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- Med School Review 🔥 > Neurology > Flashcards

Neurology Flashcards

1
Q

Face pain, lancinating pain, worse with chewing

A

Trigeminal Neuralgia

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2
Q

PD is progressive loss of dopaminergic neurons in the ____ interrupting neuralgic connections from ____ to the thalamus and motor cortex

A

Basal Ganglia

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3
Q

Fatiguable muscle weakness + diplopia/ptosis + Bulbar dysfunction + Respiratory muscle weakness

A

Myasthenia Gravis

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4
Q

Most common cause of CN III Palsy in adults (down-and-out gaze + ptosis)

A

Ischemic neuropathy 2/2 poorly controlled diabetes

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5
Q

Spontaneous lobar hemorrhage in elderly w/ Alzheimers

A

Cerebral amyloid angiopathy

(most often occipital or parietal lobes)

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6
Q

“High stepping” + UL foot drop

A

Common Peroneal Neuropathy

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7
Q

Amaurosis fugax

A

Painless, rapid, transient monocular vision loss

  • Retinal ischemia 2/2 atherosclerotic emboli from ipsi carotid artery
  • “Curtain descending over visual field”
  • Duplex US of neck for that presentation
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8
Q

Pronator drift on exam

A

UMN lesion/Pyramidal tract lesion

(due to more weakness in supinator muscles than in pronators)

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9
Q

Calcium crystals (canaliths) within the semicircular canals

A

BPPV

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10
Q

Diabetic neuropathy is a ____ motor neuron process

A

Lower Motor Neuron

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11
Q

Amyloid plaques & neurofibrillary tangles

A

Alzheimer’s Dementia

(+Loss of cholinergic neurons)

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12
Q

AD defect in chromosome 4

A

Huntington Disease

(Huntington Dementia)

  • Striatal neurodegeneration
  • Early-onset dementia (35-50yo)
  • Grimacing, ataxic gait, progressive choreiform movements
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13
Q

Progressive loss of nigrostriatal dopaminergic neurons

A

Parkinson’s Disease (BPRT:

Bradykinesia, Postural instability, Rigidity, Tremors [resting])

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14
Q

Rapidly progressive dementia, myoclonus, & sharp, triphasic synchronous discharges on EEG

A

Creutzfeldt-Jakob Disease

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15
Q

Highest risk complication of prolonged seizures or status epilepticus

A

Cortical laminar necrosis

(permanent injury due to excitatory cytotoxicity)

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16
Q

Mallory bodies on liver biopsy

A

Alcoholic hepatitis or Wilson’s Disease

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17
Q

Copper deposition in liver, basal ganglia and cornea

A

Wilson’s Disease

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18
Q

Young adult w/ tremor, rigidity, neuropsychiatric Sx, & hepatomegaly

A

Wilson’s Disease

  • Check serum ceruloplasmin and slit lamp examination
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19
Q

Single brain metastasis Tx

A

Surgical resection

(Whole brain radiation if multiple mets)

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20
Q

Brain mass at gray-white junction

A

Metastasis

(Lung > Breast > Unknown > Melanoma > Colon)

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21
Q

First-line Tx to abort cluster HA (male w/ rtetroorbital pain awoken from sleep)

A

100% Oxygen

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22
Q

Unilateral acute painless vision loss. Dx & Tx?

A

Central Retinal Artery Occlusion; Orbital massage

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23
Q

AMS + Autonomic instability + Neuromuscular excitability (tremor, hyperreflexia, myoclonus)

A

Serotonin Syndrome

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24
Q

AMS + Rigidity + Fever + Autonomic dysregulation

A

NMS

(Neuroleptic malignant syndrome; ADR to dopamine antagonists)

  • Tx: Withdraw drug +/- dantrolene
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25
Q

Small pupils that constrict poorly to light but with normal accommodation

A

Argyll Robertson pupils

(neurosyphilis)

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26
Q

Small pupils that constrict poorly to light + poor vibration/position sense

A

Tabes dorsalis

(neurosyphilis)

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27
Q

Pt is ignoring left side of space

A

Right parietal lobe lesion

(non-dominant; hemi-neglect syndrome)

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28
Q

Hemineglect syndrome. Lesion?

A

Right parietal lobe

(non-dominant)

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29
Q

Right (non-dominant) parietal lobe lesion

A

Hemi-neglect syndrome

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30
Q

Anosognosia

A

Deficit in self-awareness due to brain injury or mental illness

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31
Q

Gait instability, truncal ataxia, hypotonia, nystagmus, intention tremor

A

Cerebellar dysfunction

(2/2 chronic alcoholism)

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32
Q

Broad-based gait

A

Cerebellar dysfunction or NPH (Wet/Wacky/Wobbly)

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33
Q

Trihexyphenidyl

A

Anticholinergic used to treat Parkinsonian (resting) tremor when PD is first presenting

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34
Q

Monotherapy for Parkinsonian tremor

(resting)

A

Trihexyphenidyl

(anticholinergic)

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35
Q

Abs against voltage-gated calcium channels

A

Lambert Eaton Myasthenic Syndrome

(50% are associated with underlying cancer such as SCLC)

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36
Q

Ptosis improved with ice pack applied over eyelids for several mins

A

MG

(cold temp improves muscle strength by inhibiting breakdown of ACh at NMJ)

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37
Q

Neurocardiogenic syncope

A

Vasovagal syncope

(2/2 excessive vagal tone)

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38
Q

Syncope triggered by prolonged standing

A

Vasovagal syncope

(Neurogenic)

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39
Q

Feelings of nausea, dizziness, & warmth prior to syncope

A

Neurogenic syncope

(vasovagal)

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40
Q

Single ring-enhancing lesion w/ central necrosis on brain MRI

A

Brain abscess

(usually strep viridans or Staph aureus)

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41
Q

Multiple well-circumscribed lesions w/ vasogenic edema at the gray and white matter junction

A

Metastatic brain cancer

(Lung > Breast > Unknown > Melanoma > Colon)

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42
Q

Guillain-Barre Syndrome GI bug

A

Campylobacter jejuni

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43
Q

Result of uncontrolled infection of the skin, sinuses, and orbit in setting of valveless facial/ophthalmic venous system

A
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44
Q

Excessive accumulation of endolymph in the membranous labyrinth of the ear

A

Meniere disease

(recurrent vertigo + UL aural fullness, tinnitus, sensorineural HL)

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45
Q

Ascending paralysis

A
  • Within hours + hiking: Tick-borne Paralysis
  • Over days-weeks: GBS (Guillain-Barré Syndrome) or Spinal cord tumor
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46
Q

Tumor of Schwann cells covering vestibular branch of CN VIII

A

Acoustic neuroma

(Sx: vertigo, tinnitus, sensorineural HL)

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47
Q

Presbycusis

A

Age-related sensorineural hearing loss

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48
Q

Intracerebral hemorrhage on warfarin Tx

A

IV Vitamin K + Prothrombin Complex Concentrate (PCC; II/VII/IX/X)

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49
Q

Rapidly progressive ascending paralysis + no fever or sensory abnormalities

A

Tick-borne paralysis

  • Tx: Tick removal
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50
Q

Intermittent UL foot drop + dorsal foot numbness

A

Common fibular neuropathy

(peripheral nerve compression 2/2 leg immobilization or leg crossing)

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51
Q

AMS + Ataxia + Ophthalmoplegia

A

Wernicke Encephalopathy

  • +confabulation, personality ∆, memory loss: Wernicke-Korsakoff Syndrome
  • Tx: Thiamine
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52
Q

HA, confusion, amnesia, difficulty concentrating, sleep disturbance, anxiety - days to weeks following head trauma

A

Postconcussive Syndrome

(following mild TBI)

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53
Q

W/u of first-time seizure in adult

A
  • Electrolytes
  • Glucose
  • Calcium
  • Magnesium
  • CBC
  • Renal tests
  • LFTs
  • Toxicology Screen
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54
Q

Parkinsonism + orthostatic hypotension, impotence, incontinence, or other autonomic Sx

A

Multiple System Atrophy

(Shy-Drager Syndrome)

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55
Q

Recent diagnosis of MG

A

Chest imaging to look for thymoma

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56
Q

Heat Stroke first line Tx

A

Rapid cooling

ce water immersion), IVF

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57
Q

Waddling gait

A

Muscular Dystrophy

(2/2 weakness of gluteal muscles)

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58
Q

Parkinsonism is called by overactivity of ____ neurons, under activity of ____ neurons in the _____

A

Cholinergic; Dopaminergic; Substantia Nigra

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59
Q

4 Tenets of Parkinson Disease

A

BPRT:

  • Bradykinesia
  • Postural instability (Shuffling Gait)
  • Rigidity
  • Tremor (Resting)
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60
Q

Hyperextension injury in elderly w/ pre-existing cervical degenerative changes

A

Central Cord Syndrome

(as seen in MVC whiplash)

  • Lateral spinothalamic tract (UE > LE)
  • Loss of pain/temp in UE
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61
Q

BL spastic motor paresis distal to spinal lesion

A

Anterior Cord Syndrome

(2/2 occlusion of ASA)

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62
Q

Ipsi weakness, spasticity, loss of vibration/proprioception, Contra loss of pain/temp

A

Brown-Sequard Syndrome

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63
Q

Severe back pain + saddle anesthesia + hyporeflexia + asymmetric motor weakness

A

Cauda equina syndrome

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64
Q

Severe back pain + perianal anesthesia + hyperreflexia + BL motor weakness (mild)

A

Conus medullaris syndrome

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65
Q

Alteplase if presenting w/ ischemic stroke within ___ hours of symptom onset and no contraindications

A

3.5-4 hours

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66
Q

Halos seen around lights

A

Acute angle-closure glaucoma

67
Q

Male w/ HA behind eye that awakens pt from sleep

A

Cluster HA

  • “Sharp” and severe
    • Ptosis, Miosis
68
Q

Momentary vision loss that changes with head positioning

A

Increased ICP

  • IIH if young obese female
  • Due to optic nerve neuritis
  • Can lead to blindness
69
Q

Botulism ocular Sx

A

Fixed pupillary dilation

70
Q

Cured fish

A

Botulism

(Tx: Equine serum heptavalent antitoxin)

71
Q

Botulism Tx

A

Equine serum heptavalent antitoxin (if >1yo)

72
Q

Microatheroma + Small-Vessel Lipohyalinosis

A

Lacunar Stroke

(occlusion of deep penetrating arteries)

  • Often not appreciated on noncontrast CT
73
Q

Stroke symptoms w/ negative CT

A

Lacunar stroke

(lipohyalinosis + microatheroma)

74
Q

Hypertensive intraparenchymal hemorrhage presenting with severe occipital HA

A

Cerebellar hemorrhage

(Ipsilateral hemiataxia)

75
Q

Tremor that worsens with movement

A

Essential Tremor

(Tx: Propranolol)

  • 2nd line: Primidone, Topiramate (anticonvulsants)
76
Q

Resting tremor that improves with movement

A

Parkinson Tremor

77
Q

Butterfly appearance on brain MRI/CT

A

GBM

(Glioblastoma Multiforme; High-grade astrocytoma)

  • Heterogenous and serpiginous (wavy) contrast enhancement
78
Q

HA that worsens with changes in position, coughing, or sneezing

A

Increased ICP

(2/2 GBM, tumor, abscess, pseudotumor cerebra)

79
Q

Eyes deviate Towards hemiparesis. Location of hemorrhage?

80
Q

Contralateral hemiparesis

81
Q

Complication in untreated pseudotumor cerebra (young obese female)

82
Q

Spasticity + Bulbar Sx

(dysphagia, dysarthria) + Hyperreflexia

A

UMN Damage

83
Q

Fasciculations

A

LMN Damage

84
Q

Major cause of morbidity/mortality post-SAH

(first 24 hrs)

A

Rebleeding

(prevented w/ endovascular coiling or repair)

85
Q

Major cause of delayed morbidity/mortality post-SAH (3-10d)

A

Vasospasm

(prevented w/ nimodipine)

86
Q

Flat & Broad T waves

A

Hypokalemia

    • U waves
    • PVCs
87
Q

Holocranial HA + Vision ∆s + Pulsatile tinnitus

A

IIH

(Pseudotumor Cerebri)

  • Young obese women
  • Isotretinoin
  • Tetracyclines, GH, or Excessive VitA
88
Q

Lateral medullary syndrome. Artery?

A

PICA

(Posterior Inferior Cerebellar Artery occlusion)

  • Loss of pain/temp (ipsi face, contra body)
89
Q

Contralateral sensory loss w/o hemiparesis or motor loss. Lesion?

A

Thalamus

(Lacunar Stroke from PCA branches)

90
Q

Pure sensory stroke

A

Thalamus

(Lacunar stroke)

91
Q

Allodynia or severe paroxysmal burning pain following stroke

A

Thalamic pain syndrome

(Thalamic/Lacunar stroke)

92
Q

14-3-3 Protein in CSF

A

Creutzfeldt-Jakob Disease

(prion disease)

93
Q

VDRL in CSF

A

Neurosyphilis

(paralysis, dementia, personality ∆s, tabes dorsalis)

94
Q

Tabes dorsalis

A

Neurosyphilis myopathy

(gradual degeneration of nerves normally in the posterior column of spinal cord)

  • Dorsal column degeneration
  • Orthopedic pain (Charcot joints)
  • Reflexes decreased (DTRs)
  • Shooting pain
  • Argyll-Robertson Pupils
  • Locomotor ataxia
  • Impaired Proprioception
  • Syphilis
95
Q

Women age 15-50 + pronator drift

A

MS

  • Ataxia
  • Diplopia
  • Vertigo
96
Q

Chemotherapy-Induced Peripheral Neuropathy

A
  • Vincristine
  • Cisplatin/Carboplatin
  • Paclitaxel (Taxanes)
  • Involves stocking glove pattern paresthesias, loss of ankle jerk reflexes, & loss of pain/temp sensation
97
Q

Trigeminal Neuralgia Tx

A

Carbamazepine

98
Q

Slow broad-based shuffling gait + urinary incontinence + dementia

A

NPH

(decreased CSF absorption)

99
Q

Posterior inferior frontal gyrus

A

Broca’s area

100
Q

Acute painless vision loss + Retinal whitening + Cherry red macula

A

CRAO

(Central Retinal Artery Occlusion)

  • Tx: Ocular massage, anterior chamber paracentesis, or revascularization
101
Q

Acute painless vision loss + “Blood & Thunder” or Cotton wool spots

A

Central Retinal Vein Occlusion

102
Q

BL Trigeminal Neuralgia

103
Q

Neurologic deficits disseminated in space and time

A

MS

(women 15-50)

104
Q

Damage to MLF

(medial longitudinal fasciculus)

A

MS

(Internuclear ophthalmoplegia - Inability to adduct when looking to side)

105
Q

Multifocal ovoid subcortical hypo-/hyperintense WM CNS lesions on MRI

106
Q

Oligoclonal IgG bands on LP

107
Q

Symptoms worsen with high temperatures

108
Q

Most patients with AChR antibodies (MG) have ____ abnormalities

A

Thymus

(Thymoma, Thymic hyperplasia)

109
Q

MG pts get a CT chest to evaluate for

A

Thymic abnormalities, as thymectomy can result in long-term dz remission

110
Q

Decreased presynaptic ACh release

111
Q

Descending flaccid paralysis

A

Botulism

(preceded by GI prodrome)

112
Q

Inflammatory demyelination of CNS axons

113
Q

Migraine PPX:

A
  • Topiramate
  • Divalproex sodium
  • Tricyclic antidepressants
  • Beta Blockers (Propranolol)
114
Q

Migraine Abortive agents

A
  • Triptans
  • NSAIDs
  • Acetaminophen
  • Antiemetics (Metoclopramide, Prochlorperazine)
  • Ergots (DHE)
115
Q

SIG E CAPS

A

Sleep

Interest (loss)

Guilt (worthlessness)

Energy (lack of)

Cognition/Concentration (reduced)

Appetite (wt loss)

Psychomotor (agitation/anxiety, lethargy)

Suicide (preoccupation)

116
Q

Do not use ____ in Lewy Body Dementia

A

Typical Antipsychotics

(due to neuroleptic hypersensitivity —> Severe parkinsonism may result)

117
Q

Early insidious short-term memory loss, language deficits & spatial disorientation, later personality changes

A

Alzheimer disease

118
Q

Stepwise decline, early executive dysfunction, cerebral infarction &/or deep WM changes on neuroimaging

A

Vascular Dementia

119
Q

Early personality changes, apathy/disinhibition/compulsive behavior, localized atrophy on neuroimaging

A

Frontotemporal dementia

(Pick disease; presents w/ frontotemporal atrophy)

120
Q

Visual hallucinations, spontaneous parkinsonism, fluctuating cognition

A

Lewy Body Dementia

121
Q

Ataxia (early), Urinary incontinence, Dilated ventricles on neuroimaging

A

NPH

(Normal-Pressure Hydrocephalus)

122
Q

Rapidly progressive dementia accompanied by behavioral changes, myoclonus &/or seizures

A

Prion Disease

123
Q

HA, AMS, Sz, FND + OCPs or malignancy

A

Cerebral Venous Thrombosis

  • Order MRI brain w/ venography (CT not sensitive)
124
Q

Biconvex bleed on CT

A

Epidural hematoma

125
Q

Concave bleed on CT

A

Subdural hematoma

(tearing of bridging veins)

126
Q

Spontaneous deep intracerebral hemorrhage is typically caused by

A

Hypertensive Vasculopathy

  • Basal Ganglia (putamen)
  • Cerebellar Nuclei
  • Thalamus
  • Pons
127
Q

PICA or Vertebral Artery infarction

A

Lateral Medullary Syndrome

  • Pain & Temp Loss (ipsi face, contra body)
  • Vertigo & Nystagmus (vestibulocerebellar impairment)
  • Dysphagia, dysarthria, dysphonia, hoarseness (ipsi vocal cord paralysis)
  • Horner’s Syndrome (ptosis, miosis, anhidrosis)
    • Intractable hiccups
128
Q

Branch occlusion of vertebral artery or ASA (anterior spinal artery)

A

Medial Medullary Syndrome

  • Alternating Hypoglossal Hemiplegia
  • Contralateral arm & leg paralysis
  • Tongue deviation toward the lesion
129
Q

Restless Leg Syndrome Tx

A
  • Dopamine agonists (Pramipexole, Ropirinole)
  • Alpha-2-delta Calcium Channel Ligands (Gabapentin)
  • Iron in iron-deficiency
130
Q

Confusion + Nystagmus + Ataxia

A

Wernicke Encephalopathy

(Thiamine [B1] deficiency)

  • Tx: IV Thiamine
131
Q

Anemia + Impaired vibratory & positional sense + Ataxia

A

B12 Deficiency

132
Q

AMS, Sz, fever, HA

A

Herpes Simplex Encephalitis

133
Q

Refeeding Syndrome

A
  • Hypophosphatemia
  • Volume overload
134
Q

Avoid doing this in pts with suspected

135
Q

Donepezil

A

Cholinesterase inhibitor used to treat Alzheimer disease

136
Q

Multiple Sclerosis acute exacerbation Tx

A

IV Corticosteroids (methylprednisolone)

  • 2nd line: Plasma Exchange
137
Q

Guillain-Barre Syndrome Tx

A
  • IVIG
  • Plasmapheresis
138
Q

Tx for ALS

A

Riluzole

(Glutamate inhibitor)

  • May prolong survival and time to tracheostomy
139
Q

Hyperreflexia, spasticity

A

UMN lesion

140
Q

Early loss in visuospatial and anterograde memory formation

A

Alzheimer’s

141
Q

Early hallucinations, EPS Sx

A

Lewy body dementia

142
Q

Stepwise cognitive deterioration + vascular disease risk factors

A

Multi-infarct dementia

143
Q

Ipsilateral hemiataxia occurs in spontaneous ____ hemorrhage

A

Cerebellar

(pt with poorly controlled HTN)

  • +occipital HA
  • +neck stiffness
  • +N/V
  • +nystagmus
144
Q

Neurological disease of the Caudate & Putamen

A

Huntington’s Disease

145
Q

35-44yo w/ choreathetoid movements, behavioral disturbances, dementia

A

Huntington’s Disease

146
Q

Insidious onset of HA, memory deficits, balance problems, aphasia, or motor deficits

A

Chronic subdural hematoma

147
Q

Memory changes or other dementia symptoms in elderly depressed patient

A

Pseudodementia

148
Q

Dementia + posterior spinal column deficits

A

B12 deficiency

149
Q

Dementia, urinary incontinence, abnormal gait

A

NPH

(Normal Pressure Hydrocephalus)

150
Q

Confusion, ataxia, ophthalmoplegia

A

Thiamine deficiency

(Wernicke encephalopathy)

  • +confabulation, +amnesia —> Korsakoff’s
  • Common in alcoholics
151
Q

Memory changes + hoarseness

A

Hypothyroidism

152
Q

Basal ganglia lesion

A

Parkinson Disease

153
Q

Occipital HA, neck stiffness, N/V, nystagmus, hemiataxia

A

Spontaneous Cerebellar Hemorrhage

154
Q

Parkinsonism (BPRT) + orthostatic hypotension, impotence, incontinence (autonomic sx)

A

Multiple System Atrophy

(Shy-Drager Syndrome)

155
Q
  • Difficulty climbing stairs or blow-drying hair
  • Ocular Sx (diplopia, ptosis)
  • Bulbar Sx (dysphagia, dysarthria)
A

MG

  • Anti-ACh Receptor antibodies
  • Proximal muscle weakness, ocular sx, bulbar sx
  • ETT, PEX/IVIG, & Corticosteroids if myasthetic crisis (MG respiratory failure)
156
Q

Beta-amyloid deposition in small-medium cerebral artery vessel walls, predisposing to rupture (spontaneous lobar hemorrhage)

A

Cerebral amyloid angiopathy

(seen in Alzheimer Disease)

157
Q

Most common cause of intracranial hemorrhage in children

A

Arteriovenous malformation (AVM) rupture

158
Q

Most common cause of spontaneous lobar hemorrhage in adults

A

Cerebral Amyloid Angiopathy

(beta-amyloid deposition in small-medium arterial walls seen in Alzheimer disease)

159
Q

Acute onset severe memory impairment 2/2 vitamin B1 (thiamine) deficiency (often in alcoholism)

A

Korsakoff Syndrome

(early phase thiamine deficiency)

  • Wernicke Encephalopathy = late phase thiamine deficiency (AMS, vision ∆s, ataxia)
160
Q

Central scotoma, afferent pupillary defect, changes in color perception, & decreased visual acuity

A

Optic neuritis

  • Often autoimmune
  • Can be early MS
161
Q

Increased cup:disc ratio on fundoscopy

A

Glaucoma

(2/2 increased IOP)

  • Open-angle = trabecular meshwork (drainage canal) not blocked–more gradual onset
  • Closed-angle = trabecular meshwork blocked–acute;
    • Rapid increase in IOP
    • Caused by GTA (GH, TCAs, vitamin A)
    • Also called Acute Angle Closure Glaucoma (AACP)
    • Increased risk in eyes with more narrow angles (i.e. smaller; e.g. Farsighted pts, Asians or Eskimos)
      • This is why only 10% in the US are ACP and 90% are open-angle
162
Q

Cherry red fovea, cloudy retina

A

CRAO

(Central Retinal Artery Occlusion)

  • W/u for embolic source
  • Tx: Ocular massage & high flow O2 (for acute presentation)
163
Q

Paradoxical afferent pupillary defect on swinging light test

A

Optic neuritis

(Marcus Gunn pupil)

  • +decreased visual acuity
  • +∆ in color perception
  • +central scotoma
  • +Marcus Gunn pupils
  • Think early MS

- Med School Review 🔥 (23 decks)

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