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Step 2 CK > Neurology > Flashcards

Neurology Flashcards

1
Q

Factors that can cause/worsen idiopathic intracranial hypertension

A

GH, tetracyclines and excessive vitamin A and its derivatives (all-trans-retinoic acid, isotretinoin)

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2
Q

Initial tests to get in a patient with suspected myasthenia gravis?

A

EMG and anti-AChR antibody. If positive and the patient is

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3
Q

Level of sensation loss when it is due to spinal cord compression?

A

Typically ≥ 2 levels below the compression site.

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4
Q

What is the difference between cauda equina and conus medullaris syndrome?

A

Cauda equina has asymmetric, radiating pain with hyporeflexia and late onset bowel/bladder dysfunction.

Conus medullaris has symmetric back pain, hyperreflexia and early onset bowel/bladder dysfunction.

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5
Q

Central cord syndrome

A

Commonly seen with forced hyperextension (whiplash) and presents with burning pain, upper extremity paralysis and lower extremity sparing.

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6
Q

Most common CNS site of hypertensive hemorrhage

A

Putamen

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7
Q

Lambert-Eaton treatment

A

Plasmapheresis and immunosuppresion

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8
Q

Dysmetria

A

Tremor when attempting to touch an object

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9
Q

Dysdiadokinesia

A

Impaired rapid alternating movements

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10
Q

Which side does a patient tend to fall towards if they are symptomatic from a brain lesion compressing the cerebellum?

A

Towards the side of the lesion

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11
Q

Early findings seen in Alzheimer’s disease

A

Memory, visuospatial, cognitive impairment and language difficulty.

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12
Q

Late findings in Alzheimer’s disease

A

Personality, behavior, neuropsychiatric, incontinence, apraxia and noncognitive neurologic deficits.

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13
Q

Criteria for diagnosing Alzheimer’s disease

A

MMSE 60 and absence of other neurologic disorder.

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14
Q

Anticholinergic symptoms

A

Hot as hare, dry as a bone, blind as a bat, mad as a hatter, red as a beet and full as a flask

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15
Q

Trihexylphenidyl and benztropine are what type of drugs?

A

Anti-cholinergics

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16
Q

Why might a patient get a headache and retro-orbital pain after taking trihexylphenidyl?

A

Acute angle glaucoma

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17
Q

What is classically the dominant brain hemisphere?

A

Left, it tends to command verbal and written language

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18
Q

Histologic hallmark of prolonged seizures

A

Cortical laminar necrosis

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19
Q

Chronic phenytoin use can cause what CNS problem?

A

Cerebellar atrophy

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20
Q

Symptoms of lacunar infarct

A

Pure motor hemiparesis, pure sensory stroke, dysarthria-clumsy hand and ataxic hemiparesis.

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21
Q

Why give a hemorrhagic stroke patient nimodipine?

A

Reduces the risk of cerebral vasospam 3-10 days after bleed

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22
Q

Tinnitus red flags

A

Unilateral, pulsatile or tinnitus associated with other unilateral otalgic symptoms.

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23
Q

Hearing loss seen in otosclerosis

A

Conductive

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24
Q

Symptom most specific for dementia vs. normal aging?

A

Functional impairment

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25
Q

Imaging study of choice in patients with a new unprovoked seizue?

A

MRI if nonemergent, CT if urgent

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26
Q

Normal age-related cognitive changes

A

Tiredness, forgetfulness, difficulty word finding and trouble falling asleep.

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27
Q

Most effective medication for trigeminal neuralgia?

A

Carbamazepine

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28
Q

Comorbidity with the strongest association with strokes

A

Hypertension > Diabetes and smoking

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29
Q

Core features that must be present for diagnosis of dementia with Lewy bodies

A

Fluctuating levels of attention/alertness

Hallucinations

Motor features of Parkinsonism

You need at least 2

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30
Q

Treatment of patients with MS exacerbation

A

High dose corticosteroids, if this fails move on to plasma exchange

31
Q

Neuroimaging in:
Alzheimer’s

Wilson’s

Huntington’s

Pick’s

A

Alzheimer’s = diffuse cortical atrophy

Wilson’s = lenticular nucleus atrophy (putamen and globus pallidus)

Huntington’s = caudate atrophy

Pick’s = frontotemporal cortical atrophy

32
Q

MMSE in patients with pseudodementia

A

Should improve as depression improves

33
Q

How long until a patient with acute angle glaucoma lose their vision?

A

2-5 hours

34
Q

Most common primary sites of brain mets

A

Lung (multiple), breast (single), unknown primary, melanoma (multiple) and colon (single)

35
Q

Treatment of restless leg syndrome

A

Mild-intermittent: supplement iron if serum ferritin is ≤ 75, leg massage, heating pads, exercise and good sleep hygiene

Moderate-persistent: dopamine agonist (pramipexole, ropinirole) then alpha-2-delta Ca channel ligands (gabapentin)

36
Q

How do you diagnose CJD?

A

Rapidly progressive dementia, periodic sharp wave complexes on ECG or positive 14-3-3 CSF assay and 2/4:

Cerebellar or visual disturbance

Akinetic mutism

Myoclonus

Pyramidal/extrapyramidal dysfunction

Definitive diagnosis is done with brain biopsy or positive PRNP genetic mutation

37
Q

Drugs effective in treatment of patients with mild-moderate dementia

A

Acetylcholinesterase inhibitors: donepezil, galantamine and rivastigmine

38
Q

Wernicke encephalopathy triad

A

Encephalopathy, ocular dysfunction and gait ataxia

39
Q

Drugs used as monotherapy in patients with acute migraine attacks

A

Antiemetics like prochlorperazine, chlorpromazine or metoclopramide

40
Q

Cushing reflex

A

HTN, bradycardia, respiratory depression

41
Q

Tick-borne paralysis vs. Guillain-Barre

A

No autonomic dysfunction in tick-born paralysis

42
Q

Demented patients can benefit from antipsychotics when they become delirious; however, what type of dementia has associated hypersensitivity to neuroleptics?

A

Lewy body

43
Q

Characteristic features of brain death

A

Absent cortical and brainstem functions, spinal cord may remain intact

44
Q

Side effects of metoclopramide

A

It’s a dopamine antagonist and can result in extrapyramidal side effects like dystonia, tardive dyskinesia and Parkinsonism.

45
Q

Tremor improved with intention? Worse?

A

Improved = Parkinson’s

Worsened = Essential

46
Q

Treatment of essential tremor

A

1) Propranolol, then primidone or topiramate

47
Q

Early and late side effects seen in patients with Parkinson’s treated with levo/carbidopa

A

Early: confusion, hallucinations, agitation, dizziness, somnolence and nausea

Late: movement disorders like dyskinesia and dystonia

48
Q

Physical exam finding that is sensitive and specific for upper motor neuron disease

A

+Pronator drift (note that Romberg test is just them being able to stand without losing balance while eyes are closed and is a cerebellar test)

49
Q

Strict exclusion for use of tPA in a stroke patient

A

Hemorrhage, CNS trauma/surgery 185/110, 1.7, PT > 15 or increased aPTT.

50
Q

Only drug shown to reduce risk of early recurrence of ischemic stroke?

A

Aspirin, give within 24 hours. Give with dipyramidole if the patient stroked while on aspirin anyway.

51
Q

LP in patients with Guillain-Barre

A

Elevated protein, normal cell count

52
Q

Treatment of Guillain-Barre

A

IVIg or plasmapheresis

53
Q

Parkinson’s tetrad

A

Resting tremor, bradykinesia, rigidity and postural instability

54
Q

Heat stroke definition

A

Core body temp > 40C and mental status changes

55
Q

Uthoff phenomenon and Lhermette’s sign

A

Uthoff: MS symptoms that worsen with heat

Lhermitte: electric shock sensation down spine when flexing neck

56
Q

Imaging modality needed to confirm diagnosis of MS

A

T2 MRI

57
Q

Brown-Sequard syndrome

A

Contralateral loss of pain and sensation ~ 2 levels below the lesion.

Ipsilateral loss of motor and proprioception

58
Q

Factors that can precipitate a myasthenic crisis

A

Infection, surgery, pregnancy, medications (aminoglycosides, fluoroquinolones, macrolides and beta blockers).

59
Q

Treatment for acute dystonic reaction to antipsychotics

A

Benztropine or diphenhydramine

60
Q

Treatment for akathesia from antipsychotic use

A

Benzodiazepine

61
Q

Side effects seen in patients on primidone for essential tremor

A

Acute intermittent porphyria (abdominal pain, neurologic and psychiatric symptoms)

62
Q

What does primidone break down to after ingestion?

A

Phenobarbital and phenylethylmalonamide

63
Q

Triad of Wernicke’s encephalopathy

A

Encephalopathy, oculomotor dysfunction and ataxia

64
Q

Which metal-overload condition results in basal ganglia dysfunction? How is this disease confirmed?

A

Wilson’s. Confirm the dx with ceruloplasmin

65
Q

Cupping of the optic disk

A

Seen in glaucoma

66
Q

Edema of the optic disk

A

Seen in optic neuritis

67
Q

CNIII fibers affected in diabetes

A

Somatic only (down and out + ptosis). Parasympathetics have better blood supply and are typically not as significantly affected by microvascular hyalinization.

68
Q

Complications seen in patients with heat stroke

A

Rhabdomyolysis, coagulopathy, renal failure and ARDS.

69
Q

Organisms that are most commonly involved in brain abscesses

A

S. viridans (direct extension from sinuses)

Staph and GNRs (distant spread)

70
Q

Multiple system atrophy

A

Parkinsonism

Autonomic dysfunction

Widespread neurologic signs

71
Q

Criteria needed for clinical diagnosis of Parkinson’s disease

A

Tremor, rigidity and/or bradykinesia

72
Q

Medication used for Parkinson’s tremor in younger patients with tremor as their primary symptoms

A

Trihexylphenidyl

73
Q

If pyridostigmine doesn’t work for your patient with myasthenia gravis, what next?

A

Immunosuppress with corticosteroids, azathioprine or mycophenolate mofetil. If myasthenic crisis: steroids + plasmapheresis or IVIg if plasmapheresis is not possible.

74
Q

Hallmark CSF finding in patients with Guillain-Barre syndrome

A

Albuminocyotologic dissociation (elevated protein and normal WBC)

Step 2 CK (14 decks)

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