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Neuro Stuff Flashcards

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1
Q

Parkinsonism + Autonomic dysfunction (eg hypotension, impotence)
Widespread neurologic signs

A

Multiple system atrophy (Shy-Drager)

Anti-PD drugs generally ineffective. Tx aimed at intravascular volume expansion

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2
Q

Ashkenazi Jew

Gross dysfunction of autonomic nervous system (severe orthostatic hypotension)

A

Riley-Day

But if +Parkinsonism, consider Shy-Drager

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3
Q

What kind of stroke gives you pure motor hemiparesis?

A

Lacunar infarcts in the internal capsule (due to hypohyalinosis and microatheroma of those small vessels). CT may be normal.

Note: can’t obliterate motor without sensory for cortical stroke!

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4
Q

Lead poisoning symptoms

A

GI: abd pain, constipation
Neuro: cognitive, neuropathy (extensor weakness, stocking-glove)
Microcytic anemia (2/2 disruption of heme synthesis)
Basophilic stippling

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5
Q

Sources of lead poisoning

A

Battery manufacturing, plumbing, home restoration, distillation of alcohol through parts with lead soldering…

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6
Q

Ptosis
Down and out
Normal pupillary response

A

Ischemic CN III palsy from poorly controlled diabetes

Damages inner somatic nerves but spares peripheral parasympathetic fibers

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7
Q

Fluctuating, fatigable muscle weakness that worsens with repetitive motions of the same muscle groups. Improves with rest.

A

Myasthenia gravis.

Autoantibodies (from thymus, eg thymoma) against nicotinic acetylcholine receptors at NMJ.

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8
Q

Defense mechanism: transferring feelings to a more vulnerable object/person

A

Displacement

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9
Q

Defense mechanism: attributing one’s own feelings to others (person having an affair but accusing their spouse of having affair)

A

Projection

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10
Q

Defense mechanism: responding to manner opposite to one’s actual feelings

A

Reaction formation

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11
Q

Timing of acute stress disorder vs PTSD vs adjustment disorder

A

Acute stress disorder: >3 days but <1month
PTSD: 1mo or more

Adjustment disorder: within 3 months of identifiable stressor

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12
Q

Timing of GAD

A

GAD: 6mo

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13
Q

Drugs causing prolactin elevation

A

Antipsychotics due to dopamine blockade
(eg risperidone especially)

Note that prolactinomas in contrast will result in VERy high levels of prolactin (>200)

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14
Q

hearing loss in meniere’s

A

Sensorineural!

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15
Q

cause of meniere

A

increased volume or pressure of endolymph (due to defective resorption of endolymph?)

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16
Q

visual hallucinations
spontaneous parkinsonism
fluctuating cognition

Parkinsonism seem with severe sensitivity to potent dopamine antagonists (eg antipsychotics, risperidone)

A

dementia with lewy bodies

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17
Q

stepwise decline
early executive dysfunction
cerebral infarction or deep white matter changes on neuroimaging

A

vascular dementia

18
Q

ataxia early in dz
urinary incontinence
dilated ventricles

A

NPH

19
Q

Triad:

Confusion
Oculomotor dysfunction (horizontal nystagmus, bilateral VI palsy)
Gait ataxia (wide-based gait)
A

Wernicke encephalopathy

2/2 long-term thiamine deficiency

20
Q

Most common cause of pediatric stroke?

A

Sickle cell

21
Q

Prophylaxis for migraines

A

Topiramate
Beta blockers
Amitriptyline

22
Q

Discrete lesions at gray white junction with surrounding edema

A

Lungs Mets

23
Q

Tx for restless leg syndrome

A

Dopamine agonists (pramipexole, ropinirole)

24
Q

Tx for prolactinoma

A

dopamine agonists (cabergoline, bromocriptine)

dopamine will reduce prolactin levels and make tumor shrink

25
Q

risk of status epilepticus

A

cortical laminar necrosis (permanent injury due to excitatory cytotoxicity). risk is increased even with >5min of seizure.

26
Q

nightmare vs night terror

A

nightmare: when awakened, fully alert and can usually recall nightmare

night terror: cannot be fully awakened during episode, and no memory of incident

27
Q

brain death

A

absent cortical and brainstem functions

spinal cord may still function, thus deep tendon reflexes still present

28
Q

contralateral hemiparesis
hemianesthesia
conjugate gaze deviation toward side of lesion
headache!

A

putaminal hemorrhage
(involves internal capsule)
most frequent region in hypertensive hemorrhage

(less likely to have headache in ischemic MCA stroke)

29
Q

treatment for foodborne botulism

A

equine antitoxin

30
Q

treatment for this toxicity: bradycardia, miosis, bronchospasm, vomiting, diarrhea

A

cholinergic toxicity (organophosphate etc)

tx: atropine (blocks peripheral effects of Ach at muscarinic receptors)
and pralidoxime (aids in reactivation of acetylcholinesterase)
31
Q

diagnostic drug trial in myasthenia gravis

vs. treatment

A

edrophonium
(short-acting acetylcholinesterase inhibitor that temporarily improves muscle weakness)

treat with pyridostigmine
+/- thymectomy

32
Q

bilateral action tremor
relieved by alcohol
hereditary?

A

essential tremor

33
Q

What nerve damaged in anterior shoulder dislocation

A

Axillary

34
Q

What nerve damaged in humeral mid shaft fractures

A

Radial

35
Q

What nerve damaged in medial epicondyle fracture

A

Ulnar nerve

36
Q

Bilateral flaccid paralysis and loss of pain

A

Infarction of anterior spinal artery

37
Q

headache that worsens with leaning forward, valsalva, ocugh

A

intracranial HTN

these maneuevers increase intracranial pressure

38
Q

hyperreflexia, spasticity, muscle atrophy, fasciculations

A

ALS (upper + lower motor neuron signs)

39
Q

What is, and how to treat, catatonia?

A

Seen in severe psychiatric and medical illness.
Immobility, mutism, and posturing

Treat with benzos and ECT

40
Q

GBS vs botulism

A

GBS: ascending symmetrical paralysis, often with autonomic dysfunction, rare to have pupillary abnormalities

Botulism: descending paralysis, early cranial nerve involvement, often pupillary abnormalities

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