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UWORLD-STEP2 (BA) > IM-Neuro > Flashcards

IM-Neuro Flashcards

1
Q

Unilateral Medial longitudinal fascicles (MLF) can occur with lacunar stroke in the pontine artery distribution however, bilateral lesions usually happen in

A

Multiple sclerosis

Internuclear opthalmonplegia

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2
Q

Afferent pupillary defect
“wash out” color vision
Eye pain with movement
Monocular vision loss with central scotoma

A

Optic neuritis

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3
Q

Fever >40C (104F), confusion, muscle rigidity, autonomic instability. Dx? Cause? Tx?

A
  • Neuroleptic malignant syndrome
  • Idiosyncratic drug reaction to dopamine antagonist medications (common is 1st generation antipsychotic, haloperidol)
  • Stop the causative agent, dantrolene
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4
Q

Tetrad of Neuroleptic malignant syndrome (NMS)

A
  • Mental status change
  • rigidity
  • fever
  • autonomic dysregulation
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5
Q

The 4 common areas of the brain that Hypertensive intracranial hemorrhages occurs

A

Basal ganglia
Thalamus
pons
cerebellum

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6
Q 
Paresthesis, neuropathic pain
Symmetric, ascending weakness
Decreased/asending deep-tendon reflexes
autonomic dysfunction
respiratory compromise
Dx? Cause? Tx (2)?
A
  • Guillain-Barre Syndrome
  • Preceding GI (Campylobacter) or respiratory infection (HHV, mycoplasma and H. Influenzae)
  • IVIG or Plasmapheresis
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7
Q

Diagnostic for Guillain Barre syndrome (2)

A
  • CSF: Increased protein, Normal leukocytes

- EMG and nerve conduction

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8
Q

The most common symptom of Brain tumor is a dull headache associated with >/= 1 of the 3

A
  • N/V
  • FND
  • Symptoms worsening during the night or with portions that raise ICP (bending, coughing)
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9
Q

Pt with high-grade carotid stenosis (70-99%) should be considered for

A

Endarterectomy to reduce future stroke risk

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10
Q

Rapidly progressive dementia
myoclonus
sharp, triphasic, synchronous discharges
Dx? Cause?

A

Creutzfeldt-Jakob disease

A spongiform encephalopathy caused by Prion

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11
Q

Classic triad of

  • Fever
  • Focal/severe back pain
  • Neurologic findings
A

Spinal epidural abscess

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12
Q

How to diagnose Spinal epidural abscess (3)

A
  • Increased ESR
  • Blood and aspirate cultures
  • MRI of the spine
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13
Q

Tx for Spinal epidural abscess

A
  • Broad-spectrum antibiotics (Vancomycin + Ceftriaxone)

- Aspiration and surgical decompressions

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14
Q

The most common causative organism for Spinal epidural abscess

A

Staphylococcus Aureus

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15
Q

Ddx of demential subtypes (6)

A
  • Alzheimer disease
  • Vascular dementia
  • Frontotemporal dementia (Picks disease)
  • Demential with Lewy bodies
  • Normal pressure hydrocephalus (NPH)
  • Prion disease
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16
Q
  • early, insidious short-term memory loss
  • Language deficits and spatial disorientation
  • Later personality changes
A

Alzheimer disease

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17
Q
  • Stepwise decline
  • early executive dysfunction
  • Cerebral infarction and/or deep white matter changes on neuroimaging
A

Vascular dementia

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18
Q
  • Early personality changes
  • Apathy, disinhibition and compulsive behavior
  • Frontotemporal atrophy on neuroimaging
A

Frontotemporal dementia (Picks disease)

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19
Q
  • Visual hallucinations
  • Spontaneous parkinsonism
  • Fluctuating cognition
A

Dementia with Lewy bodies

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20
Q
  • Ataxia early in disease
  • Urinary incontinence
  • dilated ventricles on neuroimaging
A

Normal pressure hydrocephalus (NPH)

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21
Q
  • Behavioral changes
  • Rapid progression
  • Myoclonus &/or seizures
A

Prion disease

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22
Q
  • Parkinsonism
  • Autonomic dysfunction
  • Widespread neurological signs (Cerebellar, pyramidal or LMN)
A

Multiple system atrophy (Shy-Drager syndrome)

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23
Q

Postural hypotension, abnormal sweating, disturbance of bowel or bladder control, abnormal salivation or lacrimation, impotence, gastroparesis…) are called

A

Autonomic dysfunction

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24
Q

Pt with parkinsonism experiences orthostatic hypotension, impotence, incontinence or other autonomic symptoms

A

multiple system atrophy (Shy-Drager syndrome)

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25
Q

CSF WBC count? Glucose? Protein?

Normal=

A

WBC count= 0-5
Glucose= 40-70
Protein= <40

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26
Q

CSF WBC count? Glucose? Protein?

Bacterial meningitis

A

WBC count= >1,000
Glucose= <40
Protein= >250

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27
Q

CSF WBC count? Glucose? Protein?

TB meningitis

A

WBC count=100-500
Glucose= <45
Protein= 100-500

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28
Q

CSF WBC count? Glucose? Protein?

Viral meningitis

A

WBC = 10-500
Glucose=40-70(normal)
Protein= <150

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29
Q

CSF WBC count? Glucose? Protein?

Guillain-Barre

A 
WBC= 0-5 (normal)
Glucose= 40-50 (normal)
Protein= 45-1,000
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30
Q

Common chemotherapy drugs causing sensory neuropathy that spears in a stocking-glove pattern ( 3 classes)

A
  • Platinum-based (Cisplatin)
  • Taxanes (paclitaxel)
  • Vinca alkaloids (Vincristine)
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31
Q

What function is affected in Diabetic neuropathy (3)

A
  • Feeling of imbalance (due to nerves that control proprioception involvement)
  • Numbness and tingling
  • Motor symptoms (late manifestation- involved LMN)
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32
Q

How do you treat ischemic stroke on a young IV drug user patient how is running a fever? What is the cause?

A
  • Antibiotics

since the cause is bacterial endocarditis with acute cardioemoblic stroke

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33
Q

Secondary causes for Restless leg syndrome (7)

A
  • Iron deficiency anemia
  • Uremia (ESRD, CKD)
  • Diabetes mellitus
  • Multiple Sclerosis
  • Parkinson disease
  • Pregnancy
  • Drugs (antidepressants, Metoclopramide)
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34
Q

How do you use to treat restless leg syndrome (2)

A
  • 1st line-Dopamine agonists (pramipexole)

- alternative- Alpha-2-delta calcium channel ligands (gabapentin enacarbil)

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35
Q

Exertional heat stroke (EHS) is small spectrum as heat exhaustion with a body temp >40c (104) but is characterized in addition by

A

Central nervous system dysfunction (confusion, irritability and seizures)

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36
Q

How do you manage Exertional heat stroke (4)

A
  • Rapid cooling (ice water immersion)
  • Fluid resuscitation
  • Electrolyte correction
  • Management of end-organ complication
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37
Q

What end-organ complication can happened from Exertional heat stroke? (4)

A
  • Renal failure
  • Hepatic Failure
  • DIC
  • ARDS
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38
Q
  • Ipsilateral hemiparesis
  • ipsilateral dimminisedh proprioception, vibratory sensation and light touch
  • Contralateral diminished pain and temp
A

Hemisection of the spinal cord - Brown-Sequard syndrome

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39
Q

Pt with hand tremors and increased resistance has eye circus-cornea infection with a dilated and sluggish pupils , what is the diagnosis and the cause?

A

Acute-closure glaucoma

- Anticholinergic drug (Trihexyphenidyl) used for treatment of parkinson disease

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40
Q

Weakness in Myasthenia gravis can be exacerbated by various factors including

A
  • Medication (amino glycoside, mg, BB, neuromuscular blocking agents)
  • Surgery (Thymecotomy)
  • Pregnancy
  • infections
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41
Q

What beside test can be done for Myasthenia gravis and its mechanism?

A

Ice pack test to the eyelids

- Cold temp improves muscle strength by inhibiting the breakdown of acetylcholine at the neuromuscular junction

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42
Q

How do you treat pt with car accident who is experiencing pain but also a history of illicit drug on methadone rehab program?

A

Treat with narcotic (morphine IV) like any one with pain

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43
Q

The two common organisms the cause a single brain abscess, with Brain CT/MRI showing first cerebrates then infection consolidation to a ring-enhancing lesion with central necrosis

A
  • Staph aureus

- Viridians strep

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44
Q

Is it multiple or single lesion on MRI for cerebral toxoplasmosis ring0enhancing lesions?

A

Multiple ring-enhancing lesions

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45
Q

focal dystonia involving the sternocleidomastoid muscle

A

Torticollis

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46
Q

Sustained muscle contraction resulting in twisting, repetitive movements, or abnormal postures

A

Dystonia

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47
Q

Depression-related cognitive impairment in elderly pt can appear like

A

Dementia

Treat them with antidepressant and/or psychotherapy

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48
Q

The strongest association with both ischemic and hemorrhagic stroke? and reason?

A
  • Hypertension
  • Elevated shearing force on the intracerebral vascular endothelium, causing atherosclerotic process and promotes thrombi formation
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49
Q

Weakness on the lower extremities, fatigue and muscle cramps on patient that is on Thyrochlorthiazide and metoprolol

A

electrolyte imbalance (hypokalemia)

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50
Q

EKG changes with hypokalemia (3)

A
  • U waves
  • Flat and broad T waves
  • PVC beats
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51
Q

Rapidly progressive ascending paralysis
absence of fever and sensory abnormalities
normal CSF examination

A

Tick-borne paralysis

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52
Q

right-sided weakness and speech difficulty (broca’s lesion), with difficulty writing and repeating (expressive aphasia)
Location of lesion? Artery affected?

A
  • Dominant (left-hemisphere) frontal lobe

- Left MCA

53
Q 
Sparse and confluent speech
Preserved comprehension
Impaired repetition
Right hemiparesis (face and Upper limb) 
Aphasia syndrome ?
A

Broca aphasia

54
Q 
Fluent and voluminous but lacks meaning
Greatly diminished comprehension
Impaired repetition
Right superior visual field defect
Aphasia syndrome ?
A

Wernicke aphasia

55
Q

Fluent with phonemic errors
Preserved comprehension
very poor repetition
Aphasia syndrome ?

A

Conduction aphasia

56
Q

Headaches that are worst in the morning are mostly related to

A

increased ICP

57
Q

Young woman with frequent morning headache worst with head movement . Dx?

A

Idiopathic intracranial hypertension (pseudotumor cerebri)

58
Q

The site of hemorrhage for neurological findings:-

  • Contralateral hemiparesis & hemisensory loss
  • Homonymous hemianopsia
  • Gaze palsy
A

Basal ganglia (putamen)

59
Q

The site of hemorrhage for neurological findings:-

  • Usually NO hemiparesis
  • Facial weakness
  • Ataxia and nystagmus
  • Occipital headache and neck stiffness
A

Cerebellum

60
Q

The site of hemorrhage for neurological findings:-

  • Contralateral hemiparesis and hemisensory loss
  • Nonreactive biotic pupils
  • Upgaze palsy
  • Eyes deviate Toward hemiparesis
A

Thalamus

61
Q

The site of hemorrhage for neurological findings:-

  • Contralateral hemiparesis (frontal lobe)
  • Contralateral hemisensory loss (parietal lobe)
  • Eyes deviate away from hemiparesis
  • High incidence of seizures
A

Cerebral lobe

62
Q

The site of hemorrhage for neurological findings:-

  • Deep coma & total paralysis within mins
  • Pinpoint reactive pupils
A

Pons

63
Q

Hypertensive hemorrhages involve small penetrating arteries that affect locations

A
  • basal ganglia (putamen)
  • Cerebellar nuclei
  • Thalamus
  • Pons
64
Q

The 3 things caused by internal capsule affected by putaminal hemorrhage

A
  • Contralateral hemiparesis
  • Contralateral Hemianesthesia
  • Conjugate gaze deviations toward the side of the lesion
65
Q

Ignoring the left side of a space ? what part of the brain is involved?

A
  • Hemi-neglect sydnrome

- Right (non-dominant) parietal lobe

66
Q

Triad of:
Encephalopathy
Ocular dysfunction
Gain ataxia

A

Wernike encephalopathy

67
Q

Wernike encephalopathy Tx:

A

Thaiamine before or with IV fluids with glucose

68
Q

Triad of:
Gain disturbance
dementia
urinary incontinence

A

NPH (Normal pressure hydrocephalus)

69
Q

The only approved medication for ALS and its’ mechanism of action

A

-Riluzole

Glutamate inhibitor

70
Q

The best test to rule in or out Vit B 12 deficiency

A

Methylmalonic acid (MMA)

71
Q

Damage to descending corticosipinal tracts in spinal cord compression (SCC) S & S (2)

A
  • LE weakness

- Loss of Rectal tone

72
Q

Damage to Ascending sensory spinothalamic tracts in spinal cord compression (SCC) S & S

A
  • loss of sensation two level below the level of lesion
73
Q

Damage to Descending automatics in the reticulospinal tract in Spinal cord compression (SCC) S & S (3)

A
  • Urinary retention
  • Bladder flaccidity
  • Bladder shock
74
Q 
Sudden-onset severe back pain
Perianal hypo/anesthesia
Symmetric motor weakness
Hyperreflexia
Early-onset bowel and bladder dysfunction
A

Conus medullaris syndrome

75
Q 
Usually bilateral, sever radicular pain
Saddle hypo/anesthesia 
Asymmetric motor weakness
Hyporeflexia/areflexia 
Late-onset bowel and bladder dysfunction
A

Cauda equina syndrome

76
Q

Proximal muscle weakness
Autonomic dysfunction (Dry mouth…)
Cranial nerve involvement (ptosis…)
Diminished or absent deep-tendon reflexes

A

Lambert-Eaton syndrome

77
Q

Fluctuating muscle weakness
Ocular (ptosis, diplopia)
Bulbar (dysphagia, dysarthria)
Facial, neck and limb muscles

A

Myasthenia garvis

78
Q
  • Symmetrical and more proximal muscle weakness
  • Interstitial lung disease, esophageal dysmotitly, raynaud phenomenon
  • polyarthritis
  • Esophageal dysmotitlity
  • Skin findings (Gottron papules, heliotrope rash)
A

Dermatomyosities (skin findings)

Polymysoties

79
Q

27, headaches, N/V, Elevated CSF pressure, normal neuroimaging

A

Pseudotumor cerebri - Benign intracranial hyprtension

80
Q

Severe headache
bilateral periorbital edema
CN III, IV, V and VI deficiets

A

Cavernous sinus thrombosis

81
Q

Situational syncope is triggered by (3)

A

cough, micturition, defecation

82
Q

Vasovagal or neurally mediated syncope is triggered by (3) and what are the prodromal symptoms (3)

A
  • Prolonged standing, emotional distress and painful stimuli

- Nausea, warmth, diaphoresis

83
Q

The most common cause of CN III palsy in adults is ___ and due to ____

A

Ischemic neuropathy

poorly controlled diabetes mellitus

84
Q

Small penetrating artery occlusion due to hypertensive arteriolar sclerosis

A

Lacunar stroke

85
Q

Which area of the brain is affected by lacunar stroke? (3)

A
  • basal ganglia
  • Subcortical white matter (internal capsul, corona radiata)
  • Pons
86
Q

Risk factors for Lacunar stroke (5)

A
  • Hypertension #1
  • DM
  • Advanced age
  • Elevated LDL
  • Smoking
87
Q

Pure motor hemiparesis
Pure sensory stroke
Ataxic hemiparesis
Dysarthria-clumsy hand

A

-Lacunar stroke

88
Q

Complication of SAH in 24hrs?

A

rebleeding

89
Q

Complication of SAH in 3 days

A

Vasospasm

90
Q

Complication of SAH giving hyponatremia

A

SIADH secretion

91
Q

Brain tumors found in grey-white matter junctions are

A

metastatic brain tumors

92
Q

areflexic weakness in upper extremities and dissociated sensory loss following a “cape” distribution

A

Syringomyelia

93
Q

What disease is associated with Syringomyelia

A

Arnoid Chiari malformation type 1

94
Q

Monocular painless acute vision loss

A

Central retinal artery occlusion due to embolized atherosclerotic plaque form ipsilateral carotid artery

95
Q
  • Acute confusion
  • Temp >40c
  • Tachycardia
  • coagulopathic bleeding after heavy work under direct sunlight
A

Exertional heat stroke

96
Q

Worsening tremor with finger-to-nose testing, and when arms are stretched. Dx? Tx?

A

Essential tremor

Propranolol

97
Q

Antibodies against nicotinic receptors on the motor endplate found, NSIM?

A

CT scan of the chest (thymoma search :)

98
Q

-Encephalopathy
-Oculomotor dysfunction
-Postural and gait ataxia
Dx? Tx?

A

Wernicke encephalopathy

IV Thiamine followed by glucose infusion

99
Q

What are the Oculomotor dysfunction in Wernicke encephalopathy? (2)

A

Horizontal nystagmus

bilateral abducent palsy

100
Q

what is one symptom that Wernicke encephalopathy has but not pt with cobalamin (Vit B12) deficiency don’t have

A

Occulomotor symptoms (are unusual for Vit B12 deficiency )

101
Q 
Uncontrolled HTN
Occipital headache
neck stiffness
N/V
Nystagmus
Ipsilateral hemiataxia
(No hemiparesis or sensory loss)
Dx? NSIM>
A

Spontanous cerebellar hemorrhage

-CT scan of the head w/o contrast and emergent surgical decompression

102
Q

When do you discontinue Phenytoin in pt with hx of unprovoked seizure

A
  • No seizure for >2 years

- slowly tapered down

103
Q

Ischemic stroke symptoms within 3-4.5 hours ,Tx?

A

IV tPA

104
Q

Ischemic Stroke with no prior antiplatelet therapy, Tx?

A

Aspirin

105
Q

Ischemic Stroke with on antiplatelet therapy, Tx?

A

Add dipyridamole OR clopidogrel (on the top of Asprin)

106
Q

Ischemic Stroke with a-Fib, Tx?

A

Long-term anticoagulation (Warfarin, Dabigatran, rivaroxaban (Xarelto) or Apixaban (Eliquis)

107
Q

Ischemic Stroke with large anterior circulation artery occlusion within 24hrs of symptom onset, Tx (2 step)?

A

Thrombectomy (regardless if pt received tPA)

then aspirin

108
Q

Patient with intracranial large-artery atherosclerosis, Tx(2 step)?

A
  • Aspirin + clopidogrel for 90 days

- Then Aspirin

109
Q

Unilateral motor impairment, where is the lesion?

A

Posterior limb of internal capsule (lacunar infarct)

110
Q

Contralateral somatosensory and motor deficit (Face, arm and leg), where is the lesion?

A

MCA

111
Q

Contralateral somatosensory & motor deficit predominantly in LE, where is the lesion?

A

ACA

112
Q

Alteranate syndromes with contralateral hemiplegia & ipsilateral cranial nerve involvement, possible ataxia, where is the lesion?

A

Verterbrobasilar symptom lesion (supplying the brain stem)

113
Q

Conjugate eye deviation toward the side of infarct and homonymous hemianopia, where is the lesion?

A

MCA

114
Q

Aphasia (dominant hemispheres)

Hemineglect (nondominant hemisphere) where is the lesion?

A

MCA

115
Q

-Sensory ataxia
-Lancinating pains (sharp, stabbing pain. back & lower limbs)
-Neurogenic urinary incontinence
-Miotic and irregular pupils with no constriction to light but normal with accommodation
Dx? Tx?

A
  • Tabes dorsalis

- IV Penicillin

116
Q

Miotic and irregular pupils with normal constriction with accommodation but not with light, Name? Dx? Cause?

A
  • Argyll Robertson Pupils
  • Tabes dorsalis
  • Treponema pallidum (Syphillus)
117
Q

1st line of treatment for Idiopathic intracranial hypertension (2)

A

Acetazolamide +/- Furosemide

118
Q

The 4 sellar masses that are benign

A

Pituitary adenoma
Craniopharyngioma
Meningioma
Pituicytoma (low grade glioma)

119
Q

The 4 sellar masses that are malignant

A 
Primary 
- germ cell tumors
-chordoma
-lymphoma
Metastatic (breast, lung)
120
Q

Presentation in sellar mass (3)

A
  • Visual defects (bitemporal blindness-optic chiasm)
  • headache
  • Pituitary hormonal deficiencies
121
Q

1st line of tx for fibromyalgia (2)

A

aerobic exercise

good sleep hygine

122
Q

2nd line of tx for fibromyalgia

A

Tricyclic antidepressants (amitriptyline)

123
Q

Cancer pain management for mild pain (2)

A
  • Acetaminophen

- NSAIDs

124
Q

Cancer pain management for moderate pain (3)

A
  • Codeine
  • Hydrocodone
  • Tramadol
125
Q

Cancer pain management for severe pain (2)

A

Strong short-acting opioids

  • Morphine
  • Hydromorphone
126
Q

Cancer pain management for severe pain that is not controlled by short-acting opioids only (2)

A

Add long-acting opioids (calculate total daily dose and convert to long-acting formulation)

  • Fentanyl patch
  • Oxycodone
127
Q

The main differences between Parkinson and Lewy bodies on cognitive function & dementia is ?

A

-Dementia appears early in Lewy body

Late in Parkinson disease

128
Q
  • Bilateral hemiparesis
  • diminished bilateral pian and temp sensation
  • Intact bilateral proprioception, vibration sensation and light touch
A

Anterior cord syndrome

129
Q

Tx for a myasthenic crisis (3) on the top of intubation

A
  • Plasmapheresis
  • IVIG
  • Corticosteroids

UWORLD-STEP2 (BA) (19 decks)

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