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CB Internal Medicine > Neuro > Flashcards

Neuro Flashcards

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
Q

What condition presents with a combine upper motor neuron (UMN) and lower motor neuron (LMN) disorder?

A

ALS (amyotrophic lateral sclerosis)

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26
Q

What condition presents with rigidity and stiffness with unilateral resting tremor and masked facies?

A

Parkinson disease

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27
Q

What is the mainstay of Parkinson therapy?

A

Levodopa/ carbidopa

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28
Q

What is the treatment for Guillain-Barre syndrome?

A

IVIG or plasmapheresis

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29
Q

What should be avoided in the treatment of Guillain-Barre syndrome?

A

Steroids

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30
Q

What condition presents with rigidity and stiffness that progress to choreiform movements, accompanies by moodiness and altered behaviour?

A

Huntington disease

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31
Q

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?

A

Sturge-Weber syndrome

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32
Q

What is the treatment for Sturge-Weber syndrome?

A

Treat symptomatically; possible local cerebral resection of the affected lobe

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33
Q

What condition presents with multiple cafe-au-alit spots on the skin?

A

Neurofibromatosis type 1

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34
Q

What condition presents with hyperphagia, hyper sexuality, hyperoroality, hyperdocility?

A

Kluver-Bucy syndrome (amygdala)

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35
Q

What drug may be administered to a symptomatic patient to diagnose myasthenia gravis?

A

Edrophonium

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36
Q

Denervation on EMG, fibrillations

A

ALS

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37
Q

Motor neuron disease, but sparing of sensation, ocular muscles, and sphincters

A

ALS

38
Q

Red Flags INCONSISTENT with ALS

A

sensory sx, predominant pain, bowel or bladder incontinence, cognitive impairment, ocular muscle weakness

39
Q

Post-polio syndrome - how does it present

A

motor neuron disease - asymmetric muscle weakness, atrophy

40
Q

What is the most common cause of symmetrical distal stocking-glove pattern?

A

DM neuropathy

41
Q

How does glaucoma cause blindness?

A

Optic neuropathy (CRN II)

42
Q

How does a CN II defect present?

A

Blindness

43
Q

How does a CN III defect present?

A

Eye deviated down and out (superior oblique and abducens paralysis) - diplopia
Ptosis

*spares the pupil

44
Q

How does a CN V defect present?

A

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
Q

How does a CN VIII defect present?

A

Sensorineural hearing loss
Vertigo

*consider acoustic neuroma

46
Q

How does a CN IX defect present?

A

Loss of taste in posterior 1/3 of tongue

47
Q

How does a CN X defect present?

A

Failed palate elevation (uvular deviation)

48
Q

How does a CN XI defect present?

A

Ipsilateral shoulder weakness

49
Q

How does a CN XII defect present?

A

Deviation of tongue to ipsilateral side

50
Q

How do axonal neuropathies present on NCS?

A

Decreased amplitude

Axon - Amplitude
Ex: DM, B12 def

51
Q

How do demyelinating neuropathies present on NCS?

A

Decreased velocity

EX: Guillain-Barre Syndrome

52
Q

CSF: high pr, normal WBC

A

GBS

53
Q

Most common antecedent infection in GBS?

A

Campylobacter jejuni

54
Q

What do these diseases have in common:
Myasthenia Gravis
Lambert-Eaton
Botulism

A

All affect the neuromuscular junction

55
Q

How can you differentiate Myasthenia Gravis from Lambert-Eaton?

A

Myasthenia Gravis: won’t get better with exercise

Lambert-Eaton: will improve with exercise (“Eaton” = “exercise”)

56
Q

Like cause of Lambert-Easton?

A

Small Cell Carcinoma of the lung

57
Q

Associated symptoms when botulism?

A

GI (since from honey, canned food)

58
Q

Where is the issue in the neuromuscular junction in Myasthenia Gravis? vs Labert Eaton?

A

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
Q

Investigation for myasthenia gravis

A

Endorphonium (Tension) test

*assess for improvement over 2 mins following injection
it inhibits the enzyme that breaks down AcH

60
Q

Treatment options for MG?

A

Thymectomy
Acetylcholinesterase inhibitors (pyridostigmine)
Steroids

61
Q

Treatment for Lambert-EAton?

A

Remove tumor (small cell carcinoma)

62
Q

Treatment for botulism

A

Botulism anti-toxin

63
Q

What conditions are characterized by symmetric proximal weakness, absent sensory changes, high CK?

A

Myopathies

poly and dermatomyositis

64
Q

Endomysial infiltrates, necrosis on biopsy

A

Polymyositis

65
Q

Perifascicular atrophy

A

Dermatomyositis

66
Q

Grottron’s papule and Groton’s sign are pathognomonic of what condition?

A

Dermatomyocytis

67
Q

What malignancies are associated with dermatomyocytis?

A

Breast
Lung
Colon
Ovarian

68
Q

What its he most common cause of intracerebral hemorrhage (stroke)?

A

HTN (most common site is brain stem)

different than most common cause of subarachnoid hem - aneurysm

69
Q

DDX of stroke

A

Stroke
Hypertensive encephalopathy
Cerebral venous sinus thrombosis

70
Q

Key feature of hypertensive encephalopathy

A

HTN
Papilledema
Focal neurological symptoms (not seen in malignant HTN)

71
Q

How do you diagnose cerebral venous sinus thrombosis?

A

MRV or CTV

72
Q

Door to needle time from time patient was last seen normal for treatment of ischemic stroke?

(tPA candidate)

A

4.5 hrs

CT has to be negative before giving tPA

73
Q

What territory is the stroke:

Contralateral leg paralysis

A

Anterior Cerebral Artery

74
Q

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)

A

Middle Cerebral Artery

75
Q

What way does eye deviation go in a Middle Cerebral Artery stroke?

A

eye deviation TOWARDS the side of the brain lesion in MCA

76
Q

What territory is the stroke:

Contralateral hemianopsia or quadrantanopia
Midbrain findings CN III, IV palsy

A

Posterior Cerebral Artery

77
Q

What territory is the stroke:

Vertigo
Ataxia
Horner's ipsilateral 
Ipsilateral facial sensory loss
Contralateral hemiparesis 
Can't swallow
A

Posterior Inferior Cerebellar Artery (PICA) or Wallenberg Syndrome
- lateral medulla - supplies CN IX, X

78
Q

Time from onset of symptoms to tpa

A

<4.5h

79
Q

Post stroke management

A 
ASA
High dose statin (80mg atorvastatin) 
HTN management - <140/90 (ramipril)
HBA1C <7%
No smoking, exercise
80
Q

Carotid endarterectomy clearly benefits who?

A

symptomatic severe stenosis 70-99%

81
Q

How do you stratify the stroke risk for patients with a fib?

A

CHADS2

CHF (1)
HTN SBP > 160 or treated HTN (1)
Age > 75 (1)
DM (1)
Prior stroke or TIA (2)
82
Q

How do you predict/identify patients at high risk of stroke following TIA?

A

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
Q

What is the most common type of MS?

A

Relapsing Remitting (RRMS)

can go onto become Secondary Progressive (SPMS)

84
Q

What is Lhermitte’s sign in MS?

A

flexion of neck causes electric shock sensation down back into limbs indicating cervical cord lesion

85
Q

What is Uhthoff’s phenomenon?

A

worsening of symptoms (usually optic neuritis) in heat

86
Q

How do you manage MS acutely?

A

high dose methylprednisolone (1000mg IV daily 3-7 days)

87
Q

Drugs to decrease MS relapse rate long term?

A

Disease Modifying Therapy (DMT)
Terifluonmide
Interferon-B

88
Q

What cranial nerves are typically affected with cavernous sinus thrombosis?

A

III, IV, VI, V1, V2 as well as orbital pain and proptosis

89
Q

How do you differentiate optic neuritis and papilledema?

A

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
Q

Wrist drop

A

Radial nerve palsy

Saturday night palsy; mid shaft humorous fracture

91
Q

Polymyalgia Rheumatica vs Polymyositis

A

no elevated CK in polymyalgia rheumatic

CB Internal Medicine (12 decks)

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