NBME Neuro Form 3 Flashcards
Cluster HA.
Severe unilateral periorbital pain w/ rhinorrhea and lacrimation
Craniopharyngioma
Bitemporal hemianopsia (similar to pituitary adenoma), benign childhood tumor, calcified
For stroke prevention, once patient has 1st stroke start them on.
ASA
For stroke prevention, once patient has 1st stroke + has allergy to ASA, start them on.
Clopidogrel
For stroke prevention, if patient gets a stroke while on ASA then add a second agent.
Dipyrimadole
If patient has chronic afib with CHAD2 Score + 2 start them on.
Anticoagulation: Warfarin or NOAC.
In what setting are NOACs not used.
Valvular afib.
Albuminocytologic dissociation.
Increase in CSF protein count with normal cell count, seen in Guillan Barre.
Tx for Guillan Barre
IVIG or plasmaphoresis
C4 radiculopathy.
Decreased light touch to anterior and posterior shoulder region.
C5 radiculopathy.
Decreased light touch over deltoid muscle and lateral arm. “Badge patch.”
C6 radiculopathy.
Decreased light touch over thumb and index finger + lateral forearm.
C7 radiculopathy.
Decreased light touch over middle finger
C8 radiculopathy.
Decreased light touch over ring and pinky finger + medial forearm.
Memantine.
NMDA receptor antagonist that helps prevent excitotoxicity in Alzheimer’s dementia.
Donepezil.
ACE inhibitor used in Alzheimer’s dementia.
NTs in Huntington’s disease.
Increase DA
Decrease GABA
Decreased ACh
NTs in Alzheimer’s dementia.
Decreased ACh.
Amaurosis fugax.
Painless transient loss of vision 2/2 retinal emboli from ipsilateral carotid artery.
Uvulopalatopharyngoplasty used in.
Stand alone obstructive sleep apnea. Removes tonsils, adenoids and uvula.
Features of Narcolepsy.
1) Excessive daytime sleepiness
2) Hypnagogic hallucinations
Hypnopompic hallucinations
3) Cataplexy
Tx: Stimulants like Modafinil or amphetamines.
Irreversible painless vision loss 2/2 ophthalmic artery occlusion.
Temporal arteritis. Associated with polymyalgia rheumatica.
Folic acid deficiency.
Dementia, macrocytic megaloblastic anemia, no other neurological symptoms unlike Vit b12 def.
Vitamin B6 deficiency.
Pyridoxine deficiency p/w: Seizures, Peripheral neuropathy.
Fabry disease.
Sphingolipidosis disease where alpha-galactosidase p/w: peripheral neuropathy of hands/feet, angiokeratomas, cardio/renal disease.
Retinal detachment.
P/w: vision loss, showers of floaters and flashes of light.
Conus medullaris compression.
Symmetrical findings, UMN + LMN findings, absent Achilles, hyper-reflexia with patellar reflex, positive Babinski.
Neurocysticercosis.
Pork tapeworm or Taenia solium, ingested as larvae in undercooked pork, p/w: Holes in brain on CT. Tx: Praziquantel
EEG pattern classic for Prion disease.
Bi- or tri-phasic sharp wave complexes in slow background.
Myoclonus + rapidly progressive cognitive changes.
Prion disease.
Lithium side effects.
1) Tremor
2) Nephrogenic diabetes insipidus p/w: polyuria
3) HyPOthyroidism
4) Ebstein anomaly in babies
Internuclear ophthalmoplegia
Lesion in MLF seen in MS patients, p/w with conjugate horizontal gaze palsy.
Workup for Post-concussion syndrome.
Traditional neurological and radiologic procedures like MRI, CT, EEG are NOT useful in identifying effects of concussion since these typically are unremarkable or normal in athletes with severe concussion. Concussion is a METABOLIC rather than a structural injury so structural neuro-imaging are insensitive to effects of concussion. Neuro-cognitive testing is the cornerstone of proper concussion management.
EPA side effect of typical neuroleptics within 4 hrs.
Acute dystonia.
Dystonia.
Muscle spasms or contractions, neck stiffness (spasmodic torticollis), oculogyric crisis
EPA side effect of typical neuroleptics within 4 days.
Akathisia.
Akathisia.
Restlessness
Tx of Akathisia.
Beta blocker or benzodiazepines.
EPA side effect of typical neuroleptics within 4 wks.
Bradykinesia or Parkinsonian sxs like tremor, rigidity, masked facies.
Tx of Parkinsonian syndrome.
Anticholinergics (e.g. benztropine)
EPA side effect of typical neuroleptics within 4 months.
Tardive dyskinesia.
Neuroleptic malignant syndrome
FEVER:
- Fever (hyperpyrexia)
- Encephalopathy (AMS)
- Vitals unstable (HTN 2/2 autonomic instability)
- Enzymes increase (CK high 2/2 muscle RIGIDITY, increased myoglobinuria)
- Rigidity
Tx neuroleptic malignant syndrome.
Dantrolene (prevents release of Ca2+ from SR of skeletal muscle)
Spinal Stenosis.
Unique like of sciatica that starts proximal (e.g. butt and thighs), positional (upright exercises worsen the pain), pain brought on by activity t/f sounds like Claudication.
Mononuclear scotoma, where is the lesion, what is the cause.
Partial lesion in the retina, optic disc or optic nerve. Causes: macular degeneration or optic neuritis.
RT nasal hemianopsia, where is lesion, what is the cause.
Lesion in right perichiasmal region 2/2 aneurysm of the internal crotid artery impinging on uncrossed lateral retinal fibers.
LT homonymous hemianopsia, where is lesion, what is the cause.
Lesion in along right optic tract or optic radiations (best way to differentiation is whether or not there is macular sparing). Causes: Occlusion of the anterior choroidal artery –> lesion in optic tract OR Occlusion of the MCA branch affecting temporal and parietal lobe radiations.
LT homonymous superior quadrantanopia, where is the lesion, what is the cause.
Lesion along right temporal lobe (Meyer’s Loop) resulting in PIE IN THE SKY. Cause, stroke to temporal lobe (MCA inferior division).
LT homonymous inferior quadrantanopia, where is the lesion, what is the cause.
Lesion along parietal lobe (dorsal optic radiations) resulting in PIE ON THE FLOOR. Cause, stroke to parietal lobe.
LT homonymous hemianopia w/ macular sparing.
Lesion along the right primary visual cortex. Cause, stroke to PCA feeding the occipital lobe.
Why is macula spared in PCA stroke to the occipital lobe?
Macula is spared 2/2 collateral blood from MCA.
Dandy-Walker (Posterior fossa cyst).
Agenesis of cerebellar vermis with cystic enlargement of 4th ventricle (filling up the enlarged posterior fossa). Associated with hydrocephalus and spina bifida.
Chiari II.
Symptomatic in neonatal period, cerebellar vermis lies well below foramen magnum p/w: hydrocephalus, myelomeningiocele, MR, difficulty swallowing, dysphonia, stridor
Tuberous sclerosis.
1) Cutaneous lesions: Hypopigmentation, Ash leaf spots, Shagreen patches over lumbosacral region, Depigmented nevi
2) Paraventricular tubers (e.g. ependymomas)
3) Retinal harmartoma
4) Seizures: Infantile spasms (west syn) with hypsarrhythmia (high-voltage spokes and slow waves)
5) MR
Uncal herniation
1) Compression of ipsilateral CN III (p/w: blow out pupil, D&O)
2) Compression of ipsilateral PCA (p/w: contralateral homonymous hemianopia)
3) Compressin of contralateral crus cerebri at the Kernohan notch (p/w: ipsilateral paresis)
Progressive multifocal leukoencephalopathy.
PML causes by JC papovirus infection, presents in AIDS pts w/ personality changes, intellectual impairment, hemiparesis, quadriparesis, visual field defects, aphasia, ataxia, confusion, CSF is normal, MRI = focal well-defined white matter lesions (or demyelination) that no do not enhance or have mass effect.
Pseudobulbar palsy.
Lesions in the corticobulbar pathway, motor neurons to cranial nerves.
ALS spares what?
NO sensory involvement.
Bowel/bladder sphincters are spared.
Eye movements are spared (CNs spared).
Neurofibromatosis Type 1.
Von Recklinghausen’s Disease p/w:
- Cutaneous neurofibromas (benign Schwann cells and fibroblasts)
- Cafe au lait spots (pigmented skin lesions)
- Freckling in non sun-exposed areas like axilla
- Lisch nodules: hamartomas of the iris
- Optic glioma
- Ependymoma, Meningioma, Astrocytoma
- Chromosome 17
Retinal hamartomas.
NF-2 (chromosome 22)
Hamartomas of the Iris.
NF-1
Cavernous sinus syndrome.
Orbital, facial pain, swelling, fever, oculomotor neuropahty (CN 3,4,6) and trigeminal neuropathy (V1-2 ONLY), usually 2/2 thrombosis from infection with Staph aureus from face cellulitis
