Neurology Flashcards
How is Huntington disease inherited?
Autosomal dominant
What are the precipitating movements associated with trigeminal neuralgia?
What is the treatment?
- Tapping the nerve or face
- Eating
- Movement (talking)
Carbamazepine
If CT is negative and you still believe there is a stroke what is the next best test to order?
MRI
What are the risk factors for Guillain-Barre Syndrome?
- Recent respiratory or GI illness
Most commonly caused by campylocater jejuni
Symmetric, progressive ascending muscle weakness, and lack of deep tendon reflexes should make you consider what diagnosis?
Guillain-Barre Syndrome
What is the first line intravenous therapy for a patient in status epilepticus?
Lorazepam
What part of the spinal cord is responsible for pain and temperature sensation?
Lateral spinothalamic tract
What are the treatments for absence seizures?
Ethosuximide or valproic acid
A child presents with brief, sudden impaired consciousness. What diagnosis should you be thinking of?
Absence Seizures
What is the most common cause of a subarachnoid hemorrhage?
Ruptured aneurysm
Abrupt onset of the worst headache of ones life or thunderclap headache should make you think of what diagnosis?
Subarachnoid hemorrhage
What is the presentation of Reye Syndrome?
A child with recent viral illness treated with aspirin
- Encephalopathy
- Delirium
- Seizures
- Vomiting
- Hepatomegaly
What test is the single most useful test in establishing the diagnosis of multiple sclerosis?
MRI
What nerve is compressed in carpal tunnel syndrome?
Median Nerve
What is the most commonly compressed cervical nerve root?
C7
What is the classic triad of meningitis?
Fever, headache, nuchal rigidity
An LP for a patient with a viral meningitis will show elevated or decreased glucose?
Normal to slightly decreased
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?
Anterior
What is the most common primary intracranial neoplasm?
Glioma
What is the initial abortive treatment for a cluster headache?
100% oxygen
Decreased GABA and substance P should make you think of what diagnosis?
Huntington’s Diseasef
Imaging is negative for blood, but you strongly believe that there is a subarachnoid hemorrhage. What test can you order that will be definitive?
Lumbar puncture
What is a Chance Fracture?
What is it most commonly associated with?
Spinal fracture due to forceful flexion against restraint
Associated with improper seatbelt use (lap belt only)
What are you most likely to find on physical exam if the patient has an S1 radiculopathy?
Weak plantarflexion of the foot
What is a special test used to elicit radicular nerve pain?
The straight leg raise test
What movement tests the functionality of the median nerve?
Pincer function of the thumb and index finger
In a patient with Guillain-Barre, what would you expect to see in lumbar puncture results?
CSF will show elevated protein with a normal white blood cell count
Which bacterial infection commonly occurs prior to the development of Guillain-Barre syndrome?
Campylobacter jejuni infection
In a patient presenting with Guillian-Barre, what important next test should be performed to avoid complications of the diagnosis once a diagnosis of Guillian-Barre has been given?
Vital Capacity or Inspiratory Force is critical to assessing respiratory effort
What is Cushing’s Triad?
- Bradycardia
- Hypertension
- Irregular Breathing
Results from increased intracranial pressure (ICP)
What is the most common type of brain herniation?
Uncal transtentorial herniation
If a patient is given tissue-type plasminogen activator, how long should you wait before giving aspirin or clopidogrel?
24 hours
What is the most common cause of bilateral Bell’s Palsy?
Lyme Disease
What is Lhermitte Sign
Electric-shock like sensation down the spine with neck flexion. An early sign of multiple sclerosis.
In the treatment of Wernicke’s, what is the order of medications?
Thiamine must be given before glucose to avoid worsening symptoms
What artery is most commonly involved in ischemic stroke?
Middle Cerebral Artery (MCA)
What is the first-line imaging for suspected stroke?
Non-contrast CT
What is the time window for IV tPA in acute ischemic stroke?
Within 3 hours (can extend to 4.5 hours in select patients)
Which stroke syndrome presents with contralateral leg weakness more than arm weakness?
Anterior Cerebral Artery (ACA) stroke
What stroke syndrome causes homonymous hemianopsia with macular sparing?
Posterior Cerebral Artery (PCA) stroke
What is the mainstay of secondary prevention after ischemic stroke?
Antiplatelet therapy (aspirin, clopidogrel) & statin therapy
What is the classic description of a cluster headache?
Unilateral, periorbital pain with autonomic symptoms (lacrimation, rhinorrhea, ptosis, miosis)
What is the first-line abortive treatment for cluster headaches?
High-flow oxygen + sumatriptan
What medication class is first-line for migraine prevention?
Beta-blockers (propranolol), anticonvulsants (topiramate, valproate), or TCAs (amitriptyline)
What is the treatment of choice for idiopathic intracranial hypertension (pseudotumor cerebri)?
Acetazolamide ± LP for symptomatic relief
What red flag headache symptoms suggest an urgent workup (e.g., CT/MRI)?
Sudden onset (‘thunderclap’), focal deficits, AMS, fever, trauma, cancer history
What is the most common cause of new-onset seizures in adults?
Stroke (vascular disease)
What type of seizure is characterized by lip-smacking and automatisms?
Focal (partial) seizure with impaired awareness
What is the first-line treatment for absence seizures?
Ethosuximide
What is the treatment for status epilepticus?
IV benzodiazepines (lorazepam, diazepam) → fosphenytoin → phenobarbital if refractory
Which antiepileptic drug is associated with gingival hyperplasia?
Phenytoin
What is the classic triad of Parkinson’s disease?
Resting tremor, bradykinesia, rigidity
What is the first-line medication for Parkinson’s disease?
Levodopa-Carbidopa
What type of tremor worsens with movement and improves at rest?
Essential tremor
What is the treatment for essential tremor?
Propranolol or primidone
What genetic disorder presents with choreiform movements and psychiatric symptoms in middle age?
Huntington’s disease
What condition is associated with autoantibodies against acetylcholine receptors?
Myasthenia Gravis
What is the gold standard test for myasthenia gravis?
Edrophonium (Tensilon) test or acetylcholine receptor antibodies
What is the most common cause of Guillain-Barré Syndrome?
Campylobacter jejuni infection
What is the treatment for Guillain-Barré Syndrome?
IVIG or plasmapheresis (NO steroids!)
Which condition presents with ascending symmetric weakness and areflexia?
Guillain-Barré Syndrome
What is the most common initial presentation of multiple sclerosis?
Optic neuritis (painful monocular vision loss)
What imaging finding is characteristic of MS?
White matter plaques on MRI (‘Dawson’s fingers’)
What is the treatment for acute MS exacerbations?
IV corticosteroids
What is the most common long-term disease-modifying therapy for MS?
Beta-interferons or glatiramer acetate
What test confirms the diagnosis of MS when MRI is inconclusive?
CSF analysis showing oligoclonal bands
What is the most common cause of peripheral neuropathy?
Diabetes mellitus
What is the first-line treatment for diabetic neuropathy?
Gabapentin or pregabalin
What is the characteristic physical exam finding in carpal tunnel syndrome?
Positive Tinel’s and Phalen’s signs
What vitamin deficiency is associated with peripheral neuropathy?
Vitamin B12 deficiency
What is the most common cause of peripheral vertigo?
Benign paroxysmal positional vertigo (BPPV)
What maneuver is diagnostic for BPPV?
Dix-Hallpike maneuver
What maneuver is used to treat BPPV?
Epley maneuver
What type of vertigo presents with hearing loss and tinnitus?
Ménière’s disease
What is the treatment for acute vestibular neuritis?
Steroids + vestibular rehab
What spinal cord syndrome causes loss of pain and temperature bilaterally at the level of the lesion?
Syringomyelia
Which spinal cord syndrome results in ipsilateral loss of motor/vibration and contralateral loss of pain/temp?
Brown-Séquard syndrome
What spinal cord injury presents with loss of pain and temperature but preserved proprioception?
Anterior cord syndrome
What is the most common cause of cauda equina syndrome?
Herniated lumbar disc
What is the classic triad of cauda equina syndrome?
Saddle anesthesia, urinary retention, leg weakness
Evaluating reflexes in a suspected neuro injury, with damage to the upper neurons what would you expect the finding to be?
Reflexes will be increased - lower motor neuron injuries reflexes are diminished
Fasiculations are seen in what time of motor neuron injury?
Lower motor neuron injury
A patient recently diagnosed with Alzheimer’s develops nightmares, what medication would you suspect is causing his symptoms?
Donepezil - most common side effect is vivid nightmares. Medication should be stopped.
Which cranial nerve controls lateral eye movement?
CN VI, Abducens
