Neurology Flashcards
(163 cards)
1
Q
Face pain, lancinating pain, worse with chewing
A
Trigeminal Neuralgia
2
Q
PD is progressive loss of dopaminergic neurons in the ____ interrupting neuralgic connections from ____ to the thalamus and motor cortex
A
Basal Ganglia
3
Q
Fatiguable muscle weakness + diplopia/ptosis + Bulbar dysfunction + Respiratory muscle weakness
A
Myasthenia Gravis
4
Q
Most common cause of CN III Palsy in adults (down-and-out gaze + ptosis)
A
Ischemic neuropathy 2/2 poorly controlled diabetes
5
Q
Spontaneous lobar hemorrhage in elderly w/ Alzheimers
A
Cerebral amyloid angiopathy
(most often occipital or parietal lobes)
6
Q
“High stepping” + UL foot drop
A
Common Peroneal Neuropathy
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
8
Q
Pronator drift on exam
A
UMN lesion/Pyramidal tract lesion
(due to more weakness in supinator muscles than in pronators)
9
Q
Calcium crystals (canaliths) within the semicircular canals
A
BPPV
10
Q
Diabetic neuropathy is a ____ motor neuron process
A
Lower Motor Neuron
11
Q
Amyloid plaques & neurofibrillary tangles
A
Alzheimer’s Dementia
(+Loss of cholinergic neurons)
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
13
Q
Progressive loss of nigrostriatal dopaminergic neurons
A
Parkinson’s Disease (BPRT:
Bradykinesia, Postural instability, Rigidity, Tremors [resting])
14
Q
Rapidly progressive dementia, myoclonus, & sharp, triphasic synchronous discharges on EEG
A
Creutzfeldt-Jakob Disease
15
Q
Highest risk complication of prolonged seizures or status epilepticus
A
Cortical laminar necrosis
(permanent injury due to excitatory cytotoxicity)
16
Q
Mallory bodies on liver biopsy
A
Alcoholic hepatitis or Wilson’s Disease
17
Q
Copper deposition in liver, basal ganglia and cornea
A
Wilson’s Disease
18
Q
Young adult w/ tremor, rigidity, neuropsychiatric Sx, & hepatomegaly
A
Wilson’s Disease
- Check serum ceruloplasmin and slit lamp examination
19
Q
Single brain metastasis Tx
A
Surgical resection
(Whole brain radiation if multiple mets)
20
Q
Brain mass at gray-white junction
A
Metastasis
(Lung > Breast > Unknown > Melanoma > Colon)
21
Q
First-line Tx to abort cluster HA (male w/ rtetroorbital pain awoken from sleep)
A
100% Oxygen
22
Q
Unilateral acute painless vision loss. Dx & Tx?
A
Central Retinal Artery Occlusion; Orbital massage
23
Q
AMS + Autonomic instability + Neuromuscular excitability (tremor, hyperreflexia, myoclonus)
A
Serotonin Syndrome
24
Q
AMS + Rigidity + Fever + Autonomic dysregulation
A
NMS
(Neuroleptic malignant syndrome; ADR to dopamine antagonists)
- Tx: Withdraw drug +/- dantrolene
25
Small pupils that constrict poorly to light but with normal accommodation
**Argyll Robertson pupils**
| (neurosyphilis)
26
Small pupils that constrict poorly to light + poor vibration/position sense
**Tabes dorsalis**
| (neurosyphilis)
27
Pt is ignoring left side of space
**Right parietal lobe lesion**
| (non-dominant; hemi-neglect syndrome)
28
Hemineglect syndrome. Lesion?
**Right parietal lobe**
**(**non-dominant)
29
Right (non-dominant) parietal lobe lesion
**Hemi-neglect syndrome**
30
Anosognosia
**Deficit in self-awareness due to brain injury or mental illness**
31
Gait instability, truncal ataxia, hypotonia, nystagmus, intention tremor
**Cerebellar dysfunction**
| (2/2 chronic alcoholism)
32
Broad-based gait
**Cerebellar dysfunction or NPH** (Wet/Wacky/Wobbly)
33
Trihexyphenidyl
**Anticholinergic used to treat Parkinsonian** (resting) tremor when PD is first presenting
34
Monotherapy for Parkinsonian tremor
| (resting)
**Trihexyphenidyl**
| (anticholinergic)
35
Abs against voltage-gated calcium channels
**Lambert Eaton Myasthenic Syndrome**
(50% are associated with underlying cancer such as SCLC)
36
Ptosis improved with ice pack applied over eyelids for several mins
**MG**
(cold temp improves muscle strength by inhibiting breakdown of ACh at NMJ)
37
Neurocardiogenic syncope
**Vasovagal syncope**
| (2/2 excessive vagal tone)
38
Syncope triggered by prolonged standing
**Vasovagal syncope**
| (Neurogenic)
39
Feelings of nausea, dizziness, & warmth prior to syncope
**Neurogenic syncope**
**(**vasovagal)
40
Single ring-enhancing lesion w/ central necrosis on brain MRI
**Brain abscess**
(usually strep viridans or Staph aureus)
41
Multiple well-circumscribed lesions w/ vasogenic edema at the gray and white matter junction
**Metastatic brain cancer**
(Lung \> Breast \> Unknown \> Melanoma \> Colon)
42
Guillain-Barre Syndrome GI bug
**Campylobacter jejuni**
43
Result of uncontrolled infection of the skin, sinuses, and orbit in setting of valveless facial/ophthalmic venous system
44
Excessive accumulation of endolymph in the membranous labyrinth of the ear
**Meniere disease**
(recurrent vertigo + UL aural fullness, tinnitus, sensorineural HL)
45
Ascending paralysis
* Within hours + hiking: **Tick-borne Paralysis**
* Over days-weeks: **GBS** (Guillain-Barré Syndrome) or Spinal cord tumor
46
Tumor of Schwann cells covering vestibular branch of CN VIII
**Acoustic neuroma**
(Sx: vertigo, tinnitus, sensorineural HL)
47
Presbycusis
**Age-related sensorineural hearing loss**
48
Intracerebral hemorrhage on warfarin Tx
**IV Vitamin K + Prothrombin Complex Concentrate (PCC; II/VII/IX/X)**
49
Rapidly progressive ascending paralysis + no fever or sensory abnormalities
**Tick-borne paralysis**
* Tx: Tick removal
50
Intermittent UL foot drop + dorsal foot numbness
**Common fibular neuropathy**
(peripheral nerve compression 2/2 leg immobilization or leg crossing)
51
AMS + Ataxia + Ophthalmoplegia
**Wernicke Encephalopathy**
* +confabulation, personality ∆, memory loss: Wernicke-Korsakoff Syndrome
* Tx: Thiamine
52
HA, confusion, amnesia, difficulty concentrating, sleep disturbance, anxiety - days to weeks following head trauma
**Postconcussive Syndrome**
| (following mild TBI)
53
W/u of first-time seizure in adult
* **Electrolytes**
* **Glucose**
* **Calcium**
* **Magnesium**
* **CBC**
* **Renal tests**
* **LFTs**
* **Toxicology Screen**
54
Parkinsonism + orthostatic hypotension, impotence, incontinence, or other autonomic Sx
**Multiple System Atrophy**
| (Shy-Drager Syndrome)
55
Recent diagnosis of MG
**Chest imaging to look for thymoma**
56
Heat Stroke first line Tx
**Rapid cooling**
ce water immersion), IVF
57
Waddling gait
**Muscular Dystrophy**
| (2/2 weakness of gluteal muscles)
58
Parkinsonism is called by overactivity of ____ neurons, under activity of ____ neurons in the \_\_\_\_\_
**Cholinergic; Dopaminergic; Substantia Nigra**
59
4 Tenets of Parkinson Disease
**BPRT:**
* **B**radykinesia
* **P**ostural instability (Shuffling Gait)
* **R**igidity
* **T**remor (Resting)
60
Hyperextension injury in elderly w/ pre-existing cervical degenerative changes
**Central Cord Syndrome**
(as seen in **MVC whiplash**)
* Lateral spinothalamic tract (UE \> LE)
* Loss of pain/temp in UE
61
BL spastic motor paresis distal to spinal lesion
**Anterior Cord Syndrome**
| (2/2 occlusion of ASA)
62
Ipsi weakness, spasticity, loss of vibration/proprioception, Contra loss of pain/temp
**Brown-Sequard Syndrome**
63
Severe back pain + saddle anesthesia + hyporeflexia + asymmetric motor weakness
**Cauda equina syndrome**
64
Severe back pain + perianal anesthesia + hyperreflexia + BL motor weakness (mild)
**Conus medullaris syndrome**
65
Alteplase if presenting w/ ischemic stroke within ___ hours of symptom onset and no contraindications
**3.5-4 hours**
66
Halos seen around lights
**Acute angle-closure glaucoma**
67
Male w/ HA behind eye that awakens pt from sleep
**Cluster HA**
* “Sharp” and severe
* + Ptosis, Miosis
68
Momentary vision loss that changes with head positioning
**Increased ICP**
* **IIH if young obese female**
* **Due to optic nerve neuritis**
* **Can lead to blindness**
69
Botulism ocular Sx
**Fixed pupillary dilation**
70
Cured fish
**Botulism**
(Tx: Equine serum heptavalent antitoxin)
71
Botulism Tx
Equine serum heptavalent antitoxin (if \>1yo)
72
Microatheroma + Small-Vessel Lipohyalinosis
**Lacunar Stroke**
(occlusion of deep penetrating arteries)
* Often not appreciated on noncontrast CT
73
Stroke symptoms w/ negative CT
**Lacunar stroke**
**(lipohyalinosis + microatheroma)**
74
Hypertensive intraparenchymal hemorrhage presenting with severe occipital HA
**Cerebellar hemorrhage**
| (Ipsilateral hemiataxia)
75
Tremor that worsens with movement
**Essential Tremor**
**(Tx: Propranolol)**
* 2nd line: Primidone, Topiramate (anticonvulsants)
76
Resting tremor that improves with movement
**Parkinson Tremor**
77
Butterfly appearance on brain MRI/CT
**GBM**
(Glioblastoma Multiforme; High-grade astrocytoma)
* Heterogenous and serpiginous (wavy) contrast enhancement
78
HA that worsens with changes in position, coughing, or sneezing
**Increased ICP**
(2/2 GBM, tumor, abscess, pseudotumor cerebra)
79
Eyes deviate Towards hemiparesis. Location of hemorrhage?
**Thalamus**
80
Contralateral hemiparesis
??????
81
Complication in untreated pseudotumor cerebra (young obese female)
***Blindness***
82
Spasticity + Bulbar Sx
(dysphagia, dysarthria) + Hyperreflexia
**UMN Damage**
83
Fasciculations
**LMN Damage**
84
Major cause of morbidity/mortality post-SAH
(first 24 hrs)
**Rebleeding**
(prevented w/ endovascular coiling or repair)
85
Major cause of delayed morbidity/mortality post-SAH (3-10d)
**Vasospasm**
| (prevented w/ nimodipine)
86
Flat & Broad T waves
**Hypokalemia**
* + U waves
* + PVCs
87
Holocranial HA + Vision ∆s + Pulsatile tinnitus
**IIH**
(Pseudotumor Cerebri)
* Young obese women
* Isotretinoin
* Tetracyclines, GH, or Excessive VitA
88
Lateral medullary syndrome. Artery?
**PICA**
(**P**osterior **I**nferior **C**erebellar **A**rtery occlusion)
* Loss of pain/temp (ipsi face, contra body)
89
Contralateral sensory loss w/o hemiparesis or motor loss. Lesion?
**Thalamus**
| (Lacunar Stroke from PCA branches)
90
Pure sensory stroke
**Thalamus**
**(**Lacunar stroke)
91
Allodynia or severe paroxysmal burning pain following stroke
**Thalamic pain syndrome**
| (Thalamic/Lacunar stroke)
92
14-3-3 Protein in CSF
**Creutzfeldt-Jakob Disease**
| (prion disease)
93
VDRL in CSF
**Neurosyphilis**
(paralysis, dementia, personality ∆s, tabes dorsalis)
94
Tabes dorsalis
**Neurosyphilis myopathy**
(gradual degeneration of nerves normally in the posterior column of spinal cord)
* **D**orsal column degeneration
* **O**rthopedic pain (Charcot joints)
* **R**eflexes decreased (DTRs)
* **S**hooting pain
* **A**rgyll-Robertson Pupils
* **L**ocomotor ataxia
* **I**mpaired Proprioception
* **S**yphilis
95
Women age 15-50 + pronator drift
**MS**
* Ataxia
* Diplopia
* Vertigo
96
Chemotherapy-Induced Peripheral Neuropathy
* Vincristine
* Cisplatin/Carboplatin
* Paclitaxel (Taxanes)
* Involves stocking glove pattern paresthesias, loss of ankle jerk reflexes, & loss of pain/temp sensation
97
Trigeminal Neuralgia Tx
**Carbamazepine**
98
Slow broad-based shuffling gait + urinary incontinence + dementia
**NPH**
| (decreased CSF absorption)
99
Posterior inferior frontal gyrus
**Broca’s area**
100
Acute painless vision loss + Retinal whitening + Cherry red macula
**CRAO**
(**Central Retinal Artery Occlusion**)
* Tx: Ocular massage, anterior chamber paracentesis, or revascularization
101
Acute painless vision loss + “Blood & Thunder” or Cotton wool spots
**Central Retinal Vein Occlusion**
102
BL Trigeminal Neuralgia
**MS**
103
Neurologic deficits disseminated in space and time
**MS**
| (women 15-50)
104
Damage to MLF
| (medial longitudinal fasciculus)
**MS**
(Internuclear ophthalmoplegia - Inability to adduct when looking to side)
105
Multifocal ovoid subcortical hypo-/hyperintense WM CNS lesions on MRI
**MS**
106
Oligoclonal IgG bands on LP
**MS**
107
Symptoms worsen with high temperatures
**MS**
108
Most patients with AChR antibodies (MG) have ____ abnormalities
**Thymus**
| (Thymoma, Thymic hyperplasia)
109
MG pts get a CT chest to evaluate for
**Thymic abnormalities, as thymectomy can result in long-term dz remission**
110
Decreased presynaptic ACh release
**Botulism**
111
Descending flaccid paralysis
**Botulism**
| (preceded by GI prodrome)
112
Inflammatory demyelination of CNS axons
**MS**
113
Migraine PPX:
* **Topiramate**
* **Divalproex sodium**
* **Tricyclic antidepressants**
* **Beta Blockers (Propranolol)**
114
Migraine Abortive agents
* **Triptans**
* **NSAIDs**
* **Acetaminophen**
* **Antiemetics (Metoclopramide, Prochlorperazine)**
* **Ergots (DHE)**
115
SIG E CAPS
**S**leep
**I**nterest (loss)
**G**uilt (worthlessness)
**E**nergy (lack of)
**C**ognition/Concentration (reduced)
**A**ppetite (wt loss)
**P**sychomotor (agitation/anxiety, lethargy)
**S**uicide (preoccupation)
116
Do not use ____ in Lewy Body Dementia
**Typical Antipsychotics**
(due to neuroleptic hypersensitivity —\> Severe parkinsonism may result)
117
Early insidious short-term memory loss, language deficits & spatial disorientation, later personality changes
**Alzheimer disease**
118
Stepwise decline, early executive dysfunction, cerebral infarction &/or deep WM changes on neuroimaging
**Vascular Dementia**
119
Early personality changes, apathy/disinhibition/compulsive behavior, localized atrophy on neuroimaging
**Frontotemporal dementia**
(Pick disease; presents w/ frontotemporal atrophy)
120
Visual hallucinations, spontaneous parkinsonism, fluctuating cognition
**Lewy Body Dementia**
121
Ataxia (early), Urinary incontinence, Dilated ventricles on neuroimaging
**NPH**
| (Normal-Pressure Hydrocephalus)
122
Rapidly progressive dementia accompanied by behavioral changes, myoclonus &/or seizures
**Prion Disease**
123
HA, AMS, Sz, FND + OCPs or malignancy
**Cerebral Venous Thrombosis**
* Order MRI brain w/ venography (CT not sensitive)
124
Biconvex bleed on CT
**Epidural hematoma**
125
Concave bleed on CT
**Subdural hematoma**
| (tearing of bridging veins)
126
Spontaneous deep intracerebral hemorrhage is typically caused by
**Hypertensive Vasculopathy**
* Basal Ganglia (putamen)
* Cerebellar Nuclei
* Thalamus
* Pons
127
PICA or Vertebral Artery infarction
**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
Branch occlusion of vertebral artery or ASA (anterior spinal artery)
**Medial Medullary Syndrome**
* Alternating Hypoglossal Hemiplegia
* Contralateral arm & leg paralysis
* Tongue deviation toward the lesion
129
Restless Leg Syndrome Tx
* **Dopamine agonists (Pramipexole, Ropirinole)**
* **Alpha-2-delta Calcium Channel Ligands (Gabapentin)**
* **Iron in iron-deficiency**
130
Confusion + Nystagmus + Ataxia
**Wernicke Encephalopathy**
(Thiamine [B1] deficiency)
* Tx: IV Thiamine
131
Anemia + Impaired vibratory & positional sense + Ataxia
**B12 Deficiency**
132
AMS, Sz, fever, HA
**Herpes Simplex Encephalitis**
133
Refeeding Syndrome
* **Hypophosphatemia**
* **Volume overload**
134
Avoid doing this in pts with suspected
?????
135
Donepezil
**Cholinesterase inhibitor used to treat Alzheimer disease**
136
Multiple Sclerosis acute exacerbation Tx
**IV Corticosteroids** (**methylprednisolone)**
* 2nd line: Plasma Exchange
137
Guillain-Barre Syndrome Tx
* **IVIG**
* **Plasmapheresis**
138
Tx for ALS
**Riluzole**
(Glutamate inhibitor)
* May prolong survival and time to tracheostomy
139
Hyperreflexia, spasticity
**UMN lesion**
140
Early loss in visuospatial and anterograde memory formation
**Alzheimer’s**
141
Early hallucinations, EPS Sx
**Lewy body dementia**
142
Stepwise cognitive deterioration + vascular disease risk factors
**Multi-infarct dementia**
143
Ipsilateral hemiataxia occurs in spontaneous ____ hemorrhage
**Cerebellar**
(pt with poorly controlled HTN)
* +occipital HA
* +neck stiffness
* +N/V
* +nystagmus
144
Neurological disease of the Caudate & Putamen
**Huntington’s Disease**
145
35-44yo w/ choreathetoid movements, behavioral disturbances, dementia
**Huntington’s Disease**
146
Insidious onset of HA, memory deficits, balance problems, aphasia, or motor deficits
**Chronic subdural hematoma**
147
Memory changes or other dementia symptoms in elderly depressed patient
**Pseudodementia**
148
Dementia + posterior spinal column deficits
**B12 deficiency**
149
Dementia, urinary incontinence, abnormal gait
**NPH**
| (Normal Pressure Hydrocephalus)
150
Confusion, ataxia, ophthalmoplegia
**Thiamine deficiency**
(Wernicke encephalopathy)
* +confabulation, +amnesia —\> Korsakoff’s
* Common in alcoholics
151
Memory changes + hoarseness
**Hypothyroidism**
152
Basal ganglia lesion
**Parkinson Disease**
153
Occipital HA, neck stiffness, N/V, nystagmus, hemiataxia
Spontaneous Cerebellar Hemorrhage
154
Parkinsonism (BPRT) + orthostatic hypotension, impotence, incontinence (autonomic sx)
**Multiple System Atrophy**
| (Shy-Drager Syndrome)
155
* Difficulty climbing stairs or blow-drying hair
* Ocular Sx (diplopia, ptosis)
* Bulbar Sx (dysphagia, dysarthria)
**MG**
* Anti-ACh Receptor antibodies
* Proximal muscle weakness, ocular sx, bulbar sx
* ETT, PEX/IVIG, & Corticosteroids if myasthetic crisis (MG respiratory failure)
156
Beta-amyloid deposition in small-medium cerebral artery vessel walls, predisposing to rupture (spontaneous lobar hemorrhage)
**Cerebral amyloid angiopathy**
| (seen in Alzheimer Disease)
157
Most common cause of intracranial hemorrhage in children
Arteriovenous malformation (AVM) rupture
158
Most common cause of spontaneous lobar hemorrhage in adults
**Cerebral Amyloid Angiopathy**
(beta-amyloid deposition in small-medium arterial walls seen in Alzheimer disease)
159
Acute onset severe memory impairment 2/2 vitamin B1 (thiamine) deficiency (often in alcoholism)
**Korsakoff Syndrome**
(early phase thiamine deficiency)
* *Wernicke Encephalopathy = late phase thiamine deficiency (_AMS_, _vision ∆s_, _ataxia_)*
160
Central scotoma, afferent pupillary defect, changes in color perception, & decreased visual acuity
**Optic neuritis**
* Often autoimmune
* Can be early MS
161
Increased cup:disc ratio on fundoscopy
**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 (**G**H, **T**CAs, 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
Cherry red fovea, cloudy retina
CRAO
(Central Retinal Artery Occlusion)
* W/u for embolic source
* Tx: Ocular massage & high flow O2 (for acute presentation)
163
Paradoxical afferent pupillary defect on swinging light test
**Optic neuritis**
(Marcus Gunn pupil)
* +decreased visual acuity
* +∆ in color perception
* +central scotoma
* +Marcus Gunn pupils
* Think early MS
