Neurology Flashcards
Most common example of mononeuropathy?
Carpal Tunnel Syndrome
Condition that can cause Carpal Tunnel Syndrome due to excess swelling in wrist?
Pregnancy, Hypothyroidism
Condition that can cause Carpal Tunnel Syndrome due to abnormal growth of carpal bones?
Acromegaly
Condition that can cause Carpal Tunnel Syndrome due to deposition of b2 microglobulin?
Hemodialysis
Which clinical presentation can help differentiate L5 radiculopathy from common fibular nerve radiculopathy?
Common fibular nerve = loss of foot eversion; L5 = loss of foot eversion + inversion
Compression of which structure leads to meralgia paresthetica?
Lateral cutaneous nerve … as it passes under the inguinal ligament
Clinical presentation of meralgia paresthetica?
Burning + numbness over lateral thigh
42 yo female presents with 6-week Hx of fever, cough, arthralgias; Reports R-sided facial droop on R; CXR shows nodular opacities in hilar regions – diagnosis?
Neurosarcoidosis
Which CN is most affected in Neurosarcoidosis?
CN 7
Which CN is most affected in Guillain Barre?
CN 6-7
Which CN is most affected in Diphtheria?
CN 9
Which CN is most affected in DM?
CN 3-4-6
Appearance of CXR and C-Spine XR in setting of Thoracic Outlet Obstruction?
Cervical rib
Appearance of next CT in setting of Thoracic Outlet Obstruction?
Scalene muscle hypertrophy
4 examples of mononeuropathy multiplex (2+ nerves affected)?
DM, RA vasculitis, polyarteritis nodosum, Lyme disease
Clinical presentation of mononeuropathy multiplex in Lyme disease?
New-onset foot drop
Example of condition that results from polyneuropathy?
Charcot-Marie-Tooth
Clinical presentation of Charcot-Marie-Tooth?
High arch, hammer toes
Inheritance pattern of Charcot-Marie-Tooth?
AD
Treatment of choice for Guillain-Barre Syndrome?
Plasma exchange; IVIG
Clinical presentation of Guillain-Barre Syndrome?
Ascending weakness
2 conditions that contraindicate IVIG treatment for Guillain-Barre Syndrome?
CHF, Renal failure
Condition that is a variant of Guillain-Barre Syndrome, but involves descending paralysis … (instead of ascending paralysis)?
Miller-Fischer Syndrome
Which 2 functions are preserved in ALS (…but not in MS)?
Ocular movements, Bladder/bowel function
Pattern of muscle weakness in Myasthenia gravis?
Weakness worse with repetition
Pattern of muscle weakness in Lambert-Eaton Syndrome?
Weakness better with repetition
DOC for Myasthenia gravis?
Physostigmine
Diagnostic test for Myasthenia gravis?
Tensilon test
Diagnostic test for Parkinson’s Disease?
Clinical
Initial therapy for Parkinson’s Disease?
Selective dopamine agonists
Value of Selective dopamine agonists as Initial therapy for Parkinson’s Disease?
Neuroprotective
Most effective therapy for Parkinson’s Disease?
Levodopa
Why is treatment with levodopa avoided during early stages of Parkinson’s Disease?
Wears off over time
Patient presents with bradykinesia, muscle rigidity, retropulsion, vertical gaze palsy – diagnosis?
Progressive Supranuclear Palsy
4 aspects of clinical presentation for Multiple System Atrophy?
Parkinson features, cerebellar dysfunction, orthostatic hypotension, urinary incontinence
Best treatment for orthostatic hypotension in Multiple System Atrophy?
Fludrocorticol … (mineralocorticoid)
4 most common origin locations for brain metastasis?
Lung, Breast, Skin, GI
Condition associated with multiple meningiomas?
NF-2
Why are meningiomas more common females?
Tumor cells have estrogen receptors
Cell of origin for meningiomas?
Arachnoid cells
Most common malignant brain tumor in children?
Medulloblastoma
Cell of origin for medulloblastoma?
Granular cell layer of cerebellum
Most common location of Medulloblastoma?
Cerebellum; 4th ventricle
Most common location of ependymoma in children?
4th ventricle
Most common location of ependymoma in adults?
Spinal cord
2 CSF findings associated with MS?
High IgG:Albumin ratio, Oligoclonal banding
Location of lesion in MS that causes internuclear ophthalmoplegia?
Medial longitudinal fasciculus
Medial longitudinal fasciculus connects which 2 cranial nerves?
CN 3, CN 6
What ocular movement in intact in internuclear ophthalmoplegia?
Convergence
Clinical presentation of internuclear ophthalmoplegia?
Impaired adduction of affected eye
Best treatment for acute MS exacerbation (including optic neuritis)?
IV corticosteroids
Disease-modifying treatment for MS?
IFN-b
Untreatable cause of dementia?
Huntington disease
DOC for Normal Pressure Hydrocephalus?
Acetazolamide … decreases CSF production
What is the most significant risk factor for developing delirium during hospitalization?
HX of Dementia
Appearance of head CT in frontotemporal dementia?
MSK symptom seen in Creutzfeldt-Jakob Disease?
Myoclonic jerks
Appearance of EEG in Creutzfeldt-Jakob Disease?
Triphasic sharp waves
CSF analysis in Creutzfeldt-Jakob Disease reveals …
14-3-3 protein
In addition to Neisseria, what is another pathogen with structure Gram (-) cocci?
Moraxella
Clinical significance of Moraxella?
COPD exacerbation
ABX of choice for Moraxella?
Augmentin
Which type of Neisseria is fatal?
Type B
Group of patients that are especially susceptible to N. meningitidis infection?
Complement deficiency C5-C9
Most appropriate initial ABX treatment for acute N. meningitidis infection in children + adults?
Ceftriaxone + Vancomycin
‘Most appropriate initial ABX treatment for acute N. meningitidis infection in elderly + neonates?
Ceftriaxone + Vancomycin + Ampicillin
Role of ampicillin in treatment of acute N. meningitidis infection in elderly + neonates?
Suspected Listeria infection
DOC for adults + children with acute N. meningitidis infection and HX of vancomycin allergy?
Ceftriaxone + Rifampin
Pathogen responsible for meningitis in patient with AIDS, Hodgkin lymphoma, ALL?
Cryptococcus
Best treatment for urethritis in sexually-active male?
IM ceftriaxone + 7-day course of doxycycline
Which other test should be performed for urethritis in sexually-active male?
VDRL
DOC for treatment of N. gonorrhea infection in pregnant female?
Ceftriaxone + Erythromycin
Most common cause of mucopurulent cervicitis?
Chlamydia trachomatis
2 aspects of clinical presentation for disseminated gonococcal infection?
Tendonitis, Septic arthritis, Rash
Best treatment for disseminated gonococcal infection?
1g IM ceftriaxone for 7 days
Why does Mycoplasma not Gram stain?
No cell wall
Why does Chlamydia not Gram stain?
Cell wall does not contain peptidoglycan
Clinical presentation of Chlamydia serotype A-C?
Trachoma
Clinical presentation of Chlamydia serotype D-K?
Urethritis, PID, Conjunctivitis
Clinical presentation of Chlamydia serotype L1-L3?
Lymphogranuloma venereum
Clinical presentation of Lymphogranuloma venereum?
Painless genital ulcers … Suppurative LNs
Best treatment for Lymphogranuloma venereum?
Doxycycline
Best treatment for Lymphogranuloma venereum in pregnant females?
Erythromycin
Clinical presentation of Chlamydia psittaci infection?
Atypical PNA
DOC for treatment of Chlamydia psittaci?
Doxycycline
3 indications for treating HTN in setting of CVA?
Systolic BP > 220, Diastolic BP > 110, Planning to give TPA
DOC for treating HTN in setting of CVA?
Labetalol
Timeframe of head trauma, prior CVA, acute MI that contraindicates thrombolytic therapy?
3 months
Timeframe of GI bleed, hematuria that contraindicates thrombolytic therapy?
3 weeks
Timeframe of major surgery that contraindicates thrombolytic therapy?
2 weeks
Target INR before beginning warfarin in thrombolytic therapy?
1.7
MRI shows cerebellar ischemic CVA with edematous infarct tissue – what is next step in management?
Neurosurgery consult
What is the anti-platelet of choice for reduction of CVA-related mortality?
ASA
DOC to add to ASA for secondary CVA prevention?
Dipyridamole
DOC for patient with ischemic CVA due to A-Fib?
Warfarin
2 risk factors for development of seizure?
Meningitis, Encephalitis
Which anti-seizure medication may cause folate deficiency, leading to megaloblastic anemia?
Phenytoin
Which condition contraindicates use of Phenytoin?
Pregnancy … may cause NTD
2 AE of carbamazepine?
Aplastic anemia, Leukopenia
9 CYP450 inducers?
Most Chronic Alcoholics Steal Phen Phen + Never Refuse Greasy Carbs … Modafinil, Chronic ETOH, St. John’s wort, Phenytoin, Phenobarbitol, Nevirapine, Rifampin, Griseofulvin, Carbamazepine
Difference between common and classic migraine?
Common = no aura; Classic = aura
2 options for abortive treatment of migraine?
NSAIDs, Triptans
4 options for preventative treatment of migraine?
Valproate, CCBs, B blockers, TCAs
Best acute treatment for cluster HA?
O2
Best prophylaxis for cluster HA?
Verapamil
DOC for treatment of tension HA?
NSAIDs
Inflammation of which vessel is responsible for blindness in temporal arteritis?
Ophthalmic artery
2 aspects of treatment for Pseudotumor Cerebri?
Weight loss, Acetazolamide
Which symptom favors myopathy, not neuropathy?
Proximal weakness