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STEP2 > Neurology > Flashcards

Neurology Flashcards

1
Q

pt presenting w/ aphasia, contralateral weakness, hemisensory loss, & facial droop is consistent with a stroke located to the ___

A

LEFT MCA

- usually left (bc that is the dominant hemisphere for right handed pts)

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2
Q

what are the clinical findings in posterior inferior cerebellar artery (PICA) occlusion

A

= Wallenberg syndrome
(Lateral medullary syndrome, Posterior inferior cerebellar artery syndrome)

  • contralateral decrease in limb pain & temp (lateral spinothalamic tract)
  • ipsilateral decrease in FACIAL pain & temp
  • horner syndrome
  • hoarseness, dysphasia
  • vertigo, ataxia,
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3
Q

Postherpetic neuralgia always shows up where?

A

location of previous shingles flare.

compared to trigeminal neuralgia which is always on the face!

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4
Q

Young woman with muscle aches, depression, and NORMAL labs has _______.

A

Fibromyalgia

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5
Q

HYPERTENSION > rupture of what types of vessels in the basal ganglia/internal capsule

A

rupture of small PENETRATING arteries

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6
Q

what vessels is ruptured after a TBI & clx presents with passing out/lucid interval?

what does it look like on non contrast CT?

A

middle meningeal artery

Epidural hematoma==biconvex bleed (looks like a lemon cut in half)

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7
Q

What is the purpose of the Rinne hearing test?

what does a + vs - Rinne test indicate?

A

Rinne identifies a conduction problem, ie when bone&raquo_space;> air

+ = can hear at bone AND at air = no conduction problem

  • = can hear at bone NOT at air = YES conduction problem
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8
Q

what are common causes of conduction hearing loss?

A

anything that affects the outer & middle ear

ear wax
otosclerosis in young ppl (stapes in middle ear)
pagets in older ppl

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9
Q

What is the purpose of the Weber hearing test?

what does lateralization in the Weber test indicate?

A

Weber is done after Rinne to determine which ear(s) is affected

no lateralization = bilateral hearing loss
lateralization:
- Sound lateralizes to the affected ear in patients with conductive hearing loss (bc bone on top of head is felt by bone on mastoid)

  • and to the healthy ear in patients with sensorineural hearing loss (cant hear shit so goes to good ear)
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10
Q

what vessels is ruptured after a TBI & clx presents in older pts/alcoholics?

what does it look like on non contrast CT?

A

bridging veins

crescent shaped (looks like a banana) old ppl love bananas

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11
Q

midbrain atrophy with an intact pons (hummingbird sign) is mnemonic for what palsy?

A

progressive supranuclear palsy

  • lose balance
  • can’t focus with eyes
  • Parkinsonism
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12
Q

a pt with parkinsonism, gait instability, and vertical gaze palsy has what neuro palsy?

A

progressive supranuclear palsy

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13
Q

which form of neurofibromatous presents with BILATERAL vestibular schwannomas?

A

NF2. vestibular schwannomas are bilateral = 2 = NF2

** NF1, 1st you SEE, then you hear (NF2) **

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14
Q

what eye problems arise in NF1?

A

optic glioma, lisch nodules

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15
Q

what arteries would cause CN 3/occulomotor palsy if they had growing aneurysms?

think of the anatomy

A

Posterior communicating artery***
Posterior cerebral artery
Superior cerebellar artery

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16
Q

3 reasons to give ECT

A

anorexia from food refusal
suicidal
psychosis

> > do ECT bc it works faster & this pt could die without it

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17
Q

what is the order of events for Conduct disorder, Oppositional defiant disorder, and Antisocial personality disorder?

A

begins in childhood with oppositional defiant disorder (deliberately ignores/opposes adult control) for >6 months

pt gets older and develops Conduct disorder for 1 YEAR (a menace to society w/ criminal behaviors)

once legally adult (18yo) = antisocial personality disorder

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18
Q

anytime you read about a rapidly progressive malignant brain lesion (weeks) the answer is

A

Astrocytoma = glioma

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19
Q

where are astrocytomas/gliomas located in the brain on imaging?

A

Supra-tentorial (aka above the cerebellum & in the cerebrum) & crosses midline (butterfly glioma)

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20
Q

a ring enhancing, malignant lesion on brain MRI =

A

astrocytoma/gliomas are ring enhancing butterfly lesions

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21
Q

what age do people have gliomas/astrocytomas?

A

mid life/older

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22
Q

what age do people have medulloblastomas?

A

YOUNG children

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23
Q

what do meningiomas look like on MRI?

are meningiomas complicated or asymptomatic?

A

a homogenous white ball of meningeal fluid :)

asymptomatic an usually found incidentally on brain imaging :)

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24
Q

where are medulloblastomas located in the brain on imaging?

what do they normally compress?

A

INFRA-tentorial region of the CEREBELLUM

they compress the 4th ventricle/medulla (thats why its called medulloblastoma)

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25
Q

what are the symptoms that a child has with medulloblastoma?

A

intracranial pressure (e.g., papilledema, vomiting, headache) from non-communicating hydrocephalus (the 4th ventricle is obstructed by the tumor that arises from the cerebellum)

ataxia/gait probs (cerebellar vermis obstructed)

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26
Q

where are hemangioblastomas usually located in the brain on imaging?

A

cerebellum

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27
Q

what age group gets hemangioblastomas ?

A

HE-man == middle aged ppl w/ von-hipple-lindau

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28
Q

what do hemangioblastomas look like on brain MRI?

A

small, nodular, hyperintense (bc of bright blood) lesions

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29
Q

hemangioblastomas produce what hormone?

A

EPO&raquo_space;> secondary polycythemia

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30
Q

what is the mnemonic fr von hippel lindau syndrome?

A 
Hemangioblastomas 
↑ risk for RCC
Pheochromocytoma
Pancreatic lessions
Eye
Lesions
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31
Q

Idiopathic intracranial hypertension is in what gender & age group?

A

young females (premenopausal)

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32
Q

How do you know a patient has had a PURE motor stroke?

A

pt will have WEAKNESS WITHOUT SENSATION LOSS

or other stroke sym like hemi-neglect, aphasia, etc

33
Q

what arteries are infarcted during a pure motor stroke?

what area of the brain do these arteries supply?

A

leticulostriate arteries

leticulostriate arteries supply the internal capsule

34
Q

what is the roadmap to the dead ending leticulostriate arteries located in the internal capsule?

A

internal carotid > MCA > leticulostriate arteries

35
Q

what is the cause of leticulostriate lacunar infarcts/strokes?

A

HTNNNNNNNNN HYPERTENSION HTNNNNNNN!

36
Q

Cerebral vasospasm only occurs after what brain complication?

cerebral vasospasm increases the risk of what brain complication?

A

3-21 days after SAH, there is a constriction of affected blood vessels> cerebral vasospasm

communicating hydrocephalus (CSF is trapped in the sub arachnoid space)

37
Q

what are the 4 major criteria for Dissociative Identity Disorder (DID)?

A

1) Hx of physical/sexual abuse or childhood neglect
2) 2 or more completely different identities
3) Pt cant recall identity changes = severe memory gaps
4) derealization (feel like they aren’t real/aren’t a part of the world)

38
Q

what tonicity of solution will cause cerebral edema?

A

Hypotonic solution (5% dextrose or 0.45% saline)

giving a pt a hypotonic solution» fluid travels into brain > cerebral edema
WATER follows solute

39
Q

what is the first line treatment for pts with mild SIADH?

A

FLUID RESTRICTION!!!!!!

40
Q

what is the 1st line treatment for a pt with symptommatic/acute (lethargic/hyporeflexia/AMS) SIADH?

A

hypertonic saline solution (then fluid restriction; restoring sodium takes priority in pts w/ symptomatic SIADH)

41
Q

what are the characteristics of the tremor in Huntingtons disease?

A

A-rrhythmic, myoclonic, jerky

42
Q

a patient acting out his dreams =

what disease is it associated with?

A

REM sleep disturbance == Parkinsons disease

43
Q

What is the meaning of “aseptic” meningitis?

what is the most common cause?

A

Gram staining of the CSF is negative in viral meningitis, hence the name “aseptic” meningitis.

Most common cause of aseptic/viral meningitis = Coxsackievirus (Enteroviruses)

44
Q

does HSV cause meningitis?

what are the CSF findings specific to HSV?

A

NOOOOO ; HSV causes encephalitis!! And it is the most common cause of viral encephalitis!

HSV CSF:
lymphocytic pleocytosis (>75-95%)
RBCs

45
Q

what are the Clx of HSV encephalitis

A
  • seizures
  • AMS & personality changes
  • Focal neuro DEFICITS (of the medial temporal lobe; aphasia, hemiparesis, ataxia, hyperreflexia)
46
Q

tingling sensation in the arms and hands is pathognomonic for:

what malformation is it associated with?

A

Syringomyelia (a syrinx= abnormal fluid filled cavity that forms in the spinal cord as a result of noncommunicating hydrocephalus)

Chiari malformations (both)

47
Q

which Chiari malformation ALWAYS has Myelo-mening-ocele at birth?

why?

A

Chiari 2

The Myelo-mening-ocele kicks off start of events in Chiari 2:

  • Myelomeningocele (severe spina bifida) is a sac filled with spinal cord & meninges that has been DRAGGED caudally/downward
  • the caudal displacement from the Myelomeningocele causes caudal displacement of EVERYTHING above (brainstem, 4th ventricle, & cerebellum)
  • > > non communicating hydrocephalus&raquo_space;> Syrinx formation&raquo_space; Syringomyelia
48
Q

onset of symptoms in Chiari malformation 1 vs 2

A

Chiari 1= not symptomatic until adolescence

Chiari 2 = immediately symptomatic in infancy

49
Q

when is the onset of symptoms in NF 1&2

A

both onset in adolescents!!

50
Q

what other brain tumors are commonly associated/seen with the bilateral schwannomas of NF2?

A

Meningiomas (benign)
Ependymoma (deadly, die in 5 yrs)

NF2= u & ME (meningioma + ependymoma)

51
Q

Ependymoma

  • path ✓
  • epidemiology
  • MRI dx findings
  • path dx findings ✓
A
  • path: tumor of the ependymal cells that line the ventricles> COMMUNICATING hydrocephalus
  • epidemiology: children & young adults
  • MRI: intra-parenchymal tumor with CALCIFICATIONS and CYSTIC components due to necrosis and/or hemorrhage
  • Biopsy: Perivascular pseudorosettes
52
Q

Dandy-Walker malformation

  • patho
  • MRI findings
  • extracranial findings
A
  • patho: the 4th ventricle never closes. It takes over the posterior fossa= LARGE empty space in back of brain w/ very tiny cerebellum
  • MRI: LARGE hyperechoic (bc IV fluid) CYSTIC space in the posterior fossa + non communicating hydrocephalus
  • facial defects, cardiac defects, spina bifida, ataxia
53
Q

finger to nose/heel to shin test diagnoses a lesion/problem in what part of the cerebellum?

what form of ataxia is this?

A

lateral cerebellar hemispheres

LIMB ataxia

54
Q

tuncal ataxia presents with what PE findings?

damage to what part of the cerebellum> truncal ataxia?

A

inability to SIT UP or STAND up straight

cerebellar VERMIS

55
Q

what are the diagnostic clinical features in alcoholic cerebellar degeneration?

A

CHRONIC alcohol use (>10 yrs)
TRUNCAL ataxia
Gaze-evoked nystagmus

56
Q

Wernicke encephalopathy and Korsakoff syndrome are often grouped together bc they share etiology of Thiamine deficiency, BUT they are completely different conditions!!

Which condition is reversible vs irreversible?

A

wernicke = reversible bc its an ACUTE thiamine deficiency

korsakoff = irreversible bc its a CHRONIC deficiency of thiamine

57
Q

mnemonic for wernicke encephalopathy

A

Wernickes COAT

C= confusion 
O= oculomotor dysfunction via gaze induced (nystagmus when you stare) or conjugate  (nyastagmus when you try to look laterally), + diplopia
A= ataxia 
T= admin thiamine then glucose
58
Q

mnemonic for Korsakoff syndrome?

A

Korsakoff’s KART

K- Konfabulation (fabricated memories)
A- Anterograde amnesia
R- Retrograde amnesia
T- temper changes

59
Q

what direction do the EYES usually go during a STROKE?

A

eyes always deviate to the side of the lesion (ie left sided weakness = eyes deviate to the right where brain lesion is)

60
Q

what direction do the eyes deviate during a THALAMIC stroke?

A

thalamic stroke== “wrong way eyes”

eyes will deviate away from the side the lesion is on!

61
Q

what classic pupil findings are in a thalamic (“wrong way eyes”) stroke?

A

pupils = MIOTIC and NONREACTIVE

thalamic = eyes look in wrong direction & are wrong size (miotic)

62
Q

what type of meningitis has a CSF fluid analysis just like viral/aseptic meningitis, BUT has NORMAL WBC count?

A

GBS meningitis ==== albumino-cytologic dissociation (PROTEIN—CELL dissociation)

has viral CSF findings (high protein) with a NORMAL WBC count!

63
Q

Uncal herniation (midline shift) compresses the ipsilateral oculomotor nerve leads to:

A

Ipsilateral oculomotor nerve palsy → FIXED & DILATED pupil

64
Q

Uncal herniation (midline shift) compressing the ipsilateral posterior cerebral artery leads to what type of vision loss?

A

Ipsilateral posterior cerebral artery → CONTRALATERAL homonymous hemianopia

65
Q

Uncal herniation (midline shift) compressing the contralateral cerebral peduncle leads to:

A

Contralateral cerebral peduncle → ipsilateral paralysis (aka Kernohan notch phenomenon):

  • a paradoxical ipsilateral weakness (due to contralateral cerebral peduncle compression).
  • This is unusual because commonly, an ipsilateral brain lesion results in contralateral motor symptoms. It occurs in patients with increased ICP caused by intracranial hemorrhage or cerebral edema.*
66
Q

skull xray showing: Periosteal trabeculations with radiolucent marrow hyperplasia

A

Thalassemia or SCD

67
Q

skull 3 xray findings for dx of Pagets?

A
  1. cortical bone is thickened
  2. lytic lesions
  3. sclerotic lesions
68
Q

Presbycusis is always ________ sensorineural hearing loss

A

BILATERAL!

69
Q

early vs late symptoms of an acoustic neuroma

A

Early: compression of the vestibulocochlear nerve (CN VIII) in the cerebellopontine angle

  • cochlear: unilateral tinnitus & sensorineural hearing loss
  • vestibular: dizziness

Late: compression of more nerves located in the cerebellopontine angle

  • CNV- facial pain
  • CNVII- facial weakness/paralysis
  • Cerebellum- ataxia
  • 4th ventricle- hydrocephalus
70
Q

what are the clinical features of HIV associated encephalopathy?

A

subacute onset:

  • MEMORY impairment
  • DEPRESSION symptoms, and
  • MOVEMENTTTTTT disorders (ataxia, dysdiadochokinesia).
71
Q

ALL encephalopathy has a change in

A

MOOD (depression, affect, personality)

72
Q

differentiate between onset & clinical findings in
Medullaris
vs
Cauda equina

A

Medullaris = SYMMETRIC , UMN & LMN signs + early bladder/bowel problems

cauda equina = ASYmmetric , LMN signs only + LATE bladder/bowel probs

73
Q

malingering is the answer if a pt :

A

gains/benefits in the question stem. (ignore the symptoms and LOOK for the gain!)

(ex. doesnt want to return to work, hx of lying in past, avoiding/attention seeking)

74
Q

conversion disorder is the answer if a pt:

A

Is in a stressful situation & that stress manifests as REAL symptoms that dont make sense!!!

(will have proof from someone else who is worried about them)

75
Q

mastoiditis is a complication of :

what are the clx findings?

A

prolonged otitis media infection

swelling & erythema behind the ear (mastoid) that displaces the actual ear
+/- neck mass (severe)

76
Q

what is imaging & tx for mastoiditis

A

only image w/ CT of temporal bone/mastoid if theres a mass (neck)

tx: vancomycin (covers staph and strep)

77
Q

pts w/ a recent stroke will experience what type of dysphagia?

how do you dx?

A

oropharyngeal dysphagia (cant initiate a swallow bc of weak mouth/throat muscles)

dx: Videofluoroscopy (direct visualization of the entire swallowing process using continuous x-rays and barium contrast. This diagnostic test evaluates the patient’s risk of aspiration and determines whether the patient might benefit from supervised feedings, swallow rehabilitation therapy, and/or enteral nutrition)

78
Q

Bells palsy is a PERIPHERAL facial palsy (complete ipsilateral weakness) that most commonly occurs:

what is the prodrome sensation of the ear?

A

idiopathic == just a clinical diagnosis

prodrome = Painful sensation around or behind the ear , Impairment of taste in the anterior tongue
Hyperacusis

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