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Bloc J - Human Behavior > Clinical Neurology > Flashcards

Clinical Neurology Flashcards

1
Q

Someone presents with a loss of sensation and pain bilateral upper limb. What do you suspect?

A

Syringomyelia: enlargement of the central canal of spinal cord

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2
Q

What are the recommended investigations for first seizure?

A
  1. Brain imaging (CT or MRI)
  2. EEG
  3. Blood tests: blood counts, serum glucose, electrolytes
  4. Urine toxicology screen
  5. CSF: if infection suspected
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3
Q

Where are LP and spinal anaesthesia performed?

A

Below the L1-2 level in the adult, so below the cord

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4
Q

What is Charcot triad of MS?

A
  1. Scanning speech
  2. Intention tremor
  3. Nystagmus (medial longitudinal fasciculus syndrome)
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5
Q

What cord segment is tested in the knee jerk muscle strech relex?

A

L2-L4

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6
Q

Where does the needle go in a epidural anaesthesia?

A

Outside the dura

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7
Q

What is a Wernicke aphasia?

A

Fluent, paraphasia, and impaired comprehension

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8
Q

What is the treatement of trigeminal autonomic cephalalgias in the ER?

A

OXYGEN

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9
Q

Someone takes out his tongue and it deviates. What nerve is injured?

A

Hypoglossal (CN XII)

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10
Q

What are the treatement of primary headaches?

A
  1. Identify trigger factors
  2. Non-pharmacological treatment
  3. Abortive treatment
  • RIGHT when the headache stars but too frequent can cause rebound-headache
  • Tylenol, Advil, ASA, Triptans (Serotonin agonists), Metoclopramide IV in ER
  1. Prophylactic (preventive) treatment
  • Vitamin B2 (Riboflavin) 400 mg QD
  • Magnesium 600 mg QD
  • Cyproheptadine (Periactin) 4 mg TID for young kids < 10
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11
Q

What cord segment is tested in the triceps jerk muscle strech relex?

A

C7-8

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12
Q

How do venous infarction usually present?

A

Bilateral with mix of ischemia and hemorrhage

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13
Q

When DON’T we treat a first seizure?

A
  • No risk factors for recurrence
  • Normal exam
  • Normal brain imaging
  • Normal EEG
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14
Q

What vessels are the more at risk of stroke if you have chronic hypertension?

A
  1. Branches from the MCA
  2. Branches of the basilar artery
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15
Q

Someone presents with horizontal diplopia, what nerve do you suspect to be injured?

A

Abducens (CN VI)

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16
Q

What are the types of cerebral edema?

A
  1. Surrounding a tumour because of breakdown of BBB (vasogenic edema) –> responds to steroids
  2. Stroke
  3. Interstitial edema (caused by osmosis, usually related to hyponatremia)
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17
Q

Someone presents with unilateral frontal/retro-orbital headache with autonomic symptoms (pupils, tearing + redness of an eye and nasal secretion) that last 30-60 minutes. What’s your diagnosis?

A

Trigeminal autonomic cephalalgias

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18
Q

What is the best treatement for cerebral aneurysm?

A

Coiling is preferred to surgical clipping because it is less invasive (passing via the arteries, not the brain, to access the aneurysm).

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19
Q

What are the cardinal motor symptoms of Parkinson’s disease?

A
  1. Rest tremor
  2. Rigidity
  3. Bradykinesia
  4. Postural instability
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20
Q

Someone presents with facial numbness and pain (sharp, sudden, brief, electric-like). What nerve do you suspect to be injured?

A

Trigeminal (CN V)

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21
Q
  1. UMN below level
  2. Sensory loss below level
  3. Bladder Dysfunction
  4. No pain

What do you suspect?

A

Spinal Cord compression or injury

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22
Q

What are the most common causes of intraparenchymal Hemorrhage?

A
  • Chronic Hypertension (deep hemorrhage in the brain)
  • Cerebral Amyloid Angiopathy (superficial hemorrhage in the brain)
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23
Q

What cord segment is tested in the forearm jerk muscle strech relex?

A

C5-6

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24
Q

What are the elements of the ABCD2 score for stroke risk after TIA?

A

Age > 60

SBP >140 or DBP > 90

Clinical

  • Weakness
  • Language

Duration:

  • > 60 minutes
  • 10-59 minutes

Diabetes

Score > 2 21% and ≤ 2 4%

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25
Q

Someone comes it with ptosis and eyes not aligned. What nerve do you suspect to be injured?

A

Oculomotor (CN III)

26
Q

Someone has an absent gag reflex. What nerve can be injured?

A

Glosso-pharyngeal (IX): afferent

Vagus (CN X): efferent

27
Q
  • Characteristic situation
  • Prodromal symptoms
  • Rapid recovery of consciousness and alertness

What do you think is the cause of this LOC?

A

Syncope:

  1. Orthostatic: hypovolemic
  2. Neurally-mediated: vasovagal
28
Q
  1. No motor weakness
  2. Sacral (perianal) sensory loss
  3. Bladder Dysfunction
  4. No pain

What do you suspect?

A

Conus Medullaris problem (compression)

29
Q

What are the components of the CHADS2 score for risk of stroke with A. Fib?

A
  • CHF 1 point
  • HTN 1 point
  • Age > 75 1 point
  • Diabetes 1 point
  • S2 Prior* 2 points

Anticoagulate if ≥ 1

30
Q

What are the differential diagnosis for seizures in children?

A
  • Sandifer’s syndrome: GERD after eating
  • Breath holding spells: after crying, associated with iron deficient anemia
  • Febrile seizures: occurring with fever in the absence of CNS infection or electrolyte imbalance (6 months and 6 years)
  • Absence seizures: NO aura, short and no post-Ictal fatigue
  • Epilepsy

ALWAYS INVESTIGATE IF FOCAL

31
Q
  • Papilledema
  • Projectile vomiting
  • Sinus bradycardia
  • Hypertension
  • Decreased level of conscouiousness

What’s your diagnosis?

A

ICP –> cerebral edema

32
Q
  1. Patchy motor weakness
  2. Patchy sensory loss
  3. Possible bladder Dysfunction
  4. Possible pain

What do you suspect?

A

Cauda Equina problem

33
Q

What is the major cause of optic nerve (CN II) impairment?

A

Increased intracranial pressure

34
Q

When should you order a CT scan for a headache?

A
  1. New
  2. Age > 40
  3. Abnormal exam
  4. Change
  5. Thunderclap Headache
35
Q

Where does the needle go in a lumbar puncture?

A

Subarachnoid space

36
Q

In what curcumstances would you suspect an Olfactory (CN I) injury?

A
  1. Head trauma
  2. Fronto-basal tumor
37
Q

What is a Broca aphasia?

A

Impaired fluency but intact comprehension

38
Q

Someone has diploplia when looking down (ex. when going down the stairs). What nerve do you suspect to be injured?

A

Trochlear (CN IV)

39
Q

What cord segment is tested in the ankle jerk muscle strech relex?

A

S1

40
Q

What is the most important thing to do to diagnose seizures?

A

A good history (focal onset or not?)

41
Q

What is the Monroe-Kelley Hypothesis?

A

Increased ICP is due to either increase normal components (CSF, brain, blood) or addition of new components (tumor, pus, extravascular blood)

42
Q

Dysarthria, dysphagia and hoarseness are signs of damage of which nerve?

A

Vagus (CN X)

43
Q

What is the cause of Wernicke-Korsakoff Syndrome?

A

Thiamine deffciency (chronic alcoholism or bariatric surgery)

44
Q

What is Syringomyelia?

A

There is a “central canal” of the spinal cord that is a potential space in adults. It can expand, usually either because of a developmental abnormality or post-trauma.

Can cause numbness and tingling of limbs in suspended sensory loss (not below sensory level)

45
Q

A child presents with abrupt onset of irritability and lethargy, mental status change and seizures with an history of recent infection. What’s your diagnosis?

A

Acute disseminated encephalomyelitis: a demyelinating disease

46
Q

What cord segment is tested in the bicepts jerk muscle strech relex?

A

C5-6

47
Q

Someone presents with Bell’s palsy, what nerve is injured?

A

Facial (CN VII)

48
Q
  1. UMN lesions
  2. Scanning speech
  3. Intention tremor
  4. Nystasgmus

What’s your diagnosis?

A

MS

49
Q
  • Past cardiac history, older person
  • Often provoked, usually by exertion or physical activity
  • Associated cardiac symptoms may occur (palpitations)
  • Sudden and no warning (unlike syncope) and no seizure-like manifestations

What do you think is the cause of this LOC?

A

Cardiac cause:

  1. Cardiac
  2. Aortic stenosis
  3. Arrhythmias
50
Q

A patient presents with decreased lower extremity reflexes with rapidly evolving symetrical ascending muscle weakness and paresthesia without fever. What’s your diagnosis?

A

Guillain-Barré Syndrome

51
Q

What nerve is responsible for the corneal reflex?

A

V1 (ophtalmic) part of trigeminal (CN V)

52
Q

What is the most important risk factor for stroke?

A

Hypertension

53
Q

What are the obvious symptoms of Parkinson’s disease that can help you diagnose it?

A

◼ Masked facies, reduced eye blink

◼ Change in voice
◼ Trouble arising from chair
◼ Difficulty turning in bed

◼ Trouble buttoning shirt
◼ Flexed posture with loss of arm swing

◼ Sialorrhea (hypersalivation)
◼ Change in handwriting

54
Q

What are the red flags that indicate that the patient with a Parkinson’s disease diagnosis DOES NOT actually have Parkinson’s disease?

A

◼ Symmetrical presentation

◼ Rapid disease progression

◼ Poor response to levodopa

◼ Prominent, early speech or swallowing difficulties

◼ Pyramidal, cerebellar, autonomic signs

◼ Early gait disorder and falls

◼ “wheelchair sign”

55
Q

What are the 2 common clinical presentations of a ruptured aneurysm (causing SAH)?

A

“Sentinel bleed” with headache

  • Sudden onset
  • Maximal at onset
  • “Worst headache of my life”
  • Constant for many hours

“Full” Rupture

  • Loss of consciousness
  • Seizure
  • Why? Not ischemic or pressure
56
Q
  • Vocalization, tonic stiffening, clonic movements for 1-2 minutes
  • Prolonged post-ictal period; unconscious then confuse
  • Urine incontinence, tongue biting

What do you think is the cause of this LOC?

A

Seizure (neurologic cause)

57
Q

What are the IMPORTANT non-motor symptoms of Parkinson’s disease?

A

Psychiatric disturbance

  • Anxiety
  • Depression
  • Apathy

Autonomic disturbance

  • Constipation
  • Erectile dysfunction
  • Urinary frequency
  • Orthostatic hypotension
  • (Pain)

Cognitive Impairment

  • Dementia
  • Hallunications

Sleep disturbance

  • Hyposomnia
  • REM sleep behaviour disorder
  • Excessive daytime sleepiness
58
Q
  1. Migraine
  2. OCP
  3. Smoking

What are you worried about?

A

STROKE

59
Q

Where does the needle go in a spinal anaesthesia?

A

Subarachnoid space

60
Q

Someone presents with pain when eating. What nerve do you suspect to be injured?

A

Glosso-pharyngeal (CN IX)

Bloc J - Human Behavior (10 decks)

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