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Neurology 6% Flashcards

1
Q

Name the syndrome:

  • Bilateral upper + lower extremity weakness
  • Sensory loss of pain and temp in “shawl-like distribution over extremities of upper shoulders”
  • Preservation of position, light touch, proprioception
A

Central Cord Syndrome

Hyperflexion of neck

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2
Q

Name the syndrome:

  • Hemiparesis greater in lower extremity than upper
  • Urinary incontinence
  • Personality changes
  • Speech preservation
A

Anterior Cerebral Artery Infarct Syndrome

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3
Q

Name the syndrome:

  • Complete paralysis in lower extremities
  • Sensory loss of pain and temp, especially in lower extremities
  • Preservation of position, proprioception
A

Anterior Cord Syndrome

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4
Q

Name the syndrome:

  • Loss of proprioception and vibratory sense only
  • Pain, light touch, motor sensation preserved
A

Posterior Cord Syndrome

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5
Q

Name the syndrome:

  • Ipsilateral proprioception, vibratory, light touch, motor loss
  • Contralateral pain and temp loss
A

Brown Sequard Syndrome

Unilateral chord lesion

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6
Q

T/F: In Bell’s Palsy, one still has the ability to raise/wrinkle the forehead/eyebrow in the affected side.

A

False. Bell’s Palsy = idiopathic palsy of FACIAL NERVE (CN 7).
Think STROKE if ability to move forehead is retained.

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7
Q

VDRL tests for ____

A

Syphilis

“Venereal Disease Research Laboratory”

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8
Q

Recommended imaging modality in acute phase of stroke

A

Nonconstrast CT

Differentiate b/w ischemic and hemorrhagic stroke

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9
Q

____ therapy initiated for ischemic stroke and TIA.

____ therapy initiated for cardiac emboli/MI.

A

ANTIPLATELET therapy initiated for ischemic stroke and TIA.

ANTICOAGULANT therapy initiated for cardiac emboli/MI.

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10
Q

MC type of stroke

A 
Ischemic stroke (80%)
--> Thrombotic (49%) emboli (31%) Cerebrovascular occlusion
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11
Q

Stroke of the _____ artery is the most common type.

A

Middle Cerebral Artery (70%)

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12
Q

T/F: Patients w/ strokes w/ facial involvement will NOT be able to raise their eyebrows.

A

False. Only involve lower half of face

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13
Q

Lacunar Infarct = Penetrating branches of ____

Symptoms (4)

CT scan shows ___

Tx:

A

Cerebral arteries in pons, basal ganglia

  1. Pure motor (hemiparesis, hemiplegia)
  2. Ataxic hemiparesis (weakness, clumsiness leg > arms)
  3. Dysarthria (clumsy hand syndrome)
  4. Pure sensory loss (numbness, parasthesias)

Small punched out hypodense areas

Aspirin
Control risk factors (HTN, DM)
Resolves in hours - 6 weeks

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14
Q

Middle Cerebral Artery Stroke causes (Ipsilateral/contralateral) sensory/motor loss/hemiparesis, greater in ____.
Visual disturbance:
(Ipsilateral/contralateral) (homo/heteronymous) hemianopsia. Gaze preference (towards/away from) side of lesion.

A

Middle Cerebral Artery Stroke causes CONTRALATERAL sensory/motor loss/hemiparesis, greater in FACE, ARMS > leg/foot.
Visual disturbance:
CONTRALATERAL HOMOnymous hemianopsia. Gaze preference TOWARD side of lesion.

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15
Q

LEFT or RIGHT -side dominant MCA stroke?
Broca (expressive), Wernicke (sensory) Aphasia

(Define each)

A

LEFT

Broca’s aphasia = sparse output, comprehension PRESERVED

Wernicke’s aphasia = fluent, voluminous, meaningless. Markedly IMPAIRED comprehension

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16
Q

LEFT or RIGHT -side dominant MCA stroke?

Spatial deficits, LEFT side neglect

A

RIGHT

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17
Q

LEFT or RIGHT -side dominant MCA stroke?

Math comprehension, agraphia

A

LEFT

Agraphia = loss in the ability to communicate through writing

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18
Q

LEFT or RIGHT -side dominant MCA stroke?

Dysarthria, anosognosia

A

RIGHT
Anosognosia = deficit of self-awareness
Dysarthria = difficult or unclear articulation of speech

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19
Q 
Anterior Cerebral Artery Stroke causes
(Ipsilateral/contralateral) sensory/motor loss/hemiparesis, greater in \_\_\_\_. 
T/F: Face affected.
T/F: Speech preserved.
T/F: Lower motor neuron weakness
T/F: Urinary retention
T/F: Personality changes (flat affect)
A

CONTRALATERAL greater in LOWER (leg/foot) > UE –> abnormal gait

F: Face SPARED
TRUE: Speech preserved.
F: UPPER motor neuron weakness
F: Urinary INCONTIENCE 
TRUE: Personality changes (flat affect)
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20
Q

Posterior circulation of brain (3)

A

Posterior cerebral artery
Basilar artery
Vertebral artery

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21
Q

Only rTPA effective in ischemic stroke

A

Alteplase

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22
Q

Posterior Cerebral Artery Stroke causes
(Ipsilateral/contralateral) (homo/heteronymous) hemianopsia.
(Ipsilateral/contralateral) CN deficits
(Ipsilateral/contralateral) muscle weakness

Other symptoms (3)

A

CONTRALATERAL HOMOnymous hemianopsia.
IPSILATERAL CN deficits + CONTRALATERAL muscle weakness (“Crossed sx”)

Visual hallucinations
Coma
Drop attacks = sudden spontaneous falls while standing or walking, with complete recovery in seconds or minutes

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23
Q

Basilar Artery Stroke causes (4)

A

Cerebellar dysfunction
CN palsies
Decreased vision
BILATERAL sensory

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24
Q

Vertebral Artery causes (5)

A 
Vertigo
N/V
Nystagmus
Diplopia
ISPLATERAL ataxia
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25
Q

MC cause of Subarachnoid Hemorrhage

A

2ry to rupture of berry aneurysm (MC Circle of Willis)
OR
Arteriovenous Malformation (AVM)

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26
Q

“Worst HA of my life”

What other symptoms?

A

Subarachnoid hemorrhage

Meningeal sx: Stiff neck, photophobia, delirium

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27
Q

Dx of Subarachnoid hemorrhage

T/F: No focal neuro symptoms

A

CT scan
If CT scan negative –> LP: xanthochromia (RBCs), increased CSF pressure

TRUE

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28
Q 
Epidural Hematoma 
MC (arterial/venous) bleed 
Clinical manifestation:
CT shows \_\_\_
(Does/doesn't) cross suture line
A

ARTERIAL bleed

Brief LOC –> LUCID interval –> coma

CONVEX (lens-shaped)
Does NOT cross suture line

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29
Q 
Subdural Hematoma 
MC (arterial/venous) bleed 
Clinical manifestation:
CT shows \_\_\_
(Does/doesn't) cross suture line
A

VENOUS bleed d/t tearing of bridging veins

MC in elderly. May have focal neuro sx.

CONCAVE (crescent-shaped)
DOES cross suture lines

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30
Q

Amaurosis Fugax

Occurs when:

A

MONOcular vision loss (“lamp shade down on one eye”)

TIA of Internal Carotid Artery

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31
Q

Carotid endarterectomy recommended for ___ in the setting of TIA

A

pts who have internal or common carotid artery stenosis 70-99%

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32
Q

Tx of TIA

A

Aspirin +/- dipyridamole or clopidogrel (Plavix)

Thrombolytics CONTRAINDICATED!

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33
Q

Definitive Dx of TIA

A

Angiography

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34
Q

TIA may present with (ipsilateral/contralateral) hand-arm weakness w/ sensory loss, (ipsilateral/contralateral) visual symptoms

A

CONTRALATERAL hand-arm weakness w/ sensory loss, IPSILATERAL visual symptoms

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35
Q

Tx of Subarachnoid Hemorrhage

A

Supportive: bed rest, mild sedation, stool softeners (prevent straining)

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36
Q

Felbamate

SE:

A

Anticonvulsant used in pts with seizures unresponsive to other medications

SE: aplastic anemia, hepatic failiure

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37
Q

Tx of absence seizures

A

Ethosuximide

Valproic acid

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38
Q

Type of seizure characterized by an AURAS and AUTOMATISMS

A

Complex partial (temporal lobe)

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39
Q

Type of seizure where consciousness is fully maintained

A

Simple partial

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40
Q

____ levels are increased in seizures

A

Prolactin

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41
Q

Marcus Gunn pupil =

A

Bilateral pupil constriction when light in normal eye BUT pupils dilate when like shone quickly in affected eye

Seen in Optic Neuritis, associated with MS

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42
Q

Uhthoff’s phenomenon =

A

Worsening of symptoms w/ heat (exercise, fever, hot tub)

Seen in MS

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43
Q

Suspect MS in any young paitents who present with ____.

A

trigeminal neuralgia

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44
Q

Charcot’s Neurologic Triad =

A

nystagmus
stacatto speech
intentional tremor

Seen in MS

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45
Q

Dx of MS

A

MRI w/ gadolinium –> white matter plaques (hyperdensities)

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46
Q

Tx of MS
Acute exacerbations:
Relapse-remitting/progressive disease:
Fatigue sx:

A

Acute exacerbations: STEROIDS, Plasma exchange if unresponsive
Relapse-remitting/progressive disease: Beta-interferon
Fatigue sx: Amantadine

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47
Q

CSF finding in MS

A

Increased IgG (oligoclonal bands)

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48
Q

CSF findings in Guillain Barre Syndrome

A

High protein

NORMAL WBC

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49
Q

CSF findings in Bacterial Meningitis

A

High protein
INCREASED WBC (polymorphonuclear neutrophils) (100-100,000**)
DECREASED glucose

50
Q

CSF findings in Aseptic Viral Meningitis

A 
Normal glucose
INCREASED WBC (lymphocytes) (10-300)
51
Q

CSF findings in Fungal Meningitis

A 
Increased WBCs (lymphocytes)
Decreased glucose
52
Q

Lhermitte’s Sign

A

Neck flexion causes lighting-shock pain radiating from spine down the leg w/ neck flexion

Seen in MS

53
Q

Amyloid depositions (senile plaques) and neurofibrillary tangles (tau protein) seen in ___

A

Alzheimer Disease

54
Q

Tx of Alzheimer Disease

A

Acetycholinesterase inhibitors: Donepezil, Rivastigmine, Galantamine
NMDA antagonist: Memantine

55
Q

MOA of NMDA antagonists

A

reduces glutamate excitotoxicity

56
Q

Frontotemporal dementia (a.k.a. ___) presents with ___

A

A.k.a Pick’s Disease
Marked personality changes
Primitive reflexes = frontal release signs –> palmar grasp, rooting reflexes

57
Q

Vascular dementia presents as

A

forgetfulness in absence f depression and inattentiveness

58
Q

Prophylactic tx of choice for cluster HA

A

verapamil

59
Q

Triptans are ____ that cause ____

A

serotonin 5HT-1 agonists

vasoconstriction

60
Q

Tx of benign essential tremor

A

Propranolol: beta blocker
Primidone: if propranolol fails

61
Q

Parkinson disease: Degeneration of cells in the ___, causing deficiency of ____ and imbalance of ____ and ____.

A

Degeneration of cells in the SUBSTANTIA NIGRA, causing deficiency of DOPAMINE and imbalance of DOPAMINE and ACETYLCHOLINE.

62
Q

Parkinson Disease features (4)

A

RESTING tremor: pill rolling
Bradykinesia: slow, shuffling gait, masklike facies
Rigidity (Cogwheel)
Postural instability

63
Q

Tx of Parkinson disease:

Mild anticholinergic used for mild symptoms but no disability

A

Amantadine

64
Q

Tx of Parkinson disease:

Anticholinergic drugs

A

Benzotropine

Trihexyphenidyl

65
Q

Levodopa

A

Converts to dopamine

Tx of Parkinson

66
Q

Carbidopa

A

Used in combination with Levodopa, allows lower doses of levodopa and reduce side effects

Tx of Parkinson

67
Q

Bromocriptine

A

Dopamine agonist

Used for refractory Parkinson to levodopa/carbidopa therapy

68
Q

Selegiline

A

Monoamine oxidase B inhibitors

Inhibits breakdown of dopamine

69
Q

Tolcapone

Entacapone

A

Cetecholamine-O-Methyltransferase inhibitors (COMT)
Reduce metabolism of levodopa to 3-O-methyldopa
Allows lower doses of levodopa and reduce side effects

70
Q

Huntington Disease is autosomal ___ d/o. The gene is on ___ chromosome.

A

Autosomal dominant

Short arm of chromosome 4

71
Q

Huntington Disease characterized by ___
CT shows ____ & ____ atrophy.
Treatment:

A

Progressive chorea and dementia

Caudate nucleus and cerebral atrophy

Treatment:
Phenothiazine: dyskinesia
Haloperidol, clozapine: behavioral disturbances

72
Q

Tourette syndrome characterized by ___

Dx: Volumertric MRI shows ____

A

Motor tics (80%) and phonic tics

Volume loss in caudate nucleus
CT, MRI are normal. EEG not helpful.

73
Q

Coprolalia =

A

Involuntary obscene word tic

Seen in Tourette syndrome in 40%

74
Q

Treatment of Tourette syndrome

A

Fluphenazine
Pimozide
Haloperidol
Tetrabenazine

Clonazepam, clonidine used to minimize SE of long term haloperidol use.

75
Q

Cerebral palsy is characterized by ____

(Hyper/hypo)reflexia?

A

chronic impairment of muscle tone, strength, coordination or movement

Hyperreflexia

76
Q

Tx of Restless leg syndrome

A

1st line: Dopamine agonists (pramipexole, ropinirole)
2nd line: Benzos (clonazepam)

Trial of iron therapy recommended if ALL pts w/ RLS (those w/o iron overload)

77
Q

Bell palsy affects CN ___. Thought to be caused by ___, resulting in ____.
Paralysis involves ____.
Weakness peaks in about ___. Recovery usually within ___.
Treatment:

A

CN 7
Herpes simplex virus activation
Damage to myelin layer of facial nerve

FOREHEAD, lower face
Pain around ipsilateral ear

21 days
6 months

Oral prednisone begun at onset of symptoms shows increased % of pts with complete recovery

78
Q

Guillain-Barre Syndrome =

MC precipitant of Guillain-Barre Syndrome =

Muscle weakness progresses (asymmetrically/symmetrically) (ascending/decending) pattern. (Decreased/increased) DTR.

CSF findings =

A

Post infection immune mediated demyelination & axonal degeneration slows impulses

Campylobacter jejuni

Symmetrically ASCENDING
DECREASED DTR

CSF = High protein w/ NORMAL WBC

79
Q

Tx of Guillain-Barre Syndrome

A

Plasmapheresis ASAP

IVIG = good for cadiovascular instability pts and children

80
Q

75% of pts w/ Myasthenia Gravis also have ____

A

thymic abnormalities (hyperplasia or thymoma)

81
Q

Clinical manifestations of Myasthenia Gravis

A
  1. Ocular weakness:
    Extraocular muscle weakness –> diplopia
    Ptosis

2.

  • Generalized mm weakness worsening w/ repeated muscle use, relieved by rest
  • Weakness w/ prolonged chewing, dysphagia
  • Respiratory failure –> Myasthenic crisis!!
82
Q

Edrophonium/ Tensilon test

A

Rapid response to short acting IV edrophonium

Dx of Myasthenia Gravis

83
Q

Serum tests for Myasthenia Gravis

A 
Ach-receptor Ab
MuSK Ab (ab to muscle specific tyrosine kinase)
84
Q

Treatment of Myasthenia Gravis

A

Pyridostigmine, Neostigmine = acetylcholinesterase inhibitors
-MOA: increase acetylcholine by decreasing Ach breakdown

85
Q

Cholinergic crisis =

How to tell difference from myasthenic crisis?

A

d/t excess Ach d/t Ach-esterase inhibition

-weakness, N/V, pallor, sweating, salivation, diarrhea, miosis, bradycardia, respiratory failure

If flaccid paralysis improves with Tensilon = Myasthenic crisis
If worsens w/ Tensilon = Cholinergic crisis

86
Q

Myasthenic syndrome (Lambert-Eaton)

A

Ab preventing Ach release
Associated w/ small cell lung CA

Weakness IMPROVED w/ continued use (unlike Myasthenia Gravis)

87
Q

Kernig’s sign

Brudzinski’s sign

A

Kernig’s sign = inability to straighten knee w/ hip flexion

Brudzinski’s sign = neck flexion produces knee/hip flexion

88
Q

MC pathogen in bacterial meningitis in < 1 month old

Treatment:

A

Group B strep (Streptococcus agalactiae)

Tx: Ampicillin + (Cefotaxime or Aminoglycoside)

89
Q

MC pathogen in bacterial meningitis in 1 month - 18 y/o

Treatment:

A

N. meningitidis*, S. pneumo

Tx: Ceftriaxone + Vancomycin

90
Q

MC pathogen in bacterial meningitis in 18 y/o - 50 y/o

Treatment:

A

S. pneumo*, N. menigitidis

Tx: Ceftriaxone + Vancomycin

91
Q

Petechial rash associated with what pathogen in bacterial meningitis?

A

N. meningitidis

92
Q

MC pathogen in bacterial meningitis in > 50 y/o

Treatment:

A

S. pneumo
Listeria monocytogenes

Tx: Ampicillin + Ceftriaxone (+/- Vancomycin)

93
Q

MC pathogen of viral meningitis

A

Enterovirus (Echovirus, Coxsackie)

94
Q

MC pathogen of viral encephalitis

A

HSV-1

95
Q

Tx of brain abscess

A

IV PCN G
OR Ceftriaxone + Metronidazole
+ Vancomycin if suspect Staph Aureus

96
Q

Lowest - highest score on the Glasgow Coma Scale

A

3-15

97
Q 
Where's the brain tumor?
Progressive intellectual decline
Slowing mental activity
Personality changes
(Ipsilateral/contralateral) grasp reflexes
Expressive Aphasia
A

Frontal lobe

Contralateral grasp reflexes

98
Q 
Where's the brain tumor?
Seizures
Olfactory/gustatory hallucinations
Licking/smacking of lips
Depersonalization
Emotional, behavioral changes
Visual field defects
Auditory illusions
A

Temporal lobe

99
Q

Where’s the brain tumor?
(Ipsilateral/contralateral) disturbances of sensation
Cortical sensory loss (impaired stereognosis)
Inattention

A

Parietal lobe

Contralateral disturbances of sensation

100
Q 
Where's the brain tumor?
Crossed (homo/hetero)nymous hemianopia
Partial field defect
Visual agnosia
Unformed visual hallucinations
A

Occipital lobe

Crossed homonymous hemianopia

101
Q

MC type of primary intracranial neoplasms?

A

Glioma (50%)

102
Q

CSF of brain neoplasm shows

A

Xanthochromia
Increased protein
Normal WBC
Normal Glucose

103
Q

Nightmares occur during ___

A

REM sleep

104
Q

Sleep terrors occur during ____

A

stage 3 and 4 delta sleep

105
Q

Sleep walking occurs during ____ in 1st 1/3 of night and with ____ later in night.

A

3 or 4 delta sleep

REM sleep

106
Q

Tx of narcolepsy

A

Stimulants: dextroamphetamine, modafinil

107
Q

Tx of nocturnal myclonus

A

clonazepam

108
Q

Tx of Sleep terror and sleepwalking

A

Benzodiazepines

109
Q

Dreaming occurs during ___

A

REM sleep

110
Q

Delta sleep =

A

stage 3 and 4 of sleep

111
Q

Dx of Narcolepsy

A

Multiple sleep latency test

112
Q

Carbamazepine SE

Monitor w/:

A

Aplastic anemia, agranulocytosis, hyponatremia

CBC, LFT, Na testing

113
Q

UPPER motor neuron lesions cause (spastic/flaccid) paralysis (hypertonia/hypotonia), (decreased/increased) DTR, (with/without) fasciculations, (upward/downward) Babinski, (with/without) muscle atrophy.

A

UPPER motor neuron lesions cause SPASTIC paralysis, HYPERTONIA, INCREASED DTR, WITHOUT fasciculations, UPWARD Babinski, WITHOUT muscle atrophy.

114
Q

LOWER motor neuron lesions cause (spastic/flaccid) paralysis (hypertonia/hypotonia), (decreased/increased) DTR, (with/without) fasciculations, (upward/downward) Babinski, (with/without) muscle atrophy.

A

LOWER motor neuron lesions cause FLACCID paralysis HYPOTONIA, DECREASED DTR, WITH fasciculations, DOWNWARD Babinski, WITHmuscle atrophy.

115
Q

3 cardinal features of Normal pressure hydrocephalus

A

dementia + gait disturbance + urinary incontinence

116
Q

Myerson sign (a.k.a glabellar reflex)

Seen in ____

A

reflexive, sustained eye blinking in response to repetitive tapping above the nasal bridge between eyes

Parkinson disease

117
Q

Diabetes mellitus is a common cause of CN ___ palsy. Pupil sizes are (constricted/normal/dilated) in diabetics.

A 
CN 3 (also 4, 6)
BUT NORMAL (other CN 3 palsy will have dilated pupils)
118
Q

Multiple sclerosis associated with CN ___ palsy, causing diplopia.

A

CN 6 (Abducens nerve)

119
Q

Cerebral aneurysm associated with CN ___ palsy

A

CN 3

120
Q

Sarcoidosis associated with CN ___ palsy

A

CN 7

121
Q

Lyme disease associated with CN ___ palsy

A

CN 7

PANCE (20 decks)

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