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DIT Level 3 > Clinical questions - Neurology > Flashcards

Clinical questions - Neurology Flashcards

1
Q

Wernicke’s encephalopathy presentation, tx

A

ataxia, encephalopathy, oculomotor dysfunction

Tx: IV thiamine

Glucose (D5 or D50) before thiamine theoretically damages mammillary bodies worsening wernicke’s

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2
Q

Subarachnoid hemorrhage - presentation, work up, treatment

A

Severe headache, +/- LOC without trauma

W/U: CT head w/o con - if negative LP to look for blood in CSF

Tx:
ICU admit
BP control
CCB - amlodipine to prevent vasospasm
Surgical clipping or embolization to prevent re-bleeding - necessary to prevent death
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3
Q

Myasthenia graves crisis - presentation, treatment

A

Ptosis and difficulty swallowing - edrophonium with temporary resolution of ptosis
Difficulty breathing which can quickly deteriorate to respiratory failure requiring mechanical ventilation

Cause: auto-Ab to cholinergic receptors at the NMJ

Tx:
Less severe but symptomatic - cholinesterase-i : pyridostigmine
Severe (i.e. resp failure): plasmapheresis or IVIG
Chronic immunosuppression with prednisone, azathioprine

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4
Q

Brain tumor that is rare, slow growing, often found in frontal lobe in adults

A

Oligodentroglioma

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5
Q

Brain tumor that is benign, MC childhood supratentorial tumor

A

Craniopharyngioma - risk bitemporal hemianopsia

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6
Q

mc malignant primary brain tumor in adults, rapidly progressive

A

glioblastoma

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7
Q

Brain tumor that is most commonly secretes prolactin, may cause bitemporal hemianopsia

A

Pitutary adenoma - prolactinoma

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8
Q

highly malignant cerebellar tumor in children

A

medulloblastoma

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9
Q

common primary brain tumor, typically benign

A

meningioma

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10
Q

Absence (petite mal) seizure presentation and treatment

A

occasional periods of impaired consciousness lasting 30-45 seconds

Tx: ethosuximide

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11
Q

Initial dementia work up

A

TSH, B12

MRI brain to r/o normal pressure hydrocephalus or tumor

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12
Q

Lumbar spinal stenosis presentation, dx, treatment

A

gradually worsening pain walking downhill but improves walking uphill or leaning over a shopping cart

PE: DTRs decreased/absent in ankles/knees
Negative straight leg test

Dx: MRI L spine

Tx:
Mild: PT, NSAIDs
Severe: Sx decompression

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13
Q

West Nile Encephalitis presentation, dx, tx

A

presentation: headache, confusion (more common in older pts), weakness, myalgia, fever, malaise, with exposure to mosquitos - acute febrile illness in summer months

PE: maculopapular rash

CSF: elevated protein, normal glucose, moderate lymphocytes (looks viral)

Tx: supportive - fluids, rest

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14
Q

Upper motor neuron signs

A 
Hyperreflexia
weakness
decreased control
Spastic paralysis
\+ Babinski
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15
Q

Lower motor neuron signs

A

flaccid paralysis

areflexia or hyporeflexia

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16
Q

Upper or lower neuron sign associated with: stroke

A

UMN

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17
Q

Upper or lower neuron sign associated with: Bell’s palsy

A

LMN

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18
Q

Upper or lower neuron sign associated with: spasticity

A

UMN

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19
Q

Upper or lower neuron sign associated with: TIA

A

UMN

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20
Q

Upper or lower neuron sign associated with: Guillain-Barre’ syndrome

A

LMN

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21
Q

Upper or lower neuron sign associated with: caudal equine sn

A

LMN

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22
Q

Multiple sclerosis presentation, work up, tx

A

s/s of CNS lesions separated by time and space

  • optic neuritis
  • sensory deficits
  • Lhermitte sign (electrical pain down spine/arms when tilt head down
  • motor weakness
  • bowel/bladder problems
  • gait/balance problems
  • generalized fatigue

w/u: MRI brain/spinal cord with several plaques of demyelination in various stages of healing

Tx:
Acute: prednisone or methylprednisolone
Chronic: b-interferon, iterimere

23
Q

Parkinson disease - pathophys, presentation, treatment

A

Loss of dopaminergic neurons in the substantia nigra

Presentation: tremor, difficulty walking, shuffling gait with difficulty taking first step, frequent falls

PE: limited facial expression, resting tremor, increased muscle tone, cogwheel rigidity in extremities
No obvious cerebellar deficits

initial tx: Levodopa/carbidopa

  • Levodopa taken up in the CNS and converted to dopamine
  • Carbidopa inhibits breakdown of levodopa in circulation

Advanced disease: deep brain stimulation

  • subthalamic nucleus
  • decrease inhibition of movement
  • wont slow dz progression, tx symptoms and motor fluctuations
24
Q

Radial nerve palsy - presentation, tx

A

“Saturday night palsy” - wrist drop, inability to extend fingers, decreased sensation

Self limited, no treatment
Resolves on its own in 2-3 months

25
Q

Brown-sequard syndrome

A

Hemisection of spinal cord, typically penetrating wound to back

Neuro exam: loss of proprioception and vibration sense and paralysis on ipsilateral side, pain and temp loss on contralateral side

26
Q

Diagnosis of brain death and clinical scenarios that can mimic brain death

A 
Diagnosis of brain death:
Assess brain blood flow
-cerebral angiography gold standard  - inaccurate in severe hypotension
-Transcranial doppler
EEG
Mimics:
Locked In Sn
Neuromuscular paralysis
Drug intoxications
Guillain-Barre' Sn
Hypothermia
27
Q

Restless leg syndrome - work up and treatment

A

Discomfort in legs at night relieved by movement

Always check iron studies and replete if needed

Intermittent:

  • Levodopa
  • Benzos

Persistent:
Dopamine agonists: pramipexole, ropinirole
Gabapentin/pregabalin

28
Q

Cryococcus neoformans Meningitis in HIV

A

Headache and fever
LP: elevated opening pressure, CSF low glucose, mildly elevated protein, small number of lymphocytes, NO RBC

Confirm dx with india ink stain, if positive, still confirm with cryptococcal Ag in serum or CSF

Tx:
Amphotericin B + flucytosine x2 weeks
THEN PO fluconazole for 8 weeks

29
Q

LP/CSF findings for bacterial, viral, fungal meningitis

A

Bacterial:
High opening pressure
Low glucose
Neutrophil predominant

Viral:
Normal opening pressure
Normal glucose and protein
Lymphocytic predominant

Fungal:
high opening pressure
low glucose
mildly elevated protein
small number of lymphocytes
30
Q

Anterior spinal artery syndrome

A

Anterior spinal artery supplies the everything except the posterior columns of the spinal cord which is supplied by the posterior spinal artery.

Hx of atherosclerosis, AAA/repair, trauma

loss of pain and temperature and motor function bilaterally below level of the occlusion
Vibration and proprioception intact

31
Q

Normal pressure hydrocephalus

A

Dementia, gait abnormality, urinary incontinence

ddx: depression (no urinary or gait sxs), PD or LBD (no tremor or rigidity)

Tx: ventricular shunting

32
Q

Evaluation of stroke

A

CT head w/o contrast to r/o hemorrhagic stroke

  • acute blood is bright white
  • Ischemic stroke is negative first 24-48 hrs - dark on CT

MRI ischemic stroke shows earlier than CT

33
Q

Guillian-Barre syndrome

A

Recent history of respiratory infection, GI infection (Camphylobacter)

Demyelination of peripheral nerves with symmetric motor weakness and hyporeflexia that gradually ascends and involves upper extremities
-risk of respiratory failure

Paraesthesia complaints but normal sensory
Autonomic dysfunction: tachycardia, hypotension, urinary retention

Course usually progresses for 2 weeks, plateaus for 2 weeks, then improves over weeks to months

CSF: elevated protein, normal cellular count - albuminocytologic disassociation

Tx:
ICU monitoring
-Intubate if resp failure
-Plasmapheresis or IVIG if rapidly progressing or respiratory failure or bulbar involvement (can’t swallow)

34
Q

Essential tremor

A

tremor at rest, worsens with intentional movement
Less pronounced with alcohol use

Tx: b-blocker like propranolol

35
Q

Acute, self-limited vertigo with hearing loss and tinnitus

A

Acute labrynthritis

36
Q

Vertigo is independent of head movement, no hearing loss or tinnitus, may result from viral infection

A

Vestibular neuritis - tx meclizine

37
Q

Vertigo + ataxia, hearing loss, and tinnitus. MRI shows tumor near the internal auditory canal

A

Acoustic neuroma

38
Q

Vertigo with change of head position, no hearing gloss, tinnitus, or ataxia, positive Dix-Hallpike maneuver

A

Benign paroxysmal positional vertigo (BPPV)

39
Q

Chronic vertigo + hearing loss and tinnitus, treat with salt restriction and diuretics

A

Meniere’s dz

40
Q

Antithrombotic therapy for acute thrombotic stroke

A

Initially give ASA 162-325 mg
Plavix or aggrenox (asa + dipyridamole) or asa

No warfarin unless cardiothrombotic (afib)

41
Q

Indications for carotid endarterectomy

A

Symptomatic with narrowing 70-99% (recent stroke or TIA)
Symptomatic male with 50-69% stenosis
Asymptomatic 60-99% stenosis with life expectancy of more than 5 years

42
Q

Medical treatment of carotid artery stenosis

A

statin
BP control
Lifestyle modifications - quit smoking, wt loss, increase exercise

43
Q

Spinal cord compression

A

back pain, urinary incontinence, difficulty walking with BLE weakness, decreased sensation, and hyporeflexia
May have hx of cancer - concern for mets causing theca sac pressure

W/U: MRI/CT spine

First step in treatment: steroids to reduce swelling

44
Q

Amyotrophic lateral sclerosis (ALS)

A

Upper and lower motor signs - sensory neurons intact

  • muscle weakness begins in hands, progressively worsening
  • weakness in legs, worsening of balance
  • Slurred speech

PE: muscle atrophy, fasciculations in hands, calves
Decreased strength
Hyperreflexia
+ Babinski

Tx:
Riluzole slows progression
Universally fatal in 3-5 yrs

45
Q

Bells palsy

A

facial nerve palsy involves upper and lower face (if upper spared, cortical stroke), often decreased taste sensation on anterior tongue
Difficulty talking, inability to close eye all the way

Associated with HSV, Zoster, Lyme dz, sarcoidosis, DM, tumors

Tx:
High dose steroids +/- acyclovir or valacyclovir

46
Q

Syringomyelia

A

Cystic degeneration within spinal cord, usually cervical spine or upper thoracic following an injury like whiplash
-dilated area compresses the anterior white commissure causing decreased pain and temp sensation in a yolk like distribution over neck, shoulders and down both arms

Tx:
Surgical shunt to decompress dilated area

47
Q

Carpal tunnel syndrome

A

Entrapment of the medial n. by flexor retinaculum 2/2 inflammation -> tingling and weakness in the first 3 digits of hand, often associated with repetitive work

Tx:

  • wrist brace/splint - if can’t avoid repetitive use attributing to it
  • Steroid inj
  • surgery if fail above
48
Q

Most common cause of headache

A

tension headache - posterior head starts

49
Q

Periorbital pain with lacrimation and/or rhinorrhea

A

cluster headache +/- congestion ipsilateral side

50
Q

Obese woman with palpilledema and headache

A

Idiopathic intracranial hypertension - pseudotumor cerebri

51
Q

Scintillating scotomas prior to headache

A

migraine

52
Q

jaw muscle pain with chewing, headache

A

temporal arteritis (giant cell arteritis) - quick steroids risk of vision loss

53
Q

Headache responsive to 100% oxygen supplementation

A

cluster HA

54
Q

In a patient with suspected bacterial meningitis, what should be ordered prior the the LP and why

A

CT head to r/o mass

IF
AMS
Papilledema
Seizure w/in past week
Immunocompromised state
Focal neurologic symptoms

DIT Level 3 (32 decks)

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