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CanQB > Neuro > Flashcards

Neuro Flashcards

1
Q

Superior MCA stroke classic

A

Motor + sensory of arm and face

Spares legs

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2
Q

Inferior MCA stroke classic

A

Motor + sensory arm and face deficit
Spares legs
Hemianopsia
Hemineglect

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3
Q

Rt ACA stroke classic

A

Contralateral motor + sensory deficit of leg

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4
Q

Stoke management before CT

A

ABC
Oxygen
IVF

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5
Q

Role of steroids in strokes

A

No role

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6
Q

Stroke risk index?

A 
CHADS2
C: CHF
H: HTN
A: age > 75
D: DM
S: 2ry prevention for prior event.

All 1 point, S has 2 points.
0 = low risk
1-2 = moderate
>3 = high

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7
Q

What’s Anton’s syndrome?

A

Patient believe they can see when they can’t.

Unaware of blindness.

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8
Q

Anton’s syndrome is secondary to?

A

Posterior cerebral artery occlusion

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9
Q

Rx of stroke?

A
  1. < 3 hrs symptoms: tPA
  2. > 3 hrs: ASA
    If already on aspirin:
    Add dipyridamole or switch to clopidogrel.
  3. Hemorrhoid stroke = no Rx
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10
Q

Causes of Parkinson’s

A
  1. Idiopathic
  2. Meds:
    antipsychotic (thorazipine)
    Reserpine
    Metoclopromide
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11
Q

Rx of Parkinson’s

A
  1. Mild:
    - Anticholinergic (benztropine, trihexyphenidyl)
    - Amantadine
  2. Sever:
    - dopamine agonist (pramipexole, ropinirole)
    - L-dopa / carbidopa
    - COMPT (tolcapone, entacapone)
    - MOAI (rasagiline, selegiline)
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12
Q

Rx restless leg syndrome

A

Sleep hygiene: warm bath, stretch, massage.

Dopamine agonists:
Pramipexole
Ropinirole
Carbidopa/Levodopa

Opioids

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13
Q

Drugs worsen restless leg

A

Haloperidol (dopamine antagonist)

Naloxone (opioid antagonist)

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14
Q

Dorsal column lesions classic

A

Loss of position and vibratory sensation ONLY.

Narrow base position + look down to compensate proprioception loss.

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15
Q

What’s Romberg sign?

A

Fall of close their eyes.

Indicates loss of position / proprioception.

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16
Q

Walk in Parkinson’s

A

Falls esp when turning.
Stopping
Freezing (difficulty initiating walks)
Shuffle

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17
Q

Cerebellar lesion walk

A

Wide base when standing.
-ve Romberg sign.
No vibration or position loss.

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18
Q

Normal pressure hydrocephalus Classic

A

Ataxia
Urinary incontinence
Dementia

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19
Q

Dx normal pressure hydrocephalus

A

MRI

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20
Q

Efficacy of cholinesterase inhibitors in vascular and Alzheimer’s

A

Equal

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21
Q

Cholinesterase inhibitors

A

Donepezil
Rivastigmine
Galantamine

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22
Q

Effect of cholinesterase inhibitors on memory

A

Don’t restore it

Prevent rapid loss of memory.

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23
Q

Long term effect of cholinesterase inhibitors

A

Delay nursing home placement by 1 year.

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24
Q

Drugs increase risk of falls in elderly

A

Benzodiazepines

Diphenhydramine

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25
Q

Phenytoin toxicity

A

Nystagmus
No coordination
Ataxia + slurred speech
Mental confusion

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26
Q

Butemporal heminopsia indicates?

A

Lesion in optic chiasm

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27
Q

What’s picks disease

A

Frontotemporal dementia

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28
Q

Picks disease / frontotemporal dementia classic

A

Personality changes
Lack of judgment
Disinhibition
Memory intact 1st then deteriorates.

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29
Q

Dx fronto-temporal dementia

A

Wide gyri + narrow sulci (knife like)

Atrophy of frontal + temporal lobes.

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30
Q

When dose postherpetic neuralgia start?

A

3-6 mo after herpes zoster

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31
Q

How to decrease risk of post herpetic neuralgia?

A

Antiviral Rx w/in 72 HR

Amitriptyline Rx during infection.

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32
Q

GBS classic

A 
1-3 weeks after infection 
Ascending weakness 
No reflexes 
Spared sphincter 
Resp paralysis = intubation
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33
Q

LP in Sub arachnoid hemorrhage?

A

Xanthochromia

WBC:RBC >1:1000

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34
Q

Syncope + exercise =

A

Cardiac output problem

i.e. Aortic stenosis

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35
Q

Vasovagal syncope classic

A

Associated with unpleasant event

Heat, hunger, blood loss, pain

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36
Q

Atrial myxoma syncope classic

A

Related to bending or lying down drone seated position

Turning over in bed

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37
Q

Essential tremor Rx

A

Primidone (older pts)

Propranolol (younger)

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38
Q

Lewy body dementia classic

A 
Hallucinations 
Vivid dreams 
Sleep disorders
Day time sleep 
Abnormal clock drawing (visuospatial deficit)
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39
Q

Dx seizures

A

EEG

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40
Q

Mode of inheritance in Huntington?

A

AD

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41
Q

Risk of disease in child of affected parent

A

50%

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42
Q

Causes of vertigo

A 
Peripheral nerve 
Vestibular system (CNS)
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43
Q

Physiological vertigo

A

With head extension
Height vertigo
Following a spin

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44
Q

Pathological vertigo

A

Benign paroxysmal positional vertigo

Meniere’s

Vestibular neuritis

Acoustic neuroma

Vascular lesions

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45
Q

Differentiate central from peripheral vertigo?

A

Nystagmus persists during visual fixation = central.

No tinnitus = central.

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46
Q

Vertigo + nystagmus disappears with visual fixation?

A

Peripheral vertigo

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47
Q

Heatstroke def

A

Body temperature > 41 + neuro Sx

Esp. Confusion

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48
Q

Sx of multiple sclerosis

A 
Oculomotor Sx 
Parastheaia
Weakness 
Spastic 
Urinary incontinence
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49
Q

Horner syndrome

A

Miosis (small pupil)
Ptosis (drooping)
Anhidrosis

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50
Q

Cause of Horner syndrome

A

Interruption of sympathetic nerve

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51
Q

What dementia is cannot be treated?

A

Creutzfeldt-Jakob

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52
Q

Most common presentation of Parkinson’s

A

Resting tremor

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53
Q

Pallor of optic disk in multiple sclerosis

A

Optic nerve disease

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54
Q

What’s status epilepticus?

A

Seizures continuous with loss of consciousness > 20-30 min.

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55
Q

Rx of status epilepticus?

A
  1. ABC
    50ml bolus 50%D
    100mg thiamine
  2. Benzodiazepines (0.1-0.5 mg/kg lorazepam IV) wait 5 min
  3. Fos phenytoin 15-20 mg 2x
  4. Phenobarbital 15 mg/kg
  5. GA + muscular block 1st (succinylcholine)
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56
Q

Maximum dose of morphine

A

No top dose.

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57
Q

Dx of post herpetic neuralgia

A

TCA: amitriptyline, noretriptyline.

Anticonvulsant: gabapentin.

Opioids: morphine or tramadol

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58
Q

Carbamazepine in post herpetic neuralgia

A

Not effective

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59
Q

Migraine prophylaxis

A

BB
CCB
Anticonvulsants: vampiric acid, topiramate, gabapentin
TCA: amitriptyline

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60
Q

Feature of temporal lobe epilepsy

A

Memory impairment
Aura
Deja vu
Rising epigastric sensation

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61
Q

Occipital lobe seizure

A

Visual hallucinations

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62
Q

Seizure vs pseudo-seizure

A 
Seizure: 
Open eye 
High prolactin after seizure 
Tongue bite 
Postictal confusion 
Aura
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63
Q

Dx of Parkinson’s

A

No test = if must PET CT

Response to Rx

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64
Q

Most effective Rx in Parkinson’s

A

Levodopa

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65
Q

Long-term SE of levodopa

A

Fluctuations

Dyskinesia

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66
Q

Which has more SE in Parkinson’s:

Levodopa or dopamine agonists?

A

Dopamine agonists more SE

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67
Q

Uses of ginkgo biloba?

A

Delaying dementia > tinnitus

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68
Q

1st line prophylaxis in migraine

A

BB + TCA

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69
Q

Contraindication to using BB in migraine prevention

A

Asthma

CHF

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70
Q

Normal pressure hydrocephalus triad

A

Wacky, wet, wobbly.

Mental impairment
Urinary incontinence
Gait (broad-based shuffling)

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71
Q

Dx of normal pressure hydrocephalus

A
  1. No papilledema

2. CSF removal (30-40 ml).

72
Q

Wenicke-Korsakoff classic

A

Alcoholic
Apathy / confusion
Nystagmus
Ataxia

+/-
Confabulation
Ophthalmoplegia
Coma

73
Q

What’s wet beriberi?

A

Poly neuropathy
High output heart failure
Dementia + psychosis

In patients with high white rice or refined carb diet.

74
Q

Rx of Wernicke-Korskoff?

A

IV or IM thiamine 100 mg for 3-7 days

Then orally

75
Q

What’s brown-sequard?

A

Hemisectional spinal injury
Results in:
1. Ipsilateral loss of proprioception and vibration
2. Ipsilateral spasticity
3. Ipsilateral increased DTR
4. Contralateral loss of pain and temperature.
5. Hemiparesis

76
Q

Drugs cause dystonia

A

Dopamine antagonist:
Prochlorperazine
Metclopromide
Haloperidol

77
Q

Rx of dystonia?

A

Diphenhydramine benztropine

78
Q

Triggers of Guillain-Barré syndrome

A

Infection = c. Jejuni, HSV, mycoplasma.
Surgery
Vaccination

79
Q

Homosexual + ocular Sx

A

Toxoplasmosis

80
Q

Dx toxoplasmosis

A

CT to see multiple ring enhancing lesions

81
Q

Results of babnski interpretation

A

Extensor plantar = UMNL above S1

Flexor response = normal.

82
Q

Rx of temporal arthritis

A

High dose steroids

83
Q

What’s myasthenia graves?

A

Ab against acetylcholine nicotinic posts Taptic receptor at NMJ.

84
Q

Myasthenia graves classic

A

Worse weakness at night

85
Q

Dx myasthenia graves

A

Anti acetylcholine receptor antibodies.

86
Q

Amyotrophic lateral sclerosis (ALS) classic

A 
Upper and lower MNL. 
Mixed:
Weakness + fasciculation
Spasticity + atrophy 
Increased DTR and lost

Sphincters are intact

87
Q

Opioids for pain control in ICU

A

Morphine
Hydromorphone
Fentanyl

88
Q

Rx of pseudotumor cerebri

A

Acetazolamide

Weight reduction if obese

89
Q

Dx of pseudotumor cerebri

A

Blurry optic disk

High opening pressure on LP w/normal CSF

90
Q

What affects the results of mini mental state exam

A

Educational status

91
Q

Test to screen for memory loss

A

Mini mental state exam

92
Q

MCC of median nerve dysfunction

A

Carpal tunnel

93
Q

Median nerve injury classic?

A

Abnormal sensation in thumb, index, middle and ring.

Weakness of hands
Dropping things
Difficult grasping objects.

94
Q

What’s Forment’s sign?

A

For ulnar nerve

Hold a paper firmly between thumb and index (pinch grip) if examiner can pull the paper then it’s positive.

95
Q

Weak wrist extension indicates?

A

Radial nerve damage

Or C7 root

96
Q

Atrophy of 1st dorsal interosseous muscle seen in?

A

Compression of Ulnar nerve.

97
Q

What’s triazolam
Its uses
are its side effects

A

Benzodiazepine

Used for sleep disorders

Fall, amnesia and confusion

98
Q

Rx of trigeminal neurologia?

A

Carbamazepine 1st choice.

99
Q

Cauda equine syndrome classic

A

Sphincter laxity
Perianal numbness
Low back pain
Leg weakness

100
Q

Dx cauda equina syndrome

A

MRI of lumbosacral spine

101
Q

Most important risk factor for post herpetic neurologia

A

Old age

1ry infection in trigeminal dermatome esp. V1

102
Q

Who needs vaccination against shingles and why?

A

Elderly

Prevent post herpetic neuralgia

103
Q

Acute intermittent porphyria pain is never associated with?

Why?

A

Never associated with tenderness

Its neurologic pain not inflammatory.

104
Q

Sign of porphyria pain

A

Reduced by palpation (its neurologic)

105
Q

Fragile X syndrome

A

Men
Big ears
Big testicles
Big jaw

106
Q

MCC of mental retardation in men

A

Down

Fragile X

107
Q

Expressive aphasia localization

A

Broca’s area (can’t talk)

Inferateral frontal lobe (left)

108
Q

Posterior cerebral artery stroke

A

Occipital headache

Homonimous hemianopsia

109
Q

Labs in restless leg syndrome

A

Low ferritin <50 men

110
Q

SE of valporic acid

A

N/V
Headache
High bleeding time
Thrombocytopenia

111
Q

Pleural lobe lesion classic

A

Rt-Lt disorientation
Can’t calculate
Can’t draw
Can’t brush hair / dress

112
Q

Peroneal nerve distribution

A

Lateral lower limb
Dorsal foot
Weak dorsiflextiom

113
Q

L5 nerve damage

A

Weak ankle dorsiflexion
Weak eversion
Weak inversion
Weak hip

114
Q

Dx of Bell’s palsy

A

History

Paralysis in 1-2 days with maximal weakness in 3 wks.

115
Q

Rx of Bell’s palsy

A

Steroids

Anti virals

116
Q

Dizziness + diplopia

A

Serious work up

117
Q

Pain medication contraindicated in elderly?

A

Meperidine = causes seizures

118
Q

CN3 or oculomotor supply

A

Extraocular muscles except lateral rectus (by CN6) + superior oblique (CN4)

119
Q

MCC of CN3 palsy?

A

Berry aneurysm of circle of wills

120
Q

Differentiate CN3 palsy of berry aneurysm vs microvaascular disease

A

Parasympathetic Sx (dilated pupil) + ptosis + lateral deviation in berrys

Ptosis + lateral deviation w/o pupil involvement in microvascular

121
Q

Dx berrys aneurysm?

A

MRA

122
Q

Association w/ pseudodementia?

A

Depression

123
Q

Olfactory hallucinations + automatism (localization)

A

Temporal lobe

124
Q

How to screen for phenytoin toxicity?

A

Ataxia

125
Q

Analgesic contraindicated in seizure disorder

A

Tramadol

126
Q

Prophylaxis for cluster headache

A 
Verapamil (CCB)
Ergotamine 
Lithium 
Prednisolone 
Indomethacin
127
Q

Rx of cluster headache

A

100% oxygen
Triptan
Octreotide
Dihydroergotamine

128
Q

Subdural hematoma classic

A

Crescent shaped
+/- midline deviation
After head trauma
Lucid interval hours after trauma

129
Q

Foot drop indicates?

A

Lack of dorsiflexion
Peroneal nerve damage
L4-5 + S1-2

130
Q

Peroneal nerve injury

A

Lack of dorsiflexion
Weakness
Numbness
High stepping walk (steppage gait)

131
Q

1st line in tonic-clinic seizure

A

Valporic acid

132
Q

Drug contraindicated in tonic-clinic seizure + kidney stones or high Vit C or Ca intake?

A

Topiramate = causes kidney stones

133
Q

Cause of subdural hematoma

A

Trauma causes torn of bridging veins

134
Q

When does delirium termens develop?

A

2-3 days after last drink

Peaks 4-5 days after last drink.

135
Q

Delirium termens classic

A 
Altered mental status 
Agitation
Irrational believes 
Sweating
Hyperthermia 
Vitals instability 
Tremor 
Hallucinations 
Sleep disturbance + nightmare
136
Q

What predicts high risk of developing Alzheimer’s

A

Apolipoprotein 4 genotype

137
Q

Rapid correction of hyponatremua

A

Causes demyelination

138
Q

Lower motor neuron

A

Flaccid paralysis
Fasciculation
Lost reflexes
Down babnski -ve

139
Q

Upper motor neuron

A

Spasticity
Hyper reflexia
Up going babnski
Weakness

140
Q

Extrapyramidal lesions

A

Rigidity
Normal reflexes
Down babnski
No weakness

Rigid and strong

141
Q

Rx of delirium termens

A 
IVF w/ NS (not D5W)
Lorazepam 12 doses 2-4 mg q4hr
Or
Diazepam 20mg PO q1-2hr
Diazepam 2-5mg IV q1hr
142
Q

What’s contraindicated in delirium termens

A

D5W before thiamine

Causes Wernickes crisis

143
Q

What to r/o before Dx of Alzheimer’s in elderly?

A

Thyroid dysfunction

144
Q

Long term SE of dopamine agonists in restless leg

A

Early morning rebound / augmentation of Sx.

145
Q

Imaging test in Parkinson’s

A

PET or SPECT

146
Q

What’s a cerebellopontine angle tumor

A

Benign tumor of 8CN Schwann cells

147
Q

Cerebellopontine angle tumor classic

A

Diminish corneal reflex
Hearing defects
+/- tinnitus or vertigo

148
Q

Dx cerebellopontine angle tumor

A

Auditory evoked potential

MRI scanning

149
Q

MCC of syncope

A

Vasovagal

150
Q

MCC of Horner’s?

A

Apical bronchogenic carcinoma

Pancoast tumor

151
Q

Type of tremor in Parkinson’s

A

Essential

152
Q

What indicates benign positional vertigo

A
  1. Provoked by change in position or head movement

2. Lasts for < 30 sec

153
Q

MCC of spontaneous intracerebral hemorrhage

A

HTN

154
Q

Absence seizure classic

A

School age child

Seconds of loss of consciousness

Eyelid flattering

Staring into space

155
Q

Rx of absence seizure

A
  1. Ethosuximide

2. Then valporic acid

156
Q

What precipitate absence seizure?

A

Hyperventilation

157
Q

Instructions in restless leg syndrome

A

Rx iron deficiency

Cut back in caffeine, alcohol, tobacco

Relaxation techniques

Mind occupying activities: reading, TV

158
Q

Role of stretching exercise in restless leg?

A

None

159
Q

What’s not seen in brain death?

A

Hypothermia

160
Q

Risk of AD disease inheritance if one parent is affected.

A

25%

161
Q

Radial nerve palsy classic

A

Wrist drop

Numbness on dorsa of hands

162
Q

What to do if patient who’s addict is in sever pain and refuse physical exam?
Give them narcotic deposit their addiction or give less potent analgesics or move to investigation?

A

Treat pain with enough analgesics despite their addiction

163
Q

Lewy bodies dementia classic

A

Fluctuating cognition
Visual hallucinations
Parkinsonism

164
Q

What’s shy-drager syndrome

A

Parkinsonism + orthostatic hypotension

Not responsive to L-dopa

165
Q

Indication that a foot ulcer is of neuropathic origin?

A

Abnormal monofilament

166
Q

Rx of diabetic neuropathy

A

TCA
Anticonvulsant
Prcegablin is safe in elderly
Amitriptyline not effective in elderly

167
Q

Cholinergic toxicity

A 
Warm 
Sweaty 
Low HR
Low BP
Constricted pupil 
Teary eyes 
Drooling
168
Q

Antidote for cholinergic toxicity

A

Atropine and

169
Q

Organophosphate toxicity pathophysiology

A

Ach esterase inhibition = high Ach

170
Q

Korsakoff’s psychosis / alcoholic amnesiac Sx

A

Immediate memory loss
Confabulation
Disorientation
Emotional changes

171
Q

Pathophysiology of myasthenia graves

A

Ab against Ach receptors

172
Q

Disease associated with myasthenia graves

A 
Thyroiditis 
RA
SLE
Vit B12 
Thymoma
173
Q

Drug cause hypothermia

A

Clonidine

174
Q

Drug causes pseudo Parkinsonism

A

Chlorpromazine

175
Q

What’s sumatriptan

A

A 5-hydroxytryptamine (5-HTID) receptor antagonists.

176
Q

Anticonvulsant not used in kidney stones

A

Topiramate

Not in Vit C or high Ca

177
Q

Tramadol in seizures?

A

Contraindicated

CanQB (16 decks)

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