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2step > Neuro > Flashcards

Neuro Flashcards

1
Q

Man loses consciousness during coughing fit / during micturition at night

A

Situational Syncope

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2
Q

Dix-Hallpike maneuver shows upward beating torsional nystagmus, with the upper poles of the eye beating toward the floor, lasting 30 seconds

A

Benign paroxysmal positional vertigo (BPPV).

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3
Q

Asterixis, increased BUN, MS changes, distended abd w/ shifting dullness; dx/rx?

A

Hepatic Encephalopathy from increased ammonia due to cirrhosis/liver dysfunction (ascites); rx Lactulose

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4
Q

MS CSF finding

A

Oligoclonal bands increased IgG, normal total protein

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5
Q

20yof p/w urinary distention; cystometry w/ bethanicol produces exaggerated detrusor contraction; dx?

A

Upper motor neuron dysfnction, probably MS

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6
Q

Internuclear ophthalmoplegia, lesion?

A

Medial Longitudinal Fasciculus, common in MS

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7
Q

Lesion in abducens n?

A

Convergent strabismus, horizontal diplopia

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8
Q

Lesion in medial lemniscus?

A

Touch and vibration sensations b/l

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9
Q

Lesion in trochlear n?

A

Vertical diplopia and eye torsion

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10
Q

Lesion in oculomotor n?

A

ptosis and down and out eye (unopposed LR and SO)

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11
Q

Headache, vomiting, bilateral eyelid edema and extraocular movement restriction; dx?

A

Cavernous sinus thrombosis, may cause CN 3,4,5,6 deficits

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12
Q

Painful red eye, opacification and ulceration of the cornea, yellow discharge, contact lense use; dx?

A

Contact lense-associated infective keratitis, most commonly Pseudomonas

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13
Q

Acute bacterial meningitis CSF?

A

elevated opening pressure (100–300 mm H2O), 100–10,000 WBCs, Protein elevated (100–500 mg/dL), glucose decreased to

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14
Q

3-Hz spike-and-wave pattern EEG dx?

A

Absence seizures, lasting only a few seconds, and occur many times per day in affected children

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15
Q

triphasic discharge pattern in sporadic fashion on EEG?

A

Creutzfeldt-Jakob disease.

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16
Q

high-frequency electrographic discharge in the β frequency (“beta buzz”) with relatively low amplitude, an evolve into slow spike-and-wave complexes or diffuse polyspikes.

A

Tonic seizures consist of sudden-onset tonic extension or flexion of the head, trunk, and/or extremities

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17
Q

Fluent speech, good comprehension, can’t repeat sentences, dx?

A

Conductive aphasia, the lesion occurs at the arcuate fasciculus between Broca’s and Wernicke’s area.

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18
Q

Stroke w/ coma, cranial nerve palsies, apnea, visual symptoms, drop attacks, or dysphagia?

A

Basilar stroke

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19
Q

Loss of pain/temp sensation ipsilateral in face contralaterl body, vestibullocerebellar signs (vertigo, nystagmus), ipsilateral bulbar weakness (dysphagia, hoarseness), horner’s sx (ipsilateral autonomics); dx/location?

A

Wallenberg’s sx, lesion in lateral Medulla, occlusion on vertebral artery or PICA

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20
Q

Contralateral hemiparesis UE/LE (lateral corticospinal tract), decreased proproception (Medial lemniscus, later sign), ipsilateral hypoglossal dysfunction (tongue deviates ipsi); dx/location?

A

Medial Medullary sx occlusion of paramedian branches of ASA or vertebral artery

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21
Q

Ipsilateral facial n palsy w/ contralateral ataxia or hemiplegia

A

“alternate syndrome” facial nerve nucleus of the (lateral) Pons lesion/stroke, AICA occlusion

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22
Q

Ipsilateral oculomotor n palsy w/ contralateral ataxia or hemiplegia

A

“alternate syndrome” Vertibro basilar (midbrain/brainstem) lesion/stroke

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23
Q

Stroke w/ leg paresis, amnesia, personality changes, foot drop, gait dysfunction, also may show urinary incontince, cognitive changes, sensory deficits; dx?

A

Anterior cerebral artery strokes, c/l motor and/or sensory deficits more pronounced in LE

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24
Q

Stroke w/ pure motor (subcoritcal white matter/brainstem) with more face and UE than leg weakness, some dysarthria; dx?

A

Lacunar stroke; contralateral pure motor via lipohyalinosis of small vessels at post internal capsule

25
Q

Hemisensory loss with severe dysesthasia and athetosis or hemibalismus; dx/ location of lesion?

A

VPL Thalamus stroke (Dejerine-Roussy sx) w/ contralateral hemi-anaesthesia

26
Q

Weakness more prominent in the legs with poor ipsi leg arm coordination; dx?

A

Ataxic-sensory Lacunar stroke in the anterior limb of the internal capsule

27
Q

Unilateral numbness, paresthesias, hemisensory deficits of arm, trunk legs and face; dx/location?

A

Pure sensory lacunar stroke at the ventroposterolateral limb of the thalamus

28
Q

Pure motor dysarthria with hand weakness, No sensory deficits; dx location?

A

Dysarthria-Clumsy hand syndrome, lacunar stroke at the basis pontis

29
Q

Stroke w/ homonymous hemianopsia, memory deficits, alexia w/o agraphia (dom hemisphere), visual hallucination (calcarine cortex), sensory sx (thalamus); dx?

A

Posterior cerebral artery strokes; also may p/w 3rd N palsy w/ paresis of horizontal/ vertical eye movements, c/l motor deficits (cerebral peduncle)

30
Q

Stroke w/ aphasia (dominant hemisphere), neglect (non-dominant), contralateral hemiparesis, gaze preference, or homonymous hemianopsia.

A

Middle cerebral artery (MCA) stroke; conjugate eye deviates towards side of stroke

31
Q

Hemorrhage location? Contralateral hempiparesis and hemisensory loss, homonymous hemianopsia, gaze palsy

A

Basal Ganglia

32
Q

Hemorrhage location? Contralateral hempiparesis and hemisensory loss, nonreactive pupils, upward gaze, eyes deviate Towards hemiparesis

A

Thalamus

33
Q

Hemorrhage location? Facial weakness, nystagmus, ataxia, occipital headache

A

Cerebellum

34
Q

Immigrant p/w recent L sided weakness, hx of nocturnal cough, hemoptysis, exersional dyspnea, hrt palpitations; dx?

A

Rheumatic heart dz -> mitral stenosis -> pulm HTN (hemoptysis, dyspnea) and LA dilatation -> aFib -> atrial thrombus embolizes causing stroke

35
Q

Hypertensive brain bleed, location?

A

The basal ganglia and thalamus are the classic sites of a hypertensive bleed.

36
Q

Papilledema; dilated ipsilateral pupil; palsies of CN3 (most common), CN4 and 6; nuchal rigidity. Dx/ late signs?

A

Increased ICP; Hemiparesis, hypertonia, hyperreflexia, or Cushing’s triad (HTN, bradycardia, and respiratory depression) are late signs

37
Q

Damage to lateral spinothalamic tract?

A

Loss of pain and temp contralaterally 2 levels bellow lesion

38
Q

Ipsilateral ataxia, nystagmus, intentional tremor, loss of coordination?

A

Cerebellar tumor; sways towards affected side,

39
Q

Elder w/ impaired gait, cognitive difficulties, urinary incontinence; dx

A

NPH Normal Pressure Hydrocephalus; enlarged ventricles on CT

40
Q

20yof p/w headache, N&V, papilledema, vision loss, pulsatile tinitus, normal CSF except P>250, taking isoretinoin for acne; dx?

A

IIH Idiopathic Intracranial Htn (pseudotumor cerebri); meds (vit A derivatives, tetracyclines, GH); rx wt loss, Acetazolomide

41
Q

60yo p/w sudden rt sided weakness and hemiplegia, then vomiting and headache, has uncontrolled HTN, dx?

A

Intraparenchymal hemorrhage in the Putamen, involving the internal capsule (corticospinal tract)

42
Q

Personality changes, memory deficits, compulsive behaviors; dx?

A

Pick’s dz (Fronto-temporal dementia)

43
Q

Fluctuating cognition and attention, parkinsonian motor sx, hallucinations?

A

Lewy-Body Dementia

44
Q

Diabetic p/w sudden onset loss of vision, floaters, poorly visualized fundus; dx?

A

Vitreous hemorrhage; a/w diabetic retinopathy

45
Q

Ascending symmetric weakness (polyneuropathy) post GI or UR infection

A

Guillain Barre (campylobacter sequele) w/ peripheral nerve demyelination (motor, sensory, autonomic)

46
Q

55yoM p/w parkinsonism features, orthostatic hypotension, incontinence, impotence; dx?

A

Multiple system atrophy (shy-drager sx); autonomic dysfunction, widespread neural signs and parkinsonism; rx fludricortisol

47
Q

30yoF p/w central scotoma, decreased vision acuity and color changes, afferent pupillary defect, pain on eye movement; dx?

A

Optic neuritis a/w MS

48
Q

Unilateral violent hand swinging?

A

Hemiballismus; damage to contralateral subthalamic nuclei

49
Q

Funduscopy shows AV nicking, copper/silver wiring, exudates, hemorrhage, dx?

A

Hypertensive retinopathy

50
Q

Fundoscopy shows tortuos dilated veins, cotton whool spots, diffuse hemorrhage “blood and thunder”, swelling of the optic disk; dx?

A

Central vein occlusion, acute or subacute vision loss/haze

51
Q

Essential tremor, gets worst with intentional movement, rx?

A

Propanolol (BB) or Primidone (SE include abd pain, neuro/psychiatric disturbances)

52
Q

Down and out gaze with normal light and accomodation reaction, dx?

A

CN3 oculomotor somatic damage with entact parasympathetic component indicates DM ischemic injury

53
Q

Down and out gaze with fixed dilated pupil dx?

A

CN3 oculomotor somatic and parasympathetic components involved, as in Nerve Compression

54
Q

Earfullness, vertigo (20min-24h), tinnitis, hearing loss; dx?

A

Menierre’s disease, endolymph in inner ear; rx lifestyle mod (low salt), diuretics, antihistamine, anticholinergics

55
Q

Cranial mass, truncal dystaxia; dx/location?

A

Cerebellar Vermis, most likely Medulloblastoma

56
Q

Cranial mass, arm/leg/gait ataxia; dx/location?

A

Cerebellar hemispheres, most likely Astrocytoma

57
Q

Post seizure, pt holding shoulder adducted and internally rotated; dx?

A

Posterior shoulder dislocation

58
Q

Limited upward gaze, b/l ptosis and upper eye lid retraction, pupils minimal reactive to light but accommodate; dx?

A

Perinaud’s syndrome, pressure in pretectal midbrain near CN3 and superior colliculus

59
Q

2YO boy p/w headaches, vomiting, papilledema, limited upward gaze, b/l ptosis and upper eye lid retraction, pupils minimal reactive to light but accommodate; dx?

A

Pineal Gland tumur, (hydrocephalus from sylvian duct obstruction), beta-HCG may be produced showing precocious puberty

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