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Step 2 > Neuro 3 > Flashcards

Neuro 3 Flashcards

1
Q

What is blepharospasm?

A

Type of focal dystonia characterized by recurrent forceful contraction of the eyelid muscles

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2
Q

Features of blepharospasm?

A

Typically bilateral and symmetric, commonly affected by sensory input (triggered by bright lights, terminated by touching or brushing the skin around the eye)

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3
Q

What is Meige syndrome?

A

Blepharospasm of the lower face (eg, jaw or tongue)

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4
Q

Causes of blepharospasm?

A

Certain movement disorders (eg, Parkinson) or medications (antipsychotics), most are idiopathic

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5
Q

Manage blepharospasm?

A

Mild - trigger avoidance

More severe - botulinum toxin injection

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6
Q

Presentation of acute uveitis?

A

Ocular pain, light sensitivity

Pupillary constriction and redness at the limbus (ciliary flush)

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7
Q

What is myotonic dystrophy?

A

AD disorder causing weakness and delayed relaxation of muscle; involvement of the facial muscles may lead to ophthlamoparesis

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8
Q

Initial interventions for all patients with carotid artery stenosis?

A

Intensive medical management (ie, aspirin, statin, BP control)
Counseling on lifestyle changes (eg, exercise, smoking cessation)

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9
Q

Who should be considered for a carotid endarterectomy?

A

Symptomatic patients (ie, TIA or ischemic stroke in the distribution of the affected vessel within 6 months) with high-grade stenosis (70-99%)

If persistently disabling neuro deficits, 100% occlusion, or life expectancy <5 years -> unlikely to benefit

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10
Q

Antiplatelet therapy for patients with carotid artery stenosis?

A

All patients -> aspirin (first-line), clopidogrel if aspirin is not tolerated

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11
Q

Risk factors for cerebral palsy?

A

Prematurity

Low birth weight

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12
Q

What is cerebral palsy?

A

Non-progressive motor dysfunction, multifactorial etiology

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13
Q

Causes of cerebral palsy?

A

Usually caused by prenatal insults to brain development, with prematurity as the greatest risk factor -> more likely to have periventricular leukomalacia (white matter necrosis from ischemia/infection), and IVH (germinal matrix bleeding due to fragile vasculature and unstable cerebral blood flow)

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14
Q

Clinical features of cerebral palsy?

A

Delayed motor milestones (commando crawl commonly seen)
Abnormal tone, hyperreflexia
Comorbid seizures, intellectual disability

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15
Q

Most common subtype of cerebral palsy?

A

Spastic cerebral palsy with hypertonia and hyperreflexia predominantly involved in the lower extremities (spastic diplegia), equinovarus deformity (feet point down and inward)

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16
Q

Dx work-up of cerebral palsy?

A

MRI of brain
+/- EEG
+/- genetic/metabolic testing

17
Q

Management of cerebral palsy?

A

PT/OT/ST
Nutritional support
Ant-spastic medications

18
Q

Inclusion criteria for thrombolytics in stroke?

A

Ischemic stroke with measurable neurodeficits

Symptom onset <3-4.5 hours before treatment initiation

19
Q

Strict exclusion criteria for thrombolytics in stroke?

A

Hemorrhage or multilobar infarct involving >33% of cerebral hemisphere on CT scan

Stroke/head trauma in past 3 months

Hx of intracranial hemorrhage, neoplasm, or vascular malformation

Recent intracranial/spinal surgery

Active bleeding or arterial puncture in the last 7 days at non-compressible site

BP >185/110

Platelets <100,000 or glucose <50

Anticoagulant use with INR >1.7, PT >15, or increased aPTT

20
Q

Relative exclusion criteria for thrombolytics in stroke?

A 
Minor or rapidly improving neuro deficits
Major surgery/trauma in past 14 days
MI in the past 3 months
GU or GI bleeding in the past 21 days
Seizure at stroke onset
Pregnancy
21
Q

DDx - neck pain?

A
  1. Strain
  2. Facet OA
  3. Radiculopathy
  4. Spondylitic myelopathy
  5. Spondyloarthropathy
  6. Spinal mets
  7. Vertebral osteomyelitis
22
Q

Clinical clues suggesting strain as a cause of neck pain?

A

Antecedent history of neck injury

Pain/stiffness with neck movement

23
Q

Clinical clues suggesting facet OA as a cause of neck pain?

A

Older individuals
Pain/stiffness worse with movement
Relieved with rest

24
Q

Clinical clues suggesting radiculopathy as a cause of neck pain?

A

Pain radiates to shoulder/arm
Dermatomal sensory/motor/reflex findings
Positive Spurling test

25
Q

Clinical clues suggesting spondylitic myelopathy as a cause of neck pain?

A

LE weakness, gait/bowel/bladder dysfunction

Lhermitte sign

26
Q

Clinical clues suggesting spondyloarthropathy as a cause of neck pain?

A

Young men
HLA-B27
Relieved with exercise
Prolonged morning stiffness

27
Q

Clinical clues suggesting spinal mets?

A

Constant pain
Worse at night
Not responsive to position changes

28
Q

Clinical clues suggesting vertebral osteomyelitis?

A

Focal tenderness
Fevers and night sweats
IVDU, immune compromise, recent infection

29
Q

Most cases of cervical radiculopathy are caused by what two conditions?

A

Acute cervical disc herniation

Underlying cervical spondylosis

30
Q

What is cervical spondylosis?

A

Degenerative condition of the spine marked by osteophyte formation in the facet and uncovertebral joints -> neural foramina narrowing -> nerve root compression

31
Q

What can be seen on imaging in patients with cervical spondylosis?

A

Sclerotic facet joints with osteophytes

32
Q

Atlantoaxial subluxation can occur in patients with ___, leading to compressive cervical myelopathy. How does this present?

A

RA; neck pain radiating to the occiput, frequently develop progressive spastic paresis, Lhermitte sign, lower extremity manifestations

33
Q

Odontoid process fracture usually occurs in the setting of high-impact trauma and results in ___, not radiculopathy.

A

Myelopathy

34
Q

Vertebral body squaring is an early sign of ___.

A

Ankylosing spondylitis

35
Q

Management of myasthenic crisis with respiratory failure?

A

Endotracheal intubation
Hold AChE inhibitors (reduce excess airway secretions/risk of aspiration)
Plasmapheresis or IVIg + corticosteroids

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