Neurology Flashcards
1
Q
“Extrapyramidal symptom”: repetitive, abnormal, orofacial involuntary movements
A
Dyskinesia
2
Q
In initial workup for polyneuropathy, what is done?
A
Electrodiagnostic (nerve conduction and EMG) before labs. (use the results of 1st to order labs)
3
Q
PE test for Myasthenia Gravis
A
Ice test improves Sxs
4
Q
What causes PD?
What does that produce?
A
- Degeneration of Lewy Bodies.
- Lewy bodies produce Dompaine.
5
Q
Tx for Absence (Petit Mal) Seizure
A
EthoSUXimide
6
Q
What is the MIDBRAIN part of and what is its function?
A
- Brainstem
- Controls eye movements
- Relays visual and auditory info
7
Q
What is severely diminished with Alzheimer Disease (AD)?
A
Acetylcholine
8
Q
Dx for Alzheimer Disease (AD) and what does it show?
A
- CT
- Cerebral Cortex Atrophy
9
Q
PE finding in Guillain-Barre Syndrome
A
Loss DTR
10
Q
Dx for Syringomyelia
A
MRI
11
Q
1st line imaging to Dx Intracranial Hemorrhage
A
Non-contrast CT
12
Q
What does Cerebellum do?
A
- Maintains posture and balance
- Coordinates voluntary movement
13
Q
Brief LOC, blank stare, NO aura. Dx?
A
Absence (Petit Mal)
14
Q
Cerebral Palsy cause:
A
Brain injury near time of birth.
15
Q
Tx for Guillain-Barre Syndrome
A
- Plasmapheresis
- IVIG
16
Q
Dx for Myasthenia Gravis
A
- (+) Ach receptor Antibodies
2. Edrophonium (Tensilon) test
17
Q
TOC for Huntington Dz. and what does it show?
A
- CT
- Cerebral and Caudate nucleus atrophy.
18
Q
Tx for Tourette Syndrome
A
-Dopamine blockers: Pimozide, Halo, Risperidone
19
Q
Tx Restless Legs Syndrome
A
Dopamine agonist: Pramipexole, Ropinirole
20
Q
CSF: HIGH protein, normal WBC. Dx?
A
Guillain-Barre Syndrome
21
Q
Tx for Migraine and MOA
A
- Triptans or Ergos
- Serotonin 5HT-1 agonist → vasoconstrict
22
Q
Pt. presents with diplopia and muscle weakness WORSE AT NIGHT and better with rest. Dx?
A
Myasthenia Gravis
23
Q
Initial: 1) Behavioral (personality, intellect, psych) → 2) Chorea* 3) Dementia Dx?
A
Huntington Dz.
24
Q
Tx for Myasthenia Gravis
A
- Acetylcholin-Esterase Inhibitors: Pyridostigmine or Neostigmine
- Acute: Plasmapheresis or IVIG (rapid response). Mechanical ventilation.
25
Confirmatory Dx for Multiple Sclerosis and what does it show?
- MRI T2-weighted (Gadolinium)
| - White matter plaques (periventricular hyperdensities)
26
What does a LP show in Multiple Sclerosis?
- ↑ IgG (oligoclonal bands)
| - ↑ WBC (pleocytosis)
27
Tx for Multiple Sclerosis
- Acute: IV Steroids > Plasmapheresis (if no response to steroids)
- Progressive: INF-B
28
Pt. presents with sudden onset of a weak face and inability to lift right eyebrow. Dx?
Bell Palsy
29
Sustained contraction (spasm) leading to twisting of body and abnormal posturing.
Dystonia
30
Tx for Trigeminal Neuralgia
1st: Carbamazepine
2nd: Gabapentin
31
Tx for Cluster HA and Prophy
1st: Oxygen
2nd: Triptans
Prophy: Verapamil
32
HA that presents with congestion, lacrimation, conjunctivitis:
Cluster
33
TOC for suspected concussion:
CT
34
Sudden onset confused state d/t identifiable cause (infxn, med)
Delirium
35
Tx for Alzheimer Disease (AD)
1) Ach-Esterase inhibitors: Donepezil
| 2) NMDA Agonist: Memantine
36
What is seen on imagining for Glioblastomas?
Variable ring of enhancement surrounded by edema.
37
What is seen on imagining for Meningiomas?
Intensely enhancing, well-defined lesion often attached to the dura.
38
-Motor deficits: Lower ext. > upper*.
-Sensory deficit: pain, temp, light touch
+/- Bladder dyfxn
Dx?
Anterior Cord
39
Initial TOC TIA
Head CT
40
MC hemorrhage in elderly and alcoholics and what does CT show?
- Subdural
| - Concave (crescent-shaped)
41
CM: F/N/V/HA, chills → AMS, seizures.
(+) Kernig's
(+) Brudzinski's
Bacterial Meningitis
42
Cranial nerve function of voice, soft palate, gag reflex:
X (10) Vagus
43
1st: LOC → rigidity
2nd: repetitive jerking
3rd: coma/sleep
Dx?
Tonic-Clonic (Grand Mal)
44
Paresthesias of medial ankle down to foot arch involves ____ nerve.
Saphenous (L3-L4)
45
Which lobe of the brain controls hearing?
Temporal lobe
46
Teratogenic Antiepileptic drug:
Valproate
47
What is the next step with (--) CT but high suspicion of Subarachnoid Hemorrhage?
What does it show?
- LP
| - Xanthochromia
48
Sudden onset of uni neck pain or HA around eye or frontal area, can be d/t chiropractor manipulation. Dx?
Carotid Artery Dissection
49
Phenytoin SE of chronic use and what electrolyte d/o does it cause?
- Gingival hyperplasia
| - HypoCa+
50
CSF: HIGH protein, ↑ WBC, low Glucose, (+) PMN. Dx?
Bacterial Meningitis
51
Tx for Bacterial Meningitis >50 yo
Ceftriaxone + Vanco + Ampicillin (covers Listeria)
52
What BB is used to treat Essential (Familial) Tremor?
Propanolol ONLY
53
CN responsible for eye movements → LATERAL rectus muscle:
CN VI (6) Abducens
54
Sxs: sudden "worst HA ever", syncope, N/V. Dx?
Subarachnoid Hemorrhage
55
1st and 2nd MCC bacterial meningitis
1st: Strep pneumoniae
2nd: N. meningitidis
56
When is Subdural Hematoma considered CHRONIC?
After at least 3 wks
57
Subarachnoid Hemorrhage Tx
Nimodipine (decreases vasospasm)
58
Dystonic Reaction Tx
- Benztropine
| - Diphenhydramine
59
With open skull fracture, what Tx is necessary?
Abx
60
Caloric Testing: What does COWS stand for?
- Cold (water) Opposite
- Warm (water) Same
- Direction of nystagmus to see if patient really IS in a coma.
61
Dx for Subdural Hematoma
NON-contrast CT
62
Dx for Subdural Hematoma and Subarachnoid Hemorrhage
NON-contrast CT
63
MCC Guillain-Barre Syndrome
Campylobacter jejuni
64
MCC stroke <45yo
Carotid Artery Dissection
65
What time frame is ACUTE Subdural Hematoma?
≤ 3 days
66
CN responsible for head and neck motor functions of trapezius and sternocleidomastoid muscles
XI (11) Accessory
67
Migraine prophy
Anti-HTN meds → BB, CCB
68
MC HA in men:
Cluster
69
With Myasthenia Gravis and respiratory issues, what is the next step in mgmt?
Breathing study (Neg. inspiratory force)
70
MC complication of Bell’s Palsy
Keratitis
71
This Dx should NOT have post-ictal period or prolonged state of confusion:
Syncope
72
What is Cushing Reflex/Triad and what did it signify?
- HTN, brady, diminished respiratory
| - ↑ ICP
73
Daily neck stretches would most benefit what type of HA?
Tension
74
What PE hand gesture tests Median Nerve function?
"OK" sign → pincer function with thumb and index finger OR thumb and 5th finger.
75
Common cause of bilateral peripheral facial nerve palsy (can also be Bell Palsy).
Lyme disease
76
MC SE of Topiramate
Paresthesia
77
MC type of HA
Tension
78
Chronic migraine is strongly associated with which disorder?
Med overuse (rebound phenomenon)
79
Triptans and DHE are CI in:
HTN or CV disease
80
LP finding in Idiopathic Intracranial HTN (Pseudotumor Cerebri)
↑ opening pressure
81
Tx for Cluster HA
HIGH flow O2
82
MCC of Bell Palsy
HSV
83
MC sequelae p LP
HA
84
Tx for Tension HA
Daily neck stretches, NSAIDs
85
Chronic migraine is strongly associated with which disorder?
Med overuse (rebound phenomenon)
86
MC source of infection-induced delirium in the elderly population
UTI
87
Vertigo that present with HL
Meniere's and Labyrinthitis
88
What is Homonymous Hemianopia and MCC?
- Visual field loss on the same side of both eyes.
| - Stroke
89
Trigeminal Neuralgia (Tic douloureux) affects what facial distributions?
V2 (maxillary) and V3 (mandibular)
90
Tx for Carotid Artery Dissection
Heparin before Warfarin
91
What is part of immediate work up in patient with AMS?
Fingerstick Glucose
92
Most characteristic sign of idiopathic intracranial HTN
Transient vision loss
93
Normal opening pressure in adults
5 to 20 cm
94
What fracture compromises radial nerve?
Humeral shaft
95
Diplopia worse at the end of the day and muscle weakness. Dx?
Myasthenia Gravis
96
Bilateral motor paresis upper extremities more than lower. Damage to:
Central cord
97
Reversible extrapyramidal syndrome: sensation of motor RESTLESSNESS
Akathisia
98
For intracranial hemorrhage, Head CT scan is with or without contrast?
NO contrast → blood and contrast are both hyperdense
99
Tx for Intracranial Abscess
3rd gen Ceph + Metronidazole (if source unknown)
100
Contralateral hemisensory loss seen in:
Thalamic hemorrhage
101
Bell Palsy Tx
Prednisone, artificial tears, tape eyelid shut
102
With LOC, when is CT needed?
- Age ≥ 65
- Vomit ≥ 2
- Fracture
- GCS <15 p 2 hrs
103
Pt. presents with drooping eyelids, constricted pupils, and lack of sweat formation. What is the likely diagnosis?
Horner's Syndrome
104
Which antiepileptic med requires dose adjustment for patients with hypoalbuminemia?
Phenytoin
105
Tx for Intracerebral Hemorrhage
CCB → Nicardipine
106
- Contralateral loss of pain and temp
| - Ipsilateral loss of motor, position and vibration
Brown-Sequard Syndrome
107
In what setting is dual antiplatelet therapy with aspirin and clopidogrel indicated?
After percutaneous coronary intervention and stent placement.
108
Amaurosis Fugax is seen in what 3 Dx?
- Central Retinal ARTERY Occlusion
- Giant Cell (Temporal) Arteritis
- Transient Ischemic Attack (TIA)
109
What nerve would be damaged with buttock injury, hip dislocation, ↓ knee flexion, foot drop?
Sciatic
110
When treating CO2 poisoning, what does hyperbaric oxygen reduce the risk of?
Developing delayed neurologic sequelae
111
What is the 1st line treatment of multiple sclerosis exacerbations?
High-dose methylprednisolone, then prednisone taper.
112
CSF shows ↑ RBCs. MRI shows left temporal lobe edema. Dx?
Herpes Encephalitis
113
During cog testing pt. only recalls 1 of 3 words and all numbers are on 1 side on the clock on drawing. She has Hx of stroke, hyperlipidemia, HTN, DM. Daughter reports S/T memory loss. What type of dementia is this?
Vascular dementia
114
Constant headaches and bitemporal hemianopsia. Dx?
Pituitary Tumor
115
What tests is most likely to determine the source of an arterial thrombus?
Carotid ultrasound
116
What finding is consistent with a lower motor neuron deficit?
Weakness
117
2nd line Tx for Migraine
Dopamine blockers: Phe, Meto, Pro (given with Diphenhydramine)
118
Chronic back pain + abnormalities of proprioception and vibration discrimination. What portion of the spinal column is most likely affected?
Posterior column
119
A patient with an upper motor neuron lesion would exhibit what finding?
Spasticity
120
Myasthenia Gravis vs. Bell Palsy
MG: muscle weakness, diplopia/ptosis.
BP: can't wrinkle forehead or move brow. Post URI*
121
Tx for Akathisia
Benztropine
122
MC type of meningitis in a neonate
Group B Strep
123
MC type of meningitis in 1 mo to 18 yo
Neisseria Meningitis
124
Pt. reports to clinic saying her roommate was diagnosed with meningitis. She asks if she needs to be treated for prevention. What do you do?
Tx with Cipro or Rifampin
125
What med should be used in a patient recently diagnosed with Bells Palsy >60 yo?
- Acyclovir + Pneumococcal vac
| - D/T Ramsay Hunt Syndrome
126
What is the most important test to order in a patient with Meniere’s Disease?
MRI
127
When is CT contrast used in neuro?
Intracranial lesions like METS brain CA and abscesses
128
What is the next step after a Horner's Syndrome Dx?
CXR or CT scan
