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Step 2 > Neurology > Flashcards

Neurology Flashcards

1
Q

UMN vs LMN lesion

A

UMN: contralateral paralysis lower face
LMN: ipsilateral paralysis upper and lower face

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2
Q

CN XI

A

Accessory: Head turning, shoulder shrugging

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3
Q

CN XII

A

Hypoglossal: Tongue movement

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4
Q

CN XI

A

Glossopharyngeal: Taste post 2/3 tongue, swallow, salivation (parotid) carotid body, gag reflex

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5
Q

Innervation swallowing

A

CN IX, X

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6
Q

Innervation salivation

A

CN VII (submand, subling), XI (parotid)

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7
Q

Innervation tongue

A

Sensation: V, VII (taste ant 2/3), IX (taste post 1/3)
Movement: XII

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8
Q

Innervation carotid body, arch, sinus

A

CN IX: carotid body and sinus chemo and baro

CN X: cartoid arch chem and baro

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9
Q

Lateral corticospinal tract

A

Movement contralateral limbs

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10
Q

Dorsal column

A

Fine touch, vibration, conscious proprioception

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11
Q

Spinothalamic

A

Pain, temperature (crosses at level of spinal courd)

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12
Q 
Clinical reflexes: 
Biceps
Triceps
Patella
Achilles 
Babinski
A 
Biceps: C5, 6
Triceps: C7,8
Patella: L3,4
Achilles: S1,2
Babinski: UMN, normal first year
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13
Q

Presents with: Aphasia or neglect, contralateral paresis and sensory loss face and arm, gaze towards lesion, homonymous hemianopsia

A

MCA infarct

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14
Q

Presents with: Contralateral paresis and sensory loss in leg, cognitive or personality changes

A

ACA infarct

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15
Q

Presents with: Homonymous hemianopsia, memory deficit, dyslexia/alexia

A

PCA infarct

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16
Q

Presents with: Coma, “locked in” syndrome, CN palsies, apnea, crossed weakness and sensory loss of face/body

A

Basilar artery infarct

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17
Q

Presents with: Pure motor or sensory stroke, dysarthria-clumsy hand syndrome, ataxic hemiparesis

A

Basal ganglia lacunar infarct

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18
Q

Imaging for stroke

A

Emergent CT without contrast (rule out bleed)

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19
Q

Mnemonic: 4Ds of posterior circulation strokes

A

Diplopia
Dizziness
Dysphagia
Dysarthria

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20
Q

When can tPA and intraarterial thrombolysis be administered?

A

tPA: within 3 hrs

intraarterial thrombolysis: within 6 hrs

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21
Q

What can decr morbidity mortality within 48hrs of stroke

A

ASA

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22
Q

Treatment if incr ICP after stroke

A

Mannitol, hyperventilation

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23
Q

Target INR for AF and prosthetic valve

A

AF: INR 2-3

Prosthetic valve: INR 3-4

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24
Q

Drug for long term prevention after stroke

A

ASA, clopidogrel

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25
Q

Presents as: abrupt-onset, intensely painful thunderclap headache: dx, etiologies

A

SAH

Trauma, berry aneurysm, AVM

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26
Q

When is carotid endarterectomy indicated?

A

> 60% in symptomatic
70% in asymptomatic
contraindicated in 100% occlusion

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27
Q

What is associated with CNIII palsy with pupillary involvement

A

Berry aneurysm

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28
Q

What are first or second diagnostic procedures if SAH suspected?

A
  1. CT without contrast

2. If neg, LP (Look for RBC, xantochromia)

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29
Q

Complications after SAH and prevention

A

Vasospasm: 5-7 days after, Ca channel blockers
Rebleeding: keep BP

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30
Q

Definitive treatment for cerebral aneurysm

A

Surgical clipping

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31
Q

What imaging if intracerebral hemorrhage suspected

A

Noncontrast CT- look for mass effect or edema to predict herniation

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32
Q

Subdural vs Epidural: etiology and appearance

A

Subdural: rupture of bridging vein; elderly and alcoholic; Crescent shape
Epidural: tear of middle meningeal artery, skull fracture; concave/lens shape

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33
Q

Presents as trauma then lucid interval followed by altered consciousness

A

Epidural hematoma

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34
Q

Treatment of epidural hematoma

A

Emergent neurosurgical evacuation

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35
Q

What compressed in cingulate herniation

A

Frontal lobe

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36
Q

What compressed and symptoms transtentorial herniation

A

Midbrain

Rapid change mental status, Bilaterally small reactive pupils, cheyne-strokes, flexor-extensor posturing

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37
Q

Presents as Rapid change mental status, Bilaterally small reactive pupils, cheyne-strokes, flexor-extensor posturing

A

Transtentorial herniation (compression midbrain)

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38
Q

What compressed and symptoms uncal herniation

A 
CNIII entrapped (down and out pupil)
Cerebral peduncle: ipsilesional hemiparesis
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39
Q

What compressed and symptoms cerebellar tonsillar herniation herniation

A

Medullary compression

respiratory arrest

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40
Q

What aspects of new headache are concerning? How work up?

A

Abrupt onset: CT and LP, r/o SAH

Focal neuro deficits: CT or MRI

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41
Q

Presents with headache, jaw claudication

A

Temporal arteritis

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42
Q

Abortive therapy vs prophylaxis for migraines

A

Abortive: Triptans, metoclopramide (after NSAID fail)
Ppx:Anticonvulsant (gabapentin, topiramate), TCAs, bblock, CCBs

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43
Q

What headache location is concerning?

A

Posterior headache (esp children)

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44
Q

Typical headache length for migraine?

A

> 2, 72hr

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45
Q

Presents as headache, orbital pain, edema, diplopia, fever: dx and etiology

A

Cavernous sinus thrombosis

etiology: Septic thrombosis of cavernous sinus, esp S. aureus

46
Q

Diagnostic studies cavernous sinus thrombosis

A

CBC, blood culture, LP, MRI (with gad, MR venogram)= confrmatory

47
Q

Treatment cavernous sinus thrombosis

A

penicillinase-resistant penicillin (nafcillin, oxacillin)

3rd or 4th gen cephalosporin (ceftriaxone, cefepime)

48
Q

What serum marker is consistent with epileptic seizure?

A

Incr prolactin

49
Q

Simple vs complex partial seizures

A

Simple: No loss of consciousness

50
Q

Evaluation of focal seizure

A

EEG

MRI or CT to rule out focal lesion

51
Q

Treatment of acute seizure

A

> 2 min

IV benzo, phenytoin

52
Q

What are 2 hallmarks of tonic-clonic seizure

A

incontinence, tongue biting

53
Q

How long do tonic-clonic seizures typically last?

A

1-2min

54
Q

First line anticonvulsant for partial seizure, children

A

Phenobarbital

55
Q

EEG findings tonic-clonic seizure

A

10hz during tonic phase, slow waves clonic phase

56
Q

Treatment for primary tonic-clonic seizure

A

Phenytoin

57
Q

EEG and findings absence seizure

A

2hz spike and wave discharges

ethosuximide (valproic acid= second line)

58
Q

Definition and dx workup of status epilepticus

A

lasts > 10 min or repetitive without return to baseline consciousness
EEG, head CT (rule out intracranial hemorrhage)

59
Q

Treatment for status epilepticus

-Initial + if continues

A

Thiamine, glucose, naloxone
IV benzodiazepine, loading dose fosphenytoin
If continues: intubate + phenobarbital

60
Q

Presents as tonic, bilateral, symmetric jerks of head, trunk and extremeties in clusters within 6mo

A

West syndrome (infantile spasm)

61
Q

Diagnostic maneuver for BPPV, maneuver to resolve

A

Dix-Hallpike (turn head + sit to supine)- reproduce nystagmus
Epley: resolve

62
Q

Presents as recurrent episodes of severe vertigo, hearing loss, tinnitus, ear fullness: dx and tx

A

Menieres

Low-sodium diet, diuretic

63
Q

Vertigo- characteristics concerning for central lesion

A

last >1 min, gait disturbance, nausea vomiting out of proportion to nystagmus

64
Q

Presents as acute onset of severe vertigo, head-motion intolerance, gait unsteadiness with nausea, vomiting, nystagmus

A

Acute peripheral vestibulopathy (labyrinthitis, vestibular neuritis)

65
Q

What stroke mimics labyrinthitis

A

lateral pontine/ cerebellar: AICA territory

66
Q

Treatment of Acute peripheral vestibulopathy

A

corticosteroids within 72hrs

67
Q

Workup for syncope

A

telemetry to rule out arrhythmia
ECG and cardiac enzymes to rule out MI
EEG to rule out seizure

68
Q

Presents as fluctuant fatiguable ptosis or double vision, proximal muscle weakness: dx and tx

A

Myasthenia gravis
Edrophonium: anticholinesterase leads to rapid improvement
Ice test
EMG
Tx: Anticholinesterase (pyridostigmine), Prednisone

69
Q

Etiology of myasthenia gravis, associated disorders

A

Postsynaptic Ach Receptor antibodies

+ thyrotoxicosis, thymoma

70
Q

Drugs to be avoided in myasthenia gravis

A

abx (eg aminoglycosides)

b blockers

71
Q

Malignancy associated with lambert-eaton

A

Small cell lung carcinoma

72
Q

Etiology of Lambert-Eaton

A

Antibodies against presynaptic calcium channel of NMJ

73
Q

Diagnosis and tx of Lambert-Eaton

A

Dx: Incremental response after repetitive nerve stimulation
Tx: 3,4-diaminopyridine or guanidine; corticosteroids and azathioprine

74
Q

What is radiologic characteristic of MS?

A

Enhance with gadolinium

75
Q

Therapy for MS:

  • Acute exac
  • First line
  • Second line
A

Acute exac: corticosteroids
First line: immunomodulators: ifnb (avonex, betaseron), copolymer (copaxone)
Second line: Natalizumab, Mitoxantrone

76
Q

CSF and tx for GBS

A

CSF protein >55mg/dL, little or no pleocytosis

plasmapheresis or IVIG

77
Q

Treatment for ALS

A

Riluzole

78
Q

Characteristic onset of vacular dementia

A

Abrupt

79
Q

EEG findings show pyramidal signs, periodic sharp waves

A

CJD

80
Q

What should be ruled out for alzheimers?

A

Depression
Hypothyroidism
Vit B12 def
Neurosyphilis

81
Q

Treatment alzheimers

A 
Cholinesterase inhib (donepizil, rivastigmine, galantamine, tacrine)
NMDA Rec antag (Memantine)
82
Q

Pick’s disease: typical presentation and imaging

A

Significant early changes in behavior and personality

Atrophy of frontal and temporal lobes

83
Q

Presents with dementia, gait apraxia, urinary incontinence (disease + etiology)

A

NPH- impaired CSF outflow

84
Q

Presents as subacute dementia with ataxia or startle-induced myclonic jerks: dx and workup

A

CJD

CSF 14-3-3 and tau protein

85
Q

Presents with chorea, altered behavior, dementia: dx, area affected, tx

A

Huntington
Caudate and putamen
Reserpine or tetrabenazine for movement, SSRI for depression

86
Q

Parkinson’s tetrad

A

Resting tremor
Rigidity
Bradykinesia
Postural instability

87
Q

Etiology of Parkinson’s

A

Dopamine depletion of substantia nigra

88
Q

NPH vs parkinson’s

A

NPH- preservation of arm swinging

89
Q

Treatment of parkinson’s

A 
Levodopa/carbidopa
Dopamine agonist
Selegiline (MAO-B inh)
COMT inhibitors
Amantadine
90
Q

Most common primary locations of brain metastases

A 
Lung
Breast
Kidney
GI
Melanoma
(Lung and Skin go to the BRain)
91
Q

Presents with ipsilateral tinnitus, hearing loss, vertigo

A

Acoustic neuroma

92
Q

Suprasellar tumor in children, typical presentation

A

Craniopharyngioma- typically calcified

93
Q

Medulloblastoma vs Ependymoma (Grade and location)

A

Both typically arise 4th vent
Medulloblastoma- highly malignant
Ependymoma- low grade

94
Q

Workup for neurofobromatosis

A

MRI brain, brainstem, spine with gad

Optho, derm, auditory testing

95
Q

Malignancy associated with NFI

A

optic glioma

96
Q

Presents with convulsive seizures, ash leaf lesions, mental retardation

A

Tuberous sclerosis

97
Q

Workup for Tuberous sclerosis

A 
Head CT (calcified tubers, malignant astrocytoma)
ECG (Rhabdomyoma)
Renal ultrasound
Renal CT
CXR (pulm lesions, rhabdo)
98
Q

Treatment of seizures in tuberous sclerosis

A

oxcarbazepine or carbamazepine

99
Q

Broca vs Wernicke aphasia (symptom and location)

A 
Broca= expressive aphasia, posterior inferior frontal gyrus
Wernicke= receptive aphasia, left posterior superior temporal gyrus
100
Q

Etiology of broca and wernicke aphasia

A

Broca: L superior MCA stroke
Wernicke: L inf/post MCA stroke

101
Q

What is the area of dysfunction for coma?

A

Bilateral dysfunction both cerebral hemispheres or brainstem (pons or higher)

102
Q

Presents as symmetric paresthesias, stocking-glove sensory neuropathy, leg stiffness, spasticity, paraplegia, bowel and bladder dysfxn, sore tongue

A

B12 deficiency

103
Q

Presents as encephalopathy, ophtalmoplegia, ataxia

A

Wernicke encephalopathy (thiamine)

104
Q

Upper vs Lower quadrantic anopsia location

A

upper: contralateral temporal lesion (Meyer’s loop)
Lower: Contralateral parietal lesion (dorsal optic radiation)

105
Q

Presents with painful eye, hard read eye, dilated nonreactive pupil

A

Closed-Angle glaucoma

106
Q

Location closed vs open angle glaucoma

A

Closed: Iris and lens push together, disrupts flow to ant chamber
Open:Limited flow through trabecular meshwork

107
Q

Presents with gradual loss perpipheral vison, frequent need for lens changes, cupping of optic nerve head

A

Open angle glaucoma

108
Q

Treatment Closed-angle glaucoma vs open angle glaucoma

A 
Closed: Eye drops (timolol, pilocarpine, apraclonodine)
Systemic (acetoxolamide, mannitol)
Laser peripheral iridotomy
Open:
topical b-blocekers
carbonic anydrase inhib
109
Q

Presents with painless loss of central vision

A

macular degenration

110
Q

Atrophic vs exudative AMD treatment

A

Atrophic: no treatment, Vit E
Exudative: VEGF inhib, photodynamic therapy

111
Q

Presents with painless, unilateral blindness; sluggish pupil, cherry-red spot on fovea

A

Central retinal artery occlusion

112
Q

Treatment of Central retinal artery occlusion vs central venous

A

Arterial: Intra-arterial thrombolysis within 8h
Venous: laser photocoagulation

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