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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
Brown-sequard syndrome
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
Diagnosis of brain death and clinical scenarios that can mimic brain death
``` 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
Restless leg syndrome - work up and treatment
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
Cryococcus neoformans Meningitis in HIV
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
LP/CSF findings for bacterial, viral, fungal meningitis
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
Anterior spinal artery syndrome
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
Normal pressure hydrocephalus
Dementia, gait abnormality, urinary incontinence ddx: depression (no urinary or gait sxs), PD or LBD (no tremor or rigidity) Tx: ventricular shunting
32
Evaluation of stroke
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
Guillian-Barre syndrome
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
Essential tremor
tremor at rest, worsens with intentional movement Less pronounced with alcohol use Tx: b-blocker like propranolol
35
Acute, self-limited vertigo with hearing loss and tinnitus
Acute labrynthritis
36
Vertigo is independent of head movement, no hearing loss or tinnitus, may result from viral infection
Vestibular neuritis - tx meclizine
37
Vertigo + ataxia, hearing loss, and tinnitus. MRI shows tumor near the internal auditory canal
Acoustic neuroma
38
Vertigo with change of head position, no hearing gloss, tinnitus, or ataxia, positive Dix-Hallpike maneuver
Benign paroxysmal positional vertigo (BPPV)
39
Chronic vertigo + hearing loss and tinnitus, treat with salt restriction and diuretics
Meniere's dz
40
Antithrombotic therapy for acute thrombotic stroke
Initially give ASA 162-325 mg Plavix or aggrenox (asa + dipyridamole) or asa No warfarin unless cardiothrombotic (afib)
41
Indications for carotid endarterectomy
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
Medical treatment of carotid artery stenosis
statin BP control Lifestyle modifications - quit smoking, wt loss, increase exercise
43
Spinal cord compression
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
Amyotrophic lateral sclerosis (ALS)
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
Bells palsy
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
Syringomyelia
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
Carpal tunnel syndrome
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
Most common cause of headache
tension headache - posterior head starts
49
Periorbital pain with lacrimation and/or rhinorrhea
cluster headache +/- congestion ipsilateral side
50
Obese woman with palpilledema and headache
Idiopathic intracranial hypertension - pseudotumor cerebri
51
Scintillating scotomas prior to headache
migraine
52
jaw muscle pain with chewing, headache
temporal arteritis (giant cell arteritis) - quick steroids risk of vision loss
53
Headache responsive to 100% oxygen supplementation
cluster HA
54
In a patient with suspected bacterial meningitis, what should be ordered prior the the LP and why
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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