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Clin Med > Neuro > Flashcards

Neuro Flashcards

1
Q

tx for HA after concussion

A

o Acetaminophen during first 24 hours after injury for HA, NSAIDs ok after 24Hrs

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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

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3
Q

most common cranial nerve palsies : 1st and 2nd

A

7th (bell’s) and 3rd

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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.

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5
Q

is sensation affected in bell’s palsy?

A

no, facial n is motor only

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6
Q

1st line tx for bell’s palsy

A
  • 1st line = Corticosteroids – Prednisone X 1 wk
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7
Q

MCC of bell’s palsy

A

HSV

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8
Q

bell’s palsy onset: gradual or sudden?

A

gradual (hours - 3 days)

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9
Q

if bell’s is most likely dx, consider testing for ____

A

lyme

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10
Q

MCC of 3rd nerve palsy in adults

A

ischemia (diabetic nerve palsies)

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11
Q

sudden onset diplopia w/ mydriasis. dx?

A

3rd nerve palsy

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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)

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13
Q

delirium is charaterised by _____ and is worse _____

A

o Characterized by fluctuating attention and awareness (worse in evening and at night)

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14
Q

MCCs of delirium (4)

A

Fluid electrolyte disturbances (dehydration, hypo/hypernatremia), meds, infx, withdrawal

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15
Q

do what PE test for suspected encephalopathy

A

asterixis

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16
Q

horizontal shifts of midline structures > ____mm cause coma

A

> 11mm

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17
Q

decorticate posturing is below the level of the ______ and presents w/ _____

A

cerebral cortex, flexed arms

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18
Q

which is worse: decorticate or decerebrate?

A

decerebrate

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19
Q

any sleep cycles in a coma?

A

no

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20
Q

in coma, will pt have oculocephalic response?

A

no, lost

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21
Q

tx for coma pt w/ herniation syndrome (2)

A

give mannitol (1g/kg IV) and hyperventilate the patient

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22
Q

sleep cycles in persistent vegetative state?

A

yes

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23
Q

MCCs of brain death (2)

A

trauma, SAH

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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

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25
Q

tx that Paroxysmal Hemicrania and Hemicrania continua will definitely respond to

A

indomethacin

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26
Q

tx for acute cluster HA

A

oxygen (12L NRB x 15 minutes) + sumatriptan SubQ

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27
Q

1st line prophylaxis for cluster HA

A

verapamil

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28
Q

tx for mild migraines

A

1g tylenol, or NSAIDs

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29
Q

1st line tx for migraines during pregnancy

A

herbals: Mg, vitamin B2

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30
Q

MC type of primary HA

A

tension HA

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31
Q

1st line tx for tension HA

A

NSAIDs, acetaminophen, +/- caffeine

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32
Q

MCC of meningitis in adults

A

S. pneumoniae.

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33
Q

MCC of meningitis in kids <2 y/o

A

S. pneumoniae.

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34
Q

MCC of menigitis in neonates

A
  • Group B Streptococcus
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35
Q

onset in bac meningitis

A

acute (w/in 24 hrs)

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36
Q

who most commonly gets neisseria meningitis?

A

adolescents / young adults living in close proximity

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37
Q

tx meningitis w/ empiric abx + _____

A

IV dexamethasone

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38
Q

meningitis empiric abx for kids <3 mo

A

ampicillin + cefotaxime/gentamicin

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39
Q

meningitis empiric abx for 3 mo - 60 y/o

A

Ceftriaxone(Rocephin) + vancomycin

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40
Q

meningitis empiric abx for >60 y/o or immunocompromised

A

higher dose of Ceftriaxone + Ampicillin + Vancomycin

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41
Q

add what abx if listeria is poss cause of pt’s meningitis

A

ampicillin

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42
Q

3 prophylaxis options in anyone in close contact w/ meningococcal meningitis

A

cipro (adults only), ceftriaxone, rifampin

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43
Q

LP CSF has >1000 WBC, >200 protein, and low glucose <40. dx?

A

bacterial meningitis

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44
Q

LP CSF has <500 WBC, >200 protein, and normal to low glucose. dx?

A

fungal meningitis

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45
Q

MCC of enchephalitis in adults

A

HSV 1

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46
Q

encephalitis MRI shows inflammation in temporal lobes. cause?

A

HSV

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47
Q

1st line tx for encephalitis

A

high dose acyclovir

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48
Q

MC neurodegenerative disorder

A

alzheimer’s

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49
Q

avg age of onset of PD

A

60

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50
Q

PD is bradykinesia + ___ OR ____

A

resting tremor or rigidity

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51
Q

MC presenting sx of PD

A

tremor at rest

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52
Q

what type of cognitive difficulty is very common in PD

A

word finding difficulty

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53
Q

1st line tx for PD >65 y/o

A

levodopa + cardidopa

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54
Q

main way to distinguish Atypical Parkinsonism from PD

A

lack of response to levodopa

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55
Q

MC form of Atypical Parkinsonism

A
  • Progressive supranuclear palsy
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56
Q

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

A
  • Corticobasal degeneration (type of atypica parkinsonism)
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57
Q

MC movement d/o

A

essential tramor

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58
Q

essential tremor: better or worse w/ movement?

A

worse

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59
Q

essential tremor better w/ ____

A

alcohol

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60
Q

1st line for essential tremor

A

propranolol

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61
Q

RLS worst at what time of day?

A

night

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62
Q

before treating for RLS, test for ___

A

iron deficiency

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63
Q

1st line options for RLS - 2 classes

A

o Dopamine agonists – ropinirole, pramipexole, rotigotine (patch)
o Alpha 2 delta ligands – gabapentin enacarbin

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64
Q

tic d/o: onset must be before age ___

A

18

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65
Q

tourette d/o: onset must be before age ___

A

21

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66
Q

o Autosomal dominant trinucleotide repeat disorder (CAG) of the HTT gene on chromosome 4,

A

huntington’s

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67
Q

age on onset in huntington’s

A

30-50

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68
Q

death usually how long after dx in huntington’s

A

15-20 yrs

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69
Q

how many trinucleotide repeats makes the pt definitely affected w/ huntington’s

A

40+

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70
Q

tx for chorea in huntington’s (2 classes)

A

 VMAT-2 inhibitors (tetrabenazine, deutetrabenazine, valbenazine)
 Antipsychotics (D2 receptor blocking agents): risperidone or haldol

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71
Q

which treatable dz is an autosomal recessive Huntington’s phenocopy

A

Wilson’s

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72
Q

stroke leading to acute onset contralateral hemichorea or hemiballism happens where? called what?

A

basal ganglia, usually subthalamic nucleus or caudate head.
vascular chorea

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73
Q

MCC of chorea in kids

A

Sydenham’s Chorea

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74
Q

Sydenham’s Chorea is usually dx ______ after strep infx

A

4-8 wks

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75
Q

1st line med for tardive dyskinesia

A

o 1st line = Vesicular monoamine transport 2 (VMAT2) inhibitors – valbenazine, deutetrabenazine, tetrabenazine

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76
Q

dystonia is worse w/ ___ and ___

A

voluntary movement, stress/fatigue

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77
Q

which has a Repetitive, consistent pattern: dystonia or chorea?

A

dystonia

78
Q

ataxia is from a problem w/ ____ or ____

A

cerebellum or proprioceptive system (this one is aka sensory ataxia)

79
Q

autosomal recessive friedrich’s ataxia has what serious comorbidity?

A

HCM

80
Q

tremor dx: when patient is asked to voluntarily move another limb in a certain pattern, affected limb adopts the voluntary rhythm

A

functional movment d/o (specific)

81
Q

which dementia? affects frontal/executive and/or language; spares drawing

A

Frontotemporal/Cortical Dementia – Picks Disease (FTD)

82
Q

which dementia? movement and memory problems develop simultaneously; personality changes preceed memory changes; delirium prone

A

Combined Subcortical-Cortical Dementia (Lewy Body Dementia)

83
Q

which dementia can initially present with visual hallucinations, REM sleep behavior d/o, delirium, or parkinsonism?

A

Combined Subcortical-Cortical Dementia (Lewy Body Dementia)

84
Q

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

A

Combined Subcortical-Cortical Dementia (Lewy Body Dementia)

85
Q

in Pseudodementia, which sxs are most prominent?

A

depressive sx

86
Q

subcortical dementia aka vascular happens w/in ______ after a stroke

A

3 months

87
Q

avg age of onset in alzheimers

A

mid 60s

88
Q

workup to order for dementia pts: 9 and 1 imaging

A

order vitamin B12 and D and folate, HIV, syphilis, TSH, HgA1C, CMP, CBC, CT/MRI

89
Q

tx for mild AZD

A

cholinergic/acetylcholinesterase inhibitors: Donepezil (Aricept), rivastigmine, galantamine

90
Q

add ___ to tx in mod-severe AZD

A

 Memantine

91
Q

mab for AZD

A

Aducanumab

92
Q

painless asymmetrical muscle weakness in multiple muscle groups

A

ALS

93
Q

baby has a preferred hand <1 yr of age. think ____

A

cerebral palsy

94
Q

baby that has retained primitive reflexes long beyond when they should have disappeared. think ____

A

cerebral palsy

95
Q

Guillain-Barre Syndrome most commonly response to what pathogen infx

A

Campylobacter jejuni

96
Q

Guillain-Barre Syndrome : weakness is asymmetric or symmetrical? where does weakness begin?

A

symmetric and begins in legs

97
Q

what dx? facial nerve palsy, n/t in feet, difficulty swallowing, decreased DTRs

A

GBS

98
Q

tx for GBS (2)

A

IVIG, plasma exchange

99
Q

LP in GBS will show _____

A

elevated protein, NO leukocytosis

100
Q
  • Inflammatory demyelinating dz of the CNS where lesions are scattered in time and space
A

MS

101
Q

age of onset in MS

A

20-40

102
Q

what is the dx: n/t, pain, walking difficulty, scotomas, diplopia. sx are worse w/ heat

A

MS

103
Q

MS PE findings for reflexes, vibration, Rhomberg

A

hyperreflexia
poor vibration sense
positive Rhomberg

104
Q

MS sx are worse w/ ____

A

heat

105
Q

imaging for suspected MS

A
  • Brain MRI w/ gadolinium
106
Q

tx for acute MS

A

high dose, daily steroids (methylprednisolone 500-1000mg IV x 3-5 days)

107
Q

will NSAIDs help w/ MS?

A

no

108
Q

1st line for primary progressive MS

A

ocrelizumab (Ocrevus) IV is 1st line

109
Q

1st line for fatigue in MS

A

amantadine (1st line)

110
Q

1st line for muscle spasm in MS (2)

A

baclofen, tizanidine

111
Q

episode muscle weakness in muscles innervated by CNs

A

myasthenia gravis

112
Q

does myasthenia gravis involve sensory deficits?

A

no

113
Q

pt w/ diplopia, ptosis, ophthalmoplegia that gets worse w/ activity and better w/ rest

A

myasthenia gravis

114
Q

order what imaging for myasthenia gravis

A

o CT or MRI of neck and upper mediastinum – check for thymoma

115
Q

what happens after applying an ice pack if the pt has myasthenia gravis?

A

muscle tone imroves

116
Q

test serum for what antibodies in suspected myasthenia gravis

A

anti-AChR antibodies
(ACh receptors)

117
Q

myasthenia gravis tx includes ______ inhibitors

A

cholinesterase inhibitors (Pyridostigmine)

118
Q

MC type of peripheral neuropathy

A

axonal degeneration

119
Q

axonal degeneration: distal to prox or prox to distal?

A

distal to prox

120
Q
  • Lateral femoral cutaneous neuropathy (Meralgia Paresthetica) affects which type of nerves?
A

sensory only

121
Q

diabetic neuropathy is what type of polyneuropathy?

A

chronic axonal

122
Q

GBS neuropathy affects motor or sensory?

A

motor predominantly

123
Q
  • Most common type of peripheral polyneuropathy
A

Diabetic Neuropathy

124
Q

how common is neuropathy in diabetics?

A

about 50%

125
Q

MCC of seizures in 45+

A

strokes

126
Q

how are focal seizures different from generalised?

A

focal involve only 1 area or side of the brain and body

127
Q

which type of seizure?  Involves sudden loss of muscle tone that can result in the person falling down, dropping objects, or nodding head involuntarily.

A

atonic (a motor seizure)

128
Q

any postictal drowsiness in absence seizures?

A

no

129
Q

 EEG: 3 hertz spike; 3 cycles/sec generalized spike and wave activity. dx?

A

absence seizure

130
Q

1st line tx for absence seizure

A

ethosuximide = 1st line.

131
Q

febrile seizures: age and temp reqs

A

6 mo - 5 yrs; 38C+

132
Q

EEG on 9 month old showing hypsarrythmia is what?

A
  • Infantile Spasms (hyperarrhythmia, aka West syndrome)
133
Q

6 important hx Qs to characterise seizures

A
  • 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
Q

1st line tx for seizures in pregnancy (2)

A

lamotrigine, Keppra/Levetiracetam

135
Q

duration for seizure to become status epilepticus

A

> 5 minutes if tonic-clonic / >10-15min if not primarily motor or recurrent seizures w/o return to baseline over 20 minutes

136
Q

1st tx to give in status epilepticus

A

1st line is lorazepam (Ativan) 0.1mg/kg repeat once in 4 min. If no IV, midazolam IM 10mg.

137
Q

2nd tx to give in status epilepticus

A

o 2nd step is IV AED: phenytoin/fosphenytoin, levetiracetam, valproate

138
Q

most important modifiable RF for strokes

A

HTN

139
Q

ischemic strokes are MC in which artery

A

MCA

140
Q

where is the stroke? contralateral weakness and numbness of face and arm, as well as aphasia

A

left MCA

141
Q

where is the stroke? contralateral weakness and numbness of the face and arm, as well as neglect or apraxia (difficulty performing skilled movements)

A

right MCA

142
Q

where is the stroke? contralateral leg weakness and numbness

A

ACA

143
Q

where is the stroke? contralateral homonymous hemianopsia and contralateral numbness. Cannot read but can write (alexia w/o agraphia)

A

PCA

144
Q

locked in syndrome happens in what artery?

A

basilar

145
Q

where is the stroke? vertigo, visual changes (diplopia), vomiting, vibrating eyes (4 Vs)

A

verterbrobasilar

146
Q

crossed deficits (like sensory loss in ipsilateral face and contralateral body) – think stroke in which location?

A

brain stem

147
Q

order what imaging to distinguish b/w ischemic and hemorrhagic stroke

A

emergent head CT w/o contrast

148
Q

after hemorrhagic stroke is r/o, get what imaging to locate site of ischemic occlusion?

A

CTA or MRI brain w/o contrast

149
Q

stroke pt not eligible for tPA – treat BP if >________________________________ and reduce by ____%

A

> 220/120, 10-15%

150
Q

time window for tPA in ischemic stroke

A

<4.5 hours after symptom onset/last known well. Door to needle time <60min

151
Q

for tPA recipient, treat BP if >___

A

if >185/110

152
Q

time window for thrombectomy

A

 Time window up to 6 hours after LKN, can be up to 24 hours in certain circumstances

153
Q

can thrombectomy be performed after tPA is given?

A

yes

154
Q

meds to manage BP in ischemic stroke pts

A

labetolol or CCBs (nicardipine, clevidipine).

155
Q

is there any infarcation / tissue death in TIAs?

A

no

156
Q

sx in TIA last how long?

A

1-24 hrs

157
Q

tx after TIA

A

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
Q

what is bleeding in epidural hematoma?

A

o Traumatic rupture of middle meningeal artery

159
Q

classic presentation of epidural hematoma

A

immediate LOC, followed by transient recovery (“lucid interval”) lasting 20 min – few hrs, followed by rapid neurologic deterioration

160
Q

Ct scan of brain shows lens shape (like lens of eye) aka b/l convex. dx?

A

epidural hematoma

161
Q

where is bleeding in subdural hematoma?

A

o Bleeding into space between dura and arachnoid membranes

162
Q

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

A

subdural hematoma

163
Q

crescent shaped aka banana shaped bleed on brain CT

A

subdural hematoma

164
Q

where is bleeding in SAH

A

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
Q

what is more common, intracerebral hemorrhage or SAH?

A

intracerebral

166
Q

order what test for SAH

A

CT head w/o contrast

167
Q

highly suspected SAH but CT head is negative. next order? and look for?

A

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
Q

what test to order after SAH is confirmed

A

o CTA – look for aneurysm or other vascular malformation (need to know where aneurysm happened)

169
Q

BP control for SAH

A

<140

170
Q

tx after SAH to prevent vasospasm and secondary SAH

A

nimodipine X 21 days

171
Q

MCC of intracerebral hemorrhage

A

HTN

172
Q

BP control for intracerebral hemorrhage

A

SBP <160

173
Q

most cerebral aneurysms are near ______

A

circle of willis

174
Q

treat cerebral aneurysms if ____ (3)

A

 Large >7-10mm
 Symptomatic
 Coexistent in pt w/ previous aneurysmal SAH

175
Q

gold standard for dx of CNS vasculitis

A

angiography (looks like beads on a string)

176
Q

canadian head ct cannot be applied if: (5)

A

non-trauma, GCS<13, age <16, warfarin or bleeding d/o, obvious open skull fx

177
Q

delirium commonly presents as _____ and _____

A

inattention and confusion

178
Q

difference between Lewy body dementia and Parkinsons

A
  • 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
Q

Cushings triad

A

bradycardia (also known as a low heart rate), irregular respirations, and a widened pulse pressure

180
Q

What does cushing’s triad indicate?

A

Increased ICP. Likely hemorrhage

181
Q

What is the most common causative organism of meningitis in a 1-week-old child?

A

Group B Streptococci

182
Q

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

A

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
Q

Tremor in PD: better or worse with purposeful movement

A

Better

184
Q

tx for trigeminal neuralgia

A

carbamazepine

185
Q

which 3 antibiotic classes should be avoided in patients with myasthenia gravis?

A

Fluoroquinolones, aminoglycosides, and macrolides.

186
Q

Does increased muscle tone on passive range of motion suggest a peripheral or central lesion?

A

central

187
Q

lack of coordination of movement typified by the undershoot or overshoot of intended position with the hand, arm, leg, or eye

A

Dysmetria

188
Q

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

A

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
Q

new morning HAs with vomiting raises indicates what pathology and raises suspicious for what dx?

A

increased ICP, glioblastoma

190
Q

In aseptic meningitis, CSF shows mainly ______ cells within 6-8 hours, glucose is ______ and there is _____ or ______ protein.

A

mononuclear
normal
normal or low

191
Q

Closure of the eyelids is mediated by which cranial nerve?

cranial nerve III

cranial nerve V

cranial nerve VII

cranial nerve IX

A

7

Clin Med (14 decks)

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