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EM Board exam > Neuro and Psych > Flashcards

Neuro and Psych Flashcards

1
Q

Dermatomes

Upper arm

umbilicus
perineum
perianal

A

Upper arm: C-5 through T1

umbilicus: T10
perineum: S2
perianal: S5

  • C4: clavicle “C” is for “clavicle”
  • C6: thumb & index Left hand “OK” sign makes a “6” with thumb and index
  • C7: middle finger
  • C8: little finger
  • T4: nipple line “T” is for “thorax”
  • T10: umbilicus BellybutTEN
  • L1: inguinal ligament IL-L1
  • L4: knee “Down on all fours” – Down on L4
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2
Q

Cranial nerve three palsy

pupil sparing (2)

pupil involved (2)

A

pupil sparing (2): diabetes/hypertension, infarction

pupil involved (2): compression, aneurysm

nasal gaze on affected side

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3
Q

GCS

A

•Eye Opening (1-4)

–4: Spontaneous

–3: Verbal

–2: To Pain

–1: None

•Verbal (1-5)

–5: Full sentences / oriented

–4: Full sentences / confused

–3: Understandable words

–2: Garbled, moans

–1: No vocalization

•Motor Response (1-6)

–6: Follows commands

–5: Localizes pain

–4: Withdraws to pain

–3: Decorticate (Flexes)

–2: Decerebrate (Extends)

–1: Flaccid

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4
Q

Doll’s eyes (oculocephalic reflex)

A

–If brainstem is intact: Eyes move in opposite direction of head movement

–If brainstem is injured: Eyes stay fixed in orbits

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5
Q

Cold calorics (oculovestibular reflex)

A

–If brainstem and cortex are intact: Nystagmus with fast component directed to opposite ear. “Cold Opposite, Warm Same” = COWS

–Cortex injured but brainstem intact: Eyes deviate toward cold ear

–Brainstem injured: No eye deviation

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6
Q

Corneal reflex

A

–Test CN V and CN VII (touching the cornea elicits bilateral blink)

–Decreased blink in opposite eye suggests brainstem or cortical injury

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7
Q

Right Internuclear Ophthalmoplegia

A
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8
Q

Migraine

prevention (3)

treatment classes (3), contraindications

A

prevention (3): TCA, BB. CCBs

treatment classes (3)

Ergpts. Triptans, Dopamine antagonists

–Ergotamine, DHE: contraindicated in CAD, PVD, HTN, RF, pregnancy

–Sumatriptan: Contraindicated in heart disease, HTN, ergotamine, migraine with focal findings

–Dopamine antagonists: Prochlorperazine, promethazine, metoclopramide

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9
Q

Cluster headaches
treatment (3)

toxic metabolic headache-what?

A

Oxygen, intranasal lidocaine 4%, migraine treatments

toxic metabolic headache

  • Usually bilateral
  • Vasodilation of pain-sensitive arteries
  • Fever is the most common cause
  • Others: CO, hypoxia, alcohol, tyramine foods
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10
Q

Idiopathic intracranial hypertension (pseudo-tumor)

etiology
treatment (4)

A

etiology: impaired CSF absorption
treatment (4): serial lumbar puncture, acetazolamide, weight loss, shunt

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11
Q 
Subarachnoid hemorrhage
medical treatment (2)
A

Aggressive blood pressure control (nicardipine), Nimodipine

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12
Q

Hydrocephalus
ex vacuo -what

normal pressure classic triad
treatment

VP shunt, unable to depress valve, consider:

A

ex vacuo: pseudo-hydrocephalus from cerebral atrophy

normal pressure classic triad: progressive dementia, ataxia, incontinence
treatment: shunt

consider: obstruction

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13
Q

CNS mass lesion
most common cause in AIDS and description

headache characteristics: peak intensity time of day, positional change, valsalva

A

Toxoplasmosis: ring enhancing lesion

headache characteristics: worst in the morning, worse lying down and with Valsalva

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14
Q

Meningitis

Brudzinski and Kernig signs

most common bacterial causes (2)

A

Kernig’s sign: Pain in hamstrings causes inability to straighten leg when hip is flexed to 90

Brudzinski’s sign: Flexion of the hips caused by passive flexion of the neck

both have low sensitivity but high specificity

causes: strep pneumoniae, Neisseria meningitiis

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15
Q

Meningitis

treatment order (2)

CT before LP (5)

A

Steroids then (or same time as) antibiotics and seriously ill (or CSF WBC > 1000)

CT before LP

–Age at least 60

–Immunocompromised (HIV, immunosuppressive treatment and transplant pts.)

–A history of CNS disease (mass lesion, stroke or focal infection)

–Seizure within the last week

–Abnormal neuro exam / altered mental status

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16
Q

Aseptic Meningitis

causes categories (4)

A

Viral: Varicella, herpes (HSV), enterovirus, West Nile

Atypical bacterial: TB, Lyme disease (weeks after rash), Syphilis

Fungal: AIDS, transplant, chemo, chronic steroids

Noninfectious: Neurosarcoidosis, connective tissue disease, vasculitis, drugs (NSAIDs)

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17
Q
A
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18
Q
A
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19
Q

GBS

associated antecedents (3)

Hallmark finding

CSF finding
treatment meds(2)
A

Campylobacter gastroenteritis, Mycoplasma, flu vaccine
loss of DTRs
elevated protein
plasmapheresis, IV IG

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20
Q

multiple sclerosis

most common initial presentation

pathognomonic finding

A

Optic neuritis: Unilateral, Central vision loss, pain with eye movement and papillitis (papilledema of one eye)

Pathognomonic: Bilateral internuclear ophthalmoplegia
(eyes can’t look at nose)

21
Q

multiple sclerosis

diagnosis: rad, LP (2), nerve

Tx for exacerbation (3)

A

diagnosis: MRI, LP with increased protein and increased IgG oligoclonal bands

Tx: steroids, ACTH, interferon

22
Q 
Pure muscle weakness
causes review (9)
A
  • Hypokalemic periodic paralysis
  • Myasthenia gravis
  • Lambert-Eaton syndrome
  • Tick paralysis
  • Botulism
  • Certain toxins
  • Amyotrophic lateral sclerosis (ALS)
  • Polio
  • West Nile Virus
23
Q

Acute periodic paralysis

common trigger

associated conditions (2)

inheritance of hereditary form and tx

A

Exercise

associated conditions (2): hypokalemia, thyrotoxicosis

inheritance of hereditary form and tx: autosomal dominant, avoid high carbohydrate high salt diet

24
Q

Myasthenia gravis

etiology
associated comorbid condition and frequency
weakness pattern and hallmarks (2)

A

Autoantibody to acetylcholine receptor
thy,moma, 25%
proximal greater than distal weakness, worsens with activity, ptosis, diplopia

25
Myasthenia gravis diagnosis (2) and caveat with first medicine exacerbation trigger (2)
dx, caveat: –Tensilon (edrophonium) test: Increases ACh, by blocking breakdown of ACh by cholinesterase = increases muscle strength / EMG = rapid fatigue; can cause AV block, cardiac arrest - give atropine first –Blood: Anti-acetylcholine receptor antibodies exacerbation trigger (2) –Exacerbation vs. inadequate treatment (myasthenic crisis) –Over-medication (cholinergic crisis)
26
Myasthenia gravis treatment (4)
Physostigmine or neostigmine (ACH inhibitors), thymectomy, prednisone, plasmapheresis
27
Lambert-Eaton syndrome what associated comorbid finding differences from more common condition (2)
what: similar to myasthenia gravis associated comorbid finding: cancer, 50% (especially SC lung) differences from more common condition (2): decreased DTR. Weakness improves with use
28
Botulism 3 forms etiology Hallmark
3 forms: infant, wound, foodborne etiology: neurotoxin blocks ACh release Hallmark: impaired motor and autonomic function ## Footnote –Foodborne: inadequately processed canned foods –Wound: contaminated wound or street drugs –Infant: ingest spores from honey; most common in breastfed (also less severe in this subset)
29
Botulism Clinical characteristic categories (3)
–Bulbar symptoms – diplopia (the most common early finding), ptosis, dysphagia, dysphonia, dysarthria –Descending flaccid paralysis –Anticholinergic symptoms (dry mouth, urinary retention, dilated pupils, ileus, decreased tears) –Sensory exam and mental status are normal
30
Botulism treatment - all forms additional for wound variety (2)
treatment - all forms: antitoxin additional for wound variety (2): penicillin, wound debridement
31
Tick paralysis Hallmark differentiator from similar condition treatment
Hallmark: rapidly ascending paralysis differentiator from similar condition: no paresthesia, more rapid progression treatment: remove tech
32
Wernicke's encephalopathy ``` etiology classic findings (5) ``` treatment (2) Complication (sx -2)
Thiamine (B1) deficiency •Encephalopathy (altered mental status), nystagmus, ophthalmoplegia (esp. lateral rectus), ataxia, short-term memory problems treatment: thiamine, magnesium Korsakoff's psychosis: amnesia, confabulation
33
West Nile virus percent affected severe form tx
percent affected: 20% overall, rate and severity increases with age severe form: flaccid paralysis with intact sensation Dx: CSF IgM tx: supportive
34
Seizure Duration of Todd's paralysis Initial ED W/U new adult seizure (5) Peds non-febrile common causes (2)
Duration: up to 24 hours Initial ED W/U: Glucose, lytes, CT, LP, toxicology screen Peds non-febrile: hyponatremia, AGE
35
Partial Seizures Simple vs complex Drug doses (?)
* Simple: No LOC, mental status is preserved * Complex: Temporal lobe, altered mental status, bizarre behavior; “psychomotor” seizures –Lorazepam 0.05-0.1 mg/kg (longer acting; drug of choice) – Phenytoin 18 mg/kg – Phenobarbital 8-20 mg/kg
36
Status epilepticus classic and newer definitions classic board exam cause and treatment
Classic: continuous seizure greater than 30 minutes Newer: Status epilepticus ≥5 minutes of continuous seizures, or ≥2 discrete seizures between which there is incomplete recovery of consciousness Classic boards: INH overdose/B6 deficiency -\> treat with thiamine
37
Lower and upper motor neuron signs in particular: positive Babinski? Fasciculations? Increased tone? DTRs increased?
Upper: positive Babinski, Increased tone DTRs increased Lower: Fasciculations Upper: * Hyperreflexia * Clonus * Normal muscle mass * Spasticity (increased tone and reflexes) * Babinski's sign Lower * Weakness * Atrophy * Fasciculations * Decreased DTRs
38
ALS, Lou Gehrig's disease What? Cauda equina Upper vs LMN lesion? Motor or sensory? Anal tone?
Degeneration of upper and lower motor neurons etiology unknown Upper vs LMN lesion? Lower Motor or sensory? Both Anal tone? Decreased
39
Back pain, IVDA Back pain, motor \> sensory findings
Vertebral osteo/disitis Back pain, motor \> sensory findings: red flag for spinal cord compression
40
Diagnosis, typical location etiologies (3) findings associated with
Diagnosis, typical location: Syringomyelia of the cervical cord etiologies: trauma, infection, idiopathic findings: inter-osseous muscle wasting and loss of pain and temperature sensation in the hands associated with: Chiari defects of the cerebellum
41
Hemorrhagic stroke most common location goal blood pressure, agents (3)
most common location: basal ganglia, thalamus goal blood pressure, agents: 160/90, labetalol, nicardipine, nitroprusside
42
Stroke syndrome patterns (CNs, other motor, other sx) Cerebral Brainstem Pontine (4)
Cerebral: cranial nerves, motor and sensory Brainstem: ipsilateral cranial nerve and facial weakness; contralateral sensory and motor Pontine: coma, miosis, gaze paresis, altered respiratory pattern
43
Stroke syndromes MCA (3) PCA vertebrobasilar (4)
MCA: contralateral motor/sensory of face and arm, aphasia (dominant hemisphere)/hemi neglect (non dominant), contra homonymous hemianopia PCA: contra homonymous hemianopia, visual agnosia vertebrobasilar: balance, vertigo, nystagmus etc. dysarthria, dysphagia quadriplegia coma
44
Wallenberg’s syndrome: what, sx (3) Locked-in” syndrome: what, sx (3)
Wallenberg’s syndrome: vertebral artery thrombosis, ataxia/n/v, decreased pain/temperature ipsilateral face, contralateral body, ipsilateral Horner Locked-in syndrome: basilar artery occlusion at the pons (also seen in other conditions damaging the pons), patient awake and understanding, only motor activity is diaphragmatic breathing and vertical eye movements
45
Lacunar syndromes diagnostic caveat Types (5)
diagnostic caveat: often missed by CT (small micro infarct in the midbrain,HTN/DM), 25% of all ischemic strokes Types (5) your motor pure sensory ataxia-hemiparesis dysarthria-heiparesis mixed sesorimetor
46
Neurology trivia blood pressure cut off for tPA gaze preference during seizure versus intracerebral stroke Ophthalmoplegic migraine headaches worse on awakening
185/110 seizure away from focus, stroke-towards affected side migraine with cranial nerve palsy's of 3,4,6, diplopia worse on awakening: hypoxia, mass, cluster, pseudo-tumor
47
Neurology trivia 2 myopathy weakness pattern unexplained syncope consider neurologic medication contraindicated in second and 3rd° AV block
Proximal greater than distal muscle weakness vertebrobasilar ischemia phenytoin
48
Neuroleptic malignant syndrome etiology and timing symptoms (3) treatment (2)
etiology and timing: neuroleptics causing decreased dopamine, usually within two weeks of starting medication symptoms (3): fever, AMS, unstable vital signs, elevated CPK/leadpipe rigidity treatment (2): bromocriptine and dantrolene
49
Serotonin syndrome etiology and cause categories (4) symptom categories (3) treatment (2)
``` etiology: Access central and peripheral serotonin - antidepressants, opioids, CNS stimulants, triptands symptom categories (3) ``` cognitive: **AMS,** agitation, hypomania, hallucinations, coma autonomic: shiverring, diaphoresis, **HTN, tachy,** nausea, diarrhea somatic: **myoclonus, tremor, hyperreflexia** treatment (2): benzodiazepines, chlorpromazine, Cyproheptadine

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