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First Aid Step 2 > Neuro > Flashcards

Neuro Flashcards

1
Q

Unilateral, severe periorbital HA with tearing and conjuctival erythema

A

Cluster HA

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2
Q

Prophylactic Tx migraine

A

AntiHTN
Antidepressants
Anticonvulsants
Diet changes

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3
Q

Most common pituitary tumor. Tx?

A 
Prolactinoma
DA agonist (bromocriptine)
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4
Q

55 yo pt presents with acute “broken speech”. What type of aphasia? What lobe and vascular distribution?

A

Broca’s aphasia

Frontal Lobe, left MCA distribution

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5
Q

Most common cause SAH

A

Trauma

2nd: berry aneurysm

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6
Q

Crescent shaped hyperdensity on CT that does NOT cross midline
What vessels affected

A

Subdural hematoma

Bridging veins

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7
Q

Hx significant for initial altered mental status with an intervening lucid interval. Dx? Source? Tx

A

Epidural hematoma
Middle meningeal a.
Neurosurgical evacuation

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8
Q

CSF findings with SAH

A

Elevated ICP, RBC, xanthochromia

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9
Q

Albuminocytologic dissociation

A

GBS (inc protein in CSF without significant inc in cell count)

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10
Q

Cold water flushed into pt’s ear, fast phase of nystagmus toward opposite side, Normal or Pathological?

A

Normal

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11
Q

Most common primary sources of mets to brain

A

Lung
Breast
Skin (melanoma)
GI tract

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12
Q

May be seen in kids who are accused of inattention in class and confused with ADHD

A

Absence seizures

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13
Q

Most frequent presentation of intracranial neoplasm

A

HA

Primary neoplasm much less common than brain mets

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14
Q

Most common cause of seizures in children (2-10 yr)

A

Infection
Febrile seizures
Trauma
Idiopathic

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15
Q

Most common cause seizures young adults (18-35)

A

Trauma
Alcohol
Brain tumor

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16
Q

First line med for status epilepticus

A

IV BDZ

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17
Q

Confusion, confabulation, opthalmoplegia, ataxia

A

Wernicke’s due to def thiamine

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18
Q

% lesion for CAE

A

70% if Sx

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19
Q

Most common causes dementia

A

AD

multi-infarct

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20
Q

Combined UMN and LMN disorder

A

ALS

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21
Q

Rigidity and stiffness with unilateral resting tremor and masked facies

A

PD

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22
Q

Mainstay Tx PD

A

Leveodopa/carbidopa

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23
Q

Tx GBS

A

IVIG or plasmapheresis

Avoid steroids

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24
Q

Rigidity and stiffness that progress to choreiform movements, accompanied by moodiness and altered behavior

A

HD

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25
Q

6 yo girl presents with port wine stain in V2 distribution with mental retardation, seizures, and ipsilateral leptomeningeal angioma

A

Sturge WEber
Tx: Sx
Possible focal cerebral resection of affected lobe

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26
Q

Multiple cafe au lait spots on skin

A

NF1

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27
Q

Hyperphagia, hypersexuality, hyperorality, hyperdocility

A

Kluver Bucy (amygdala)

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28
Q

May be administered to Sx pt to Dx MG

A

Edrophononium

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29
Q

ACA supplies

A

Medial and superior surfaces

Frontal lobes

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30
Q

MCA supplies

A

Lateral surfaces and temporal lobes

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31
Q

PCA supplies

A

Inferior surfaces and occipital lobes

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32
Q

Basilar artery supplies

A

Midbrain and brainstem-pons

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33
Q

AICA supplies

A

Brainstem (pons)

Part of cerebellum

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34
Q

PICA

A

Brainstem (medulla)

Parts of cerebellum

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35
Q

Dorsal columns medial lemniscus of spinal cord responsible for …

Anatomical structures involved with this pathway…

A

Pressure, vibration, 2 point discrimination, proprioception

Pacini’s
Meissner’s
Mm spindles
Golgi tendon organs

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36
Q

Fasciculus gracilis

A

Lower body, extremities

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37
Q

Fasciculus cuneatus

A

Upper body, extremities

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38
Q

Lateral corticospinal tract responsible for, what parts of body

A

Voluntary Motor - contralateral
Arms more medial
Legs more lateral

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39
Q

Spinothalamic tract responsible for..

Anatomical structures…

A

pain and temperature
Sacral posterior
Cervical anterior

Free n endings, pain fibers

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40
Q

Tracts affected by ALS

Sx

A

Corticospinal trac - voluntary movement
anterior horn - motor
Sx: spastic and flaccid paralysis

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41
Q

Tracts affected by Poliomyelitis

Sx

A

anterior horn

Sx: flaccid paralysis

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42
Q

Tracts affect by tabes dorsalis
Part of what disease process
Sx

A

Dorsal columns
Tertiary syphilis
Impaired proprioception and pain

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43
Q

Tracts affected by Vit B12 def

Sx

A

Dorsal columns, corticospinal tract

Bilat loss vibration and discrimination; Bilateral spastic paresis affecting legs before arms

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44
Q

Tracts affected by spinal artery syndrome

Sx

A

Corticospinal, spinothalamic, central horn, lateral gray matter = DORSAL COLUMN SPARED
Sx: bilat loss pain and temp (one level below lesion), bilat spastic paresis (below lesion), bilat flaccid paralysis (level of lesion)

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45
Q

Syringomelia - tracts affected

Sx

A

anterior horn, anterior white commissure

Sx: Bilat loss of pain and temp (one level below lesion), bilat flaccid paralysis (level of lesion)

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46
Q

Brown Sequard Syndrome- tracts

Sx

A

All tracts on ONE SIDE of spinal cord
Sx: ALL ARE BELOW LESION- Ipsi loss of vibration and discrimination, ipsi spastic paralysis, contra loss of pain and temp

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47
Q

CN I
Type
Fcn

A

OLFACTORY
Sensory
Smell

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48
Q

CN II
Type
Fcn

A

OPTIC
Sensory
Sight

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49
Q

CN III
Type
Fcn

A

OCULOMOTOR
Motor
Medial, sup, inf rectus mm
Inf oblique mm, ciliary mm, sphincter of eye

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50
Q

CN IV
Type
Fcn

A

TROCHLEAR
Motor
Superior oblique of eye

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51
Q

CN V
Type
Fcn

A

TRIGEMINAL
Both
Sensation face, mm of mastication

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52
Q

CN VI
Type
Fcn

A

ADBUCENS
Motor
Lateral rectus of eye

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53
Q

CN VII
Type
Fcn

A

FACIAL
Both
Taste (ant 2/3 tongue), mm facial expression, sapedius mm, stylohyoid mm, digastric mm, lacrimal, submandibular, sublingual

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54
Q

CN VIII
Type
Fcn

A

VESTIBULOCOCHLEAR
Sensory
Hearing, balance

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55
Q

CN IX
Type
Fcn

A

GLOSSOPHARYNGEAL
Both
Taste (post 1/3 tongue), pharyngeal sensation, stylopharyngeus mm, parotid gland

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56
Q

CN X
Type
Fcn

A

VAGUS
Both
Sensation of trachea, esophagus, viscera; laryngeal, pharyngeal mm; visceral autonomics

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57
Q

CN XI
Type
Fcn

A

ACCESSORY
Motor
SCM and trapezius

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58
Q

CN XII

A

HYPOGLOSSAL
Motor
Tongue

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59
Q

Newborn most common cause meningitis

A

GBS

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60
Q

1 month - 2 yr most common cause meningitis

A

Strep pneumo

N meningitidis

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61
Q

2-18 yr most common cause meningitis

A

N meningitidis

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62
Q

18-60 yr most common cause meningitis

A

S pneumo

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63
Q

80+ most common cause meningitis

A

S pneumo

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64
Q

Reason to not do lumbar puncture

A 
Signs of increased ICP
-Papilledema
-Focal neuro deficits
-Pupil assymetry
Risk of uncal herniation
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65
Q

Children with viral infection given aspirin

A

Reye’s syndrome

Encephalitis

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66
Q

Brudzinski sign

A

Neck flexion in supine pt causes reflexive hip flexion

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67
Q

Kernig sign

A

Painful knee extension with hip flexion in supinre pt

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68
Q

Meningitis + N. meningitidis causes what Sx

A

Petechiae

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69
Q

Tx bacterial meningitis

A

3rd gen cephalosporin until cultures return

Close contacts: Rifampin and cipro if Neisseria

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70
Q

Tx fungal meningitis

A

Amphotericin B

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71
Q

Tx TB meningitis

A

RIPE

Rifampin, isoniazid, pyrazinamde, ethambutol

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72
Q

Labs meningitis: Inc WBC w/ PMN, INc P, Dec Glc, Dec Prot

A

Bacterial

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73
Q

Labs meningitis: Inc WBC w/ lymph, INc P, dec glc, inc prot

A

Fungal or TB

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74
Q

Labs meningitis: inc WBC w/ lymph, INc P, glc and prot normal

A

Viral

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75
Q

Encephalitis infection - skin lesions

A

HSV

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76
Q

Encephalitis infection - parotid swelling

A

Mumps

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77
Q

Encephalitis infection- macupapular rash

A

WNV

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78
Q

Ring enhancing lesion

A

Brain abscess

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79
Q

Negri bodies

A

Rabies

Round eosinophilic inclusions in neurons

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80
Q

Branches affected in trigeminal neuralgia

A

Maxillary(V2) and mandibular (V3)

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81
Q

Tx trigeminal neuralgia

A

Carbamazepine

Baclogen, phenytoin, gabapentin, valproate, clonazepam, other antivonculsants

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82
Q

Unilateral throbbing HA w/ N/V

A

Migraine

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83
Q

Tx migraines

A

NSAID, ergots, sumatriptans, metoclopramide

Prophy: TCA, Beta blocker, CCB, ergots, anticonvulsants

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84
Q

HA in young man, unilateral, periorbital, lacrimation, Horner

A

Cluster

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85
Q

Tx cluster

A

100% O2, ergots, sumatriptan

Prophy like migraines

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86
Q

Horner syndrome

A

Ptosis
Miosis
Anhidrosis

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87
Q

Bilateral HA with tightness in occipital region or neck

A

Tension

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88
Q

Tx tension

A

NSAID, ergots, sumatriptan, relaxation exercises

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89
Q

TIA w/ carotid bruits

A

Suggest atherosclerosis origin

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90
Q

TIA w/ harsh systolic murmur

A

Suggest AS cause

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91
Q

Why not Tx HTN immediately after stroke

When to Tx

A

Dec cerebral perfusion

YES: BP >220/120 or CAD

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92
Q

Associated with berry aneurysm

A

polycystic kidney disease

Marfan

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93
Q

Traumatic lumbar puncture vs SAH

A

Traumatic- decline RBC in CSF

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94
Q

Lucid interval

A

Epidural

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95
Q

Slowly progressive HA wks to days -brain hematoma

A

Subdural

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96
Q

Convex, lens shaped hyperdensity

A

Epidural

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97
Q

Concave, crescent hyperdensity

A

Subdural

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98
Q

Hematoma crosses midline

A

Epidural

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99
Q

Emergent surgery drainage essential

A

Epidural

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100
Q

Rupture middle meningeal a/

A

Epidural

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101
Q

Rupture bridging vv

A

Subdural

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102
Q

Aphasia: nonfluent with good comprehension, writing aphasia, aware of inabilities

A

Broca (Expressive)

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103
Q

Located Broca

A

Inferior frontal gyrus, dorsolateral frontal cortex, anterior parietal

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104
Q

Poor comprehension, word salad, neologisms, not aware of disorder

A

Wernicke

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105
Q

Posterior superior temporal gyrus, inf parietal lobe

A

Wernicke

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106
Q

Fluent speech, frequent attempt to corrext word, word substitations

A

Conduction

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107
Q

Supramarginal gyrus and angular gyrus

A

Conduction

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108
Q

Nonfluent speech and poor comprehenesion

A

Global

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109
Q

Large infarct left cerebral hemisphere

A

Globral

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110
Q

3 W normal P hydrocephalus

A

Wacky- cognitive impaired
Wet- incontinence
Wobbly- gait changes

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111
Q

Epilepsy vs seizures

A

Epilepsy: recurrent seizures

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112
Q

Generalized vs partial seizures

A

Generalized: entire cortex
Partial: focal neuro deficits

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113
Q

Focal sensory or motor WITHOUT loss of consciousness

A

Simple partial

Sensory- paresthesias, hallucinations
Motor- repetitive or purposeless movement

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114
Q

Hallucinations, automatisms, deja vu, impaired consciousness, postictal

A

Complex Partial

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115
Q

Sustained contraction of mm (name), repetitive contract and relax (name) brief contraction then repetitive contraction (name), brief repetitive contractions (name), loss of tone (name)
LOSS OF CONSCIOUSNESS, postictal, unilat weakness lasting hrs (name)”

A 
Tonic
Clonic
Tonic clonic
myoclonic
atonic
Todd paraylsis

Generalized

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116
Q

Brief episodes (5-10 s) of impaired consciousness with normal mm tone, possible eye blinking, no postictal, children

Appear to be daydreaming, are amnestic of evet, stare off into space

A

Absence

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117
Q

Most commonly in temporal lobe (seizure)

A

complex partial

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118
Q

EMG shows 3 cycle/s spike and wave pattern

A

Absence/petit mal

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119
Q

Repetitive or unremitting seizures for > 20 minutes without any period of consciousness
Tx

A

Status epilepticus

Tx: IV BDZ, if refractory phenobarb or pentobarb

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120
Q

Common signs of PD

A 
SMART
Shuffling gait
Masklike facies
Akinesia
Rigidity (cogwheeling)
Tremor (resting)
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121
Q

Spasticity, increased DTR, + Babinski

A

UMN damage

122
Q

Flaccid paralysis, atrophy, fasciculations decreased DTR, - Babinski

A

LMN damage

123
Q

Neurodegenerative disorder that affects substantia nigra

A

PD

124
Q

Neurodegenerative disorder that affects anterior horn and corticospinal

A

ALS

125
Q

Neurodegenerative disease affecting caudate and putamen

A

HD

126
Q

Lewy bodies

A

PD

127
Q

Cortical atrophy

A

AD

128
Q

White matter atrophy w/ oligoclonal bands on LP

A

MS

129
Q 
AB bind AchR
Testing
Tx
Assoc
Sx
A 
MG
Edrophonium improves Sx
Anticholinesterase: neostigmine, pyridostigmine
Thymoma, thyroiditis, thyrotoxicosis
Sx: proximal mm weakness
130
Q

Paraneoplastic, Ab to presynaptic Ca channels

A

Lambert Eaton

Most commonly assoc w/ lung ca

131
Q

Tx benign essential tremor

A 
Beta blocker
Primidone
Clonazepamn
Thalamotomy
Deep brain stimulation
132
Q

Chorea - assoc diseases

A 
HD
Hyperthyroidism
Stroke
SLE
Levodopa use
Rheumatic fever (Sydenham)
133
Q

Describe athetosis

Associated diseases

A 
Writhing snakeline movements
Cerebral palsy
Encephalopathy
HD
Wilson disease
134
Q

Described dystonia

Assocaited diseases

A 
Sustained proximal limb and trunk contractions
Wilson
PD
HD
Encephalitis
Tardive dyskinesia
135
Q

Describe hemiballismus

ASsociated diseases

A

Flinging of extremities

Stroke of subthalamic nucleus

136
Q

Associated disease w/ tics

A

Tourette
OCD
ADHD

137
Q

Most common primary brain tumor adults

A

Glioblastoma

138
Q

Most common primary brain tumor kids

A

Astrocytoma- benign

Medulloblastoma - malignant

139
Q

Tentorium as landmark, where are tumors adults vs kids

A

Adults: above
Kids: below

140
Q

chr 22- nf1 or 2

A

2

141
Q

chr 17 - - nf1 or 2

A

1

142
Q

bilat acoustic neuroma - nf1 or 2

A

2

143
Q

Dx criteria NF1

A

COFFINS

Cafe au lait
Optic glioma
Freckling
FH
Iris hamartomas
Neurofibromas
Skeletal lesions
144
Q

BDZ affect on sleep cycle

A

Lengthen N2, shorten N3

145
Q

Coma causes: pupils large, nonreactive - where lesion

A 
Below midbrain (CN III involved)
Possible uncal herniation
146
Q

Coma causes: pupils small and reactive- where lesion

A

Thalamic involvement, transtentorial herniation

147
Q

Coma causes: pinpoint pupils

A

Opiod

148
Q

Coma causes: pupils immobile

A

Metabolic

149
Q

Normal response to ice water in ear

A

Conjugate deviation toward ice water

150
Q

Ice water in ear - no ABD or ADD

A

CN VI, CN III

151
Q

Ice water in ear - conjugate nystagmus

A

Psychogenic

152
Q

Spastic paralysis - where lesion

A

High spinal cord

153
Q

Decorticate posturing - elbow flex, legs extended - where lesion

A

Cortical or thalamic compression

154
Q

Decerebrate posturing - elbow extend, legs flex - where lesion

A

Pontine, medullary

155
Q

Describe persistent vegatative state

Recovery unlikely after how long

A

Normal sleep cycles, inability to perceive/respond to environment, preserved ANS >1 month

> 3 month

156
Q

Type of seizure with febrile seizure

A

Tonic clonic

157
Q

Communicating vs noncommunicating hydrocephalus

A

Noncomm: obstruction 4th ventricle
Comm: dysfcn subarachnoid cistern or arachnoid villi

158
Q

Cherry red spots on retina, Ashkenazi Jew
Enzyme def
Genetics

A

Tay Sachs
Hexosaminidase A (ganglioside)
AR

159
Q

Defect in closure of vertebral arches, usu at LS jcn

A

Spina bifida occulta

160
Q

Defect in closure of vertebral arches with meninges and spinal cord herniation

A

Myelomeningocele

161
Q

Defect in closure of vertebral arches with herniation of meninges

A

Meningocele

162
Q

Failure of NT closure, absence forebrain, meninges, portions of skull

A

Ancephaly

163
Q

Labs during pregnancy that indicate neural tube problems

A

Increased alpha fetopreotin and acetylcholinesterase

164
Q

2 types cerebral palsy

A

Spastic

Dyskinetic: choreathetoid, dystonic ataxic

165
Q

Argyll Robertson pupil
What is it
Diseases

A

Accommodation to near object, nonreactive to light

Syphilis, SLE, DM

166
Q

Marcus Gunn pupil
What is it
Diseases

A

Light in affected pupil causes minimal bilat constriction
Light in normal pupil- normal bilat constriction

Afferent n defect

167
Q

Horner syndrome
What is it
Diseases

A

Ptosis, miosis, anhidrosis

Sympathetic trunk lesion (Pancoast tumor)

168
Q

MLF syndrome
What is it
Diseases

A

With lateral gaze, absent contralat eye adduction

Intracranial lesion, MS

169
Q

Adie pupil
What is it
Diseases

A

Minimally reactive dilated pupil

Abnormal innervation of iris

170
Q

Focal point anterior to retina, refracting power of eye too great

A

Myopia

Far vision blurry

171
Q

Image focal point posterior to retina

Refracting power of eye insufficient

A

Hyperopia

Near vision blurry

172
Q

Asymmetric cornea surface causing inconsistent refraction of light

A

Astigmatism

173
Q

Deviation of eye unable to be overcome by normal motor control

A

Strabismus

Double vision and progressive blindness

174
Q

Development defect in neural pathways of eye leading to poor visual acuity and spatial differentiation in affected eye

A

Amblyopia

175
Q

Uveitis - 3 areas affected

A

Iris
Choroids
CIliary bodies

176
Q

Anterior vs Posterior uveitis

A

Ant: painful, slit lamp shows inflammation and keratin deposits on corniea
Post: slit lamp shows eye inflammation and retinal lesions

177
Q

Most common viral cause conjunctivitis

A

Adenovirus

178
Q

Bacterial conjunctivitis in young people

A

Chlamydia

GC

179
Q

Perinatal from mom to baby

A

GC

C. trachomatis

180
Q

When to suspect glaucoma

A

Frequent changes of lens prescriptions

181
Q

Open vs closed angle glaucoma

A

Open: gradual
Closed: acute

182
Q

Glaucoma vs macular degen vision loss

A

Glaucoma: peripheral to central, closed unilat
Macular: central to peripheral, bilat

183
Q

Retinal a vs v occlusion exam

A

Artery: cherry red spot
Vein: cotton wool spots, edema, retinal hemorrhages

184
Q

Retinal a vs v occlusion exam

A

Artery: cherry red spot
Vein: cotton wool spots, edema, retinal hemorrhages

185
Q

Causes otitis media

A 
Strep pneumo
H. flu
Moraxella 
S pyogenes 
Viruses
186
Q

Tx otitis media

A

Unresolved - 10 d amoxicillin; resistant use amoxicilin- clauvulanic acid or stronger cephalosporin

187
Q

Complications otitis media

A 
Mastoiditis
Meningitis
Hearing Loss
Sigmoid sinus thrombosis
Middle ear drainage
188
Q

Causes otitis externa/swimmers ear

A

Staph aureus
Pseudomonas
S epidermidis

189
Q

Tx otitis externa

A

Topical polymyxin, neomycin, hydrocortisone

Pseudomonas: oral ceph or cipro

190
Q

Dix Hallpike maneuver

A

Moving from sit to supine while turning head to side induce nystagmus in benign positional vertigo

191
Q

Cause benign positional vertigo

Tx

A

Otolith in inner ear - problem w/ semicircular canal

Tx: Epley, meclizine CI

192
Q

Cause meniere/endolymphatic hydrops

A

Vertigo caused by distension of endolymph compartment of inner ear
LOW FREQUENCY HEARING LOSS

193
Q

Tx meniere

A

Antichol, antiemetics, antihistamine decrease exacerbation; thiazide reduce occurrences; surgery

194
Q

Benign tumor of Schwamm cells of CN VIII can lead to hearing loss 2/2 nerve compression

A

Acoustic neuroma/ schwanomma

195
Q

Preserved bone conduction, poor air conduction

A

Conductive hearing loss confirmed via Rinne test

196
Q

Both impaired bone and air conduction

A

Asymmetric Weber, normal Rinne shows sensorineural hearing loss

197
Q

Biceps DTR

A

C5

198
Q

Triceps DTR

A

C7

199
Q

Patella DTR

A

L4

200
Q

Achilles DTR

A

S1

201
Q

Babinski sign indicates

A

UMN lesion, ok first year of life

202
Q

Stroke - aphasia of dominant hemisphere, neglect of nondominant hemisphere, contralateral paresis and sensory loss in face and arm, gaze toward lesion, homonymous hemianopsia
What vessel?

A

MCA

203
Q

Stroke- Contra paresis and sensory loss in leg, cognitive or personality changes
What vessel?

A

ACA

204
Q

Homonymous hemianopsia, memory deficits, dyslexia/alexia

What vessel?

A

PCA

205
Q

Locked in syndrome, coma, CN palsies (diplopia), apnea, visual Sx, drop attacks, dysphagia, dysarthria, vertigo, “crossed weakness and sensory loss” affecting the ipsi face and contra body
What vessel?

A

Basilar artery

206
Q

Pure motor or sensor stroke, dysarthria - clumsy hand syndrome, ataxic hemiparesis

A

Basal ganglia lacunar

207
Q

MCA stroke Sx

A 
CHANGes
Contralateral paresis and sensory loss in face and arm
Homonymous hemianopsia
Aphasa- dominant
Neglect- nondominant
Gaze toward lesion
208
Q

CI tPA therapy after stroke

A

SAMPLE STAGES

Stroke or head trauma in last 3 months
Anticoag with INR>1.7 or prolonged PTT
MI recent
Prior intracranial hemorrhage
Low platelet 185 or >100
Surgery past 14 d
TIA
Age 400 or low <50 glc
Seizures present at onset of stroke
209
Q

Conditions associated with berry aneurysm that make SAH more likely

A

MAKE and SAH more likely

Marfan
Aortic coarctation
Ehlers Danlos
Sickle cell
Atherosclerosis
History - Fh
210
Q

2/2 mass lesions of frontal lobes, no specific s/s, see on CT - type of herniation

A

Cingulate

211
Q

Large supratentorial mass lesions push midbrain inferiorly; presents with rapid change in mental status, bilat small and reactive pupils, Cheyne-Stokes respiration, flexor or extensor posturing

A

Downward transtentorial (central) herniation

212
Q

2/2 mass lesions of middle fossa. CN III entrapped leading to fixed and dilatered ipsi pupi followed by eye that is down and out. Ipsilesional hemiparesis (false localizing) results from compression of cerebral peduncle against tentorial edge

A

Uncal herniation

213
Q

2/2 posterior fossa mass lesions. Tonsillar herniation–>medullary compression–>respiratory arrest. Usually rapidly fatal

A

Cerebellar tonsillar herniation into foramen magnum

214
Q

HA associated with vascular and 5HT changes

A

Migraine

215
Q

Classic vs common migraines

A

Classic: unilat w/ preceeding visual aura with scotomas (bright or flashing lights) or visual field cuts

Common: May be bilat and periorbital without preceeding auras

216
Q

Most common organism of cavernous sinus thrombosis

A

S aureus

Fungi- Mucor or Aspergillus

217
Q

Dx cavernous sinus thrombosis

A

MRI with gadolinium, MR venograph

218
Q

Tx cavernous sinus thrombosis

A

Penicillinase resistant Rx (nafcillin and oxcillin) + 3rd/4th cephalosporin
Need IV abx 3-4 wks

219
Q

elevated postictal

A

Prolactin

220
Q

Generalized epilepsy in infant, interictal EEG with hypsarrhythmia

Tx

A

Infantile spasms/West syndrome

Tx: ACTH hormone, prednisone, clonazepam, valproic acid

221
Q

Childhood onset seizure, refractory to Tx, daily multiple seizures, ages 2-6, assoc mental retardation, behavior disorders, abnormal interictal EEG with slow spike and wave complexes

A

Lennox-Gastaut syndrome

222
Q

Acute onset severe vertigo, head motion intolerance, gait unsteadiness, N/V, nystagmus
If has auditiory or aural Sx?
If not?

A

Acute peripheral vestibulopathy

Labyrinthitis
Vestibular neuritis (can be Dx after viral infection)
223
Q

Recurrent vertigo without auditory Sx that affect migraine suffers

A

Vestibular migraine

Like Meniere’s without auditory or visual Sx

224
Q

Repetitive nerve stimulation

MG vs Lambert Eaton

A

MG: decremental response
Lambert: incremental response

225
Q

Triad of MG

A

Scanning speech
Intranuclear opthalmoplegia
Nystagmus

226
Q

Cause GBS

A

CAMPYLOBACTER JEJUNI, virus, influenza

227
Q

Presentation GBS

A

Acute, rapidly progressive demyelinating AI of peripheral nn == WEAKNESS, ascending paralysis

228
Q

5 A GBS

A 
Acute inflammatory demyelinating polyradiculopathy
Ascending paralysis
Autonomic neuropathy
Arrhythmias
Albuminocytologic dissociation
229
Q

Type of MS: full recovery or deficits may remain after each episode

A

Relapsing-remitting

230
Q

Type of MS: minor remission and plateaus may take place during progression

A

Primary progressive

231
Q

Type of MS: full recovery or progressive deficits after each episode

A

Progressive relapsing

232
Q

Type of MS: relapses, minor remissions, plateaus may take place during progression

A

Secondary progressive

233
Q

Best prognosis MS

A

relapsing remitting

234
Q

Causes dementia

A 
DEMENTIAS
NeuroDegenerative diseases
Endocrine
Metabolic
Exogenous
Neoplasm
Trauma
Infection
Affective disorders
Stroke/Structural
235
Q

Pseudodementia

A

Difference with AD is in pseudo pt concerned about memory loss

236
Q

Triad normal pressure hydrocephalus

A

Dementia-wacky
Gait aprazia-wobbly
Urinary incontinence- wet

237
Q

Rapid cognitive decline over wks to months

A

CJD

238
Q

Gait PD vs normal P hydrocephalus

A

NPH: arms still swing

239
Q

Primary CNS tumor arises in brain parenchyma. Presents with seizures and focal deficits

A

Astrocytoma

240
Q

Primary CNS tumor with high mitotic activity and endothelial proliferation/necrosis in tumor = ring enhancing lesion with central necrosis on MRI

A

Glioblastoma multiforme

Poor prognosis

241
Q

Originates from dura mater or arachnoid, imaging reveal dural tail

A

Meningioma

242
Q

Derived from Schwann cells, presents ipsi tinnitis, hearing loss, vertigo

A

Acoustic neurona/ Schwannoma

243
Q

Primary CNS tumor kids: primitive neuroectodermal from 4th ventricle causes inc ICP, very malignant

A

Medulloblastoma

244
Q

ARise from epndyma of centricle or spinal cord, low grade, may cause obstructive hydrocephalus

A

Ependymoma

245
Q

Most common suprasellar tumor in kids, calcification common, benign, may cause hypopituitarism

A

Craniopharyngioma

246
Q

Convulsive seizures, ash leaf lesions, mental retardation, shagreen patch, sebaceous adenoma

A

Tuberous sclerosis

247
Q

Vit def Wernicke and Korsakoff

A

Vit B1/thiamine

248
Q

Triad Wernicke’s

A

Encephalopathy
Opthalmoplegia
Ataxia

249
Q

Korsakoff

A

Wernicke + anterograde and retrograde amnesia, horizontal nystagmus, confabulations

250
Q

Peripheral neuropathy Vit Def

A

B12/cyanocobalamin

Posterior and lat columns of spnal cord

251
Q

Vit def: irritability, personality changes without neuro Sx

A

Folate

252
Q

Positive India Ink prep

A

Cryptococcus

253
Q

Area: decreased or no reflexes or fasciculations

A

LMN

254
Q

Area: hyperreflexia

A

UMN

255
Q

Area: apathy, inattention, unhibited or labile affecte

A

Frontal lobes

256
Q

Area: Broca/motor aphasia

A

Dominant frontal lobe

257
Q

Area: Wernicke/sensory aphasia

A

Dominant temporal lobe

258
Q

Area: memory impairment, aggression, hypersexuality

A

Temporal lobes

259
Q

Area: inability to read, write, name, do math

A

Dominant parietal lobe

260
Q

Area: ignoring one side of body, difficulty dressing

A

Nondominant parietal lobe

261
Q

ARea: visual hallucinations, illusions

A

Occipital

262
Q

Area: CN III and IV

A

Midbrain

263
Q

Area: CN V< VI< VII< VIII

A

Pons

264
Q

Area: CN IX, X, XI, XII

A

Medulla

265
Q

Area: ataxia, dysarthria, nystagmus, intention tremor, dysmetria, scanning speech

A

Cerebellum

266
Q

Area: resting tremor, chorea

A

Basal ganglia

267
Q

Area: hemiballismus

A

Subthalamic nucleus

268
Q

Anosmia plus hypogonadism 2/2 def gonadotropin releasing hormone

A

Kallman syndrome

269
Q

Intracranial HTN, papilledema, daily HA worse in morning, may be N/V, obese

A

Pseudotumor cerebri

270
Q

Tx meningitis <1 month

A

Ampicillin: Listeria
Cefotoxamine:
Vancomycin: MRSA

271
Q

Tx meningitis 1month to 50 yrs

A

Vancomycin

Ceftriaxone

272
Q

Prophy for meningococcal meningitis

A

Rifampin or cipro

273
Q

AR degeneration of anterior horn cells (LMN), hypotonic at birth, slowly progressive course

A

Werdnig Hoffman disease

274
Q

Ragged red fibers on mm biopsy

A

Mitochondrial myopathies- Leverl hereditary optic atrophy

275
Q

Cause resting tremor

A

basal ganglia disease

276
Q

Cause intention tremor

A

Cerebellar disease

277
Q

Cause hemiballismus

A

Subthalamic nuclei

278
Q

Orthostatic hypotension

A

Drop BP >20 mmHg or reflex tachy 20 bpm

279
Q

Cushing triad indicating inc ICP

A

Increasing BP
Bradycardia
Respiratory irregularity

280
Q

Conjunctivitis that occurs in first 24 hrs of life

A

Most likely chemical 2/2 silver nitrate/erythromycin given prophy for GC conjunctivitis prevention

281
Q

Conjunctivitis in infant at age 2-5 d, purulent discharge

Mom has Sx

A

GC; Tx topical erythyromycin plus IV or IM 3rd gen cephalosporin

282
Q

Conjunctivitis of infact at age 5-14 d

Mom no Sx

A

Chlamydia

Tx: systemic abx - oral erythromycin to prevent chlam pneumo

283
Q

Dot blot hemorrhages, microaneurysms, neovascularization - retinal changes in what disease?

A

DM

284
Q

Arteriolar narrowing, copper or silver wiring, cotton wool spots, papilledema- retinal changes in what disease

A

HN

285
Q

Sudden unilateral painless vision loss

A

Central retina a/v occlusion
Retinal detachment
Stroke or TIA - amaurosis fugax
Vitreous hemorrhage

286
Q

Sudden unilateral painful vision loss

A

Closed angle glaucoma
Migraine
Optic neuritis or papillitis
Trauma

287
Q

Sudden bilateral vision loss

A

Conversion reaction or hysteriA
Exposure to UV
Toxins- methanol

288
Q

Gradual onset vision loss, uni or bi

A 
Cataracts
Diabetes
Direct insult to brain
Eye infection
Open angle glaucoma
Macular degen
Optic neuritis
Papilledema
Presbyopia
Uveitis
289
Q

Cataracts in neonate

A 
TORCH
Toxoplasmosis
Other
Rubella
CMV
HSV
290
Q

Presbyopia

A

inability to accomodate to near vision

291
Q

Orbital cellulitis vs preorbital cellulitis

A

Both: fever, swollen eyelids, history trauma,

Orbital: opthalmoplegia, proptosis, severe eye pain, dec visual acuity = MEDICAL EMERGENCY

292
Q

Most common bugs orbital/periorbital cellulitis

A

Strep pneumo, Hib, staph or strep

293
Q

Complication orbital cellulitis

A

Meningitis
Vein thromboses
Blindness

294
Q

Hordeolum

A

Painful red lump along eyelid margin 2/2 acute glandular obstruction

295
Q

Chalazion

A

Painless lump on eyelid margin from chronic granulomatous inflammation

296
Q

Conjuctivitis and vesicular eyelid eruption that progresses to dendritic keratitis seen with fluorescein

A

Herpes simplex keratitis

Tx: topical antiviral s(idoxuridine or trifluridine)
NO STEROIDS

297
Q

When to refer child with lazy eye or strabismus

A

> 3 months

298
Q

Lesion CN III/oculomotor causes

A

Eye down and out, latearl movement only possible
Resolves on own
If pupil blown, emergency!!

299
Q

Lesion CN IV/trochlear causes

A

When gaze is medial, pt cannot look down = vertical diplopia

300
Q

Lesion CN VI/abducens causes

A

Cannot look laterally = horizontal diplopia

Most common

301
Q

Lesion CN V and VII causes

A

corneal drying due to loss of corneal blink reflex

First Aid Step 2 (22 decks)

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