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CB Internal Medicine > Neuro > Flashcards

Neuro Flashcards

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1
Q

What condition presents with:

unilateral, severe periorbital headache with tearing and conjunctival erythema

A

Cluster headache

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2
Q

What is the prophylactic treatment for migraine?

A

Antihypertensives, antidepressants, anticonvulsants, dietary changes

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3
Q

What is the most common pituitary tumor?

A

Prolactinoma

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4
Q

What is the treatment for prolactinoma?

A

Dopamine agonists (bromocriptine)

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5
Q

A 55 year old patient presents with acute “broken speech”. What type of aphasia is this?

A

Broca’s aphasia

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6
Q

What lobe and vascular distribution are affected in Broca’s aphasia?

A

Frontal lobe, left MCA distribution

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7
Q

What is the most common cause of SAH?

A

Trauma (second most common cause is berry aneurysm)

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8
Q

A crescent-shaped hyper density on CT that does not cross the midline. What is the diagnosis?

A

Subdural hematoma

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9
Q

What causes a subdural hematoma?

A

Torn bridging veins

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10
Q

A patient presents with a history significant for initial altered mental status, with an intervening lucid interval. What is the diagnosis?

A

Epidural hematoma

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11
Q

What causes epidural hematoma?

A

Middle meningeal artery damage

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12
Q

What is the treatment for epidural hematoma?

A

Neurosurgical evacuation

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13
Q

What are the CSF findings with SAH?

A

1) Increased ICP
2) RBCs
3) Xanthochromia

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14
Q

What condition is associated with:

Albuminocytologic dissociation

A

Guillain-Barre syndrome (increased protein in CSF without a significant increase in cell count)

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15
Q

Cold water is flushed into a patient’s ear, and the fast phase of the nystagmus is toward the opposite side. Is this normal or pathologic?

A

Normal

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16
Q

What are the most common primary sources of metastases to the brain?

A

1) Lung
2) Breast
3) Skin (melanoma)
4) Kidney
5) GI tract

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17
Q

What may be seen in children who are accused of inattention in class and are often confused with ADHD?

A

Absence seizures

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18
Q

What is the most frequent presentation of intracranial neoplasm?

A

Headache.

Primary neoplasms are much less common than brain metastases

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19
Q

What are the most common causes of seizure in children (2-10 years)?

A

1) Infection
2) Febrile seizures
3) Trauma
4) Idiopathic

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20
Q

What are the most common causes of seizures in young adults (18-35 years)?

A

1) Trauma
2) Alcohol withdrawal
3) Brain tumor

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21
Q

What is the first line medication for status epilepticus?

A

IV benzodiazepine

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22
Q

What presents with confusion, ophthalmoplegia, and ataxia?

A

Wernicke encephalopathy due to a deficiency of thiamine

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23
Q

___ % lesion in a symptomatic patient is an indication for carotid endarterectomy?

A

70 %

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24
Q

What are the most common causes of dementia?

A

Alzheimer disease and vascualr/multi-infarct

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25
What condition presents with a combine upper motor neuron (UMN) and lower motor neuron (LMN) disorder?
ALS (amyotrophic lateral sclerosis)
26
What condition presents with rigidity and stiffness with unilateral resting tremor and masked facies?
Parkinson disease
27
What is the mainstay of Parkinson therapy?
Levodopa/ carbidopa
28
What is the treatment for Guillain-Barre syndrome?
IVIG or plasmapheresis
29
What should be avoided in the treatment of Guillain-Barre syndrome?
Steroids
30
What condition presents with rigidity and stiffness that progress to choreiform movements, accompanies by moodiness and altered behaviour?
Huntington disease
31
A 6 year old girl presents with a port-wine stain int he V1 distribution, intellectual disability, seizures, and ipsilateral leptomeningeal angioma. What is the condition?
Sturge-Weber syndrome
32
What is the treatment for Sturge-Weber syndrome?
Treat symptomatically; possible local cerebral resection of the affected lobe
33
What condition presents with multiple cafe-au-alit spots on the skin?
Neurofibromatosis type 1
34
What condition presents with hyperphagia, hyper sexuality, hyperoroality, hyperdocility?
Kluver-Bucy syndrome (amygdala)
35
What drug may be administered to a symptomatic patient to diagnose myasthenia gravis?
Edrophonium
36
Denervation on EMG, fibrillations
ALS
37
Motor neuron disease, but sparing of sensation, ocular muscles, and sphincters
ALS
38
Red Flags INCONSISTENT with ALS
sensory sx, predominant pain, bowel or bladder incontinence, cognitive impairment, ocular muscle weakness
39
Post-polio syndrome - how does it present
motor neuron disease - asymmetric muscle weakness, atrophy
40
What is the most common cause of symmetrical distal stocking-glove pattern?
DM neuropathy
41
How does glaucoma cause blindness?
Optic neuropathy (CRN II)
42
How does a CN II defect present?
Blindness
43
How does a CN III defect present?
Eye deviated down and out (superior oblique and abducens paralysis) - diplopia Ptosis *spares the pupil
44
How does a CN V defect present?
Loss of facial sensation Loss of corneal reflex Weakness and wasting of muscles of mastication Deviation of jaw to ipsilateral side when open Trigeminal neuralgia
45
How does a CN VIII defect present?
Sensorineural hearing loss Vertigo *consider acoustic neuroma
46
How does a CN IX defect present?
Loss of taste in posterior 1/3 of tongue
47
How does a CN X defect present?
Failed palate elevation (uvular deviation)
48
How does a CN XI defect present?
Ipsilateral shoulder weakness
49
How does a CN XII defect present?
Deviation of tongue to ipsilateral side
50
How do axonal neuropathies present on NCS?
Decreased amplitude | Axon - Amplitude Ex: DM, B12 def
51
How do demyelinating neuropathies present on NCS?
Decreased velocity | EX: Guillain-Barre Syndrome
52
CSF: high pr, normal WBC
GBS
53
Most common antecedent infection in GBS?
Campylobacter jejuni
54
What do these diseases have in common: Myasthenia Gravis Lambert-Eaton Botulism
All affect the neuromuscular junction
55
How can you differentiate Myasthenia Gravis from Lambert-Eaton?
Myasthenia Gravis: won't get better with exercise Lambert-Eaton: will improve with exercise ("Eaton" = "exercise")
56
Like cause of Lambert-Easton?
Small Cell Carcinoma of the lung
57
Associated symptoms when botulism?
GI (since from honey, canned food)
58
Where is the issue in the neuromuscular junction in Myasthenia Gravis? vs Labert Eaton?
MG - Post synaptic channel receptors (autoimmune antibodies anti-AChR or anti-MuSK) Lambert Eaton - presynaptic (autoimmune due to antibodies against presynaptic voltage-gated calcium channels, causing decreaed ACh release)
59
Investigation for myasthenia gravis
Endorphonium (Tension) test | *assess for improvement over 2 mins following injection it inhibits the enzyme that breaks down AcH
60
Treatment options for MG?
Thymectomy Acetylcholinesterase inhibitors (pyridostigmine) Steroids
61
Treatment for Lambert-EAton?
Remove tumor (small cell carcinoma)
62
Treatment for botulism
Botulism anti-toxin
63
What conditions are characterized by symmetric proximal weakness, absent sensory changes, high CK?
Myopathies | poly and dermatomyositis
64
Endomysial infiltrates, necrosis on biopsy
Polymyositis
65
Perifascicular atrophy
Dermatomyositis
66
Grottron's papule and Groton's sign are pathognomonic of what condition?
Dermatomyocytis
67
What malignancies are associated with dermatomyocytis?
Breast Lung Colon Ovarian
68
What its he most common cause of intracerebral hemorrhage (stroke)?
HTN (most common site is brain stem) | different than most common cause of subarachnoid hem - aneurysm
69
DDX of stroke
Stroke Hypertensive encephalopathy Cerebral venous sinus thrombosis
70
Key feature of hypertensive encephalopathy
HTN Papilledema Focal neurological symptoms (not seen in malignant HTN)
71
How do you diagnose cerebral venous sinus thrombosis?
MRV or CTV
72
Door to needle time from time patient was last seen normal for treatment of ischemic stroke? (tPA candidate)
4.5 hrs CT has to be negative before giving tPA
73
What territory is the stroke: Contralateral leg paralysis
Anterior Cerebral Artery
74
What territory is the stroke: ``` Contralateral weakness and sensory loss of face and arm If dominant (usually left) aphasia If non dominant (usually right) neglect ``` (all contralateral)
Middle Cerebral Artery
75
What way does eye deviation go in a Middle Cerebral Artery stroke?
eye deviation TOWARDS the side of the brain lesion in MCA
76
What territory is the stroke: Contralateral hemianopsia or quadrantanopia Midbrain findings CN III, IV palsy
Posterior Cerebral Artery
77
What territory is the stroke: ``` Vertigo Ataxia Horner's ipsilateral Ipsilateral facial sensory loss Contralateral hemiparesis Can't swallow ```
Posterior Inferior Cerebellar Artery (PICA) or Wallenberg Syndrome - lateral medulla - supplies CN IX, X
78
Time from onset of symptoms to tpa
<4.5h
79
Post stroke management
``` ASA High dose statin (80mg atorvastatin) HTN management - <140/90 (ramipril) HBA1C <7% No smoking, exercise ```
80
Carotid endarterectomy clearly benefits who?
symptomatic severe stenosis 70-99%
81
How do you stratify the stroke risk for patients with a fib?
CHADS2 ``` CHF (1) HTN SBP > 160 or treated HTN (1) Age > 75 (1) DM (1) Prior stroke or TIA (2) ```
82
How do you predict/identify patients at high risk of stroke following TIA?
ABCD2 Score ``` Age >60 (1) BP HTN >140/90 (1) Clinical Features: unilateral weakness (2), speech disturbance no weakness (1) Duration: 10-59 min (1), >60 min (2) DM (1) ``` Risk: 0-3 low; 4-5 mod; 6-7 high
83
What is the most common type of MS?
Relapsing Remitting (RRMS) can go onto become Secondary Progressive (SPMS)
84
What is Lhermitte's sign in MS?
flexion of neck causes electric shock sensation down back into limbs indicating cervical cord lesion
85
What is Uhthoff's phenomenon?
worsening of symptoms (usually optic neuritis) in heat
86
How do you manage MS acutely?
high dose methylprednisolone (1000mg IV daily 3-7 days)
87
Drugs to decrease MS relapse rate long term?
Disease Modifying Therapy (DMT) Terifluonmide Interferon-B
88
What cranial nerves are typically affected with cavernous sinus thrombosis?
III, IV, VI, V1, V2 as well as orbital pain and proptosis
89
How do you differentiate optic neuritis and papilledema?
Vision loss: rapid in optic neuritis, central, colour vision loss (vs late visual loss in papilledema) RAPD: RAPD in optic neuritis (not in papilledema) Note: Absent of pailledema in retro-orbital papilledema
90
Wrist drop
Radial nerve palsy | Saturday night palsy; mid shaft humorous fracture
91
Polymyalgia Rheumatica vs Polymyositis
no elevated CK in polymyalgia rheumatic

CB Internal Medicine (12 decks)

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