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2CK Smartbook > Neuro > Flashcards

Neuro Flashcards

1
Q

a patient in a MVA is alert then suddenly becomes vegetative; CT shows minute punctate hemorrhages with blurring of grey-white border; what is the diagnosis?

A

diffuse axonal injury (key clues: deceleration injury, sudden rapid decline, sx out of proportion to CT findings, grey-white border damage in the area where densities are different)

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2
Q

steps of working up a solitary pulm nodule

A

chest x-ray, compare to previous, if stable do nothing, if new do chest CT, if benign do serial CT’s, if suspicious do PET or biopsy, if definite malignancy surgery

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3
Q

a patient with previous whiplash injury develops decreased pain and temp sensation in upper extremities along with weakness; what is the diagnosis

A

syringomyelia (CSF expansion of the central canal leads to compression of spinothalamic crossing fibers and possibly cervical and thoracic portions of corticospinal tracts)

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4
Q

what are four main pathognomonic symptoms of fetal alcohol syndrome

A
  1. small palpebral fissures
  2. smooth philthrum
  3. thin upper lip
  4. microcephaly
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5
Q

how do you differentiate between cauda equina syndrome and conus medularis syndrome

A

cauda equina syndrome involves UNILATERAL radicular pain, saddle hypoesthesia, asymmetric muscle weakness, hyporeflexia due to peripheral neuropathy

conus medularis involves BACK PAIN w/o significant radicular pain, perianal hypoesthesia and symmetric muscle weakness and hyperreflexia (more of an UMN b/c it is part of spinal cord)

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6
Q

what is the most common pediatric brain tumor

A

astrocytoma (note: they can be infratentorial or supratentorial)

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7
Q

what differentiates a complex partial seizure with lip smacking from an absence seizure with lip smacking

A

in absence there is no post-ictal state; also, hyperventilation during EEG can reproduce an absence seizure pattern (3Hz spike and wave pattern)

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8
Q

what’s the difference between a typical vs. atypical absence seizure

A

atypical absence seizure lasts longer and has slower spike and wave pattern (

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9
Q

what is Lennox Gastaut syndrome

A

childhood seizures of multiple types, impaired cognition, slow spike and wave EEG activity

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10
Q

a patient on metoclopramide for gastroparesis develops muscle pain and contraction; why is this and what do you do for it

A

dystonic reaction; metoclopramide is a dopamine antagonist and like the antipsychotics can cause extrapyramidal symptoms like parkinsonisms, dystonic rxns and rarely NMS; tx=benztropine or diphenhydramine

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11
Q

in what condition do you see albumino-cytologic dissociation

A

Guillain-Barre

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12
Q

what CSF findings are characteristic of Multiple Sclerosis

A

oligoclonal bands (IgG relative increase compared to other classes); however a CSF IgG index can have false positives

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13
Q

port-wine stain, leptomeningeal angiomas, glaucoma, seizures, mental retardation are all a part of what syndrome

A

Sturge-Weber

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14
Q

what are the symptoms of tuberous sclerosis

A

HAMARTOMA: hamartomas, adenoma sebaceum, mitral regurg, ash-leaf spots, rhabdomyoma, (tuberous sclerosis), autosomal dOminant, mental retardation, renal Angiomyolipoma, seizures

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15
Q

you diagnose a patient with likely Guillain Barre; what should you do next for management?

A

serial spirometry to assess FEV and FVC to determine if intubation is needed (peak flow is a less accurate alternative)

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16
Q

how does hyperventilation help decrease intracranial pressure

A

increased paCO2 promotes vasodilation and increased cerebral blood flow; lowering the CO2 in the blood promotes vasoconstriction to lower cerebral blood flow and thereby lower intracranial pressure

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17
Q

what is the most important risk factor for stroke

A

hypertension (not smoking)

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18
Q

sporadic upper motor and lower motor neuropathies with no sensory deficits is characteristic of what disease

A

Amyotropic Lateral Sclerosis

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19
Q

what drugs are used to treat Alzheimers

A

cholinesterase inhibitors (donepezil, galantamine, rivastigmine) and the NMDA-R antagonist memantine

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20
Q

what is the treatment for a solitary brain met vs. multiple brain mets

A

for a single brain met: surgical resection, then follow with stereotactic radiosurgery or whole brain radiation therapy

multiple mets: whole brain radiation therapy or supportive therapy

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21
Q

what is Todd’s paralysis

A

post-ictal paralysis

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22
Q

how do you differentiate between the two causes of ring enhancing lesions in an AIDS patient

A

toxoplasmosis usually shows multiple lesions (toxo serologies are not confirmatory as they are positive in many people) whereas CNS lymphoma would be a single lesion (check for CSF EBV DNA to confirm dx)

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23
Q

if you see EBV DNA in the CSF of a patient you should be thinking what condition

A

CNS lymphoma

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24
Q

an exclusively breastfed baby develops bilateral bulbar palsies followed by descending flaccid paralysis; what is the diagnosis and how do you treat it

A

botulism (via ingestion of dust-borne spores)

tx=human-derived botulism immune globulin

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25
Q

how can you differentiate between botulism and Werdnig-Hoffman (spinal muscular atrophy)?

A

spinal muscular atrophy does not affect the pupils and the motor weakness is more pronounced in the lower extremities than upper

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26
Q

what medications predispose to pseudotumor cerebri

A

tetracyclines and isotrentinoin (hypervitaminosis A)

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27
Q

what is Shy-Drager syndrome

A

Shy-Drager syndrome also known as multiple system atrophy involves Parkinsonism, autonomic dysfunction (orthostatic hypotension, incontinence, gastroparesis, etc.) and widespread neurologic deficits

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28
Q

what is the first line therapy for pseudotumor cerebri

A

acetazolamide (inhibits choroid plexus carbonic anhydrase)

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29
Q

how do you differentiate between a basal ganglia hemorrhage and thalamus hemorrhage

A

both have contralateral loss of motor and sensation
basal ganglia involves gaze away from the hemiparesis (toward the hemorrhage) whereas thalamic hemorrhage involves gaze away from the hemorrhage and is associated with nonreactive miotic pupils

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30
Q

what drug is used to prevent cerebral vasospasm

A

nimodipine

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31
Q

besides monitoring with spirometry, how do you treat Guillain Barre Syndrome

A

IVIG or plasmapheresis (glucocorticoids are not effective)

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32
Q

what laboratory result confirms diagnosis of Guillain Barre Syndrome

A

CSF analysis showing albuminocytologic dissociation (high protein with normal WBC)

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33
Q

a child with an ear infection has headaches and vomiting at night and in the morning; what is your greatest concern (dx?) and what is the next step of workup?

A 
brain abscess (as a complication of otitis media)
get a CT with contrast (will show ring-enhancing lesion) or brain MRI
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34
Q

how do you differentiate anterior cord syndrome from central cord syndrome

A

anterior cord usually occurs after a burst fracture and involves bilateral loss of motor and pain/temp sensation below the lesion

central cord usually follows a cervical injury and involves bilateral motor weakness and pain/temp sensation in a cape distribution

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35
Q

cephalohematoma vs. caput succedaneum

A

cephalohematoma=subperiosteal hemorrhage, slow forming, no scalp discoloration, limited to one cranial bone

caput succedaneum=scalp bruise from birth trauma (presenting part) that can cross suture lines

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36
Q

what is the treatment for a simple febrile seizure

A

reassurance;

for a complicated seizure (longer than 15 min or multiple episodes) consider imaging

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37
Q

key distinction between normal aging and dementia

A

dementia=impaired daily function

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38
Q

what does aura tell you about the type of seizure

A

that it is likely partial (since the aura comes from a discrete focus)

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39
Q

what does very high creatine kinase tell you about the type of seizure

A

likely generalized (either primarily or secondarily to a partial)

40
Q

what are the most common side effects of levodopa/carbidopa

A

hallucinations, confusion, dizziness

41
Q

intraventricular hemorrhage from germinal matrix is most commonly due to what predisposing factors

A

prematurity and low birth weight

42
Q

name a drug that is used to treat resting tremor in young patients with Parkinson’s

A

trihexyphenidyl

43
Q

headaches that are worse at night or worsen with leaning forward, valsalva or cough are concerning for what condition

A

intracranial hypertension

44
Q

prochlorperazine, chlorpromazine and metoclopramide all have what mechanism of action

A

D2 receptor antagonists (antiemetics)

45
Q

what should you provide for abortive therapy for migraine?

prophylaxis?

A

abortive: NSAIDs, triptans (require early administration), antiemetics (metoclopramide, prochlorperazine)
ppx: antiepileptics (gabapentin, topiramate), TCA’s, beta-blockers, CCB’s

46
Q

what is tolterodine

A

an anticholinergic

47
Q

what does a positive arm drop test tell you (passively abduct the arm past 90 degress and ask the patient to adduct)

A

if the arm drops rapidly= positive => likely rotator cuff tear

48
Q

Parkinson’s is caused by overactivity of ______ neurons and underactivity of ______ neurons

A

overactivity of cholinergic neurons

underactivity of dopaminergic neurons

49
Q

how can you differentiate BPPV from Meniere’s disease

A

in Meniere’s disease vertiginous episodes are usually preceeded by ear fullness/pain and there is often accompanying hearing los/tinnitus
BPPV has no auditory sx and is brought on by predictable head movements

50
Q

which two kinds of point mutations in DNA typically cause the most severe disease

A

nonsense (stop codon) and frameshift

51
Q

what are the similarities and differences between Marfan’s and Homocystinuria

A

both: tall, long arms and fingers, joint and skin hyperlaxity
Marfan’s: aortic root dilation, normal intellect
Homocystinuria: mental retardation, fair complexion, HYPERCOAGULABILITY (strokes, MI’s)

52
Q

how do you treat homocytinuria

A

B6, folate and B12 to lower homocysteine levels and antiplatelets or anticoagulation to reduce risk of thrombotic events

53
Q

what treatment should you start in a patient who had a stroke from septic embolus

A

antibiotics ONLY (no aspirin)

54
Q

name four major complications of heat stroke

A

rhabdomyolysis, renal failure, ARDS and coagulopathy

55
Q

a patient with an insect bite on the face develops severe headaches, bilateral periorbital edema and extraocular muscle movement deficits; what is the dx and tx?

A

dx: cavernous sinus thrombosis (infectious origin due to valveless veins in the face)
tx: antibiotics, monitor/prevent cerebral herniation

56
Q

a patient with a past history of opioid abuse is in severe pain due to MVA; what treatment should be given?

A

IV morphine; patients with addiction history should be given same treatment as other patients in acute pain (adequate treatment of severe acute pain actually decreases risk of relapse)

57
Q

what do you see on EEG for a patient with Creutzfeld-Jacob

A

sharp, triphasic wave forms on EEG

58
Q

forceful abduction and external rotation (blocking a basketball shot) results in inability to internally rotate the arm and sensation loss over the lateral upper arm; what is the likely nerve injury

A

axillary nerve; anterioinferior dislocation of the humerus in the glenohumeral joint causes axillary nerve damage resulting in deltoid and teres minor weakness as well as loss of sensation over lateral upper arm

59
Q

a MMSE less than what number is indicative of dementia

A

less than 24

60
Q

impaired rapid alternating movements and intention tremor suggests lesion of what CNS structure

A

cerebellum

61
Q

medulloblastoma usually develops in what part of the cerebellum?
what specific deficit does this cause?

A

cerebellar vermis

truncal ataxia

62
Q

what are the characteristic features of neurofibromatosis 1 vs. neurofibromatosis 2?

A

NF1: cafe au lait spots, macrocephaly, learning disabilities, neurofibromas
NF2: bilateral accoustic neuromas and cataracts

63
Q

what is the most important risk factor for cerebral palsy

A

prematurity

64
Q

hypertonia, hyperreflexia, clasp-knife spasticity, intellectual disability and equinovarus deformity (toes pointing down and inward) suggests what disease

A

cerebral palsy

65
Q

most common intracranial lesion in neurofibromatosis 1

A

optic glioma

66
Q

a hyperextension injury in a patient with degenerative spine changes resulting in upper > lower extremity weakness should make you think

A

central cord syndrome (syringomyelia)

67
Q

differentiate between L5 radiculopathy and common peroneal neuropathy

A

both have impaired eversion and dorsiflexion; L5 radiculopathy will also have weak inversion and plantarflexion due to tibial nerve deficit and will also have radiculopathic shooting back pain

68
Q

most common site of lacunar infarcts

A

internal capsule

69
Q

a stroke causing contralateral face arm and leg weakness with no other deficits is likely due to a lesion where?

A

internal capsule

70
Q

what happens to pupilary light reflex and deep tendon reflexes in brain death

A

pupilary light reflex=gone, DTRs=present
brain death=cerebrum and brainstem death, though the spinal cord may still be functioning and therefore DTR’s can be present in a brain dead person

71
Q

ESR and CK for steroid-induced myopathy vs. polymyalgia rheumatica vs. hypothyroid myopathy

A

steroid-induced: normal ESR, normal CK
polymyalgia rheumatica: high ESR, nl CK
hypothyroid: nl ESR, high CK

72
Q

a patient with only motor deficits and with contralateral face, arm and leg hemiparesis should make you think of what territory and blood supply

A

posterior limb of the internal capsule; anterior choroidal artery

73
Q

what are the motor and sensory deficits of a femoral nerve injry

A

motor deficits: thigh flexion, knee extension

sensory deficits: anterior thigh and knee, medial leg

74
Q

etiology of Friedrich’s ataxia and associated symptoms

A

autosomal recessive trinucleotide repeat (GAA) leading to dysfunctional frataxin gene and impaired mitochondrial function

sx: staggering ataxic gate, kyphoscoliosis, hypertrophic cardiomyopathy, pes cavus, hammer toes

75
Q

spinal muscular atrophy, poliomyelitis and ALS all involve which nervous structure

A

anterior horn of the spinal cord

76
Q

what are the four types of extramyramidal system side-effects seen with dopamine 2 antagonists and in what order do they occur?

A
  1. acute dystonia
  2. akathesia
  3. drug-induced Parkinsonisms (i.e. bradykinesia, resting tremor)
  4. tardive dyskinesia
77
Q

contralateral anesthesia (and dysesthesia) with transient contralateral hemiparesis and athetosis is indicative of what condition and what nervous structure

A

Dejerine-Roussy syndrome (also known as thalamic pain syndrome); VPL of the thalamus

78
Q

a 60 year old gets bitemporal vision loss: what two categories of tumors should you suspect

A

pituitary adenoma and craniopharyngioma (bimodal age distribution)

79
Q

how can you differentiate between aminoglycoside toxicity and Meniere’s

A

Meniere’s is a chronic condition with episodes of vertigo, tinnitus and low frequency hearing loss

aminiglycosides can cause hearing loss and vestibulopathy, but rarely vertigo (due to bilaterality) and rather tend to cause a positive head thrust with difficulty holding gaze on head turn and horizontal saccades upon return to object

80
Q

for CN3, where are the parasymp fibers relative to the motor fibers

A

motor is protected (inner nerve; damaged by ischemia)

parasympathetic is on the outside (damaged by compression)

81
Q

how does cyanotic heart disease predispose to brain abscess

A

right to left shunt bypasses the lungs where bacteria are often trapped and phagocytosed

82
Q

what are the three P’s of McCune Albright syndrome

A

precocious puberty, pigmentation (cafe au lait spots), and polyostotic fibrous dysplasia

83
Q

what is the gold standard for diagnosis of muscular dystrophy and what findings do you see

A

genetic testing (not biopsy!)

deletion of dystrophin gene on chromosome Xp21

84
Q

what is the inheritence pattern of Duchenne muscular dystrophy

A

X-linked recessive

85
Q

a child with hypotonia/weak suck reflex, hyperphagia, obesity, and hypogonadism should make you think of what condition

A

Prader-Willi (big momma’s boy, small willi)

due to maternal uniparental disomy of chromosome 15q11-q13

86
Q

what are the symptoms of Angelman syndrome

A

inappropriate smiling/ laughter, hand flapping, ataxia, seizures, MR

87
Q

how can you tell Duchenne vs. Becker muscular dystrophy

A

Duchenne onset is 2-3 years of age while Becker is 5-15 and weakness is milder

88
Q

an adolescent who develops myotonia (delayed muscle relaxation) and dysphagia likely has what condition?
what is the inheritance pattern?

A

myotonic dystrophy

autosomal dominant (as opposed to Duchenne and Becker which are X-linked recessive)

89
Q

lens dislocation in Marfan’s vs. homocysinuria

A

Marfan’s: upward lens dislocation

homocystinuria: downward lens dislocation

90
Q

what causes edema in Turner’s syndrome

A

congenital lymphedema due to abnormal development of lymphatic system

91
Q

what drug that is used to treat essential tremor can cause acute intermittent porphyria (abdominal Pain, Port wine urine, Polyneuropathy, Psychiatric sx,

A

primidone (which gets converted to phenobarbitol)

92
Q

most common pathogen to cause brain abscess due to local extension from sinusitis

A

viridans strep (staph is more common via hematogenous spread to brain)

93
Q

pharmacotherapy for restless leg syndrome includes what

A 
dopamine agonists (pramipexole)
calcium channel ligands (gabapentin)
iron for deficient patients
94
Q

a child has a seizure at home; in the ED she has evidence of otitis media and neuro exam is normal; she is now alert and cooperative; what should you do next?

A

oral antibiotics; no further workup needed for febrile seizure

95
Q

when you give a triptan what other drug for migraine do you have to avoid

A

ergotamines (triptans and ergotamines both affect serotonin receptors to cause vasoconstriction so risk of vasospasm is high and they have to be given at least 24 hours apart)

96
Q

first line medical treatment for pseudotumor cerebri

A

acetazolamide +/- furosemide

2CK Smartbook (18 decks)

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