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Shelf Exams > Neurology > Flashcards

Neurology Flashcards

1
Q

Which artery in the brain is likely occluded if a patient experiences:

Hemianopia

A

MCA

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2
Q

Anterior cord syndrome

A

Due to spinal cord infarction (Anterior spinal artery)

o Below injury patients have loss of movement, pain, and temperature
• Intact touch and proprioception due to sparing of the dorsal columns

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3
Q

Findings at disc level: L3-L4

A

Weakness of knee extension, dec patellar reflex

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4
Q

EEG shows sharp, triphasic and synchronous discharges

A

Creutzfeldt-Jakob disease
- rapidly progressive dementia, myoclonus, and EEG changes
Spongiform disease caused by a prion

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5
Q

Visual disturbance with painful eye movement is suspicious for?

A

Optic neuritis

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6
Q

Atrophy in Alzheimers

A

Atrophy is most pronounced in the temporoparietal lobes and hippocampus

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7
Q

CSF in SAH

A

Blood in the CSF

Xanthochromia (yellow color of CSF)

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8
Q

Hemisection of the spinal cord (Brown Sequard)

A

Usually due to a clean cut injury (knife blade)

  • ipsilateral motor loss
  • ipsilateral touch, vibration, proprioception loss
  • contralateral pain and temp loss
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9
Q

First line imaging modality for stroke

A

CT head without contrast

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10
Q

Dominant hemisphere infarct vs nondominant hemisphere infarct

A

dominant hemisphere
- aphasia, agnosia, agraphia, acalculia

nondominant hemisphere
- hemineglect: if R parietal is effected, will only acknowledge the left side of the world

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11
Q

Internuclear ophthalmoplegia results from damage to?….

A

Medial longitudinal fasciculus

Immune-mediated demyelination

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12
Q

What is a significant risk associated with tumors of the posterior fossa?

A

Herniation

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13
Q

Dejerine-Roussy syndrome (thalamic pain syndrome)

A

Occurs in lacunar strokes to the thalamus (pure sensory loss)
- Results in severe paroxysmal burning pain over the affected area that is exacerbated by light touch

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14
Q

If a patient cannot tolerate Ethosuximide, what drug is started to control absence seizures?

A

Divalproex sodium

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15
Q

If a young patient (<50) presents with a stroke, what should you consider in the workup

A

Vasculitis, hypercoagulable state, and thrombophilia

  • Protein C, protein S, antiphospholipid antibodies
  • Factor V Leiden mutation
  • ANA, ESR, RF
  • RPR, lyme serology
  • Transesophageal echocardiogram with bubble study
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16
Q

Patient presents with right arm and face paralysis and loss of sensation to the same areas. where is the infarct?

A

Left middle cerebral artery (MCA)

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17
Q

Pickwickian syndrome

A

Obesity associated with hypersomnia

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18
Q

Acute onset of hemiballismus, where is the infarct?

A

Subthalamic nucleus

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19
Q

Findings at disc level: L4-L5

A

Weakness of dorsiflexion, difficulty heel walking

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20
Q

Patient presents with wide based gait and incoordination. On exam they have impaired heel to shin but finger to nose is intact. What do you suspect?

A

Alcoholic cerebellar degeneration

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21
Q

A patient hits their head and loses consciousness for a few seconds. They spontaneously gain consciousness and appear normal for a period of time. Eventually they become somnolent with headache and vomiting, and a blown unilateral pupil. What do you suspect?

A

Epidural hematoma: brief loss of consciousness followed by a lucid interval. The expansion of the hematoma leads to dec consciousness and inc intracranial pressure (nausea, vomiting, headache)

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22
Q

What should you suspect in a patient with parkinson features with autonomic dysfunction?

A

Shy Drager Syndrome (Multiple System Atrophy)

Degenerative disease characterized by the following:

  1. Parkinsonism
  2. Autonomic dysfunction (postural hypotension, abnormal sweating, disturbance of bowel or bladder control, abnormal salivation or lacrimation, impotence, gastroparesis, etc)
  3. Widespread neurological signs (cerebellar, pyramidal or lower motor neuron)
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23
Q

Mesial temporal sclerosis

A

o Temporal lobe epilepsy
o Most common cause of intractable complex partial seizures in adults
o Dx by MRI – sclerotic hippocampus
o Treatment: surgical resection

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24
Q

Eye deviation in stroke vs seizure

A

Stroke: Eyes deviates toward infarct
- Because side affected is hyporeactive, so the normal side pushes eyes toward the side of infarct

Seizure: Eyes deviate away from seizure
- Because the side affected is hyperactive and pushes eyes toward the normal side

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25
Q

Landau Kleffner syndrome

A

Pediatric seizure disorder

Loss of language function and an abnormal EEG during sleep

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26
Q

Brain death (3 features)

A
  • unresponsiveness
  • absence of brainstem reflexes (pupillary, corneal, oculocephalic, gag, oculovestibular)
  • apnea
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27
Q

Pupil sparing third nerve palsy

ptosis, down and out eye, normal pupil response

A

Common neuropathy seen in diabetes

Etiology: is microvascular infarction of the central fibers of the oculomotor nerve causing the paralysis of the extraocular muscles while sparing the peripherally located parasympathetic pupillary fibers and hence the preserved pupillary reflex.

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28
Q

What is the most common neurologic complication of chronic renal failure?

A

Peripheral neuropathy due to axonal degeneration

Usually improves with dialysis

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29
Q

Presentation of thrombotic vs embolic stroke

A

Thrombotic: classically the patient awakens from sleep with neurologic deficits

Embolic: rapid onset (within seconds), deficits are initially maximal

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30
Q

Carbon tetrachloride

A

Potent hepatic toxin

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31
Q

Lennox Gastaut syndrome

A

Mental dysfunction
Multiple seizure types
2 Hx generalized spike wave discharges on EEG

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32
Q

Most common causes of syringomyelia

A

Arnold Chiari malfomations

Prior spinal cord injuries

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33
Q

Inheritance of Duchenne and Becker muscular dystrophy

A

X linked recessive

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34
Q

What is seen in pathology of HIV dementia

A

Microglial nodules

o Gross brain atrophy and inflammatory activation of microglial cells – activated macrophages and microglial cells form groups (microglial nodules) around small areas of necrosis

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35
Q

Lambert Eaton muscle weakness

A

Proximal

Improves with repetitive stimulation

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36
Q

First line treatment for a cluster headache

A

high flow 100% O2

Unilateral, associated with ipsilateral lacrimation, rhinorrhea, red eye, stuffy nose, and can be accompanied by horner syndrome

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37
Q

Complication of placement of ventriculoperitoneal shunt for normal pressure hydrocephalus

A

subdural hematoma due to the reduction in CSF volume may cause the brain to pull away from the covering meninges, stretching and potentially rupturing the bridging veins

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38
Q

Patient presents with bilateral trigeminal neuralgia, what do you suspect?

A

Multiple sclerosis

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39
Q

An aneurysm involving what arteries can cause compression of CN3?

A

o Posterior cerebral artery
o Superior cerebellar artery
o Posterior communicating artery

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40
Q

Pure sensory lacunar stroke

A

Involves the thalamus

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41
Q

Myasthenic crisis

A

Respiratory failure
Precipitated by infection, surgery, pregnancy, or certain medications

Treat with intubation and IVIG and steroids

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42
Q

Part of the brain responsible for facial recognition

A

inferior occipitotemporal cortex (fusiform gyrus)

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43
Q

Which artery in the brain is likely occluded if a patient experiences:

Abulia

A

ACA

Abulia = lack of will or initiative

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44
Q

Most common cause of a brain abscess

A

Streptococcus

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45
Q

Why is lamotrigine not an ideal choice in the acute setting? What should you start instead?

A

Lamotrigine needs to be slowly titrated up over several weeks due to risk of rash

Can immediately start patient on Keppra

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46
Q

Goal LDL in a stroke patient

A

<70

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47
Q

Wernicke Encephalopathy Triad

A

Dementia
Gait Disturbance
Oculomotor dysfunction

48
Q

Treatment of myasthenic crisis

A

Intubation to prevent respiratory collapse

Plasmapharesis or IVIG, and corticosteroids

49
Q

Path finding in Parkinson disease

A

Lewy bodies (a- synuclein): intracytoplasmic inclusion bodies

50
Q

Carotid Dissection causing stroke

A

Ipsilateral Horner syndrome
Contralateral hemiparesis

In a young patient, likely 2/2 trauma

51
Q

CSF in Guillain Barre syndrome

A

albuminocytologic dissociation (increased protein with normal cell count)

52
Q

Which cranial nerve is commonly implicated in lyme disease?

A

CN 7

53
Q

Central cord syndrome

  • mechanism
  • findings
A

Occurs with hyperextension injuries in elderly patients with pre-existing degenerative changes in the cervical spine

o Impair pain and temperature by interrupting the crossing sensory fibers as they cross to the contralateral STT.
o If involves anterior horn, then causes lower motor weakness

54
Q

Stroke Risk Factors

A
  1. age
  2. HTN
    - smoking
    - DM
    - HLD
    - a fib
    - CAD
    - Family hx of stroke
    - carotid bruits
55
Q

TIA

  • What differentiates it from a stroke?
  • How long does it last
  • Pathophysiology
A

Transient Ischemic Attack

  • neurologic deficit that lasts from a few minutes to no more than 24 hours
  • Usually lasts less than 30 mins
  • Usually embolic
  • Inc risk of stroke
56
Q

If a pt has asterixis what test should you order?

A

Complete metabolic panel

57
Q

Common vs classic migraine

A

o Migraine without aura = common migraine

o Migraine with aura = classic migraine
Aura = clAssic

58
Q

Patient with HIV has ring enhancing lesions on MRI. What is your differential

A

toxo: multiple lesions
Lymphoma: solitary lesions

Definitive diagnosis with stereotactic brain biopsy

59
Q

Muscle weakness in myasthenia gravis

A

Worsens with repeated stimulation

Improves with rest (more ACh to overcome the autoantibodies)

60
Q

Resting tremor vs intention tremor

A 
Resting = parkinsons
Intention = Essential tremor
61
Q

Why are there increased amounts of RBCs in HSV encephalitis

A

Due to hemorrhagic destruction of the temporal lobes

62
Q

Parinaud syndrome

A

aka Dorsal midbrain syndrome

  • Upward gaze palsy (Inability to look up) often presenting as diplopia
  • loss of pupillary light reflex
  • convergence-retraction nystagmus
  • upper eyelid retraction

due to lesion in superior colliculi (midbrain)

Stroke, hydrocephalus, pinealoma

63
Q

Infant botulism vs adult botulism

A

o Adult botulism: ingestion of preformed toxin

o Infant botulism: ingestion of spores that germinate and form the toxin (usually in honey, also environmental)

64
Q

When a seizure includes an olfactory aura, where is the seizure likely localized?

A

Temporal lobe; hippocampus or parahippocampal gyrus

65
Q

Which artery in the brain is likely occluded if a patient experiences:
urinary incontinence

A

ACA

66
Q

Signs of uncal herniation

A

The uncus is the innermost part of the temporal lobe

Signs
• Ipsilateral pupil dilation (compression of CN3)
Pupillary fibers run on the outside of CN3, so they are easily compressed by the uncus
• Ipsilateral visual field deficit/hemianopia (compression of posterior cerebral artery)
• Ipsilateral hemiparesis (compression of contralateral cerebral peduncle)
False localization sign

67
Q

Patient presents with muscle wasting of the small muscles of the hand and loss of pain and temperature to the bilateral upper extremities.

A

syringomyelia

68
Q

Subarachnoid bleed: caused by what and what is an important sequela to take under consideration

A

Secondary to rupture of ordinary arteries and veins (berry aneurysm), fills sulci and cisterns

  • Bleeding between the arachnoid mater and pia mater
  • Berry aneurysms are associated with EDS and ADPKD
  • Can also be due to trauma and AV malformations

4-10 days after hemorrhage, vasospasm can occur and cause an ischemic infarct (prevent this with Nimodipine – Calcium channel blocker)

69
Q

Painless, rapid, and transient (<10 mins) monocular vision loss. Pt describes it as a curtain descending over the visual field

  • What is this
  • What are risk factors
  • How do you diagnose it
A

Amaurosis fugax: Retinal ischemia due to atherosclerotic emboli originating from the ipsilateral internal carotid artery –> ophthalmic artery

RF: HTN, HLD, smoking

Dx: with duplex US of the neck

70
Q

Cheyne Stokes breathing

A

apnea is followed by gradually increasing then decreasing tidal volumes until the next apneic period

Episodes of apnea cause hypercapnia, and then the body compensates by hyperventilating, which overshoots and causes hypocapnia → leads to another apneic episode to inc CO2 levels

Seen in neurologic disease (stroke, brain tumors, TBI) and is a poor prognostic sign
• Indicates bihemispheric dysfunction

71
Q

Patient presents with left leg weakness and loss of sensation, where is the infarct?

A

Right anterior cerebral artery (ACA)

72
Q

Bilateral acoustic neuromas

A

Neurofibromatosis type 2

Chromosome 22

73
Q

In an MCA infarct where will the eyes deviate?

A

Toward the side of infarct

74
Q

Pure motor lacunar stroke

A

Involves the internal capsule

75
Q

AICA vs PICA infarct

A

Similarities:
o Vomiting, vertigo, nystagmus (vestibular nuclei)
o Dec pain and sensation to ipsilateral face (spinal trigeminal nucleus) and contralateral body (lateral spinothalamic tract)
o Ipsilateral ataxia and dysmetria (cerebellar peduncles)
o Ipsilateral Horner Syndrome (sympathetic fibers)

PICA (lateral medullary syndrome)
Hoarseness/dysphagia (Nucleus Ambiguus)
* Think Pikachu (PICA, Can’t chew)

AICA (Lateral pontine syndrome)
Ipsilateral upper and lower facial paralysis (facial nucleus CN7)
*Think fACIAl (has AICA spelled backwards)

76
Q

Lumbar spine stenosis presentation

A

Worse with standing, relieved by sitting
Worse with walking downhill
Less severe with walking uphill

77
Q

Which cranial nerve is commonly implicated in sarcoidosis?

A

CN7 – Bell Palsy

78
Q

Findings at disc level: L5-S1

A

Weakness of plantarflexion, difficulty in toe walking, dec Achilles reflex

79
Q

Therapy for acute stroke

A
  1. fibrinolytic therapy (tPA)

2. Aspirin, if the patient is not a candidate for tPA

80
Q

Diabetic neuropathy

A
  • a symmetric, distal, lower limb, sensory polyneuropathy with a variable degree of motor and autonomic involvement.
  • It develops when diabetes mellitus has been present for several years.
  • A highly significant association has been found between the presence of polyneuropathy and retinopathy or nephropathy
  • Tx with pregabalin
81
Q

Most common causes of intraparenchymal hemorrhage

A

HTN

  • less commonly due to cerebral amyloid angiopathy
82
Q

Tests for myasthenia gravis

A

Ice pack test: an ice pack is applied over the eyelids for several minutes, leading to an improvement in the ptosis
• The cold temperature improves muscle strength by inhibiting the breakdown of Ach at the NM junction

Edrophonium: short acting acetylcholinesterase inhibitor

83
Q

Which cancers metastasize to the brain?
Solitary lesions
Multiple lesions

A

Multiple lesions: Lung, melanoma

Single lesions: Breast, colon, kidney

84
Q

Treatment of acute spinal injury

A

High dose IV steroids within the first 8 hours

85
Q

EBV DNA in CSF of an AIDS patient indicates?

A

Primary CNS lymphoma

MRI reveals a weakly ring-enhancing mass that is usually solitary and periventricular

86
Q

CSF in multiple sclerosis

A

inc immunoglobulins with oligoclonal IgG bands and myelin basic protein

87
Q

Afferent pupillary defect (aka Marcus Gunn pupil)

A

Due to optic nerve damage or severe retinal injury

Shine light in affected eye: both eyes do not constrict to a normal extent but the affected pupil shows less constriction than the unaffected pupil.

Shine light in normal eye: both eyes constrict normally and equally.

It is because of a decrease in afferent input reaching the pretectal pathway responsible for the pupillary light response in the midbrain via damaged optic nerve, but efferent fibers to the affected eye are delivered via cranial nerve III.

88
Q

What does pronator drift test for? What does a positive test look like?

A

Sensitive and specific for upper motor neuro or pyramidal/corticospinal tract disease
- The affected arm drifts downward and the palm turns (pronates) toward the floor

89
Q

Which antiemetic should not be started in patients with Parkinsons

A

Metoclopramide (dopamine blocking activity)

Start Zofran

90
Q

First step in evaluation of acute stroke

A

Head CT without contrast – to evaluate for acute hemorrhage

cant give tpa if they have a hemorrhage

91
Q

Treatment of essential tremor

A

Action tremor

Treat with B blocker (propranolol) or primidone

92
Q

Therapeutic hyperventilation

A

Used to reduce intracranial pressure

Blow of excess CO2 which causes cerebral vasoconstriction, leading to a decrease in intracranial pressure

93
Q

Periodic paralysis can be associated with which electrolyte?

A

Potassium

hyperkalemic or hypokalemic periodic paralysis

94
Q

Most common cause of spontaneous lobar hemorrhage?

A

Cerebral amyloid angiopathy

Particularly common in people >60 without HTN

95
Q

Contraindications to t-PA

A 
Unknown time of stroke
Uncontrolled HTN (>185/90)
Bleeding disorder
Anticoagulant use
Recent trauma/surgery
96
Q

what is Lambert Eaton syndrome associated with?

A

Paraneoplastic syndrome: Small Cell Carcinoma of the lung

97
Q

Jacksonian March

A

Sequential seizure: the patient develops focal seizure activity that is primarily motor and spreads

Often becomes generalized and the patient has an LOC and may have a generalized tonic clonic seizure

98
Q

3 causes of stroke

A
  1. ischemia due to atherosclerosis
  2. afib with clot emboli to brain
  3. septic emboli from endocarditis
99
Q

Lacunar infarct is often due to….

A

HTN – Causes thickening of the vessel wall (narrowing of the arterial lumen)

100
Q

Most common cause of TIA/CVA

A

Emboli

then thrombosis, lacunar, and nonvascular causes like low cardiac output or anoxia

101
Q

Treatment of bacterial meningitis

A

Older than 1 month, younger than 65: Vancomycin and ceftriaxone

Older than 65: Vancomycin, Ceftriaxone and Ampicillin (to cover for Listeria)

102
Q

4 cardinal features of Parkinson disease

A

Resting tremor, bradykinesia, rigidity, postural instability

103
Q

Part of the brain implicated in Wilson Disease

A

o Effects the putamen and globus pallidus– hyperkinetic movements

o A rare AR mutation that results in impaired cellular transport of copper and dec excretion into bile and blood → Causes copper to leak from injured hepatocytes and accumulate in the liver, brain, and eye.

o Neuropsych signs and symptoms= depression, rigidity, personality changes, impulsivity, basal ganglia injury (ataxia, parkinsonism, tremor)

104
Q

Which anti-epileptic is associated with kidney stones?

A

Topiramate

105
Q

Which anti-epileptic is associated with liver dysfunction?

A

Valproic acid

106
Q

Which anti-epileptic is associated with megaloblastic anemia?

A

Phenytoin – inhibits folate

107
Q

Which anti-epileptic is associated with nystagmus?

A

Phenytoin

108
Q

3 cardinal findings in brain death

A

unresponsiveness, absence of brainstem reflexes and apnea

109
Q

Which nerves are most commonly implicated in neuropathies? How does this clinically present?

A

small, unmyelinated and lightly myelinated nerve fibers (pain and temperature)

• Complain of burning pain and paresthesias

110
Q

Vitamin B12 deficiency neurologic defects

A

Subacute combined degeneration
Causing anemia, ataxia, paresthesia, impaired position and vibration sense.

o Demyelination of (SCD)
• S: Spinocerebellar tracts
• C: lateral Corticospinal tracts
• D: Dorsal columns

111
Q

Memory center of the brain

A

Medial temporal lobe (hippocampus)

112
Q

Is unilateral deafness peripheral or central, or are both possible?

A

Peripheral
Cochlear nuclei project to both temporal lobes

If there is unilateral deafness, it is a peripheral process

113
Q

What drug can worsen tinnitus?

A

Aspirin

114
Q

Difference between ADEM and MS?

A

ADEM is monophasic: one episode, is not recurring like MS

115
Q

What can improve outcome of a patient with severe traumatic head injury

A

Hypothermia

116
Q

Age related macular degeneration

A

Progressive bilateral loss of central vision

Shelf Exams (8 decks)

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