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neuro general Flashcards

1
Q

anterior dislocation of the humeral head damages what nerve

A

axillary

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2
Q

primary motor versus sensory cortex

A

motor is frontal and sensory is parietal; they are separated by the central sulcus

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3
Q

angular gyrus

A

makes an upside down U in the parietal lobe

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4
Q

olfactory area

A

underside of frontal lobe

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5
Q

anterior commisure

A

connects the R and L hemispheres across the midline;

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6
Q

what does an ACA infaraction affect?

A

legs

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7
Q

what does a PCA infarction affect?

A

visual

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8
Q

lesions in the internal capsule

A

contralateral hemiparesis or hemiplegia

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9
Q

internal capsule blood supply

A

MCA deep branches or anterior choroidal

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10
Q

watershed infarct

A

man in a barrell; affects proximal arms

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11
Q

caudate atrophy

A

huntingtons

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12
Q

PRES

A

posterior reversible encephalopathy syndrome; can be caused by chemtherapy, preeclampsia, and hypertensive encephalopathy

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13
Q

Meyer’s loop

A

part of optic radiations; temporal lobe; lesion causes pie in the sky

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14
Q

optic radiations

A

tract from the LGN of the thalamus to the occipital cortex

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15
Q

why do you get macular sparing

A

dual blood supply of PCA and MCA to the macula

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16
Q

visual field in papilledema

A

peripheral constriction, enlarged blind spot

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17
Q

visual field in optic neuritis

A

central scotoma

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18
Q

pupil in PRES

A

normal; the blindness is cortical

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19
Q

left side neglect

A

right parietal extinction

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20
Q

transcortical sensory aphasia

A

like wernicke’s but you can repeat

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21
Q

transcortical motor aphasia

A

like broca’s but you can repeat

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22
Q

mixed transcortical aphasia

A

like a global aphasia but you can repeat

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23
Q

where does global aphasia localize

A

broadly the lateral frontal and lateral temporal lobes

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24
Q

where do the transcortical things localize

A

basically where their correlate localizes but more superiorly

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25
Q

conduction aphasia localizes where?

A

arcuate fasciculus, white matter tract between brocas and wernickes

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26
Q

huntington’s disease movement disorder

A

chorea

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27
Q

midbrain has what CNs

A

3,4

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28
Q

pons has what CNs

A

5,6,7,8

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29
Q

medulla has what CNs

A

9,10,12

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30
Q

you see CN lesion plus crossed motor with what CNs

A

3,6,12, and maybe 7 because motor is more medial and these are the medial CNs

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31
Q

you see CN lesion plus crossed sensory with what CNs

A

CNs 5,8,10 because these CNs are more lateral

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32
Q

landmarks in the midbrain

A

colliculi, cerebral peduncles, cerebral aqueduct; cns 3 and 4

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33
Q

landmarks in the rostral pons

A

fourth ventricle, cn 5

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34
Q

landmarkes in the caudal pons

A

fourth ventricls, cns 6,7,8

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35
Q

landmarks in the rostral medulla

A

4th ventricle, olic, cns 9,10,12

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36
Q

caudal medulla

A

crossing axons of medial lemniscus, pyramidal decussation

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37
Q

cause of lateral medullarysyndrome

A

infarction due to PICA (post inf cerebellar art) or, more often, vertebral artery disease

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38
Q

how to treat lateral medullary syndrome

A

heparin

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39
Q

features of lateral medullary syndrome

A

crossed AND dissociated sensory loss; medial lemniscus spared/ipsilateral facial pain and temp loss but contalat body pain and temp loss

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40
Q

Left MLF lesion

A

affects the ability of the right eye to move according to what the left does

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41
Q

what are the three cerebellar arteries

A

superior cerebellar; ant inferior; post inferior

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42
Q

what supplies the midbrain

A

posterior cerebral artery

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43
Q

INO is named how

A

for the eye that is having trouble ADDucting

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44
Q

INO in young person? In old? Is most likeley caused by what

A

in young, MS; in old, stroke due to occlusion of the paramedian pontine perferating vessels

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45
Q

polio

A

motor, not sensory

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46
Q

the UMN passes through what part of the brain

A

posterior limb of the internal capsule

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47
Q

medial lemniscus

A

dorsal columns

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48
Q

spinal cord versus vertebra

A

in the cervical cord, the nerves exit ABOVE bones; in thoracic and below, nerves exit BELOW bones;

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49
Q

mismatch in the cord and spine

A

there is a C8 nerve, but not C8 bone

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50
Q

dermatome hand

A

C6 thumb; C7 next two; C8 next two

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51
Q

pinky towe

A

S1

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52
Q

cape distibution

A

C3, C4

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53
Q

back of head

A

C2-3

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54
Q

nipples

A

T4

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55
Q

waist

A

t10

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56
Q

groin

A

L1

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57
Q

ankle jerk reflex

A

s1

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58
Q

Lhermitte’s symptoms

A

electric sensation that runs down the back into the limbs

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59
Q

no arm deficits below what spinal level

A

T1

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60
Q

conus versus cauda equina pain

A

conus is mild and symmetric; CE is severe and radicular

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61
Q

cauda equina syndrome

A

bladder dysfunction and saddle anesthesia; emergency

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62
Q

conus vs CE onset

A

conus is subacute and bilateral; CE is gradual and asymm

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63
Q

conus vs CE sensory

A

conus is saddle symmetric; CE is asymmetric

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64
Q

conus vs CE motor

A

conus is mild and symm; CE is severe LMN and asymm

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65
Q

conus vs CE bowel/bladder

A

conus is early, severe; CE is late, mild

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66
Q

reflex loss in conus vs CE

A

conus loss is ankle and knee; cau

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67
Q

three neurons involved in Horner’s syndrome

A

brain to synapse at T1; then up from T1 to C2 and synapse; then from C2 to eyelids, sweat glands, and pupil

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68
Q

anterior cord syndrome affects what?

A

everythign except dorsal columns

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69
Q

causes of anterior horn lesions

A

polio, west nile virus encephalomyelitis

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70
Q

what does b12 def affect

A

myelopathy plus polyneuropathy

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71
Q

what can cause an isolated spinothalamic tract syndrome

A

paraneoplastic syndrome

72
Q

what can cause myelopathy plus polyneuropathy

A

vit B12 def; vit E def

73
Q

myelopathy

A

pathology of the spinal cord

74
Q

root plus long tract signs

A

sarcoidosis, spondylosis

75
Q

ascending sensory loss

A

consider SC lesion, AIDP or CIDP

76
Q

proximal muscle weakness

A

watershed or myopathy

77
Q

confusion can be caused by what electrolyte abnormalities?

A

hypo and hypernatremia; hypokalemia; hyper/hypocalcemia; hypomagnesemia, hypermagnesemia

78
Q

how could someone get hyponatremic

A

SIADH (retaining too much water), adrenal insuff (cortisol is reqd to excrete free water); diarrhea; diuretic

79
Q

what happens if you correct hyponatremia too quickly?

A

so you give salt back too fast, water rushes out of the cells and this leads to central pontine myelinolysis

80
Q

sx of central pontine myelinosis

A

acute paralysis, dysphagia, dysarthria, abducens pasies, coma, flaccid quadriplegia

81
Q

when would you see hypernatremia in the medical setting

A

diabetes insipidus (lack of ADH), dehydration

82
Q

what neuro sx do you see with hypokalemia

A

myopathy

83
Q

what sx do you see with hypercalcemia

A

obtundation

84
Q

what neuro sx do yu see with HYPOcalcemia or HYPOmagnesemia

A

incr DTRs, tetany, seizure

85
Q

what neuro sx do you see with hypermanganesemia

A

parkinsonisms-MRI hyperintensities in the basal gang

86
Q

anything that damages the brain can cause hyponatremia

A

mechanism is impacts ADH secretion or storage or something

87
Q

what MRI abnormalities can be seen in hepatic failure

A

increased signal in basal gang; correlates with manganese deposition

88
Q

anti-epileptic drug metabolism- old drugs

A

old drugs are phenytoin, carbamazepine, valproate, phenobarbitol, primidone; these are mostly hepatically excreted

89
Q

AED drugs- new; how are these excreted?

A

gabapentin is 100% renal; the rest (lamotrigine, topiramate, tiagabine, zonisamide, keppra, oxcarbazepine) are mostly hepatic with some renal

90
Q

some AEDs can cause rashes

A

if this happens, stop the drug

91
Q

what pain meds should be used for postherpetic neuralgia

A

TCAs, gabapentin, pregabalin, opioids, topical lidocaine patches

92
Q

what causes seizures in the elderly?

A

about 1/3 have no diagnosis; most frequent cause is stoke; over 90% of seizures in the elderly recur

93
Q

old people get cognitive problems on anticholinergic drugs

A

right

94
Q

what kind of neuro problems can be seen with renal disease

A

headache, polyneuropathy, chronic uremia, seizures- beware heavily protein bound AEDs- note free levels

95
Q

bursts of triphasic waves are often seen on EEG of what patients

A

renal or hepatic failure

96
Q

what to know about renal failure and AEDs

A

phenytoin/valproate/carabamazepine have altered protein binding- follow free levels; water soluble, low protein bound drugs need dose adjustments;

97
Q

dialysis dementia

A

caused by aluminum accum; aphasia, dysarthria, myoclonus, atazia, dementia

98
Q

nephrogenic systemic fibrosis

A

skin induration (can look like scleroderma) and pachymeningitis that may involve dura/CNs; thickened dura on CT; headache, papilledema, lymphocytic CSF rxn

99
Q

PRES sx

A

seizures, headache, hypertension, altered sensorium, vision

100
Q

what causes PRES?

A

either hyperperfusion sydnrome or endothelial dysfunction due to drugs

101
Q

which drugs can cause PRES

A

calcineuron inhib (tacrolimus, cyclosporine), sirolimus, cytarabine, gemcitabine, etc

102
Q

B12 def causes what

A

subacute combine degeneration (dorsal columns and corticospinal tract)

103
Q

tingling

A

can be dorsal columns

104
Q

what are the mechanisms of B12 pathology?

A

B12 is involved in two processes- succinyl coA production and purine metabolism; you measure methylmalonate and homocysteine

105
Q

thiamine deficiency can have what symptoms?

A

nutritional polyneuropathy; wernicke-korsakoff syndrome; cerebellar degeneration; nutritional amblyopia

106
Q

what parts of the brain are affected in Wernicke-korsakoff syndrome

A

mamillary bodies, medial dorsal thalamus, periaqueductal gray, suerpior cerebellar vermis

107
Q

what does too little pyridoxine cause?

A

polyneuropathy

108
Q

what does too much pyridoxine do

A

sensory ataxia (posterior columns)

109
Q

what does niacin deficiency cause?

A

pellagra; which can cause an encephalopathy/neuropathy in alcoholics unresp to thiamine

110
Q

On MRI flair you see hyperintensity in mamillary bodies and periaqueductal gray with enhancement

A

wernickes

111
Q

what are some neuro complicatons of gastric bypass surgery causing B12 def

A

clinically GBS-like but CSF has normal protein; treat with surgical revision to reduce bypassed jejunum

112
Q

too much vit A

A

pseudotumor cerebra

113
Q

too little vit A

A

xeropthalmia (night blindness)

114
Q

too little Vit E

A

remember absorption requires bile and fat; spinocerebellar degeneration and polyneuropathy

115
Q

vit D def

A

proximal myopathy that coexists with osteomalacia,

116
Q

paresthesias

A

localized to dorsal columns

117
Q

tuberous sclerosis is aut dom

A

right

118
Q

subependymal nodules

A

seen in tuberous sclerosis; may obstruc at foramen of monro

119
Q

foramen of monro

A

aka interventricular foramina; connects the lateral ventricles with the third ventricle

120
Q

medications that reduce effectiveness of OCPs

A

dilantin, phenobarb/primidone; tegretol/carbatrol/trileptal; topamax at high doses; most older and some newer ARDS induce OCP metabolism

121
Q

fourth ventricle on CT

A

frown

122
Q

quadrigeminal cistern on CT

A

smile

123
Q

what is the quadrigeminal cistern

A

opening in the subarachnoid space filled with CSF; quadrigeminal extends from the third ventricle to the great cerebral vein

124
Q

when can you do an LP without CT?

A

less than 60 yo; ne seizure; no immune deficits; nonfocal exam

125
Q

normal CSF

A

less than or equal to 4 lymphs; protein less than 15-45; glucose 2/3 of serum

126
Q

traumatic tap

A

1 extra WBC for every 700 RBCs

127
Q

bacterial vs viral meningitis opening pressure

A

bacterial has increased opening pressure, viral does not

128
Q

supination

A

radial nerve

129
Q

treatment for meniere’s disease

A

labrinthe ablation with gentamycin

130
Q

hydrocephalus ex vacuo

A

when your brain atrophies and ventricles are bigger to fill the space

131
Q

acqueduct

A

between third and fourth ventricles

132
Q

abnormalities in the posterior hemispheres on diffusion weighted MRI and presence of 14-3-3 protein in CSF

A

dreutxfeld jacob disease

133
Q

paranoia, hoarding behavior, and visuospatial deficits are characteristic of early alzheimers

A

yes

134
Q

what AED can change the effectiveness of OCPs

A

phenytoin

135
Q

side effects of cytosine arabinoside

A

this is a chemo agent with side effects causing cerebellar issues

136
Q

akathisia (need to move the legs) and fidgety movements most common on what drugs

A

anti-psychotics

137
Q

how to fix the dystonic reactions that you get from the anti-psychotics

A

anti-cholinergic like diphenhydramine (benadryl)

138
Q

what other drugs besides the anti-psychotics can cause parkinsonism like reactions

A

metoclopramide and valproate and amphotericin B

139
Q

steroid psychotic reaction

A

agitation, sleep disturbance, and paranoia

140
Q

how to treat the steroid psychotic reaction

A

neuroleptics

141
Q

AED most commonly assoc with teratogenicity

A

valproate (NTDs and cognitive issues)

142
Q

other side effects of valproate

A

weight gain, hair loss, parkinsonian like state

143
Q

known interaction between erythromycin and what drugs are bad?

A

carbamazepine, phenytoin, oxcarbazepine, etc; interactions cause ataxia, nystagmus, and, at higher levels, diplopia

144
Q

CK in statin-induced myopathy

A

may be normal or elevated

145
Q

AED most assic with hyponatremia

A

oxcarbamazepine; polypharm in the form of thiazide diuretics or levetiracetam may aggravate the situation

146
Q

what antidepressant is associated with increased risk of seizures and should not be given to patients with epilepsy?

A

buproprion

147
Q

symptoms of anti-cholinergic excess

A

tachycardia, blurred vision, fever, mental status changes

148
Q

what drugs cause anti-cholinergic effects

A

TCAs (amitryptaline, nortriptyline, imipramine)

149
Q

what is serotonin syndrome?

A

hypertension, tachycardia, tachypnea, hyperthermia, mydriasis (large pupils), hyperactive bowel, hyperreflexia

150
Q

anti-cholinergic toxidrome

A

hypertension, tachycardia, tachypnea, large pupils, skin is hot and dry; bowls are decreased

151
Q

differences between serotonin syndrome and anti-cholinergic excess

A

serotonin has hypersalivation and sweaty skin, whereas anticholinergic is dry mucus membranes and dry hot skin; bowels hyperactive in serotonin and decreased in anticholinergic

152
Q

neuroleptic malignant syndrome

A

RIGIDITY; caused by dopamine ANTAG; htn, tahycardia, tachypnea, hyperthermia; pupils are normal; sweaty skin; bradyreflexia; stupor/alert mutism/coma

153
Q

malignant hyperthermia

A

caused by inhalatio nal anesthetics; hypertension, tachycardia, tachypnea; pupils normal, skin sweaty; decreaed bowel sounds; rigor-mortis like rigidity; hyporeflexia; mental status is agitated

154
Q

enlarged blind spot

A

think papilledema

155
Q

cnetral scotoma

A

think optic neuritis or ischemic optic neuropathy

156
Q

sheehan’s syndrome

A

don’t forget adrenal insuff

157
Q

why horner’s in cartotid dissection?

A

sympathetics run along the internal carotid artery

158
Q

What kind of drug cauases INO

A

paramedian pontine perforating vessel stoke

159
Q

polymyalgia rheumatica

A

at risk for central retinal artery occlusion due to temporal arteritis; also shoulder, neck and hip pain

160
Q

basilar migraine

A

seen in kids; dizziness, slurred speech, and double vision; then severe headache

161
Q

third nerve palsy assoc with what

A

post communicating artery aneurysm

162
Q

patient with pcomm aneurysm and third nerve palsy has the aneurysm clipped but deteriorates three days later

A

vasospasm (treat with nimodipine)

163
Q

what neuro drug can cause angle closure glaucoma

A

topamax

164
Q

optic nerve glioma

A

NF1

165
Q

acoustic shwannoma

A

NF2

166
Q

ischemic optic neuropathy

A

can be seen in diabetic patients; painless loss of vision; can be due to temporal arteritis

167
Q

trigeminal neuralgia treatment

A

carbamazepine

168
Q

jaw claudication

A

temporal arteritis (also assoc with anemia)

169
Q

lesion is hyperdense on non-contrast CT and then enhances uniformly with contrast s

A

extra-axial (like meningioma)

170
Q

lesion that enhances heterogeneously with contrast

A

intra-axial (like GBM)

171
Q

what patients should not receive triptans

A

those with CAD or uncontrolled hypertension

172
Q

cavernous sinus thrombosis

A

eye movement abnormalities

173
Q

what runs through the cavernous sinus

A

3,4,V1, V2, and 6 in the lateral wall

174
Q

Ramsay Hunt syndrome

A

herpes infection of the facial nerve near the ear; can cause facial palsy and hearing loss on one side;

175
Q

elevated CSF pressure

A

think crypto in immunosuppressed person

Neuro (43 decks)

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