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
2
Q
Afferent pupillary defect
“wash out” color vision
Eye pain with movement
Monocular vision loss with central scotoma
A
Optic neuritis
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
4
Q
Tetrad of Neuroleptic malignant syndrome (NMS)
A
- Mental status change
- rigidity
- fever
- autonomic dysregulation
5
Q
The 4 common areas of the brain that Hypertensive intracranial hemorrhages occurs
A
Basal ganglia
Thalamus
pons
cerebellum
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
7
Q
Diagnostic for Guillain Barre syndrome (2)
A
- CSF: Increased protein, Normal leukocytes
- EMG and nerve conduction
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)
9
Q
Pt with high-grade carotid stenosis (70-99%) should be considered for
A
Endarterectomy to reduce future stroke risk
10
Q
Rapidly progressive dementia
myoclonus
sharp, triphasic, synchronous discharges
Dx? Cause?
A
Creutzfeldt-Jakob disease
A spongiform encephalopathy caused by Prion
11
Q
Classic triad of
- Fever
- Focal/severe back pain
- Neurologic findings
A
Spinal epidural abscess
12
Q
How to diagnose Spinal epidural abscess (3)
A
- Increased ESR
- Blood and aspirate cultures
- MRI of the spine
13
Q
Tx for Spinal epidural abscess
A
- Broad-spectrum antibiotics (Vancomycin + Ceftriaxone)
- Aspiration and surgical decompressions
14
Q
The most common causative organism for Spinal epidural abscess
A
Staphylococcus Aureus
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
16
Q
- early, insidious short-term memory loss
- Language deficits and spatial disorientation
- Later personality changes
A
Alzheimer disease
17
Q
- Stepwise decline
- early executive dysfunction
- Cerebral infarction and/or deep white matter changes on neuroimaging
A
Vascular dementia
18
Q
- Early personality changes
- Apathy, disinhibition and compulsive behavior
- Frontotemporal atrophy on neuroimaging
A
Frontotemporal dementia (Picks disease)
19
Q
- Visual hallucinations
- Spontaneous parkinsonism
- Fluctuating cognition
A
Dementia with Lewy bodies
20
Q
- Ataxia early in disease
- Urinary incontinence
- dilated ventricles on neuroimaging
A
Normal pressure hydrocephalus (NPH)
21
Q
- Behavioral changes
- Rapid progression
- Myoclonus &/or seizures
A
Prion disease
22
Q
- Parkinsonism
- Autonomic dysfunction
- Widespread neurological signs (Cerebellar, pyramidal or LMN)
A
Multiple system atrophy (Shy-Drager syndrome)
23
Q
Postural hypotension, abnormal sweating, disturbance of bowel or bladder control, abnormal salivation or lacrimation, impotence, gastroparesis…) are called
A
Autonomic dysfunction
24
Q
Pt with parkinsonism experiences orthostatic hypotension, impotence, incontinence or other autonomic symptoms
A
multiple system atrophy (Shy-Drager syndrome)
25
CSF WBC count? Glucose? Protein?
| Normal=
WBC count= 0-5
Glucose= 40-70
Protein= <40
26
CSF WBC count? Glucose? Protein?
| Bacterial meningitis
WBC count= >1,000
Glucose= <40
Protein= >250
27
CSF WBC count? Glucose? Protein?
| TB meningitis
WBC count=100-500
Glucose= <45
Protein= 100-500
28
CSF WBC count? Glucose? Protein?
| Viral meningitis
WBC = 10-500
Glucose=40-70(normal)
Protein= <150
29
CSF WBC count? Glucose? Protein?
| Guillain-Barre
```
WBC= 0-5 (normal)
Glucose= 40-50 (normal)
Protein= 45-1,000
```
30
Common chemotherapy drugs causing sensory neuropathy that spears in a stocking-glove pattern ( 3 classes)
- Platinum-based (Cisplatin)
- Taxanes (paclitaxel)
- Vinca alkaloids (Vincristine)
31
What function is affected in Diabetic neuropathy (3)
- Feeling of imbalance (due to nerves that control proprioception involvement)
- Numbness and tingling
- Motor symptoms (late manifestation- involved LMN)
32
How do you treat ischemic stroke on a young IV drug user patient how is running a fever? What is the cause?
- Antibiotics
| since the cause is bacterial endocarditis with acute cardioemoblic stroke
33
Secondary causes for Restless leg syndrome (7)
- Iron deficiency anemia
- Uremia (ESRD, CKD)
- Diabetes mellitus
- Multiple Sclerosis
- Parkinson disease
- Pregnancy
- Drugs (antidepressants, Metoclopramide)
34
How do you use to treat restless leg syndrome (2)
- 1st line-Dopamine agonists (pramipexole)
| - alternative- Alpha-2-delta calcium channel ligands (gabapentin enacarbil)
35
Exertional heat stroke (EHS) is small spectrum as heat exhaustion with a body temp >40c (104) but is characterized in addition by
Central nervous system dysfunction (confusion, irritability and seizures)
36
How do you manage Exertional heat stroke (4)
- Rapid cooling (ice water immersion)
- Fluid resuscitation
- Electrolyte correction
- Management of end-organ complication
37
What end-organ complication can happened from Exertional heat stroke? (4)
- Renal failure
- Hepatic Failure
- DIC
- ARDS
38
- Ipsilateral hemiparesis
- ipsilateral dimminisedh proprioception, vibratory sensation and light touch
- Contralateral diminished pain and temp
Hemisection of the spinal cord - Brown-Sequard syndrome
39
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?
Acute-closure glaucoma
| - Anticholinergic drug (Trihexyphenidyl) used for treatment of parkinson disease
40
Weakness in Myasthenia gravis can be exacerbated by various factors including
- Medication (amino glycoside, mg, BB, neuromuscular blocking agents)
- Surgery (Thymecotomy)
- Pregnancy
- infections
41
What beside test can be done for Myasthenia gravis and its mechanism?
Ice pack test to the eyelids
| - Cold temp improves muscle strength by inhibiting the breakdown of acetylcholine at the neuromuscular junction
42
How do you treat pt with car accident who is experiencing pain but also a history of illicit drug on methadone rehab program?
Treat with narcotic (morphine IV) like any one with pain
43
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
- Staph aureus
| - Viridians strep
44
Is it multiple or single lesion on MRI for cerebral toxoplasmosis ring0enhancing lesions?
Multiple ring-enhancing lesions
45
focal dystonia involving the sternocleidomastoid muscle
Torticollis
46
Sustained muscle contraction resulting in twisting, repetitive movements, or abnormal postures
Dystonia
47
Depression-related cognitive impairment in elderly pt can appear like
Dementia
| Treat them with antidepressant and/or psychotherapy
48
The strongest association with both ischemic and hemorrhagic stroke? and reason?
- Hypertension
- Elevated shearing force on the intracerebral vascular endothelium, causing atherosclerotic process and promotes thrombi formation
49
Weakness on the lower extremities, fatigue and muscle cramps on patient that is on Thyrochlorthiazide and metoprolol
electrolyte imbalance (hypokalemia)
50
EKG changes with hypokalemia (3)
- U waves
- Flat and broad T waves
- PVC beats
51
Rapidly progressive ascending paralysis
absence of fever and sensory abnormalities
normal CSF examination
Tick-borne paralysis
52
right-sided weakness and speech difficulty (broca's lesion), with difficulty writing and repeating (expressive aphasia)
Location of lesion? Artery affected?
- Dominant (left-hemisphere) frontal lobe
| - Left MCA
53
```
Sparse and confluent speech
Preserved comprehension
Impaired repetition
Right hemiparesis (face and Upper limb)
Aphasia syndrome ?
```
Broca aphasia
54
```
Fluent and voluminous but lacks meaning
Greatly diminished comprehension
Impaired repetition
Right superior visual field defect
Aphasia syndrome ?
```
Wernicke aphasia
55
Fluent with phonemic errors
Preserved comprehension
very poor repetition
Aphasia syndrome ?
Conduction aphasia
56
Headaches that are worst in the morning are mostly related to
increased ICP
57
Young woman with frequent morning headache worst with head movement . Dx?
Idiopathic intracranial hypertension (pseudotumor cerebri)
58
The site of hemorrhage for neurological findings:-
- Contralateral hemiparesis & hemisensory loss
- Homonymous hemianopsia
- Gaze palsy
Basal ganglia (putamen)
59
The site of hemorrhage for neurological findings:-
- Usually NO hemiparesis
- Facial weakness
- Ataxia and nystagmus
- Occipital headache and neck stiffness
Cerebellum
60
The site of hemorrhage for neurological findings:-
- Contralateral hemiparesis and hemisensory loss
- Nonreactive biotic pupils
- Upgaze palsy
- Eyes deviate Toward hemiparesis
Thalamus
61
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
Cerebral lobe
62
The site of hemorrhage for neurological findings:-
- Deep coma & total paralysis within mins
- Pinpoint reactive pupils
Pons
63
Hypertensive hemorrhages involve small penetrating arteries that affect locations
- basal ganglia (putamen)
- Cerebellar nuclei
- Thalamus
- Pons
64
The 3 things caused by internal capsule affected by putaminal hemorrhage
- Contralateral hemiparesis
- Contralateral Hemianesthesia
- Conjugate gaze deviations toward the side of the lesion
65
Ignoring the left side of a space ? what part of the brain is involved?
- Hemi-neglect sydnrome
| - Right (non-dominant) parietal lobe
66
Triad of:
Encephalopathy
Ocular dysfunction
Gain ataxia
Wernike encephalopathy
67
Wernike encephalopathy Tx:
Thaiamine before or with IV fluids with glucose
68
Triad of:
Gain disturbance
dementia
urinary incontinence
NPH (Normal pressure hydrocephalus)
69
The only approved medication for ALS and its' mechanism of action
-Riluzole
| Glutamate inhibitor
70
The best test to rule in or out Vit B 12 deficiency
Methylmalonic acid (MMA)
71
Damage to descending corticosipinal tracts in spinal cord compression (SCC) S & S (2)
- LE weakness
| - Loss of Rectal tone
72
Damage to Ascending sensory spinothalamic tracts in spinal cord compression (SCC) S & S
- loss of sensation two level below the level of lesion
73
Damage to Descending automatics in the reticulospinal tract in Spinal cord compression (SCC) S & S (3)
- Urinary retention
- Bladder flaccidity
- Bladder shock
74
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Sudden-onset severe back pain
Perianal hypo/anesthesia
Symmetric motor weakness
Hyperreflexia
Early-onset bowel and bladder dysfunction
```
Conus medullaris syndrome
75
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Usually bilateral, sever radicular pain
Saddle hypo/anesthesia
Asymmetric motor weakness
Hyporeflexia/areflexia
Late-onset bowel and bladder dysfunction
```
Cauda equina syndrome
76
Proximal muscle weakness
Autonomic dysfunction (Dry mouth...)
Cranial nerve involvement (ptosis...)
Diminished or absent deep-tendon reflexes
Lambert-Eaton syndrome
77
Fluctuating muscle weakness
Ocular (ptosis, diplopia)
Bulbar (dysphagia, dysarthria)
Facial, neck and limb muscles
Myasthenia garvis
78
- Symmetrical and more proximal muscle weakness
- Interstitial lung disease, esophageal dysmotitly, raynaud phenomenon
- polyarthritis
- Esophageal dysmotitlity
- Skin findings (Gottron papules, heliotrope rash)
Dermatomyosities (skin findings)
| Polymysoties
79
27, headaches, N/V, Elevated CSF pressure, normal neuroimaging
Pseudotumor cerebri - Benign intracranial hyprtension
80
Severe headache
bilateral periorbital edema
CN III, IV, V and VI deficiets
Cavernous sinus thrombosis
81
Situational syncope is triggered by (3)
cough, micturition, defecation
82
Vasovagal or neurally mediated syncope is triggered by (3) and what are the prodromal symptoms (3)
- Prolonged standing, emotional distress and painful stimuli
| - Nausea, warmth, diaphoresis
83
The most common cause of CN III palsy in adults is ___ and due to ____
Ischemic neuropathy
| poorly controlled diabetes mellitus
84
Small penetrating artery occlusion due to hypertensive arteriolar sclerosis
Lacunar stroke
85
Which area of the brain is affected by lacunar stroke? (3)
- basal ganglia
- Subcortical white matter (internal capsul, corona radiata)
- Pons
86
Risk factors for Lacunar stroke (5)
- Hypertension #1
- DM
- Advanced age
- Elevated LDL
- Smoking
87
Pure motor hemiparesis
Pure sensory stroke
Ataxic hemiparesis
Dysarthria-clumsy hand
-Lacunar stroke
88
Complication of SAH in 24hrs?
rebleeding
89
Complication of SAH in 3 days
Vasospasm
90
Complication of SAH giving hyponatremia
SIADH secretion
91
Brain tumors found in grey-white matter junctions are
metastatic brain tumors
92
areflexic weakness in upper extremities and dissociated sensory loss following a "cape" distribution
Syringomyelia
93
What disease is associated with Syringomyelia
Arnoid Chiari malformation type 1
94
Monocular painless acute vision loss
Central retinal artery occlusion due to embolized atherosclerotic plaque form ipsilateral carotid artery
95
- Acute confusion
- Temp >40c
- Tachycardia
- coagulopathic bleeding after heavy work under direct sunlight
Exertional heat stroke
96
Worsening tremor with finger-to-nose testing, and when arms are stretched. Dx? Tx?
Essential tremor
| Propranolol
97
Antibodies against nicotinic receptors on the motor endplate found, NSIM?
CT scan of the chest (thymoma search :)
98
-Encephalopathy
-Oculomotor dysfunction
-Postural and gait ataxia
Dx? Tx?
Wernicke encephalopathy
| IV Thiamine followed by glucose infusion
99
What are the Oculomotor dysfunction in Wernicke encephalopathy? (2)
Horizontal nystagmus
| bilateral abducent palsy
100
what is one symptom that Wernicke encephalopathy has but not pt with cobalamin (Vit B12) deficiency don't have
Occulomotor symptoms (are unusual for Vit B12 deficiency )
101
```
Uncontrolled HTN
Occipital headache
neck stiffness
N/V
Nystagmus
Ipsilateral hemiataxia
(No hemiparesis or sensory loss)
Dx? NSIM>
```
Spontanous cerebellar hemorrhage
| -CT scan of the head w/o contrast and emergent surgical decompression
102
When do you discontinue Phenytoin in pt with hx of unprovoked seizure
- No seizure for >2 years
| - slowly tapered down
103
Ischemic stroke symptoms within 3-4.5 hours ,Tx?
IV tPA
104
Ischemic Stroke with no prior antiplatelet therapy, Tx?
Aspirin
105
Ischemic Stroke with on antiplatelet therapy, Tx?
Add dipyridamole OR clopidogrel (on the top of Asprin)
106
Ischemic Stroke with a-Fib, Tx?
Long-term anticoagulation (Warfarin, Dabigatran, rivaroxaban (Xarelto) or Apixaban (Eliquis)
107
Ischemic Stroke with large anterior circulation artery occlusion within 24hrs of symptom onset, Tx (2 step)?
Thrombectomy (regardless if pt received tPA)
| then aspirin
108
Patient with intracranial large-artery atherosclerosis, Tx(2 step)?
- Aspirin + clopidogrel for 90 days
| - Then Aspirin
109
Unilateral motor impairment, where is the lesion?
Posterior limb of internal capsule (lacunar infarct)
110
Contralateral somatosensory and motor deficit (Face, arm and leg), where is the lesion?
MCA
111
Contralateral somatosensory & motor deficit predominantly in LE, where is the lesion?
ACA
112
Alteranate syndromes with contralateral hemiplegia & ipsilateral cranial nerve involvement, possible ataxia, where is the lesion?
Verterbrobasilar symptom lesion (supplying the brain stem)
113
Conjugate eye deviation toward the side of infarct and homonymous hemianopia, where is the lesion?
MCA
114
Aphasia (dominant hemispheres)
| Hemineglect (nondominant hemisphere) where is the lesion?
MCA
115
-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?
- Tabes dorsalis
| - IV Penicillin
116
Miotic and irregular pupils with normal constriction with accommodation but not with light, Name? Dx? Cause?
- Argyll Robertson Pupils
- Tabes dorsalis
- Treponema pallidum (Syphillus)
117
1st line of treatment for Idiopathic intracranial hypertension (2)
Acetazolamide +/- Furosemide
118
The 4 sellar masses that are benign
Pituitary adenoma
Craniopharyngioma
Meningioma
Pituicytoma (low grade glioma)
119
The 4 sellar masses that are malignant
```
Primary
- germ cell tumors
-chordoma
-lymphoma
Metastatic (breast, lung)
```
120
Presentation in sellar mass (3)
- Visual defects (bitemporal blindness-optic chiasm)
- headache
- Pituitary hormonal deficiencies
121
1st line of tx for fibromyalgia (2)
aerobic exercise
| good sleep hygine
122
2nd line of tx for fibromyalgia
Tricyclic antidepressants (amitriptyline)
123
Cancer pain management for mild pain (2)
- Acetaminophen
| - NSAIDs
124
Cancer pain management for moderate pain (3)
- Codeine
- Hydrocodone
- Tramadol
125
Cancer pain management for severe pain (2)
Strong short-acting opioids
- Morphine
- Hydromorphone
126
Cancer pain management for severe pain that is not controlled by short-acting opioids only (2)
Add long-acting opioids (calculate total daily dose and convert to long-acting formulation)
- Fentanyl patch
- Oxycodone
127
The main differences between Parkinson and Lewy bodies on cognitive function & dementia is ?
-Dementia appears early in Lewy body
| Late in Parkinson disease
128
- Bilateral hemiparesis
- diminished bilateral pian and temp sensation
- Intact bilateral proprioception, vibration sensation and light touch
Anterior cord syndrome
129
Tx for a myasthenic crisis (3) on the top of intubation
- Plasmapheresis
- IVIG
- Corticosteroids
