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Success on Step 2 > Neurology > Flashcards

Neurology Flashcards

1
Q

One pupil is dilated and nonreactive to light or accommodation

A

Hutchinson pupil

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2
Q

UMN lesions affect what areas of the nervous system?

A

The brain or the spinal cord

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3
Q

What is the presentation of UMN lesion?

A

Increased muscle tone, increased reflexes, babinski is positive

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4
Q

What is the next step in diagnosis if you suspect a patient has an UMN lesion?

A

CT or MRI

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5
Q

Why does a patient with an UMN lesion have sparing of the Upper face?

A

Remember that the upper motor neurons synapse at both an upper and lower nucleus. The upper nuclei supplies the upper half of the face while the lower nuclei supplies the lower half. Keep in mind there is colateral innervation from the oppisite side of the cortex that suplies the neuron, meaning that the upper part of the face is innervated.

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6
Q

Lesion on the ____ motor neuron results in complete paralysis of one side of the face, resulting in an inability to close the eyes, smile, and decreased labial folds

A

LMN

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7
Q

A sensitive test for UMN lesion. Patients are asked to extend their hands with their palm up and close their eyes.

A

Pronator drift, if the patients palms rotate downward this is a positive sign.

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8
Q

What are the signs of LMN lesion?

A

Flaccidity, hyporeflexia, atrophy, fibrillation (small contractions detected on EMG) fasciculations (larger contractions)

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9
Q

What are etiologies for Bell’s palsy?

A

Herpes simplex, lyme, sarcoidosis

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10
Q

The inability to perform a series of rapidly alternating movements. Ask the patient to keep one hand over the other and rapidly move the upper hand in alternating supination/pronation.

A

Dysdiadokinesia

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11
Q

The patient overshoots when attempting to reach something

A

Dysmetria

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12
Q

Slurred speech

A

dysarthria

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13
Q

Signs that the cerebellum may be damaged?

A

DANISH Pendulum; dysdiadokinesia, dysarthria, ataxia, nystagmus, intention tremor, slurred speech, hypotonia, persistent back and forth swinging of the leg

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14
Q

What is the next step in managment if you suspect a patient has cerbellar comprimise?

A

CT or MRI

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15
Q

A 53 yo pt suddenly has painless loss of vision (like a “dark curtain” over one eye) followed by spontaneous recovery. What is the Dx?

A

Amaurosis fugax, which affects the retinal branch of the internal carotid artery

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16
Q

A 50 yo F patient woke up with symptoms of difficulty speaking and weakness in his right leg that lasted for 3 hours. Patient is currently asymptomatic. What is the next step in managment?

A

Aspirin, statin, Patient should also get a carotid duplex to see if intervention is required.

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17
Q

Where do the vertebral arteries originate from?

A

The subclavian artery

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18
Q

What branches does the basilar artery give off?

A

Pontine

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19
Q

The basilar artery eventually gives rise to what first portion to the circle of Willis?

A

The posterior cerebral artery

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20
Q

This artery of the brain gives off the lenticulostriate arteries

A

MCA

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21
Q

Where is the stroke happening in a patient where the upper extremities, and face are affected, homonymous hemianopia (it is contralateral)

A

MCA

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22
Q

Branches off of the MCA, supply what deeper structures of the brain?

A

The Internal capsule, thalamus, basal ganglia and temporal lobe.

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23
Q

A patient with MCA in the right lobe of the brain will have these additional signs associated with speech?

A

Broca and Wernicke’s

24
Q

A patient with MCA in the left lobe of the brain will have these additional signs?

A

Hemineglect, constitutional apraxia where the can understand what’s going but cannot execute the task

25
Q

CN I

A

olfactory

26
Q

CN II

A

Optic

27
Q

CN III

A

Oculomotor which controls all the eye muscles except for the SO, and the lateral rectus

28
Q

CN IV

A

Trochlear (supplies the SO), superior is on the top looking down

29
Q

CN VI

A

Abducens (supplies the lateral rectus)

30
Q

CN VII

A

Facial

31
Q

CN VIII

A

Vestibulocochlear

32
Q

IX

A

Glossopharyngeal

33
Q

X

A

Vagus, efferent limb of the gag reflex,

34
Q

XI

A

Acessory

35
Q

XII

A

hypoglossal, in a lesion the tounge will deviate to the affected side

36
Q

What is the next step in managment for a patient with new onset of Bell’s Palsy?

A

Steroids, if the symptomology is severe then consider acyclovir.

37
Q

What is the most common complication of Bell’s palsy?

A

Corneal ulceration

38
Q

If a patient has weakness first assess whether or not?

A

The patient has UMN or LMN symptoms. If the patient has no sxm’s of the latter then consider another pathology like neuromuscluar junction issues, myopathy and electrolyte balance

39
Q

Patient has presentation of being unable to move his right leg for the past 4 hours what area of the brain is compromised?

A

Left ACA

40
Q

This stroke causes homonymous hemianopia without motor or sensory deficits

A

PCA

41
Q

This stroke is purely motor/or purely sensory

A

Lacunar infarct

42
Q

An ischemic stroke in the midbrain would affect what cranial nerves?

A

III

43
Q

An ischemic stroke in the pons would affect what cranial nerves

A

VI

44
Q

An ischemic stroke at the cerebellum would affect what nerves

A

XII

45
Q

A patient presents with sudden onset of focal neurological deficit CT is consistent with a hemorrhagic infarct what is the next best step in mangament?

A

Anti-platelet which is not TPA

46
Q

A patient presents with sudden onset of focal neurological deficit CT is negative for hemorrhage what is the next best step in management?

A

TPA and CT angiography of the head and neck

47
Q

Antiplatelets like aspirin, clopidogrel should be started ____ hours after a CVA?

A

48 hours

48
Q

What is the most common risk factor for a stroke?

A

HTN

49
Q

What is the most common risk factor for a lacunar stroke?

A

HTN

50
Q

Patients with hemorrahgic stroke tend to present with..

A

high ICP, bradycardia, abducens nerve palsy ( this is because most common area of a hemorrahic stroke is the MCA) and papilladema

51
Q

What is the MCC of subarachnoid hemorrhage?

A

Berry aneurysm

52
Q

A 60 yo M presents to the office with the worst headache he has ever had, and vomiting what is the dx?

A

Subarachnoid hemorrhage

53
Q

If a CT scan is negative for hemorrhagic stroke, but your index of suspicion for a hemorraghic stroke is still high what is the best next step in mangament?

A

Lumbar puncture, only if the ICP is not too high. Xanthochromia

54
Q

After you confirmed the diagnosis is hemorrhagic stroke what it the next step in managment?

A

Get an MRA to locate the aneurysm

55
Q

What can we do to treat a hemorrhagic stroke?

A

administer a calcium channel blocker to prevent vasospasm which is the most fatal side affect of a hemorrhagic stroke. The arteries of the brain constrict to prevent continued blood loss

56
Q

A 70yo M with PMH of HTN, diabtetes, and CAD. Recently had a clipping procedure for a hemorrhagic stroke. Today post-op day 1 he complains of intense headache and nausea what intervention can reduce the ICP in this patient?

A

ventriculoperitoneal shunt

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