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MS3 > Neurology > Flashcards

Neurology Flashcards

1
Q

cauda equina syndrome vs conus medullaris syndrome

A

CES: spinal roots, more radicular pain, late onset fecal and urinary incontinence, arreflexia
CMS: early onset fecal/urinary incontinency, hyperreflexia- mix of LMN and UMN

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2
Q

heat stroke symptoms

A

temp over 104
CNS dysfunction
rhabdo, renal failure, resp failure, DIC

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3
Q

non traumatic SAH is most commonly due to

A

ruptured berry aneurysm

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4
Q

most common cause of IC hemorrhage in children

A

cerebral AV malformation

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5
Q

another word for vasovagal syncope

A

neurocardiogenic syncope

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6
Q

what is hypertensive vasculopathy

A

charcot bouchard aneurysm due to high BPs can cause deep intracerebral hemorrhage like putaminal or lenticular hemorrhage

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7
Q

bilateral trigeminal neuralgia caused by

A

MS

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8
Q

what the thresholf for hyperglycemic hyperketotic state

A

blood sugar >600

more commonly >1000

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9
Q

sphenoid bone fracture will cause what kind of brain bleed

A

acute EPIdural hematoma

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10
Q

Spinal Epidural Abscess

A
  • signs: back pain, fever, neurological symptoms (you may see distended bladder)
    spreads hematologically from staph infection.
    need MRI of spine to diagnose
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11
Q

spinal cord compression symptoms

A

focal back pain

early: hyporeflexia of LE, symmetric LE weakness
late: hyper-reflexia, Babinski, paralysis

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12
Q

Uhthoff syndrome?

A

worsening MS in warm temp

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13
Q

acute headache, nausea, blurry vision, sluggish and dilated pupil

A

angle closure glaucoma

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14
Q

what meds cause acute angle closure glaucoma

A

decongestants, antiemetics, anticholinergics

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15
Q

essential tremor

A

tremor with intention motion

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16
Q

migraine medical treatment

A

acute: sumitriptan and NSAIDs
prophylactic: Amitryptiline, B blocker, topimirate

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17
Q

dopamine pathways

A
  1. nigrostriatal- movement disorders
  2. mesolimbic- psychotic disorders like hallucinations or euphoria
  3. tuberoinfundibular- prolactin
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18
Q

HSV encephalitis CSF findings

A
  • lymphocytic pleocytosis
  • RBC due to temporal lobe hemorrhage
  • normal opening pressure, normal glucose
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19
Q

CSF OP > 250 but otherwise normal CSF

A

pseudotumor cerebri aka idiopathic intracranial htt

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20
Q

IIH/pseudotumor cerebri medication causes

A

Growth Hormone, tetracyclines, hypervitamin A (isoretinoin)

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21
Q

ischemic CN III palsy vs compression CN III palsy

A

inner somatic n
superficial parasympathetic
ischemic will affect inner n’s first and spare the pupils
whereas compression will affect both EOM and pupils

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22
Q

what is paradoxical agitation?

A

benzodiazepines can cause agression and agitation in the elderly (1%)

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23
Q

whats the mechanism by which low CO2 can cause decreased ICP

A

low CO2 causes cerebral vasoconstriction which decreases CBF

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24
Q

what are headache warning signs that would req early imaging

A
  1. new characteristics, is this diff from previous headaches
  2. onset >40 yo
  3. onset trauma
  4. present at awakening
  5. neurologic findings/defecits
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25
Q

what is the Wernicke Encephalopathy triad

A

gait ataxia, ocular dysfunction, and encephalopathy

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26
Q

what are amitrityline side effects?

A

anticholinergic - dry mouth
histamine- sleepiness
alpha agonist- ortho static hypotension

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27
Q

EBV DNA in CSF is specific for ?

A

primary CNS lymphoma

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28
Q

how do you treat severe cancer pain

A

short acting opioid

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29
Q

what are the treatment options for schitzophrenia suspected?

A

if pt is agreeable, do oral not IV or IM longacting!
there is no different btw the antipsychotics except for clozapine, which has severe agranulocytosis and should be saved for pts unreponsive to 1st line tx

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30
Q

fasciculations are 1. upper? 2. lower? motor neuron findings?

A

fasciculations indicate LMN damage

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31
Q

where is Broca’s area

A

Dominant Frontal Lobe

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32
Q

what is wallenberg syndrome

A

it is a lateral medullary infarct
can cause ipsilateral face and contralateral body loss of pain and temp
ipsilateral Horner’s and bulbar symptoms
vestibulocerebellar impairment.

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33
Q

what is subclavian steal?

A

when the subclavian A is stenosed and steals reverse blood flow from vertebral A.
symptoms include asymettrical BPs in UE, dizziness with exercise of UEs, and parasthesia in UE

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34
Q

how to manage acute MS flare

A

GC, 2nd line plasmapheresis

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35
Q

where is the lesion causing hemineglect

A

R (non dom) parietal lobe

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36
Q

for what kind of stroke would you order a contrast vs noncontrast CT?

A

hemorrhagic- non contrast

ischemic- contrast

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37
Q

cavernous sinus thrombosis

A

infection from face affects cavernous sinus and causes ICH. CN III , IV, and VI are affected.

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38
Q

most common cause of spontaneous (non traumatic) lobar hemorrhage in >60 yo

A

amyloid angiopathy

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39
Q

most likely AE of status epilepticus

A

cortical necrosis

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40
Q

drop arm test- what is it? whats it sensitive for?

A

passively raise pt’s arm over head, and have them bring it back down. if they suddenly drop the arm and are unable to lower it in a controlled fashion it is indicative of a supraspinatous injury.

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41
Q

GBS treatment

A

supportive care
IVIG
plasmapheresis

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42
Q

what would hypokalemia present as in clinic?

what about on EKG?

A

in clinic: muscle weakness, cramping, and decreased DTR

U waves, flattening of T wave, PVCs,

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43
Q

syringomyelia clinical findings?

A

muscle wasting, motor weakness, loss of pain and temperature in arms and hands/ or capelike distribution
-dorsal columns spared

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44
Q

who would benefit from carotid endartectomy?

A
  • symptomatic- has had TIA
  • WITH carotid occlusion of 70-99%

without both of these pts can do anti-platelets and statin therapy

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45
Q

steppage gait is caused by?

A

L5 radiculopathy or common peroneal neuropathy

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46
Q

following a subarachnoid hemorrhage whats a risk in the first day? whats a risk after 3 days?

A
  • rebleed within 24 hr

- cerebral vasospasm

47
Q

alcoholic cerebellar degeneration

A

> 10 yrs alcoholism causes toxic injury to purkinje cells in cerebellar vermis, leading to problems with gait/falls in the setting of a normal sensory exam.

48
Q

Pick’s disease

A

behavioral variant of Frontaltemporal dementia. 1. behavior changes 2. hoarding/compulsivity 3. executive function/memory

49
Q

how to treat delirium?

A

Haloperidol

50
Q

SCC vs cauda equina vs conus medullaris

A

a sensory level excludres CES
conus has back pain, urinary incontinence but is less likely to have sensory involvement or weakness
SCC has a clear sensory level with sensory loss and incontinence and weakness

51
Q

asymmetric ascending paralysis over the course of hours

A

tick toxin release

52
Q

MRI of Alzheimer’s

A

temporal and parietal atrophy

expecially hippocampi

53
Q

what is the theory for NPH pathophysiology?

A

decrease of CSF absorption or some form of obstruction causes a a transient increase in pressure, but the ventricles increase in size and pressure normalizes

54
Q

central cord syndrome vs anterior cord syndrome

A

central- usually following whiplash, causes decreased sensory and motor in arms and spares the legs
anterior- trauma injury to ASA, loss of motor and sensory of pain/temp

55
Q

CT showing minute punctate hemorrhages and blurring of grey and white interface

A

diffuse axonal injury

56
Q

Riluzole

A

glutamate inhibitor approved for ALS. can prolong life span and time to trach

57
Q

intracranial hypertension

A

headache worse at night, nausea/vom, focal changes ex- vision

58
Q

lumbar spinal stenosis prov/palliation

A

prov- extension ex: standing or walking downhill

pall- flexsion, ex- sitting or walking uphill

59
Q

acute dementia and sharp triphasic on EEG is?

A

CJD

60
Q

thalamic pain syndrome

A

paroxysmal burning pain esp sensitive to light touch

61
Q

cluster headache treatment? prophylaxis?

A

tx- 100% O2, IM Sumitriptan

ppx- Lithium, Ca ch blocker

62
Q

botulinum treatment

A

equine antitoxin therapy

63
Q

TPA window

A

3-4.5 hr

64
Q

Livedo Reticularis

A

a mottled skin appearance

an AE of amantidine

65
Q

anterior shoulder dislocation

A

causes injury to axillary n

happens when force applied to ex rot, abducted shoulder.

66
Q

Parkinsonian gait

A

narrow based, shuffling, fenistrating, hypokinetic, no movement of arms

67
Q

Brown Sequard symptoms

A

ipsilateral hemiparesis, loss of proprioception and light touch at LEVEL of injury and below
contralat loss of pain and temp 1-2 BELOW LEVEL of injury

68
Q

what does MRI of brain mets look like?

A

multiple circumscribed lesion at gray and white matter junction with surround edema

69
Q

treating a Myasthenia Crisis

A

HOLD the pyridostigmine

give plasmapheresis, or IVIG, with corticosteroid

70
Q

central cord syndrome

A

UE weakness that spares the lower extremities

caused by hyperextension in a pt with osteoarthritis

71
Q

whats the treatment for idiopathic intracranial hypertension?

A

acetalzolamide +/- furosemide

72
Q

how to work up amaurosis fugaux?

A

carotid doppler

73
Q

2 most common causes of brain abscess

A
  • strep viridans

- staph aureus

74
Q

IIH most serious consequence?

A

blindness

75
Q

extra axial well circumscribed meningeal mass?

A

meningioma

76
Q

how can you tell apart ACA from MCA infarct

A

ACA: LE> UE affected
MCA: face/UE> LE affected.

77
Q

pronator drift is sensitive for

A

pyramidal/corticospinal tract lesion

78
Q

Neuroleptic Malignant syndrome

A
  • fever
  • rigidity
  • autonomic dysfunction
  • mental status change
79
Q

Lewy Body Dementia

A

cognitive disturbance
Parkinsonism
visual hallucination

80
Q

Multiple Systems Atrophy (shy drager syndrome)

A

Parkinsonism, orthostatic hypotension, autonomic dysfunction

81
Q

corneal vesicles and dendritic ulcers

A

HSV keratitis

82
Q

how to manage sunconjunctival hemorrhage?

A
  • just observe for 48 hr, it should self resolve

usually benign and due to simple trauma

83
Q

how to manage conjunctivitis?

A

simple viral- use cold compress

bacterial superinfection- give antibiotics, this will be more purulent

84
Q

“curtain coming down over my eye” with preceding floaters

A

retinal detachment will show gray retina with tears

85
Q

closed angle vs open angle glaucoma

A

closed angle is acutely painful eye, headache, and mid-dilated NR pupil
open angle is slower with a gradual loss of vision, seen in AA esp with diabetes and glaucoma hx.

86
Q

acute angle glaucoma diagnosis

A

goniometry is ophtho available

tonometry in emergency

87
Q

sudden loss of vision, floaters, can’t visualize fundus, red glow

A

vitreous hemorrhage most often due to diabetic retinopathy

88
Q

dacrocystitis

A

infection of lacrimal duct. redness and pain over medial canthal region. purulent discharge sometimes

89
Q

contact lens wearer gets corneal ulceration and injection of sclera, painful.

A

contact keratitis usually caused by pseudomonas or serratia

90
Q

CMV retinitis vs HIV retinitis vs toxo chorioretinitis

A

CMV- yellow and fluffy with hemorrhages around vasculature
HIV- cotton wool, without hemorrhage, around vasculature
toxo- not around vasc

91
Q

whats sympathetic ophthalmia

A

it is the “spared eye injury”. when one eye is injured and loses sight the other eye experiences disturbances due to an immune mediated reaction from the exposure of “hidden agents”

92
Q

anterior uveitis

A

red painful eye, decreased visual acuity, hazy aqueous humor, pupillary constriction
assn with IBD, Sarcoid etc.

93
Q

vertical lines in visual grid test seen as wavy and blurred is found in

A

macular degeneration

94
Q

sudden painless loss of vision is most likely? treatment?

A

CRAO

give ocular massage to dislodge thrombus into a more distant branch of eye, and high flow O2.

95
Q

what does CRVO look like on fundoscopy

A

blood and thunder

hemorrhage, dilated tortous veins, cotton wool spots

96
Q

what does the visual fields of macular degeneration look like

A

central vision lost, with peripheral and navigational vision intact

97
Q

retinal necrosis in HIV+ pt is caused by

A

HSV

98
Q

what are the fetal hydrantoin features

A
  • caused by use of AEDs in pregnancy

- midfacial hypoplasia, microcephaly, cleft palate/lip, hirsutism, developmental delay, hirsutism

99
Q

homocystinuria

A

fair and marfanoid with hyperelasticity, thrombosis is common so watch out for stroke
give B6, folate, and antiplatelet agents

100
Q

heat stroke complications

A

DIC (bleeding)
rhabdo
ARDS
renal failure

101
Q

cherry red spot seen in blindness?

A

CRAO

102
Q

how to reverse warfarin

A

vit K (can take a day)
prothrombin complex
FFP ( not preferred bc it takes time to prepare and infuse)

103
Q

glactosemia

A

a def in galactose 1P uridyl transferase

cataracts, vomitting, jaundice, MR etc.

104
Q

how is galactosemia diff from a galactokinase def or a UDP galactose 4 epimerase def

A

galactokinase- purely cataracts

UDP galactose 4 epimerase def- all of galactosemia + HYPOTONIA and sensorineural DEAFNESS

105
Q

most common cause of spontaneous lobar hemorrhage in >60 yo

A

amyloid angiopathy, causes weakening of the vessels make a rupture and bleed out more likely. Esp common in alzheimers

106
Q

CONUS vs CAUDA

A

CONUS- peri anal numbness, hyper-reflexia, early onset incontinence
CAUDA- saddle anesthesia, hyporeflexia , late onset incontinence

107
Q

how to differentiate vascular dementia and alzheimer’s

A

alzheimer’s has early onset memory loss, but vasc has early onset executive function losses.

108
Q

commando crawl baby with equinovarus deformity of lower extremities has what?

A

CP

109
Q

shy drager syndrome

A

parkisonism + autonomic instability (post hypo, ED) + neuro signs

110
Q

Myotonic Dystrophy genetics

A

AD

111
Q

Myotonic Dystrophy features

A 
myotonia (slow to release grip)
dysphagia
weak face 
catarcts
frontal balding
small testis 
cardiac conduction
112
Q

glucocorticoid induced myopathy has what lab findings?

A

normal ESR and CK

113
Q

carotid endartectomy indication

A

> 70% stenosis with symptoms

114
Q

NPH caused by ?

A

decreased CSF absorption

MS3 (6 decks)

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