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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
MC cause of Subarachnoid Hemorrhage
2ry to rupture of berry aneurysm (MC Circle of Willis) OR Arteriovenous Malformation (AVM)
26
"Worst HA of my life" What other symptoms?
Subarachnoid hemorrhage Meningeal sx: Stiff neck, photophobia, delirium
27
Dx of Subarachnoid hemorrhage T/F: No focal neuro symptoms
CT scan If CT scan negative --> LP: xanthochromia (RBCs), increased CSF pressure TRUE
28
``` Epidural Hematoma MC (arterial/venous) bleed Clinical manifestation: CT shows ___ (Does/doesn't) cross suture line ```
ARTERIAL bleed Brief LOC --> LUCID interval --> coma CONVEX (lens-shaped) Does NOT cross suture line
29
``` Subdural Hematoma MC (arterial/venous) bleed Clinical manifestation: CT shows ___ (Does/doesn't) cross suture line ```
VENOUS bleed d/t tearing of bridging veins MC in elderly. May have focal neuro sx. CONCAVE (crescent-shaped) DOES cross suture lines
30
Amaurosis Fugax Occurs when:
MONOcular vision loss ("lamp shade down on one eye") TIA of Internal Carotid Artery
31
Carotid endarterectomy recommended for ___ in the setting of TIA
pts who have internal or common carotid artery stenosis 70-99%
32
Tx of TIA
Aspirin +/- dipyridamole or clopidogrel (Plavix) Thrombolytics CONTRAINDICATED!
33
Definitive Dx of TIA
Angiography
34
TIA may present with (ipsilateral/contralateral) hand-arm weakness w/ sensory loss, (ipsilateral/contralateral) visual symptoms
CONTRALATERAL hand-arm weakness w/ sensory loss, IPSILATERAL visual symptoms
35
Tx of Subarachnoid Hemorrhage
Supportive: bed rest, mild sedation, stool softeners (prevent straining)
36
Felbamate SE:
Anticonvulsant used in pts with seizures unresponsive to other medications SE: aplastic anemia, hepatic failiure
37
Tx of absence seizures
Ethosuximide | Valproic acid
38
Type of seizure characterized by an AURAS and AUTOMATISMS
Complex partial (temporal lobe)
39
Type of seizure where consciousness is fully maintained
Simple partial
40
____ levels are increased in seizures
Prolactin
41
Marcus Gunn pupil =
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
42
Uhthoff's phenomenon =
Worsening of symptoms w/ heat (exercise, fever, hot tub) Seen in MS
43
Suspect MS in any young paitents who present with ____.
trigeminal neuralgia
44
Charcot's Neurologic Triad =
nystagmus stacatto speech intentional tremor Seen in MS
45
Dx of MS
MRI w/ gadolinium --> white matter plaques (hyperdensities)
46
Tx of MS Acute exacerbations: Relapse-remitting/progressive disease: Fatigue sx:
Acute exacerbations: STEROIDS, Plasma exchange if unresponsive Relapse-remitting/progressive disease: Beta-interferon Fatigue sx: Amantadine
47
CSF finding in MS
Increased IgG (oligoclonal bands)
48
CSF findings in Guillain Barre Syndrome
High protein | NORMAL WBC
49
CSF findings in Bacterial Meningitis
High protein INCREASED WBC (polymorphonuclear neutrophils) (100-100,000**) DECREASED glucose
50
CSF findings in Aseptic Viral Meningitis
``` Normal glucose INCREASED WBC (lymphocytes) (10-300) ```
51
CSF findings in Fungal Meningitis
``` Increased WBCs (lymphocytes) Decreased glucose ```
52
Lhermitte's Sign
Neck flexion causes lighting-shock pain radiating from spine down the leg w/ neck flexion Seen in MS
53
Amyloid depositions (senile plaques) and neurofibrillary tangles (tau protein) seen in ___
Alzheimer Disease
54
Tx of Alzheimer Disease
Acetycholinesterase inhibitors: Donepezil, Rivastigmine, Galantamine NMDA antagonist: Memantine
55
MOA of NMDA antagonists
reduces glutamate excitotoxicity
56
Frontotemporal dementia (a.k.a. ___) presents with ___
A.k.a Pick's Disease Marked personality changes Primitive reflexes = frontal release signs --> palmar grasp, rooting reflexes
57
Vascular dementia presents as
forgetfulness in absence f depression and inattentiveness
58
Prophylactic tx of choice for cluster HA
verapamil
59
Triptans are ____ that cause ____
serotonin 5HT-1 agonists | vasoconstriction
60
Tx of benign essential tremor
Propranolol: beta blocker Primidone: if propranolol fails
61
Parkinson disease: Degeneration of cells in the ___, causing deficiency of ____ and imbalance of ____ and ____.
Degeneration of cells in the SUBSTANTIA NIGRA, causing deficiency of DOPAMINE and imbalance of DOPAMINE and ACETYLCHOLINE.
62
Parkinson Disease features (4)
RESTING tremor: pill rolling Bradykinesia: slow, shuffling gait, masklike facies Rigidity (Cogwheel) Postural instability
63
Tx of Parkinson disease: | Mild anticholinergic used for mild symptoms but no disability
Amantadine
64
Tx of Parkinson disease: | Anticholinergic drugs
Benzotropine | Trihexyphenidyl
65
Levodopa
Converts to dopamine Tx of Parkinson
66
Carbidopa
Used in combination with Levodopa, allows lower doses of levodopa and reduce side effects Tx of Parkinson
67
Bromocriptine
Dopamine agonist | Used for refractory Parkinson to levodopa/carbidopa therapy
68
Selegiline
Monoamine oxidase B inhibitors | Inhibits breakdown of dopamine
69
Tolcapone | Entacapone
Cetecholamine-O-Methyltransferase inhibitors (COMT) Reduce metabolism of levodopa to 3-O-methyldopa Allows lower doses of levodopa and reduce side effects
70
Huntington Disease is autosomal ___ d/o. The gene is on ___ chromosome.
Autosomal dominant | Short arm of chromosome 4
71
Huntington Disease characterized by ___ CT shows ____ & ____ atrophy. Treatment:
Progressive chorea and dementia Caudate nucleus and cerebral atrophy Treatment: Phenothiazine: dyskinesia Haloperidol, clozapine: behavioral disturbances
72
Tourette syndrome characterized by ___ Dx: Volumertric MRI shows ____
Motor tics (80%) and phonic tics Volume loss in caudate nucleus CT, MRI are normal. EEG not helpful.
73
Coprolalia =
Involuntary obscene word tic Seen in Tourette syndrome in 40%
74
Treatment of Tourette syndrome
Fluphenazine Pimozide Haloperidol Tetrabenazine Clonazepam, clonidine used to minimize SE of long term haloperidol use.
75
Cerebral palsy is characterized by ____ (Hyper/hypo)reflexia?
chronic impairment of muscle tone, strength, coordination or movement Hyperreflexia
76
Tx of Restless leg syndrome
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
Bell palsy affects CN ___. Thought to be caused by ___, resulting in ____. Paralysis involves ____. Weakness peaks in about ___. Recovery usually within ___. Treatment:
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
Guillain-Barre Syndrome = MC precipitant of Guillain-Barre Syndrome = Muscle weakness progresses (asymmetrically/symmetrically) (ascending/decending) pattern. (Decreased/increased) DTR. CSF findings =
Post infection immune mediated demyelination & axonal degeneration slows impulses Campylobacter jejuni Symmetrically ASCENDING DECREASED DTR CSF = High protein w/ NORMAL WBC
79
Tx of Guillain-Barre Syndrome
Plasmapheresis ASAP | IVIG = good for cadiovascular instability pts and children
80
75% of pts w/ Myasthenia Gravis also have ____
thymic abnormalities (hyperplasia or thymoma)
81
Clinical manifestations of Myasthenia Gravis
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
Edrophonium/ Tensilon test
Rapid response to short acting IV edrophonium Dx of Myasthenia Gravis
83
Serum tests for Myasthenia Gravis
``` Ach-receptor Ab MuSK Ab (ab to muscle specific tyrosine kinase) ```
84
Treatment of Myasthenia Gravis
Pyridostigmine, Neostigmine = acetylcholinesterase inhibitors -MOA: increase acetylcholine by decreasing Ach breakdown
85
Cholinergic crisis = How to tell difference from myasthenic crisis?
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
Myasthenic syndrome (Lambert-Eaton)
Ab preventing Ach release Associated w/ small cell lung CA Weakness IMPROVED w/ continued use (unlike Myasthenia Gravis)
87
Kernig's sign Brudzinski's sign
Kernig's sign = inability to straighten knee w/ hip flexion Brudzinski's sign = neck flexion produces knee/hip flexion
88
MC pathogen in bacterial meningitis in < 1 month old Treatment:
Group B strep (Streptococcus agalactiae) Tx: Ampicillin + (Cefotaxime or Aminoglycoside)
89
MC pathogen in bacterial meningitis in 1 month - 18 y/o Treatment:
N. meningitidis*, S. pneumo Tx: Ceftriaxone + Vancomycin
90
MC pathogen in bacterial meningitis in 18 y/o - 50 y/o Treatment:
S. pneumo*, N. menigitidis Tx: Ceftriaxone + Vancomycin
91
Petechial rash associated with what pathogen in bacterial meningitis?
N. meningitidis
92
MC pathogen in bacterial meningitis in > 50 y/o Treatment:
S. pneumo Listeria monocytogenes Tx: Ampicillin + Ceftriaxone (+/- Vancomycin)
93
MC pathogen of viral meningitis
Enterovirus (Echovirus, Coxsackie)
94
MC pathogen of viral encephalitis
HSV-1
95
Tx of brain abscess
IV PCN G OR Ceftriaxone + Metronidazole + Vancomycin if suspect Staph Aureus
96
Lowest - highest score on the Glasgow Coma Scale
3-15
97
``` Where's the brain tumor? Progressive intellectual decline Slowing mental activity Personality changes (Ipsilateral/contralateral) grasp reflexes Expressive Aphasia ```
Frontal lobe Contralateral grasp reflexes
98
``` Where's the brain tumor? Seizures Olfactory/gustatory hallucinations Licking/smacking of lips Depersonalization Emotional, behavioral changes Visual field defects Auditory illusions ```
Temporal lobe
99
Where's the brain tumor? (Ipsilateral/contralateral) disturbances of sensation Cortical sensory loss (impaired stereognosis) Inattention
Parietal lobe Contralateral disturbances of sensation
100
``` Where's the brain tumor? Crossed (homo/hetero)nymous hemianopia Partial field defect Visual agnosia Unformed visual hallucinations ```
Occipital lobe Crossed homonymous hemianopia
101
MC type of primary intracranial neoplasms?
Glioma (50%)
102
CSF of brain neoplasm shows
Xanthochromia Increased protein Normal WBC Normal Glucose
103
Nightmares occur during ___
REM sleep
104
Sleep terrors occur during ____
stage 3 and 4 delta sleep
105
Sleep walking occurs during ____ in 1st 1/3 of night and with ____ later in night.
3 or 4 delta sleep REM sleep
106
Tx of narcolepsy
Stimulants: dextroamphetamine, modafinil
107
Tx of nocturnal myclonus
clonazepam
108
Tx of Sleep terror and sleepwalking
Benzodiazepines
109
Dreaming occurs during ___
REM sleep
110
Delta sleep =
stage 3 and 4 of sleep
111
Dx of Narcolepsy
Multiple sleep latency test
112
Carbamazepine SE Monitor w/:
Aplastic anemia, agranulocytosis, hyponatremia CBC, LFT, Na testing
113
UPPER motor neuron lesions cause (spastic/flaccid) paralysis (hypertonia/hypotonia), (decreased/increased) DTR, (with/without) fasciculations, (upward/downward) Babinski, (with/without) muscle atrophy.
UPPER motor neuron lesions cause SPASTIC paralysis, HYPERTONIA, INCREASED DTR, WITHOUT fasciculations, UPWARD Babinski, WITHOUT muscle atrophy.
114
LOWER motor neuron lesions cause (spastic/flaccid) paralysis (hypertonia/hypotonia), (decreased/increased) DTR, (with/without) fasciculations, (upward/downward) Babinski, (with/without) muscle atrophy.
LOWER motor neuron lesions cause FLACCID paralysis HYPOTONIA, DECREASED DTR, WITH fasciculations, DOWNWARD Babinski, WITHmuscle atrophy.
115
3 cardinal features of Normal pressure hydrocephalus
dementia + gait disturbance + urinary incontinence
116
Myerson sign (a.k.a glabellar reflex) Seen in ____
reflexive, sustained eye blinking in response to repetitive tapping above the nasal bridge between eyes Parkinson disease
117
Diabetes mellitus is a common cause of CN ___ palsy. Pupil sizes are (constricted/normal/dilated) in diabetics.
``` CN 3 (also 4, 6) BUT NORMAL (other CN 3 palsy will have dilated pupils) ```
118
Multiple sclerosis associated with CN ___ palsy, causing diplopia.
CN 6 (Abducens nerve)
119
Cerebral aneurysm associated with CN ___ palsy
CN 3
120
Sarcoidosis associated with CN ___ palsy
CN 7
121
Lyme disease associated with CN ___ palsy
CN 7

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