Clinical Neurology Flashcards by Raymond Gonzales

What to observe to assess toddlers gross motor ability? (2x)

Getting up from the prone position

How well did you know this?

Not at all

Perfectly

Assess coordination in 7 yo?

Pretend to walk a tightrope

How well did you know this?

Not at all

Perfectly

Aspect of neuro exam in young child that is most subjective and challenging

Sensory Exam

How well did you know this?

Not at all

Perfectly

Ruling out what condition would make one choose a CT instead of an MRI in a patient with abnormal mental status?

Acute brain hemorrhage

How well did you know this?

Not at all

Perfectly

7 yo child with new onset esotropia, 1st step in management?

Order MRI of brain

How well did you know this?

Not at all

Perfectly

Modality of neuro imaging to demonstrate differences in gray and white matter in children w/ schizophrenia and ADHD compared to healthy children

MRI

How well did you know this?

Not at all

Perfectly

Neuroimaging finding most common in non-accidental head trauma?

Subdural hematoma

How well did you know this?

Not at all

Perfectly

14 yo falls off a house, brief loss of consciousness, then recovered, 3 hours later becomes unconscious and taken to ER with right dilated pupil. Head CT shows?

Epidural hematoma

How well did you know this?

Not at all

Perfectly

What findings on CT would make you consider substance-induced neurocognitive disorder from inhalant abuse?

1) Global cerebral and cerebellar atrophy

2) Loss of brain mass in thalamus, basal ganglia, pons, and cerebellum

How well did you know this?

Not at all

Perfectly

Diagnosing seizures in youth with intellectual disability is more challenging because? (2x)

More repetitive and stereotyped behaviors at baseline

How well did you know this?

Not at all

Perfectly

Most common aura symptom preceding complex partial seizures? (2x)

Anxiety

How well did you know this?

Not at all

Perfectly

Medication that may worsen juvenile myoclonic epilepsy?

Oxcarbazepine

How well did you know this?

Not at all

Perfectly

Preliminary symptom in Landau-Kleffner syndrome?

Acquired aphasia

How well did you know this?

Not at all

Perfectly

4 yo boy w/ previously normal development is losing responsiveness to parents verbal communication over the past year. He has had 2 tonic-clonic seizures and his EEG shows bilateral independent spike and wave discharges. Diagnosis?

Landau-Kleffner Syndrome

How well did you know this?

Not at all

Perfectly

Diagnosis of a teenager who has several 2-3 minute episodes of being “in a daze,” smacking lips, fumbling with clothing followed by confusion and sleepiness?

Complex partial seizure

How well did you know this?

Not at all

Perfectly

Psychotic 17 yo has seizures, most likely lesion location on MRI?

Left temporal lobe

How well did you know this?

Not at all

Perfectly

What medication used for seizures can decrease IQ?

Phenobarbital

How well did you know this?

Not at all

Perfectly

Repetitive transcranial stimulation can cause?

Induction of seizure

How well did you know this?

Not at all

Perfectly

Type of EEG pattern seen in an adolescent with absence seizures and new onset myoclonic jerks, worse in morning after staying up late to work on book report?

Brief bursts of generalized 3.5 to 4.0-Hz spike-and-waves

How well did you know this?

Not at all

Perfectly

Treatment for child with multiple staring spells and EEG with symmetrical 3-Hz spike and waves?

Ethosuximide

How well did you know this?

Not at all

Perfectly

8 yo with ADHD well controlled on long acting stimulant with concern of episodes staring out the window during school. EEG shows diffuse alpha rhythm during hyperventilation. Diagnosis?

Normal behavior

How well did you know this?

Not at all

Perfectly

Child with declining grades in school with staring spells for 8-10 seconds associated with eye blinking several times per day. Next step?

EEG

How well did you know this?

Not at all

Perfectly

Increased risk of what medication side effect would you be concerned about in a HLA-B*1502 positive female adolescent patient with epilepsy, well controlled on antiepileptic, now presenting with poor concentration, trouble with memory, hair growth on chin, and hyperplasia of gingiva?

Stevens-Johnson syndrome

How well did you know this?

Not at all

Perfectly

7 yo is conscious during 3 minute episode of mouth twitching and generalized jerking movements. Prognosis?

Spontaneous improvement without treatment

How well did you know this?

Not at all

Perfectly

What area of the brain are you trying to approximate on an EEG by using nasopharyngeal electrodes inserted into the nostrils?

Basal temporal lobe

Most helpful in diagnosis of non-epileptic seizures? (3x)

Prolonged video EEG

What serum measurement helps to differentiate between organic and non-epileptic seizures? (2x)

Prolactin

In children with psychogenic non-epileptic seizures, most frequent environmental cause?

Parental conflict

16 yo patient with 2wk history of progressive left-sided weakness and paresthesias gets worse when promoted to varsity sports. Work-up is normal. What is the best initial approach?

Reinforce continuation of daily living and functional tasks

Child with non-epileptic seizures keeps getting sent to ER from school. Why should parents share the diagnosis with the school?

Potential risk of inappropriate and invasive medical treatment

Adolescent admitted to peds neuro service due to functional seizures. Best approach for talking with family and patient about conversion disorder diagnosis?

Emphasizing that the episodes are involuntary

Abnormal findings would be found on what diagnostic test of patient who needs to brace hands against the floor and walk his hands up his leg to stand?

Electromyography (EMG)

Area affected in spinal muscular atrophy?

Anterior horn cells

Area of brain affected in young child walking with a broad based lurching gait, moving side to side?

Cerebellum

Diagnostic test that would be abnormal in a young child who gets up from ground by walking his hands up his legs, has a waddling gait, and has weak leg and arm strength with normal muscle mass?

EMG

3 yo with motor weakness, what would be a characteristic of an UMN lesion?

Increased deep tendon reflexes

Preschool age child presents with hand biting, episodes last seconds to minutes, can be distracted from biting, history of rhythmic movement of hands at 2 yo. Diagnosis?

Developmental coordination disorder

Deep brain stimulation is recommended in what condition in adolescence?

Dystonia

Effective way to assess muscle strength in a 3 yo child?

Ask child to move from floor to chair

Multiple motor tics in 13 year old over the course of six months?

Provisional tic disorder

Findings from 2015 meta-analysis of placebo-controlled trials of stimulants and tic disorder association?

No association between worsening or new tic disorder

Treatment for Tourette's disorder when tics unresponsive to meds or HRT, continues into adulthood, and functionally debilitating?

Deep brain stimulation

Child presents with headaches. Question to assess for frequency and severity?

Number of missed school days due to pain from headache

Physician interviews child with possible migraines. What would make physician order a CT scan of head?

Abnormal motor exam

First line medication for prophylaxis for migraine?

Propranolol

Medication for migraine prophylaxis that can worsen depression?

Propranolol

Child has normal neuro exam, but multiple episodes of dizziness, occipital headache, vertigo, hemiparesis, all spontaneously resolve in 24 hours. Diagnosis?

Basilar artery migraine

Neuroimaging in peds pt w/ migraine is indicated?

When there's no family history of migraine

Most frequent comorbidity in patients with TBI?

Depression

What is the medical condition associated with chronic aggressive behavior?

Traumatic brain injury

12 yo falls, hits head, unconscious. Then has some difficulty following conversation. Likely course of cognitive function?

Complete recovery

6 months after TBI, 15 yo with increased forgetfulness, testing shows deficient working memory. Affected cortical area?

Prefrontal cortex

What request can be used to test the memory of a 15 year old regaining consciousness after MVA?

“Use your cell phone to call your parents”

Child has Anti-NMDA-Receptor Encephalitis. Pt anxious, confused, waxy flexibility, minimal verbalization and staring episodes. What is initial treatment for motor symptoms? (2x)

Lorazepam

17 yo has flu-like illness, then psychosis, paranoia, catatonia, and LLQ abdomen mass. Test to order? (2x)

Anti-NMDA receptor antibodies

16 yo female with memory/confusion issues for three weeks, presents w/ new onset agitation, hallucinations, insomnia, inattention, brief seizure, elevated HR/BP, ovarian lesion on ultrasound, otherwise normal exam. Diagnosis?

Anti-N-methyl-d-aspartate receptor encephalitis

Adolescent admitted for paranoia, hallucinations, mood lability, then develops facial tics, autonomic instability, obtunded. Adnexal mass on workup. Removal likely to normalize activity of receptor for which neurotransmitter?

Glutamate

Child has multiple hyperpigmented, ovoid, and smooth macules on the arms, chest, and back with freckling in both axillae. Mother also has macules, freckling in axilla, and optic tumor. What psychiatric symptoms does the child likely have? (2x)

Attention-Deficit/Hyperactivity Disorder

16 yo adolescent with newly diagnosed Schizophrenia has history of language delay. Pt has long narrow face, small mouth, hypernasal speech with history of cleft palate and ventricular septal defect. Syndrome? (2x)

DiGeorge syndrome

Which developmental disorders are associated with same locus of chromosome 15, but with different phenotype expression? (2x)

Prader-Willi and Angelman

Genetic abnormality of velocardiofacial syndrome? (2x)

Gene deletion

Child w/tumors in brain, heart, and kidneys, seizures, intellectual disability. Likely presents with sx of? (2x)

Autism

Psychotic adolescent with self-injurious behavior and chorea with elevated LFTs. Diagnosis? (2x)

Wilson Disease

16 yo male with persistent irritability, depression, and impulsivity despite many medications and therapy. On exam, pt has tremor, drooling, speech problems, and brownish tinge of cornea. Screening tool?

24-hour urine copper test

Diagnosis for a 14 year old adolescent with defiant behavior at home and school who presents with generalized dystonia, wing-beating action tremor in the arms and forced grin?

Wilson disease

Highly comorbid with Fragile X?

ADHD

Common finding in 7 yo with worsening vision in left eye, headaches, skin changes, father also had same skin changes, edema of optic disc seen on exam?

Cafe Au Lait spots

How can you determine carrier status for Fragile X syndrome for pre-pregnancy planning?

Southern blot S - D N - R O - O W - P

What is comorbid with syndrome of hypotonia, obesity, small hands, short stature, micro-orchidism, and paternal deletion of 15q11-15q13?

Compulsions

Child with hyperphagia, obesity, intellectual disability, aggressive behavior, and obsessive-compulsive tendencies. Result of what genetic error?

Deletion

15 yo male with intellectual disability, short, hypogonadism, low muscle tone. What other symptom may be present?

Hyperphagia

What intellectual disability is most commonly associated with OCD?

Prader-Willi

MRI shows symmetric basal ganglia lesions, child gets up from floor by pushing up with hands, grows progressively weaker. Diagnosis?

Mitochondrial disorder

How do you rule out a particular condition associated with Down’s syndrome?

Echocardiogram

What has contributed to the improved ability to identify the ideology for intellectual disability?

Genetic factors

Young child with seizures, ID, port wine stain on half of face. Diagnosis?

Sturge-weber syndrome

17 yo patient with malar distribution rash, macules on arms, bright lesions in cortex on MRI indicating tubers. What is the associated psych diagnosis?

Autism spectrum disorder

Psychiatric disorders most frequently concurrent with Neurofibromatosis I?

Autism, Depression, ADHD

Child with ADHD having more difficulty getting up from floor to chair over past 6 months. Diagnosis?

Duchenne muscular dystrophy

Child who repeatedly trips and sprains ankles, climbs up his legs using hands in order to stand. Diagnosis?

Duchenne muscular dystrophy

Four year old with limited social skills, facial angiomas, hypopigmented spot, absence seizures?

Tuberous sclerosis

To reduce intellectual disability in patients with homocystinuria, give which vitamin?

Vitamin B6

Karyotyping is still the preferred test in?

Prenatal trisomies

Fragile X syndrome genetic abnormality

Trinucleotide expansion

Genetic syndrome caused by MICROdeletion?

Williams syndrome

In Rett and Fragile X syndromes, what is the function of Mecp2 (methyl-CpG-binding protein)?

Transcription