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PANRE > Neurology > Flashcards

Neurology Flashcards

1
Q

what are symptoms or Lower motor neuron disease?

A

wasting, weakness, hypotonia, loss of reflexes, fascinations, changes to hair and skin.

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2
Q

What does asterixis indicate?

A

metabolic encephalitis or disease of thalamus.

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3
Q

what are symptoms consistent with Upper Motor Nueron lesions?

A

flaccid, loss of reflexes increase tone/spascity, clonus + babinski

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4
Q

List 6 medications that can be used for migraine prophylaxis

A

beta blockers, tricyclics, calcium channel blockers, NSAIDs, and valproic acid

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5
Q

A patient present with what appears to be an inability to understand speech Which aphasia should be at the top of your differential

A

Wernicke’s aphasia

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6
Q

A patient presents with facial paresis, arm drift and abnormal speech pattern. What are the first 3 tests to order?

A

Thinking it is a stroke - Noncontrast CT of the brain or MRI, serum glucose and Oxygen saturation.

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7
Q

A patient is brought in following a seizure in which she did not lose consciousness. What is the most likely diagnosis?

A

Simple partial seizure.

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8
Q

A patient is having a stroke and there is no evidence of hemorrhage. What is the first line medical treatment?

A

If its in the first 4 hours and no contraindications - Thrombolytics should be given.

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9
Q

A patient presents with a painful ipsilateral third nerve palsy. What is the most likely diagnosis?

A

Posterior comminicating artery aneyrysm.

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10
Q

What seizure medication can given the overgrowth of gums (gingival hyperplasia)

A

Phenytoin

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11
Q

A sudden thunder clap headache should make you think of what diagnosis?

A

subarachnoid hemorrhage

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12
Q

Describe KErnig’s sign

A

patient lies supine. flex the hip while keeping the same knee strain. If it elicits back pain, test is positive.

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13
Q

Imaging is negative for blood, but you strongly believe there is a subarachnoid hemorrhage. What test can you order that will be definitive?

A

Lumbar puncture.

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14
Q

What percentage of strokes are ischemic? What percentage are hemorrhagic?

A

80% ischemic 20% hemorrhagic

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15
Q

You believe that a patient has had a stroke. He presents with aphasia, loss of hearing in one ear and loss of vision in the left eye. IS the blockage in the anterior or posterior circulation?

A

Anterior circulation

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16
Q

Under what conditions would aspirin or clopidogrel be used following a TIA as prophylaxis?

A

These are antiplatlet medications. They would be used unless there is a known cardiac etiology for the embolism. Patient with a cardia cause should use heparin or Coumadin.

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17
Q

A patient who is asymptomatic should consider having an endarterectomy at what percent blockage of the carotid after? what about a symptomatic patient?

A

70% in asymptomatic, and greater than 60% in a symptomatic patient.

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18
Q

A patient presents complaining of the worst headache of her life.What might you be expecting their blood pressure to be?

A

This is typically the description of a subarachonoid hemorrhage. You would expect the blood pressure to be elevated.

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19
Q

Name one abortive drug for migraines

A

sumitriptan, zolmitriptan, ergotamine.

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20
Q

An EEG showing focal rhythmic discharges at the onset of the seizure should make you think of what diagnosis

A

Simple partial seizure

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21
Q

What is the single most important thing to be concerned about in a patient in status epilepticus?

A

Airway, airway airway, followed by management of hyperthermia.

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22
Q

Describe Brudzinski’s sign.

A

When you lift a patient’s head, the patient automatically flexes at the hips. Found in patients with meningitis.

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23
Q

A patient presents with a lateralized throbbing headache. She is also complaining of nausea, vomiting and photophobia What type of headache is this likely?

A

Migraine.

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24
Q

MIDDLE AGE MAN PRESENTS with a unilateral periorbital headaches that have been occurring daily for several weeks. Therese headaches are extremely painful. Which type of headache is this?

A

Cluster headache

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25
Q

List 3 drugs for treatment of cluster headaches.

A

Oxygen, sumatriptan, stadol

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26
Q

s 34 yo presents with symptoms which are replacing and remitting over the past few weeks.These include visual problems and weakness in her right arm. What is the most likely diagnosis?

A

Multiple sclerosis

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27
Q

A patient has a tremor with motion in his hands. What medication do you prescribe?

A

This is an active tremor. A beta blocker likel proplanolol is a good start.

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28
Q

A shuffling gait should make you think of what diagnosis?

A

Parkinson’s disease

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29
Q

Give 2 classes of drug therapy for treating Parkinson’s

A

Dopaminergic (levodopa) and anticholenergics are second line

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30
Q

Decrease GABA and substance P should make you think of what diagnosis?

A

Huntington’s

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31
Q

Is Huntington’s autosomal dominant or recessive?

A

Dominant

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32
Q

A patient presents with weakness that he has felt in him lower legs and now feels in his knees and hips bilaterally. he has decreased deep tendon reflexes. This has been getting progressively worse. What is the most likely diagnosis?

A

Gullain - Barre

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33
Q

Name 3 medications used to break a seizure?

A

Diazepam, lorazepam, phenytoin or fosphenytoin.

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34
Q

There is an MRI result of multiple foci of demylination in the white matter. What is the most likely diagnosis?

A

Mutliple sclerosis

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35
Q

A patient presents following a seizure. Just before the seizure she recalls seeing flashing lights all around her. What type of seizure should be at the top of you diagnosis tree?

A

complex partial

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36
Q

List 3 medications ued to “treat” multiple sclerosis

A

Steroids, interferon beta, copolymer 1

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37
Q

What is the most common type of dementia?

A

Alzheimer’s, may be as hight as 80%

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38
Q

A study result comes back with intracellular neurofibrillary tangles and extracellular neuritic plaques. what is the most likely diagnosis?

A

Alzheimer’s

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39
Q

What 4 chromosomes have been linked to dementia?

A

1, 14, 19,21

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40
Q

is the ankle jerk reflex of lumbar or sacral origin?

A

sacral

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41
Q

A patient complains of an aching headache which feels like a band around his head. What is the most likely diagnosis?

A

tension headache.

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42
Q

A patient presents to our office complaining of a tremor in his right hand. He states that after a beer it completely goes away. what is the most likely diagnosis?

A

Benign essential tremor - or familiar tremor.

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43
Q

List 2 medications you would use to treat an essential tremor.

A

beta blocker (propanololo) and primidone.

44
Q

AT what age do symptoms of Huntingon’s disease appear?

A

Around 30 yo

45
Q

A 35 yo patient comes to your office because is wife made him. She has noticed that he has been increasingly moody and irritable as well as very restless. You order a CT scan that shows cerebral atrophy as well as atrophy of the caudate nucleus. What is the most likely diagnosis?

A

Huntington’s disease.

46
Q

What is the medication sod choice for a patient with Tourette’s syndrome?

A

Haloperidol

47
Q

A slit lam shows Kayser-Fleischer rings. What is the most likely diagnosis?

A

Wilson’s disease.

48
Q

Wilson’s disease is associated with the build up of which mineral?

A

here is a efficiency of the copper binding protein and therefore a build up of copper.

49
Q

What are the genitive characteristics of Wilson’s disease?

A

Autosomonal recesive , Chromosone 13

50
Q

What cranial nerve is affected in Bell’s palsy?

A

CN VII - the facial nerve.

51
Q

A lumbar puncture for a patient with bacterial meningitis will show elevated or decreased WBCs? Glucose? Protein?

A

Elevated WBCs, decreased glucose and elevated protein

52
Q

What symptom is associated with a classic migraine?

A

an aura.

53
Q

Elevated circulating acetycholine receptor antibiotics should ou make your this of what diagnosis?

A

Myasthenia gravis

54
Q

Duchenne’s and Beckers’ muscular dystrophy have what genetic characteristic?

A

X- linked recessive.

55
Q

What is the age range of for Duchenne’s muscular dystrophy?

A

3-5 years old.

56
Q

And EEG showing generalized spikes and associated slow waves should make you think of what diagnosis?

A

Generalized or abscess seizure

57
Q

What is the most common primary intracranial neoplasm?

A

Glioma

58
Q

What is the most common fuse of subarachnoid hemorrhage aside from trauma?

A

Ruptured cerebral aneryssm

59
Q

What are the most common primary cancers sites that

A

Lung Breast and kindney

60
Q

A RESTING OR PILL ROLLING TREMOR SHOULD MAKE YOU THINK OF WHICH DIAGNOSIS?

A

Parkinson disease

61
Q

Weakness and numbness in the left hand may be a blockage in which carotid artery?

A

right

62
Q

A patient has an intracranial neoplasm causing auditory illusions, olfactory hallucinations and emotional changes. Which lobe is the lesion most likely in?

A

Temporal

63
Q

If you are looking for lesions associated with multiple sclerosis and you order an MRI do you order with gadolinium or without?

A

with gadolinium

64
Q

What is the defining symptoms of Alzheimers

A

Progressive memory impairment

65
Q

Which nerve root is responsible for the knee jerk relent?

A

L3-L4

66
Q

An EEG showing interictal spikes should make you think of what diagnosis?

A

Complex partial seizure

67
Q

Which is the most commonly herniated vertebral disc?L4-L5

A

L4-L5 and L5-S1

68
Q

What 3 symptoms are classic for a normal pressure hydrocephalus.

A

Gait disturbance, dementia, and uringary incontinence.

69
Q

A patiente presents with inability to speak and a right sided weakness. HE seems to be able to understand speech and follows commands well. What type of aphasia should you be thinking?

A

Broca’s aphasia

70
Q

Alcohol may be a major factor in which encephalopathy?

A

Wernicke’s

71
Q

A patient complains of muscle weakness and fatigababilty that improved with rest. What is the most likely diagnosis?

A

Myasthenia gravis

72
Q

A lead pip or cog wheeling rigidity should make you think of what diagnosis?

A

Parkinson disease

73
Q

What is the treatment for RSD (complex regional pain syndrome)?

A

NSAIDs, Cortisone, gabapentin, amitryptyline, regional block, vit C

74
Q

Changes on xray in RSD

A

Early - Increase bone scan

Late osteopenia

75
Q

What is the primary diagnostic test for peripheral neuropathy?

A

NCV-EMG

Labs - HGBA1c, B6, RPR, TSH

76
Q

Symptoms of diabetic neuorpathy

A

Pain/burning, Changes to vibration sense, erectile dysfunction, stocking glove distribution

77
Q

What is abortive therapy for cluster headaches?

A

100% O2, Tryptans

78
Q

Prophylactic treatment for Cluster headaches?

A

Verapamil

79
Q

Name some migraine triggers

A

stress, food, (chocolate/etoh), tells, bright lights, menstruation

80
Q

Tyrptan usage is contraindicated in what disease states?

A

Pregnancy and CVD/PVD

81
Q

When would you consider prophylactic treatment for migraines?

A

2-3 migraines/week

Propanolol, verapamil, TCAs/ gabapentin, botox injections

82
Q

What is encephalitis?

A

infection/inflammation of the parachyma of the brain

83
Q

Causative agents in encephaitis

A

Viral/amoebic/fungal

If immunocompromised - Zoster/CMV/EBV

84
Q

You look at lumbar puncture of a suspected encephalitis - what would you expect t to find?

A

Elevated opening pressure, increase protein, normal glucose, increased lymphocytes

85
Q

What are predisposing conditions for meningitis in children? adults?

A

Children - OM

Adults - pneumonia

86
Q

What are the causative. bugs of meningitis in kids/adultus/college/pregnant women

A

Kids - h flu
adults - strep pneumo
college - N. menigitis
Pregnant - Listeria monocytogenes

87
Q

what is the empiric treatment for meningitis?

A

Strep pneumo - PCN/Vanco
N Menig - PenG/amp +3rd gen cephalosporins
h flu - 3rd gen Ceph/ cefoxin
Listeria - Amp + 3rd gen ceph

88
Q

What medication is used if there is increased intracranial pressure due to meningitis?

A

Mannitol

89
Q

What are the causative agents in viral meningitis?

A

60% enterovirus/ then coxackie/echovirus

90
Q

What are the signs/symptoms of Huntington’s chorea?

A

Chorea/dementia/behavioral changes

91
Q

What chromosome is altered in Huntington’s?

A

Chromosome 4 - it its an example of Mendelian mutation

92
Q

What are absolute contraindications for tPA administration?

A 
BP > 185/110
Major surgery last 2 weeks
known GI bleed
H/O intracranial hemorrhage
Recent anticoagulation in the past 24 hours
93
Q

What is the most common area of cerebral ischemia/stroke

A

Middle cerebral artery

94
Q

What are the deficits found in MCA stroke?

A

contralateral meniparesis, expressive aphasia, homonymous menaopsia

95
Q

What is the deficits in a ICA stroke

A

ipsilateral blindness

96
Q

What are the deficits in vertebral/ cerebella stroke

A

ataxia & syncope

97
Q

describe a stuporous state

A

transient arousal by vigorous stimuli

98
Q

Describe coma state

A

Unconsious, unresponive to extrenal events, reflexes/postural moves may remain

99
Q

vegetative state

A

wakefulness retained but unresponsive to self/environment

100
Q

treatment of coma - unknown causative agent

A

the coma cocktail- dextrose, naloxone, thiamine, flumazide

101
Q

Treatment for Guillain-Barre

A

Plasma phoresis, IVIG(gammaglobulin). respiratory support

102
Q

What are the lumbar puncture findings in Multiple sclerosis>

A

oligoclonal bands and myelin basic proteins

103
Q

What are the MRI findings in Multiple sclerosis?

A

multifocal white matter change, black holes - axonal damage, “Dawson’s tongs or fangs”

104
Q

In Tourette’s syndrome are phonetic tics more common that motor tics?

A

no

105
Q

Signs and symptoms for Tourette’s

A

age of onset < 21 years old
have motor/ phonetic tics > 1 year
likely presence of anxiety/OCD

106
Q

Treatment for Tourettes

A

Haldol
Cognitive behavior meds
clonidine

PANRE (12 decks)

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