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3rd Year > Neurology > Flashcards

Neurology Flashcards

1
Q

Metastases to brain by incidence

A

Lung (80% and multiple lesions) > Breast (single lesion) > melanoma (multiple lesion) > colon (single lesion)

prostate is exceedingly rare
**If single lesion, standard of care is to resect

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2
Q

Amaurosis fugax

A

painless loss of vision in eye from emboli. “curtain coming over eye”

Impending risk of TIA/Stroke. Most emboli from carotid bifurcation -> test with duplex US of neck

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3
Q

strabismus

A

improper alignment of eyes

disorder of EOM or of CN III/IV/VI

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4
Q

Febrile Seizure age range

A

6mo-6years

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5
Q

Does the use of antipyretics reduce the incidence of febrile seizures?

A

No it does not (more specifically it doesn’t reduce the recurrence rate of febrile seizures in those known to have them).

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6
Q

Normal cup to disk ratio?

pathologic?

A

.3 is avg, up to .5 physiologic

> .5 ratio = pathologic
often indicative of glaucoma

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7
Q

dysarthria

A

motor speech disorder

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8
Q

aphasia

A

difficulty with language (production or understanding)

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9
Q

multiple OILY cysts in sella turcica, bitemporal hemianopsia,

A

craniopharyngeoma from rathke’s pouch

more common in children, but bimodal distribution with increased incidence again in 50’s-60’s

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10
Q

meningismus triad

A

headache, photophobia, nuchal rigidity

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11
Q

perivascular cuffing

A

accumulation of lymphocytes densely around vessel, an indicator of inflammation.

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12
Q

Bulbar symptoms

A

refers to medullary CN’s 9,10,11,12

  • dysphagia (difficulty swallowing)
  • dysarthria
  • spasticity of tongue or weakness
  • ect

-in ALS, often starts with bulbar and progresses to involve other CN’s

ddx; ALS, Myasthenia Gravis, botulism, infarct, guillan-barre…

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13
Q

Area postrema

A

A circumventricular region of brain (no BBB)
A spot on the posterior medulla that receives sensory input and largely controls vomiting through autonomic processes.

  • ICP can stimulate the area postrema
  • samples blood for toxins/noxious substances
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14
Q

how to find mastoiditis?

A

May see fluid accumulation in mastoid air cells on CT and MRI

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15
Q

1st unprovoked seizure

-workup

A
  • MRI/CT
  • consider EEG

If unsure

  • tox screen
  • metabolite screen

#

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16
Q

triad of brain abscess

A

Fever, focal neurologic defects, headache (nighttime/morning = mass effect headache)

  • seizure initial presentation in 25%
  • temporal/parietal
  • frontal/ethmoid sinusitis -> frontal
  • dental infection -> frontal
  • bacteremia -> multifocal gray/white junction
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17
Q

indolent

A

disease with slow progression

or a slow healing (indolent ulcer, indolent

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18
Q

neuroimaging findings

Autism
OCD
Panic Disorder
PTSD
Schizophrenia
A

Autism: increased total brain volume
OCD: orbitofrontal cortex and striatum
Panic Disorder: Decreased amygdala volume
PTSD: decreased hippocampal volume
Schizophrenia: increased cerebral ventricle volume (esp. lateral)

*Routine imaging not done for known psychiatric disorders, other than to rule out other organic causes

**amygdala: emotional learning, memory modulation (esp tied to emotions), olfactory memory. They are medial nuclei in basalar temporal lobe.

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19
Q

dysmetria

A

dysmetria = “wrong length”

lack of coordination of range in movement (typified by undershoot or overshoot)

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20
Q

manage alzheimer’s

A

1st: acetylcholinesterase inhibitors: donepezil (Aricept), rivastigmine (Exelon), galantamine (Razadyne)

# Vitamin E
# memantine (NMDA receptor antagonist). USED IN MODERATE TO SEVERE DEMENTIA
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21
Q

Multiple System’s Atrophy

Shy-Drager Syndrome + olivopontocerebellar atrophy + striatonigral degeneration

A

Degenerative Disease with

1) Parkinsonism
2) Autonomic dysfunction (orthostatic hypotension, abnormal sweating/bowel/saliva, impotence…)
3) Widespread neurologic signs (cerebellar, UMN, LMN)

# bulbar symptoms also occur and can be fatal
#anti-parkinson drugs are not effective
  • *cognitive function relatively well preserved
  • ** alpha synuclein present
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22
Q

parkinson’s tx

A

EARLY

Dopamine Agonists: Bromocriptine ergot replaced by nonergot’s: pramipexole, ropinirole, rotigotine

MAO-B inhibitors: selegiline/rasagiline; prevent dopamine breakdown centrally and provide symptomatic (possible disease modifying) as monotherapy.

COMT inhibitors: entacapone and tolcapone:

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23
Q

pramipexole

A

Dopamine Agonist used in parkinsonism and RLS

*less prone to promote dyskinesia than levodopa

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24
Q

ropinirole

A

Dopamine Agonist used in parkinsonism

*less prone to promote dyskinesia than levodopa

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25
Q

rotigotine

A

Dopamine Agonist used in parkinsonism

*less prone to promote dyskinesia than levodopa

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26
Q

Selegiline

A

MAO-B inhibitor centrally acting for parkinsons. prevent dopamine metabolism. may have some disease modifying effects

**MAO-Ai’s are in the gut and associated with htn and tyramines. MAO-Bi’s are not assoc with this at standard doses.

***Selegeline may has some MAO-Ai at higher doses

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27
Q

rasagiline

A

MAO-B inhibitor centrally acting for parkinsons. prevent dopamine metabolism. may have some disease modifying effects

**MAO-Ai’s are in the gut and associated with htn crisis and tyramines. MAO-bi’s are not assoc with this at standard doses.

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28
Q

entacopone

tolcapone

A

COMT inhibitors: in presence of carbidopa (decarboxylase inhibitor), COMT becomes major metabolizer of dopamine… so these inhibit that and increased levodopa

**action primarily in periphery

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29
Q

Stalevo

A

combo tablet

levodopa, carbidopa, entacapone

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30
Q

semiology of mesial temporal seizures

A

A SYNDROME
Most common focal epilepsy syndrome. Often arises from near/within hippocampus. associated with hippocampal sclerosis on MRI. often impaired consciousness

aura: rising epigastric sensation, deja vu, fear, jamais ju
(being in a situation you have before but not really recognizing it)

automatisms (usually same side as seizure): stereotyped lip smacking, picking with hands.

vs dystonic posturing is often contralateral to lesion

**Often refractory to anticonvulsants but responds well to surgical intervention

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31
Q

focal seizure vs stroke lesion eyes

A

look away from the light (frontal lobe seizure)
look toward the lesion (stroke)

**UNLESS Thalamic lesion; look away from lesion

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32
Q

frontal lobe seizure semiology

A

+- impaired consciousness

eyes look away from lesion (not head)

hemiclonic: isolate muscle movement -> may jacksonian march

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33
Q

how much of dementia does multi-infarct dementia account for?

A

15-20%

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34
Q

what happens to the sella turcica in 70% of people with idiopathic intracranial hypertension (IIH/pseudotumor cerebri)?

A

The sella turcica becomes flattened -> empty sella on MRI

**ventricles are often shrunk

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35
Q

bilateral acoustic neuromas and cataracts

A

neurofibromatosis type 2

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36
Q

multiple areas of T2 weighted periventricular hyperintensities

(not time/space)

A

multiple infarct dementia

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37
Q

anterior (ventral) ventral cord syndrome s/s and cause

A

this is your anterior spinal artery occlusion with distal paresis/UMN signs/loss pain/temp

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38
Q

hyperextension injury in setting of pre-existing degenerative changes (spondylosis) of cervical spine

A

central cord syndrome (CCS)

involves bilateral paresis of arms (more medial) and decussating fibers of spinothalamic tract (pain/temp) in a dermatome or three

*syringomyelia can also cause this

**cervical spondylosis causes may cause progressive narrowing of central canal, but may be asymptomatic before trauma

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39
Q

retinal hemorrhage in an infant

A

nearly pathognomonic sign of abusive head trauma (shaken baby with subdural venous tearing)

*caused by vitreoretinal traction

40
Q 
#appears in early adolescence
#bilateral/unilateral muscle jerks (single or repetitive)
#most often occurs in morning
#1/3 have had absence seizures, many have had tonic-clonic seizures
A

Juvenile Myoclonic epilepsy SYNDROME

generally responds well but incompletely to antiepileptics

genetic studies suggest polygenetic heritable cause

precipitate by sleep deprivation

41
Q

Lennox-gastaut syndrome

A

SYNDROME

Triad:

1) multiple seizure types
2) EEG

42
Q

atypical absence seizure

A
  • lasts longer

- slow spike/wave

43
Q

uncus importance

  • seizures
  • herniation
A

ipsilateral hemiparesis from contralateral (prior to decussation) compression of crus cerebri(the anterior part of cerebral peduncle containing motor fibers)

-seizures originating in uncus often have an unpleasant smell/odor aura

- mass effect will cause TRANSTENTORIAL herniation 
#ipsilateral CN III compression. early parasympathetic loss (mydriasis). Late eom -> down and out gaze
44
Q

PRNP gene

A

prion protein gene test

**s/s rapidly progressive dementia and myoclonus

45
Q

dysdiadochokinesia

A

inability of ROM

  • cerebellar lesion sign
  • may be cerebral sign too
46
Q

brachioradialis reflex

A

C5/C6 - > supination and flexion of forearm

47
Q

common locations hypertensive intracranial bleeds

A

Basal ganglia: most common

**s/s appear early focal -> diffuse later vs ischemic =abrupt and maximal at onset

48
Q

cancer risk CT by age

A

1: 1500 @ 1y/o
1: 5000 @ 10y/o

49
Q

proptosis

A

=exophthalmos
bulging of eyes anteriorly

…graves or hypothyroidism

50
Q

cluster headache

A 
#men > women
#repetitive headaches weeks -> months
#often occur same time every day... possible circadian hypothalamus problem

Tx;

1st) 100%O2
alternate:
- sumitriptan
- indomethicin, nsaids

*verapamil as prophylaxis, as is lithium

51
Q

friedricks ataxia

A 
progressive, autosomal recessive GAA trinucleotide disorder
#wheelchair by 25
#death 30-35
#*abnormal tocopherol transfer protein (frataxin)

s/s cardiac, ataxia, nystagmus, hammer toes, hypertrophic cardiomyopathy (cause of death), pes cavus (high arch)

52
Q

where will a pure motor deficit occur involving same side of face, upper/lower extremities?

A

posterior limb internal capsule

53
Q

hepatosplenomagally (protuberant abdomen), cherry red spot, areflexia

A 
niemann-Pick disease
#Sphingomyelinase deficiency
#autosomal recessive
#2-6mo age of onset
#regression (loss of motor milestones), hypotonia, feeding difficulties
#nearly universally fatal by 3yo
54
Q

cherry red spot, hyperreflexia, normal spleen/liver

A 
Tay-Sachs disease
#hexosaminidase A deficiency
#autosomal recessive
#age of onset 2-6 mo
#motor regression, hypotonia, feeding difficulties
55
Q

regression, hypotonia, areflexia

no cherry red spot, no hepatomegally

A 
Krabbe's disease (galactocerebrosidase deficiency)
#aut recessive
#lysosomal storage disease
#blindness
#deafness
56
Q

glucocerebrosidase deficiency

A 
Gaucher's disease
#anemia
#thrombocytopenia
#hepatosplenomegally
#NO REGRESSION
57
Q

is ckd a risk factor for cvd?

A

yes

58
Q

what dementia shows relatively early primitive reflexes

A

frontotemporal dementia

  • grasp reflex
  • snout reflex
59
Q

vascular dementia accounts for what % of dementia?

A

15-20%

60
Q

topiramate (topomax)

A

blocks V gated Na channels and enhances GABA(A)
USE:
epilepsy (and other seizure disorders)

*ET,

61
Q

Primidone

A

MOA: reduces neuron excitability…

Seizures, ET(off label)

62
Q

anterior dislocation of the shoulder damages what nerve?

A

axillary -> paralyze deltoid/teres minor, lose lateral sensation upper arm

63
Q

radial nerve injury

A

fx humeral shaft

-> wrist drop + sensory loss dorsal arm/forearm/lateral dorsum of hand

64
Q

ulnar nerve injury

A

medial epicondyle fx of humerous or deep laceration anterior wrist

-> claw hand (4th/5th digits), medial sensory loss of hand palmar/dorsum

65
Q

musculocutaneous nerve

A

Not frequently injured by trauma

innervates
biceps
brachialis (under biceps)
coracobrachialis

66
Q

tolterodine

A

anti-muscarinic

USE: overactive bladder, urgency, urge incontinence

67
Q

amitryptaline

A

used for prophylaxis of migraines, not for aborting
**other prophylaxis: topiramate, valproic acid, CCB, beta blockers,

abort

  • NSAIDS
  • triptans (ie sumatriptan and others) can abort, but must be given early in migraine

-chlorpromazine, prochlorperazine, metoclopramide are all antiemetics that also decrease pain in migraines

68
Q

diagnosis of migraines

A 
#repeated headache 4-72hrs duration
#normal physical exam
#no other cause

2+ of Unilateral pain, throbbing pain, aggravated by movement, moderate/severe intensity

PLUS
1+ of
nausea/vomiting or photophobia and phonophobia

69
Q

fair complexion, musty mousy odor, intellectual disability, eczema

A

phenylketonuria (ARecessive) from phenylalanine hydroxylase deficiency (no phenylalanine -> turosine)

Tx; low phenylalanine diet

70
Q

aldolase B deficiency

A

Hereditary fructose intolerance, accumulation of F1P

s/s
1st vomiting, lethargy, poor feeding —->
2nd seizure and encephalopathy

71
Q

classic galactosemia

A

Autosomal recessive
galactose 1 phosphate uridyltransferase deficiency, accumulation of Galactose-1-P -> galactilol

s/s first few days -> jaundice, hepatomegaly, failure to thrive with breast milk

–> continues to involve infantile cataracts (galactilol accumulates in lense of eye), mental disability

Tx; exclude galactose and lactose (glucose + galactose)

72
Q

congenital hypothyroidism s/s

A

high TSH

  • large fontanelles, failure to thrive, hypotonia
  • NOT assoc with seizures/vomiting
73
Q

momentary vision loss on change in head position

A

papilledema (can also increase blind spot)

74
Q

uvea
anterior?
posterior

A

anterior: iris and ciliary body
posterior: choroid

75
Q

what drug may cause oscillopsia?

A

aminoglycosides through disruption in vestibulo-occular reflex -> oscillating objects with abnormal head thrust (the fixd gaze test)

76
Q

pulsatile headache, whooshing tinnitus, papilledema, visual field defect, CN palsy (esp VI)

A

pseudotumor cerebri (idiopathic intracranial hypertension)

77
Q

pseudotumor cerebri medication associations

A

isotretenoin (vit A excess), tetracycline, growth hormone

withdrawal of medication usually resolves symptoms

78
Q

clozapine

A

2nd generation gold standard for TREATMENT RESISTANT schizophrenia used after failing 2 other antipsychotics

SE: agranulocytosis

79
Q

clozapine

A

-pine = atypical antipsychotic
MOA: complicated; anti dop, antiadren, antiserotonin
USE: schizo(helps + and - symptoms), bipolar, ocd,

SE: *agranulocytosis (weekly WBC monitoring), seizures; less EPS and antichoinergic than traditionals

olanzapine is another atypical, as is risperidone

**Clozapine is the gold standard for TREATMENT RESISTANT schizophrenia, must fail 2 antipsychotics prior to use

80
Q

risperidone- Risperdal

A

atypical antipsychotic

SE: less extrapyramidal and anticholinergic

81
Q

olanzapine- Zyprexa

A

atypical antipsychotic

SE: less extrapyramidal and anticholinergic

82
Q

quetiapine- Seroquel

A

atypical antipsychotic

SE: less extrapyramidal and anticholinergic

83
Q

aripiprazole- Abilify

A

atypical antipsychotic

SE: less extrapyramidal and anticholinergic

84
Q

ziprasidone - Geodon

A

atypical antipsychotic

SE: less extrapyramidal and anticholinergic

85
Q

paliperidone - Invega

A

atypical antipsychotic

SE: less extrapyramidal and anticholinergic

86
Q

extrapyramidal side effects antipsychotics

A

MORE in TYPICALS
hrs: acute dystonia (muscle spasm, stiffness, oculogyric crisis(upward deviation of eyes)

days: akathisia (restless)
wks: bradykinesia (parkinsonism), resting tremor
months: tardive dyskinesia )smack lips, stereotyped facial movements

87
Q

chlorpromazine

thioridazine

A

-zine = traditional low potency neuroleptics
low potency antipsychotics (neuroleptics)
-high anticholinergic SE
-antidopaminergic (D2) in mesolimbic area
-antiadrenergic

USE: Schizo

**every other traditional neuroleptic is high potency with fewer anticholinergic SE, but increased extrapyramidal effects/tardive dyskinesia

“Cheating Thieves are LOW”

88
Q

High potency traditional neuroleptics (3)

A

“Try Fly High”
trifluoperazine
fluphenazine
haldol

MOA: anti D2 receptor

antipsychotics, mostly of positive symptom control

SE: Extrapyramidal rxn

89
Q

neuroleptic malignant syndrome

A

from traditional antipsychotics
rigidity, myoglobinuria, autonomic instability(tachycardia), hyperpyrexia, rhabdomyolisis

tx; dantrolene or d2 agonist

90
Q

vermilion border

A

the upper lip border btw kerotinized skin and lip (less kerotinized)

91
Q

philtrum

A

the slit/groove btw nose and lip

92
Q

fetal alcohol syndrome facial dysmorphisms

A

1) thin vermillion border (upper lip)
2) lack of philtrum
3) small palpebral fissures (width of opening of eyelids

*often microcephaly, cognitive, behavioral problems

93
Q

migraines in children note

A

often bifrontal and shorter duration

94
Q

tick borne paralysis

A

arises from neurotoxin release, takes 4-7 days for its sufficient release. Must search person for tick.

May appear like GBS, but won’t have CSF protein (found in 90% of GBS by 1 week). Also occurs over hours vs days/weeks with GBS

Tx; removal of tick usually results in spontaneous recovery

95
Q

alexia

A

cannot understand written word

96
Q

agraphia

A

lack of ability to communicate through writing (motor or understanding)

97
Q

gabapentin

A

MOA: structurally similar to GABA, but binds voltage gated calcium channels.

USE: Peripheral neuropathy, 2nd line for RLS

3rd Year (4 decks)

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