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Medicine > Neurology > Flashcards

Neurology Flashcards

1
Q

localization of change in level of consciousness

A

brainstem reticular activating system or bicerebral hemispheres

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2
Q

cause of HTN in OSA

A

hypoxemia activates hypothalamus –> incr sympathetic tone

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3
Q

cause of hyperacusis

A

CN VII lesion (very proximal to its origin from the brainstem as the nerve to stapedius is one of the first branches).
CN V damage decreases tensor tympani muscle function but is usually not noticed by pts

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4
Q

medications inducing dystonia

A

antipsychotics (haloperidol), buspirone, SSRIs, metclopramide, AEDs

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5
Q

Tx of primary dystonias

A

meds: anticholinergics, benzos, baclofen

if severe, deep brain stimulation of internal globus pallidus

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6
Q

medications causing parkinsonism

A

antipsychotics, metoclopramide, prochlorperazine (compazine)

toxin-manganese

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7
Q

Parkinsons medication shown to decrease levodopa induced dyskinesias

A

amantadine

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8
Q

EEG pattern in absence seizure

A

3 hz spike and wave pattern

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9
Q

EEG pattern in relaxed adult w eyes closed

A

Alpha wave activity w freq 8-13 hz over posterior aspect of head

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10
Q

vessel responsible for lateral medullary syndrome (Wallenburg)

A

vertebral artery. could also be PICA

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11
Q

Lennox gastaut syndrome

A

Mental retardation, multiple seizure types, and 1-2 hz generalized spike wave discharges.
usually present <7 y/o
Many children w this have hx of infantile spasms (west syndrome)

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12
Q

Landau kleffner syndrome

A

Loss of language function and abnormal EEG during sleep

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13
Q

Intractable complex partial seizures in adults often due to

A

Mesial temporal sclerosis. Tx is anterior temporal lobe resection as meds are ineffective

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14
Q

West syndrome

A

Generalized seizure disorder of infants characterized by recurrent spasms, EEG pattern of hypsarrhythmia, retardation

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15
Q

Tx of absence seizures

A

Ethosuximide. If not tolerated due to gi sx or if there assoc w generalized tonic clonic, divalproex sodium

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16
Q

Tx of seizures if eclampsia

A

Mg sulfate

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17
Q

Moyamoya disease

A

Non inflammatory cerebral vasculopathy that’s leads to occlusion of large arteries at the circle of Willis. Cause of stroke in young pts. Tx is surgery to bypass blockage

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18
Q

How does schistosoma mansoni affect the nervous system

A

Deposits eggs in the valveless veins of batson which drain the spinal cord. Granulomas formed around the eggs compress the cord

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19
Q

Tx of lyme in CSF

A

IV ceftriaxone or penicillin 10-14 days. if allergic, tetracycline qid for 30 days

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20
Q

EEG findings in herpes encepahlitis

A

bilateral, periodic epileptiform discharges originating from temporal lobes

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21
Q

Tx of b12 deficiency

A

IM B12. Good for any cause of deficiency.

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22
Q

Tx of juvenile myoclonic epilepsy

A

valproic acid, lamotrigine

avoid phenytoin or carbamazapine which make Sx worse

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23
Q

EEG pattern in juvenile myolconic epilepsy

A

6-8hz irregular polyspike and wave

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24
Q

Visual defect in b12 deficiency

A

Centrocecal scotoma-enlargement of blind spot into central vision.
Also seen in tobacco-alcohol amblyopia(if acute consider methyl alcohol ingestion), tertiary syphilis, and leber optic atrophy (mitochondrial inherited disease)

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25
Q

Oculomasticatory myorhythmia

A

Pendular convergence of the eyes in assoc w contractions of masticatory muscles. Pathognomonic for whipple disease

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26
Q

Alien hand syndrome

A

Seen in pml caused by JC virus

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27
Q

Effect of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)

A

Illicit drug gives a high similar to heroin. Dmgs substantial nigra -> Parkinson’s that evolves over weeks.

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28
Q

Holmes-Adie syndrome

A

benign, idiopathic condition characterized by unilat or sometimes bilat unresponsive pupils to light and may slowly constrict to accomodation, impaired corneal sensation, and absent or depressed DTR in the legs. most common in females 20-40 y/o

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29
Q

Meige syndrome?
caused by?
Tx?

A

focal dystonia characterized by blepharospasm, forceful jaw opening, lip retraction, neck contraction, tongue thrusting
Idiopathic or caused by antipsychotics
Tx - botulinum injection

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30
Q

Tx of pseudotumor cerebri

A
  1. Large vol tap in initial eval
  2. Acetazolamide
  3. Lumbar peritoneal shunt or vp shunt
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31
Q

Brain lesion in pt with Von Hippel lindau

A

Hemangioblastoma. Needs resection due to risk of bleed

32
Q

Deficiency in metachromatic leukodystrophy

A

Arylsulfatase A

33
Q

Deficiency in Tay Sachs

A

Hexosaminidase

34
Q

Deficiency in gaucher disease

A

Glucocerebrosidase

35
Q

Von Hippel lindau

A

Polycystic liver/kidney, renal cell carcinoma, retinal telangectasias, cerebellar tumors, hemangioblastomas in cns, hemangioma in bones, adrenals, ovaries

36
Q

Tuberous sclerosis

A

presents with cognitive impairment, epilepsy, and skin lesions (facial angiofibromas, adenoma sebaceum)
a/w retinal hamartoma, renal angiomyolipoma, cardiac rhabdomyoma

37
Q

Tx of seizures in tuberous sclerosis

A

ACTH

38
Q

Congenital lower motor neuron disease

A

Werdnig Hoffman - young, lethal

Kugelberg-welander - older kids, less lethal

39
Q

Presentations of types of chiari malformations

A

1-adult. Presents w cerebellar signs

2-infants. Presents w hydrocephalus ( cerebellum lies far below foramen magnum )

40
Q

Sx of myotonic dystrophy

A

Diff relaxing grip, hypersomnolence, premature baldness, testicular atrophy, cataracts, cardiac defects, psychiatric problems

41
Q

Location of dmg to brain in chronic alcoholism

A

Purkinje cells of superior vermis of cerebellum

42
Q

CNS dmg due to triorthocresyl phosphate aka “jake”

A

organophosphate that also causes severe motor polyneuropathy that can -> death

43
Q

Miller Fisher variant of GBS

A

areflexia, ataxia out of proportion to sensory defects, ophthalmoplegia, predominant cranial nerve weakness rather than extremities, and positive anti-GQ1b (ganglioside) Abs

44
Q

Differentiating botulism from GBS

A

botulism has descending paralysis. Also has more CN involvement generally

45
Q

What to monitor in GBS

A

forced vital capacity (FVC) and negative inspiratory force (NIF). Intubate for FVC < 15-20 ml/kg

46
Q

Mutation seen in familial cases of ALS (10% of cases overall)

A

up-regulation of copper-zine superoxicde dismutase (SOD1)

47
Q

Tx of organophosphate poisoning

A

atropine + pralidoxime

48
Q

Sx of lead poisoning?

Tx?

A

abd pain, constipation, anemia (basophilic stippling), lead lines, peripheral neuropathy espec wrist drop.
Tx- penicillamine

49
Q

neuro effects of CO poisoning

A

occur 1-3 weeks after initial event
typically extrapyramidal disorder w/ parkinsonian gait and bradykinesia
imaging - classic hypodenisities in globus pallidum bilaterally

50
Q

Sturge Weber syndrome

A

port wine stain on face, contralateral hemiparesis, retardation, seizures, glaucoma, leptomeningeal angiomatosis (capillary angiomatoses of the pia matter is key pathologic feature)

51
Q

afferent pupillary defect

A

aka marcus gunn pupil

sequela of optic neuritis in MS pts.Dx by swinging flashlight test

52
Q

Gradenigo syndrome

A

caused by osteomyelitis of petrous pyramid of temporal bone as a result of poorly treated ear infections. -> facial pain and diplopia due to CN 5&6 involvement.

53
Q

ocular bobbing

A

rapid downward deviation of eyes followed by slow upward conjugate eye movements. sign of pontine damage

54
Q

bilateral acoustic schwannomas

A

NF2

55
Q

Foster Kennedy Syndrome

A

unilateral anosmia with ispilateral optic atrophy, contalateral papilledema. a/w olfactory groove meningioma that compresses optic&olfactory nerve and cause incr ICP

56
Q

Risk of AAA surgery

A

Occlusion of artery of adamkiewicz which supplies lower 2/3 of spinal cord and enters cord T10 to L1. Can -> paraplegia

57
Q

How can the Fed control the money supply?

A

By buying and selling the government’s securities.

58
Q

Tx of tics in Tourette’s

A

Atypical neuroleptics fluphenazine, pimozide
Haloperidol
Clonazepam, naltrexone, botulinum injections

59
Q

Disorders associated w Tourette’s

A

ADHD, OCD

60
Q

First step in evaluating language delay

A

Audiological evaluation

61
Q

Tx of cluster headaches

A

Prophylactic - verapamil, lithium, ergotamine

acute - 100% O2, sumatriptan

62
Q

Signs of basilar skull fx

A

Periorbital ecchymosis(raccoon eyes), ecchymosis over mastoid region (battle sign), hemotympanum, cns rhinorrhea/otorrhea

63
Q

Sx of uveitis

A

blurred vision, moderate pain, conjunctival injection, constricted pupils. hypopyon(pus in eye) in anterior uveitis

64
Q

organisms responsible for brain abscess spread from middle ear infxn, mastoids, or paranasal sinus

A

aerobic/anaerobic strep (60-70%), bacteroides species (20-40%), staph aureus (10-15)

65
Q

Dx of CMV retinitis? Tx?

A

fundoscopic exam showing yellow-white patches of retinal opacification and hemorrhages
ganciclovir or foscarnet

66
Q

pathogenesis of sympathetic ophthalmia

A

penetrating injury to one eye -> uncovering of hidden antigens -> immune mediated inflammation of other eye (anterior uveitis, panueveitis, papillary edema, or blindness may develop)

67
Q

gait in parkinson’s

A

hypokinetic, narrow based, shuffling/festinating (catching their center of gravity)

68
Q

in a pt with giant cell arteritis, how to differentiate polymyalgia rheumatica vs steroid induced myopathy(steroids used for tx of arteritis)

A

ESR and CK will be normal in steroid myopathy

69
Q

compare lewy body dementia vs alzheimers

A

w/ lewy body you have parkinsonism, hallucinations, fluctuating Sx, as well as visuospatial defects > memory defects

70
Q

meds causing focal dystonias i.e. torticollis

A

typical antipsychotics, metoclopramide, prochlorperazine

71
Q

emergent Tx of central retinal artery occlusion

A

ocular massage and high flow oxygen. Intra-arterial tPA may be useful but hasnt been studied.

72
Q

NF 1 vs 2

A

both - cafe au lait spots, neurofibromas, meningiomas
1- optic nerve glioma, axillary/inguinal freckling, iris hamartomas (lisch nodules), bony lesions
2- bilat acoustic schwannomas, cataracts

73
Q

Sx of uncal herniation

A

ipsilateral hemiparesis (crus cerebri compression)
ipsilateral CN III palsy - blown, down & out
contralateral homonymous hemianopsia (PCA compression)
AMS/coma - reticular activating system compression

74
Q

Sx of anabolic steroid abuse

A

aggression, acne, male pattern baldness, gynecomastia, decr testicular size/sperm count, virilazation in females, hepatic dysfunction, erythrocytosis, decr HDL, cardiac dysfunction (at high doses)

75
Q

CT reading for PML

A

multiple non enhancing lesions in white matter without mass effect

76
Q

meds associated with pseudotumor cerebri

A

vitamin A toxicity, isotretinoin, steroids, OCPs

Medicine (6 decks)

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