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STEP 5: NEURO SHELF > Miscellaneous_PretestStepup > Flashcards

Miscellaneous_PretestStepup Flashcards

1
Q

In a pt with vertigo, what is the best test to r/o ischemic event = central vertigo - more worrisome vs peripheral vertigo?

A

MRI w/ contrast - Detect stroke, tumor, demyelination (MS)

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2
Q

What is the main distinguishing Sx of CENTRAL VERTIGO? of PERIPHERAL VERTIGO?

A

CENTRAL: + Neighborhood focal neurologic deficits (hemiparesis, hemisensory deficits, diplopia, dysarthria, dysphagia)

PERIPHERAL: + Tinnitus/hearing loss

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3
Q

What is the clinical triad of MENRIERS?

A

TINNITUS + VERTIGO + HEARING LOSS

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4
Q

What is a very useful agent for vertigo? What properties does this medication have?

A

MECLIZINE - Anti-emetic, anti-cholinergic, anti-histamine

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5
Q

What is the typical Tx for BPPV?

A

EPPLEY MANEUVER

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6
Q

What is the typical Tx for VESTIBULAR NEURITIS/LABYRINTHITIS?

A

Steroids + Meclizine

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7
Q

What is the typical Tx for MENRIER’S DISEASE?

A

Salt restriction + HCTZ + Meclizine

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8
Q

What are the 2 main ways to distinguish between SYNCOPE and SEIZURE?

A

1) LOC Duration - Syncope LOC duration &laquo_space;Seizure LOC if there is LOC
2) Bladder control - Seizure (+ Urinary/fecal incontinence) and Syncope (- Urinary incontinence= bladder control is NOT retained)

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9
Q

What are the 2 types of SYNCOPE that occur when pt is upright (sitting or standing)?

A

VASOVAGAL (Neurocardiogenic, vasodepressor, simple faints)

VASCULAR: ORTHOSTATIC

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10
Q

What are possible life-threatening causes of SYNCOPE if it is exertional?

A

HCM

AORTIC STENOSIS

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11
Q

Which type of syncope can a TILT-TABLE STUDY reproduce Sx in particularly susceptible people?

A

VASOVAGAL SYNCOPE

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12
Q

What is the proposed pathophysiology of VASOVAGAL SYNCOPE?

A

NORMAL: Standing up (Venous pooling -> Decrease ECV -> Decrease SV -> Decrease CO -> Decrease MAP) -> Enhanced SNS (tachy + vasoconstriction) + Decreased PNS

VASOVAGAL: Paradoxical withdrawal of SNS + Enhanced PNS -> Bradycardia, Vasodilation, Marked Decrease BP, Decreased cerebral perfusion

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13
Q

What is a physical maneuver to treat VASOVAGAL? What are two possible pharmacological medications to treat VASOVAGAL SYNCOPE?

A

Recumbent position + raise legs

BETA BLOCKERS/ DISOPYRAMIDE (Class IA)

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14
Q

What is the treatment of VASCULAR: ORTHOSTATIC syncope?

A

Na+ intake
Fluids

Possible consideration of FLUDROCORTISONE

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15
Q

What is the most important decision making factor in SYNCOPE pts?

A

GOAL #1: To determine if it is CARDIOGENIC or NON-CARDIOGENIC: Determine if pt has/doesn’t have structural heart disease + Abnormal EKG

CARDIOGENIC = Worst prognosis 
NON-CARDIOGENIC = Better prognosis
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16
Q

If pt does NOT have heart disease and SYNCOPE is unexplained, what becomes the most important test for evaluating for VASOVAGAL or VASCULAR: ORTHOSTATIC?

A

TILT TABLE TEST- Will be POSITIVE in vasovagal and orthostatic syncope

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17
Q

What test is done on ALL syncopal pts?

A

EKG - Because it can identify any life-threatening causes (Vtach, other arrhythmia, MI)

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18
Q

What is the most common age group of ALS? What is affected in this pathology?

A

Between 50-70

Anterior horn + CST + CBT - Only MOTOR involvement (PROGRESSIVE MUSCLE WEAKNESS) = LMN + UMN signs

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19
Q

What major organ is involved in END-STAGE ALS? What is the progression to end-stage?

A

RESPIRATORY MUSCLE WEAKNESS

Initially -> DOE dyspnea on exertion -> ORTHOPNEA at rest -> SLEEP APNEA -> RESPIRATORY FAILURE (END-STAGE)

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20
Q

What is the classic presentation of an ALS pt? (Remember Dr. Belsh’s pts)

A

A 50yo male whose muscles have atrophied, fasciculations seen in triceps, increased tone, hyper-reflexic, slurred speech, weight loss/fatigue, but has no associated pain

NORMAL/unaffected: Sensory, cognition, bowel/bladder control, extra-ocular muscles, sexual fn

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21
Q

What is the etiology of ALS?

A

10% familial, 90% sporadic

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22
Q

What is the prognosis of ALS?

A

POOR

80% 5-year mortality, 100% 10-year mortality

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23
Q

What is the specific diagnostic test for ALS?

A

NONE

EMG and Nerve conduction studies - useful for confirming LMN degeneration + r/o NMJ d/o

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24
Q

What is the clinical diagnosis of PROBABLE ALS?

A

Involvement of 2 regions

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25
What is the clinical diagnosis of DEFINITE ALS?
Involvement of 3-4 regions - bulbar, cervical, thoracic, and lumbosacral
26
What is the Tx of ALS?
Mostly supportive RILUZOLE = Glu-blocking agent but not much evidence supporting it (only delays death by 3-5mo)
27
What is the purpose of an EMG study? Which types of pathologies can be detected using an EMG?
EMG Study - Measures contractile property of skeletal muscles 1) LMN LESION - FIBRILLATIONS/fasciculations at rest 2) MYOPATHY - NO ACTIVITY at rest, DECREASING AMPLITUDE with muscle contraction
28
What is the purpose of a NERVE CONDUCTION STUDY? Which types of pathologies can be detected using a NCS?
NCS: Tests speed of conduction through the nerve 1) DEMYELINATION - MS, GBS (Decreased conduction velocity) 2) MYASTHENIA GRAVIS - Repetitive stimulation causes fatigue (worsened with muscle use)
29
Ddx of FACIAL NERVE PALSY?
1) STROKE - Pontine stroke 2) BELLS PALSY - Idiopathic, diabetic mononeuropathy, viral etiology 3) VIRAL - HSV, HIV, Lyme, VZV, GBS (bilateral palsy) 4) NEOPLASTIC - Leptomeningeal carcinomatosis, acoustic neuroma, schwannoma NF2, cholesteatoma
30
What is the Tx of TRIGEMINAL NEURALGIA? Which pathology is this most commonly associated with?
CARBAMAZEPINE | Most commonly associated with MULTIPLE SCLEROSIS
31
What is the 1st line Tx for SYMPTOMATIC MENINGIOMA (p/w HA, seizure, FND due to mass effect)?
SURGICAL RESECTION
32
What is the 1st line Tx for DIFFUSE METASTATIC BRAIN DISEASE?
WHOLE BRAIN RADIATION
33
Compare NF-1 and NF-2 (gene mutation, location of mutation gene, main clinical features).
NF-1 = VON RECKLINGHAUSEN, NF1 tumor suppressor protein NEUROFIBROMIN (Chrom 17), CAFE AU LAIT/ MULTIPLE NEUROFIBROMAS/ LISCH NODULES/ Macrocephaly, feeding problems, short stature, learning disabilities NF-2 = CENTRAL NEUROFIBROMATOSIS, NF2 tumor suppressor protein MERLIN (Chrom 22), BILATERAL ACOUSTIC NEUROMAS + CATARACTS
34
What is the most common type of INTRACRANIAL LESION in NF1 that typically manifests during toddlerhood? What should be ordered if the NF1 pt starts having HOLOCRANIAL HEADACHES?
OPTIC PATHWAY GLIOMA Order MRI of BRAIN/ORBIT
35
Which neurocutaneous syndrome is associated with CORTICAL HAMARTOMAS + ASH LEAF HYPOPIGMENTED MACULES + FACIAL ANGIOFIBROMAS + CARDIAC RHABDOMYOMA + RENAL ANGIOLEIOMYOMAS?
TUBEROUS SCLEROSIS (TSC1, TSC2)
36
What is a common neurological complication in PREMATURE BABIES (<30wks gestation) or <3.3lbs)? How do they present with this side effect?
INTRAVENTRICULAR HEMORRHAGE - CP: LETHARGY + DECREASED TONE + RAPIDLY INCREASING HEAD CIRCUMFERENCE + BULGING FONTANELS + HIGH PITCHED CRY + SEIZURES
37
What is a common complication of PREMATURE/UNDERWEIGHT NEONATES with INTRAVENTRICULAR HEMORRHAGE?
COMMUNICATING HYDROCEPHALUS - Blood in subarachnoid space -> impairs ability of arachnoid villi to absorb CSF
38
How do MIGRAINES in children differ from MIGRAINES in adults?
CHILDREN - More BIFRONTAL, shorter duration ADULTS - Typically more UNILATERAL, can last up to 72hrs
39
What is the FIRST LINE OF TX for ACUTE MIGRAINE HEADACHES in children <12yo?
NSAIDS + SUPPORTIVE (Lying in a dark, quite room with a cool cloth on forehead)
40
What is CUSHING REFLEX?
TRIAD: HTN + BRADYCARDIA + RESPIRATORY DEPRESSION in response to increased ICP
41
What are the typical sx of INTRACRANIAL HTN?
HEADACHE (worse at night), N/V, AMS, Papilledema, FND, Cushing reflex
42
Multiple brain lesions in BOTH HEMISPHERES + Surrounding edema is highly suggestive of ___?
BRAIN METASTASIS
43
Where are the most common sites of brain metastasis?
LUNG >> BREAST > UNKNOWN> MELANOMA > COLORECTAL
44
Where is the most common INJURY resulting in ACUTE EPIDURAL HEMATOMA/?
SPHENOID BONE - laceration of middle meningeal artery
45
COMA PT: Traumatic acceleration/deceleration shearing forces of BRIDGING VEINS CTH: Diffuse, small bleeds at gray-white matter junction
DIFFUSE AXONAL INJURY (diffuse damage to small axons)
46
NEWBORN (e.g. 10hr old) Pt: SWELLING limited to SURFACE OF ONE CRANIAL BONE No visible pulsations (swelling) until several hours later + No discoloration of overlying scalp = ? Tx = ?
CEPHALOHEMATOMA Subperiosteal hemorrhage (SLOW process) Tx = Generally spontaneously resorbs within 2wks-3mo
47
NEWBORN Pt: DIFFUSE, ECCHYMOTIC SWELLING OF THE SCALP usually involving portion of the head presenting during vertex delivery. Extends across midline + across suture lines
CAPUT SUCCEDANEUM
48
NEWBORN Pt: PULSATIONS + INCREASED PRESSURE UPON CRYING + ROENTGENOGRAPHIC evidence of bony defects = ?
CRANIAL MENINGOCELE
49
NEONATES: APNEA + PALLOR/CYANOSIS + POOR SUCKLING + ABNORMAL EYE SIGNS + HIGH-PITCHED CRY + MUSCULAR TWITCHING/CONVULSIONS + HYPOTONIA/PARALYSIS + decreased hematocrit/ metabolic acidosis + shuck + TENSE/BULGING FONTANELS = ?
INTRACRANIAL HEMORRHAGE - commonly associated with PREMATURITY
50
NEWBORN Pt: INDENTATIONS OF CALVARIUM similar to a dent in a ping-pong ball as a complication of FORCEPS DELIVERY or FETAL HEAD COMPRESSION
DEPRESSED FRACTURES
51
What are the normal milestones for 3yo, 4yo, 5yo, 6yo?
3yo - Able to copy a cross/circle 4yo - Able to copy square/rectangle 5yo - Able to copy triangle 6yo - Able to copy a diamond
52
PORT-WINE STAIN (Red flat lesion) on CNV distribution + FOCAL/GENERALIZED SEIZURES + MENTAL RETARDATION = ?
STURGE WEBER SYNDROME Other possible findings: HEMIANOPIA + HEMIPARESIS + HEMISENSORY DISTURBANCE + IPSILATERAL GLAUCOMA
53
SKULL X-RAY: "TRAMLINE" Gyriform intra-cranial calcifications seen in a child >2yo = ?
STURGE WEBER SYNDROME
54
What is the Tx of STURGE WEBER SYNDROME?
1) Control seizure 2) Reduce IOP 3) Argon laser therapy - Remove skin lesions
55
BILATERAL RETINAL HEMORRHAGES in an INFANT<1yo is pathognomonic for?
ABUSIVE HEAD TRAUMA - Subdural bleeding (accel/decel causing shearing of dural veins + coup-contrecoup injury + VITREORETINAL TRACTION) + AMS/SEIZURES/INCREASED HEAD CIRCUMFERENCE + Bulging/tense anterior fontanelle = SHAKEN BABY SYNDROME
56
What type of toxicity is seen with TRIHEXPHENIDYL or BENZTROPINE?
ANTI-CHOLINERGIC TOXICITY: Dry skin, dry mouth, constipation, urinary retention, vision changes, flushing, confusion
57
IPSILATERAL ATAXIA (Pt tends to fall Towards side of lesion, asked to stand with feet tog, sways towards side of lesion) + IPSILATERAL HYPOTONIA + INTENTION TREMOR + NYSTAGMUS + RAM DEFICITS + INCREASED ICP - headache, nausea, vomiting, papilledema = ?
CEREBELLAR TUMOR | compression and obstructing CSF causes INCREASED ICP
58
WIDE BASED GAIT + Feet lifted higher than usual + Feet make SLAPPING SOUND when contacting the floor (to help them know where their LL are relative to the floor) + POSITIVE ROMBERG= AFFECTING WHAT?
POSTERIOR/DORSAL COLUMNS TABES DORSALIS (manifestation of neurosyphilis) or VitB12 deficiency
59
GAIT: Affected arm is ADDUCTED + Affected leg is EXTENDED/swings outward in a semicircle. What happened to the pt most likely?
HEMIPARETIC PT (Due to stroke)
60
GAIT: WADDLING gait due to weakness of gluteal muscles
MUSCULAR DYSTROPHY
61
RISPERIDONE AE 1: Decreased dopamine in TUBEROINDFUNDIBULAR pathway = ? AE 2: Decreased dopamine in NIGROSTRIATAL PATHWAY = ?
AE 1: HYPERPROLACTINEMIA - Decreased dopamine in D2R (tuberoinfundibular path) - Decreased inhibition of PRL -> ERECTILE DYSFN + DECREASED LIBIDO + BILATERAL BREAST ENLARGEMENT + AMENORRHEA + GALACTORRHEA AE 2: PARKINSONIANISM (SN to basal ganglia) - Mvmt coordination
62
RISPERIDONE THERAPEUTIC EFFECT = ?
Decreased dopamine in MESOLIMBIC PATHWAY (ventral tegmentum to limbic) - Antipsychotic effect
63
INCREASED DOPAMINE in MESOLIMBIC PATHWAY is associated with? DECREASED DOPAMINE in MESOLIMBIC PATHWAY is associated with?
INCREASED DOPA IN MESOLIMBIC = EUPHORIA (drug use) + delusions/hallucinations in schizophrenics DECREASED DOPA in mesolimbic = ANTI-PSYCHOTIC EFFICACY
64
INCREASED DOPAMINE in NIGROSTRIATAL PATHWAY is associated with? DECREASED DOPAMINE in NIGROSTRIATAL PATHWAY is associated with?
INCREASED DOPA IN NIGROSTRIATAL = HUNTINGTON SX (Chorea/tics) DECREASED DOPA IN NIGROSTRIATAL = PARKINSON'S
65
INCREASED DOPAMINE IN TUBEROINDFUNDIBULAR PATHWAY is associated with? DECREASED DOPAMINE in NIGROSTRIATAL PATHWAY is associated with?
INCREASED DOPA IN TUBULOINFUNDIBULAR = HYPO-PRL DECREASED DOPA IN TUBULOINFUNDIBULAR = HYPER-PRL (Gynecomastia, breast enlargement, decreased libido, amenorrhea, galactorrhea
66
How does a TRANSTENTORIAL HERNIATION OF UNCUS (parahippocampal gyrus) during HEAD TRAUMA present?
1) Compression of IPSILATERAL CN III: IPSILATERAL DOWN/OUT/MYDRIASIS 2) Compression of CONTRALATERAL CRUS CEREBRI against tentorial edge: IPSILATERAL HEMIPARESIS 3) Compression of IPSILATERAL PCA: CONTRALATERAL HOMONYMOUS HEMIANOPIA 4) Compression of RETICULAR FORMATION: Altered LOC, COMA
67
How does TROCHLEAR N. PALSY present?
VERTICAL DIPLOPIA Worsens - Eye looks down and towards nose (walking downstairs or reading) Gets better - tilt head away and chin towards lesion
68
ABNORMAL HEAD THRUST TEST (Rapid head movement away from a fixed target causes eye mvmt AWAY from target followed by HORIZONTAL SACCADE twd it) is indicative of __? (Hint: drug toxicity)
GENTAMICIN (AMINOGLYCOSIDE) Toxicity 1) Damage to cochlear cells = HEARING LOSS 2) Damage to motion-sensitive hair cells = VESTIBULOPATHY Vestibulopathy +/- ototoxicity (hearing loss) NORMAL: Rapid head movement away from target causes eyes to remain FIXED on target
69
ENLARGED BLIND SPOTS + HEADACHE/VISION LOSS that gets worse with changes in head position (Comes on in the morning when she stands up suddenly OR stoops fwd abruptly) = ?
PSEUDOTUMOR CEREBRI (IDIOPATHIC INTRACRANIAL HTN) - Papilledema Headaches worse in morning are generally 2/2 INCREASED ICP
70
Hours to days after a mild TBI: HA + Confusion/amnesia + Difficulty concentrating + vertigo + mood alteration/anxiety + sleep disturbance = ?
POST-CONCUSSIVE SYNDROME (Can last >=6mo)
71
OCULAR DISTURBANCES + ALTERED CONSCIOUSNESS + ATAXIA + SIGNIFICANT MEMORY IMPAIRMENT = ?
KORSAKOFF SYNDROME Can occur concurrently or BEFORE Wernicke encephalopathy Both caused by VitB1 deficiency
72
How do you differentiate between PSEUDOTUMOR CEREBRI and NPH on MRI?
NPH: Dilated ventricles compared to sulci PSEUDOTUMOR CEREBRI: Slit-like (shrunken) 3rd ventricle
73
GENERALIZED SYMMETRIC PROXIMAL MUSCLE WEAKNESS (LE weakness >UE weakness) + HYPOREFLEXIA
WERDNIG-HOFFMAN DISEASE (SPINAL MUSCULAR ATROPHY)
74
ALTERED MENTAL STATUS + GAIT INSTABILITY (ATAXIA) + OCULAR DISTURBANCES (HORIZONTAL NYSTAGMUS/CONJUGATE GAZE PALSY) = ?
WERNICKE ENCEPHALOPATHY
75
CORE TEMP >40 + AMS (Acute confusion + hyperthermia + tachycardia + persistent epistaxis/coagulopathic bleeding)
HEAT STROKE
76
When do pts get MALIGNANT HYPERTHERMIA?
Genetically susceptible individuals under anesthesia such as HALOTHANE + SUCCINYLCHOLINE
77
CONTRALATERAL SENSORY (Pain, vibration, agraphesthesia, astereognosis) + Contralateral inferior quadrantanopsia = Where is the lesion?
DOMINANT PARIETAL LOBE
78
ANOSOGNOSIA (Denial of one's disabilities) + CONTRALATERAL apraxia = Where is the lesion?
NON-DOMINANT PARIETAL LOBE
79
HA + FEVER + PROPTOSIS + IPSILATERAL DEFICITS IN CN 3,4,5,6 + BILATERAL PERIORBITAL EDEMA = ?
CAVERNOUS SINUS THROMBOSIS 2/2 infection of the medial face or sinuses spreading into cavernous sinus
80
What is the management for SOLITARY BRAIN METASTASIS in pts with good performance status and stable extracranial disease? How about for MULTIPLE BRAIN METASTASES?
SURGICAL RESECTION for solitary brain mass WHOLE BRAIN RADIATION for diffuse metastasis brain
81
Which cord syndrome is commonly associated with a BURST FRACTURE OF THE VERTEBRA or Anterior spinal artery infarct after repair of a thoracic aorta aneurysm?
ANTERIOR CORD SYNDROME
82
FEVER (>40 generally) + GENERALIZED MUSCLE RIGIDITY + AUTONOMIC INSTABILITY (diaphoresis, dry mucous membranes, labile BP, tachypnea, tachy)
NEUROLEPTIC MALIGNANT SYNDROME - IDIOSYNCRATIC drug rxn to dopamine antagonists (most commonly HALOPERIDOL)
83
TRIAD: Altered mental status + autonomic instability + NM excitability (tremor, HYPER-REFLEXIA, MYOCLONUS) = ?
SER SYNDROME
84
What is the Tx of NEUROLEPTIC MALIGNANT SYNDROME 2/2 DOPAMINE ANTAGONISTS?
1) REMOVE offending agent 2) Supportive care (hydration, cooling) 3) DANTROLENE, BROMOCRIPTINE
85
STEPPAGE GAIT (Foot slaps due to weakness in foot dorsiflexion) with NEGATIVE romberg sign is most commonly associated with __?
L5 RADICULOPATHY - COMMON PERONEAL/FIBULAR NEUROPATHY

STEP 5: NEURO SHELF (9 decks)

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