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Uworld/shelf > Neurology > Flashcards

Neurology Flashcards

1
Q

typical features of cerebellar degeneration

A
  • progressive gait dysfunction
  • truncal ataxia
  • nystagmus
  • intention tremor or dysmetria
  • impaired rapid alternating movements
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2
Q

what is dysdiadochokinesia?

A

impaired rapid alternating movements

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3
Q

what is dysmetria

A

limb-kinetic tremor when attempting to touch a target

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4
Q

what is Babinski sign and what does it indicate

A

upward deviation of great toe when stroke foot

suggests UMN lesion

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5
Q

what is the clasp knife phenomenon?

A

velocity dependent resistance to passive limb movement

seen in pts with hypertonia due to pyramidal tract disease

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6
Q

what cancers have primarily multiple brain mets?

A

lung

melanoma

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7
Q

what cancers usually have solitary brain mets?

A

breast
colon
renal cell

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8
Q

list cancers that met to brain in order of highest frequency

A
  1. lung
  2. breast
  3. unknown primary
  4. melanoma
  5. colon
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9
Q

cerebral toxoplasmosis most common in CD4 ___

A

<100

ring enhancing lesions

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10
Q

head imaging with nonenhancing/hypodense lesions, calcified granulomas indicates ____

A

neurocysticercosis

these are cysts at various stages of development

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11
Q

CSF findings of GBS

A

high protein
few cells
(albuminocytologic dissoc)

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12
Q

difference in time course for symptoms of GBS vs tick borne paralysis

A

tick- ascending paralysis over hours (ticks must feed 4-7 days first tho for release of neurotoxin)

GBS- days to weeks

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13
Q

examples of autonomic dysfunction that is often seen in GBS

A

tachycardia
urinary retention
arrhythmias

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14
Q

how and when does chemotherapy induced neuropathy present

A

weeks after treament

symmetrical paresthesias in fingers and toes spreading proximally in a stocking glove pattern

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15
Q

symptoms of anterior cord syndrome

A

BL motor function loss at and below level of injury

decr pain and temp sensation BL that begins 1-2 levels below cord injury

vibration, proprio ok

(basically lose everything except vibration, proprio)

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16
Q

lesions in ___ (3) generally cause UMN symptoms

A

brain

spinal cord

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17
Q

lesions in ____ cause LMN signs

A

level of spinal root

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18
Q

what symptoms should you suspect cauda equina syndrome

A

severe radicular lower back pain

plus:

  • impaired motor/patchy sensory/reflex activity in LE
  • bowel/bladder dysfunction
  • or saddle anesthesia
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19
Q

management if cauda equina syndrome symptoms

A

urgent MRI

surgical decompression within 24-48 hours to prevent irreversible neurologic sequelae

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20
Q

what nerve roots does cauda equina carry

A

L2-L5
S1-S5
coccygeal nerve

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21
Q

memantine

  • usage
  • mechanism
A

severe Alzheimer disease

blocks action of glutamate on NMDA receptor

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22
Q

what labs should you always get in someone with dementia

A

thyroid function
vitamin B12

these are potentially reversible causes

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23
Q

potential etiologies of intracranial hypertension

A
  • trauma
  • space occupying lesions
  • hydrocephalus
  • impaired CNS venous outflow
  • pseudotumor cerebri
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24
Q

presentation of intrancranial hypertension

A
  • headache - worse at night
  • n/v
  • mental status changes, cog dysfunction
  • focal neuro sxs (vision change, unsteady gait)
  • seizure
  • symptom worsening with maneuvers that further incr ICP
  • papilledema
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25
Q

what maneuvers can worsen symptoms of intracranial hypertension

A

leaning forward
valsalva
cough

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26
Q

what is cushing reflex and what does it suggest

A

HTN, bradycardia, respiratory depression

brainstem compression

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27
Q

exam findings of acute angle closure glaucoma

A

conjunctival erythema

mid-dilated pupil poorly reactive to light

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28
Q

why can heavy ETOH cause alcoholic neuropathy?

A

alcohol is neurotoxic and results in axonal neuropathy characterized by reduction in small myelinated and unmyelinated fibers

can occur with or without thiamine deficiency

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29
Q

symptoms of alcoholic neuropathy?

A

symmetric distal polyneuropathy (stocking glove)

characterized by paresthesia, burning pain, ataxia

also commonly lose distal DTRs (eg ankle), light touch, vibration sense

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30
Q

list common causes of peripheral neuropathy

A
  • DM
  • hypothyroid
  • vit B12 deficiency
  • medications (eg phenytoin, cisplatin, platinum chemo, disulfiram)
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31
Q

name the cranial nerves

A

2: optic
3: oculomotor
4: trochlear
5: trigeminal
6: abducens
7: facial
8: vestibulocochlear
9: glossopharyngeal
10: vagus
11: spinal accessory
12: hypoglossal

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32
Q

most common cause of CN3 (oculomotor nerve) palsy

A

ischemic neuropathy due to poorly controlled DM

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33
Q

UMN signs

A

hyperreflexia, spasticity

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34
Q

LMN signs

A

muscle atrophy

fasciculations

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35
Q

how does ALS usually present

A

asymmetric limb weakness
bulbar dysfunction

upper and motor neuron symptoms

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36
Q

risk factors multiple sclerosis

A 
vit D deficiency
smoking
white female
HLA-DRB1
USA, europe, cold climate
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37
Q

multiple sclerosis diagnosis

A

episodic/progressive sxs disseminated over time and space
hyperintense lesions on T2 MRI
oligoclonla IgG on CSF analysis

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38
Q

what are bulbar symptoms

A

dysphagia, dysarthria

seen in multiple sclerosis

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39
Q

epidemiology of myasthenia gravis

A

women 20s-30s

men 60s-80s

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40
Q

what are ocular symptoms of myasthenia gravis

A

diplopia

ptosis

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41
Q

broad flat T waves

A

hypokalemia

also- U waves, ST depression, premature ventricular beats

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42
Q

primary CNS lymphoma is associated with what virus

A

EBV

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43
Q

Brown-Sequard presentation

A

ipsilateral hemiparesis, decr proprio, vibration, light touch AT The level of injury

contralateral diminished pain and temperature 1-2 levels BELOW level of injury (bc lateral spinothalamic tract decussates 1-2 levels above entry point for the corresponding sensory neuron)

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44
Q

genetics of Huntington disease

A

Autosomal dominant CAG repeat expansion

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45
Q

neuropathology of Huntington

A

loss of GABA-ergic neurons

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46
Q

imaging features of Huntington

A

caudate nucleus and putamen atrophy

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47
Q

what is the greatest risk factor for stroke

A

HTN

high pressure increases shearing force on intracerebral vascular endothelium, promoting formation of thrombi

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48
Q

treatment mild/intermittent restless leg

A

supplement iron when ferritin <= 75
supportive (massage, heating pads, exercise)
avoid aggravating factors (eg slep depriv, meds)

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49
Q

treatment persistent/moderate to severe restless leg

A 
dopamine agonists (pramipexole)
alternate- alpha 2 delta calcium channel ligands (gabapentin enacarbil)
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50
Q

list secondary causes of restless legs

A
  • iron deficiency anemia
  • uremia
  • DM
  • multiple sclerosis, parkinson disease
  • pregnancy
  • drugs (eg antidepressants, metoclopramide)
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51
Q

how does ETOH cause alcoholic neuropathy

A

ETOH is neurotoxic, resulting in axonal neuropathy characterized by reduction in number of small myelinated and unmyelinated fibers

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52
Q

symptoms of alcoholic neuropathy

A

symmetric distal polyneuropathy (stocking glove) - sxs include paresthesia, burning pain, numbness, loss of DTRs

exam usu has loss of light touch and vibration
gait ataxia is common

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53
Q

metabolic causes of peripheral neuropathy

A

DM
hypothyroid
B12 deficiency

other: MM, MGUS, plasma cell disorders

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54
Q

toxic causes of peripheral neuropathy

A

ETOH
meds- phenytoin, disulfiram, platinum chemo
heavy metals

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55
Q

infectious causes of periph neuropath

A

HIV

Lyme

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56
Q

hereditary causes of periph neuropathy

A

CMT

porphyria

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57
Q

symptoms of intracranial hypertension

A

HA worse at night, N/V, metal status changes

focal neuro symptoms (eg vision change, unsteady gait)

seizures

symptoms worsen with maneuvers that increase ICP such as leaning forward, valsalva, cough

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58
Q

what is cushing reflex and what does it suggest

A

HTN
bradycardia
respiratory depression

worrisome finding suggestive of brainsteem compression

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59
Q

exam findings of acute angle closure glaucoma

A

conjunctival erythema

mid-dilated pupil that is poorly reacive to light

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60
Q

temporal arteritis is associated with what condition

A

polymyalgia rheumatica (prox muscle stiffness/tenderness)

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61
Q

for what condition should you get CT chest to check for thymoma

A

myasthenia gravis

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62
Q

treatment for myasthenia gravis

A 
acetylcholinesterase inhibitors (eg pyridostigmine)
thymectomy

+/- immunotherapy (steroids, azathioprine)

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63
Q

medications that can cause myasthenia gravis exacerbation

A
  • abx: fluoroquinolones, aminoglycosides
  • anesthetics-neuromuscular blocking agents
  • cardiac meds - BB, procainamide
  • other: magnesium sulfate, penicillamine
  • tapering of immunosuppressive medications
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64
Q

causes of myasthenia gravis exacerbations

A

meds
pregnancy/childbirth
infection
surgery

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65
Q

what is thalamic pain syndrome

A

severe paroxysmal burning pain over area affected by a talamic stroke, exacerbated by light touch (allodynia)

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66
Q

lateral medullary infarct occurs due to occlusion of what arteries?

A

Posterior Inferior Cerebellar or vertebral artery

–> wallenberg syndrome

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67
Q

what is wallenberg syndrome and what are the symptoms

A

vestibulocerebllar sxs (vertigo, diff sitting upright w/o support, diplopia, nystagmus, ipsilat limb ataxia)

sensory sxs- lose pain and temp in ipsilateral face + contralateral trunk and limbs

ipsilateral bulbar muscle weakness- dysphagia, aspiration, dysarthria, dysphina, hoarseness (ipsilat vocal cord paralysis)

autonomic dysfnx - ipsilat Horner’s syndrome, intractable hiccups, lack of automatic respiration esp during sleep

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68
Q

what is transverse myelitis

A

immune-mediated infiltration of inflammatory cells into a segment of the spinal cord

–> neuron and oligodendrocyte cell death and demyleination

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69
Q

symptoms of transverse myelitis

A

rapidly progressive motor weakness that progresses from flaccid to spastic with UMNS

autonomic dysfunction

sensory deficits with a distinct sensory level

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70
Q

what spinal cord level does transverse myelitis often affect?

A

*inflammation localizes to contiguous spinal cord segments, usually in the thoracic cord

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71
Q

LP and MRI findings in transverse myelitis

A

MRI: enhancement of affected cord segments

LP: pleocytosis and elevated IgG

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72
Q

management of transverse myelitis

A

high doese IV glucocorticoids, foten with plasmapheresis

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73
Q

symptoms of anterior spinal artery syndrome?

A

weakness and loss of pain/temp below lesion

proprioception, vibration spared

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74
Q

cause and symptoms of subactue combined degeneration

A

B12 deficiency

  • sensory ataxia
  • progressive spastic parapersis
  • incontinence

occurs over years, often a/w neuropsych changes

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75
Q

most common cause oculmotor (CN3) palsy

A

ischemic neuropathy dt poorly controlled DM

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76
Q

symptoms of CN3 palsy

A

ptosis, diplopia
down-and-out gaze

normal pupillary response

(damage to inner somatic nerve fibers that innervate leavtor of eyelid and 4 of the EOM / while sparing the peripheral parasympathetic fibers that innervate sphincter or iris and the ciliary muscles)

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77
Q

what extraocular muscles are innervate by CN3 (oculomotor)

A

Superior rectus
Medial rectus
Inferior rectus
Ingerior oblique

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78
Q

3 cardinal signs of Parkinson disease

A

rest tremor (freq manifests in one hand first)
bradykinesia
rigidity

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79
Q

meaning of myelopathy

A

a nervous system disorder that affects the spinal cord

80
Q

symptoms of cervical myelopathy

A

progressive ambulation difficulty and extremity weakness

LMN signs at level of lesion (arms) –> weakness, atrophy

UMN signs below level of lesion (legs) - eg hyperreflexia

81
Q

most common cause of cervical myelopathy in older adults

A

spondylosis (degenerative spine disease that causes canal narrowing with cord compression)

82
Q

cause of Bell palsy

A

reactivation of herpes simplex virus

83
Q

Treatment of Bell palsy

A

steroids

some also recommend acyclovir

84
Q

what is Todd paralysis

A

self-limited, focal weakness or paralysis that occurs after a focal or generalized seizure

sxs are self-limited and resolve in hours

85
Q

cause of infant botulism

A

ingestion of C botulinum spores –> colonize gut and lead to production and release of neurotoxin

86
Q

how is cause of foodborne botulism diff from infant botulusm

A

foodborne: ingest preformed C botulinum toxin
infant: ingestion of spores

87
Q

difference in presentation of foodborne vs infant botulism?

A

foodborne: descending flaccid paralysis preceded by prodrome of n/v, abdominal pain, diarrhea
infant: bulbar palsies, constipation, drooling, hypotonia- even if infant hasn’t been fed honey!

88
Q

infant presents w/ bulbar palsies, constipation, hypotonia, has never eaten honey - what’s going on?

A

suspect infant botulism from inhalation of soil spores

89
Q

highest incidence of infant botulsm?

A

California
Pennsylvania
Utah

(have greatest concentration of soil C botulinism spores)

90
Q

treatment of infant botulism

A

botulism immune globulin ASAP, even before diagnostic confirmation of stool spores or toxin

91
Q

treatment of foodborne botulism

A

botulism antitoxin

92
Q

symptoms of spinal muscular atrophy (Werdnig Hoffmann disease)

A

generalized symmetric proximal weakness, hyporeflexia

weakness greater in lower than upper extremities

93
Q

diagnosis of absence sz

A

EEG with 3Hz spike wave discharges during episodes

94
Q

Friedreich ataxia inheritance pattern

A

autosomal recessive

95
Q

Friedriech ataxia is due to what mutation

A

excess trinucleotide repeat, most commonly GAA –> abnormal frataxin protein which is highly expressed in heart, brain, pancreas

96
Q

neurologic findings of Friedreich ataxia

A
  • loss of position and vibration sense (dorsal spinal column)
  • dysarthria
  • loss of DTRs
  • progressive gait and limb ataxia
97
Q

non-neurologic findings of Friedreich ataxia

A
  • hypertrophic cardiomyopathy (incr risk arrhythmia, HF, may have fhx sudden cardiac death)
  • kyphoscoliosis, pes cavus
98
Q

additional management after IV abx for native valve bacterial endocarditis with acute cardioemoblic stroke

A

none, careful observation

consider surgery if significant valve dysfunction, persistent/hard to treat infection, or recurrent embolism

99
Q

what time frame does foodborne botulism symptoms develop?

A

within 36h of toxin ingestion

100
Q

mechanism of botulism toxin

A

inhibits presynaptic release of Ach at the NMJ

101
Q

presentation of putaminal hemorrhage involving the adjacent inernal capsule

A

contralateral hemiparesis and hemianesthesia

conjugate gaze deviation TOWARD side of lesion (dt damage of frontal eye field efferents)

102
Q

medial medullary syndrome occurs due to occlusion of __

A

vertebral or anterior spinal artery

contralteral paralysis of arm and leg (lat corticospinal tract)

contralateral loss of position sense (dorsal column medial lemniscus)

tongue deviation toward lesion (Hypoglossal nerve)

103
Q

treatment options for postherpetic neuralgia

A

gabapentin, pregabalin
TCA (amytriptylline)

topical capsaicin and lidocaine
opioids effective but not preferred due to dependence

104
Q

explain neurogenic shock cause and symptoms

A

lesions above T1 interrupt descending sympathetic fibers –> unopposed parasympathetic stimulation of vessels and heart = hypotension and bradycardia, hypothermia bc lack of peripheral vasoconstriction; areflexia, anesthesia, paralysis, distended bladder below level of the lesion

usu have initial period (sev minutes) of massive sympathetic stimulation due to release of NE from adrneals, leading to HTN and tachy

105
Q

secondary stroke prevention for acute ischemic stroke

A

sntiplatelet with aspirin

106
Q

secondary stroke prevention in those with acute cardioembolism

A

anticoagulation wtih heparin

107
Q

pt with worse headache in his life. CT negative. next step?

A

suspected SAH, some CTs still negative

get LP to check for high opening pressure and xanthochromia

108
Q

etiology of cerebral amyloid angiopathy

A

abnormal beta-pleated amyloid deposition in cerebral vessels leading to vessel fragility

second most common cause od intracerebral hemorrhage after HTN, typically lobar in location, pts age >75

109
Q

symptoms of hypertensive encephalopathy

A

marked BP elevation w/ progressive HA, N/V, nonlocalizing neuro symptoms (eg confusion, restlessness) due to cerebral edema

110
Q

sxs of vertebral artery dissection

A

with head/neck trauma

local pain
focal neuro deficits dt cerebral iscehmia cause by thromboembolism or hypoperfusion

concomitant disruption of posterior infecrior cerebellar artery –> lateral medullary syndrome

111
Q

medical treatment for idiopathic intracranial hypertension?

what if fail medical therapy?

A

acetazolamide +/- furosemide

optic nerve sheath decompression or lumboperitoneal shunting if refractory to medical therapy

steroids and LP can be used as bridging therapy for pts awaiting definitive surgical tx, but not rec as long term primary tx

112
Q

symptoms of aminoglycoside toxicity

A

can be ototoxic to both the cochlea AND vestibular system

= sensorineural hearing loss and imbalance

113
Q

positive head thrust test assesses vestibuloocular reflex which is affected by _______ vestibulopathies

A

peripheral, but not central

114
Q

what is equinovarus deformity

A

clubfoot - feet point down and inward

115
Q

progressive multifocal leukoenceophalopathy is associated with reactive of __ virus

A

JC

116
Q

manifestations of common fibular neuropathy

A

usually transient

  • foot drop
  • sensory changes over dorsal foot, lateral shin
  • impaired dorsiflexion
  • impaired great toe extension
117
Q

causes of common fibular neuropathy

A

leg immobilization
leg crossing
protracted squatting

118
Q

most frequently affected locations of hypertensive hemorrhages

A

basal ganglia (putamen)
cerebellar nuclei
thalamus
pons

119
Q

putaminal hemorrhage almost always involves the adjacent ____ leading to sytmpoms of?

A

internal capsule

contralateral hemiparesis and hemianesthesia (disruption of the corticospinal and somatosensory fibers) and conjugative gaze deviation twd side of the lesion (damage of frontal eye field efferents)

120
Q

lobar hemorrhages due to amyloid angiopathy most often involve which lobes?

A 
occipital lobe (causing homonymous hemianopsia)
parietal lobe (causing contralat hemisensory loss)
121
Q

next step in pt with Guillaine-Barre who is hemodynamically stable

A

serial PFTs to assess respiratory muscle strength

122
Q

most common mononeuropathy in pts on dialysis? cause?

A

carpal tunnel syndrome

mos commonlyy: dialsis relaed amyloidosis- inflamm stim formation of beta 2 microglobulin, which is inadeq cleared and deposied as myloid within carpal tunnel

other:

  • incr venous pressure during HD
  • blood racking from fisual into the carpal tunnel
  • deposition calcium phosphae in unnel
123
Q

tetanus MOA

A

closridium tetani toxin blocks release of inhibitory Glycine and GABA across the synaptic cleft

124
Q

differences between neonatal conjunctivitis caused by chlamydia vs gonorrhea

A

gonorrhea_ presents age 2-5 days, purulent

chlamydia: 5-14 days, milder chemosis and lid swelling, watery discharge

125
Q

formal visual acuity testing is recommended starting at __

A

age 4 / cooperative 3yo

should be screened at every well child

126
Q

initial workup of suspected dementia

A
  • neuropsych testing
  • CBC, CMP, TSH, B12
  • neuroimaging
127
Q

most common type of headache in pediatric population

A

migraines

128
Q

indications for head imaging in a child with HA

A
  • coordination difficulty
  • n/t or focal neuro signs
  • HA that causes awakening from sleep
  • increasing HA frequency
129
Q

tx acute dystonia

A

benztropine, diphenhydramine

130
Q

sxs craniopharyngioma

A

optic chiasm compression -> bitemporal hemianopsia

pituitary stalk compression -> endocrinopathies- growth failure in children, pubertal delay, sexual dysfnx in adults, DI

131
Q

classic presentation of Friedrich ataxia?

A

progressive ataxia in adolescence

132
Q

what is cephalohematoma?

A

bleed over he surface of one cranial bone, due to birth rauma

subperioseal bleeding is slow so swelling often no visible until several hours afer birth

nonender, doesn’ cross suure lines
mosl uncomplic and resorb sponaneousl wihin few weeks o monhs. a increased risk for hperbili as blood breaks down, m need phooherap

133
Q

features of Lennox-Gastaut sndrome

A

usu presns b age 5 w/ ID and severe seizures of various types

inerictal EEG: slow spike and wave pattern

134
Q

what type of seizures are triggered by hperventilaion?

A

absence

135
Q

absence EEG

A

3 Hz spike wave

136
Q

absence tx

A

ethosuximide

137
Q

facors disinguishing Marfan from homocsnuria?

A

homocsinuria is AR

  • intellectual disability
  • thrombosis (eg stroke), hromboemoblic evens a an age

fair complexion, megaloblasic anemia

138
Q

most common predisposing factor for orbital cellulitis?

ttttt

A

sinusitis

not as common but also /maxillary/ tooth abscess

139
Q

how to reverse warfarin

A

IV vitamin K (effects in 12-24h)

prothrombin complex concentrate- contains vitamin K activated factors, acts within minutes and lasts hours (FFP if not available)

140
Q

how to reverse warfarin

A

IV vitamin K (effects in 12-24h)

prothrombin complex concentrate- contains vitamin K-dependent clotting factors, acts within minutes and lasts hours (FFP if not available)

141
Q

characteristics febrile seizure, management

A

no previous afebrile seizure

quick return to baseline

reassurance

142
Q

ACA occlusion leads to contralateral sensory and motor deficit predominantly in ___ extremity

A

lower

may also have urinary incontinence

143
Q

MCA occlusion leads to contralat sensory and motor deficit primarily in __

A

face, upper limb

144
Q

Anterior spinal artery stroke

A

contralateral paralysis upper and lower limb

ipsilateral tongue deviation (hypoglossal)

145
Q

dysphagia, hoarseness, decr gag reflex = ___ stroke

A

PICA

146
Q

loss of pinprick sensation over 1st and 2nd webspaces beween toes can be due o __ or __

A

injur ot L5 roo or peroneal nerve

147
Q

type 2 neurofibromatosis involves a gene abnormality on chromosome _

A

22

148
Q

neglect is more common with __-sided brain lesions

A

right

149
Q

most common brain tumor in children?

A

low grade astrocytoma

150
Q

medulloblastomas arise from ______ and presents with __

A

cerebellar vermis

ataxia (dt involvement of cerebellum)

151
Q

neuroblastomas arise from __ and usu present with __

A

sympathetic ganglion cells

abdominal mass

152
Q

what is Uhthoff phenomenon

A

MS sxs worsening during exposure to high temps

153
Q

differences in signs/sxs of HSV vs CMV retinitis?

A

HSV(and VZV) = painful ketatitis/conjunctivitis –> rapidly progressive visual loss
fundoscopy: widespread, pale peripheral lesions, cenral retinal necrosis

CMV- no pain, no conjunctivitis
fundoscopy: fluffy white lesions, hemorrhages

154
Q

MRI Alzheimer’s disease shows ____ atrophy

A

temporal lobe

155
Q

meds that can precip acute glaucoma

A

anticholinergics

156
Q

vision changes expected with open angle glaucoma

A

tunnel vision (lose peripheral vision)

157
Q

wernicke encephalopathy triad

A

ataxia
oculomotor sxs
encephalopathy (confusion, lethargy)

158
Q

3 black box warnings for valproic acid?

A
  • teratogen
  • life-threatening pancreatitis
  • hepatotoxicity
159
Q

Babinski reflex is normal up to age __

A

2 years

160
Q

inheritance NF1

A

autosomal dom

161
Q

inheritance NF2

A

autosomal dom

162
Q

characteristics of CIDP

A

2 months symmetric both proximal and distal weakness

reduced/absent DTRs

163
Q

what can differentiate Alzheimer’s from frontotemporal dementia?

A

memory is often spared in FTD

164
Q

burning, numbness/tingling = ___ lobe seizure

A

parietal

165
Q

deja vua, unusual taste/smell, feeling of fear = __ lobe seizure

A

temporal

166
Q

pt with diplopia and tilting head to one side

A

trochlear nerve palsy (CN4)

167
Q

hemiballismus is due to lesion in __

A

subthalamic nucleus

168
Q

sxs commonly seen in Bell’s Palsy

A

hyperacusis

decr taste anterior 2/3 of ipsilat tongue

169
Q

expected pupil exam for non-pupil sparing CN 3 palsy vs pupil sparing CN 3 palsy?

causes?

A

non-pupil sparing: expect one pupil to be more dilated. due to CN3 compression; parasymp fibers respondible for pupil constriction are not spared

pupil sparing: expect pupils to be symmetric. due to nerve ischemia such as from DM. parasymp fibers are spared

170
Q

management of generalized status

A
  1. IV benzos for sz termination
  2. nonbenzo AED to prevent recurrence (eg fosphenytoin, phenytoin, keppra, valproate)
  3. MRI, CT to eval for structural abnormality, hemorrhage, ischemia
  4. continuous EEG if pt does not return to normal state of consciousness after medical therapy
171
Q

characteristics of frontotemporal dementia

A

early personality changes
compulsive behaviors
hpyerorality
frontotemporal atrophy on imaging

172
Q

characteristics of vascular dementia

A

early executive dysfunction
stepwise
cerebral infarct and/or deep white matter changes on imaging

173
Q

manifestation of phenytoin toxicity

A

cerebellar dysfunction (horiz nystagmus, ataxia, dysmetria, slurred speech), hyperreflexia

AMS

174
Q

inheritance tuberous scelrosis

A

autosomal dominant

TSC gene mutations -> benign tumors (hamartomas) of brain, skin, other organis

175
Q

most common presenting feature of tuberous sclerosis

A

seizures

176
Q

exam signs of tuberous sclerosis

A
  • hypopigmented macules (ash leaf spots)
  • angiofibromas
  • thickened skin w/ orange peel like texture
  • subependymal nodules on brain imaging (brain hamartomas)
177
Q

all pts with suspected tuberous sclerosis should be evaluated for __

A

cardiac rhabdomyoma, with echo

178
Q

cervical spondylotic myelopathy presents with __ signs in UE and ___ signs in LE

A

LMN in uppers (cervical spinal root compression)

UMN in lowers (compression of spinal cord descending tracts)

179
Q

sxs syringomyelia

A

loss of pain and temp in cape-like distribution (shoulders, back, arms)

180
Q

inheritance Duchenne’s and Becker’s

A

XLR

181
Q

inheritance myotonic dystrophy

A

autosomal dominant

182
Q

Bell Palsy management

A

glucocorticoids!

+/- acyclovir, valacyclovir which may speed time to recovery

protective eyewear if can’t close their eye

183
Q

what is an early finding of macular degeneration

A

straight lines appear wavy

184
Q

neuroimaging Alzheimer’s

A

temporal lobe atrophy

185
Q

sxs macular degeneration

A

central vision loss

186
Q

sxs glaucoma

A

peripheral vision loss

early on is asymptomatic
exam shows cupping of optic disc

187
Q

epidural hematoma most likely to compromise which cranial nerve early on?

A

3 oculomotor

188
Q

complications after bacterial meningitis in children

A
  • intellectual/behavioral disabilities
  • hearing loss
  • cerebral palsy
  • epilepsy (usu focal)
189
Q

features of glucocorticoid-induced myopathy

A

proximal muscle weakness and atrophy (LE more involved)

NO pain

NORMAL ESR and CRP

190
Q

two agents that might provoke idiopathic intracranial htn

A

vitamin A

glucocorticoids

191
Q

peak time for etoh wihdrawal seizures

A

1-2 days

192
Q

peak time for DTs

A

2-4d

193
Q

olfactory sz are a/w lesions in _

A

mesial temporal lobe, esp hippocampus or parahippocampal gyrus

194
Q

most common visual field defect after L temporal lobectomy

A

R superior quadrantanopsiaff

195
Q

differentiating polymyositis from polymyalgia rheumatica?

A

polymyositis- weakness

polymyalgia rheumatica- also painful

Uworld/shelf (5 decks)

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