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Neurology Flashcards

1
Q

Herniation. Rapid change in mental status. Bilateral small and reactive pupils. Cheyne-stoke respiration. Flexor or extensor posturing

A

Downward transtentorial (central) herniation

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2
Q

Herniation. Fixed and dilated ipsilateral pupil followed by ‘down and out’ pupil. Ipsilateral hemiparesis (false localizing).

A

Seen with epidural hematoma. Uncal herniation. Mass lesion in middle fossa. Fixed pupil due to CN III become entrapped. False localizing due to compression of cerebral peduncles (opposite the mass lesion ) against tentorial edge.

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3
Q

Herniation. Medullary compression -> respiratory arrest. Rapidly fatal.

A

Cerecellar tonsillar herniation into for amen magnum

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4
Q

What hormone is elevated in the immediate post ictal period

A

Prolactin

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5
Q

Infantile spasm (west syndrome)

A

Form of generalized epilepsy usually secondary to other conditionp (eg PKU). Presents with bilateral symmetric jerks of the head , trunk and extremities in clusters of 5-10. Arrest of psychomotor development at age of seizure onset. treat with ACTH, prednisone and clonazepam or valproate to help spasms. No impact on prognosis

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6
Q

Lennox Gastaut syndrome

A

Childhood onset epilepsy. Treatment resistant. Multiple seizure per day, usually nocturnal. Associated with mental retardation, behavior disorder and delayed psychomotor development. Treatment resistan

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7
Q

What medication is contraindicated in BPPV?

A

Antivertigo medications such as meclizine because they inhibit central compensation, which may lead to chronic unsteadiness

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8
Q

Labyrinthitis vs vestibular neuritis

A

Both are acu onset of sever vertigo, head motion intolerance and gait instability with n/v and nystagmus. With auditory or aural symptoms it is called Labyrinthitis, without it is called vestibular neuritis.
Usually presents in people one week after viral infection.
Usually presents with abnormal vestibuloocular reflex. Has a predominantly horizontal nystagmus that always beats in one direction, Opposite the lesion

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9
Q

Menieres dz

A

Recurrent vertigo with auditory symptoms with last for hours to days. Patient progressives loses low frequency hearing over years.
Txt with low sodium diet and diuretics.

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10
Q

Vestibular migraine

A

Recurrent vertigo without auditory symptoms. Affects 10% of ppl with migraines. Basically menieres dz without auditory symptoms. Can be prevented with migraine medication.

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11
Q

Drugs used to slow mild to moderate alziehmers

A 
Cholinesterase inhibitors (donepezil, rivastigmine, galantamine, tacrine)
Tacrine is used less often because it is associated with hepatotoxicity
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12
Q

Drugs used to slow advanced alziehmers

A

Memantine (NMDA receptor antagonist )

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13
Q

Elevates CSF markers of CJD

A

Protein 14-3-3 and tau protein

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14
Q

Startle induced myoclonus jerks associate with rapid cognitive decline (over weeks - month)

A

CJD

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15
Q

Chorea, altered behavior, and dementia. With strong family history

A

Huntington dz. you see atrophy of caudate and putamen)

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16
Q

Treatments to minimize unwanted movements in Huntington dz

A

Reserpine or tetrabenzine

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17
Q

Herniations. Non specific signs

A

Cingulate

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18
Q

Medulloblastoma?

Arises from which anatomical structure?

A

Most common brain neoplasm in children.

Arises from the 4th ventricle and cause increased icp due to obstruction

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19
Q

Drainage of aqueous humor of eye

A

Produced by ciliary body on iris, travels through pupil -> anterior chamber -> trabecular mesh work in the angle of the anterior chamber. Disruption leads to increased ocular pressure, glaucoma

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20
Q

Open vs closed angle glaucoma

A

Open is more Common.
Closed occurs when iris dilates and pushed against lens, disrupting flow of humor to anterior chamber. Presents with dilated, non reactive eye. Extreme eye pain, blurred vision, hard and red eye. MEDICAL EMERGENCY. Treat with timolol, pilocarpine, acetazolamide, mannitol. Laser iridotomy. AVIOD PUPIL DILATORS SUCH AS ATROPINE.
Open occurs when flow through trabecular meshwork is impaired. You see cupping of optic nerve head on optho exam. Less painful. Gradual increase in intra ocular pressure and progressive vision loss. Treat with topical bblocker (timolol, betaxolol) to reduce production or pilocarpine to increase outflow.

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21
Q

Manifestation of basilar stroke

A

Locked in syndrome
cranial nerve palsy
Drop attacks, dysphasia, dysarthria, vertigo
Crossed weakness and sensory loss affecting ipsilateral face and contralateral body

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22
Q

Manifestations of basal ganglia lacunar strokes

A

Pure motor (posterior limb of internal capsule)
Pure sensory (contralateral thalamus VPL)
dysarthria clumsy hands syndrome; (anterior limb)
ataxia hemiparesis (posterior limb)
Mixed motor/sensory thalamus and adjacent posterior limb

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23
Q

Gaze preference with cortical stroke

A

Gaze preference toward side of the lesion

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24
Q

Indications for carotid endarterectomy

A

Stenosis greater than 60% in symptomatic patients or greater than 70% in asymptomatic patients
contraindicated in 100% percent occlusion

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25
Q

Single greatest respect for stroke

A

Hypertension

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26
Q

Cranial nerve palsy associated with Berry aneurysms

A

Cranial nerve three palsy with pupillary involvement

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27
Q

Timing for LP in the setting of subarachnoid hematoma

A

First attempt CT without contrast if CT is negative perform LP
LP can be falsely negative and first 6 to 12 hours (not developed) and first 24 to 28 hours (resolved )

28
Q

Classic versus common migraine

A

classic: unilateral and preceded by visual aura.

Common migraine: maybe bilateral and Perporbital without proceeding Ora

29
Q

Treatment for migraines

A

Trpitans; metocolopramide (and other anti-emetics such as chlorpromazine and prochlorpermaine)
Prophylaxis for frequent or severe migraines include anticonvulsants (gabapentin and topiramate), TCAs (amitriptyline), beta blockers (propranolol) and calcium channel blocker’s

30
Q

Treatment and prophylaxis for cluster headaches

A

100% O2 is the most effective and rapid treatment modality
Acute therapy: high flow oxygen, dihydroergotamine, octreotide, sumatriptan or zolmitriptan
Prophylactic therapy: transitional (prednisone, ergotamine), maintenance (verapamil, methysergide, lithium, valproic acid, topiramate)

31
Q

Most common cause of cavernous sinus thrombosis: micro organism

A

Staph aureus

32
Q

Treatment for Cavernous sinus thrombosis

A

Treat aggressively and empirically with Penicillinase resistant penicillin (nafcillin or oxacillin) plus a third or fourth generation cephalosporin (Ceftriaxone or cefepime) to provide broad coverage pending blood cultures.
Metronidazole can be added to cover anaerobes and vancomycin can be added to cover MRSA.
IV antibiotics are required for at least 3 to 4 weeks. Surgical drainage may be necessary if no response antibiotics within 24 hours

33
Q

What hormone is elevated in the immediate postictal period

A

Elevated prolactin levels

34
Q

First line for partial seizures in children

A

Phenobarbital

35
Q

EEG findings in grand mal seizures

A

10 Hz activity during tonic phase and slow waves during the clonic phase

36
Q

First line for grand mal seizures

A

Phenytoin or then valproic acid

37
Q

First and second line treatment for absence seizures

A

First line: Ethosuximide

Second line:valproic acid

38
Q

Steps in status epilepticus

A

Continual seizure activity for more than 10 minutes
First ABCs
Then administer thiamine ->glucose and naloxone for presumed potential etiologies
Give IV benzodiazepine plus a loading dose of fosphenytoin
If Seizure continues intubate and load phenobarbital

39
Q

Labyrinthitis appears similar to which stroke

A

Lateral Pontine/cerebellar stroke (a I C a territory)

40
Q

Vestibular neuritis mix with stroke

A

Lateral medullary/cerebellar stroke (PICA territory)

41
Q

Treatment of acute peripheral vestibulapathy (Labyrinthitis and vestibular neuritis)

A

Gets diffusion weighted MRI if high-risk patient

Give IV steroids

42
Q

Treatment of myasthenia gravis

A

Pyridostigmine for symptomatic treatment (get rid of MG)
Prednisones and immunosuppressants are mainstay
Plasmapheresis an IV IG for
resection of thymoma may be curative
Avoid aminoglycoside and b-blockers

43
Q

Lambert Eaton is associated with

A

Small cell lung carcinoma

44
Q

what cell line mediate multiple sclerosis

A

T-cell mediated

45
Q

Treatment for multiple sclerosis

A 
High-dose steroids in the acute setting
Interferon B (avonex, betaseron) is main treatment
Natalizumab in an effective second line therapy for caries risk of JC virus
46
Q

Causes of Guillain-Barré syndrome

A

Campylobacter, upper respiratory viral illnesses

47
Q

What treatment slows down progression of ALS

A

Riluzole

48
Q

Cause of normal pressure hydrocephalus

A

Impaired in CSF outflow from the rain

49
Q

Major difference between gait Abnormality inParkinson’s and normal pressure hydrocephalus

A

Preservation of arm swing in normal pressure hydrocephalus

50
Q

Nero transmitter abnormalities in Parkinson’s, Alzheimer’s and myasthenia gravis

A

Parkinson’s disease = dopamine deficiency
Alzheimer’s disease = acetylcholine and Norepinephrine
Myasthenia gravis = absent acetylcholine activity

51
Q

Treatment for Parkinson’s

A

Levodopa/carbidopa is the mainstay
other dopamine agonist such as (ropinirole, pramipexole, bromocriptine) can be used in early disease as well as Apomorphine ( another dopamine agonist)
Anticholinergic: trihexyphendyl and benztropine
Selegiline (MAO-B inhibitor) maybe neuroprotective and decreased need for levodopa
COMT inhibitors (entacapone or tolcapone) can help increase the availability of levodopa
Amantadine has mild antiparkinsonian activity and may improve akinesia, rigidity and tremor

52
Q

Most common sources of brain metastases

A

Mneumonic Lung and Skin Go to the BRain

Lung, skin, GI, breast, Renal

53
Q

Neuroectodermal tumor arising from the fourth ventricle in children

A

Medulloblastoma

May seed subarachnoid space. May cause obstructive hydrocephalus

54
Q

Tumor arising from ependyma of the ventricle

A

Ependymoma. May cause obstructive hydrocephalus

55
Q

Tumor arising from the suprasellar in children

A

Craniopharyngioma. Calcification is common. May cause hypopituitarism

56
Q

Café au lait spots, freckles in the axilla or inguinal area, optic glioma, Lisch nodules (pigmented iris hamartomas).

A

Neurofibromatosis 1

Chromosome 17

57
Q

Bilateral acoustic neuroma

A

Neurofibromatosis 2

Chromosome 22

58
Q

Ash leaf (hypo pigmented lesions) lesions on trunk and extremities, mental retardation, sebaceous Adenomas (small red nodules on the nose and cheeks in the shape of a butterfly) and shagreen patch (a rough papule and the lumbosacral region with orange peel consistency)

A

Tuberous sclerosis

59
Q

Iris dilates and pushes against the lens of the eye thus disrupting flow of aqueous humor into anterior chamber

A

Closed angle glaucoma. Generally occurs unilaterally
Presents with extreme Eye pain, blurry vision. Hard red eye. Eyes dilated and nonreactive
Medical emergency. Avoid pupil dilating medication such as atropine
Treat with eyedrops (Tamala, pilocarpine, apraclonidine) or systemic medications as acetazolamide or mannitol

60
Q

Diseased trabecular meshwork limiting flow of aqueous humor

Leads to gradual increase in pressure and progressive vision loss

A

Open angle glaucoma,. Generally occurs bilaterally
Seen an African-American.
You see cupping of the disc

61
Q

What’s drop foot caused by

A

L5 radiculopathy

Impingement of common peroneal nerve

62
Q

Cauda equine vs conus medullarus symptoms

A

Caudal equina compressions causes LMN signs since it come from nerve roots and conus medullarus caused both LMN and UMN signs because it is a part of the spinal cord.
Cauda equina syndrome presents as unilateral radiculopathy, Hyporeflexia ,saddle area anesthesia and asymmetric lower extremity weakness
Both are managed with emergent MRI, intravenous steroids and neurosurgery consult
Conus medullarus presents as symmetric Lower extremity weakness, hyperreflexia, perry anal anesthesia and early onset bowel and bladder dysfunction

63
Q

Nighttime akinesia of the feet feeling like there but the need to move
Diagnosis and treatment

A

Restless leg syndrome. Treat with dopamine agonist similar to those used in Parkinson

64
Q

Diagnostic testing for Duchenne’s muscular dystrophy

A

Genetic testing

not muscle biopsy

65
Q

Sudden loss of vision and presence of floaters Funduscopic exam

A

Vitreous hemorrhage usually caused by diabetic retinopathy

The fundus is usually very hard to visualize or details are not visualable

66
Q

In a migraine patient who has taken sumatriptan, what medications should be avoided and why?

A

Ergot derivatives such as (dihydroergotamine ) should be avoided
Both sumatriptan and dihydroergotamine are used as abortive for migraines. However they both cause significant vasoconstriction and thus reduce neurogenic inflammation. Together they can cause severe, prolonged vasoconstriction which can lead to HTN, MI or stroke.

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