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Neurology clerkship > Neuro basics > Flashcards

Neuro basics Flashcards

1
Q

Cause of motor conduction defects w/o sensory symptoms

A

Lead

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2
Q

Causes of sensory conduction defects w/o motor symptoms

A

Paraneoplastic

HIV

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3
Q

Time required for denervation

A

10-21 days after injury

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4
Q

Nerve conduction study results for neuropathy

A

Axonal - nml/mildly slow - toxic, metabolic, DM causes

Demyelinating - very slow - autoimmune, acquired, post-infectious (GBS)

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5
Q

Repetitive nerve stimulation responses

A

Decremental - Myasthenia gravis

Incremental - Botulism, Lambert-Eaton

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6
Q

Xanthochromia

A

Yellow CSF due to RBC breakdown 12h-14d after bleed

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7
Q

Cytoalbumino-dissociation

A

CSF: High protein, low WBC

In demyelinating neuropathies (GBS)

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8
Q

LP CIs

A 
Raised ICP (somnolence, headache, imbalance, N/V, focal neuro deficit, new seizure, papilledema):
Tumor, abscess
Subarachnoid/intracerebral bleed
Posterior fossa mass
Low platelet count under 50k
INR over 1.5 (warfarin)
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9
Q

Do what before and after LP?

A

Review HCT/MRI to see:
No mass lesion + 4th ventricle, quadrigeminal cistern are open
Always check serum glucose as reference post-LP (CSF should have over 2/3 serum)

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10
Q

RBCs in CSF means?

A

Traumatic tap if decreasing concentration with subsequent tubes (or rarely active bleed)

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11
Q

Meningitis treatment

A 
Treat empirically for likely bacteria/virus before LP:
10mg IV dexamethasone q6h for 4d
Ceftriaxone/Cefotaxime
Vancomycin
Acyclovir
ADD AMPICILLIN for those over 50y
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12
Q

Reasons for EEG

A

Assess coma/consciousness
Seizure (vs pseudoseizure)
Creutzfeldt-Jacob disease
Periodic lateralizing epileptiform discharge (PLED) in herpes encephalitis

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13
Q

Seizures

A

Abnormal, paroxysmal, excessive CNS neuron discharge
Eyes are open
Generalized - abnormal in all leads w/ spikes

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14
Q

Head CT terms

A

Hyperdensity - white - bone, blood, Ca

Hypodensity - black - CSF, ischemia (abnormal after 6-24h), chronic subdural, edema, tumor

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15
Q

Parts of brain that bleed w/ chronic HTN? Sx?

A

Aneurysms at branches of cerebral arteries
Lenticulostriate aa
Cerebellar aa
Intraventricular hemorrhage in premature infants;
Focal sx that progress to ICH signs (headache, N/V, AMS)

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16
Q

Metastases to brain that commonly bleed?

A

Melanoma, RCC

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17
Q

Subarachnoid hemorrhage management

A 
Sedation/valium if conscious
Give nimodipine, statin, MCA doppler, and consider angioplasty for vasospasm
Keep BP higher to maintain perfusion
Operate early on aneurysms
Monitor for hydrocephalus
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18
Q

MRI terms

A 
Hypointensity - dark
Hyperintensity - white
T1, T2
Flair - MS
Diffusion weighted imaging - detects ischemia
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19
Q

Glasgow coma scale

A 
Out of 15:
Eye opening (4) - spontaneous, voice, pain, none
Verbal response (5) - nml convo, disoriented, incoherent, sounds, none
Motor response (6) - nml, localized to pain, withdraws from pain, decorticate (flexor), decerebrate (extensor), none
3-8 = Severe
9-12 = Moderate
13-15 = Mild
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20
Q

MMSE

A 
Out of 30:
Orientation to time = 5
Orientation to place = 5
Registration = 3 (repeat named prompts)
Attention/Calculation = 5 (serial 7s/'world' backwards)
Recall = 3 (registration recall)
Language = 2 (name pencil and watch)
Repetition = 1 (Speak back a phrase)
Complex commands = 6 (Varies. Draw figure shown.)
Over 24 = Nml
Over 19 = Mild cognitive impairment
Over 10 = Mod
Under 9 = Severe
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21
Q

Seizure etiology

A

Etiology - Alcohol withdrawal, illicit drugs, meds; Brain tumor/trauma; Cerebrovascular disease (Subdural hematomas, HTN encephalopathy); Degenerative CNS disorders (AZD); Electrolytes (hyponatremia, uremia, liver failure, hypoglycemia); Idiopathic (60%)

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22
Q

Stroke treatment, management, secondary prevention

A

Maintain elevated, but not very high BP
BMP (Cr for contrast), glucose, CBC, INR, Troponins, ECG, tox screen — Stat CT
If no hemorrhage, thrombolysis/thrombectomy

ECG for arrhythmia, Echo for endocarditis, Carotid U/S, Lipids, HbA1c, TSH, Homocysteine, ESR/CRP, Blood cx

ASA, dipyrimadole, clopidogrel; hold anticoag
Carotid revascularization (CEA, stenting)
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23
Q

How to test visual fields

A

Patient and examiner cover opposite eyes

Test one eye and one visual field at a time

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24
Q

Testing aphasia

A

What did you have for breakfast?
Touch your L foot with your R hand.
Repeat: The brown dog ran down the muddy hill.

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25
Q

Diffuse petechiae/purpura in meningitis case?

A

Neisseria meningitidis

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26
Q

Leukonychia

A

Mees’ lines on nails seen in arsenic (or other heavy metal) poisoning

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27
Q

Alopecia is common in what poisoning?

A

Thallium (non-standard pattern)

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28
Q

Dysphonia

A

Difficulty producing voice sounds (laryngeal issue)

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29
Q

Dysarthria

A

Difficulty articulating individual words (slurred speech)

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30
Q

Dysprosody

A

Difficulty with melody, rhythm of speech, inflection, intonation (Non-dom hemisphere stroke)

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31
Q

Aphasia

A

Language problem (Dom hemisphere stroke)

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32
Q

CN2 testing

A

Perform visual acuity and visual fields first
Perform fundoscopic exam and pupillary light reflex second
CN2 = afferent, CN3 = efferent

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33
Q

Conditions with anosmia

A

Head trauma
Frontal lobe mass/abscess
PD, AZD

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34
Q

Relative afferent pupillary defect occurs with what?

A

RAPD in CN2 injury

Eye with defect dilates with swinging light to it

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35
Q

Argyll Robertson pupil

A

‘Prostitute’s’ - accommodates, but doesn’t react

Neurosyphilis, maybe DM

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36
Q

Horner’s syndrome

A

Ptosis, miosis, anhidrosis

Dysfunction of SNS to orbit, face

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37
Q

Vertical gaze palsy

A

No up/down eye mvt

Midbrain lesion

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38
Q

Horizontal gaze palsy

A

PPRF - brainstem lesion

INO - MLF lesion

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39
Q

CN4 palsy

A

Head tilt toward unaffected side to compensate

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40
Q

Pupillary light reflex circuit

A

Light hits either retina, CN2 to pretectal nucleus, bilateral connections to E-W nuclei, PSNS pupillary constriction via CN3

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41
Q

CN3 palsy with blown pupil

A

Due to mass effect - emergent

Uncal herniation or PcommA aneurysm

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42
Q

CN3 palsy with reactive pupil

A

DM

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43
Q

INO

A

Can look to affected side

Affected eye cannot adduct while unaffected has concurrent nystagmus

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44
Q

CN7 lesions

A

Bell’s palsy = LMN lesion affecting whole 1/2 of face

Stroke = UMN lesion affecting only bottom of 1/2 of face

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45
Q

CN12 lesions

A

‘Lick your wounds’

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46
Q

Resting tremor

A

While patient is relaxed

PD specific

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47
Q

Postural tremor

A

When limb is being held up

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48
Q

Action tremor

A

When limb is moved

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49
Q

UMN lesion pattern

A

No initial atrophy
No fasciculations
Hyperreflexive with increased tone

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50
Q

LMN lesion pattern

A

Atrophy, fasciculations

Decreased reflexes and tone

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51
Q

Tics

A

Intermittent, stereotyped - face or body

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52
Q

Chorea

A

Random movements - ‘fidgets’

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53
Q

Dystonia

A

Sustained abnormal posture

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54
Q

Myoclonus

A

Lightening-like abrupt jerks

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55
Q

Duchenne muscular dystrophy

A

XR dystrophin mutations
Dilated cardiomyopathy, muscle pseudohypertrophy
Gower’s sign

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56
Q

Myotonic dystrophy

A

AD
Myotonia - failure of spontaneous release from handshake
Pacemaker due to arrhythmia (conduction abnmlities)
Insulin resistance, cataracts

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57
Q

Pronator drift (down)

A

Indicates UMN lesion of contralateral pyramidal tract (or ipsilateral cerebellum if drifting upward)
Screen for mild weakness due to stroke

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58
Q

Cerebellar dysfxn signs

A

Dysmetria, Dysdiadochokinesis, Titubation, Dysarthria, Nystagmus, Intention tremor, Broad-based stance/gait

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59
Q

Dysmetria

A

Zig zag to target w/ finger

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60
Q

Dysdiadochokinesis

A

Impairment making smooth, rapid, alternating mvts

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61
Q

Titubation

A

Coarse tremor of the trunk

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62
Q

Dysarthria

A

Impairment of speech motor fxn - NOT language disorder

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63
Q

Cerebellar dysfxn indicates lesion of which side?

A

Ipsilateral

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64
Q

Heel-shin test performed in what position?

A

Supine

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65
Q

Romberg sign indicates?

A

Dorsal column dysfxn, NOT cerebellar

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66
Q

Graphesthesia

A

Identify number drawn on hand

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67
Q

Stereognosis

A

Identify object placed in hand

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68
Q

Dermatomal distribution of neuropathy indicates?

A

Radiculopathy (disk herniation), VZV, spinal cord lesion

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69
Q

REM sleep occurs?

A

Later at night.

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70
Q

For concussion ask about?

A

Cause, Loss of consciousness, Imaging, New sx

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71
Q

Peripheral neuropathies treated with?

A

TCAs, Pregabalin, Gabapentin, Duloxetine (SNRI)

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72
Q

Seizure types

A

Generalized: Tonic-clonic (grand mal), Absence, Myoclonic
Focal (partial): Simple (no AMS), Complex (AMS)
Focal may become generalized secondarily

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73
Q

Seizure treatments

A

Treat underlying cause first (metabolic, toxic)
Consider treatment withdrawal if seizure-free w/ nml EEG for 1y
Carbamazepine, Ethosuximide, Gabapentin, Lacosamide, Lamotrigine, Levetiracetam, Oxcarbazepine, Phenobarbital, Phenytoin, Topiramate, Valproate, Zonisamide

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74
Q

Seizure presentation

A 
Aura (t = s-m)
Ictal period (s-m): Tonic and/or clonic mvts of body
Postictal (m-h): Slowly resolving confusion, disorientation, lethargy. May have focal neuro deficits (Todd's paralysis)
Status epilepticus
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75
Q

Status epilepticus

A

Cts tonic-clonic seizure at least 30m or repeated seizures w/o resolution of postictal encephalopathy.
Complications: neuronal death, rhabdo, lactic acidosis

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76
Q

Epilepsy

A

Recurrent unprovoked seizures

1% of pop

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77
Q

What immediately threatens brain tissue?

A 
H's:
Hypoxia
Hyperthermia
Hypoglycemia
Herniation
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78
Q

PD questions

A

Tremor? Memory? Gait/falls? Dyskinesias/Freezing? Hallucination (from Dx or SE)?

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79
Q

Headache red flags

A 
Thunderclap headache - SAH
Positional headache - CSF leak
Exertional headache - (HTN) usually migraine
New headache if over 50yo - mass
Substantial change in headache pattern
Constant headache in same location
Aura that is sudden, lasts over 1h, or doesn't resolve
Systemic sx - infxn
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80
Q

Transverse myelitis

A 
Inflammation of spinal cord causing UMN signs
Due to:
Bacterial infxn (Mycoplasma, Borellia, Bartonella)
Viral infxn (HSV, VZV, EBV, CMV, HIV)
Rare vaccination rxn
MS
Paraneoplastic syndrome
Vascular etiology
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81
Q

Drugs lowering seizure threshold

A 
Theophylline
Isoniazid, metronidazole, penicillins (give B6)
TCAs, bupropion, 5-HT agents
Steroids, insulin
Opiates, stimulants
Anticholinergics, AChEIs, antihistamines
Heavy metals, lithium
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82
Q

Non-Rx causes of lower seizure threshold

A 
Sleep deprivation, stress
Fever
Rx withdrawal
Flashing lights
Menstruation
Metabolic - electrolyte abnmls, DM
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83
Q

Most common primary cancers metastasizing to brain in order of occurrence

A

Lung, breast, melanoma, colon
Multi met: Lung, melanoma
Single met: Breast, colon, RCC
Prostate CA rarely goes to brain

84
Q

Sleep stages

A 
Beta - awake
Alpha - eyes closed
Theta - N1
Sleep spindles - N2
Delta - N3 (night terrors, sleepwalking, bedwetting)
Beta - REM (flaccid paralysis)
85
Q

Parkinsonism

A

Associated w/ Lewy bodies (a-synuclein) and loss of dopaminergic neurons of SNpc
May have hallucinations in addition to motor sx
Dementia presents late in PD
On spectrum w/ Lewy body dementia, but more motor involvement first

86
Q

Huntington’s

A

AD c4 CAG repeats
(CAG - Caudate loses ACh and GABA)
Neuronal death by glutamate tox
Chorea/Athetosis (writhing), personality changes, dementia

87
Q

Hemiballismus

A

Sudden flailing of arm w/ or w/o ipsilat leg

SubThNu stroke contralaterally (lacunar)

88
Q

Myoclonus

A

Sudden brief uncontrolled muscle contraction

Metabolic causes - liver, renal failure

89
Q

Essential tremor

A

Associated w/ action, not present at rest

May self-Rx w/ EtOH. Propranolol, primidone first line

90
Q

Resting tremor

A

Present in Parkinsonism

Pill-rolling, alleviated by intention

91
Q

Intention tremor

A

Zig-zag of intentional mvt to target

Cerebellar dysfxn

92
Q

Homunculus organization

A

Head = lateral, inferior

Lumbar, sacral = medial, superior

93
Q

Broca’s area

A

Anterior to cranial primary motor cortex in dominant (L) frontal cortex
Stroke = good comprehension, poor language formation
Broca’s broken boca

94
Q

Wernicke’s area

A

Dominant (L) temporal lobe posterior to primary auditory cortex
Stroke = poor comprehension, can form language but it is incoherent
Wacky Wernicke

95
Q

Amygdala lesion

A

Kluwer-Bucy syndrome: Hypersexuality, hyperorality, disinhibition
HSV-1 assoc

96
Q

Frontal lobe lesion

A

Disinhibition, concentration deficits, poor judgment

Primitive reflex reemergence

97
Q

Gerstmann syndrome

A

L (dom) parietal-temporal cortex stroke

Agraphia, acalcula, finger agnosia, L-R disorientation

98
Q

R (non-dom) parietal-temporal cortex lesion

A

CL agnosia (hemispatial neglect)

99
Q

Midbrain (reticular activating system) lesion

A

Reduced arousal

100
Q

B/l mammillary body lesion

A

Wernicke-Korsakoff syndrome: Confusion, ataxia, ophthalmoplegia; memory loss, confabulation, personality change
EtOH assoc - always give B1 before glucose to suspected EtOH px to prevent this

101
Q

Basal ganglia lesion

A

Resting tremor/chorea/athetosis

PD

102
Q

Cerebellar hemisphere lesion

A

Ipsilateral intention tremor, fall towards affected side

103
Q

Cerebellar vermal lesion

A

Truncal ataxia, dysarthria

104
Q

Peripheral neuropathy lab tests

A

B12, TSH, HbA1c, blood glucose, SPEP

105
Q

B/l hippocampus lesion

A

Anterograde memory loss

106
Q

PPRF lesion

A

Look away from lesion

107
Q

FEF lesion

A

Look towards lesion

108
Q

Cerebral pontine myelinosis

A

From low to high (Na), pons will die – Locked-in syndrome

109
Q

Global aphasia

A

Lesion of Broca + Wernicke areas

110
Q

Conduction aphasia

A

Poor repetition, but fluent speech and intact comprehension

Lesion of arcuate fasciculus

111
Q

Cerebral perfusion controls

A

PCO2 increase causes increased cerebral blood flow

Low PO2 only inceases cerebral flow once under 50

112
Q

Charcot-Bouchard microaneurysms

A

Chronic HTN effect on lenticulostriate aa (thalamus, basal ganglia)

113
Q

Post-stroke pain syndrome

A

Neuropathic pain due to thalamic lesion causing wk-mth of allodynia

114
Q

Intraparenchymal hemorrhage

A

Due to HTN. Assoc w/ amyloidosis (AZD), neoplasm, vasculitis

Typically into internal capsule. Can be lobar

115
Q

Communicating hydrocephalus

A

Down CSF absorption – up ICP, papilledema, herniation

Post meningitis

116
Q

Hydrocephalus ex vacuo

A

Appearance of up CSF space from brain atrophy

No wet, wobbly, wacky sx

117
Q

Werndig-Hoffmann and poliomyelitis lesions

A

LMN lesions only

W-H = floppy baby

118
Q

MS lesions

A 
Random and asymmetric
Demyelination
Scanning speech, nystagmus, intention tremor
High CSF protein w/ oligoclonal bands
Periventricular plaques
119
Q

ALS lesions

A

Combined UMN and LMN lesions w/o sensory or cortical loss

120
Q

Presbycusis

A

Age-related gradual hearing loss

121
Q

Friedreich ataxia

A

AR c9 GAA repeat causes multiple tract degen – weakness, DTR loss, vibr loss, proprio loss
Presents in children w/ kyphoscoliosis, hypertrophic cardiomyopathy

122
Q

Brown-Sequard syndrome

A

Cord hemisection
I/L UMN signs below lesion
I/L loss of FT, Pr, V 1-2 lv below lesion
C/L Pa, T, CT loss below lesion
I/L loss of all sensation at lesion level
I/L LMN signs at lesion
Horner’s if lesion above T1 due to oculo-SNS path damage

123
Q

Parinaud syndrome

A

Conjugate vertical gaze palsy due to superior colliculus lesion

124
Q

Acute angle closure glaucoma presentation

A

Painful sudden vision loss, halos around lights, frontal headache
Don’t give epinephrine b/c of mydriasis

125
Q

Papilledema

A

Increased ICP: Bigger blind spot, elevated optic disc, blurred margins on fundoscopy

126
Q

Pick disease

A

Frontotemporal dementia and atrophy
Personality changes, parkinsonism, dementia, aphasia
Spherical tau aggregates

127
Q

Lewy body dementia

A

Initially dementia and visual hallucinations, followed by parkinsonism
On spectrum w/ PD, but dementia first
Due to a-synuclein defect

128
Q

Creutzfeldt-Jakob

A

Rapidly progressive dementia w/ myoclonus
Specific 3Hz EEG
14-3-3 protein in CSF

129
Q

GBS

A 
Autoimmune Schwann cell destruction = LMN motor and sensory neuropathy
May have autonomic dysfxn - give steroids if SNS failure
Albuminocytologic dissociation (high CSF protein w/ nml cell count)
Treat w/ plasmapheresis, IVIG
***Steroids are not demonstrated to improve outcomes
130
Q

PML

A

Oligodendrocyte (CNS) destruction due to reactivated JC virus
Seen in AIDS, natalizumab
Rapidly progressive and fatal

131
Q

Postinfectious encephalomyelitis

A

Multifocal perivenular inflammation and demyelination

Commonly after measles, VZV, rabies/smallpox vax

132
Q

Metachromatic leukodystrophy

A

AR lysosomal storage disease
Arylsulfatase A deficiency – Impaired myelin production
CNS + peripheral demyelination, ataxia, dementia

133
Q

Charcot-Marie-Tooth disease

A

AKA Hereditary Motor and Sensory Neuropathy
Usually AD defective myelin protein production
Assoc scoliosis, foot arch deformities

134
Q

Krabbe disease

A

AR lysosomal storage disease
Galactocerebrosidase deficiency
Peripheral neuropathy, dev delay, optic atrophy, globoid cells

135
Q

Adrenoleukodystrophy

A

XR defect of very long chain FA metabolism – buildup in nerves, adrenals, testes
Coma, adrenal gland crisis

136
Q

Sturge-Weber

A

GNAQ acquired activation

Port wine face stain, Ipsilateral leptomeningeal angioma, Seizures, Intellectual disability, Early onset glaucoma

137
Q

Tuberous sclerosis

A

Hamartomas, Angiofibromas/renal Angiomyolipoma, MR, Ash-leaf spots/Shagreen patches, Rhabdomyoma, AD, Mental retardation, Seizures

138
Q

NF1

A

AD c17 mutation

Cafe-au-lait, Iris hamartomas, Neurofibromas, Optic gliomas, Pheochromocytomas

139
Q

VHL

A

AD c3 VHL mutation – angiogenesis

Cavernous hemangiomas in skin, organs; B/l RCC; Hemangioblastomas of CNS (cerebellum); Pheochromocytomas

140
Q

Partial seizures

A

1 brain area, most often medial temporal lobe w/ preceding aura
Simple partial - consciousness ok
Complex partial – impaired consciousness

141
Q

Generalized seizures

A 
Diffuse brain involvement
Absence (staring) - 3Hz, no post-ictal
Myoclonic - quick repetitive jerks
Tonic - stiffening
Tonic-clonic - alternating stiffening/mvt
Atonic - drop to floor (not fainting)
142
Q

Status epilepticus causes

A

All demos - fever (infxn), trauma, metabolic
Children - genetic/congenital
Adults - tumors, stroke
Elderly - stroke

143
Q

MCA stroke

A

Upper limb + face
Motor + sensory cortex
Wernicke + Broca areas
Hemineglect if non-dom side, Aphasia if dom side

144
Q

ACA stroke

A

Lower limb

Motor + sensory cortex

145
Q

Lenticulostriate aa stroke

A

Striatum + Internal capsule
C/l hemiparesis/hemiplegia
Common location of lacunar infarcts secondary to uncontrolled HTN

146
Q

ASA stroke

A

Lat corticospinal tract + Medial lemniscus
CN XII if caudal medulla
C/l hemiparesis of upper + lower limbs, C/l down proprioception, I/l CN XII dysfxn
Medial medullary syndrome from ASA br infactions

147
Q

PICA stroke

A

Lat MEDULLA (VesNu, Sp5Nu, NuAmb, LatSpThTr)
Vomiting, vertigo, nystagmus (VesNu); Down P/T/CT to I/l face (Sp5Nu) + C/l body (LatSpThTr); laryngeal dysfxn (NuAmb specific); Horner’s syndrome.
Lateral medullary (Wallenberg) syndrome
Don’t PICA ho[a]rse that can’t [eat]

148
Q

AICA stroke

A

Lat pons (CNNu, VesNu, 7Nu, Sp5Nu, CocNu)
Vomiting, vertigo, nystagmus (VesNu); Facial paralysis + gland dysfxn (CNNu); Deafness (CocNu)
Lateral pontine syndrome
FACIAL DROOP means AICA is pooped

149
Q

PCA stroke

A

Occipital and visual cortex

C/l hemianopia w/ macular sparing

150
Q

Basilar a stroke

A

Medulla, pons, lower midbrain, CorSp, CorBulb, Ocular CNNu, PPRF lesions
Locked-in syndrome
Preserved consciousness and blinking w/ loss of all other mvt

151
Q

ACom lesion

A

Usually aneurysm

Visual field defects

152
Q

PCom lesion

A

Usually aneurysm

CN3 palsy with ptosis and pupil dilation

153
Q

Akathisia

A

Restlessness, motion assoc w/ 1st gen antipsychotics and PD

Seen in low dopaminergic state

154
Q

NT changes in AZD

A

Low ACh

155
Q

NT changes in anxiety

A

High NE

Low GABA, 5-HT

156
Q

NT changes in depression

A

Low NE, 5-HT, dopamine

157
Q

NT changes in Huntington’s

A

Low GABA, ACh

High dopamine

158
Q

NT changes in PD

A

Low dopamine

High seratonin, ACh

159
Q

NT changes in schizophrenia

A

High dopamine

160
Q

NE synth site, changes in diseases

A

Locus ceruleus (pons) – Stress, panic
High in anxiety
Low in depression

161
Q

Dopamine synth site, changes in diseases

A

VTA, SNc – Reward, pleasure
High in HD
Low in PD, depression

162
Q

5-HT synth site, changes in diseases

A

Raphe nuclei
High in PD
Low in anxiety, depression

163
Q

ACh synth site, changes in diseases

A

Basal nucleus of Meynert
High in PD
Low in AZD, Huntington’s

164
Q

GABA synth site, changes in diseases

A

Nucleus accumbens – Reward, pleasure

Low in anxiety, Huntington’s

165
Q

Delirium treatment

A

Address underlying cause – infxn, metabolic, etc
Optimize brain condition w/ O2, hydration, pain control
Antipsychotics such as haloperidol

166
Q

Neuroleptic malignant syndrome sx, treatment

A

Rigidity, myoglobinuria, autonomic instability, hyperpyrexia due to dopamine antagonism
Treat w/ dantrolene, D2 agonists (e.g., bromocriptine)

FEVER: Fever, Encephalopathy, unstable Vitals, high Enzymes, Rigidity

167
Q

Tardive dyskinesia, Rx, and development

A

Stereotypic oral-facial movements as a result of long-term antipsychotic use. Potentially irreversible.
Seen w/ high potency 1st gen antipsychotics especially: Trifluoperazine, Fluphenazine, Haloperidol

Evolution of EPS side effects:
ƒ 4 hr acute dystonia (muscle spasm, stiffness,
oculogyric crisis)
ƒ 4 day akathisia (restlessness)
ƒ 4 wk bradykinesia (parkinsonism) ƒ
 4 mo tardive dyskinesia
168
Q

Tethered spinal cord

A

Urinary, bowel control issues
Low back pain
B/l muscle weakness, abnml gait
Foot, spine abnmlities

Assoc w/ spina bifida, Chiari malform
Once neuro sx develop, they may become irreversible

169
Q

Bell’s palsy

A

Idiopathic or as a complication in AIDS, Lyme, Sarcoid, Tumors, Diabetes
LMN lesion leads to paralysis of entire side of face
Treatment involves steroids
Most cases resolve spontaneously

170
Q

Patients with Bell’s usually experience:

A

Pain in ear preceding weakness
I/l numbness + weakness in face
Hearing unaffected

171
Q

Normal pressure hydrocephalus presentation

A

Psychomotor slowing
Incontinence
Enlarged ventricles

172
Q

Serial therapeutic agents order for status epilepticus

A

Glucose, lorazepam, fosphenytoin, phenobarbital

173
Q

EMG results in carpal tunnel syndrome

A

Prolonged distal latency of median nerve conduction velocity across wrist

174
Q

Immediate Rx for TMJ

A

High dose prednisone

175
Q

Treatment of increased ICP due to head trauma

A

Steroids

176
Q

BZD effects in elderly delirious patients

A

Increased SE risk, prolonged action, and may cause paradoxical agitation
Use haloperidol if absolutely necessary, but watch for NMS

177
Q

Putamen hemorrhage sx

A

C/l hemiparesis, C/l hemiplegia, conjugate gaze deviation toward side of lesion

178
Q

Obtain what in patients with neuropathy and borderline B12?

A

Serum methylmalonic acid (more sensitive for deficiency than B12 alone)

179
Q

Diffuse axonal injury

A

Most significant cause of morbidity in TBI. CT shows numerous minute punctate hemorrhages w/ blurring of grey-white interface

180
Q

Hypokalemia signs + ECG

A

Weakness, fatigue, cramps
Paralysis, arrhythmia if severe
ECG: Us, flat/broad Ts, PVCs

181
Q

ICH sx, treatments

A

AKA pseudotumor cerebri
Presents as headache, (N/V, AMS), papilledema suggestive of mass in young obese female w/ nml CT and elevated CSF pressure.
Treat w/ weight loss, acetazolamide
Shunt or CN2 fenestration to prevent blindness w/o resolution
NO INCONTINENCE

182
Q

Risks for CVA

A

HTN - strongest
Smoking, DM - strong
High cholesterol - marginal
EtOH - protective if mild/mod

183
Q

Improvement of ptosis w/ ice suggests …?

A

Myasthenia gravis: AChE inhibited at cold temps –> Better competition w/ autoAbs

184
Q

Cluster headache sx, Rx

A

Acute, severe retroorbital pain that may awaken, be assoc w/ i/l eye erythema, secretions, Horner’s
Acute: O2 (best), ergots, NSAIDs
Ppx: CCBs, steroids, ergots, NSAIDs

185
Q

Cushing reflex sx? Suggests?

A

HTN, bradycardia, resp depression

Suggests brainstem compression

186
Q

Lumbar spinal stenosis sx

A

Assoc w/ degenerative joint disease
“Neuropathic claudication” - exacerbated w/ walking + relieved by spinal flexion (opens canal), worsened by extension (closes)
Found on MRI

187
Q

Wilson’s disease, sx, labs

A

Abnml copper deposits in tissue (liver, basal ganglia, cornea)
Pres w/ liver or psych disease
Rings on slit lamp exam, up urine Cu, down ceruloplasmin

188
Q

Primary CNS lymphoma

A

Suspect w/ single periventricular weak ring lesion on MRI + HIV + EBV DNA in CSF

189
Q

RLS labs, Rx MOA

A 
Always check Fe
Dopamine agonists (rupinirole, pramipexole) or gabapentin
190
Q

Posterior internal capsule CVA sx

A

U/l weakness w/o sensory loss or cortical sx

191
Q

Cauda equina syndrome sx, management

A

Severe low back pain, unilateral radiculopathy, saddle anesthesia, hyporeflexia, asymmetric motor weakness, late onset incontinence/retention
Emergent MRI, steroids, neurosurg

192
Q

Conus medullaris syndrome sx

A

Severe back pain, perianal anesthesia, hyperreflexia, mild bilateral motor weakness, early onset incontinence/retention
Emergent MRI, steroids, neurosurg

193
Q

Spinal cord compression sx, management

A

Back pain, B/l LE weakness + sens loss, ataxia, late bowel/bladder
May acutely develop spinal shock, hyporeflexia, flaccid paraplegia
Emergent MRI, neurosurg, may add steroids

194
Q

Riley-Day syndrome

A

AKA familial dysautonomia
AR, esp Jewish
Gross ANS dysfxn w/ severe orthostatic hypotension

195
Q

Multiple system atrophy sx

A

Parkinsonism + orthostatic hypotension, impotence, incontinence, other ANS sx

196
Q

Exertional heat stroke sx, management

A

Over 104F, CNS dysfxn

Treat w/ rapid cooling, preferably ice water immersion

197
Q

Tick-borne paralysis sx, management

A

Rapidly progressive ascending (asymmetric) paralysis w/o fever, sensory sx, or CSF findings
Remove tick for spontaneous improvement

198
Q

Opioid OD sx

A

Pinpoint pupils, resp depression (usually under 12/m)

199
Q

Cerebellar hemorrhage pres

A

HTN hx, AMS, focal occipital headache, w/ Xa inhibitor/anticoag use

200
Q

MG sx, Rx, management

A

Anti-AChR autoAbs
Ptosis, fatigue, gen weakness. May have thymic mass–removal may improve sx
Treat w/ AChEIs, steroids for flares
Intubate + plasmapheresis/IVIG for acute crisis

201
Q

Management of metastatic brain tumors

A

Solitary: Resect if good status and stable disease
Multiple: Whole brain radiation therapy

202
Q

Sydenham’s chorea

A

Rapid uncoordinated jerks of face, hands, feet w/o LoC after GABHS/ARF

203
Q

AZD requirements for diagnosis

A

After eliminating other causes by H/P, must do head CT/MRI

204
Q

Endolymphatic fistula sx

A

Vertigo associated w/ pressure changes to head/environment

205
Q

Meniere’s sx

A

Episodic vertigo w/ u/l tinnitus, hearing loss, ear fullness

206
Q

HTN crisis treatment

A

Nitroprusside

Not CCBs

Neurology clerkship (1 decks)

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