Neuro Flashcards
1
Q
Limited upward gaze, upper eyelid retraction, and pupils non reactive to light but reactive to accommodation. What syndrome? What mass is it associated with?
A
Parinaud syndrome associated with pineal gland masses
2
Q
Strokes less than ___ hours old are not usually visible on ct
A
Six
3
Q
How to identify ischemic changes of stroke not detected on ct
A
MRI
4
Q
Function of lateral corticospinal tract
A
Movement of ipsilateral limbs and body
5
Q
Lesion of lateral corticospinal tract causes
A
Ipsilateral paresis at and below level of lesion
6
Q
Lesion of dorsal column medial meniscus tract causes
A
Ipsilateral loss of fine touch, vibration, proprioception at and below level of lesion
7
Q
Lesion of spinothalamic tract causes
A
Contralateral loss of pain and temp at and below level of lesion
8
Q
Dorsal column medial meniscus has what function
A
Fine touch, vibration, conscious perception
9
Q
Spinothalamic tract has what function
A
Pain, temperature
10
Q
Affects what part of the spinal cord?
Causes what?
Polymyositis
A
Anterior horns
Lmn lesions and flaccid paralysis
11
Q
Affects what part of the spinal cord?
Ms
A
Mostly white matter in cervical region; dcmm and spinothalamic
12
Q
Affects what part of the spinal cord?
Causes what?
Ams
A
Anterior horns and lateral corticospinal
Fasiculations, atrophy and weakness of muscles, commonly of hands
13
Q
Tx of Lou Gehrig’s
A
Riluzole might help
14
Q
Affects what part of the spinal cord?
Occlusion of anterior spinal artery
A
Front, but spares dorsal columns
15
Q
Affects what part of the spinal cord?
Causes what?
Tabes dorsalis
A
Dcmm
Impaired sensation and proprioception, ataxia, poor coordination
16
Q
Affects what part of the spinal cord?
Causes what?
Syringomyelia
A
Syrinx (csf filled cavity in the spinal cord), expanding to damage spinothalamic tract
Capelike bilateral loss of pain and temp in upper extremities
17
Q
Affects what part of the spinal cord?
Causes what?
Vit b12 def
A
Dcmm and lateral corticospinal
Ataxia, paresthesia, impaired posture and vibration sense
18
Q
What five diseases can cause facial nerve palsy
A
Aids Lyme Sarcoidosis Tumors Diabetes
Alexander Bell had STDs
19
Q
Tx of increased icp
A
Mannitol and hyperventilation
20
Q
If it has been <3hrs since onset of stroke treat with
A
Tpa
21
Q
If it has been > 3hr since onset of stroke, treat with
A
Aspirin
22
Q
In Mca stroke gaze preference is to side of
A
Lesion
23
Q
Mca stroke of the ___ hemisphere results in neglect
A
Non dominant
24
Q
Mca stroke of the ___ hemisphere results in aphasia
A
Dominant
25
Stroke of the ___ causes contralateral paresis and sensory loss in the leg and cognitive or personality changes
Aca
26
Stroke of the ___ causes contralateral paresis and sensory loss in the face and arm
Mca
27
Sx of lacunar strokes
Pure motor, pure sensory, ataxic hemiparesis or dysarthria
28
Triceps nerve root
C7
29
Biceps nerve root
C5
30
Patella nerve root
L4
31
Achilles nerve root
S1
32
Lp in subarachnoid hemorrhage May show
Rbcs and xanthochromia
33
After subarachnoid hemorrhage how do you prevent vasospasm and subsequent ischemic stroke
Ccbs eg nimodipine
34
—- is major cause of delayed morbidity and mortality in pt with sah
Vasospasm
35
Blown pupil suggests impending
Ipsilateral brainstem compression
36
Onset of sx in subdural hematoma is fast or slow?
Slow (days to weeks)
37
Etiology of subdural hematoma
Rupture of bridging veins
38
Etiology of epidural hematoma
Head trauma -> tear of middle meningeal artery
39
Demographic of epidural hematoma
Severe trauma pts
40
Appearance of subdural hematoma
Crescent shape and mass effect with midline shift
41
Appearance of epidural hematoma
Biconvex lens shape
42
Dx of cavernous thrombosis
MRI with gadolinium and mr venography
43
Tx of cavernous sinus thrombosis
Penicillinase-resistant penicillin (nafcillin or oxacillin) plus third or fourth gen cephalosporin
44
Woman with high BMI with retro orbital headache, n/v, diplopia, papilledema. If not brain tumor what is it?
Pseudotumor cerebri aka idiopathic intracranial htn
45
Can cluster headaches wake you from sleep
Yes
46
Rf of pseudotumor cerebri
Obesity
Tcas
Excess vit a
47
Acute tx of cluster headache
High flow o2 or sumatriptan injection
48
Prophylactic therapy for cluster headache
Verapamil
49
Pt presents with episode of lip smacking associated with impaired level of consciousness followed by confusion, think
Complex partial seizures
50
Aura is common in ___ seizures
Partial
51
Can you see a postictal focal neuro deficit in partial seizure
Yes
52
Impaired level of consciousness in partial simple seizure
No
53
Impaired level of consciousness in complex partial seizure
Yes
54
Complex partial seizure usually involves the ___ lobe
Temporal
55
What seizure am I? Sudden loss of consciousness, possible contraction of muscles, incobtinence, tongue biting, possibly Cyanotic in octal period, postictal confusion and drowsiness
Tonic clonic generalized seizure
56
Initial dx if you suspect brain tumor
Ct of the brain
57
EEG finding in petit mal/absence seizures
3 per second spike and wave discharges
58
For partial and tonic clonic seizures what is the first line tx in kids
Phenobarbital
59
Tx of status epilepticus
Abcs
Thiamine, then glucose and naloxone
Iv benZos for first 20 min then iv fosphenytoin If still seizing after 20 min
60
Withdrawal from what four drugs can cause seizures
```
ABBA
Alcohol
Benzos
Barbs
Anticonvulsants
```
61
Pt with vertigo and vomiting for one week post viral infxn think
Acute vestibular neuritis
62
Tx of acute vestibular neuritis
Corticosteroids and antivertigo agents (meclizine)
63
Tx of menieres
Meclizine or benzos acutely, chronically limit salt intake to avoid fluid retention
64
Etiology of myasthenia gravis
Autoimmune disorder caused by antibodies that bind to the postsynaptic acetylcholine receptors at nm junction
65
Ptosis or double vision, proximal muscle weakness and symptoms worsening at end of day
Myasthenia gravis
66
Dx of myasthenia gravis
Acetylcholine receptor antibody or edrophonium (tensilon test)
67
Myasthenia gravis is associated with __oma
Thymoma
68
Tx of myasthenia gravis
Pyridostigmine (anticholinesterases) and possibly prednisone. Resection of thymoma can be curative
69
Weaknsss __ with activity in lambert Eaton
Improves
70
Eye involvement in myasthenia gravis or Lambert Eaton
Lambert Eaton
71
Tx of acute ms exacerbations
Iv corticosteroids and plasma exchange
72
Disease modifying meds for ms
Abcs
Avonex (interferon b1a)
Betaseron (interferon b1b)
Copaxone (copolymer 1)
73
For optic neuritis in ms, give iv or oral corticosteroids
Iv
74
Guillain barre is associated with __ albumin in csf
Increased
| Csf protein level >55
75
Tx of guillain barre
Plasmapheresis and ivig
76
Older man with slowly progressive weakness in upper extremities, fasciculations and atrophy, but without bladder disturbance and normal cervical mri, think
ALS
77
Many pp with als present with bulbar involvement, meaning
They have difficulty swallowing, loss of tongue motility and difficulty speaking
78
Three w’s of normal pressure hydrocephalus
Wet (incontinence)
Wobbly (gait apraxia)
Wacky (dementia)
79
Description of gait in normal pressure hydrocephalus
“Magnetic”
| “Feet glued to the floor”
80
Essential tremors are _- at rest and ____ with movement
Suppressed
| Exacerbated
81
Three treatments for essential tremors
Propanolol
Primidone
Topiramate
82
Etiology of Parkinson’s
Dopamine deficiency
| Ach excess
83
Major side effect of levodopa/carbidopa
Hallucinations
84
Major side effects of dopamine agonists (ropinirole, bromocriptine, pramipexole)
Confusion
Hallucinations
Compulsive gambling
85
Etiology of Alzheimer’s
Ach and norepinephrine deficiencies
86
Medulloblastomas are primitive ___ tumors
Neuroectoderm
87
Medulloblastomas arise from
Fourth ventricle or cerebellar vermis
88
Pilocytic astrocytomas and medulloblastomas are located where
Posterior fossa/infratentorial tumor
89
Bilateral vestibular schwannomas are seen in nf 1 or 2
Two
90
Lisch nodules (pigmented iris hamartomas) are seen in nf 1 or 2
One
91
Freckling in axillary or inguinal area is seen in nf 1 or 2
Nf1
92
Optic gliomas are seen in nf1 or 2
One
93
Nf1 is clinically evident by age
15
94
Nf2 is clinically evident by
20
95
61 yo man with 6 mo hx of progressively worsening nausea and morning headache in no acute distress. What is it and what is preferred study.
Icp
| MRI
96
Brocas aphasia is due to insult to what area in brain
Posterior inferior frontal cortex
97
Initial treatment of coma
Dextrose
Oxygen
Naloxone
Thiamine
98
Classic triad of wernicke encephalopathy
Encephalopathy
Ophthalmoplegia
Ataxia
99
Closed angle glaucoma headaches are triggered
| By
Darkness due to pupillary dilation
100
Which occurs bilaterally and which unilaterally? Open vs closed angle glaucoma
Open-bilateral
| Closed-unilateral
101
Left hemianopsia with macular sparing is due to ___ infarction
Pca
102
Open angle glaucoma is due to what etiology
Disease of the trabecular meshwork resulting in decreased drainage
103
Rfs for open angle glaucoma
>40 yrs
Black
Diabetes
Myopia
104
Rfs for closed angle glaucoma
Asian
| Prolonged pupillary dilation
105
Cupping is associated with open or closed angle glaucoma
Open
106
Sudden eye pain and Red-hard eye seen in open or closed angle glaucoma
Closed
107
Tx of acute closed angle glaucoma
```
Eye drops (timolol, pilocarpine)
Iv mannitol
Laser peripheral iridotomy
```
108
What med shouldn’t you give in closed angle glaucoma
Atropine or meds that can cause pupillary dilation
109
Painless unilateral blindness and cherry Ted spot on fovea of old person
Central retinal artery occlusion
110
Presentation of detached retina
Light flashes, floaters, curtain across visual field
111
Newborn with cyanosis that is aggravated by feeding and relieves by crying
Choanal atresia
112
Cerebellar hemorrhage presents with
Occipital headache
Neck stiffness
Ipsilateral hemiataxia
113
Best treatment for cluster headaches
100% oxygen by face mask
114
Babies should be able to respond to name and babble by how many months
Six
115
Acetazolamide is used to treat
Open angle glaucoma and benign intracranial htn
116
Can you get intention tremor with cerebellar degeneration
Yes
117
Migraines in children are __ frontal
Bifrontal
118
Occipital headaches in children are common or rare ?
Rare
119
___ hematomas in children are most common as a result of tbi, following fracture of __ bone
Epidural
| Sphenoid
120
Ophthalmic artery branches off the
Internal carotid
121
Csf in Ms reveals
Oligoclonal IgG bands
122
Csf in guiallan barre shows
```
Albuminocytologic dissociation (increased albumin (protein) >55 in
Csf without elevation in wbcs
```
123
Someone got something blown into their eye but you can’t see it with a penlight. What do you do?
Fluorescein exam or slit lamp exam
124
MRI of metastatic brain cancer will show
Well circumscribed lesions with vasogenic edema at gray and white matter junction
125
Most common cause of deep intracerebral hemorrhage
Hypertensive vasculopathy
126
How does hypertensive vasculopathy cause spontaneous deep intracerebral hemorrhage
Chronic hypertension leads to formation of Charcot Bouchard aneurysms which may rupture and bleed within the deep brain structures
127
Triad of normal pressure hydrocephalus
Abnormal gait
Incontinence
Dementia
128
Tx of rls
Ropinerol and pramipexole (dopamine agonists)
129
Alzheimer’s causes atrophy of what lobes
Temporal and parietal lobes
130
Nontraumatic subarachnoid hemorrhage is most commonly due to
Ruptured berry aneurysm
131
Achilles’ tendon reflex can be absent or decreased in what age group
Elderly
132
What is dacrocystitis?
Infection of the lacrimal sac
