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U World Step 2 > Nervous system > Flashcards

Nervous system Flashcards

1
Q

HSV encephalitis (CSF findings)

A

Lymphocytic pleocytosis

Elevated protein

Elevated RBCs

Normal glucose

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2
Q

Bacterial meningitis (CSF findings)

A

Neutrophilis pleocytosis

Elevated protein

Low glucose

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3
Q

Tuberculous meningitis (CSF findings)

A

Lymphocytic pleocytosis

Elevated protein

Very low glucose (e.g., 7)

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4
Q

Leading causes of brain metastases

A

Melanoma

Lung cancer

Breast cancer

Renal cell carcinoma

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5
Q

Amyotrophic Lateral Sclerosis

A

Upper motor neuron signs + lower motor neuron signs

Preserved sensation

May have cognitive dysfunction

Usually >40 years old

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6
Q

Complex seizures

A

Involve loss of consciouness

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7
Q

Partial seziures

A

Seizure activity with a focal origin within the brain

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8
Q

Todd’s paralysis

A

Transient post-seizure neurologic symptom

Transient, focal weakness, usually affecting the appendages

Resolves within 48 hours

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9
Q

Most important prognostic factors for astrocytomas

A

Patient age

Functional status

Tumor grade

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10
Q
A

Gadolinium-enhanced brain MRI

Used to diagnose brain abscess

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11
Q

Brain abscess

  1. Microbiology
  2. Pathogenesis
  3. Clinical manifestations
  4. Treatment
A
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12
Q

Alzheimer disease

A

Early, insidious short-term memory loss

Language deficits and spatial disorientation

Later personality changes

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13
Q

Vascular dementia

A

Stepwise decline

Early executive dysfunction

Cerebral infarction &/or deep white matter changes on neuroimaging

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14
Q

Frontotemporal dementia

A

Early personality changes

Apathy, disinhibition & compulsive behavior

Frontotemporal atrophy on neuroimaging

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15
Q

Dementia with Lewy body

A

Visual hallucinations

Spontaneous parkinsonism

Fluctuating cognition

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16
Q

Normal-pressure hydrocephalus

A

Ataxia early in disease

Urinary incontinence

Dilated ventricles on neuroimaging

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17
Q

Prion disease

A

Behavioral changes

Rapid progression

Myoclonus &/or seizures

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18
Q

Cisplatin: Common adverse effects

A

Nephrotoxicity

Tinnitus and hearing loss

Electrolyte abnormalities

Severe nausea and vomiting

Neurotoxicity

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19
Q

Typical chemo regimens for non small-cell lung cancer

A
  1. cisplatin + etoposide + docitaxel

or

  1. carboplatin + paclitaxel
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20
Q

Juvenile myoclonic epilepsy

A

Progression from absence to myoclonic to generalized tonic-clonic seizures

Presents in teenage years

Occur upon awakening

Genetic basis

Symptoms can be worsened with sleep deprivation

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21
Q

Parkinson’s disease

A

Dementia

Falls

Festinating gait

Slowed speech

Resting hand tremor

Cogwheel rigidity on passive range of motion

Caused by a loss of dopaminergic neurons in the substantia nigra

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22
Q

CSF findings in Guillain-Barre Syndrome

A

Albuminocytologic dissociation:

  • Elevated protein content
  • Normal leukocyte count
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23
Q

Spinal Epidural Absess

  1. Causes
  2. Classic triad
  3. Treatment
A
  1. Concurrent distant infection, injection drug use, or spinal procedure
  2. Fever, back pain, neurologic manifestations
  3. Broad-spectrum antiobiotics and aspiration/surgical decompression
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24
Q

Treatment for epidural metastases

A

High-dose glucocorticoids

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25
Q

Botulism

  1. Symptoms
  2. Treatment
A
  1. Descending bilateral paralysis beginning in the cranial nerves
  2. Equine anti-toxin
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26
Q

Kernig sign

Budzinsks sign

A

Both suggestive of meningeal irritation

Kernig sign: Inability to extend the knee >135 degrees when hip is flexed

Brudzinsks sign: Passive flexio of the neck results in flexion of the lower extremities

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27
Q

Migraine therapies

  1. Abortives
  2. Preventives
  3. Co-administration caution
A

Coadministration of a triptan and an ergot derivative or an additional triptan after a first dose may result in prolonged vasospasm due to overactivation of serotonin receptors, which can lead to severe elevations in blood pressure, myocardial infarction, or stroke.

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28
Q

Amarosis fugax

A

Painless, sudden and transient (<10 minutes) monocular vision loss

Retinal artery emboli originating from an ipsilateral carotid artery atherosclerotic plaque

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29
Q

Posterior uveitis

A

Painless vision loss and floaters

Produces choroidal infammation

Associated with systemic inflammatory disorders (IBS, ankylosing spondylitis) or infection (CMV)

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30
Q

Optic neuritis

A

Monocular vision loss over several weeks with painful eye movement

Afferent pupillary defect with optic disc swelling on fundoscopy

Often associated with MS

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31
Q

Temporal (giant cell) arteritis

A

Medium- to large-vessel vasculitis that affects adults age >50

Can present with monocular vision loss

Unilateral headache

Jaw claudication

Constitutional symptoms (e.g., fever, fatigue)

Polymyalgia rheumatica (proximal muscle weakness/pain)

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32
Q

Postictal vision loss

A

Can result formoccipital lobe seizures

Preceding visual aura marked by flashes of light and color

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33
Q

Uhthoff phenomenon

A

Feature of MS, where heat exposure may exacerbate symptoms

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34
Q

Post-traumatic syringomyelia

A

3-4% of patients with spinal cord injuries

Often caused by whiplash

Englargement of the central canal of the spinal cord due to CSF retention

Impaired strength, impaired pain/temperature sensation in upper extremities

Preservation of dorsal colume function (light touch, vibration, position sense)

Diagnose with MRI

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35
Q

Cervical spondylosis

A

Patients over 40

Results from disk degeneration

Neck pain and stiffness

May lead to spinal stenosis

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36
Q

Sudden infant death syndrome

  1. Risk factors
  2. Prevention
A

SIDS: Unexplained death before the age of 1

Risk is decreased with:

smoke avoidance

pacifier use

sleeping in the supine position with firm bedding

room-sharing without bed-sharing

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37
Q

Criteria for thrombolytics in stroke

  1. Inclusion criteria
  2. Strict exclusion criteria
  3. Relative exclusion criteria
A
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38
Q

Resting tremor

A

Low amplitude, low frequency (4-6 Hz) tremor that starts in one hand

Pill rolling tremor

Often presenting symptom of Parkinson’s disease

Parkinsonian tremors are more pronounced with distractibility

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39
Q

Tremors

  1. Essential
  2. Parkinson’s disease
  3. Cerebellar
  4. Physiologic
A
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40
Q

Essential tremor

A

Fine tremor

Suppressed at rest

Exacerbated at the end of goal-directed movements

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41
Q

Treatment for essential tremor

A

First line: Propranolol, especially if patient is hypertensive

Alternative medications: Primidone, topiramate

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42
Q

Building rapport with a psychotic patient with no insight

A

Nonjudgemental stance that acknowledges the patient’s experience and perspective without endorsing specific delusions or hallucinations

43
Q

Exertional heat stroke

A

Acute confusion

Extreme hyperthermia > 105 F

Tachycardia

Coagulopathic bleeding

44
Q

Central cord syndrome

A

Occurs with hyperextension injury in patients with pre-existing degenerative changes in the cervical spine.

Weakness is more pronounced in the upper extremities than the lower.

May have selective loss of pain and temp sensation in the arms due to damage to lateral spinothalamic tract.

45
Q

Anterior ventral cord syndrome

A

Bilateral spastic motor paresis distal to the lesion.

Usually due to occlusion of the spinal artery.

46
Q

Brown-Sequard syndrome

A

Caused by cord hemisection (due to penetrating injury)

Ipsilateral: Weakness, spasticity, loss of vibration sense and proprioception

Contralateral: Loss of pain and temperature sensation

47
Q

Posterior cord syndrome

A

Bilateral loss of vibratory and proprioceptive sensation

Weakness, paresthesias, urinary incontinence or retention

MS or vascular disuption (e.g. vertebral dissection) may be causes

48
Q

Differential diagnosis of neuromuscular weakenss

  1. Upper motor neurons
  2. Anterior horn cells
  3. Peripheral nerves
  4. Neuromuscular junction
  5. Muscle fibers
A
49
Q

Clinical features of multiple sclerosis

  1. Features suggesting multiple sclerosis
  2. Disease pattern
  3. Diagnosis
A
50
Q
A

MS

51
Q

Brain death

A

Absence of cortical and subcortical function

The spinal cord is still functioning; Deep tendon reflexes may still be present

52
Q

Uncal herniation

  1. Lesion
  2. Neurologic signs
A
53
Q

Treatment of cancer pain

  1. Mild
  2. Moderate
  3. Severe
A
54
Q

Riluzole

A

Glutamate inhibitor approved for use in patients with ALS

55
Q
A

Thymoma

56
Q

Acetylcholinesterase inhibitors used to treat Alzheimer’s

A
  1. Donepezil
  2. Rivastigmine
  3. Galantamine
57
Q

Management of patients suspected of having Guillain Barre syndrome

A

Assess patient’s respiratory status by serial spirometry

58
Q

Diagnostic pulmonary tests (Indications, disadvantages)

  1. Spirometry
  2. Peak flow meter
  3. Chest x-ray
  4. Chest CT
  5. Pulse oximeter
  6. Arterial blood gas
A
59
Q

Multiple system atrophy

A

Shy-Drager syndrome

Degenerative disease characterized by:

  1. Parkinsonism
  2. Autonomic dysfunction (postural hypotension, abnormal sweating, disturbance of bowel or bladder control, abnormal salivation or lacrimation, impotence, gastroparesis)
  3. Widespread neurological signs (cerebellar, pyramidal or lower motor neuron)
60
Q

Galactosemia

A

Caused by galactose-1-phosphate uridyl transferase deficiency

Vomiting

Poor weight gain

Jaundice

Hepatomegaly

Convulsions

Cataracts

Increased risk for E. coli neonatal sepsis

Treat by removing galactose from diet

61
Q

Acute causes of hemiplegia in children

  1. Cause
  2. Features
A
62
Q

Reversal of bleeding due to warfarin

A

Intravenous vitamin K and prothrombin complex concentrate

(can use fresh frozen plasma if PCC not available)

63
Q

Reversal of heparin

A

Protamine sulfate

64
Q

Treatment for bleeding in patients with thrombocytopenia or taking anti-platelet therapy

A

Consider platelet transfusion

65
Q
  1. Pathogenesis
  2. Risk factors
  3. Clinical features
  4. Diagnosis
  5. Treatment
A
66
Q

Clinical Features of Alzheimer’s disease

  1. Early findings
  2. Late findings
A
67
Q

Diagnostic features of Lewy Body Dementia

  1. Central (required)
  2. Core
  3. Suggestive
  4. Supportive
  5. Conflicting (Make LBD less likely)
A
68
Q
A

Lobar hemorrhage

Spontaneous lobar hemorrhage is most commonly caused by cerebral amyloid angiopathy, especially in the elderly.

69
Q
A

Subdural hematoma

Results from rupture of bridging veins, most commonly from head trauma

70
Q
A

Cardioembolic stroke

Patients have multiple ischemic infarcts at the grey-white junction

71
Q
A

Ischemic stroke

Area of hypodensity affecting a vascular distribution

72
Q
A

Epidural hematoma

Caused by tearing of the middle meningeal artery

Acute hemorrhage in a biconvex pattern that does not cross suture lines

73
Q
A

Subarachnoid hemorrhage

Sudden onset of severe (thunderclap) headache and hyperattenuation of the sulci and basal cysterns on head CT

Caused by ruptured saccular (berry) anuerysms

74
Q

Cephalohematoma

A

Subperiosteal hemorrhage

Presents a few hours after birth as scalp swelling limited to one cranial bone.

Most cases do not require any treatment and resorb spontaneously within 2 weeks to 3 months.

75
Q

Caput succadeneum

A

Diffuse, sometimes ecchymotic, swelling of the scalp.

It usually involves the portion of the head presenting during vertex delivery.

May extend across the midline and across suture lines.

76
Q

Clinical characteristics of major stroke subtypes

  1. Ischemic (thombotic)
  2. Ischemic (embolic)
  3. Intracebral hemorrhage
  4. Spontaneous subarachnoid hemorrhage
A

Embolic strokes usually have sudden onset with maximal symptoms at the beginning.

77
Q

Neurologic findings according to location of intraparenchymal hemorrhage

  1. Basal ganglia
  2. Cerebellum
  3. Thalamus
  4. Cerebral lobe
  5. Pons
A
78
Q

Complications of infective endocarditis

  1. Cardiac
  2. Neurologic
  3. Renal
  4. Musculoskeletal
A
79
Q

Myasthenic crisis

  1. Precipitating factors
  2. Signs/symptoms
  3. Treatment
A

Precipitating medications:

Aminoglycosides, fluoroquinolones, macrolides, beta blockers

80
Q

Treatment for normal pressure hydrocephalus

A

Large volume lumbar punctures

If successful, ventriculoperitoneal shunting

81
Q

Initial diagnostic workup of a first-time seizure in an adult

A

Basic blood Tests

Serum electrolytes

Glucose

Calcium

Magnesium

CBC

Renal and Liver Function

Tox Screen

82
Q

Myasthenia gravis

  1. Epidemiology
  2. Symptoms/signs

3. Diagnosis

4. Treatment

A
83
Q

Clinical features of sellar masses

  1. Causes
  2. Clinical presentation
A
84
Q

Visual field defects, Location of lesion, Possible causes

A
85
Q
A

Acoustic neuroma

86
Q

Cerebellopontine angle tumors

A

Acoustic neuromas, meningiomas

Headache

Hearing loss

Vertigo

Tinnitus

Balance problems

87
Q

Complication of status epilepticus (seizure > 5 min)

A

Cortical laminar necrosis

Can lead to persistent neurologic deficits and recurrent seizures

Result of excitatory cytotoxicity,

88
Q

Pediatric brain tumor locations

A
89
Q

Most common type of brain tumor in children

A

Atrocytoma

(Pilocytic astrocytoma)

90
Q

HIV-infected patient

Altered mental status

EBC DNA in CSF

Solitary, weakly ring-enhancing periventricular mass on MRI

A

Primary CNS lympoma

(EBV DNA in CSF is specific for primary CNS lymphoma)

91
Q

Spinal epidural abscess

  1. Epidemiology
  2. Manfestations
  3. Diagnosis
  4. Treatment
A
92
Q

Differential diagnosis of myopathy

(Disorder, Clinical features, ESR, CK)

  1. Glucocorticoid-induced myopathy
  2. Polymyalgia rheumatica
  3. Inflammatory myopathies
  4. Statin-induced myopathy
  5. Hypothyroid myopathy
A
93
Q

Spinal cord compression

  1. Causes
  2. Signs and symptoms: Early and Late
  3. Management
A
94
Q

Absence seizures

  1. Clinical features
  2. Diagnosis
  3. Comorbidities
  4. Treatment
A
95
Q

Tuberous sclerosis

A

Genetic neurocutaneous disease

Cardiac rhabdomyomas

Renal angiomyolipomas

Epilepsy

96
Q
A

AV malformation

Most common cause of intraparenchymal hemorrhage in children

97
Q
A

Basal ganglia hemorrhage

Spontaneous deep intracerebral hemorrhage is typically caused by hypertensive vasculopathy involving the penetrating branches of the major cerebral arteries.

Common locations: basal ganglia, cerebellar nuclei, thalamus, pons.

98
Q

Cerebrospinal fluid analaysis (WBC count, glucose, protein)

  1. Normal
  2. Bacterial meningitis
  3. Tuberculosis meningitis
  4. Viral meningitis
  5. Guillain-Barre
A
99
Q
A

Papillidema

100
Q

Fetal hydrantoin syndrome

A

Midface hypoplasia, microcephaly, cleft lip and palate, digital hypoplasia, hirsuitism, and developmental delay

Caused by expsoure to anticonvulsant medications

Phenytoin, carbamazepine

101
Q
A

Central retinal artery occlusion

102
Q
A

Central retinal vein occlusion

103
Q

Wernicke encephalopathy

  1. Associated conditions
  2. Pathophysiology
  3. Clinical features
  4. Treatment
A

Can be induced iatrogenically by administering glucose before thiamine, because glucose increases the body’s requirement for thiamine (a cofactor for many enzymes).

Thiamine: B1

104
Q

Classical triad of brain abscess

A

Fever

Headaches

Focal neurologic deficits

Congenital heart disease and recurrent sinusitis are risk factors.

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