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Neurology > General Signs > Flashcards

General Signs Flashcards

1
Q

Down Beat Nystagmus (11)

A 
Chiari
MS
Wernicke
Brainstem Encephalitis
Cerebellar degenration and Obsoclonus
Hypomagnesemia
Basilar Invagination
Lithium
Syringobulbia
Paraneoplastic
GAD
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2
Q

Bilateral Facialis (10)

A 
GBS
Lyme
HIV
Menigeal Carcinomatosis
Sarcoidosis 
Moebius
Melkersson Rosenthal
Kennedy
Fascioscapulohumeral
Amyloidosis
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3
Q

Vertical Gaze Palsy

A 
Midbrain Infarction
Parinaud
Pinealoma
Hydrocephalus
PSP PD CBD
Whipple
Niemann Pick C
Gaucher
Tay Sachs
bilateral INO
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4
Q

Painful Ophthalmoplegia (19)

A 
Tolossa Hunt
Orbital Pseudotumor
Thyroid Ophthalmoplegia is not painful
Cavernous Sinus Syndrome
Carotid Aneurysma
PCA ANeurysma
Cavernous SInus Thrombosis
Carotid Cavernous Fistula
Diabetes
Tempo Arteritis
Neuplasm 
Metastasis
Apoplex Pituitary
Meningioma
Sarcoidodi
Sinusitis
Mucocele
VZV
Muomycosis
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5
Q

DYT 1

A

Torsin A
Oppenheim, Jewish, Action Dystonia
low pnetrance

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6
Q

X linked Dystonia Parkinsonism

A

DYT 3 LUBAG Filippinos

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7
Q

Dopa Responsive Dystonia

A 
DYT 5 
girls more than boys
SEGAWA
Chromosome 14
worsening during the day
action leg dystonia progressive
Tetrahydrobiopten defect
Dopa Sensitive
No Dyskinesia later on
OCD
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8
Q

Paroxysmal Dyskinesia

Kinesogenic

A 
dystonia chorea attacks
male 80%
sound or movement as trigger
1 min up to 100 per day
DYT 10 Chr 16
Antiepileptic Tretament CBZ PYT
Autosomal Dominant
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9
Q

Paroxysmal Dyskinesia

Non-Kinesogenic

A

infancy, longer attacks, less often, 10 min to hours, Chr 2
coffee etchanol tiredness as triger
Azetazolamide, Clonazepam

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10
Q

Paraneoplastic cerebellar degeneration (antibodies?)

A

Anti Yo Ri Tr CV2 Ma VGCC

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11
Q

paraneoplastic cerebellar degeneration (decription)

A 
rapid onset cerebellar syndrome
subset with LEMS
small cell lung, breast, ovary, hodgkin
#1 anti Yo (breast gynaecology)
anti Ri: truncal, opsoclonus (breast)
--> can lead to dementia
SCLC often anti Hu and later paraneoplastic encephalomyelitis
Hodgkin: anti Tr
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12
Q

Limbic encephalitis

A

Men under 45> possible anti Ma and testis tumor

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13
Q

new variant CJD: whats different to sporadic CJD?

A

1) patients are younger (27y)
2) psychiatric and sensory symptoms as first signs
3) no typical EEG changes
4) longer duration of disease

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14
Q

Oligodendroglioma mutations

A

if 1p and 19q = good chemotherapy response

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15
Q

GBM

A 
older patients EGFR upregulated
younger p53 mutated
more men than women
extracranial metastasis possible
Temozolamide/ Temodal and Radiation
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16
Q

Meningioma

A 
women more then men
NF2: 22q gene mutations 
Estrogen receptors
psammoma
calcification
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17
Q

Metastasis to brain

A 
Lung
Breast
Melanoma
Colon
Kidney
Testicle
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18
Q

Bloody metastasis:

A

Melanoma
Chorionepitheliioma
Kidney

Lung
Thyroid

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19
Q

Medulloblastoma

A 
children post fossa
Rossette Formation
boys more than girls
Chromosome 17 loss
N-Myc bad prgognosis
72% JC Virus
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20
Q

Neuroblastoma

A

adrenal Gland
number one solid tumor in children
Polymyoclonus Opsoclonus

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21
Q

Choroid Plexus Papilloma

A

SV40 virus?

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22
Q

Hippel Lindau

A

AD VHL Gene
Hemangioblastoma of Cerebellum
also Hemangioma of spinal cord and retina
renal pancreatic cysts

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23
Q

Pineal Tumor

A

CSF follow up level of Melatonin after surgery

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24
Q

chemotherapy sensitive brain tumor:

A

anaplastic oligodendroglioma

1p/19q very sensitive

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25
Q

Radiation injury

A

1) acute: seizure, worsening of tumor symptoms, ICP
possibly brain edema but not visible on MRI!!

2) early delayed: focal tumor symptoms, Tumor enlargement: pseudo-growth

3) late delayed: coagulation necrosis, white matter, softening, liquification,
symptoms of delayed: tumor progressin like or DEMENTIA

migraine like syndrome: with aphasia, hemiparesis hemianopia CSF protein elevated,

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26
Q

Anterior Cavernous SInus Thrombosis

A 
chemosis and proptosis
III
IV
VI
and V1
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27
Q

Posterior Cavernous Sinus Thrombosis

A 
spread to inferior petrosal sinus:
VI
IX
X
XI
no proptosis

additional involvement of superior petrosal sinuns: V nerve palsy!

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28
Q

Sturge Weber

A 
port wine nevus
ipsilateral meningeal angioma
MR
seizures
hamiparesis
glaucoma
hemiatrophy
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29
Q

Optic neuritis first sign of MS in …%?

A

First sign in 25%

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30
Q

Progression to MS if ON in 5 y? females, males

A

75% females

34% males

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31
Q

ON and no MRI findings, how much MS?

A

22%

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32
Q

MBP in MS?

A

elevated in CSF

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33
Q

Weston Hurst

A

acute hemorrhagic encephalomyelitis

hyperacute ADEM

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34
Q

Antibodies in Interferones?

A

Betaseron 34% -every 2nd day IGN beta1b
Rebif 24% - 3*/week, beta 1a
Avonex 2-5% - 1/week, beta 1a

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35
Q

Kernohan Woltman Phenomenon

A

Babinski ipsilateral to lesion due to uncal herniation with pressure on Brain Stem

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36
Q

ICH acute signs

A

vomiting
hypertension
bradycardia

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37
Q

pontine damage (hemrrhage) how are the pupils?

A

extreme miosis

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38
Q

retinal hemorrhages due to ICP?

A

Terson Syndrome (in SAH)

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39
Q

clinical signs in MOYMOYA

A

1) sudden weakness, headache seizures
2) prolonged TIA
3) TIA induced by hyperventilation or hyperthermia
4) ICH
5) EEG rebuildup: after hyperventilation 5 min slow waves

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40
Q

ICH locations

A

1) Putamen (50%)
2) lobar white matter frontal, temporal, pareital
3) Thalamus
4) cerebellar hemisphere
5) Pons

death in 30% in 30 days

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41
Q

Medication in ICH for blood pressure

A

STICH Trial:
don’t use calcium antagonists, they increase ICP

Use Betablockers or ACE

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42
Q

SAH score

A

Hunt and Hess

I asymptomatic (slight headache stiff neck)
II no focal signs, headache, neckstiff, --> SX

III drowsiness, confused mild focal
IV stupor coma decerebration
V Deep Coma

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43
Q

Rupturing of Aneurysma

A

In 5 years rupturing:

2.5 = >10%

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44
Q

cavernous malformation

A

1% per year bleed
halo of small bleed around
50% brainstem
10% multiple

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45
Q

cavernous hemangioma on MRI

A

pocorn lesion

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46
Q

Loss of smell (syndromes 3; other diseases: 6)

A

1) Kallmann
2) Turner XO
3) Albinos

1) AD
2) PD
3) HD
4) Pick
5) Korsakow
6) MTLE

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47
Q

Dropped Head Camptocormia (9)

A

1) Polymyositis
2) inclusion body myositis
3) ALS
4) MG
5) Nemalin Rod Myopathy
6) local radiation
7) isolated neck extensor myopathy
8) PD
9) MSA

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48
Q

Respiratory Muscle involvement

A 
ALS
MG
Nemailn Myopaty
Pompe 
Mitochondrial
GBS
Truchinosis (Diaphragm)
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49
Q

Carotid Artery Stenosis - symptomatic

A

70-99% - CEA
70-99% - CEA > STENT

50-70 % - MAN: CEA > medical
50-70 % - women: medical > CEA

<50%: medical

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50
Q

Carotid Artery Stenosis - NON symptomatic

A

60-99% CEA in men only if Sx less than 3%

women: medical treatment always

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51
Q

Zidovudine myopathy vs

HIV myopathy

A

zidovudine: RRF

HIV myopathy: nemailne rod myopathy

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52
Q

Seizures in meningitis

A

Haemophilus influenzae

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53
Q

Blood in CSF in meningitis (5)

A

1) Anthrax meningitis
2) Hantavirus
3) Dengue Fever
4) Ebola
5) Amebic Meningoencephalitis

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54
Q

Recurrent Meningitis (5)

A

1) structural bacterial
2) EBV
3) Behcet
4) Mollaret HSV 1/2
5) Vogt Koyanagi Haradi: meningitis iridocyclitis depigmentation of hair

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55
Q

legionella meningitis CSF

A

normal

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56
Q

Cat scratch disease

A 
Bartonella henselae
adenopathy
encephalopathy
high fever
seizures
vasculitis in AIDS patients
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57
Q

Brucellosis meningitis typical features:

A

1) ICP with papiledema
2) meningoencephalitis
3) lymphocytic pleocytosis aseptic

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58
Q

Whipple disease features (6)

A

1) slowly progressive memory loss
2) ataxia
3) seizures
4) supranuclear ophthalmoplegia vertical
5) myoclonus (palatal)
6) myorhithmia oculomastoidal

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59
Q

aseptic meningitis
photophobia
conjunctival redness
hepatitis

what could it be?

A

Weill disease
Leptospira
rat urine

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60
Q

mucormycosis

A

fungal
in DM
nasal paranasal sinuses
hemorrhgaic infarcts

61
Q

genes in hereditary spastic paralegia HSP

A

1) spastin

2) Atlastin (before 10 y)

62
Q

juvenile onset ALS

A

ALS2 gene
slow progressive
anarthria dysphagia

63
Q

definition of PLS primary lateral sclerosis

A

ALS patient without any lower motor signs for 5 years

64
Q

SMA subtypes

A

1) Wernig Hoffmann Type I 50% SMN-1 early death
2) II and III Kugelberg Welander
in form III cramps typical

65
Q

Kennedy

A 
CAG repeat 
x linked 
androgen receptor
Gynecomastia
Oligospermia
testicular atrophy
66
Q

Spastic symptoms in other diseases

  • ataxia
  • leukodystrophy
A

1) SCA 1 bulbar and extrapyramidal
2) SCA 2 hypokinetic rigid slow saccades
3) SCA 3 Machado Joseph portugese pure spastic syndrome no ataxia but PD like ATAXIN 3

4) Friedreichs (GAA rpeat, AR)
5) Krabbe beta galaktosidase
6) MLD
7) ALD (x linked)
8) Bassen KOrnzweig
9) alpha tocopherol transferase deficiency

67
Q

differentiate plexopathy:

radiation vs tumor invasion

A

radiation:
from upper side
Myokimia
Painless

tumor invasion:
from lower side
Horner
painful

68
Q

Causes for posterior cord syndromes: (6)

A

1) B2
2) Cu deficiency
3) Folate def
4) HIV vacuolar
5) HTLV
6) syphilis

69
Q

B12 deficiency

A

1) cognitive, psychiatric
2) optic neuropaty
3) orthostatic hypotension
4) Axonal peripheral neuropathy
5) subacute combined degeneration (post and lat column)

Cobalamin low
Howell jolly bodies

(NO can mimmick!)

70
Q

cu deficiency (casues 3; signs 4)

A

causes: ZN ingestion; bariatric Sx, Celiac disease

1) anemia neutropenia
2) sensory ataxia
3) pyramidal signs
4) axonal PN

71
Q

Viral meningitis with low glucose (4)

A

1) Mumps
2) HSV-2
3) Lymphocytic choriomeningitis LCMV
4) VZV

72
Q

negri bodies

A

rabies

73
Q

acute anterior poliomyelitis (5)

A

1) Polio virus RNA
2) Coxackie virus
3) WNV
4) Japanese encephalitis
5) Echovirus 70 71 (hemorrhgaic conjunctivitis)

74
Q

Rasmussen

A

CMV

HSV1

75
Q

HIV neuropathy treatment

A

Lamotrigine

76
Q

tongue tremor (cause)

A

Mercury poisoning

and ataxia cerebellar syndrome
granular cell layer in cerebellum disappears
concentric constriction of visual field

77
Q

Lewy Body Dementia pathology

A

Lewy Bodies in cortex: ubiquitin and synuclein
no HALO like in PD!!!

no tangles or plaques

78
Q

Huntington disease facts

A

1) young onset patients inherited gene from FATHER
2) late onset patients from MOTHER
Chr. 4; CAG repeat, 11-34 normal
anticipation
caudate putamen atrophy
PET: caudate
small eurons in BG affected before bigger ones

memory spared
Blinking frequency increased
Tongue protrusions
slow eye movements slow pursuit
No volitional saccades possible

TX: Halidol NOT DOPA

79
Q

chorein gene

A

neuroacanthocytosis 9q

80
Q

Polyglycosan Body Disease

A

adult-onset AR
progressive neurogenic bladder
gait difficulties (i.e., spasticity and weakness) mixed upper and lower motor neuron
sensory loss predominantly in the distal lower extremities
cognitive difficulties (often executive dysfunction)

GBE1 glycogen brancher enzyme defect

81
Q

HD childhood begin:

A

Westphal variant: rigidity PD like

82
Q

PD genetic without Lewy Bodies

A

Park 2 parkin
Park 6 PINK1
Park 8 LRRK +/-

83
Q

genetic PD

A

sleep benefit
Dopa sensitive
early onset

84
Q

PArk 8 LRRK-2

A

no lewy bodies +/-
no tremor
jews

85
Q

parkin 6

A

PARK 2
50% of all young onset PD
no dementia
no Lewy Bodies

86
Q

von Economo

A

no tremor
depression
105 dopa resposnsive

87
Q

vocal cord palsy and PD?

A

MSA

also gray discoloration hands

88
Q

Segawa

A 
DYT 5
14q
hereditary dystonia
DOpa responsive
OCD
sleep benefit (like genetic PD)
first legs stiff falls
retrocollis
later PD
89
Q

DRPLA

A

dentatorubraopallidolusian Atrophy
Chr. 12
CAG repeat

Japan
ataxia
choreoathetosis
dystonia
PD
myoclonus
epilepsy 
dementia
90
Q

Hemiplegic ALS

A

MILLS VARIANT

91
Q

Dynactin

A

Bulbar ALS genetic variant DCTN

92
Q

Retinitis Pigmentosa (6)

A

1) Refsum Disease
2) Friedreichs
3) Cockayne
4) Bassen KOrnzweig
5) PEO
6) Kearns Sayre KSS

93
Q

SIADH causes (7)

A

1) trauma
2) meningitis
3) stroke
4) SAH
5) neuplasm
6) GBS
7) CBZ

94
Q

Delirium Tremens symptoms

A

Start 48-96 hours after last drink (2-3 days)
5% Mortality

Confusion
Delusion
Hallucinations
Tremor
Aggitation
Insomnia
Autonomic Features
Epileptic Seizures
Tachykardia
95
Q

Delirium Tremens Lab

A

Hypomagnesemia
Hypokalemia
PCo2 low
Ph Increased (Hyperventilation)

96
Q

Moyamoya

A

Surgical treatment is an option

97
Q

Vertebral artery dissection

A

no female preponderance (there is in Carotid Artery)

C1-2 most commmon

98
Q

carotid artery dissection

A

women
late 30/40s

fibromuscular disease
ehlers danlos
marfan
osteogenesis imperfecta
Loeys Dietz syndrome (TGF beta R mutation)
alpha 1 antitrypsin

MRI string sign

99
Q

Alzheimer Pathology

A

1) Neurofibrillary tangles: abnormaly phosphorylated tau; but also others: ubiquitin, cholinesterase, beta amyoid
pattern: layer II enthorhinal cortex, CA1, subicular hippocampus, amygdala, deep layers of neocortex III V VI
- –> correlates with degree and duration of dementia

2) Plaques: BetaA4, congo red; amyloid; periphery: microglial cells;
3) vascular amyloid deposits n the walls of vessels;

4) Granuluvacuolar Degenration: intraneuronal clusters of small vacuoles; basophillic granuels,
HIPPOCAMPUS CA1
nowhere else!

5) HIRANO BODIES: CA1 hippocampus rod like red structures: more common in the GUAM disease
6) SYnaptic loss
7) loss Ncl meynert and coeruleus

100
Q

GUAM

A

Amyotrophic lateral sclerosis/parkinsonism-dementia complex (lytico-bodig)

severe cortical atrophy
neurofibrillary tangles
depopulation of substantia nigra
NO LEWY BODIES
NO AMYLOID PLAQUES

but yes, tangles neurofibrillary tangles yes

101
Q

MS pathology

A

plaques: periventricular; subependymal veins line the ventricles;
spinal cord: where pial veins lie in white matter
optic nerve and chiasma (not optic tract)

102
Q

Vertebral artery dissection

A

no female preponderance (there is in Carotid Artery)

C1-2 most commmon

103
Q

carotid artery dissection

A

women
late 30/40s

fibromuscular disease
ehlers danlos
marfan
osteogenesis imperfecta
Loeys Dietz syndrome (TGF beta R mutation)
alpha 1 antitrypsin

MRI string sign

104
Q

Alzheimer Pathology

A

1) Neurofibrillary tangles: abnormaly phosphorylated tau; but also others: ubiquitin, cholinesterase, beta amyoid
pattern: layer II enthorhinal cortex, CA1, subicular hippocampus, amygdala, deep layers of neocortex III V VI
- –> correlates with degree and duration of dementia

2) Plaques: BetaA4, congo red; amyloid; periphery: microglial cells;
3) vascular amyloid deposits n the walls of vessels;

4) Granuluvacuolar Degenration: intraneuronal clusters of small vacuoles; basophillic granuels,
HIPPOCAMPUS CA1
nowhere else!

5) HIRANO BODIES: CA1 hippocampus rod like red structures: more common in the GUAM disease
6) SYnaptic loss

105
Q

GUAM

A

Amyotrophic lateral sclerosis/parkinsonism-dementia complex (lytico-bodig)

severe cortical atrophy
neurofibrillary tangles
depopulation of substantia nigra
NO LEWY BODIES
NO AMYLOID PLAQUES

but yes, tangles neurofibrillary tangles yes

106
Q

MS pathology

A

plaques: periventricular; subependymal veins line the ventricles;
spinal cord: where pial veins lie in white matter
optic nerve and chiasma (not optic tract)

107
Q

EEG smooth chandelier cells

A

IPSP in duperfisciel layers

108
Q

Deep pyramidal cells EEG

A

EPSP superfiscial

109
Q

Vertx sharp wave

A

onset of sleep, children

110
Q

Lambda waves

A

during reading, saccades, positive large wave

111
Q

BETS

A

beningn epileptiform transients of sleep

112
Q

WEBINO

A

wall-eyed bilateral internuclear ophthalmoplegia (WEBINO)

113
Q

Sulpiride

A

Modal

114
Q

Essential Tremor Treatment options

A

1) Propranolol Beta blocker
2) Primidone, Gabapentin, Topiramate
3) Alcohol
4) Benzodiazepine
5) Botox splenius capitis muscles

115
Q

TIA Differential Diagnosis

A 
Seizures
Migraine
TGAs
Meningioma
GBM
Metastasic brain tumors
Subdural hematoma
116
Q

NMO pathology

A

demyelination
necrotic and infiltrated with neutrophils and eosinophils
Complement and immunoglobulin deposits of types IgM and IgG

MS: upregulation of AQP4
NMO: Loss

117
Q

Park 2

A

Parkin 6 :

no dementia and no Lewy Bodies

118
Q

MSA: nucleus without pathology?

A

Red Nucleus

119
Q

Lathyrism

A

pyramidal pattern of motor weakness combined with greatly increased tone in the thigh extensors and adductors and in the gastrocnemius muscles so that the more severely affected walk on the balls of their feet with a lurching scissoring gait. Extensor plantar responses are uniformly present in such cases, and the knee and ankle tendon reflexes are exaggerated and often clonic.

neurotoxin ODAP

Grasspea

120
Q

Entacapone Side effects

A

Diarrhea 5%
Decoloration of Urine
increases Area under the Curve AUC

121
Q

Epinephrine effect:

A

1) Increases systolic pressure
2) beta receptors: vasodilatation
beta block: vasocostriction

122
Q

Treatment without Biopsy in Brain tumor? which one?

A

Brainstem Glioma

123
Q

MGMT

A

Malignant gliomas: have a repair Gene called MGMT

If MGMT is methylated, chemotherapy response much better

124
Q

Entacapone Side effects

A

Diarrhea 5%
Decoloration of Urine
increases Area under the Curve AUC

125
Q

Epinephrine effect:

A

1) Increases systolic pressure
2) beta receptors: vasodilatation
beta block: vasocostriction

126
Q

Treatment without Biopsy in Brain tumor? which one?

A

Brainstem Glioma

127
Q

MGMT

A

Malignant gliomas: have a repair Gene called MGMT

If MGMT is methylated, chemotherapy response much better

128
Q

VPA

A

Na, GABA

129
Q

Keppra

A

SV2A Block

130
Q

LTG

A

Na

131
Q

Topiramate

A

Na, GABAa, AMPA, KAINATE, Calcium

132
Q

Felbamate

A

Hepatotoxic

NMDA R antagonist

133
Q

Antiepileptic leading to Leukopenia:

A

1) CBZ
2) PHT
3) VPA

134
Q

Depression and EPilepsy. Which treatment?:

A

VPA
CBZ

don’t give KEPPRA, TOPAMAX, VGB, Benzos

135
Q

Epilepsy and Porphyria: which drugs are ok?

A

Keppra

LTG

136
Q

Antiepileptics which induce liver enzymes:

A

PHT
CBZ
Barbiturate

NOT VPA

Topiramate Enzyme nducer if above 200mg

137
Q

Pro Osteoporotic

A

CBZ
Phenytoin
Barbiturates
VPA

all reduce testosterone and increase cholesterole

138
Q

VPA

A

Na, GABA

139
Q

Keppra

A

SV2A Block

140
Q

LTG

A

Na

141
Q

Topiramate

A

Na, GABAa, AMPA, KAINATE, Calcium

142
Q

Felbamate

A

Hepatotoxic

NMDA R antagonist

143
Q

Antiepileptic leading to Leukopenia:

A

1) CBZ
2) PHT
3) VPA

144
Q

Depression and EPilepsy. Which treatment?:

A

VPA
CBZ

don’t give KEPPRA, TOPAMAX, VGB, Benzos

145
Q

Epilepsy and Porphyria: which drugs are ok?

A

Keppra

LTG

146
Q

Antiepileptics which induce liver enzymes:

A

PHT
CBZ
Barbiturate

NOT VPA

Topiramate Enzyme nducer if above 200mg

147
Q

Pro Osteoporotic

A

CBZ
Phenytoin
Barbiturates
VPA

all reduce testosterone and increase cholesterole

148
Q

Cyp2c19

A

Decreased clopidogrel metabolism

Neurology (7 decks)

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