Neuro Flashcards
1
Q
tx for HA after concussion
A
o Acetaminophen during first 24 hours after injury for HA, NSAIDs ok after 24Hrs
2
Q
canadian head CT rule says minor head injury pts are high risk if: (5)
A
GCS <15 at 2 hrs post injury, suspected open or depressed skull fx, signs of basilar skull fx (hemotympanum, racoon eyes, CSF otorrhea / rhinorrhea, battle’s sign), > 2 episodes of vomiting, age > 65
3
Q
most common cranial nerve palsies : 1st and 2nd
A
7th (bell’s) and 3rd
4
Q
how to tell the difference b/w bell’s palsy and stroke
A
Bell’s: Unilateral facial nerve paralysis that includes forehead (CANNOT wrinkle forehead). stroke CAN wrinkle forehead.
5
Q
is sensation affected in bell’s palsy?
A
no, facial n is motor only
6
Q
1st line tx for bell’s palsy
A
- 1st line = Corticosteroids – Prednisone X 1 wk
7
Q
MCC of bell’s palsy
A
HSV
8
Q
bell’s palsy onset: gradual or sudden?
A
gradual (hours - 3 days)
9
Q
if bell’s is most likely dx, consider testing for ____
A
lyme
10
Q
MCC of 3rd nerve palsy in adults
A
ischemia (diabetic nerve palsies)
11
Q
sudden onset diplopia w/ mydriasis. dx?
A
3rd nerve palsy
12
Q
if suspect isolated 3rd nerve palsy, order ____ for imaging and why
A
contrast enhanced MRI w/ MRA or CTA (to evaluate for intracranial aneurysm)
13
Q
delirium is charaterised by _____ and is worse _____
A
o Characterized by fluctuating attention and awareness (worse in evening and at night)
14
Q
MCCs of delirium (4)
A
Fluid electrolyte disturbances (dehydration, hypo/hypernatremia), meds, infx, withdrawal
15
Q
do what PE test for suspected encephalopathy
A
asterixis
16
Q
horizontal shifts of midline structures > ____mm cause coma
A
> 11mm
17
Q
decorticate posturing is below the level of the ______ and presents w/ _____
A
cerebral cortex, flexed arms
18
Q
which is worse: decorticate or decerebrate?
A
decerebrate
19
Q
any sleep cycles in a coma?
A
no
20
Q
in coma, will pt have oculocephalic response?
A
no, lost
21
Q
tx for coma pt w/ herniation syndrome (2)
A
give mannitol (1g/kg IV) and hyperventilate the patient
22
Q
sleep cycles in persistent vegetative state?
A
yes
23
Q
MCCs of brain death (2)
A
trauma, SAH
24
Q
autonomic s/s to ask about for cluster HA (5)
A
o Swollen/droopy eye, small pupils, reddened conjunctiva, tearing, nasal discharge or congestion
25
tx that Paroxysmal Hemicrania and Hemicrania continua will definitely respond to
indomethacin
26
tx for acute cluster HA
oxygen (12L NRB x 15 minutes) + sumatriptan SubQ
27
1st line prophylaxis for cluster HA
verapamil
28
tx for mild migraines
1g tylenol, or NSAIDs
29
1st line tx for migraines during pregnancy
herbals: Mg, vitamin B2
30
MC type of primary HA
tension HA
31
1st line tx for tension HA
NSAIDs, acetaminophen, +/- caffeine
32
MCC of meningitis in adults
S. pneumoniae.
33
MCC of meningitis in kids <2 y/o
S. pneumoniae.
34
MCC of menigitis in neonates
* Group B Streptococcus
35
onset in bac meningitis
acute (w/in 24 hrs)
36
who most commonly gets neisseria meningitis?
adolescents / young adults living in close proximity
37
tx meningitis w/ empiric abx + _____
IV dexamethasone
38
meningitis empiric abx for kids <3 mo
ampicillin + cefotaxime/gentamicin
39
meningitis empiric abx for 3 mo - 60 y/o
Ceftriaxone(Rocephin) + vancomycin
40
meningitis empiric abx for >60 y/o or immunocompromised
higher dose of Ceftriaxone + Ampicillin + Vancomycin
41
add what abx if listeria is poss cause of pt's meningitis
ampicillin
42
3 prophylaxis options in anyone in close contact w/ meningococcal meningitis
cipro (adults only), ceftriaxone, rifampin
43
LP CSF has >1000 WBC, >200 protein, and low glucose <40. dx?
bacterial meningitis
44
LP CSF has <500 WBC, >200 protein, and normal to low glucose. dx?
fungal meningitis
45
MCC of enchephalitis in adults
HSV 1
46
encephalitis MRI shows inflammation in temporal lobes. cause?
HSV
47
1st line tx for encephalitis
high dose acyclovir
48
MC neurodegenerative disorder
alzheimer's
49
avg age of onset of PD
60
50
PD is bradykinesia + ___ OR ____
resting tremor or rigidity
51
MC presenting sx of PD
tremor at rest
52
what type of cognitive difficulty is very common in PD
word finding difficulty
53
1st line tx for PD >65 y/o
levodopa + cardidopa
54
main way to distinguish Atypical Parkinsonism from PD
lack of response to levodopa
55
MC form of Atypical Parkinsonism
* Progressive supranuclear palsy
56
dx? Markedly asymmetric unilateral rigidity and bradykinesia
* Apraxia
* Cortical sensory loss (agraphesthesia)
* Asterognosia (difficulty recognizing objects by touch alone)
* Alien limb
Early onset of balance problems. `
Usually no tremor
* Corticobasal degeneration (type of atypica parkinsonism)
57
MC movement d/o
essential tramor
58
essential tremor: better or worse w/ movement?
worse
59
essential tremor better w/ ____
alcohol
60
1st line for essential tremor
propranolol
61
RLS worst at what time of day?
night
62
before treating for RLS, test for ___
iron deficiency
63
1st line options for RLS - 2 classes
o Dopamine agonists – ropinirole, pramipexole, rotigotine (patch)
o Alpha 2 delta ligands – gabapentin enacarbin
64
tic d/o: onset must be before age ___
18
65
tourette d/o: onset must be before age ___
21
66
o Autosomal dominant trinucleotide repeat disorder (CAG) of the HTT gene on chromosome 4,
huntington's
67
age on onset in huntington's
30-50
68
death usually how long after dx in huntington's
15-20 yrs
69
how many trinucleotide repeats makes the pt definitely affected w/ huntington's
40+
70
tx for chorea in huntington's (2 classes)
VMAT-2 inhibitors (tetrabenazine, deutetrabenazine, valbenazine)
Antipsychotics (D2 receptor blocking agents): risperidone or haldol
71
which treatable dz is an autosomal recessive Huntington’s phenocopy
Wilson's
72
stroke leading to acute onset contralateral hemichorea or hemiballism happens where? called what?
basal ganglia, usually subthalamic nucleus or caudate head.
vascular chorea
73
MCC of chorea in kids
Sydenham’s Chorea
74
Sydenham’s Chorea is usually dx ______ after strep infx
4-8 wks
75
1st line med for tardive dyskinesia
o 1st line = Vesicular monoamine transport 2 (VMAT2) inhibitors – valbenazine, deutetrabenazine, tetrabenazine
76
dystonia is worse w/ ___ and ___
voluntary movement, stress/fatigue
77
which has a Repetitive, consistent pattern: dystonia or chorea?
dystonia
78
ataxia is from a problem w/ ____ or ____
cerebellum or proprioceptive system (this one is aka sensory ataxia)
79
autosomal recessive friedrich's ataxia has what serious comorbidity?
HCM
80
tremor dx: when patient is asked to voluntarily move another limb in a certain pattern, affected limb adopts the voluntary rhythm
functional movment d/o (specific)
81
which dementia? affects frontal/executive and/or language; spares drawing
Frontotemporal/Cortical Dementia – Picks Disease (FTD)
82
which dementia? movement and memory problems develop simultaneously; personality changes preceed memory changes; delirium prone
Combined Subcortical-Cortical Dementia (Lewy Body Dementia)
83
which dementia can initially present with visual hallucinations, REM sleep behavior d/o, delirium, or parkinsonism?
Combined Subcortical-Cortical Dementia (Lewy Body Dementia)
84
which dementia is likely to affect problem solving abilities, sense of direction or spatial awareness, fluctuating cognitivie abilities/attention/alertness, severe sensitivity to meds used to tx hallucinations
Combined Subcortical-Cortical Dementia (Lewy Body Dementia)
85
in Pseudodementia, which sxs are most prominent?
depressive sx
86
subcortical dementia aka vascular happens w/in ______ after a stroke
3 months
87
avg age of onset in alzheimers
mid 60s
88
workup to order for dementia pts: 9 and 1 imaging
order vitamin B12 and D and folate, HIV, syphilis, TSH, HgA1C, CMP, CBC, CT/MRI
89
tx for mild AZD
cholinergic/acetylcholinesterase inhibitors: Donepezil (Aricept), rivastigmine, galantamine
90
add ___ to tx in mod-severe AZD
Memantine
91
mab for AZD
Aducanumab
92
painless asymmetrical muscle weakness in multiple muscle groups
ALS
93
baby has a preferred hand <1 yr of age. think ____
cerebral palsy
94
baby that has retained primitive reflexes long beyond when they should have disappeared. think ____
cerebral palsy
95
Guillain-Barre Syndrome most commonly response to what pathogen infx
Campylobacter jejuni
96
Guillain-Barre Syndrome : weakness is asymmetric or symmetrical? where does weakness begin?
symmetric and begins in legs
97
what dx? facial nerve palsy, n/t in feet, difficulty swallowing, decreased DTRs
GBS
98
tx for GBS (2)
IVIG, plasma exchange
99
LP in GBS will show _____
elevated protein, NO leukocytosis
100
* Inflammatory demyelinating dz of the CNS where lesions are scattered in time and space
MS
101
age of onset in MS
20-40
102
what is the dx: n/t, pain, walking difficulty, scotomas, diplopia. sx are worse w/ heat
MS
103
MS PE findings for reflexes, vibration, Rhomberg
hyperreflexia
poor vibration sense
positive Rhomberg
104
MS sx are worse w/ ____
heat
105
imaging for suspected MS
* Brain MRI w/ gadolinium
106
tx for acute MS
high dose, daily steroids (methylprednisolone 500-1000mg IV x 3-5 days)
107
will NSAIDs help w/ MS?
no
108
1st line for primary progressive MS
ocrelizumab (Ocrevus) IV is 1st line
109
1st line for fatigue in MS
amantadine (1st line)
110
1st line for muscle spasm in MS (2)
baclofen, tizanidine
111
episode muscle weakness in muscles innervated by CNs
myasthenia gravis
112
does myasthenia gravis involve sensory deficits?
no
113
pt w/ diplopia, ptosis, ophthalmoplegia that gets worse w/ activity and better w/ rest
myasthenia gravis
114
order what imaging for myasthenia gravis
o CT or MRI of neck and upper mediastinum – check for thymoma
115
what happens after applying an ice pack if the pt has myasthenia gravis?
muscle tone imroves
116
test serum for what antibodies in suspected myasthenia gravis
anti-AChR antibodies
(ACh receptors)
117
myasthenia gravis tx includes ______ inhibitors
cholinesterase inhibitors (Pyridostigmine)
118
MC type of peripheral neuropathy
axonal degeneration
119
axonal degeneration: distal to prox or prox to distal?
distal to prox
120
* Lateral femoral cutaneous neuropathy (Meralgia Paresthetica) affects which type of nerves?
sensory only
121
diabetic neuropathy is what type of polyneuropathy?
chronic axonal
122
GBS neuropathy affects motor or sensory?
motor predominantly
123
* Most common type of peripheral polyneuropathy
Diabetic Neuropathy
124
how common is neuropathy in diabetics?
about 50%
125
MCC of seizures in 45+
strokes
126
how are focal seizures different from generalised?
focal involve only 1 area or side of the brain and body
127
which type of seizure? Involves sudden loss of muscle tone that can result in the person falling down, dropping objects, or nodding head involuntarily.
atonic (a motor seizure)
128
any postictal drowsiness in absence seizures?
no
129
EEG: 3 hertz spike; 3 cycles/sec generalized spike and wave activity. dx?
absence seizure
130
1st line tx for absence seizure
ethosuximide = 1st line.
131
febrile seizures: age and temp reqs
6 mo - 5 yrs; 38C+
132
EEG on 9 month old showing hypsarrythmia is what?
* Infantile Spasms (hyperarrhythmia, aka West syndrome)
133
6 important hx Qs to characterise seizures
* Was there a prodrome/aura?
* Was it witnessed?
* How long did it last? How quickly did the pt come to?
* Was there a post-ictal state?
* Loss of bowel or bladder control? Vomiting?
* Recent head injury or injury as a result of the seizure?
134
1st line tx for seizures in pregnancy (2)
lamotrigine, Keppra/Levetiracetam
135
duration for seizure to become status epilepticus
> 5 minutes if tonic-clonic / >10-15min if not primarily motor or recurrent seizures w/o return to baseline over 20 minutes
136
1st tx to give in status epilepticus
1st line is lorazepam (Ativan) 0.1mg/kg repeat once in 4 min. If no IV, midazolam IM 10mg.
137
2nd tx to give in status epilepticus
o 2nd step is IV AED: phenytoin/fosphenytoin, levetiracetam, valproate
138
most important modifiable RF for strokes
HTN
139
ischemic strokes are MC in which artery
MCA
140
where is the stroke? contralateral weakness and numbness of face and arm, as well as aphasia
left MCA
141
where is the stroke? contralateral weakness and numbness of the face and arm, as well as neglect or apraxia (difficulty performing skilled movements)
right MCA
142
where is the stroke? contralateral leg weakness and numbness
ACA
143
where is the stroke? contralateral homonymous hemianopsia and contralateral numbness. Cannot read but can write (alexia w/o agraphia)
PCA
144
locked in syndrome happens in what artery?
basilar
145
where is the stroke? vertigo, visual changes (diplopia), vomiting, vibrating eyes (4 Vs)
verterbrobasilar
146
crossed deficits (like sensory loss in ipsilateral face and contralateral body) -- think stroke in which location?
brain stem
147
order what imaging to distinguish b/w ischemic and hemorrhagic stroke
emergent head CT w/o contrast
148
after hemorrhagic stroke is r/o, get what imaging to locate site of ischemic occlusion?
CTA or MRI brain w/o contrast
149
stroke pt not eligible for tPA -- treat BP if >________________________________ and reduce by ____%
>220/120, 10-15%
150
time window for tPA in ischemic stroke
<4.5 hours after symptom onset/last known well. Door to needle time <60min
151
for tPA recipient, treat BP if >___
if >185/110
152
time window for thrombectomy
Time window up to 6 hours after LKN, can be up to 24 hours in certain circumstances
153
can thrombectomy be performed after tPA is given?
yes
154
meds to manage BP in ischemic stroke pts
labetolol or CCBs (nicardipine, clevidipine).
155
is there any infarcation / tissue death in TIAs?
no
156
sx in TIA last how long?
1-24 hrs
157
tx after TIA
o Aspirin -- 81mg X 21+ days. If pt was already on ASA, increase dose to 325mg. If allergic to ASA, clopidogrel (Plavix) 75mg.
o Lifestyle modifications
158
what is bleeding in epidural hematoma?
o Traumatic rupture of middle meningeal artery
159
classic presentation of epidural hematoma
immediate LOC, followed by transient recovery (“lucid interval”) lasting 20 min – few hrs, followed by rapid neurologic deterioration
160
Ct scan of brain shows lens shape (like lens of eye) aka b/l convex. dx?
epidural hematoma
161
where is bleeding in subdural hematoma?
o Bleeding into space between dura and arachnoid membranes
162
dx? o Injury to bridging veins of the dura caused by trauma, intracranial hypotension (low CSF pressure leading to tension on the veins), or can occur spontaneously
subdural hematoma
163
crescent shaped aka banana shaped bleed on brain CT
subdural hematoma
164
where is bleeding in SAH
o Bleeding within potential space between arachnoid mater and pia matter/brain. blocks CSF circulation and increases ICP that can cause hydrocephalus and damage surrounding cells
165
what is more common, intracerebral hemorrhage or SAH?
intracerebral
166
order what test for SAH
CT head w/o contrast
167
highly suspected SAH but CT head is negative. next order? and look for?
lumbar puncture (more sensitive)
Elevated RBC count that does not diminish from tube 1 to tube 4
Xanthochromia – yellowish tint representing hemoglobin degradation products (can take up to 12 hours to appear, so does not rule out)
168
what test to order after SAH is confirmed
o CTA – look for aneurysm or other vascular malformation (need to know where aneurysm happened)
169
BP control for SAH
<140
170
tx after SAH to prevent vasospasm and secondary SAH
nimodipine X 21 days
171
MCC of intracerebral hemorrhage
HTN
172
BP control for intracerebral hemorrhage
SBP <160
173
most cerebral aneurysms are near ______
circle of willis
174
treat cerebral aneurysms if ____ (3)
Large >7-10mm
Symptomatic
Coexistent in pt w/ previous aneurysmal SAH
175
gold standard for dx of CNS vasculitis
angiography (looks like beads on a string)
176
canadian head ct cannot be applied if: (5)
non-trauma, GCS<13, age <16, warfarin or bleeding d/o, obvious open skull fx
177
delirium commonly presents as _____ and _____
inattention and confusion
178
difference between Lewy body dementia and Parkinsons
- only difference from PD is that PD motor sx start 1+ yr before dementia. in LB, dementia starts at same time or slightly before motor
179
Cushings triad
bradycardia (also known as a low heart rate), irregular respirations, and a widened pulse pressure
180
What does cushing’s triad indicate?
Increased ICP. Likely hemorrhage
181
What is the most common causative organism of meningitis in a 1-week-old child?
Group B Streptococci
182
A 55 year old male with prostate cancer presents with mid back pain gradually worsening over three months. Now on physical exam he has symmetric weakness 4/5 in multiple muscle groups of the legs bilaterally, 3+ reflexes at the knees, sustained clonus at the ankles, and upgoing Babinski plantar reflex. What is the most likely vertebral location of his metastatic tumor?
T8
L2
S1
S3
T8. The physical findings are consistent with an upper motor neuron lesion, with weakness, hyperreflexia, upgoing toe, and sustained clonus. There is malignant invasion of the T8 vertebra with spinal cord compression. L2, S1 and S5 are distal to the spinal cord and will present with lower motor neuron symptoms, like weakness and hyporeflexia.
183
Tremor in PD: better or worse with purposeful movement
Better
184
tx for trigeminal neuralgia
carbamazepine
185
which 3 antibiotic classes should be avoided in patients with myasthenia gravis?
Fluoroquinolones, aminoglycosides, and macrolides.
186
Does increased muscle tone on passive range of motion suggest a peripheral or central lesion?
central
187
lack of coordination of movement typified by the undershoot or overshoot of intended position with the hand, arm, leg, or eye
Dysmetria
188
A 5 year-old female is brought to your facility by her parents. They have noted increasing ataxia in their daughter over the past two weeks. An MRI of the brain demonstrates a mass arising from the roof of the fourth ventricle. What is the most likely diagnosis?
astrocytoma
ependyoma
glioblastoma multiforme
hemangioblastoma
medulloblastoma
medulloblastoma
Medulloblastoma is the most common malignant brain tumor in children, accounting for 10-20% of primary CNS neoplasms and approximately 40% of all posterior fossa tumors.
189
new morning HAs with vomiting raises indicates what pathology and raises suspicious for what dx?
increased ICP, glioblastoma
190
In aseptic meningitis, CSF shows mainly ______ cells within 6-8 hours, glucose is ______ and there is _____ or ______ protein.
mononuclear
normal
normal or low
191
Closure of the eyelids is mediated by which cranial nerve?
cranial nerve III
cranial nerve V
cranial nerve VII
cranial nerve IX
7
