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Step 3 > Neuro > Flashcards

Neuro Flashcards

1
Q

How do you demonstrate brain death on exam?

A

Absence of deep brain reflexes

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2
Q

Can a brain dead patient move?

A

Yes, can have spontaneous movements from the peripheral nervous system or spinal cord

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3
Q

In myasthenia gratis, Ab attack what receptor?

A

Acetylcholine

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4
Q

Wernicke encephalopathy is d/t a deficiency in?

A

Thiamine

AMAS + oculomotor dysfunciton + ataxia

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5
Q

Pt is treated for Wernicke, now having retrograde amnesia and confabulation (making up stories). Why?

A

Korsakoff syndrome
Late stage complication of chronic thiamine deficiency
Mammillary body atrophy on MRI
The patients rarely improve

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6
Q

Kiddo with hearing loss and SubQ skin masses

A

Neurofibromatosis
Acoustic neuromas (from Schwann cells)
Schwann cells - myelinated PNS axons and CN axons

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7
Q

Side effect of carbamazepine (anti-eleptic)?

A

Neutropenia/bone marrow suppression
Elderly also get SIADH
Also - glaucoma, urinary retention, constipation

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8
Q

1st line therapy for prolactinoma (regardless of size)?

A

Dopaminergic receptor agonist (bromocriptine, cabergoline)

Can decease tumor size in a few days which can help visual symptoms

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9
Q

New onset depression at age >65 increases the pts risk of?

A

Alzheimer dz

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10
Q

Pt with acute severe unilateral HA
Dilated pupil on same side
Blurry vision on same side
Concerning for?

A

Carotid a. dissection
get a CTA head/neck
Gets compression on the superior cervical sympathetic ganglion

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11
Q

What should be measured in someone with Guillain Barre

A

Vital capacity to monitor respiratory status

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12
Q

Treatment of Guillain Barre?

A

Therapeutic plasma exchange or IVIG

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13
Q

Pt with new onset lower extremity weakness and loss of bowel/bladder control
Dx and what next?

A

Transvere myelitis
Different from GBS because they have flaccid paralysis, hyporeflexia
Need spinal MRI
Tx - steroids

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14
Q

Pt has symptoms of intracerebral hemorrhage + CN III palsy in the weeks before the event, where is the lesion?

A

PCA aneurysm

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15
Q

Pt has symptoms of intracerebral hemorrhage + ataxia. Where is the lesion?

A

Posterior inferior cerebellar a. aneurysm

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16
Q

Pt with lower extremity weakness, numbness, + Romberg, constricted pupils on exam

A

Late neurosyphilis
Tabes dorsalis - sensory ataxia, lancinating pains
Argyll Robertson pupils - constriction w/ accommodation but not with light

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17
Q

Most common cause of b/l diaphragmatic paralysis?

A 
ALS
Respiratory weakness (worse when supine), lower extremity atrophy, tongue fasciculation's
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18
Q

Young person with DVT now has a stroke. What should be part of the workup?

A

Bubble study to look for intracardiac shunt

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19
Q

Preferred test to dx MS?

A

MRI

ovoid periventricular white matter lesions

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20
Q

Tx for acute MS flare?

A

IV solumedrol
po steroids has high rate of recurrence
Can pursue plasmapheresis if no response to treatment

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21
Q

Long term tx for MS?

A

Beta-interferon or flatiramer
Decreases the frequency of exacerbations
Reduces the number of brain lesions in its with relapsing-remitting MS

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22
Q

How should you counsel a woman with MS that wants to get preggo?

A

Typically have lower disease activity during pregnancy
Higher activity in postpartum period
Most therapies are low risk of harm to fetus

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23
Q

What can you give a MS patient that is having a hard time with spasticity?

A

Baclofen

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24
Q

Cancers with high rate of metastasis to spine?

A 
prostate
breast
lung
non-Hodgkin's lymphoma
RCC
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25
Q 
Dementia + 2 or more of the following:
Fluctuating cognition
Visual hallucination
Shuffling gait, increased tone
Rapid eye movement during sleep
A

Dementia w/ Lewy bodies

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26
Q

What treatment can make a Lewy body dementia pt prone to orthostatic?

A

Anti-psychotics especially first generation

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27
Q

Dementia
Difficulty walking, lower extremity parathesia
Hyperreflexia

A

Vit B12 deficiency

Prone to hemolytic anemia d/t poor erythropoiesis

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28
Q

Pt with decreased sensation over anterolateral thigh but nl reflexes and strength

A

Meralgia paresthetica
Lateral femoral cutaneous nerve entrapment
Tx - weight loss and avoid tight clothing

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29
Q

Teenager presenting with symptoms of paralysis after campling

A

High suspicion for tick paralysis
toxin is in tick saliva
Six start 4-7 days after attachment
Progressive gait ataxia and ascending paralysis
exam: NL sensation, absent DTRs, afebrile
Tx - remove the icky thing

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30
Q

Headache + papilledema. Now what?

A

MRI

don’t do LP in use there is herniation

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31
Q

Premature infant, spasticity, hyperreflexia, not meeting gross motor milestones
Dx and workup?

A

Suspicious for CP

Get an MRI

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32
Q

2 days after removal of a parathyroid adenoma pt has b/l facial asymmetry

A

Hungry bone syndrome

If unilateral think of an alternative dx

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33
Q

LP with high RBC w/o xanthochromia is?

A

A traumatic tap

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34
Q

High risk features of head trauma in a kid < 2

A 
AMS
LOC
Severe mech (>3ft, MVA)
Nonfrontal scalp hematoma
Palpable skull fracture
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35
Q

How do you counsel people to return to sport after concussion?

A

rest for 24 hours after injury. After that gradually increase activity level each 24 hour period if asymptomatic. Maybe able to return to full play in 1 wk

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36
Q

Absent cremaster reflex but all other strength and sensation intact. C/f?

A

Isolated loss of Cremasteric reflex is suggestive of diabetic neuropathy
L1-L2

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37
Q

Teenager
Upper extremity twitching x months
No GTC seizure
Cx?

A

Juvenile myoclonic epilepsy
Tx - Valproic acid
can initially present as absence as well
Aggrevated by sleep deprivation and alcohol
EEG b/l polyspike and slow wave discharges during ictal period

38
Q

Side effect of Valproic acid?

A

Thrombocytopenia
Hepatotoxicity
Teratogen –> NTD

39
Q

Can brain dead people have DTRs?

A

Yes, because these are peripheral reflexes

40
Q

infectious cause of SAH in a sexually active young adult?

A

Syphillis
Causes intracranial arteritis
Tx - PCN

41
Q

Six of phenytoin toxicity?

A

Earliest - nystagmus on lateral gaze
blurred vision, diplopia, ataxia, slurred speech, lethargy, AMS
Late - coma

42
Q

Best way to visualize head injury 2/2 trauma in an infant?

A

CT

no ultrasound - this is better for intraventricular hemorrhage in premies

43
Q

1st line to prevent cluster HA?

A

Verapamil

44
Q

Teenager describing feeling sleepy all the time, falls asleep at inappropriate times, hallucinations surrounding sleep, or cataplexy

A

c/f narcolepsy, needs a sleep study

45
Q

1st line tx for narcolepsy

A

Modafinil

Sleep hygiene

46
Q

Narcoleptic patient has cataplexy triggered by emotion. Dx?

A

Venlafaxine

47
Q

ipsilateral face loss of pain/temperature
Contralateral body loss of pain temp
ipsilateral body weakness
Vestibular syx - Nystagmus, vertigo, ipso limb ataxia, Horner’s syndrom
Face motor function spared
What is this?

A

Wallenberg syndrome

Lateral medullary infarct d/t occlusion of PICA or vertebral a.

48
Q

Tongue deviates toward lesion
Contralateral body with paralysis
Where is the lesion?

A

Medial Medullary syndrome (alternating hypoglossal hemiplegia)
occlusion of vertebral or ACA

49
Q

Contralateral ataxia
Hemiparesis of face, trunk, limbs
Where is the lesion?

A

Medial mid-pontine infarction

Ataxic hemiparesis

50
Q

What should be ruled out if you are concerned about dementia?

A

Anemia
Folate/B12 levels
hypothyroidism
Depression

51
Q

Common age range for febrile seizure?

A

3month - 6 years

52
Q

Progressive weakness following URI
Loss of sensory, urinary retention
Dx?

A

Transverse myelitis

53
Q

Cushing’s triad of intracranial hemorrhage

A

Bradycardia
HTN
Respiratory depression

54
Q

eye with down and out palsy

A

CN III

55
Q

dementia with lots of personality changes

A

Frontotemporal dementia

56
Q

Tx for Parkinsons

A 
Dopa agonist (pramipexole)
or Levodopa
Prefer pramipexole in younger pmts because of the long term side effects of levodopa
57
Q

If you suspect NPH wait is the first step in management?

A

LP

If syx get better –> VP shunt

58
Q

Pt has involuntary closing of R eye in response to bright light
Dx, Tx?

A

Focal dystonia (blepharospasm)
Older women are predisposed
Tx - Botox

59
Q

Pt has stroke symptoms and cannot lift the affect eyebrow or corner of mouth

A 
Bells palsy (CN VII),
CVA has preservation of forehead and eyebrow movements because upper motor portion of CN VII is in a different location than the lower branch
60
Q 
Unilateral lower extremity weakness
Muscle cramping in same extremity
Atrophy on exam, fasciculation's in face and tongue
difficulty chewing
Dx?
A

ALS

61
Q

What is Riluzole?

A

ALS treatment
Glutamate inhibitor
Doesn’t cure, but prolongs survival and delays need for trach

62
Q

Cut off for carotid endarctectomy?

A

Symptomatic stenosis 70-99%and life expectancy > 5years

63
Q

Infant with developmental delay, seizures, hypopigmented “ash-leaf spots”

A

Tuberous scleorsis
AD
de novo in 80% of cases
EEG is indicated as their seizures worsen over time

64
Q

Usual cause of death in tuberous sclerosis?

A

Neurologic problems

epilepsy

65
Q 
Pt with headaches
lost pupillary reaction
Vertical gaze restriction
loss of balance while walking
dx?
A

pituitary adenoma
Parinaud’s syndrome
Some can also secrete HCG and cause precocious puberty in males

66
Q

IF you suspect a brain bleed and pt has down and out eye finding, ptosis, anisocoria, where is the bleed likely to be?

A

PCA aneurysm

lesion in CN III

67
Q

How do you assess respiratory effort in a pt suspicious for Guillain-Barre?

A

Check tidal volume and negative inspiratory force (vital capacity)

68
Q

Who should receive plasma exchange in Guillain- Barre?

A

If non ambulatory and six present <4 wks

Shortens the time to full recovery

69
Q

Most common complication in spina bifida?

A

Neurogenic bladder - nearly universal
Result of folate deficiency during pregnancy
Elevated alpha-fetoprotein on maternal screenings
Over half of patients will have hydrocephalus after repair and require a VP shunt
Neurogenic bowel also common and require a bowel regimen

70
Q

Workup for suspected SAH

A

CT - can be negative especially if >6 hours since symptom onset
followed by LP

71
Q

b/l band HA without throbbing

A

Tension type HA

72
Q

throbbing headache

A

Migraine

73
Q

After a Carotid endarterectomy pt has tongue deviation. Which nerve is affected?

A

Hypoglassal

74
Q

Pt has dysphonia after a carotid endarterectomy is d/t damage to?

A

Recurrent Laryngeal

75
Q

Asymetric smile after carotid endarterectomy is damage d/t?

A

Facial nerve

76
Q

Pt has absent CN. How do you confirm brain death?

A

Apnea testing

77
Q

sudden onset but transient monocular blindness

A

Amaurosis fugax
Caused by carotid archery atherosclosis
Often have a carotid bruit
Need carotid dopplers

78
Q

Bells palsy + hepatosplenomegaly suggests?

A

Sarcoid

Can have uveitis, arthritis, CNS findings with infiltrate of organs

79
Q

what confirms dx of sarcoid?

A

LN Bx with noncaseating granulomas

80
Q

work up for reversible causes of dementia?

A

CBC
CMP
TSH
B12

81
Q

1st line tx for dementia?

A

Acetylcholinesterase inhibitors
Donepezil, rivstigmine, galantamine
2nd line - NMDA receptor antagonist; memantine

82
Q

h/o febrile seizures increases risk of?

A

Recurrence

Epilepsy

83
Q

What is construction apraxia?

A

Pt is unable to copy a drawing.
Lesion in non dominant parietal lobe
Can also have dressing apraxia (difficulty putting on a coat or pants)

84
Q

Unable to do math, name fingers, write, and confuses R/L

Dx and location of lesion?

A

Gerstmann syndrome

Dominant parietal lobe

85
Q

deficit in visual field, unable to interpret complex sounds

Where is lesion?

A

non dominant temporal lobe

86
Q

deficit in visual field
aphasia
Dx and location?

A

Wernicke’s aphasia

Dominant temporal lobe

87
Q

Parkinson’s patient with psychomotor slowing and blunted affect. Tx?

A

Add SSRI, underlying depression

88
Q

best way to dx epidural abscess?

A

MRI

89
Q

what medications increase risk of pseudo tumor?

A

acne treatments, irsotretinoin and minocycline

90
Q

leg with generalized spike and wave

A

absence sz

91
Q

how is management after spa different from non spa cva

A

no anti platelet

keep bp <185/100 to avoid hemorrhagic conversion

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