Neuro quick facts Flashcards by Josh Spiegel

6-12 Hx tremor? 10-12Hz tremor? 3-6Hz tremor?

Benign essential tremor, physiologically enhanced tremor (caffeine or hyperthyroid), Parkinsons dz

How well did you know this?

Not at all

Perfectly

where is the atrophy in huntingtons dz

caudate&raquo_space;> putamen

How well did you know this?

Not at all

Perfectly

40y/o w/ personality change and later develops dementia, dysarthria and chorea

huntingtons

How well did you know this?

Not at all

Perfectly

how does the juvenile form of huntingtons present?

westphal variant is like parkinsons (hypo kinetic)

How well did you know this?

Not at all

Perfectly

what causes dystonia at rest starting in the leg with no other neuro findings

brain lesion (secondary dystonia)

How well did you know this?

Not at all

Perfectly

what gene is expanded in spinocerebellar ataxia

ataxin gene

How well did you know this?

Not at all

Perfectly

What is seen in Spinocerebellar ataxia 1, 2, 3, 6, 7

1: pyramidal signs
2: dementia
3: parkinsonism and lid retraction (big eyes) [aka mach ado joseph dz (impaired temperature discrimination in all limbs)]
6: very late onset
7: infantile onset

How well did you know this?

Not at all

Perfectly

if tardive dyskinesia occurs when a patient is on metoclopramide what do you switch to in order to continue DA reduction

Reserpine + tetrabenzine

How well did you know this?

Not at all

Perfectly

what are 3 risk factors that increase the risk of permanent dyskinesia

old age, female, co-existing brain damage

How well did you know this?

Not at all

Perfectly

if there is a cervical vertebral fracture above C3 what causes respiratory difficulties

phrenic nerve paralysis

How well did you know this?

Not at all

Perfectly

if someone is <9y/o and has quadriparesis what must be ordered

MRI

How well did you know this?

Not at all

Perfectly

What is it very important to do if you suspect an epidural hematoma but the CT is normal and then there is change in mental status

Re-do CT

How well did you know this?

Not at all

Perfectly

what is the MC neurobehavioral disorder in hospitals

delirium

How well did you know this?

Not at all

Perfectly

what is the pathophys of Subarachnoid hemorrhage becoming delirium

SAH –> secondary SIADH –> delutional hyponatremia –> delirium

How well did you know this?

Not at all

Perfectly

what constitutes concussion grades

1: no loss of consciousness and all symptoms resolve 15 mins
3: any loss of consciousness

How well did you know this?

Not at all

Perfectly

what is post-concussive syndrome

iritability + change in intellectual fxn in 4 wks after w/ resolution boy 3 mo

How well did you know this?

Not at all

Perfectly

what are the criteria to get a CT with a concussion

if persistent HA, emesis, >60y/o, on drugs or alcohol, anterograde amnesia, seizure, injury above clavicle

How well did you know this?

Not at all

Perfectly

what is the MCC of hemorrhagic stroke

uncontrolled HTN

How well did you know this?

Not at all

Perfectly

how do you evaluate strokes

BEC (blood, EKG, CT)

How well did you know this?

Not at all

Perfectly

What are the grades for SAH 1-5

1/2: no focal signs

3: mild focal signs
4: hemiparesis
5: comatose

How well did you know this?

Not at all

Perfectly

what is MCC of SAH coming from ant comm a.

ADPKD

How well did you know this?

Not at all

Perfectly

what is MCC of SAH presentation from Post comm a.

CN 3 paralysis

How well did you know this?

Not at all

Perfectly

what 3 conditions predispose you to spontaneous dissection

marfans, ehlers danlos, and fibromuscular dysplasia

How well did you know this?

Not at all

Perfectly

what is the severe form of AVM and what happens

Moyamoya; causes secondary occlusion of the CoW

How well did you know this?

Not at all

Perfectly

what do you call an stroke of unknown etiology and what usually causes it

cryptogenic stroke; usually secondary to patent foramen ovale

define a seizure

abnormal neuronal activity

what are 4 things that lower seizure threshold

EtOH, Rx, too little sleep, menstrual cycle

what is the difference btw a simple and complex seizure

with a simple seizure you maintain consciousness

what are the 2 types of partial seizures and the 5 types of generalized seizures

Partial: simple and complex Generalized: tonic, myoclonic, tonic-clonic, absence, atonic

what drug do you use for a partial seizure

carbamazepine

what drug do you use for a complex seizure

topiramate

what is the MC seizure in adults w/ epilepsy

Complex partial seizure

3 Hz spike and wave

absence seizure

how do you precipitate an absence seizure

hyperventilation

what test do you use to evaluate syncope

tilt-table test (+ if they pass out or if BP drops 20 systolic)

what are 2 things that can cause syncope

dec CO and arrythmias

how do you confirm pseudoseizures

continuous 24 Hr EEG w/ video; previous hx of trauma/traumatic experience

what is the difference btw a classic and a common migraine

classic has aura; common does not

what is the presentation/progression of a migraine

trigger -> prodrome -> +/-aura -> migraine HA +/- associated symptoms

unilateral periorbital thorbbing headache

migraine

what is given as a migraine abortive drug and what is given for prophylaxis

Abortive: triptan (5HT-agonist) prophylaxis: topomax

hat band headache

tension HA

intense pain behind ears going toward temples

occiptial neuralgia (secondary inflammation of greater occipital nerves)

what do you give for occipital neuralgia

steroid + anesthetic injection at greater occipital nerve exit point

progressive impaired memory and one other cognitive fxn w/o change in consciousness that alters daily living or quality of life

dementia

what neurotransmitter changes are seen with Alzheimers

decrease in Ach from destruction of nucleus basal is of meynert

what is the progression of alzheimers in the brain

hippocampus degeneration early --> parietotemporal cortex follows --> frontal cortex last

what is pseudo dementia

a severe form of depression where pts answer with "i don't know"

what are lewy bodies made of

alpha synuclien

syndrome of sensory loss and spastic paresis; loss of dorsal columns and lateral CST; hallucinations

B12 def

what is seen on labs with b12 def

low b12, high homocysteine and MMA

what is the pathophys of optic neuritis

possibly secondary AI + demyelinating dz of optic nerve

what is uhthoffs phenomenon

in MS where heat causes worsening of demyelinating dz

what is the tx for optic neuritis

IV steroids (give IFN-b1 if they have MS)

focal demyelination in MS causes plaques that are made of what?

lymphocytes/macrophages, IgG/M complement, and dying oligodendroglia

what is the order of subtypes of MS from worst to best prognosis

primary progressive, secondary progressive, relapsing remitting, and benign

how do you dx MS

it is a clinical dx

what is seen on T2 MRI with MS pts

dawson's fingers (periventricular /corpus callusum lesions)

What drugs are given for MS

IFNb1, IV steroids, mitoxantrone (antineoplastic used to reduce worsening MS)

pt w/ MS and encephalitis w/o fever

Acute disseminated encephalomyelitis

what is the pathophys of Acute disseminated encephalomyelitis

AI acute uniphasic demyelinating dz of the CNS associated w/ post viral / vaccine illness

what is the mechanism of perivascular demyelination of ADEM

T cell mediated

what would you see with ADEM

perivenular demyelination

what percent of ADEM pts develop MS

25%

what do you call incomplete leg extension secondary to blood irritating lumbosacral roots causing decreased hamstring fxn and what is it a sign of

kernigs sign; meningitis

what do you call neck flexion causing involuntary leg/hip flexion and what is it a sign of

brudzinski sign; meningitis

baby and honey

infantile botulism

what does botulism cause in the presynaptic cell

cleaves v+t snares preventing neurotransmitter release

what do you evaluate for with infantile botulism

respiratory depression

myelin pallor on MRI

HIV associated dementia

first dec concentration, then personality change, then ataxia, then dementia

HIV associated dementia

rapidly progressing dementia

CJD

spongiform encephalopathy

CJD

change in muscular coordination leading to myoclonus and rapidly progressing dementia

CJD

pulvinar hockey stick on MRI

CJD

what would cause tabes dorsal is to present much faster

concurrent HIV infection

what causes tabes dorsalis

neurosyphilis (t. pallidum)

lancinating pain and sensory ataxia, CN change, impotence/bowel-bladder problems, and hyporeflexia

Classical tabes dorsalis

infant and cats

toxoplasmosis

what are 3 ways to get toxoplasmosis

ingestion of meat w/ cysts, ingestion of water w/ cat feces, vertical transmission

chorioretinitis, intracranial calcivications, and hydrocephalus in an HIV pt

Toxoplasmosis

what do you use to tx toxo

pyrimethamine, sulfadiaine; bactrim prophylaxis if CD4<200

non reactive pupil, normal CT, and frontal headache that does not improve w/ tylenol; pupil constricts w/ pilocarpine

holmes adie pupil

where is the lesion in a holmes aide pupil

after the ciliary ganglion

graying out vision

inc ICP (pseudotumor cerebri)

how do you treat pseudotumor

high vol LP, acetazolamide, VP shunt

herpes in the ear w/ hearing loss but no damage to tympanic membrane

ramsay hunt syndrome

what kind of hearing loss occurs in ramsay hunt syndrome

sensorineural

what is the MCC of CNVII palsy

idiopathic (bells palsy)

85% of MG pts have what condition

thymic hyperplasia

anti MuSK Ab

what do you give for MG

pyridostigmine and plasmaphoresis

what is it important to evaluate for during Myasthenic crisis

FVC (respiratory fxn)

what causes BPPV

otoliths (Ca-stones) in posterior semicircular cancal

what is the difference btw menieres dz and BPPV

menieres dz has hearingloss

what 2 dz have high protein w/ normal cell count on CSF and what is that called

CIDP/AIDP; albuminocytologic dissociation

GBS will show what on babinski test

negative because UMN and CST are unaffected

double vision, droopy eyes, dilated pupils, droopy face, dry mouth, dysphagia what does this pt have

botulism

what is the triad for miller fischer

ataxia, opthalmoplegia and areflexia

anti-GQ1b Ab

Miller fisher (GBS)

pts with dermatomyositis have inc risk for what

ovarian cancer

heliotrope rash and gotron papules

dermatomyositis

anti-Jo-1 Ab

dermatomyositis

increased CD4 cells in a perivascular pattern on biopsy

dermatomyositis

what percent of ALS is hereditary and what is the other part

10% hereditary; 90% sporadic

what is the MC mutation in hereditary ALS

SOD

what is the standard treatment for ALS

riluzole

what constitutes the clinical diagnosis of ALS

UMN+LMN signs in 3 separate regions

tinel sign and phalen sign; what are they and what do they tell you

Tinel sign: symptoms of pain by tapping wrist Phalen sign: pain w/in 1 min of hands back to back tells you carpal tunnel syndrome

carpal tunnel syndrome is a neuropathy of what nerve

Median nerve

what is the clinical presentation of Carpal tunnel

pain at night (feel swollen) must shake hands when wake up

common peroneal nerve comes from what root(s)

L4-5

steppage gait is seen with which neuropathy

common peroneal palsy

what are 4 seizures seen btw 3yr-20yr/o

benign rolandic, absence, JME, febrile

what seizures are seen btw 6mo-6yr

febrile seizures

all idiopathic seizure disorders resolve spontaneously except which one

JME

what percent of kids w/ a simple febrile seizure are at risk for epilepsy

2-4%

proximal muscle weakness, + gower sign, and toe walking

duchenes muscular dystrophy

what labs should you order if you suspect DMD and what would it show

CK (inc 5x normal)

what is the MCC of death in DMD

respiratory dz

what are the diagnostic criteria of tourettes

at least 1 motor and 1 phonetic tic that lasts for 1 yr

what are 2 disorders associated w/ tourettes

OCD, ADHD

nocturnal episode involving face/speech and inc salivation w/ loss of consciousness and FHx

benign rolandic epilepsy

when is it ok to treat for benign rolandic epilepsy

if they have 3+ seizures

baby w/ agyria and pachgyria, epicentral fold dysmorphism

miller dieker syndrome

what is the MC tumor in the CP angle

acoustic neuroma (schwannoma)

what are the MC places of primary tumors that metastasize to the brain

Lung> breast> skin> colon> kidney

floppy baby

werdnig hoffman dz

positive for increased SMN1 gene

werdnig hoffman dz; causes fewer motor neurons

a baby w/ werdnig hoffmans dz would have shown what in utero?

decreased movement and polyhydramnios