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Neuro Flashcards

1
Q

A lesion to which artery will result in motor/sensory deficits of the LE and trunk?

A

Anterior cerebral artery

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2
Q

A lesion to which artery will result in motor/sensory deficits of the face and UE and aphasia?

A

Middle cerebral artery

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3
Q

A lesion to which artery will lead to impaired vision?

A

Posterior cerebral artery (supplies the occipital lobe)

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4
Q

What is Wallenberg syndrome? What vessel is affected?

A
  • loss of pain and temp on the CONTRALATERAL body.
  • loss of pain/temp on the IPSILATERAL face
  • cerebellar defects

-PICA (posterior inferior cerebellar artery) –> supplying the lateral medulla.

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5
Q

Lesion of the non dominant parietal lobe (normally the right)?

A

Contralateral (normally left) hemispatial neglect

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6
Q

Lesion of the dominant parietal lobe (normally the left)?

A

Gerstmann syndrome (agraphia, acalculia, finger agnosia)

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7
Q

Lesion of the bilateral amygdalae?

A

Kluver-Bucy syndrome (disinhibition, loss of fear, hyperorality/hyperphagia, hyper sexuality)

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8
Q

Lesion of the sub thalamic nucleus?

A

Hemiballismus

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9
Q

Positive Romberg indicates a lesion where?

A

Dorsal columns (NOT cerebellum)

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10
Q

Spastic paralysis and fasciculations?

A

ALS (UMN and LMN lesions)

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11
Q

Impaired proprioception and pupils that accommodate but do not react to light?

A

Tabes Dorsalis (tertiary syphilis)

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12
Q

Bilateral loss of pain and temp below the lesion and hand weakness?

A

Syringomyelia (damage to the anterior white commissure)

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13
Q

Bilateral loss pf pain/temp below the lesion, bilateral spastic paralysis below the lesion and bilateral flaccid paralysis at the level of the lesion?

A

Anterior spinal artery syndrome (lose all but the dorsal columns)

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14
Q

Organism causing meningitis with CSF showing gram-positive diplococci?

A

S. pneumonia

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15
Q

Organism causing meningitis with CSF showing gram-negative diplococci?

A

Neisseria meningitidis

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16
Q

Organism causing meningitis with CSF showing small gram-negative coccobacilli?

A

Haemophilus influenzae

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17
Q

Organism causing meningitis with CSF showing Gram-positive rods?

A

Listeria

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18
Q

Empiric ABX for meningitis in neonates (

A

-ampicillin and gentamicin +/- cefotaxime

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19
Q

Empiric ABX for meningitis in infants (1-3 months) and adults (

A

3rd gen cephalosporin and Vancomycin (to cover resistant S. pneumo)

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20
Q

Empiric ABX for meningitis in adults >50yo?

A
  • Ampicillin (covers Listeria)
  • Vanco
  • Cefotaxime or ceftriaxone
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21
Q

When should dexamethasone be given for meningitis?

A
  • S. pneumo
  • child with HiB
  • TB meningitis
  • Give steroids BEFORE or WITH first dose of ABX
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22
Q

Suspected cause of fungal meningitis in HIV? How is it diagnosed? Tx?

A

Cryptococcal

  • Cryptococcal antigen or India ink.
  • Tx: IV amphotericin and Flucytosine x 2 weeks then oral fluconazone x 8 weeks
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23
Q

Who should receive prophylactic ABX if someone has Neiserria meningitidis? Which ABX?

A
  • Close contacts (droplet spread)

- Rifampin, cipro or ceftriaxone are acceptable

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24
Q

What is the pathogen that causes neurocysticercosis? What is normally the presenting symptom? How do you diagnose it?

A
  • Taenia soluim (after ingestion of the eggs that were excreted from a human carrier)
  • new onset seizures
  • CT or MRI –> multiple cysts with scolex inside the cyst –> calcified when collapses
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25
Q

Where does HSV-1 normally cause meningitis?

A

Temporal lobe

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26
Q

How do you treat a patient that has been bitten by an animal suspected of having rabies or an animal that cannot be observed for 10 days?

A

Rabies vaccine and rabies immunoglobulin

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27
Q

What type of meningitis is associated with CSF showing elevated WBC (lymphocytes), elevated protein and normal glucose?

A

viral

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28
Q

What type of meningitis is associated with CSF showing elevated WBC (lymphocytes), elevated protein and decreased glucose?

A

Fungal or TB

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29
Q

Jaw muscle pain with chewing?

A

Temporal arteritis

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30
Q

Obese woman with papilledema?

A

Idiopathic intracranial HTN (IIH) (used to be pseudo tumor cerebrii)

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31
Q

Headache with extra ocular muscle palsies?

A

Cavernous sinus thrombosis

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32
Q

Headache responsive to 100% oxygen?

A

Cluster

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33
Q

What is the recommended treatment for TIA?

A
  • Antiplatelet therapy (clopidogrel and aspirin/dipyridamole preferred or ASA alone)
  • anti-lipid (high intensity statin)
  • BP
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34
Q

What are the surgical indications for carotid endarterectomy?

A
  • Symptomatic its with narrowing 70-99%
  • Symptomatic MEN 50-69%

-Asymptomatic patients with narrowing 60-99%, provided the life expectancy is > 5 years and the surgeon has a preoperative complication rate of

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35
Q

What imaging is recommended for a pt with a recent TIA?

A
  • carotid US

- echocardiogram

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36
Q

When must thrombolytics be given in the setting of an ischemic stroke?

A

3-4.5 hours (up to 6 hours if you can inject directly into the clot)

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37
Q

What are the contraindications to thrombolytic therapy?

A
  • Hemorrhage on CT
  • recent surgery
  • Anticoagulation
  • Recent hemorrhage (including GI)
  • BP >185/100
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38
Q

When should BP be treated in an ischemic stroke?

A

BP>220/120

-allow permissive HTN in these patients to allow increased blood flow to the area surrounding the damaged tissue

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39
Q

Treatment for hemorrhagic stroke?

A
  • Stop anticoagulants and reverse if possible (FFP and Vit K)
  • Keep BP
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40
Q

What medication should be given ASAP for an ischemic stroke?

A

Aspirin

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41
Q

What type of hemorrhage do you suspect in a patient taking warfarin that falls and bumps his head?

A

Subdural

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42
Q

What type of hemorrhage do you suspect in a patient with a sudden onset severe headache, vomiting and meningismus?

A

SAH

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43
Q

What type of hemorrhage do you suspect in a patient with a brief loss of consciousness following a head trauma with a rapid clinical deterioration hours later?

A

Epidural

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44
Q

What type of hemorrhage do you suspect in a elderly patient with a mild headache for 2 weeks, now becoming lethargic?

A

Subdural

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45
Q

What type of hemorrhage do you suspect in a patient with a unilateral hemiparesis and BP of 220/130?

A

Parenchymal hemorrhage

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46
Q

What type of hemorrhage do you suspect in a patient with a ruptured AVM?

A

Parenchymal hemorrhage or SAH

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47
Q

Biconvex-shaped (lens-shaped) hematoma?

A

Epidural

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48
Q

Crescent-shaped hematoma?

A

Subdural

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49
Q

What are the 2 most common locations of aneurysms of the Circle of Willis?

A

Anterior communicating artery and posterior communic ating artery

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50
Q

What is the treatment for a subarachnoid hemorrhage?

A
  • Clip the ruptured aneurysm.
  • Stop anticoagulants
  • SBP
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51
Q

Which type of seizure will show 3 cycle per second spike and wave pattern? Tx?

A

Absence

-Ethosuximide

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52
Q

What is status epilepticus? How is it treated?

A
  • life-threatening seizure that lasts longer than 5 minutes.
  • Tx: 1. ABCs. 2. Benzos, 3. phenobarbital ((if intubated)
  • Phenytoin will prevent recurrence.
53
Q

Which anti-epileptics are teratogens?

A
  • Phenytoin
  • Carbamazepine
  • Valproic acid (can cause spina bifida)
54
Q

What drugs cause agranulocytosis?

A
  • Carbamazepine
  • Clozapine
  • Colchicine
  • PTU and Methimizole
55
Q

Which anti-epileptics are hepatotoxic?

A

Valproic acid and carbamazepine

56
Q

What brain lesion is seen in patients with Huntington disease?

A

atrophy of the caudate nucleus

57
Q

What is the BEST diagnostic test to diagnose ALS? What will it show?

A

EMG

-widespread acute and chronic muscular degeneration and reinnervation

58
Q

What medication is used to treat ALS?

A

Riluzole

use riLUzole to treat Lou Gehrigs

59
Q

What medication is most commonly used to treat Huntington disease?

A

Tetrabenazie (DA antagonist)

60
Q

What are the C’s associated with Huntington disease?

A
  • CAG repeat
  • Chromosome Cuatro (4)
  • Choreiform movement
  • Cognitive decline
  • Caudate nucleus atrophy
  • Cuarenta (40)=age of onset.
61
Q

What is the typical initial presenting symptom of ALS? What is NOT affected in ALS?

A
  • Asymmetric limb weakness
  • Bulbar dysfunction (dysarthria or dysphagia)

-Sensation is not affected, just movement

62
Q

What are eosinophilic inclusions of alpha-synuclein and ubiquitin? What are these associated with?

A
  • Lewy bodies

- Parkinsons

63
Q

What are the signs of optic neuritis?

A
  • Acute eye pain that is worse with eye movement
  • central vision loss
  • Afferent pupil defect (Marcus Gunn pupil: No constriction in either pupil when light is shone in the affected eye; both pupils constrict when light is shone into the unaffected eye)
  • Common finding in MS
64
Q

What is Lhermitte’s sign? What is it associated with?

A
  • Neck flexion that causes electrical shock-like tingling radiating down the back of the neck and into the extremities
  • MS
65
Q

What is the Internuclear ophthalmoplegia?

A
  • Damage to the medial longitudinal fasciculus
  • Ispilateral eye cannot ADDUCT on lateral gaze.
  • Horizontal nystagmus in the contralateral eye during lateral gaze. Normal convergence.
  • Seen in MS
66
Q

What is the most sensitive test for MS?

A
  • MRI of the brain and orbit
  • MRI of the spine
  • Will show demyelinating lesions of varying age
67
Q

What is the treatment for an acute MS flare? What about maintenance?

A
  • acute: high-dose glucocorticoids

- maintenance: Interferon beta (decreases the frequency of exacerbations)

68
Q

What is the main PE finding in syringomyelia?

A
  • Loss of pain and temp in 1-3 segments below the syrinx.

- 2/2 compression of the spinothalamic tract in the anterior white commissure.

69
Q

What is the treatment for Alzheimer disease?

A
  • Cholinesterase inhibitors (Donepezil, Galantine, Rivastigmine)
  • Memantine
70
Q

What type of dementia is associated with visual hallucinations and frequent falls?

A

Demential with Lewy Bodies

71
Q

Dementia with inappropriate social behavior or progressive aphasia?

A

Frontotemporal dementia (Pick disease)

72
Q

What is the cause of normal pressure hydrocephalus? What is the triad often seen with this?

A
  • Impaired reabsorption of the CSF by the arachnoid granules –> CSF builds up
  • Presentation: Wacky, wobbly, wet.
73
Q

What are the two most common causes of delirium?

A
  • Drugs (Benzos, anticholinergics, antihistamines, glucocorticoids, EtOH and drugs of abuse)
  • UTI
74
Q

How can you differentiate vascular dementia from Alzheimer?

A

MRI showing previous infarct in vascular dementia

75
Q

Which cause os syncope is consistent with occurring while shaving?

A

carotid sinus hypersensitivity

76
Q

Syncope while standing and singing in choir concert?

77
Q

Syncope with prolonged loss of consciousness?

A

Likely a cerebrovascular cause

78
Q

Syncope proceeded by palpitations?

A

cardiogenic (likely 2/2 arrhythmia)

79
Q

With an intact brainstem, which way should the patient’s eyes move with I’ve water infusion into the ear canal?

A

Towards the ear with the ice water

-with nystagmus away

80
Q

What is the differential for loss of consciousness?

A 
AEIOUTIPS
Alcohol
Epilepsy
Insulin
Overdose/Opioids
Uremia
Trauma
Infection
Psychogenic
Stroke
81
Q

What initial therapy should be considered with a patient coming into the ER with a loss of consciousness?

A
  • Thiamine
  • then glucose (don’t want to worsen wernicke’s)
  • naloxone
82
Q

What is the oculocephalic maneuver? What result indicates brain death?

A
  • Doll’s eye test: Move the patient’s head side to side. Pt’s eyes should stay fixed on a set point straight ahead
  • If braindead, the eyes will move with the head
83
Q

What medications are first-line treatment for restless leg syndrome?

A

DA agonists

-Pramiprexole and Ropinirole

84
Q

When do night terrors occur?

85
Q

What is the treatment for narcolepsy?

A
  • Regular sleep schedule (nap)
  • Improve daytime sleepiness: Modafinil, armodafinil, amphetamines
  • Reduce REM: Venlafaxine, fluoxetine, atomoxetine
  • Severe symptoms: sodium oxybate
86
Q

What are the brain tumors seen in adults?

A

MGM Studios

  • Metastasis
  • Glioblastoma
  • Meningioma (peripheral, resectable)
  • Schwannoma (CN8)
87
Q

What are the brain tumors seen in children?

A

“Animal kingdom, Magic kingdom, Epcot”

  • Astrocytoma
  • Medulloblastoma
  • Ependymoma
88
Q

Which pediatric brain tumors compress the 4th ventricle?

A

Medulloblastoma and Ependymoma

89
Q

Characteristic findings in Neurofibromatosis type 1?

A
  • cafe-au-lait spots
  • axillary or inguinal freckling
  • Lisch nodules (hamartomas of iris)
  • Neurofibromas
  • Optic pathway gliomas
90
Q

Characteristic finding of Neurofibromatosis type 2?

A

Bilateral vestibular schwannoma

91
Q

How is myasthenia gravis diagnosed? What is the next step that should be done?

A
  • (+) Ach Receptor Antibodies
    (or Endophonium or Tension test)
    -CT Chest* -> associated with thymoma and neoplasm of the thymus
92
Q

What is lambert-eaton associated with 60% of the time?

A

Small cell lung cancer

93
Q

What is the treatment for Lambert-Eaton and Myasthenia Gravis? How do the differ?

A
  • LE: plasmapheresis or IVIG

- MG: acetylcholinesterase inhibitors (neostigmine , pyridostigmine)

94
Q

Treatment of Bell’s Palsy?

A
  • Acyclovir
  • Glucocorticoids
  • Eye care
95
Q

What is the treatment for tics (verbal or motor)?

A

DA antagonists (fluphenazine, pimozide, tetrabenazine)

96
Q

Ptosis, mitosis and anhidrosis? Associated with what?

A
  • Horners syndrome

- Pancoast tumor (non-small cell lung cancer)

97
Q

Where is the lesion if someone presents with left anopia?

A

Left optic nerve

98
Q

Where is the lesion if someone presents with bitemporal hemianopia?

A

Optic chiasm

99
Q

Where is the lesion if someone presents with right homonymous hemianopia?

A

Left optic tract

100
Q

Where is the lesion if someone presents with right upper quadratic anopia?

A

Left temporal lobe

101
Q

Where is the lesion if someone presents with right lower quadratic anopia?

A

Left parietal lobe

102
Q

Where is the lesion if someone presents with right hemianopia with macular sparing?

A

Left occipital lobe

103
Q

The most common cause of blindness age >55?

A

Macular degeneration

104
Q

The most common cause of blindness less than 55yo?

105
Q

The most common cause in blacks of any age?

106
Q

If someone presents with left sided strabismus, which eye should be patched?

A

-the left (bad) eye to prevent amblyopia

107
Q

Loss of central vision in an old person?

A

Age-related macular degeneration

108
Q

Painless, sudden vision loss? Often flashing lights and floaters and then a “curtain pulled over the eye”?

A

Retinal detachment

109
Q

Acute, painless vision loss in a patient with a h/o atherosclerosis, HTN, a fib, DM? What will the fundoycopic exam show?

A
  • Central retinal artery occlusion

- Pale retina with a cherry red spot

110
Q

Sudden onset of unilateral eye pain, blurred vision and colored halos that encircle light sources, “rock-hard” eye, and a fixed, mid-dilated pupil?

A

Acute angle-closure glaucoma

111
Q

Main cause of anterior uveitis? Posterior?

A
  • Anterior=systemic inflammation (seronegative spondyloarthropathies)
  • Posterior=infections (HSV, CMV, toxoplasma,
112
Q

What is herpes simple keratitis? What is a worrisome complication of it?

A
  • HSV infection of the cornea.

- corneal ulceration

113
Q

Night blindness or bitot spots (areas of abnormal squamous cell proliferation and keratinization of the conjunctiva)?

A

Vit A deficiency

114
Q

Exam finding in open-angle glaucoma?

A

cup-to-disc ration >50%

115
Q

What is the treatment for acute angle-closure glaucoma?

A
  • ophthalmology referral
  • Timolol, apraclonidine and pilocarpine drops (decrease pressure)
  • Acetazolamide
  • if refractory, IV mannitol
  • Pt needs laser iridotomy
116
Q

What are some characteristic features of orbital cellulitis?

A
  • proptosis
  • pain with eye movement
  • ophthlmoplegia –> diploplia
117
Q

First-line treatment for acute otitis media?

A

Amoxicillin (ABX always for kids

118
Q

Treatment for otitis external?

A

-Topical ABX: ofloxacin, ciprofloxain, polymyxin B/neomycin

119
Q

What type of vertigo is caused by otoliths being dislodged in the inner ear?

A

BPPV

-Tx: Epley maneuvers

120
Q

What is the cause of Meniere’s disease? Tx?

A
  • excessive fluid in the inner ear.
  • tx: limit intake of salt, caffeine, nicotine and EtOH.
  • Diuretics (HCTZ)
121
Q

Weber is midline, Left Rinne AC>BC, Right Rinne AC>BC. diagnosis?

122
Q

Weber lateralizes right, Left Rinne AC>BC, Right Rinne BC>AC. diagnosis?

A

Right conductive hearing loss

123
Q

Weber lateralizes left, Left Rinne AC>BC, Right Rinne AC>BC. diagnosis?

A

Right sensorineural hearing loss

124
Q

Weber is midline, Left Rinne BC>AC, Right Rinne BC>AC. diagnosis?

A

Bilateral conductive hearing loss

125
Q

Albuminocytologic dissociation in the CSF is seen with what condition?

A

-Guillan barre syndrome

126
Q

What is the goal BP for an ischemic stroke?

127
Q

What is the goal BP for an intracerebral hemorrhage?

128
Q

What is the goal BP for SAH?

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