Neurology Flashcards
You believe a patient has had a stroke. He presents with aphasia, loss of hearing in one ear and loss of vision in his left eye. Is the blockage likely in the anterior or posterior circulation?
Posterior
Wilson’s disease is associated with a build up of what mineral?
There is a deficiency of the copper binding protein
Which nerve root is responsible for the knee jerk reflex?
L3-L4
Which disc is most commonly herniated?
L4-L5 followed by L5-S1
What three symptoms are classic for a normal pressure hydrocephalus?
Gait disturbance, dementia and urinary incontinence
What symptom is associated with a classic migraine?
Having an aura
What percentage of strokes are ischemic? What percentage are Hemorrhagic?
80%, 20%
What is the treatment of choice for a patient with tourette’s?
Haloperidol
What is the single most important thing to be concerned about with a patient in status epilepticus?
Airway followed by management of hyperthermia
What is the most common primary intracranial neoplasm?
Glioma
What is the most common cause of subarachnoid hemorrhage aside from trauma?
Ruptured cerebral aneurysm
What is the most common cause of dementia?
Alzheimer’s disease, it may be as high as 80%
What is the medical treatment for a stroke in which the CT has shown no evidence of a hemorrhage?
Heparin/coumadin, thrombolytics, steroids, hyperosmotics
What is the defining symptom of Alzheimer’s?
Progressive memory impairment
What is the age range for Duchenne’s muscular dystrophy?
3-5 years old
What four chromosomes have been linked to dementia?
1,14,19,21
What cranial nerve is most commonly affected Bell’s palsy?
CN VII
What are the most common causes of mets to the brain?
Lung, breast, kidney
What are the genetic characteristics of Wilson’s disease?
Autosomal recessive, chromosome 13
Weakness and numbness in the left hand might be a presumed blockage in which carotid artery?
Right
Under what conditions would aspirin or clopidogrel be used following a TIA as prophylaxis?
These are antiplatelet medications. They would be used unless there is a known cardiac etiology for the embolism. Cardiac patients would use heparin and coumadin.
There is an MRI result of multiple foci of demyelination in the white matter. What diagnosis should you be thinking of?
Multiple Sclerosis
Seizure in which patient experiences an aura. What diagnosis should you be thinking of?
Complex partial
Patient has a tremor with motion in his hands. What medication might you prescribe?
This patient has an active tremor therefore a beta blocker like propranolol is a good start
Patient complains of an aching headache which feels like a band around his head. What diagnosis should you be thinking of?
Tension headache
Name three medications used to break a seizure?
Diazepam, lorazepam, phenytoin or fosphenytoin
Name one abortive drug for migraines.
Triptans (sumatriptan, zolmitriptan), Ergotamine
Middle age male presents with unilateral periorbital headaches occurring daily for several weeks and is extremely painful. Which type of headache is the most likely cause?
Cluster headache
List two medications you might use to treat an essential tremor?
Beta blocker (propranolol), Primidone
List three medications used to “treat” multiple sclerosis?
Steroids, interferon-beta, copolymer
List three drugs that treat cluster headaches
Oxygen, sumatriptan, butoprophal
List six medications that can be used for migraine prophylaxis?
Beta blockers, tricyclics, calcium channel blockers, NSAIDs and valproic acid
Lead pipe or cogwheel rigidity should make you think of what diagnosis?
Parkinson’s disease
Is the ankle jerk reflex of lumbar or sacral origin?
Sacral
Is Huntington’s autosomal dominant or recessive?
Dominant
If you are looking for lesions associated with multiple sclerosis and you order an MRI do you order with gadolinium or without?
With
If CT is negative and you still believe there is a stroke what test should you order?
Lumbar puncture
Give two classes of drug therapy for a parkinson’s patient.
Dopaminergic - levodopa, anticholinergics are second line
Elevated circulating acetylcholine receptor antibodies should make you think of what diagnosis?
Myasthenia gravis
EEG showing interictal spikes should make you think of what diagnosis?
Complex partial seizure
EEG showing generalized spikes and associated slow waves should make you think of what diagnosis?
Generalized or absence seizure
EEG showing focal rhythmic discharges at the onset of the seizure should make you think of what diagnosis?
Simple partial seizure
Duchenne’s and Becker’s muscular dystrophy have what genetic characteristic?
X linked recessive
Describe Kernig’s sign
patient lies supine bend hip and attempt to straighten the knee. Back pain is positive.
Describe Brudzinski’s sign
When you lift the patient’s head the patient bends his hips
Decreased GABA and substance P should make you think of what diagnosis?
Huntington’s
At what percentage of blockage is an endarterectomy indicated? At what point is it no longer indicated?
> 30%, >98%
At what age do symptoms of Huntington’s disease appear?
Around 30 years old
Alcohol may be a major factor in which encephalopathy?
Wernicke’s
A sudden thunderclap headache should make you think of what diagnosis?
Subdural hematoma
A study result comes back with intracellular neurofibrillary tangles and extracellular neuritic plaques. What diagnosis should you be thinking of?
Alzheimer’s disease
A slit lamp shows Kayser-Fleischer rings. What diagnosis should you be thinking of?
Wilson’s disease
A shuffling gait should make you think of what diagnosis?
Parkinson’s disease
A resting or pill rolling tremor should make you think of what diagnosis?
Parkinson’s disease
A patient presents with weakness that he felt in his lower legs and now feels in his knees and hips bilaterally. He has decreased deep tendon reflexes. This has been getting progressively worse. What diagnosis should you be thinking of?
Guillian-Barre
A patient presents with signs of a stroke to the ED what is the most important test to get?
CT
A patient presents with lateralized throbbing headache. The patient has nausea and vomiting and photophobia. What type of headache is most likely?
Migraine
A patient presents with inability to speak and right sided weakness. He seems to understand speech and follows commands well. What diagnosis should you be thinking of?
Broca’s aphasia
A patient presents with a painful ipsilateral third nerve palsy. What diagnosis should you be thinking of?
PCOM - posterior communicating artery aneurysm
A patient presents to your office complaining of a tremor in his right hand. He states after a beer it goes away completely. What diagnosis should you be thinking of?
Benign essential tremor or familial tremor
A patient presents complaining of the worst headache of their life. What might you expect their blood pressure to be?
Typically this is the description for a subarachnoid hemorrhage. You would expect the blood pressure to be elevated
A patient is brought in following a seizure in which the patient did not lose consciousness. What diagnosis should you be thinking of?
Simple partial seizure
A patient has a intracranial neoplasm causing auditory illusions, olfactory hallucinations and emotional changes. What lobe is the lesion likely in?
Temporal
A patient complains of muscle weakness and fatigability that improves with rest. What diagnosis should you be thinking of?
Myasthenia gravis
A lumbar puncture for a patient with bacterial meningitis will show elevated or decreased wbc’s? Glucose? Protein?
Elevated wbc’s, decreased glucose and elevated protein
A A patient presents with what appears to an inability to understand speech. What diagnosis should you be thinking of?
Wernicke’s aphasia
A 35 year old patient comes to your office because his wife made him. He has been increasingly irritable and moody. She has also noticed that he is very restless. Your order a CT scan which showed cerebral atrophy as well as atrophy of the caudate nucleus. What diagnosis should you be thinking of?
Huntington’s disease
34 Year old female presents with a waxing and waning symptoms. These include visual problems and weakness in her right arm. What diagnosis should you be thinking of?
Multiple Sclerosis
