explainable by drugs
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33
Q

Another term for proptosis is _________________.

A

exophthalmos

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34
Q

The most common site of cranial nerve sarcoidosis is ____________.

A

CN VII

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35
Q

True or false: in cases of meningitis, steroids should only be given to children.

A

False. Studies have shown that steroids decrease the risk of neurologic sequelae in all age groups.

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36
Q

What are the usual ages of onset for relapsing-remitting MS and primary progressive MS?

A
  • RR: 29 to 32

* PP: 35 to 39

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37
Q

How can you differentiate essential tremor from enhanced physiologic tremor?

A

Enhanced physiologic tremors are usually faster (up to 12 Hz) and does not have as prominent a family history.

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38
Q

Corticocortical efferents arise mainly from layer _________.

A

III

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39
Q

Layers I, IV, and VI receive ______________.

A

most of the thalamic efferents

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40
Q

Most of the cortex is what kind of cell?

A

Pyramidal cells

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41
Q

Upper motor neurons in the cortex are called _________ cells.

A

Betz

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42
Q

Describe the two layers of the enteric nervous system and where they are.

A
  • Auerbach (myenteric) plexus: between the outer/longitudinal and the inner/circular smooth muscle layers
  • Submucosal plexus: between the inner/circular smooth muscle layer and the mucosa
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43
Q

True or false: TCAs are first-line agents in the treatment of chronic pain.

A

True! Anything that increases both serotonin and norepinephrine can treat chronic pain.

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44
Q

What lab abnormalities are often present in serotonin syndrome?

A
  • Leukocytosis
  • Elevated CK and K (rhabdomyolysis)
  • Hypomagnesemia
  • Hyponatremia
  • Hypocalcemia
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45
Q

Locked-in syndrome results from infarctions at the ________________.

A

base of the pons; infarctions to the top of the pons typically affect the midbrain, too, and will cause alterations in consciousness or pupillary manifestations

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46
Q

What factor has the greatest correlation with polysomnography-confirmed OSA?

A

Neck circumference!

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47
Q

The first REM episode is usually _________ minutes after sleep onset.

A

90

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48
Q

A patient presents with loss of motor innervation in the median nerve distribution. She denies sensory loss. What nerve is likely injured?

A

Anterior interosseous nerve

The median nerve passes the antecubital fossa and splits into the sensory and motor divisions.

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49
Q

Tuberous sclerosis is passed on in what inheritance pattern?

A

Autosomal dominant with variable penetrance (chromosome 9 or 16)

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50
Q

________________ is the most common nerve injured in increased ICP.

A

Abducens nerve (because of where it passes through the cavernous sinus)

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51
Q

Excess zinc intake can cause copper deficiency which can cause _________________.

A

neuropathy with loss of vibratory sensation and proprioception

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52
Q

The inferior muscles of the eye aid in depression and ______________ of the eye.

A

extorsion

The superior muscles do intorsion.

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53
Q

The CHADS2 scale is used to _______________.

A

evaluate stroke risk in patients with atrial fibrillation

  • CHF history
  • HTN
  • Age greater than 75
  • Diabetes
  • Stroke history (2 points)
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54
Q

Lesions to the corticobulbar pathways produce what symptoms?

A

The “pseudobulbar” affect: inappropriate laughter with dysarthria and dysphagia

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55
Q

Which four drugs have been associated with causing absence seizures?

A
  • Phenytoin
  • Carbamazepine
  • Gabapentin
  • Lamotrigine
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56
Q

True or false: most patients with congenital muscular dystrophy have cognitive impairment.

A

True

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57
Q

In addition to diarrhea and arthralgias, Whipple’s disease can also cause _______________.

A

dementia

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58
Q

If a person has a sulfa allergy and needs a carbonic anhydrase inhibitor, then ______________ can be used.

A

topiramate

59
Q

What is apneustic breathing?

A

Taking a pause at full inspiration

This pattern of breathing is characteristic of pontine lesions.

60
Q

Comatose patients with pinpoint pupils likely have a lesion in the _________________.

A

pons

61
Q

Describe transverse myelitis.

A
  • Inflammatory disorder of the spinal cord white matter
  • Often occurs after an illness
  • Weakness, areflexia, and a sensory level deficit
62
Q

What’s the difference between CPAP and BiPAP?

A

CPAP creates a continuously positive airway pressure that pneumatically splints the airway open. BiPAP alternates the airway pressure in inspiration and expiration to aid in breathing.

63
Q

What is decorticate posturing?

A
  • Flexion of the elbows

* Extension of the lower extremities

64
Q

Disinhibition of the ______________ leads to decorticate posturing.

A

red nucleus

65
Q

True or false: anterior spinal artery infarctions do not cause paraplegia.

A

False. The lower motor neurons are usually affected.

66
Q

How is the nystagmus pattern different for central and peripheral sources?

A
  • Peripheral nystagmus results from canalithiasis and points away from the affected side.
  • Central nystagmus results from affected vestibular nuclei and points to the affected side.
67
Q

What side effects did Sketchy not include for topiramate?

A
  • Word-finding difficulty

* Appetite suppression

68
Q

______________ is the site of melatonin production.

A

The pineal gland

69
Q

A non-contrast CT, lumbar puncture, and ______________ shoud be done in all cases of nontraumatic SAH.

A

four-vessel angiogram

These do not need to be done urgently, but you need to get one eventually to evaluate for the presence of other aneurysms (which likely caused the first SAH).

70
Q

Importantly, cyclobenzaprine (Flexeril) cannot treat muscle spasms due to ______________.

A

upper motor neuron disease (aka spasticity)

71
Q

An open-ring sign on MRI could suggest ______________.

A

tumefactive multiple sclerosis

72
Q

True or false: the deep peroneal nerve is solely motor.

A

False

The deep peroneal nerve provides innervation to the skin in the webbing between the 1st and 2nd digits.

73
Q

Cluster headaches can technically be as short as ___________.

A

15 minutes

74
Q

________________ is the most common incomplete spinal injury.

A

Central cord syndrome (due to cervical hyperextension)

This presents with greater muscle impairment in the upper extremities than in the lower extremities, sometimes in a cape-like distribution.

75
Q

Which anti-epileptic medication has the fewest drug-drug interactions?

A

Gabapentin (because it is renally excreted)

76
Q

Explain complex regional pain syndrome (CRPS).

A
  • Pain and dysautonomia
  • Often occurs after an injury but the pain is much worse than would be expected from the injury
  • Pain that gets worse over time
77
Q

What is moyamoya?

A

A noninflammatory, nonatherosclerotic vasculopathy of the intracranial arteries that can cause ischemia; presents in children and adults; treat with anticoagulation

78
Q

What antibody is often positive in cases of paraneoplastic cerebellar degeneration?

A

Anti-Yo

Think of a guy yo-yoing in the Sketchy prison scene.

79
Q

Symptoms of Duchenne muscular dystrophy usually appear by age _______.

A

6

80
Q

HIV-related myelopathy shows what microscopic changes?

A

Microvacuolar demyelination in the lateral and posterior columns

81
Q

____________ can occur in multiple sclerosis but it is a rare occurrence.

A

Limb atrophy

82
Q

What condition is associated with restless leg syndrome?

A

Anemia!

This can be from a variety of sources, so look for folate deficiency, iron deficiency, or chronic renal failure.

83
Q

OnlineMedEd gave some incorrect instruction on the indications for carotid endarterectomy (CEA). Explain.

A

Dustyn said CEA is indicated if there are symptoms and the stenosis is greater than 70%. Board Vitals says symptoms and greater than 50%.

84
Q

Explain the “I was lifting weights and now I have a droopy eye” phenomenon.

A

Carotid dissection causes impairment of the carotid sympathetic nerves that travel up from the neck. These innervate Muller’s muscle which is responsible for the opening of the resting eye.

85
Q

List the two most common sites of artery disruption in Wallenberg lateral medullary syndrome.

A
  • Intracranial segment of the vertebral artery

* Posterior inferior cerebellar artery

86
Q

True or false: most migraine patients do not have an aura.

A

True. Only about 20% do.

87
Q

If a patient has hemiparesis and dysarthria but no ______________, then it is like a medial medullary infarction.

A

nystagmus, Horner syndrome, or loss of pain sensation in the face

88
Q

The most common cause of intracranial hemorrhage is ______________.

A

hypertension

89
Q

Does Erb’s palsy arise from a C5/C6 injury or an upper-trunk injury?

A

Upper-trunk

The long thoracic nerve (which arises from C5/C6) is generally unaffected.

90
Q

If there are abnormalities in the _____________ muscle in a femoral nerve injury, then the femoral nerve was likely injured in the intrapelvic region.

A

iliacus

Note: the femoral nerve can be injured by retroperitoneal hematomas that arise from femoral artery procedures.

91
Q

If a patient with myasthenia gravis presents with ______________, then you should prepare to intubate and give immunoglobulin.

A

decreased respiratory drive and dysarthria

92
Q

What receptors does acetylcholine act on in the heart to produce bradycardia?

A

M2 (remember the heart motorcycle girl in the Sketchy scene)

93
Q

Some studies have shown abnormal levels of ________________ in delirious patients.

A

melatonin

94
Q

Which is the only cranial nerve that is not a part of the peripheral nervous system?

A

CN II

The optic nerve is a part of the diencephalon, which is the CNS.

95
Q

What is the technical term for when a concussion damages both sides of the brain?

A

Coup contrecoup

96
Q

The most common symptom of multiple sclerosis is ________________.

A

fatigue

97
Q

Smelling is primarily handled by which part of the brain?

A

The limbic system

98
Q

Why do anoxic events lead to surges of dopamine in delirium?

A

COMT needs ATP to function. Without O2, ATP drops and COMT activity drops.

99
Q

Excess levels of estrogen during pregnancy can cause what movement symptoms?

A

Chorea gravidarum

100
Q

Describe Balint syndrome.

A

Caused by a lesion to the bilateral parietoocipital areas, Balint’s syndrome presents with these three symptoms:
• Simultanagnosia (inability to see more than one object at a time)
•Oculomotor apraxia (inability to move the eyes to a new object even though the EOM are functioning)
•Ocular ataxia

101
Q

The syndrome in which you have hallucinations but know that they are hallucinations is called ______________.

A

Charles Bonnet syndrome

Think: in Charles Bonnet Syndrome the patient Can’t Believe what they’re Seeing.

102
Q

Neurotransmitter metabolites are cleared through _________________.

A

an acid-transport system in the choroid plexus

103
Q

True or false: clubbing and neuropathy can result from obstructive sleep apnea.

A

False. While neuropathy can result, clubbing cannot.

104
Q

Seizures in the Sylvian region typically cause ______________.

A

tongue and mouth sensations or movements

105
Q

In ______________ pain, the pain is often way out of proportion to organic causes.

A

idiopathic

106
Q

What is psychogenic pain?

A

Just an older name for idiopathic pain

107
Q

Discuss the effects of infarcting the dorsolateral, dorsomedial, and orbitofrontal parts of the frontal lobe.

A
  • Dorsolateral (upper sides of the forehead): defects in judgment and planning; depression
  • Dorsomedial (upper part of the interhemispheric area): defects in volition; lack of interest in doing anything
  • Orbitofrontal (above the eye sockets): judgment, planning, disinhibition

Just think, the orbitofrontal area is by the eyebrows, and you’ll make a lot of eyebrows raise with disinhibited behavior. The dorsomedial area is on the crown of the head, and without this area you have no direction moving forward.

108
Q

Theses three symptoms characterize dementia with Lewy bodies: _________________.

A
  • Parkinsonism
  • Fluctuating cognitive function
  • Visual hallucinations
109
Q

What is a mnemonic for the stages of grief?

A 
Death Always Brings Deep Acceptance
•Denial 
•Anger
• Bargaining
• Depression 
•Acceptance
110
Q

What is the three-month mortality for delirium?

A

Roughly 25%

Think: 25% of a year = 25% mortality.

111
Q

The top cause of mortality in serotonin syndrome is ______________.

A

seizures

112
Q

Which antiepileptic medication can cause decreased appetite?

A

Topiramate

113
Q

The “fencer’s posture” is associated with seizures in the ________________.

A

supplementary motor area

114
Q

Describe the benefits of fosphenytoin.

A
  • Is a prodrug
  • Can be given faster intravenously because there is no risk of hypotension and purple glove syndrome (as there is in phenytoin)
  • Can be given intramuscularly
115
Q

What are the side effects of lamotrigine (be sure to include the ones Sketchy didn’t!)?

A
  • Stevens-Johnson syndrome
  • Blurred vision
  • Dizziness
  • Ataxia
116
Q

Which antiepileptic medication can cause emotional lability and aggression?

A

Levetiracetam (Think “LABILEvetiracetam”)

117
Q

Which antiepileptic causes cerebellar atrophy?

A

Phenytoin

118
Q

Which two side effects of valproate did Sketchy neglect?

A

Hair loss and PCOS

119
Q

What are the “fifth day fits”?

A

Many kids get short myoclonic episodes with apnea during the first few weeks of life. This is a diagnosis of exclusion.

120
Q

Regarding absorption, elderly patients tend to have __________________.

A

decreased gastric acidity; this makes acidic drugs more absorbable and alkaline drugs less absorbable

121
Q

Valproate is a liver ____________.

A

inhibitor

122
Q

Describe Ohtahara syndrome.

A
  • Severe epilepsy presenting in the neonatal stage

* Burst suppression seen on EEG

123
Q

Dystonic limbs usually represent a seizure in the __________________.

A

contralateral temporal lobe

124
Q

________________ increases the clearance of lamotrigine.

A

Ethinylestradiol (in hormone replacement therapy and contraceptives)

125
Q

_____________ can worsen generalized epilepsy.

A

Carbamazepine and phenytoin

126
Q

_________________ are the last resort therapies for refractory epilepsy.

A

Corpus callosum dissection and vagus nerve stimulators

127
Q

Topiramate is metabolized primarily by ____________.

A

the kidneys

128
Q

Anti-NMDA encephalitis is associated with ______________.

A

ovarian teratomas

129
Q

“Aggravation by routine physical activity” is a descriptor for _____________.

A

migraines

130
Q

Describe the preventive therapy for cluster headaches.

A

Think “verapamil plus…”
• Valproic acid
•Lithium
• Melatonin

131
Q

The _________________ nerves exits between the posterior cerebral artery and the superior cerebellar artery.

A

oculomotor and trochlear

132
Q

What is the genetic disorder that causes migraines, strokes, and early onset dementia?

A

CADASIL

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy

133
Q

List the two functions of the nucleus tractus solitarius.

A
  • Caudal: baroreceptor reflex
  • Rostral: taste

(You use the RoSTRal at ReSTauRants and the CAudal for the CArotid bodies.)

134
Q

True or false: acoustic neuroma presents with vertigo.

A

False.

Vertigo is a peripheral symptom (associated with Meniere’s).

135
Q

A positional headache with a stiff neck that worsens with standing is characteristic of ______________.

A

CSF leaking headache

136
Q

Which drug treats pseudotumor cerebri?

A

Topiramate (because it is also a carbonic anhydrase inhibitor)

137
Q

What pattern of visual loss if characteristic of pseudotumor?

A

Blurriness or widening blind spot

138
Q

Activation of the accessory nerve causes ____-lateral head rotation.

A

contra

You look opposite to the SCM.

139
Q

What are the characteristics of Chiari headaches?

A

Chiari malformations only cause headaches by the disruption of CSF flow. Thus, they will worsen by coughing or straining and may have papilledema.

140
Q

What are normal opening pressures for LPs in kids and adults?

A
  • Kids: 3-6 cm H2O

* Adults: 8-18 cm H2O

141
Q

What is the frequency of Parkinson’s tremor?

A

4 to 6 Hz

142
Q

Which lobe is Wernicke’s area in?

A

Left posterior temporal lobe

143
Q

Explain the phenomenon of crocodile tears.

A

After Bell’s palsy, facial nerve axons can get misdirected and activate the lacrimal glands when eating.

MS3 - Neurologic Care (22 decks)

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