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Psychiatric > Neuro > Flashcards

Neuro Flashcards

1
Q

this tremor is only associated with anxiety and fatigue

A

Enhanced physiologic tremor

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2
Q

In this movement disorder, a tremor is the ONLY symptom

A

Benign essential tumor

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3
Q

Patient complaining of tremor in both arms; he notes that he uses alcohol to relieve them, and when he is stressed they get worse. Exam shows normal muscle tone/reflexes and NO bradykinesia; what do you suspect?

A

Benign Essential Tremor

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4
Q

what is the most common movement disorder?

A

benign essential tremor

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5
Q

what is the treatment given to patients with benign essential tremor?

A

Propranolol (Betablocker) or Primidone

botox can help voice and limb tremor too

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6
Q

explain the characteristics of the tremor in benign essential tremor

A

Postural tremor
Bilateral
symmetric
UPPER EXTREMITIES

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7
Q

T or F: benign essential tremor is worsened by stress, while dystonias are worsened by voluntary movements

A

TRUE

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8
Q

how would you explain secondary dystonia?

A

brought on by drugs or other neurologic disorders/medication

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9
Q

This disorder is characterized as involuntary muscle contractions occurring as part of another LARGER neurologic disorder’ the tremors are NOT the dominant feature

A

Dystonia Plus

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10
Q

What agents would you choose to treat symptoms of dystonia?

A

Levodopa
Anticholinergics (kids only)
Botox (Tx of choice for focal dystonia!)
Deep Brain Stimulation

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11
Q

A patient with dystonia comes into the ER appearing to be in extreme distress and holding his throat. His mother states that he was supposed to have surgery and has been stressed out lately. On exam, you notice his vocal cords and laryngeal muscles are spasming. What emergency are you concerned about?

A

Dystonic Storm - Admit to ICU and prepare to stabilize the airway!

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12
Q

what is the most common type of dystonia?

A

focal dystonia

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13
Q

before confirming dystonia in a child, what major disease needs to be ruled out?

A

WILSONS DISEASE

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14
Q

This progressive disability is characterized by a RESTING TREMOR, rigidity, and bradykinesia

A

Parkinson’s Disease

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15
Q

Early-onset parkinsons would be symptoms prior to what agE?

A

40 years

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16
Q

What are the 4 cardinal signs of Parkinsons

A

“TRAP”
Tremor (resting, “pill rolling”)
Rigidity (smooth/lead pipe OR oscillating/cogwheeling)
Akinesia/Bradykinesia: slowed movement, decrease in speed with continuous actions
Postural instability

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17
Q

In assessing a tremor in your patient, you stand behind her and quickly pull backwards on her shoulders. She stumbles backward, taking 10 steps and nearly falls. What is at the top of your differential?

A

Parkinsons

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18
Q

What is diagnostic of Parkinsons?

A

Substantial response to Dopamine medications

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19
Q

What are the 3 hallmark features of pathology of neurons in a patients with Parkinsons

A
  • Degeneration of dopaminergic neurons in SUBSTANTIA NIGRA
  • Reduced striatal dopamine
  • Lewy bodies (halos)
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20
Q

Although response to dopamine agonists are diagnostic of parkinsons, what is typically the INITIAL treatment and why?

A

MAO-B inhibitors: these treat mild symptoms quite well, and dopamine agonists only last 4-6 years, so save for later on

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21
Q

what is the gold standard and most effective treatment for Parkinsons?

A

Levodopa + Carbidopa: great control for 4-6 years; save for later stages

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22
Q

what is a great surgical option for symptoms in parkinsons

A

Deep Brain Stimulation

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23
Q

this disorder is characterized by adult-onset, inherited disease with cell loss in the basal ganglia and cortex

A

Huntingtons

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24
Q

Huntington’s Disease happens as a result of multiple polyglutamine repeats of CAG on the _____ arm of chromosome number ____

A

short; 4

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25
Q

how would you describe the progression of symptoms in Huntington’s disease?

A

advance from hyperkinetic to hypokinetic movements

choreiform movements to finally becoming bradykinetic

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26
Q

T or F: Huntington’s disease is curable with DBT

A

FALSE - incurable

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27
Q

Drug-induced abnormal movements are typically associated with drugs that block which type of receptors?

A

Dopamine

psych drugs, drug to treat n/v and gastroesophageal disorders

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28
Q

what is the most common type of ACUTE drug-induced abnormal movements?

A

Dystonia (focal in adults and generalized in kids)

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29
Q

Minutes after giving patient medication to treat his nausea, he begins to experience severe spasms that mimic chorea. You determine that he is experiencing acute drug-induced dystonia. What do you treat him with?

A

IV Anticholinergics!(diphenhydramine)

can also give benzos or dopamine agonists

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30
Q

What is the most common subacute reaction to drug-induced movements?

A

Akathisia (motor restlessness with need to move that is alleviated by moving)

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31
Q

What is the term used to describe choreiform movements of the mouth, lips, and tongue that occurs YEARS after initiation of neuroleptic drugs

A

Tardive dyskinesia

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32
Q

How can you treat tardive dyskinesia?

A

D/C offending medication (may take 3 months to correct)

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33
Q

What is tardive Dystonia?

A

dystonia with involvement of axial muscles and rocking movement of trunk

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34
Q

T or F: tardive dystonia reverses with D/C of medication

A

FALSE - this persists despite D/C

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35
Q

Patient present to the clinic complaining of lack of sleep. Upon further questioning, she states that at night her legs feel a “creepy crawly” sensation, that can only be relieved if she gets up and walks around. what is at the top of your differential?

A

Restless leg syndrome

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36
Q

What are the 2 first-line agents used in treating Restless leg syndrome?

A

Dopaminergic Agents

Presynaptic alpha 2 agonists

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37
Q

An option for patients with RLS is “Relaxis”. what is this?

A

a vibratory stimulation device used for treatment that stimulates the legs during sleep, taking away the discomfort

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38
Q

Interestingly, there is an association with what deficiency, that if treated, can sometimes relieve the RLS symptoms

A

Iron deficiency

always test for this!

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39
Q

A mother brings in her 7 year old child and tells you he has been blinking and jerking his neck constantly for some time, and it’s starting to affect his quality of life. What are you suspecting?

A

Tourettes (simple motor tic)

complex includes movement of multiple muscle groups - jumping, head banging

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40
Q

What is the difference between simple and complex phonic tics?

A

simple (grunting)

complex (repeating expressions)

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41
Q

what is Corprolalia?

A

tourettes with complex phonic tics, specifically with shouting obscene words

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42
Q

when is therapy indicated in Tourettes’ syndrome, and what do you Rx?

A

when tics are disabling and interfere with QoL

  • Clonidine
  • Guanfacine
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43
Q

A Thunderclap headache is what type of stroke?

A

hemorrhagic

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44
Q

What are the 2 types of strokes?

A

ischemic and hemorrhagic

Ischemic further categorized as embolic, thrombotic, and lacunar infarcts

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45
Q

in embolic stroke, what are the 2 most common sites that the clot breaks and travels from

A

internal carotids and aortic arch

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46
Q

what is the most common underlying disorder that causes hemorrhagic stroke (rupture of aneurysm)

A

Hypertension

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47
Q

Patient presents with facial droop, arm weakness, and speech slurring; on further exam, you note weakness and contralateral leg. Where did the stroke happen?

A

Anterior Cerebral Artery

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48
Q

Patient has signs of a stroke, and upon further exam you note loss of sensation in head, neck, arm, difficulty speaking, and homonymous hemianopia. Where did the stroke occur?

A

Middle Cerebral artery

most common

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49
Q

what artery would most likely be involved in a stroke that causes sudden, PAINLESS, vision lossq

A

Ophthalmic/Central Retinal Artery

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50
Q

T or F: if a patient has homonymous hemianopia, their eyes deviate to the affected side

A

True

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51
Q

which arterial stroke is usually clinically silent and why?

A

Vertebral artery; circulation is maintained by the other vertebral artery

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52
Q

Patient present with facial droop, arm weakness, and speech slurring. On further exam and questioning, you note hyperpathia (exaggerated pain) that happened spontaneously. Which artery did the stroke happen?

A

Posterior Cerebral artery

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53
Q

Posterior Inferior Cerebellar Artery occlusion can lead to LATERAL MEDULLARY SYNDROME. what is this characterized by?

A

vertigo and nystagmus

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54
Q

What is the diagnostic test of choice for assessing stroke?

A

CT Angiography

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55
Q

Why do we do a CT first in assessing stroke?

A

to rule out cerebral hemorrhage; this is done first before we administer antiplatelets.

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56
Q

What is the treatment of choice for ischemic/embolic stroke?

A

tPA; clot buster

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57
Q

what is the time frame for administering tPA

A

4.5 hours

58
Q

what are some common causes of hemorrhagic stroke?

A

head trauma
ruptured aneurysm
arteriovenous malformation

59
Q

what is the #1 risk factor for hemorrhagic stroke

A

hypertension

60
Q

Patient presents with what feels like the worst headache of their life; it has remained unchanged for days. They also have a fever of 101 and elevated BP. What is at the top of your differential?

A

Hemorrhagic stroke (Thunderclap headache)

61
Q

What is a Herald Bleed?

A

an aneurysmal leak; patient reports atypical headache 1-3 weeks prior to SAH

62
Q

When treating stroke, what medication does EVERY patient get?

A

antiplatelets (ASA, clopidogrel)

63
Q

What is the required stenosis amount to qualify for a carotid endarterectomy?

A

stenosis >70%

64
Q

what defines Epilepsy?

A

2 unprovoked seizures that are >24 hours apart

this has to be occurring for >5 months

65
Q

what type of headache is described as pain with underlying muscular cause (tight neck, shoulder pain)

A

Tension headache

66
Q

Patient presents with a headache further described as a band of pain, pointing to both sides of his forehead. He also states sore trapezius muscles. What is at the top of your ddx

A

Tension headache

67
Q

treatment tension headache?

A

Analgesics: Tylenol, NSAIDs, Aspirin

avoid tobacco, alcohol

68
Q

what is the difference between common migraine and classic migraine?

A

Common: no aura
classic: aura

69
Q

female presents to clinic complaining of a severe headache, described as unilateral in the front of her forehead. She states it has been ongoing for the past 12 hours, and it’s worse with activity. Only sleep relieves it. What are you thinking?

A

Migraine

70
Q

how long do tension headaches last?

A

> 30 minutes

71
Q

how long do migraines last?

A

4-72 hours

72
Q

Your patient with migraines states that NSAIDs and Aspirin “don’t touch the pain”. What can you prescribe her?

A

Abortives - TRIPTAN

73
Q

your patient is complaining of an excruciating headache. He says that it feels like it is behind one eye and radiated just to the same side. When asked if this was the first time he’s had this, he states that they happen at the same time every day and last 45 minutes. He can’t take it anymore. What are you thinking?

A

Cluster headache

74
Q

of the headache types, which are unilateral

A

migraines
cluster headaches

(tension are bilateral)

75
Q

T or F: a migraine is commonly mistaken for a sinus headache or eye strain due to visual symptoms

A

True

76
Q

T or F: if a person has a thunderclap headache, try a trial of Triptan. If it relieves the headache, it was simply a migraine

A

False!! Triptan can mask the symptoms of headache due to a Subarachnoid hemorrhage! Don’t assume it’s a migraine!

77
Q

a Coma is described as dysfunction in what areas of the brain?

A

cerebral hemisphere

reticular activating system

78
Q

patient c/o “electric shock” pain that comes and goes, especially when she is brushing her teeth. Pain is unilateral. what are you thinking?

A

Trigeminal Neuralgia

79
Q

what is a major risk factor to trigeminal neuralgia

A

Multiple Sclerosis

80
Q

After diagnosing a patient with trigeminal neuralgia, you prescribe them which treatment?

A

Carbamazepine (2-3x daily)

81
Q

patient presents with paroxysmal attacks of pain in the throat that is provoked by swallowing. Similar to trigeminal neuralgia, you’re thinking this patient has ____

A

glossopharyngeal neuralgia

82
Q

what is the disorder caused by acute facial nerve paralysis due to inflammation at geniculate ganglion

A

Bell’s Palsy

83
Q

Maximal weakness of bell’s palsy peaks how many days after onset?

A

3-7 days

improves within 3 weeks

84
Q

T or F: in Bell’s palsy, the forehead is NOT involved

A

FALSE - if forehead is NOT involved, think STROKE!

85
Q

patient presents with unilateral pain that started behind his ear last night, and now he is unable to wrinkle his forehead, facial pain, and numb feeling in face. Sensation preserved

A

Bell’s Palsy

86
Q

which organ is most vulnerable in someone with Bell’s Palsy?

A

the eyes; prescribe artificial tears and tape eye shut at night

87
Q

on exam you note hammer-toe dysformity. What is at the top of your ddx?

A

charcot-marie Tooth

88
Q

patient presents with aching pain and numbness in his feet. It has began to travel upwards to his shins, and he became worried. What history question could you ask him regarding his health in the past?

A

have you had any GI or respiratory illness 6 weeks prior?

Guillain - Barre

89
Q

What do you do when you diagnose a patient with Guillain-Barre syndrome?

A

ADMIT TO ICU!

could lose respiratory function and need vent

90
Q

what is the treatment of choice for patients with Guillain-Barre (after admission to ICU)

A

IVIG or plasma exchange

NO STEROIDS!!!!

91
Q

T or F: demyelinating disease such as multiple sclerosis affects the CNS and the PNS

A

FALSE - affects CNS and spares the PNS

92
Q

What are the 2 kinds of multiple sclerosis, and which is most common?

A

relapsing and remitting (most common) & Progressive

93
Q

This neurological disorder has a strong association/risk factor with vitamin D deficiency

A

multiple sclerosis

94
Q

chronic inflammation and demyelination causes lesions in the CNS, eventually leading for scarring/sclerosis

A

Multiple Sclerosis

95
Q

Dawson’s fingers are seen in MRI of the brain in MS. What does that mean?

A

lesions located around the ventricular surface in perivenous pattern of demyelination

96
Q

there is no treatment that reverses MS. Instead you can treat acute attacks and give disease-modifying agents. What are those?

A

Glucocorticoids

Immunomodulators

97
Q

which disease of the lower motor neurons is also considered a pediatric disorder?

A

Duchenne’s Muscular Dystrophy

98
Q

this disorder is progressive muscle degeneration and weakness caused by the absence of DYSTROPHIN

A

Duchenne’s muscular dystrophy

99
Q

on examining a patient with suspected muscular dystrophy, you have him lie down on the floor; he needs to walk his hands up his body in order to stand. What is this test called?

A

Gower’s Maneuver

100
Q

what gold standard diagnostic lab will neurology test for to diagnose Duchenne’s muscular dystrophy?

A

Serum CK (elevated 20-100x)

will also do genetic testing for 427kDa

101
Q

in this slowly progressing disorder, tremor is the only symptoms. it is relieved by alcohol and worsened by stress

A

Benign essential tremor

102
Q

the treatment for benign essential tremor is usually just reassurance, but you CAN prescribe which 2 medications?

A

Propranolol

Primidone

103
Q

what is the most common of the movement disorders?

A

benign essential tremor

104
Q

T or F: on physical exam of benign essential tremor, you will see bradykinesia and/or rigidity

A

FALSE - exam is unremarkable; bradykinesia and rigidity are signs of parkinsonism

105
Q

this movement disorder is brought on by voluntary movements and relieved by relaxation and sensory tricks

A

Dystonias

106
Q

this nonprogressive neurological disorder is due to either prenatal development malformation or perinatal/postnatal CNS damage

A

Cerebral palsy

107
Q

what exam findings might you see in a patient with cerebral palsy

A

spasticity (stiff)
dyskinesia (involuntary movement)
ataxia (shakiness)

108
Q

what is the diagnostic for cerebral palsy?

A

MRI and genetic testing

109
Q

T or F: meningitis is most commonly caused by viruses

A

FALSE: bacterial

110
Q

what is the triad of symptoms of meningitis

A

headache + fever + nuchal rigidity

111
Q

What is Kernig sign?

A

passive knee extension; painful in patient with meningitis

112
Q

What is Brudzinski sign?

A

flexion of hips and knees inward in pain when neck is flexed toward chin (positive for meningitis)

113
Q

What is diagnostic of Meningitis

A

CSF analysis (via lumbar puncture)

114
Q

this disorder is caused by inflammation of the parenchyma of the brain. (sometimes with meningeal inflammation)

A

Encephalitis

115
Q

is encephalitis commonly viral or bacterial?

A

VIRAL

116
Q

what is diagnostic of encephalitis?

A

MRI

also get CSF analysis

117
Q

Treatment of encephalitis

A

Acyclovir (empirical viral therapy)

Antimicrobial empiric therapy as well

118
Q

what is the disorder characterized by an intracerebral collection of pus as a result of many factors such as cranial infection, head wound, hematogenous spread

A

Brain abscess

119
Q

patient complains of unilateral headache, vomiting, and a recent dental infection. What is the next best option via diagnosing what you think it is?

A

MRI with gadolinium (suspected brain abscess)

culture the pus aspirate if possible

120
Q

treatment for brain abscess?

A

Cefotaxime or metronidazole (empiric)

121
Q

If your comatose patient is experiencing Cheyne-stoke or biot breathing, where is the dysfuntion?

A

both hemispheres

122
Q

if your comatose patient is hyperventilating, where is the dysfunction?

A

midbrain

123
Q

if you patient who is comatose has inspiratory gasps with pauses, where is the dysfunction?

A

pons/medulla

124
Q

you witness a person having a syncopal attack. what is the FIRST thing you do?

A

check for pulses- if absent perform CPR

if present, lay person supine with legs in air to end the attack

125
Q

what is bells palsy strongly linked to?

A

herpes virus

126
Q

patient has bell’s palsy - you tell him that the symptoms (weakness) may be maximal at ______ days but should subside by _____

A

3-7 days

3 weeks

127
Q

at what time frame does the progression of Guillain-Barre syndrome PEAK?

A

2-4 weeks

128
Q

T or F: severe Guillain-Barre syndrome can result in quadriparesis and respiratory arrest requiring vent

A

True

129
Q

what CSF findings might you see in someone with guillain-Barre?

A

protein >0.55 (no elevation in WBC)

130
Q

what might EMG (electromyogram) show in a person with guillain-barre

A

slowing of nerve conduction >60%

131
Q

what 3 exam findings will be in a patient with cerebral palsy?

A

stiff (spastic)
dyskinesia (movement)
ataxic (shaky)

132
Q

what will the CSF show in a patient with bacterial meningitis?

A

elevated protein

low glucose

133
Q

although meningitis and encephalitis are similar, their diagnostic studies are different. what are they?

A

Meningitis: lumbar puncture

Encephalitis: MRI

134
Q

What are some red flags regarding headache/migraine that indicate further imaging?

A 
age < 40
first or worst 
treatment not working
change in severity
neurological signs
135
Q

Horner’s syndrome is seen in 30% of patients with what disorder?

A

cluster headaches

136
Q

what 2 things to give patient with cluster headaches?

A

IV triptans

oxygen

137
Q

if a patient has EXTREME hypotension following an injury, what do you need to be mindful of?

A

possibility of a spinal cord injury

138
Q

should you give a patient who has a concussion NSAIDs/Aspirin?

A

NO - can make symptoms worse

139
Q

how long must seizures persist in order to Dx epilepsy?

A

5 months

140
Q

patient presents with extremely severe headache. On physical exam he has BP 160/110 and is running a fever. What are you thinking

A

SAH

Psychiatric (2 decks)

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