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[2a] A ⼀ Step 2 OD USLME > ✅NEUROLOGY > Flashcards

✅NEUROLOGY Flashcards

1
Q

Cerebral Salt Wasting etx

A

⬇︎Brain adrenergic output to Kidney –> ⬇︎PCT Na+ Reabsorption–> hypOvolemic hypONatremia

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2
Q

[Wernicke Korsakoff Syndrome] Clinical Presentation (3)

A

Wernicke problems come in a CAN of beer!

[Confusion & Confabulation]

Ataxia (Gait & Postural)

[Nystagmus + Oculomotor Dyf]

chronic alcoholism = most common cause

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3
Q

[Wernicke Korsakoff Syndrome] MOD

A

Wernicke Problems come in a CAN of beer!

[Thiamine B1 Deficiency] from (below) –> BL circuit dysfunction between mammillary bodies & ANT Thalamus:

  1. Chronic Alcoholism = MOST COMMON
  2. Giving [Glucose that doesn’t have B1] to a B1-deficient pt (i.e. homeless malnutrition pt)
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4
Q

Tx for [Wernicke Korsakoff Syndrome] (2)

A

[Thiamine B1 IV] ➜ Glucose

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5
Q

What’s the major complication of [SubArachnoid Hemorrhage] during recovery?

________________

How do you tx this?

Usually in the Suprasellar Cistern

A

Severe Cerebral Vasospasm 4-12 days post SAH onset

________________

Prevent with [Nimodipine CCB]

Other complications: Rebleeding, SIADH, Seizures

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6
Q

Describe the Demographic for the HA:

Migraine-2

Cluster

Tension

A

Migraine = Female and [Kids(will be bifrontal)]

Cluster = Male (100% O2 tx)

Tension = Female

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7
Q

Describe the Onset for the HA:

Migraine

Cluster

Tension

A

Migraine = Variable but possibly during menstruation

Cluster = During Sleep (100% O2 tx)

Tension = When Stressed “think tense”

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8
Q

Describe the Location for the HA:

Migraine

Cluster

Tension

A

Migraine = POUND = [Pounding/One-3 Day Duration /Unilateral/Nausea/Disabling] + photo vs. phonophobia & [flashing dots aura]

Cluster = Behind 1 eye (100% O2 tx)

Tension = [Bilateral & Band-like around the head]

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9
Q

Describe the Character for the HA:

Migraine

Cluster (3)

Tension (2)

A

Migraine = POUND = [Pounding/One Day-3 day Duration/Unilateral/Nausea/Disabling] + photo vs. phonophobia & [flashing dots aura]

Cluster = [Excruciating, sharp & steady] (100% O2 tx)

Tension = Dull & tight

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10
Q

Describe the Duration for the HA:

Migraine

Cluster

Tension

A

Migraine = POUND = [Pounding/One-3 Day Duration /Unilateral/Nausea/Disabling] + photo vs. phonophobia & [flashing dots aura]

Cluster = 15 - 90 MINUTES (100% O2 tx)

Tension = 30 min to 7 DAYS!!!! (Tammy’s Entire Work Week)

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11
Q

Describe the Associated Sx for the HA:

Migraine

Cluster - 4

Tension

A

“VTAP the migraine BEFORE it gets comes, and SEND it on its way when it does! “

Migraine = POUND = [Pounding/One-3 Day Duration /Unilateral/Nausea/Disabling] + photo vs. phonophobia & [flashing dots aura]

________________

Cluster = [Sweating/ Pupil Change / Lacrimation / Rhinorrhea]

Tension = [Muscle “Tension” in Head, Neck or Shoulders]

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12
Q

Which bone is associated with Epidural Hematoma?

A

Sphenoid

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13
Q

Violent Infant Shaking —> ⬜ . This is characterized by what 3 things?

________________

How is this differentiated from similar conditions?

A

[AHT- Abusive Head Trauma]! =

  1. Subdural Hemorrhage (from tearing bridging veins between Dura and Arachnoid)
  2. [BL Retinal Vein Hemorrhages]
  3. POSTERIOR rib fractures
  • ________________*
  • Usually* Accidental Fall is not sufficient for Subdural Hemorrhage OR [BL Retinal Vein Hemorrhage]
  • AHT is formely known as Shaken Baby Syndrome*
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14
Q

What lab values differentiate seminomatous vs. NonSeminomatous Germ cell tumors?

A

seminomatous = ⬆︎bHCG

________________

NonSeminomatous(yolk sac/choriocarcinoma/embryonal) = [⬆︎bHCG AND AFP]

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15
Q

[Thiamine B1] deficiency causes ⬜ and BeriBeri

________________

Describe BeriBeri (2)

A

[Wernicke Korsakoff Syndrome] and [BeriBeri]

________________

BeriBeri (Wet vs. Dry vs. BOTH) is associated with…

  1. Heart involvement = WET
  2. Symmetrical Peripheral Neuropathy = DRY

[Thiamine B1] is needed to Decarboxylate a-ketoacids (carb metabolism)

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16
Q

Clinical Presentation for [Bells Palsy] (4)

A

Facial CN7 paralysis from inflammatory edema –> Loss of FACE

Loss of Facial m –> Unilateral Paralysis to ENTIRE HALF of face

Loss of Afferent somatics from Ear –> Hyperacusis

Loss of Crying 2/2 Loss of Parasympathetics to [Lacrimal/Salivary/Sublingual/Submandibular] glands

Loss of [Eating with Taste] 2/2 Loss of Taste to ANTERIOR 2/3 TONGUE

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17
Q

Clinical Criteria for diagnosing Alzheimer’s -5

A

CLAV –> HANDU

  1. GOE 2 Cognitive deficits
  2. Worsening Memory
  3. Consciousness intact
  4. Onsets after 60 yo
  5. No other Systemic/Neuro DO to cause cognitive defects
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18
Q

Normal Pressure Hydrocephalus Sx (3)

________________

Which is earliest to present?

A

⬇︎CSF absorption –> Wacky, Wobbly & Wet!

Wacky (memory loss)

Wet (Urinary Incontinence from compressing periventricular cortico-cortical white fibers traveling to sacral micturition center)

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19
Q

What causes [Normal Pressure Hydrocephalus]? -2

________________

what does [Normal Pressure Hydrocephalus] do to overall [subarachnoid space volume]?

A

[Idiopathic episodic ⬇︎Arachnoid villi CSF absorption] vs obstruction

________________

NOTHING

[NPH does NOT ⬆︎ subArachnoid space volume]

________________

Wacky, Wobbly & Wet!

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20
Q

ANY Clinical Suspicion of Stroke warrants _____. Why?-2

A

NonContrast Head CT; Ischemic stroke benefits from Thrombolytics vs ICH requires neurosurgery

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21
Q

How do ICH (IntraCranial Hemorrhage) stroke appear on NonContrast Head CT?

________________

How long does this take?

A

[HYPERdense White]; IMMEDIATELY!

Ischemic Stroke = [hypOdense dark] and takes >24 hrs to appear

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22
Q

Ethosuximide Indication

A

Sux to have Silent Seizures

Silent (Absent) Seizures

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23
Q

Features of Absence Seizures -4

A
  1. Staring spells that pauses a pt mid-activity
  2. < 20 seconds
  3. Not responsive to external stimulation
  4. NO recollection

________________

  • Provoked by Hyperventilation or photic stimulation / Dx = 3 Hz EEG spike*
  • ADHD staring spells occur only DURING BOREDOM!*
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24
Q

Name the 2 common triggers of Absence Seizures-2

________________

Dx?

A
  1. Hyperventilation
  2. photic stimulation

________________

3 Hz EEG spike

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25
Q

Why is it so important to recognize ⬜ in childen with epilepsy?

A

ADHD

________________

⬆︎ quality of life

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26
Q

Newborn Galactosemia etx

A

[ABSENCE OF {GALT}] prevents conversion of [Galactose1P ➜ UDP Galactose] ➜ accumulation of [Galactose 1P] ➜ accumulation of [Galactose] ➜ [Aldose reductase alternatively converts excess Galactose ➜ GALACTITOL] ➜

GALACTITOL accumulates in [Brain/Eye/Liver/Kidney]

________________

(GALT) = [Galactose 1 Phosphate Uridyl Transferase]

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27
Q

newborn Galactosemia affects (⬜#) major organs

________________

Describe how it affects each

A

4

________________

Galactitol accumulation in

[Brain ➜ convulsions & irritability]

[Eye ➜ BL cataracts]

[Liver ➜ hepatomegaly, jaundice, (E.Coli Sepsis), failure to Thrive, vomiting]

[Kidney ➜ urine with (reducing substance unmetabolized sugar)]

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28
Q

[Cavernous Sinus Thrombosis] etx

A

Infection of face vs teeth spreads thru facial veins –> cavernous sinus

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29
Q

Lacunar Stroke etx

A

lenticulostriate vessels perfuse [Be TIC] (not Pons)

Lacunar Stroke= [Thrombotic HTN Arteriolosclerosis & Thrombotic microatheromas] of lenticulostriate vessels –> [cystic infarcts < 15 mm] –> Lacunar Syndrome

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30
Q

Describe the Lacunar Syndrome CP

A

lenticulostriate vessels perfuse [Be TIpC] (not Pons)

1A: Basal Ganglia–>HemiBallismus & involuntary writhing

1B: ThalamuS VPL –> Sensory Stroke CTL

1C: [Internal Capsule-POST limb/Corona Radiata]–> Motor stroke (ataxia vs. clumsy hand-dysarthria)

________________

  • Lacunar Stroke= [Thrombotic HTN Arteriolosclerosis & Thrombotic microatheromas] of lenticulostriate vessels –> [cystic infarcts < 15 mm] –> Lacunar Syndrome*
  • VPL=VentroPosteroLateral nc*
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31
Q

What is Dejerine Roussy Syndrome

A

lenticulostriate vessels perfuse [Be TIC]

S/p Lacunar Thalamus Sensory stroke eventually –> Severe Paroxysmal BURNING worst w/light touch = Allodynia

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32
Q

Clinical Presentation of Congenital Syphilis -7

A
  1. Frontal Bossing
  2. Deaf
  3. Saddle nose
  4. Rhinitis
  5. Hutchinson Mulberry Molars
  6. Liver/Spleen Dz
  7. Saber Shins
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33
Q

Clinical Presentation for Fetal Hydantoin Syndrome -9

A

p HHH HHH en (“PHEN”)

  1. [palate and Lip Cleft]
  2. Head small with neuro deficits
  3. HypOplastic face
  4. Heart defects
  5. HypOplastic digits
  6. HypOplastic nails
  7. Hirsutism
  8. [embryopathy 2/2 phenytoin or carbamazipine intrauterine exposure]
  9. [neonatal bleeding 2/2 phenytoin ⬇︎ neonatal Vitk]
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34
Q

Classic signs of Fetal Alcohol Syndrome - 4

A
  1. Microcephaly
  2. Small Palpebral fissures
  3. Long Smooth Philtrum
  4. Thin Upper Lip
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35
Q

Sturge Weber Syndrome Clinical Presentation -5

A
  1. SEIZURES
  2. Red Facial Lesion (Port Wine Stain vs Red Nevus along CN5 territory = congenital UL cavernous hemangioma)
  3. Glaucoma IPL
  4. Homonymous Hemianopsia CTL
  5. Hemiparesis

Tramline Gyriform Calcifications on CT

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36
Q

Sturge Weber Syndrome Dx

A

Tramline Gyriform Calcifications on CT

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37
Q

Sturge Weber Syndrome Tx -3

A
  1. Seizure control
  2. Glaucoma control (⬇︎Intraocular pressure)
  3. [Red Facial lesion] control with Argon laser

________________

  • Tramline Gyriform Calcifications on CT*
  • Red Facial Lesion = Port wine stain vs Red nevus along CN5 territory*
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38
Q

In [Neurofibromatosis Type 1], Fleshy cutaneous neurofibromas are made of ⬜, which embryologically come from ⬜.

_____________________

These pts may also have hyperpigmented spots known as ⬜

A

Schwann cells ; Neural Crest.

________________

[Cafe Au Lait Spots (image)]

Image: Cutaneous Neurofibromas & Cafe Au Lait Spots

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39
Q

Main features of Narcolepsy -4

A
  1. Paralysis upon Awakening
  2. [sudden REM entry > 3x/week & >3 mo]
  3. cataplexy
  4. hypnaGOgic/hypnopompic hallucinations
    * hypnoGOgic = when GOing to sleep*
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40
Q

Cataplexy may be treated with ⬜-suppressing drugs

________________

Name 2 examples

A

REM Sleep

________________

[Sodium Oxybate] and Antidepressants

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41
Q

List the 3 main causes of HemipLegia in Kids

A
  1. Seizure w/Todds Paralysis
  2. Hemorrhagic Stroke 2/2 AVM
  3. HemipLegic Migraine (Teens w/Fam hx, self-resolving)
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42
Q

Describe Todds Paralysis

A

focal (ipsilateral UE and LE) paralysis after seizure that resolves naturally within 36 hours

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43
Q

What Dz occurs from [Tetrahydrobiopterin BH4] deficiency?

________________

Explain the etx

A

(PKU) Phenylketonuria

________________

Dihydropteridine Reductase becomes deficient w/out [Tetrahydrobiopterin BH4] cofactor –> Inability to convert Phenylalanine –> Tyrosine –> MESS sx

PKU smells a MESS!

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44
Q

Phenylketonuria tx (2)

________________

Why is Newborn screening important for these?

A
  1. low phenylALAnine diet
  2. [TetraHydroBiOpterin BH4] supplementation

NEWBORN SCREENING–> early dx –> early tx –> Normal lives!!

________________

PKU smells a MESS!

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45
Q

PKU-Phenylketonuria S/S (4)

A

PKU smells a MESS!

Musty Odor

Eczema

Seizures

Slow mentally (retard)

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46
Q
  • Newborn screening is ESSENTIAL for early dx of PKU, which “smells a MESS”*
  • ________________*

How do you diagnose PKU?

A

Tandem mass spectrometry of dried blood spots –> detects PKU products

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47
Q

Name the classic complaint pts with Presbycusis will give regarding conversations - 2

A

Can hear one-on-one BUT can not hear if there’s ANY background noise + BL tinnitus

Sensorineural hearing loss secondary to age

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48
Q

What conditions are associated with [Berry Saccular Aneurysm]? (5)

A

“Eating AppleBerries Can Sound Heavenly”

  1. ADPKD**
  2. [Ehlers Danlos Syndrome]
  3. HTN
  4. SAH (from Trauma > Berry Saccular Aneurysm)
  5. Coarctation of Aorta (associated w/HTN)

Image: Blood around Brainstem & Basal Cisterns

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49
Q

[Communicating Hydrocephalus] cause

A

[Meningitis vs SAH vs Intraventricular hemorrhage] ➜ disruption of [Arachnoid Villi granulation] CSF reabsorption

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50
Q

[SubArachnoid Hemorrhage]

Dx-3?

________________

Tx-2?

Usually in Suprasellar Cistern

A

Dx:

  1. NonContrast Head CT
  2. Lumbar Puncture revealing Xanthochromia (6 hrs after onset)
  3. Cerebral Angiography

________________

Tx: [Endovascular Coiling/Stenting to stabilize aneurysm] + Nimodipine

Xanthochromia comes from Blood breakdown products

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51
Q

What’s the major complication of [SubArachnoid Hemorrhage] 24 hrs post onset?

A

REBLEEDING WITHIN 6 HRS –> MAJOR CAUSE OF DEATH!

Other complications: SIADH, Seizures

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52
Q

Lumbar puncture with CSF pressure ⬜ = Intracranial HTN

A

> 250 mmH20

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53
Q

PCiiH [Pseudotumor Cerebri Idiopathic Intracranial HTN] Tx - 3

A

Big Girl with PCiiH just SAT on her problems

  1. Surgery (Shunt vs Optic N sheath fenestration)
  2. Acetazolamide (inhibits Choroid Plexus Carbonic Anhydrase)
  3. Topiramate (will also –> Wt loss :-) )

This HA will make you go Blind!

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54
Q

[Syringomyelia central cord syndrome] etx

________________

CP-2?

A

Formation of [CSF filled cavity = SYRINX] in C8-T1 region of spinal cord –> damage of STT [Ventral white commissure (crossing fibers)] –>

________________

  1. [BL Cape distribution Pain/Temp Loss in Arms & Hands]
  2. ***Eventually Ventral Horns are also destroyed –> [LMN (FAAW)] - Fasciculations / Atrophy / Areflexia / Weakness
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55
Q

Parkinsonism Clinical signs (8)

A

PARK & hamp

[Pill Rolling Resting 4-6 Hz unilateral Tremor] worst with Rest & Mental Task

[AReflexia posturally] –>Shuffling Gait/Fall when turning or stopping

[Rigidity Cogwheel]

BradyKinesia

+

  • hypOphonic speech
  • autonomic ⬇︎ (constipation / bladder problems / orthostatic hypOtension)
  • micrographia
  • poker masked face
  • PARK = primary signs*
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56
Q

Name the Major UMN signs (5)

A

UMN signs = Weak MESH

Weakness

[Spastic Gait & Paralysis] (partially from disproportionate Extensor weakness)

[Exaggerated Reflexes (Babinski)]

Mental Status change

HemipLegia

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57
Q

Name the Lower Motor Neuron signs - 4

A

LMN signs (FAAW) - Fasciculations / Atrophy & Areflexia / Weakness

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58
Q

3 Main causes of Spinal Cord Compression

A
  1. DJD Disc Herniation (Smoking risk factor)
  2. [Epidural Staph a. Abscess (think IV drug user vs DM)]
  3. Tumor (Prostate/Renal/Lung/Breast/Multiple Myeloma mets)

Dx = MRI, Positive Straight Leg, Classic S/S

DJD=Degenerative Joint Disease

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59
Q

Causes of [Anterior Spinal Cord Syndrome] - 2

A

Thoracic AAA Repair vs Vertebra Burst Fracture

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60
Q

Describe the 3 main sx for [Brown Sequard Syndrome]

A
  1. Ipsilateral DCP Loss of 2TVP-2point/Touch/Vibration/[Position Proprioreception]

2. Ipsilateral CST Loss –> [UMN (Weak MESH)]

  1. Contralateral STT Loss of Pain/Temp 2 LEVELS BELOW ORIGINAL LESION
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61
Q

Causes of [Brown Sequard Syndrome] - 3

A
  1. [(Extramedullary Tumor]
  2. Trauma
  3. [DJD Disc Hernation (Smoking risk factor)]
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62
Q

[Cauda Equina Syndrome] etx

________________

Clinical Presentation - 5

A

(Compression of S2 - S4 n. roots) –>

  1. Saddle Anesthesia (image)
  2. ⬇︎ Anocutaneous Reflex (perianal pinpoint does NOT cause anal sphincter contraction)
  3. Incontinence (urinary AND fecal)
  4. uL Radiculopathy
  5. hypOreflexia (Conus Medullaris syndrome has HYPEReflexia)

Decompression required within 72 hours!!!

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63
Q

Where does Charcot Bouchard Aneurysms occur (4)

A

Charcot Bouchard Tears Pink

  • Basal Ganglia
  • Cerebellum
  • Thalamus (shown in image below)
  • Pons

Acute ICHH [Intraparenchymal CharcotBouchard HTN Hemorrhage] in image

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64
Q

What causes Hemiballismus

A

Lacunar Stroke damage to [Subthalamic nc. of the Basal Ganglia] (important in modulating basal ganglia output) –>

CTL Hemiballismus

Note: Basal Ganglia is in Subcortical nuclei

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65
Q

Huntington’s Dz Clinical Presentation (2)

A
  • “Hunting 4​ food is way too aggressive & dancey”*
    1st: Aggressive Dementia w/ strange behavior
    2nd: Dance-like Chorea mvmnts
  • AUTO DOM = Affects BOTH sexes equally!!*
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66
Q

When does Huntington’s Dz onset

A

30 - 50 y/o

AUTO DOM = Affects BOTH Sexes Equally!!

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67
Q

Parkinson’s Dz Tx - 6

A

“Eat SALADS after you Park”

  1. [Levodopa (Dopamine Precursor) + Carbidopa]
  2. Amantidine
  3. Anticholinergics
  4. [Dopamine PostSynaptic Agonist] (NonErgot: Ropinirole vs. Pramipexole) & (Ergot:Bromocriptine)
  5. Selegiline
  6. Surgery
    - Pallidotomy: Destructive of [Globus Pallidus:internal]
    - SubThalamic nuc. inhibition with electrode
    - ANT Choroidal a ligation
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68
Q

Lesch Nyhan etx

A

MALE DO in which HGPRT deficiency –> ⬆︎ Purine –> Uric Acid accumulation

–> CROUG ( UE Self-Injury (Biting) / Choreoathetosis / Retardation / Gout / Obstructive Nephropathy

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69
Q

Lesch Nyhan Clinical Presentation - 7

A

[6 mo old Male] with [hypOtonia + vomiting] eventually –> CROUG

Choreoathetosis

Retardation

[Obstructive nephropathy]

[UE SELF-INJURY (BITING)]

Gout

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70
Q

Dx for Multiple Sclerosis - 5

A
  1. Clinical (SLUM SiiiN)
  2. T2 MRI: [Periventricular white matter demyelinating plaques with lipid laden macrophages]
  3. T1 MRI Black holes
  4. CSF Oligoclonal IgG bands
  5. Visual conduction velocity test

Sx will be disseminated in time and space

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71
Q

CP for [MIOS-MLF Internuclear Ophthalmoplegia Syndrome] (3)

A

[MIOS-MLF Internuclear Ophthalmoplegia Syndrome]

*[Impaired ADDuction of affected eye]

+

[Normal ADDuction of affected eye during [near reflex convergence]

+

*[Nystagmus of UNaffected eye when attempting to ABduct]

Image: L MIOS

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72
Q

Clinical Manifestation of Multiple Sclerosis (9)

A

Charcot classic triad of MS is a [SLUM SiiiN] !

Sensory sx (think BL Trigeminal Neuralgia)

Lhermittes sign = “electric tingling” down spine into arm & legs when chin is touched to chest

Uhthoff phenomenon (sx ⬆︎ during heat)

Motor sx

Scanning Speech

[Internuclear Ophthalmoplegia (MIOS)] / Intention Tremor / Incontinence

Neuritis Optic - (uL eye pain + vision loss + Marcus Gunn afferent pupillary defect) = ALSO RISK FACTOR

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73
Q

Which drugs are used to treat Multiple Sclerosis Exacerbation?-2

A

1st: [Methylprednisolone IV High Dose]
2nd: [Plasmapharesis (Refractory)]

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74
Q

Which drugs are used to treat Multiple Sclerosis maintenance?-3

A
  1. β-interferon
  2. Glatiramer acetate
  3. Natalizumab
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75
Q

Myotonia Dystrophy Clinical Manifestation - 6

A

My Tonia, My Toupee, My TV Viewers, My Throat, My Ticker, My Testicles,

Tonia = MyoTonia = [⬇︎ relaxation after volitional muscle contraction with Weakness & Atrophy] (cant let go of doorknob)

Toupee = Frontal Balding

TV viewer = Cataracts

Throat = SEVERE DYSPHAGIA –> Aspiration PNA

Ticker = Arrhythmia

Testicle = Testicular Atrophy

[AUTO DOM CTG Repeat]

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76
Q

Main features of Duchenne Muscular Dystrophy - 5

A
  1. [CALF PSEUDOHYPERTROPHY requiring gower manuever + teenage wheelchair]
  1. [Xp21 deletion] (X-link recessive deletion on Chromo Xp21)
  2. Scoliosis
  3. [peds onset at 2 yo]
  4. [cardiomyopathy ➜ 20-30 yo DEATH]
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77
Q

Main features of Becker Muscular Dystrophy - 4

A
  1. [Xp21 deletion] (X-link recessive deletion on Chromo Xp21)
  2. Scoliosis
  3. [peds onset at 5 yo]
  4. [cardiomyopathy ➜ 40-50 yo DEATH]
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78
Q

Frontotemporal Pick’s Dementia

Sx -2

A

Prounouced Frontal & Temporal lobe atrophy –>

[Socially inappropriate Behavior] + aphasia

OCCURS MORE IN FEMALES!!!

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79
Q

Dementia with Lewy Bodies (DLB) CP - 3

A

DLB at the DMV

  1. Dementia confusion periodically
  2. MichaelJFox Parkinsonism (PARK + hamp) tht does NOT respond to dopaminergic tx
  3. Visual Hallucinations

Lewy Body= [LABS (Lewy α-synuclein BodieS)] that are Eosinophilic intracytoplasmic accumulations

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80
Q

Tick Paralysis and Gullain Barre both present with ascending paralysis

What differentiates Tick Paralysis? - 3

A

Tick Paralysis has…

  1. NO Autonomic Dysfunction
  2. Normal CSF (GBS CSF=High Protein > 40)
  3. Can be Asymmetrical (GBS=Symmetrical)
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81
Q

CP of Cerebellar Damage - 7

A

Cere is def on GRINDRR

Gait Ataxia IPSILATERAL

Rapid alternating mvmnt impairment

Intention tremor/Dysmetria IPSILATERAL

Nystagmus IPSILATERAL (medial AND Lateral Vermis)

Dysarthria (Lateral Vermis only)

Rebound phenomenon (pt hits themself in face if flexing bicep and examiner releases arm-image)

Reflex Pendular (knee swings >4x after Deep tendon reflex is elicited)

Vermis is midline

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82
Q

Describe the “Clasp Knife” phenomenon

________________

What disease is this related to?

A

Rapid SPASTIC RESISTANCE to passive mvmnt of limb

________________

UMN (Weak MESH) Pyramidal Tract dz

  • Pyramidal Tract = Corticospinal and Corticobulbar*
  • Pronator Drift also indicates Pyramidal Tract Dz*
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83
Q

Dx for Creutzfeldt Jakob disease - 6

A
  1. [PRNP prion protein] genetic testing
  2. EEG Biphasic vs Triphasic sharp wave complexes
  3. Postmortem brain biopsy
  4. ⬆︎CSF 14-3-3 proteins
  5. MRI Cortical Ribbons
  6. MRI basal ganglia hyperintensity
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84
Q

[Creutzfeldt Jakob Dz] etx

A

PrP (prion protein), normally in neurons as [α -helical structure] converts–> [INFECTIOUS Beta pleated sheets] –> Protease resistance –>

Vacuoles in [Gray Matter Neurons & Neutrophils] develop –> Cyst = [Spongiform Gray Matter]

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85
Q

[Creutzfeldt Jakob Dz] CP - 2

A

[RAPIDLY Progressive Dementia] + [STARTLE Myoclonus] –> DEATH

Can be Acquired vs. Inherited

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86
Q

[Amyotrophic Lateral Sclerosis] (Lou Gehrig’s) etx - 2

A
  1. Rare = [Superoxide Dismutase gene mutation] –> copper-zinc dysfunction —>[Upper AND Lower Motor Neuron Disease!]
  2. Common = Idiopathic

UMN Dz includes loss of neurons in motor nc. 5/9/10/12

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87
Q

DDx of Neuromuscular Weakness has 5 origins

Describe Upper Motor Neuron causes of Neuromuscular weakness - 4

A
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88
Q

DDx of Neuromuscular Weakness has 5 origins

Describe Anterior Horn Cell causes of Neuromuscular weakness - 4

A
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89
Q

DDx of Neuromuscular Weakness has 5 origins

Describe Peripheral Nerves causes of Neuromuscular weakness - 5

A
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90
Q

DDx of Neuromuscular Weakness has 5 origins

Describe Neuromuscular JUNCTION causes of Neuromuscular weakness - 4

A
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91
Q

DDx of Neuromuscular Weakness has 5 origins

Describe Muscle Fibers causes of Neuromuscular weakness - 5

A
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92
Q

Guillain Barre Tx - 2

A

IVIG vs Plasmapheresis

Guillain Barre CSF = HIGHLY ELEVATED Protein > 40

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93
Q

Postconcussive syndrome can occur __(length of time)__ after any TBI (Traumatic Brain Injury).

Describe CP for Postconcussive Syndrome - 4

A

hours-days;

  1. Continued Confusion/Amnesia
  2. HA
  3. Mood changes
  4. Vertigo

This is Self-Resolving

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94
Q

In pts with Traumatic Brain Injury (TBI), what’s the major cause of morbidity?

A

Diffuse axonal injury at Gray-White matter junction (since this is where density difference is highest​)

USE MRI FOR DX

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95
Q

How long does it take ketoralac to reach Max efficacy

A

3 hours

Dose = q4-6 hrs

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96
Q

You suspect a baby has ingested Botulinum spores

What’s the Clinical Presentation? - 4

A
  1. Descending Flaccid Paralysis (Floppy Baby)
  2. Ptosis
  3. Poor Suck & Gag Reflex w/drooling
  4. Constipation

Tx = IMMEDIATE Botulinum Ig

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97
Q

Spinal Muscular Atrophy etx and CP

A

[ANT Horn Cell degeneration] from [Chromo 5 SMN1 and 2 gene mutations]–> LMN signs of FAAW- Weakness/[atrophy & areflexia] /Fasciculations

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98
Q

Spinal Muscular Atrophy

What’s the difference between Infant type and Adult type

A

*Infantile onset = (Werdnig Hoffman) –> [Auto Recessive FATAL condition –> Floppy Baby from defuse [Distal muscle atrophy]

________________

*Milder childhood/adult onset types –> [Non-fatal Chronic Disability]

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99
Q

Why are Multiple Sclerosis pts at risk for BL Trigeminal Neuralgia

A

Demyelination may occur at Trigeminal nucleus –> BILATERAL neuralgia

Sx will be disseminated in space and time

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100
Q

After Getting Labs, NonContrast Head CT is next for dx unprovoked seizures

When would MRI be the better option?

A

elective NONemergent situations

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101
Q

After Getting Labs, NonContrast Head CT is next for dx unprovoked seizures

Name structural causes of epilepsy-7

A

Temporal Sclerosis-shown in image

Cortical Dysplasia

TBI (Traumatic Brain Injury)

Vascular Malformation

Infection

Tumor

Infarction

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102
Q

[LEMS - Lambert Eaton Myasthenic Syndrome] etx

A

[Autoimmune attack against (Presynpatic Ca+ channel)–> No ACh release]

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103
Q

What other condition is [LEMS​ - Lambert Eaton Myasthenic Syndrome] associated with?

A

“LEMS has a good SOLC(soul)”

SOLC-Small Oat cell Lung Carcinoma

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104
Q

Name 4 Differentiating Factors for Myasthenia Gravis vs. [Lambert Eaton Myasthenic Syndrome]

A
  1. [LEMS] improves with exercise/exertion during the day!
  2. [LEMS] will show no imprvmnt with [Tensilon Edrophonium] injection OR ice pack
  3. [LEMS] nerve testing shows INC muscle responses
  4. [LEMS] has autonomic dysfunction (orthostasis, dry mouth, impotence)
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105
Q

What other condition is [Myasthenia Gravis] associated with?

A

May cause Thymoma (thymic hyperplasia)

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106
Q

[Myasthenia Gravis] etx

________________

Demographic?-2

A

Autoantibodies block and degrade [postsynpatic nicotinic ACh Receptors]] –> [⬇︎ motor end plate potential]

_____________________

Presents in [Women 20-30] and [Men 60-80]

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107
Q

[Myasthenia Gravis] Clinical Presentation (5)

A

“Give me Mya’s P DDD F”

[Ptosis

[Diplopia from Disconjugate gaze]

Dysarthria-bulbar dysfunction

Dysphagia w/nasal regurgitation-bulbar dysfunction

[FATIGABLE Weakness Muscularly (Extraocular/RESP/Proximal/limbs/worst w/repetition)]

Tx: Pyridostigmine AChesterase inhibitor

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108
Q

[LEMS - Lambert Eaton Myasthenic Syndrome] Clinical Presentation - 3

A
  1. Weakness of [Proximal limbs and trunk] mimicking myopathy, better with exercise
  2. Autonomic sx (Dry mouth /Orthostasis / Impotence)
  3. ⬇︎Deep Tendon Reflexes
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109
Q

You suspect a pt had an ischemic Stroke

After FIRST, ruling out Hemorrhagic stroke with ⬜ , what thrombolytic therapy should be given?

________________

When should you give it?

A

NonContrast Head CT; IV Alteplase

________________

WITHIN 4.5 HOURS OF SX ONSET!

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110
Q

How are HTN and DM mngmnt related to Acute CVA/TIA - 2

A

BP > 185/110 in setting of stroke can –> ICH - so Use Labetalol

&

Hyperglycemia augments brain injuries (so ONLY use NonDextrose IVF)

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111
Q

What is Therapeutic hypOthermia often used for?

________________

How low of temp can you go?

A

Prevents hypoxic Brain injury in pts with [out of hospital cardiac arrest]

________________

32C

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112
Q

Therapeutic hypOthermia prevents [hypoxic Brain injury] in pts with [out of hospital cardiac arrest]

________________

SE of this?-4

A

;

  1. HYPERKalemia
  2. ⬇︎Cardiac Output
  3. ⬆︎Coagulation
  4. Immunosuppression
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113
Q

Homocystinuria Clinical presentation-5

A

auto recessive [Cystathionine synthase] deficiency –> Thromboembolism–> Stroke

  1. Marfanoid habitus (elongated limbs, arachnodactyly, scoliosis) - MH
  2. Ectopia Lentis - MH

{3. Retarded -h}

{4. Fair Hair & Eyes -h}

{5. Stroke -h}

________________

  • MH = MARFAN and HOMOCYSTINURIA*
  • h = homocystinuria only*
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114
Q

Homocystinuria tx -2?

A

auto recessive [Cystathionine synthase] deficiency –> Thromboembolism–> Stroke

tx = [Pyridoxine B6] + AntiCoag

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115
Q

Homocystinuria dx-2

A

auto recessive [Cystathionine synthase] deficiency –> Thromboembolism–> Stroke

[Homocysteine⬆︎] and [Methionine⬆︎]

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116
Q

Name the Differences in cp between Marfan and Homocystinuria - 3

A

Marfan DO NOT HAVE

  1. Retardation
  2. Fair Complexion
  3. Strokes
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117
Q

Tay-Sachs etx ; CP-3

A

auto recessive B-hexosaminidase A deficiency –>

  1. Cherry Red Macula
  2. Seizures
  3. Retarded
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118
Q

Pronator Drift is a good indicator of what type of disease?

A

UMN Pyramidal Tract Dz (think stroke)

  • Pyramidal Tract = Corticospinal and Corticobulbar*
  • Clasp Knife phenomenon also indicates Pyramidal Tract Dz*
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119
Q

Etx of Parkinsons Disease

A

[LAB (Lewy α-synucleinBodies)] accumulate in [substantia nigra pars compacta] –>degeneration –> of [substantia nigra pars compacta] –> ⬇︎Dopamine to stimulate the [Striatum blocker] which –> unblocked [Globus pallidus internal] continuously inhibiting [VA/VL Thalamus] from stimulating motor cortex

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120
Q

Alzheimer’s Dz etx (3)

A

Alzheimers etx = CHA

**Cleavage, Hemorrhage, (ACh⬇︎) **

  1. Cleavage of [chromo 21 transmembrane amyloid precursor glycoprotein] –> [β-amyloid] which accumulates–> [Neuritic Senile plaques] in temporal lobe early on.

________________

  1. Hemorrhages Spontaneously occur in Occipital/Parietal lobes (image) from [β-amyloid] deposition in cerebral vessels

________________

  1. ACh ⬇︎ in the [Basal nc. of Meynert & Hippocampus] 2/2 [β-amyloid] accumulation causing defective [Choline Acetyltransferase] in those areas –> Alzheimer Sx (CLAV–>HANDU)
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121
Q

What type of Hemorrhage is shown in image ; What is this typically associated with?

A

Lobar Hemorrhage (parietal) ; Amyloid Angiopathy 2/2 Alzheimers

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122
Q

Hypokalemic periodic paralysis CP-2

Occurs right after vigorous activity

A
  1. SUDDEN generalized muscle weakness +
  2. ⬇︎ Deep Tendon Reflexes

Occurs right after vigorous activity

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123
Q

Benzos can cause an uncommon SE known as Paradoxical Agitation. Describe this

A

[⬆︎Agitation, confusion and disinhibition] within a hour of benzo admin. GIVING MORE BENZOS WILL WORSEN THIS!

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124
Q

What is a Cephalohematoma? Tx?

A

Neonatal SubPeriosteal Hemorrhage limited to 1 cranial bone (i.e. does NOT cross suture lines) that onsets hours after birth and presents as scalp swelling +/- ⬆︎jaundice;

Tx = Nothing, since it self-resorbs within 2 weeks-3 mo.

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125
Q

Cerebellar infarction of medial vermis presents as _____-2

A
  1. Nystagmus
  2. Vertigo
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126
Q

Cerebellar infarction of Lateral vermis presents as _____-6

A

Cere is def on GRINDRR

Gait & Coordination Ataxia - IPSILATERAL

Rapid alternating mvmnt impairment

Intention tremor/Dysmetria - IPSILATERAL

Nystagmus (medial AND Lateral Vermis infarcts)

Dysarthria (Lateral Vermis only)

Rebound phenomenon

Reflex Pendular (knee swings >4x after Deep tendon reflex is elicited)

Intention tremor = worst as finger moves closer to target

​

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127
Q

Describe Features of BENA (Brocas Expressive NonFluent Aphasia) -4

A
  1. Right Hemiparesis
  2. Nonfluent speech
  3. Impaired Repetition
  4. Impaired Naming

BENA = Dominant Inferior Frontal

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128
Q

Describe Features of Wernickes Aphasia - 3

A
  1. R SUP homonymous quadrantanopia
  2. Comprehension problems
  3. Impaired Repetition

Conductive AND Wernicke Area = Dominant SUP Temporal

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129
Q

Describe Features of CONDUCTION Aphasia

A

VERY POOR Repetition

This is in addition to Fluent but many phonemic errors

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130
Q

Status Epilepticus clinical criteria?-2

A
  1. Single seizure > 5 min OR
  2. Cluster of Seizures w/ no return to baseline in between episodes

Image showing Cortical Laminar Necrosis s/p Status Epilepticus

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131
Q

What is the long term outcome of status epilepticus on the brain? ; Dx for this?

A

Cortical laminar necrosis ; MRI w/cortical hyperintensity

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132
Q

What is the most common cause of ICH in kids?

A

ArterioVenous Malformation

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133
Q

Tx for Cluster HA - 1st, 2nd and 3rd choice

A

1st = 100% O2 Nasal Canula

2nd = Sumatriptan

3rd = NSAIDs

Px = Verapamil

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134
Q

Px for Cluster HA

A

Verapamil

Also Px for Migraines

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135
Q

Neonatal Intraventricular Hemorrhage occurs in premies less than ⬜ weeks gestation or less than ⬜ grams

________________

Px?

A

< 30 weeks vs 1500g

________________

Antenatal Maternal Corticosteroids

  • Normal Gestation = 37-42 WG*
  • Image: BL IVH & Dilated Vt*
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136
Q

What is the Etx of Intraventricular Hemorrhage in premature babies less than ⬜ weeks or less than ⬜ grams

A

< 30 weeks vs 1500g

________________

Subependymal germinal matrix contains thin-walled vessels that easily rupture. Normally, these migrate before birth, but in premies they never have the chance which –> IVH –> ⬇︎Arachnoid CSF absorption –> Communicating Hydrocephalus

  • Normal Gestation = 37-42 WG*
  • Image: BL IVH & Dilated Vt*
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137
Q

Choroid plexus cyst are identified ⬜ trimester and a marker for ⬜ in babies

________________
How do they affect the baby?

A

2ND

________________

Aneuploidy

________________

does NOT affect baby. Regressess spontaneously and is benign

Dark holes = Cyst

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138
Q

What are the 7 major complications of Newborn Prematurity

Less than 32 weeks gestation specfically

A

“Premies stay BURPPIN”

Bronchopulmonary Dysplasia

UcantBreathe (Neonatal Respiratory Distress Syndrome)

Retinopathy

  • *P**atent Ductus Arteriosus
  • *P**alsy CEREBRAL

Intraventricular Hemorrhage

Necrotizing Enterocolitis (⬆︎gastric residual volume with abd distension)

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139
Q

How do Traumatic Carotid Injuries occur?-3 ; Dx-2

Image: Carotid Dissection

A
  1. Penetrating Trauma
  2. Oropharyngeal trauma (falling w/object in mouth)
  3. Neck Strain (yoga, sports)

Dx = CT angio vs MR angio

These will present like Strokes

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140
Q

[DLB (Dementia with Lewy Bodies)] Tx

A

Rivastigmine AChinesterase inhibitor

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141
Q

What are the hallmark pathological findings for Alzheimers-2

A

[Tau Neurofibrillary tangles] & [Neuritic Senile Plaques]

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142
Q

Most serious complication of Guillain Barre? How do you determine when this complication gets really bad?

A

Respiratory Failure; FVC ≤ 20 mL/kg via SPIROMETRY means intubate!

HR, BP, Quadriparesis, FACIAL palsy are other serious complications

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143
Q

Levodopa is used to treat Parkinson’s Disease

Early SE?-3 ; Late SE

A

Early SE (HAD) = Hallucinations/Agitation/Dizziness

Late SE (5-10 yrs post tx) = Involuntary mvmnts

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144
Q

Dx for VitB12 deficiency - 3

A
  1. [⬆︎ Methylmalonic Acid levels]
  2. CBC showing Macrocytic Anemia
  3. Serum Vitamin levels
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145
Q

There are 3 Main causes of Spinal Cord Compression

Dx for Spinal Cord Compression-3

A
  1. MRI
  2. Classic S/S (BLE weakness, Worst w/spinal extension, better w/flexion, UMN signs)
  3. Positive Straight Leg

Note: In Acute Cord Compression, pts will have spinal SHOCK x3days = AReflexia and Flaccid paralysis

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146
Q

HemiNeglect Syndrome

A

Stroke in R Parietal Cortex (NonDominant hemisphere) –> Neglect of anything on the Left side

This is only in R handed people. It’s opposite for L handed

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147
Q

[Juvenile Myoclonic Epilepsy] CP

________________

Demographic?

A

Generalized Seizures +/- Absence seizures, most frequently in 1st hour after waking

________________

Teens

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148
Q

Lennox Gastaut CP-2

A

Lennox Gastaut

  1. Lala Land Retarded before 5 yo
  2. Generalized Tonic Clonic Seizures SEVERE
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149
Q

Lennox Gastaut Dx?

A

Slow Spike-Wave EEG

________________

Lennox Gastaut

150
Q

[Glioblastoma Astrocytoma] Radiographic Findings - 2

A
  1. Butterfly lesion from crossing Corpus Collosum
  2. Midline shift from Lateral Vt Compression
    * GBM is usually a HIGH GRADE Astrocytoma*
151
Q

List the n. roots associated with Common Peroneal n.

A

L4-S2

________________

foot is dropPED (Peroneal Everts & Dorsiflexes)

  • Commonly caused by L5 Radiculopathy*
  • Dx: Knee MRI vs EMG*
152
Q

List the n. roots associated with Tibial n.

A

L4-S3 (Three)

________________

can’t walk on TIPtoes (Tibial Inverts & Plantarflexes)

Commonly caused by L5 Radiculopathy

153
Q

A: List the n. roots associated with [SUP Gluteal n.]

B: Associated Injury (2)

C: Sensory deficit

D: Motor Deficit (2)

A

[SUP Gluteal nerve]

A: L4-S1

B: [Superomedial Butt injection] vs. POST Hip dislocation

C: none :-)

D: [Trendelenburg gait] & [No Thigh ABduction]

154
Q

A: List the n. roots associated with [inferior Gluteal n.]

B: Associated Injury (2)

C: Sensory deficit

D: Motor Deficit

A

[inferior Gluteal nerve]

A: L4-S2

B: Butt injection vs. POST Hip dislocation

C: none :-)

D: [No Thigh Extension]

155
Q

Which grade Astrocytoma is this? How can you tell? CP?

A

LOW grade astrocytoma; it has NO CONTRAST ENHANCEMENT ; Seizures

156
Q

Which disorder results in a Waddling gait and why?

A

Muscular dystrophy; Gluteal m weakness

Waddling Gait = walks like Penguin from Batman

157
Q

Describe En-Bloc Gait ; What type of ataxia is this?

A

Minimal mvmnt of head while walking w/staggering gait; Vestibular Ataxia

Will be accompanied w/Vertigo & Nystagmus

158
Q

How does hypOthyroidism affect Neuro system - 4

A
  1. it causes ⬇︎ in DTR
  2. ⬇︎ motor relaxation phase
  3. Mood ∆
  4. Dementia
159
Q

Long term SE of resolved Bacterial Meningitis - 3

A
  1. ⬇︎ Cognition (Retardation, Milestone regression)
  2. Hearing loss
  3. Seizures
160
Q

What is the main factor for differentiating Seizure vs Syncope

A

Seizure will have DELAYED RETURN to baseline 2/2 postictal state (confusion, focal neuro deficits, lethargy)

Seizure may also have olfactory aura & tongue lacerations

161
Q

Pts with Myasthenia Gravis may develop Myasthenia CRISIS, which presents clinically as ⬜ !!!

What are precipitants of this?-3

A

P DDD F

Respiratory Failure!

Precipitants = FIS:

  1. Fluoroquinolones
  2. Infection
  3. Surgery

Crisis Tx: [Intubate + Plasmapharesis + IVIG + Steroids]

162
Q

Memantine MOA

________________

Indication

A

Blocks Glutamate from binding to NMDA Receptor

________________

Moderate to Severe Alzheimer’s

163
Q

Vascular Dementia presents with ⬇︎executive function and dementia just like other Neuro Disorders

What is the differentiating factor for separating Vascular Dementia from other Neuro Disorders? - 2

A

VaD has [asymmetric, focal neuro ⬇︎]and is abrupt

164
Q

What causes Charcot Bouchard Aneurysms?

________________

Rupture of Charcot Bouchard Aneurysm leads to ⬜ ?

A

Charcot Bouchard Tears Pink

Uncontrolled HTN ; [Intraparenchymal HTN Hemorrhage]

165
Q

Charcot Bouchard Aneurysms occur 2/2 ____ and in 4 distinct locations

Describe CP for Charcot Bouchard Aneurysm ruptured in Basal Ganglia? - 3

A

Uncontrolled HTN –> Charcot Bouchard Aneurysm –> [Intraparenchymal HTN Hemorrhage]

Charcot Bouchard Tears Pink

Basal Ganglia

  1. CTL Hemiparesis
  2. CTL ⬇︎ Sensory
  3. Eye Deviation TOWARD side of lesion

Acute [Intraparenchymal HTN Hemorrhage] in image

166
Q

Charcot Bouchard Aneurysms occur 2/2 ____ and in 4 distinct locations

Describe CP for Charcot Bouchard Aneurysm ruptured in Cerebellum? - 7

A

Uncontrolled HTN –> Charcot Bouchard Aneurysm –> [Intraparenchymal HTN Hemorrhage]

Charcot Bouchard Tears Pink

Cerebellum

Cere is def on GRINDRR

Gait & Coordination Ataxia - IPSILATERAL

Rapid alternating mvmnt impairment

Intention tremor/Dysmetria - IPSILATERAL

Nystagmus (medial AND Lateral Vermis)

Dysarthria (Lateral Vermis only)

Rebound phenomenon

Reflex Pendular (knee swings >4x after Deep tendon reflex is elicited

Acute [Intraparenchymal HTN Hemorrhage] in image

167
Q

Charcot Bouchard Aneurysms occur 2/2 ____ and in 4 distinct locations

Describe CP for Charcot Bouchard Aneurysm ruptured in Thalamus? - 3

A

Uncontrolled HTN –> Charcot Bouchard Aneurysm –> [Intraparenchymal HTN Hemorrhage]

Charcot Bouchard Tears Pink

Thalamus

  1. CTL Hemiparesis
  2. **Eye Deviation Toward Hemiparesis**
  3. Nonreactive Miosis

Acute [Intraparenchymal HTN Hemorrhage] in image

168
Q

Charcot Bouchard Aneurysms occur 2/2 ____ and in 4 distinct locations

Describe CP for Charcot Bouchard Aneurysm ruptured in Pons? - 3

A

Uncontrolled HTN –> Charcot Bouchard Aneurysm –> [Intraparenchymal HTN Hemorrhage]

Charcot Bouchard Tears Pink

Pons

  1. Pinpoint REACTIVE pupils (damaged descending sympathetic fibers)
  2. Coma
  3. Total Paralysis

Acute [Intraparenchymal HTN Hemorrhage] in image

169
Q

Genetic cause for [Fragile X]

A

[CGG repeat] –>[FMR1 gene Methylation] on [X Chromo long arm] –>small gap near tip of [X Chromo long arm]

170
Q

Fragile X CP - 5

A

X-Large…

  1. Personality (Autism, ADHD)
  2. Ears
  3. Forehead
  4. Chin (long face)
  5. Testes

Etx: C-GG repeat

171
Q

Deficency of which Vitamin mimics Friedreich Ataxia

A

Vitamin E (will also have Hemolytic anemia)

________________

FriEdreich Ataxia [Chromo 9 Auto Recessive]

SuBACute Combined Degeneration affects SAME 3 columns

172
Q

Describe Friedreich Ataxia (8)

A

FriEdreich is Fratastic! He’s your fav., twisted, frat brother, always studdering and falling, but has a sweet, big heart

FriEdreich = [Vitamin E Deficiency] mimics it

Fratastic has 9 letters = [Chromo 9 Auto Recessive GAA repeat]

twisted = Kyphoscoliosis @ childhood

frat = [frataxin (iron binding protein) defect]

studdering = Dysarthria

falling = [Falls & Ataxia + (Pes Cavus High Foot Arch)]

sweet = DM

big heart = Hypertrophic Cardiomyopathy = COD

Involves Degeneration of [Dorsal, Lateral CST & SpinoCerebellar]

173
Q

Friedreich Ataxia Mode of Inheritance

A

FriEdreich Ataxia

[Chromo 9 Auto Recessive]

SuBACute Combined Degeneration affects SAME 3 columns

174
Q

[Shy Drager Multiple System Atrophy] CP - 3

A
  1. Multiple System Atrophy
  2. [Parkinsonism tht doesnt respond to dopaminergic rx]
  3. [Autonomic Dysfunction (orthostasis, impotence, incontinence)]

  • Tx = intravascular volume expansion to treat orthostasis*
  • DO NOT CONFUSE WITH [RILEY DAY FAMILIAL DYSAUTONOMIA] WHICH HAS NO PARKINSONISM*
175
Q

[Riley Day Familial Dysautonomia] CP

A

Autonomic Dysfunction (orthostasis, impotence, incontinence)

auto recessive in kids of Ashkenazi Jewish decent

176
Q

[Riley Day Familial Dysautonomia] Mode of inheritance ; demographic

A

auto recessive ; kids of Ashkenazi Jewish decent

177
Q

[Myasthenia Gravis] Dx-5

A

P DDD WF

  1. ACh R Ab Assay
  2. MuSK (Muscle-Specific tyrosine Kinase) Ab Assay (only if #1 is neg)
  3. [Tensilon Edrophonium]–> Improves all sx
  4. Ice Pack to eyelids –> Improves Ptosis by inhibiting ACh breakdown at NMJ
  5. BE SURE TO GET CT CHEST AFTER DX TO COVER FOR THYMOMA, POSSIBLE THYMECTOMY!!!!
178
Q

Amaurosis Fugax CP ; etx

A

Painless, transient ( < 10 min) monocular vision loss characterized as curtain being descended over eye

_________________

Carotid Artery atherosclerotic emobil

179
Q

Ocular Tonometry indication

A

Measuring intraocular pressure in acute [closed angle glaucoma]

Image: Acute [Closed Angle Glaucoma]

180
Q

Name the 3 components of EPS-ExtraPyramidalSymptoms

A

EPS = DAD

[Drug-induced Parkinsonism]

Akathisia (restlessness)

Dystonia (sudden twisted posture worst with activity)

Tx = Benztropine vs Diphenhydramine

181
Q

What is EPS caused by, and which drugs are the most likely to cause it?

A

[Blocking Nigrostriatal D2]; [1st generation Antipsychotics (Haloperidol/Fluphenazine)]

182
Q

Congenital Torticollis etx

A

Malpositioning of Head in Utero vs During birth –> constant contraction of SCM–>Lateral Neck swelling

Torticollis also possible in Adults

183
Q

Describe Athetosis ; What disease is it seen in?

A

Slow, writhing mvmnts of hands & feet often occuring with Chorea (Choreoathetosis) ; Huntington’s

184
Q

Neonate comes in with Hydrocephalus, delineated by bulging fontanelles

Dx?

________________

Tx?

A

Head CT

________________

Ventricular Shunt

185
Q

Describe the difference between Cyanotic and Pallid [Breath Holding Spells]. ; Demographic for these?

A

Cyanotic: Crying –> Breath Holding, Cyanosis, [LOC 2/2 syncope]

Pallid: Pain from minor trauma –> Breath Holding, pallor, diaphoresis & [LOC 2/2 syncope]

6 mo - 2 yo

sometimes associated w/ iron deficiency anemia

186
Q

ACA occlusion CP-3

A
  1. CTL Weakness worst in LE
  2. CTL Numb worst in LE
  3. Urinary Incontinence
187
Q

ASA occlusion CP-2 ; Which syndrome is this?

A

AKA MEDIAL Medullary Syndrome

  1. CTL UE & LE Weakness
  2. Ipsilateral hypoglossal loss
188
Q

In comparing Ischemic Stroke to Hemorrhagic Stroke CP, both have _____. What are the differentiating factors?-2

A

Both = Focal neuro ∆

Hemorrhagic Stroke ALSO has [worsening HA + AMS from ⬆︎ICP]

Remember: ANY Suspicion of Stroke warrants NonContrast Head CT

189
Q

Benztropine & Trihexyphenidyl are in what class of drugs?

________________

How can pts on these develop Retro-Orbital HA during OD?

A

Anticholinergics; OD can –> Acute Glaucoma –> RetroOrbital HA

________________

  • Red as a beet, Dry as a bone, Hot as a hare, Blind as a bat, Mad as a hatter, Bowel & Bladder lose their tone, and the Heart runs alone*
  • Image: Acute Closed Angle Glaucoma*
190
Q

How do you treat Refractory Serotonin Syndrome

A

Cyproheptadine

(antihistamine with anti-serotonergic properties)

191
Q

Stiff Person Syndrome etx

A

RARE autoimmune Disorder

192
Q

What is the most common cause of Fatal Sporadic Encephalitis in the U.S.? Should you use CT or MRI for dx?

A

Herpes Encephalitis ; MRI (and then CSF PCR=Gold Standard Dx)

193
Q

Between DM, Smoking and HTN, which carries the GREATEST STROKE Risk?

A

HTN

194
Q

A: Describe Opsoclonus-Myoclonus Syndrome

B: What Childhood tumor is it associated with?

A

A: [Non-Rhythmic Conjugate Eye mvmnts] with myoclonus= “Dancing Eyes and Feet”

B: Neuroblastoma (onset 2 y/o)

Arises from Neural crest

195
Q

Neuroblastoma Dx - 3

A
  1. Calcifications on Radioimaging (Xray/CT)
  2. ⬆︎ VMA and Homovanillic acid catecholamines
  3. Amplification of N-myc protoOncogene
196
Q

Metanephros is the precursor to ⬜

________________

What tumor is this associated with?

A

MeTanephros

Renal Parenchyma Tissue

________________

Wilms’ tumor

197
Q

MeSonephros is precursor to ⬜ ⬜ and ⬜

A

Seminal Vesicles / Ejaculatory ducts / Vas Ductus Deferens

198
Q

ParaMesonephron is the precursor of the ⬜(3)

A

Fallopian Tubes / Uterus / Part of Vagina

199
Q

Name the classic sx of IntraCranial Hypertension - 4

A
  1. Positional HA worst at night/morning
  2. Papilledema / vision ∆
  3. AMS
  4. NV
200
Q

S/S of Acute [Closed angle glaucoma] - 3

A
  1. RetroOrbital HA w/⬇︎Vision
  2. Conjunctival Erythema
  3. Dilated pupil poorly responsive to light

Occurs in Pts > 60 yo

201
Q

Identify

A

image

202
Q

Identify

A

A: Thalamus

B: Dorsal Midbrain

C: Pons

D: Dorsal Medulla

E: Cerebellum

203
Q

Diagnostic Criteria for Febrile Seizure - 5

A
  1. 6 mo - 6 yo
  2. Temp > 38C
  3. No hx of Afebrile seizures
  4. No CNS infection
  5. No acute metabolic cause of seizure (pt would have dehydration)

Tx = Reassurance only!

204
Q

Sx of mild hypOkalemia?-2

________________

Sx of SEVERE hypOkalemia?-5

A

Mild: Weakness + Muscle Cramps

________________

SEVERE ( < 2.5):

  1. Flaccid Paralysis
  2. hypOreflexia
  3. tetany
  4. Rhabdo
  5. Arrhythmia
205
Q

Meniere’s Disease etx

A

⬆︎endolymphatic fluid in inner ear–> Membranous labyrinth swelling and rupture –> [KRE- K+ Rich Endolymph] leak into [Na+ rich perilymph] –> abnormal hair cell function –> VTH sx

**Very Terrible Hearing **

206
Q

Indication of Head Thrust Test ; Describe how to do the test

A

differentiates in nystagmus pts between peripheral & central vertigo;

pt looks at fixed target and their head is rapidly turned from the target. Normally, eyes remained fix on target, but in [Peripheral vestibular dysfunction pts] eyes move w/head and then horizontal saccade back to target after

207
Q

BPPV (Benign Paroxysmal Positional Vertigo) etx and CP-3

A

Ca+ otoliths accumulated within semicircular canals –> Dizzines, Nystagmus and Nausea only

208
Q

Normal Pressure Hydrocephalus etx-2

A

Wacky, WOBBLY & Wet!

[⬇︎Arachnoid villi CSF absorption vs Obstructive Hydrocephalus] –> transient ⬆︎in Vt pressure –> Enlarges Vt –> After while, Vt Pressure NORMALIZES to the enlarged Vt

209
Q

Riluzole MOA ; Indication

A

Inhibits release of Glutamate ; ALS

SE: ⬆︎Transaminases, Wt loss, Dizziness

210
Q

Identify disease process

A

Central Retinal A. occlusion

Note the Retinal Whitening!

211
Q

Px for Migraine HA - 4

A

VTAP the migraine BEFORE it comes, and SEND it on its way when it does!

  1. Verapamil
  2. Topiramate
  3. Amitryptyline
  4. Propranolol
212
Q

Tx for Acute Migraine HA - 4

A

VTAP the migraine BEFORE it comes, and SEND it on its way when it does!

  1. Sumatriptan
  2. Ergots (Bromocriptine)
  3. NSAIDs
  4. D2 Blockers (Metaclopramide/Prochlorperazine)
213
Q

Cerebral Palsy is a group of clinical syndromes generally characterized as ______

What are the 3 types? What’s the greatest risk factor for Cerebral Palsy?

A

Nonprogressive motor dysfunction ;

Cerebral Palsy is just SAD

  1. Spastic
  2. Ataxic
  3. Dyskinetic

Greatest RF = prematurity ( < 32 wks gestation) but EtOH is second

214
Q

Cerebral Palsy is a group of clinical syndromes generally characterized as ______

How does it present? - 3

A

Nonprogressive motor dysfunction (Prematurity>EtOH = RF) ;

Cerebral Palsy is SAD

  1. BL equinovarus club feet (image)
  2. UMN signs LE >UE
  3. Mental Retardation

Greatest RF = prematurity ( < 32 wks gestation)

215
Q

CP for Chemotherapy Peripheral Neuropathy - 4

A
  1. Stocking Glove symmetrical paresthesias starting at toes/fingers and spreading proximal
  2. Early loss of ankle jerk reflex
  3. Loss of Pain/Temp
  4. Motor weakness

Drug Culprits: Cisplatin / Paclitaxel / Vincristine

216
Q

SIDS is sudden infant death that can’t be explained

What are 4 major ways to ⬇︎ risk of SIDS?

A
  1. Supine Sleeping position
  2. NO second hand smoke
  3. Use Pacifier during sleep
  4. ROOM sharing (NOT bed sharing)
217
Q

Causes of [Magnetic “Frontal” Gait Apraxia] ? - 2

Inability to walk on command and feels like feet are magnets

A
  1. Normal Pressure Hydrocephalus
  2. Frontal Lobe Degeneration
218
Q

CP of Conversion Disorder -2

________________

Demographic-3?

A

[Sudden Vision Loss] + [PseudoSeizures idiopathic]!

________________

  1. Teens WITH WITNESSES AROUND
  2. Physically abused
  3. Depressed pts
219
Q

Edinger Westphal nucleus provides ⬜ to the ⬜ ganglion

CP of a pt with R damaged EW nucleus

A

PreGanglionic [ParaSympathetic efferent OUTflow] to ciliary ganglion

R (Ipsilateral) FIXED DILATED pupil not reactive to light

220
Q

What are the major functions of [Vagus CN10] - 5

A

VAGUS

Vocal Cord Phonation

[Aortic baro/chemoreceptor Parasympathetics]

[Gag reflex - EFFerent (loss of Gag = CN9 problem)]

U‘ll COUGH reflex- when vagus receives signal afferently

[Swallowing & Palate Elevation]

Image: Left Ipsilateral CN10 palate dysfunction

221
Q

Tx for Clostridium Botulinum poisoning - 3

A
  1. Equine Heptavalent Antitoxin (passive immunity)
  2. Botulinum Ig
  3. Guanidine
222
Q

Describe Physiologic Tremors

A

benign [12-14 Hz high freq] tremor that occurs posturally (i.e. when holdings arms out), activated w/emotion or caffeine

223
Q

A lesion in the Upper Thoracic Spinal Cord produces what CP - 4

A
  1. Sensory loss nipples downward
  2. Paraplegia
  3. Bladder Incontinence
  4. Fecal Incontinence
224
Q

A lesion in the Lower Thoracic Spinal Cord produces what CP

A

Sensory loss Umbilicus downward

225
Q

A: What are Craniopharyngiomas

B: What type of tissue do they arise from

A

A: Suprasellar tumors (Mostly in Kids but NOT ALWAYS)

B: Remnants of Rathke’s Pouch (Embryonic Precursor of ANT Pituitary)

226
Q

Loss of Gag Reflex indicates what cranial nerve damage

A

Glossopharyngeal CN9 Ipsilateral

227
Q

Dysphagia indicates what n. damage (2)

A

[Glossopharyngeal CN9] and [Vagus CN10]

228
Q

Dysphonia/Hoarseness indicates what n. damage

A

[Vagus CN10]

229
Q

Atomoxetine Indication

A

NonStimulant ADHD Rx

230
Q

Explain why a child presenting with Migraine s/s is no major concern ; Where do these occur in kids?

A

Migraine HA are most common HA in peds and occur before 20 yo in 50% ; Bifrontal (if occipital, be suspicious!)

231
Q

Tx of Pediatric Migraine - 3

A
  1. Dark Quiet Room +
  2. NSAID
  3. Triptans (refractory)

Triggers = stress/lights/odors/foods

232
Q

Parkinson’s Disease Dx

A

PHYSICAL EXAM! revealing at least 2/4 of PARK

233
Q

How is Carotid Artery Dissection associated with Horner Syndrome?

A

Carotid A Dissection –> Partial Horner (Ptosis + Miosis only) 2/2 postganglionic sympathetic fiber damage

234
Q

CP of Craniopharyngiomas - 3

________________

Demographic?-2

A
  1. BiTemporal Hemianopsia
  2. HA
  3. Pituitary Hormonal Deficiencies (i.e. ⬇︎Libido)

Demographic: MOSTLY KIDS, but some adults

235
Q

How long does it take pts with Subdural hematoma to have sx? Why is this a problem for elderly?

A

1-2 days; Elderly may have insidious subdural bleeds for weeks after injury –> Confusion/Somnolence/HA/FOCAL Neuro ∆

Image: L Chronic Subdural Hematoma

236
Q

Step-Wise Tx to Restless Leg Syndrome - 4

A

1st: NonPharm (Leg Massage/Heat/Exercise/Iron Supplement)
2nd: Dopamine Agonist NonErgots (Pramipexole/Ropinirole)
3rd: Gabapentin (if pt also has insomina vs chronic pain)
4th: Opioids

237
Q

Which medications should be given to a pt with stroke and no prior antiplatelet tx?-2 ; When should it be given?

A

ASA + Statin ; Within 24 hrs of onset

238
Q

Which medications should be given to a pt with acute ischemic stroke and on ASA already? - 2

Give within 24 hr of onset

A

Make sure ASA is first

[Clopidogrel 75 QD vs Dipyridamole 200 BID]

239
Q

Why is Heparin NOT USED in pts with Acute Stroke?

A

⬆︎Bleeding Risk if stroke turns out to be Hemorrhagic

240
Q

Which disease process does this patient have?

Keeps R arm ADDucted and swings R leg outward in semicircle as they walk

A

Hemiparesis 2/2 stroke

241
Q

What are the Afferent and Efferent nerves for Corneal Reflex?

A
242
Q

What are the Afferent and Efferent nerves for Lacrimal Reflex?

A
243
Q

A: Primary CNS Lymphoma is the ⬜ most common cause of ⬜ in HIV pts

B: What virus is this associated with?

C: What WBCs would you expect to see in the brain tissue

A

A: 2nd most common cause of ring enhancing lesions in HIV pts (1st = Toxoplasmosis Gondi)

B: EBV

C: B-lymphocytes

244
Q

What is [Hydrocephalus Ex Vacuo] and which pts do you see it in?

A

Ventricular Enlargement only because of cortical atrophy, typically found in HIV pts (cortical atrophy is normal sequelae in HIV)

True Hydrocephalus is actual build up of CSF (obstruction vs. hyperproduction**)

245
Q

PML Clinically Presents like Multiple Sclerosis

Describe PML-Progressive Multifocal Leukoencephalopathy

A

Opportunistic infection 2º to [John Cunningham PolyomaVirus]—-> [multiple white matter lesions] (Hyperintense Flair signal on radiology) –> Death vs. Severe Neuro injury

246
Q

Describe 2 neuro conditions associated with HIV

A
  1. HIV Encephalopathy which = [microglial nodule GREY MATTER ENCEPHALITIS] in pts with ~CD4 < 200 —> Subactue HIV associated Dementia (HAD) + parkinsonism
  2. HIV Meningitis–>Persistent Pleocytosis, neuro sx and Dementia via Direct Viral invasion vs. inDirect inflammation

HIV LeukoEncephalopathy is the same thing but with White matter instead

247
Q

What Dx should you suspect in a Young HIV Pt witih Dementia?

________________

Pgn?

A

AIDS Dementia= slow cognitive & behavioral decline with POOR PGN . Note: This presentation is Similar to [SuBACute Combined Degeneration]

HIV LeukoEncephalopathy is the same thing but with White matter instead

248
Q

PML (Progressive Multifocal Leukoencephalopathy) Clinically Presents like Multiple Sclerosis

Where does PML typically occur in the brain? - 2

A

[SubCortical White Matter] or [Cerebellar Peduncles]

Usual Demographic: HIV pts (reversal of immunosuppresion stops JC Polyoma virus progression)

249
Q

PML (Progressive Multifocal Leukoencephalopathy) Clinically Presents like Multiple Sclerosis

How is PML related to the drug, Natalizumab?

A

Also can be a Rare Side Effect of Natalizumab (MS drug) in pts who are also JC Virus positive

Usual Demographic: HIV pts (reversal of immunosuppresion stops JC Polyoma virus progression)

250
Q

Parinaud Syndrome etx ; How does it clinically present?-3

A

“Parinaud loved his PUP”

Direct Compresion of [Midbrain Pretectum SUP Colliculi] (possibly from Germinoma) –>

  1. Ptosis
  2. Upward Gaze paralysis (can NOT look up)
  3. Pupil ∆

these can also cause obstructive hydrocephalus

251
Q

Pt comes in with Foot Drop

What are the 2 main DDx?

A

Common Peroneal n compression vs L5 Radiculopathy(will be accompanied with shooting back pain)

Dx: Knee MRI vs EMG

252
Q

Status Epilepticus Mngmt - 5

A

1st: ABCs!
2nd: Ativan IV bolus 0.1mg/kg = 4-8 mg (repeat in 5-10 min if needed)
3rd: FosPhenytoin IV 20 units/kg (no faster than 150 mg/min) (Continuous IV Phenytoin –>Purple Glove Syndrome and so is alternative)

4th (if still status): [Alternate Diazepam Levatiracetam]

5th (if still status): Pentobarb coma

Image showing Cortical Laminar Necrosis s/p Status Epilepticus

253
Q

DDx for Intracerebral Hemorrhage - 5

A
  1. HTN (Charcot Bouchard aneurysm vs Cocaine)
  2. Warfarin OD
  3. Tumor Metz (Papillary Thyroid/Renal/Melanoma/Testicular)
  4. AVM
  5. Hemorrhagic Conversion of [Ischemic infarct 3-5 days prior]
254
Q

Key points for mngmt of Intracerebral Hemorrhage - 5

A
  1. BP < 140 (Use Labetalol & Nifedipine, not Hydralazine)
  2. ⬇︎ICP with Mannitol vs [23% Hypertonic Saline] vs Hyperventilate
  3. Osm Goal = 300-320
  4. Na+ >>>>>> 145
  5. Repeat CT after 6 hours
255
Q

Ulnar Nerve Syndrome tx-3

A
  1. Elbow Protectors
  2. Avoid direct elbow pressure or mvmnt
  3. Surgery

May also occur at forearm in DM pts

256
Q

Ulnar Nerve Syndrome Risk Factors - 3

A
  1. Surgery Malpositioning
  2. Male
  3. DM

May also occur at forearm in DM pts

257
Q

Tx for Bell’s Palsy - 4

A
  1. [CTS PO within 3 days of onset] (self resolves within 6 mo.)
  2. Valacyclovir 500 mg BID (HSV may be inciting factor)
  3. Artificial Tear to affected eye during day
  4. Ophthalmic ointment to affected eye at night
258
Q

Where is the hypoglossal nucleus located?

A

Dorsomedial Medulla

259
Q

Isolated Hypoglossal CN12 palsy is not common

What’s the most common cause of this when it’s isolated? What are other causes?-6

A
  1. TUMOR
  2. Guillain Barre
  3. Multiple Sclerosis
  4. Surgery
  5. Infection
  6. Trauma
260
Q

Pt has CHRONIC burning tingling dysthesia

Tx? - 3

A
  1. TCA (Amitriptyline or Nortriptyline)
  2. Gabapentin
  3. Carbamazepine

dysthesia = unpleasant sensation

261
Q

Top DDx for CHRONIC Sensory Neuropathy - 5

A
  1. VitB12 deficiency
  2. Sjogren’s Syndrome (check SSA Ro and SSB La)
  3. [Pyridoxine B6] toxicity
  4. Cisplatin toxicity
  5. Inflammatory ganglionopathy (viral vs immune)
262
Q

Where do most disc herniations occur? - 2 ; Risk factor for disc hernation?

A

between

  • L4 - L5 OR
  • L5 - S1

SMOKING = Risk factor

Positive Crossed Straight Leg = Lumbar Disc hernation

263
Q

What 4 locations is pain radiated to in L5 Radiculopathy?

A
  1. Lower Back
  2. Butt
  3. Lateral Thigh
  4. LateralAntero Calf

L5 Radiculopathy can also cause Foot dropPED

264
Q

Which reflexes are spared in L5 Radiculpathy? - 2

A

Patellar and Ankle Jerk

265
Q

DDx for an expanding intramedullary mass? - 6

Image: Intramedullary mass + expanding edema

A
  1. Sarcoidosis
  2. Ependymoma (usually in 4th vt)
  3. Meningioma benign
  4. Demyeliating Disease (Multiple Sclerosis)
  5. Metastasis
  6. Transverse Myelitis

Image: Intramedullary mass + expanding edema

266
Q

Tx for Sarcoid Myelopathy

Image: Intramedullary mass + expanding edema

A

Corticosteroids

Image: Intramedullary mass + expanding edema

267
Q

What regions of the spinal cord does the Anterior Spinal Artery perfuse? - 3

A
  1. ANT horns
  2. Lateral Corticospinal Tract
  3. Lateral Spinothalamic Tract

POST Spinal Artery perfuses Dorsal Column

268
Q

What is Aphasia?

A

⬇︎Language Processing (speech/writing vs comprehension + repetition)

269
Q

HYPERdensity on CT represents what? - 3

A
  1. Blood
  2. Bone
  3. Calcification (normal and often seen in choroid plexus)
270
Q

Most common cause of Spinal Cord Ischemia?-2 ; Other causes?-3

A

[Aortic Disease (thromboembolic)] or [Aortic Surgery]

Others= Hematomyelia, AVM, Fracture/Dislocation

271
Q

When is [CEA-Carotid Endarterectomy] indicated?

A

Only when pt has a [SYMPTOMATIC 70-99% Stenosis]

272
Q

The VertebroBasilar arterial system (Posterior Circulation) perfuses which major structures? - 4

A
  1. Brainstem
  2. Cerebellum
  3. Spinal Cord
  4. Labyrinths
273
Q

What areas of the brain are involved in CONDUCTION Aphasia? - 4

A

VERY POOR Repetition

  1. Arcuate Fasciculus = MOST COMMON
  2. Supramarginal Gyrus
  3. Auditory Cortex
  4. Large Posterior Perisylvian area
274
Q

Main Features of TIA - 2

A
  1. Transient ( No more than 1 day long but typically < 20 min)
  2. Leaves NO residual deficits or radiomanifestations
275
Q

CP of VertebroBasilar TIA - 4

A

Brainstem: Diplopia, Dysarthria

Cerebellum: BL Clumsiness

Spinal Cord: BL Weakness

Labyrinths

276
Q

Surgery is a LAST OPTION for treating Essential Tremor

List the Surgical Procedures available-2 ; What is the goal of the surgery?

A
  1. Stereotactic VIM Thalamotomy
  2. VIM Thalamic Stimulation

Goal = VIM (Ventralis InterMedius) thalamic nc

Onsets at 45 yo and 50% cases are AUTO DOM

277
Q

Both Mannitol and [Hypertonic Saline (3%/5%/23%)] are used to ⬇︎ ICP

List advantages of using Hypertonic saline? - 3

A
  1. Anti-Inflammatory
  2. Does NOT cross into interstitial space like Mannitol does eventually (Mannitol causes rebound edema!)
  3. Expands systemic volume

Hypertonic Saline can ONLY be given via Central line :-(

278
Q

Myasthenia Gravis, LEMS and [Myopathies (polymyositis/dermatomyositis)] can be similar

How can you differentiate these based on reflexes?

A

Myopathies[polymyositis/dermatomyositis] and LEMS have ⬇︎ Reflexes.

Myasthenia is normal

279
Q

How are migraines associated with Pregnancy?

A

Migraines commonly start 2nd trimester of Pregnancy

But also be suspicious of [Pseudotumor Cerebrii]

280
Q

Memory depends on a BL 4-way circuit

What is this circuit?-4

A

“Having Fun Memories Around”

[Hippocampus temporal lobe] –> Fornix –> Mammillary Bodies —> ANT Thalamus

281
Q

Memory depends on a BL 4 way-circuit

How is this Memory circuit often damaged?-3

A

“Having Fun Memories Around”

[Hippocampus temporal lobe] –> Fornix –> Mammillary Bodies –> ANT Thalamus

  1. [Thiamine B1 deficiency] –> disruption between [Mammillary Bodies] and [ANT Thalamus]
  2. Anoxia –> BL [Hippocampus temporal lobe] damage
  3. HSV –> BL [Hippocampus temporal lobe] damage
282
Q

Describe Constructional Apraxia ; Describe Dressing Apraxia

________________

What causes both of these?

A
  • Constructional Apraxia = Can’t Construct a Drawing (i.e. copy a house)
  • Dressing Apraxia = Can’t get Dressed

________________

Both caused by Parietal Lobe lesion

283
Q

Name 2 examples of Frontal Lobe release signs?

________________

When is this normal? When is it abnormal?

A
  1. Sucking examiner finger when corner mouth is lightly stroked
  2. Toes latching onto examiner finger when rubbed

________________

normal = during infancy when [descending inhibitory pathway myelination] is still incomplete

________________

Abnormal = in Adults and means Frontal lobe damage

284
Q

What is Anton’s syndrome

A

Unawareness of Vision loss from Occipital lobe damage –> Denial of vision loss

​”Anton didn’t know he was blind!”

285
Q

What’s the only imaging modality for diagnosing Alzheimer’s Disease?

________________

Which areas does it reveal this in? - 3

A

CLAV –> HANDU

PET scan revealing [PIB-Pittsburgh Compound B] binding to β-amyloid and being taken up in

  1. PreFrontal
  2. Temporal
  3. Parietal
286
Q

Which 3 Neuro Diseases Cross the Corpus Callosum?

A
  1. Gliomas (AGE - i.e. Glioblastoma)
  2. Multiple Sclerosis
  3. CNS Lymphoma
287
Q

20% of patients with ⬜ go on to develop Multiple Sclerosis

A

[SLUM SiiiN]

Neuritis Optic - (uL eye pain + vision loss + Marcus Gunn afferent pupillary defect) = ALSO RISK FACTOR

Image: T1 MRI Black Holes Dx

288
Q
A

SAH usually occur in Suprasellar Cistern

289
Q

Usually Simple Partial Seizures originate in a single hemisphere

What happens when Simple Partial seizures involve BOTH hemispheres (i.e. COMPLEX Partial Seizure)? - 2

A

ONLY If BOTH hemispheres become involved –>

  1. IMPAIRED BUT NOT LOST OF consciousness (won’t follow commands and will have postictal amnesia)
  2. +/-automatisms (repetitive chewing, sucking, swallowing)

=COMPLEX Partial Seizure

290
Q

Usually Simple Partial Seizures originate in a single hemisphere

What happens when Simple Partial seizures spread DIFFUSELY to bilateral cortex areas - 3

A

= Secondary GENERALIZED TONIC CLONIC

  1. Generalized Convulsions
  2. LOST of Consciousness may occur
  3. Postictal Amnesia
291
Q

List the difference between Primary and Secondary Generalized Tonic Clonic Seizures

________________

Seizure ATTaCK

A

Primary GTC occur when electrical discharge simultaneously comes from diffuse bilateral cortical areas (i.e. Absence)

vs

Secondary GTC comes from the spread of a [simple partial seizure]

292
Q

List the sequence of events for a Seizure - 5

A

Seizure ATTaCK

1st: Aura (nausea/dizziness) vs Simple Partial
2nd: Tonic: Sudden Stiffness–>Falling and cry out
3rd: [Time Out: aPNEA] –> Cyanotic, dusky face
4th: Clonic convulsions + oral involvement
5th: [Krazed: Postictal Amnesia (pt only recalls aura) + Lethargy + incontinence]

293
Q

Describe NonEpileptic Pseudoseizures

________________

Demographic-2?

A

Episodic jerking movements that occur WITH NO cortical discharge (falls under conversion disorder)

________________

  1. Teens WITH WITNESSES AROUND
  2. Physically abused pts
  3. Depressed pts
294
Q

What are the major triggers of [Partial Seizures and Secondary GTC] - 3

A
  1. Infarct
  2. Tumor
  3. Viral Encephalitis
295
Q

Pt just fell and started GTC seizing right in front of you!

How should you manage them? - 4

A

Seizure ATTaCK

1st: Roll pt onto side
2nd: Stabilize Head BUT NOT THEIR MVMNTS
3rd: KEEP THINGS OUT OF MOUTH OR AROUND PT
4th: ER if > 5 min

296
Q

Carbamazepine, Phenytoin, Gabapentin are only used to treat what type of seizures? - 3

A
  1. Simple Partial
  2. Complex Partial
  3. Simple/Complex Partial convert –> Secondary GTC
297
Q

Name the CNS Neoplasms that are of Glial Origin (i.e. Glioma) - 3

A

AGE comes from Glia

  1. Astrocytoma (i.e. Glioblastoma)
  2. OligodendroGlioma (adult frontal lobe)
  3. Ependymoma (ependymal cells line ventricles)

These stain positive for GFAP

298
Q

What should be used to treat edema surrounding brain tumors?

Image: MRI showing Tumor with Hyperdense surrounding edema

A

Dexamethasone

NOT effective in ⬇︎ICP during Stroke

299
Q

What is Meningeal Carcinomatosis?

________________

Tx?

A

Spread of CA to CSF which diseminates to Meninges, Cortex, Cranial n, spinal nerve roots

________________

Tx = Intrathecal Chemo

300
Q

Explain how collateral blood flow to a “complete” circle of willis help prevent ischemic CVA/TIA?

A

[External Carotid: Opthalmic A] can retrogradedly perfuse Circle of Willis when Internal Carotid is blocked

301
Q

What structures does the lenticulostriate vessels perfuse (4)

A

lenticulostriate vessels perfuse everything in [Be TIPC] EXCEPT PONS!

Basal Ganglia

Thalamus = pure sensory stroke

[Internal Capsule / / Corona Radiata] = pure motor stroke

302
Q

Describe the likely regions involved for the following deficits

A: Weakness of Face and UE

B: Weakness of LE

C: Numbness of Face and UE

D: Numbness of LE

A

A: CTL Precentral MCA territory (Face and UE weak)

B: CTL Precentral ACA territory (LE weak)

C: CTL PostCentral MCA terrtory (Face and UE numb)

D: CTL PostCentral ACA territory (LE numb)

303
Q

Which imaging should be obtained for CVA/TIA w/u? - 4

A
  1. NonContrast Head CT
  2. TTEchocardiography (evaluate for cardioembolism)
  3. Carotid cervical US
  4. CTA/MRA (CTA shown in image-evaluate for Vertebrobasilar abnormalities)
304
Q

Why is Altered mental status in a pt who had a large ischemic stroke 4 days prior alarming? - 2

A

Within 3-5 days (below) can develop:

  1. Hemorrhagic conversion of infarct
  2. Brain Edema
305
Q

What’s the most common cause of SubArachnoid Hemorrhage?

________________

What’s the 2nd?

Usually in the Suprasellar Cistern

A

Trauma > [Berry Saccular Aneurysm]

306
Q

What is Prosody?

________________

A stroke in what part of the brain creates [Sensory receptive Aprosody]?

A

Using changes in vocal pitch/inflection to convey language (i.e. You gave this to me? vs You gave this to me)

________________

[NonDominant Cortex opposite to Wernicke’s area]

example: Sensory receptive Aprosody

307
Q

What is [Sensory receptive aprosody]?

________________

How does it occur?

A

Inability of pt to understand prosody/vocal inflections by other people

________________

Damage to [NonDominant Cortex opposite to Wernicke’s area]

308
Q

What is the action of the Inferior Oblique m?

________________

What is the action of the Superior Oblique m?

A

IOUO SODO

InferiorOblique = Up and Out

SuperiorOblique (innervated by Trochlear CN4) = Down and Out

309
Q

What is unique about [Trochlear CN4]?

A

Only cranial nerve to exit DORSAL midbrain and then decussate and innervate CTL Superior Oblique muscle

IOUO SODO

310
Q

What is the difference in clinical presentation between [neuro nystagmus (cerebellum/vestibular)] vs drug nystagmus? -2

A

neuro nystagmus = asymmetrical(slow jerk toward side of lesion) & occurs only with certain eye positions

vs

drug nystagmus = symmetrical & occurs all the time

311
Q

What does the PPRF have to do for Right Horizontal Gaze

A
  • Activate Right Abducens nc in Pons
  • Activate Left EdingerWestphal in Dorsal Midbrain
  • MLF connects all this, leaving R PPRF, decussating and then joining L oculomotor nc*
  • Image: Left MIOS*
312
Q

A: MIOS seen in Younger pts indicates ⬜

B: MIOS seen in OLDER pts indicates ⬜

C: What is the purpose of the MLF

A

[MIOS-MLF Internuclear Ophthalmoplegia Syndrome]

1) Younger pts= Multiple Sclerosis
2) Older pts= [Pontine a. lacunar stroke]

________________

MLF coordinates CN3 with CN6

________________

Image: Left MIOS

313
Q

Explain [Relative Afferent Pupillary Defect]

A

partial optic n vs retinal lesion –> pupils BOTH constrict when light is shown in normal eye BUT when light is swung to lesioned eye BOTH eyes Dilates since lesioned eye has ⬇︎ afferent input

314
Q

Recall the Oculosympathetic Horner’s pathway - 9

A
  1. Hypothalamus
  2. Passes as hypothalamospinal tract in lateral medulla
  3. [IML C8-T1 Cilospinal Center of Budge]
  4. Under Subclavian Artery as sympathetic trunk
  5. Lung Apex
  6. SUP cervical ganglion near carotid bifurcation

6A. Facial Sweat Glands

6B. carried with CN5B1 thru cavernous sinus & then SUP orbital fissure to Pupil Dilator

6C. Innervates [Muller’s superior tarsal muscle]

2 / 5 / 6 / 6B are most common sites of Horner’s syndrome

315
Q

What would a [R Partial Retinal lesion] manifest as

A

R Monocular scotoma

316
Q

Lesion at which letter would result in [R Nasal Hemianopia]

A

D

317
Q

Lesion at which letter would result in [L Pie on the Floor (Homonymous INF quadrantanopia)] lesion

A

G

318
Q

Parkinsonism is often caused by ⬜ or ⬜

________________

Name 2 rare causes of Parkinsonism

A

Common = [Substantia nigra pars compacta degeneration] vs [D2 Blocker Drugs]

________________

rare = [Toxic levels of CO2] or [ManGanese]

PARK** & **hamp

319
Q

Risk Factors for Migraines - 2

________________

VTAP the migraine BEFORE it comes, and SEND it on its way when it does!

A
  1. Fam Hx
  2. Menstruation (hormones during cycle ⬆︎ risk)
320
Q

Migraine etx

________________

How are the Trigeminal nerves associated-2

________________

VTAP the migraine BEFORE it comes, and SEND it on its way when it does!

A

Genetic [GainOfFunction mutation in excitatory NMDA receptor]–>burst of cerebral activity when triggered—>hyperemia (usually occipital lobe)–> sx. Burst is followed by Cortical Depolarization tht has slow but deliberate forward advance –> Triggers Trigeminal pathway

Trigeminal afferents :

  1. send impulses–>[Brain Stem APCTZ] & hypothalamus–> Nausea/Photophobia/Phonophobia
  2. retroactively depolarize–>release of substance P –> neurogenic inflammatory pain + vasoDilation
321
Q

Pt has advancing foot crossing over opposite foot similar to closing scissor blades

What causes Scissors Gait?

A

UMN (Corticospinal Tract spasticity) lesions

Spasticity causes Scissors Gait

322
Q

What causes a Broad based Ataxic gait? - 2

A

Cerebellar vs [Dorsal Column Pathway] dysfunction

323
Q

Tx for EPS-ExtraPyramidalSymptoms - 2

A

EPS = DAD

Benztropine vs Diphenhydramine

324
Q

How do you differentiate Tunnel Vision 2/2 [Glaucoma or Retinal Degeneration] from Psychiatric etiology?

A

As examiner moves further away …

[Glaucoma or Retinal degeneration] = Tunnel Vision enlarges in cone pattern

vs

Psychiatric = Tunnel vision stays Tunnel

325
Q

Which Artery of the Base of Brain can cause unilateral hearing loss if occluded?

A

AICA

Other causes: [Petrous bone trauma]

326
Q

Meniere’s Disease CP-3?

A

**Very Terrible Hearing ** that is recurrent

  1. Vertigo
  2. Tinnitus
  3. Hearing loss which –> Permanent eventually
327
Q

Acute Labyrinthitis CP - 4?

A

**Very Terrible Nystagmus & Hearing **

  1. Vertigo
  2. Tinnitus
  3. Nystagmus
  4. Hearing loss which –> Permanent eventually
328
Q

What is the [ARAS (Ascending Reticular Activating System)] important for?

________________

Lesions of the ⬜ where ARAS is located leads to what? - 2

A

ARAS(AlwaysRetainingAwakeState) = keeps you awake!

________________

lesions of upper brain stem –> Somnolence or Coma

329
Q

DSM5 Criteria For Narcolepsy (2)

A

[Recurrent and sudden entry into REM sleep at least (3 x/week) x 3 mo.]

+

1 of the following:

a. Cataplexy
b. [Low CSF hypOcretin1 orexin A]
c. [REM latency ≤ 15 min] (goes into REM in less than 15 min)

330
Q

What is Hypocretin 1 and 2 also known as, and what is their function?

A

[Hypocretin 1 (Orexin A)[and [Hypocretin 2 (Orexin B)] are [Lateral hypothalamus neuropeptides] that promote wakefullness & inhibit [REM sleep-related phenomena]

These are deficient in Narcolepsy

331
Q

Tetanus takes ⬜ days to onset after exposure to endospores

________________

Tx? - 4

A

2 days;

  1. Mechanical ventilation ICU
  2. Human Tetanus Immune Globulin
  3. Abx
  4. Diazepam

Comes from puncture wound vs burn

332
Q

DDx for Clostridium Botulinum - 4

A

Also consider…

  1. Myasthenia Gravis
  2. Atypical Guillain Barre
  3. Tick Paralysis
  4. Brain Stem infarct

Adult tx: Equine Heptavalent Antitoxin (passive immunity)

333
Q

How do Adults present after Lead Poisoning?

________________

How do Children present after Lead Poisoning?-2

A

Adults: [Workplace paint vs. lead battery] –> Peripheral neuropathy

________________

Children: [ingeting lead paint flakes] –> [Encephalopathy + Abd pain]

334
Q

What part of the cerebellum is affected by Alcoholic degeneration?

A

ANT SUP vermis

Explains Dysmetria of LE > UE

335
Q

Which areas of the brain are affected by [HSE-Herpes Simplex Encephalitis]? - 2

A
  1. Medial temporal
  2. Inferior frontal
336
Q

Brain Contusions are superficial hemorrhages in which lobe regions? - 3

________________

What type of motion causes these?-2

A
  1. Basal
  2. [Ventral Frontal]
  3. [Ventral ANT Temporal]

________________

Angular or Rotational (NOT LINEAR)

337
Q

[Dorsal tectal midbrain] lesions selectively involve [⬜(Sympathetic vs Parasympathetic)] fibers

________________

How does this affect Pupils?

A

ParaSympathetic ;FIXED Dilated BL Pupils from unopposed Sympathetics

338
Q

How is the [Oculocephalic Dolls eye Reflex] used to assess brainstem function?

A

Eyes should remain stationary and fixed as head is rotated = normal brain stem function

339
Q

Describe Pseudoexacerbation of Multiple Sclerosis

A

[SLUM SiiiN]

Infection in MS pt –>⬆︎ Body temp –> ⬇︎Conduction in [Remyelinated healed CNS areas] –> clinically APPEARS to be MS exacerbation BUT REALLY ISN’T!

Image: T1 MRI Black Holes Dx

340
Q

Nerve roots for Ankle Jerk Reflex

A

“1, 2 buckle my shoe - 3, 4 kick the door - 5, 6 pick up sticks - 7, 8 lay down straight”

S1 - S2

341
Q

Nerve roots for Patellar Reflex

A

“1, 2 buckle my shoe - 3, 4 kick the door - 5, 6 pick up sticks - 7, 8 lay down straight”

L3 - L4

342
Q

Nerve roots for Biceps Reflex

A

“1, 2 buckle my shoe - 3, 4 kick the door - 5, 6 pick up sticks - 7, 8 lay down straight”

C5 - C6

343
Q

Nerve roots for Triceps Reflex

A

“1, 2 buckle my shoe - 3, 4 kick the door - 5, 6 pick up sticks - 7, 8 lay down straight”

C7 - C8

344
Q

Sciatica etx ; Clinical Presentation - 3

A

“Having Sciatica makes you break LAWS”

  • [Lower Back pain w/radiation down POSTERIOR thigh –> lateral foot]
  • Ankle jerk reflex ABSENT (this can occur naturally with age!)
  • Weak Hip Extension
  • [S1 n PosteroLateral compression at L4-5 or L5-S1] –> UMN signs
345
Q

Neonatal Abstinence Syndrome

Classic Signs - 5

A

TYT Does Heroin

  1. Tremors
  2. Yawning
  3. Tachypnea
  4. Diarrhea
  5. High Pitched Cry

Caused by maternal opioid (Heroin) use during pregnancy

346
Q

Major causes of Altered Mental Status-20

A

AEIOU TIPS

347
Q

Where do most Medulloblastomas occur?

________________

How does this present clinically?

A

Cerebellar VERMIS

________________

Truncal ataxia

348
Q

Meniere’s Disease tx - 5

A

1st: Diet change (restrict Na+, caffeine, Nicotine, EtOH)
2nd: Benzo, antihistamines, antiemetics
3rd: Diuretics for long term

Sx = VTH (Vertigo, Tinnitus, Hearing loss)

349
Q

Alcoholic cerebellar degeneration causes damage to the ⬜

________________

How can you differentiate Alcoholic cerebellar damage from other causes of cerebellar damage?

A

[Purkinje cells of cerebellar vermis]

________________

Alcoholic cerebellar damage LEAVES LIMB COORDINATION INTACT (no intention tremor)

Cere is def on GRINDRR

350
Q

What are the neurological manifestations of DM in the extremities

A

Symmetrical loss of 2TVP (2point,Touch,Vibration,Proprioception) distally

GAIT IS INTACT

351
Q

Sciatica tx -2

________________

Sciatica dx

A

“Having Sciatica makes you break LAWS”

NSAIDs + APAP = 1st line as Sciatica sx are self limited

Dx = CLINICAL (Only use MRI for confirmation of disc herniation if sensory/motor deficit, cauda equina syndrome sx or epidural abscess r/o)

352
Q

Brain Death is a clinical diagnosis and involves absent cortical and brain stem functions

What are the legal complications of disabling articial life support for a pt who is newly diagnosed with Brain Death?

A

None - Brain death is a legally acceptable definition of death

353
Q

Brachial Plexus damage of

[Radial C7 n]

________________

causes -3

A
  1. [Crutches/Axilla damage]
  2. < [Supracondylar Fall onto outstretched arm] ➜ [proximal humerus anteroLATERAL displacement] >
  3. Midshaft Humerus
354
Q

Brachial Plexus damage of

[Radial C7 n]

________________

clinical presentation? -2

A

[Saturday night palsy wrist drop]

[No Tricep Reflex]

355
Q

Brachial Plexus damage of

[Axillary C7 n]

________________

causes -3

A
  1. [Surgical NECK humerus]
  2. [ANTERIOR humerus displacement]
  3. Shoulder Injury
356
Q

Brachial Plexus damage of

[Axillary C7 n]

________________

clinical presentation?

A

[Deltoid paralysis]

357
Q

Brachial Plexus damage of

[long thoracic C5-T1 n]

________________

causes -2

A
  • STABS
  • [MASTECTOMY AXILLARY NODE DISSECTION]
358
Q

Brachial Plexus damage of

[long thoracic C5-T1 n]

________________

clinical presentation? -2

A

[winged scapula]

[inability to ABduct shoulder > 90º]

359
Q

Brachial Plexus damage of

[ULNAR C8-T1 n]

________________

clinical presentation?

A

[ULNAR PARTIAL CLAW (4th and 5th digit flexed AT REST)]

________________

([hyperextension of 4th MCP and 5th MCP] + [flexion of 4th PIP and 5th PIP])

360
Q

Brachial Plexus damage of

[ULNAR C8-T1 n]

________________

cause -3

A
  1. [FALL ONTO FLEXED ELBOW ➜ POSTERIOR PROXIMAL HUMERUS DISPLACEMENT]
  2. [MEDIAL EPICONDYLE]
  3. [BICYCLIST HOOK OF HAMATE INJURY = GUYAN CANAL SYNDROME]

________________

[Ulnar Partial claw (4th and 5th digits flexed AT REST)]

361
Q

Brachial Plexus damage of

[median C5-T1 n]

________________

clinical presentation?

A

[Pope’s Blessing Thumb Paralysis]

362
Q

Brachial Plexus damage of

[median C5-T1 n]

________________

cause?

A

[Supracondylar Humeral Fall onto outstretched arm] ➜ [anteroMEDIAL proximal humerus displacement]

363
Q

Brachial Plexus damage of

[DISTAL median C5-T1 n]

________________

clinical presentation? -2

________________

(DISTAL to elbow)

A

median claw

________________

[1st and 2nd digits FLEXED AT REST]

+

[Thumb thenar palsy ➜ thenar atrophy]

364
Q

Brachial Plexus damage of

[proximal median C5-T1 n]

________________

clinical presentation? -2

________________

(proximal to elbow)

A

Pope’s blessing

________________

[4th and 5th digits FLEX ALONE WHEN FISTING (Pope’s Blessing)]

+

[Thumb thenar palsy ➜ thenar atrophy]

365
Q

Brachial Plexus damage of

[musculocutaneous C5-C6 n]

________________

clinical presentation? -2

A

[elbow flexion ⬇︎]

[variable sensory loss]

366
Q

Brachial Plexus damage of

[posterior cord C7]

________________

clinical presentation?

A

[wrist drop]

367
Q

Brachial Plexus damage of

[lower Trunk C8-T1]

________________

cause -3

A
  1. < [extra rib / thoracic outlet syndrome] ➜ UE paresthesia + UE weakness >
  2. [sudden upward arm stretch]
  3. [CABG surgery]

________________

[klumpke palsy claw hand]

368
Q

Brachial Plexus damage of

[lower Trunk C8-T1]

________________

clinical presentation?

A

[klumpke palsy claw hand]

369
Q

Brachial Plexus damage of

[Upper Trunk C5-C6]

________________

cause

A

[Baby Delivery lateral neck pull]

370
Q

Brachial Plexus damage of

[Upper Trunk C5-C6]

________________

clinical presentation?

A

[Erb Palsy Waiter’s Tip]

371
Q

Demonstrate Sensory Innervation of the Hand

Ulnar nerve

________________

Median nerve

________________

Radial nerve

A

[2a] A ⼀ Step 2 OD USLME (21 decks)

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