Neurology Flashcards
1
Q
Hemicrania continua - Definition and Treatment
A
- Cluster headaches without remission
- Indomethacin
2
Q
Patient presents with sudden pain on the right side of her face that travels from her mouth to her ear. The pain began when she was eating dinner. Suspicion?
A
Trigeminal neuralgia
3
Q
Young patient presents with what seems like trigeminal neuralgia. What should you work this patient up for before making a diagnosis of trigeminal neuralgia?
A
Multiple sclerosis
4
Q
Patient presents with pain in the throat and on the back of the tongue. He said the pain started when he was swallowing a bite of his dinner. What do you suspect?
A
Glossopharyngeal neuralgia
5
Q
Migraine accompanied by visual hallucination before or during
A
Classic migraine
6
Q
Migraine with no associated prodrome
A
Common migraine
7
Q
We should limit the use of simple analgesics for treatment of migraines to how many times per month before switching to preventative treatment?
A
< 15 days/month, or < 10 days if using a combination of drugs
8
Q
Most common type of primary headache?
A
Tension headache
9
Q
Patient complains of recurring episodes of severe pain behind his right eye, accompanied by a runny nose and watery eyes. Suspicion?
A
Cluster headaches
10
Q
Syndrome of cluster headaches with no period of remission
A
Hemicrania continua
11
Q
How long does the tonic phase of a tonic-clonic seizure last?
A
< 1 minute
12
Q
What hormone levels will be elevated in tonic-clonic seizures?
A
Prolactin
13
Q
Under what circumstances would you want to perform a lumbar puncture on a seizure patient?
A
- When any sign of infection is present
- In the evaluation of new-onset seizures in the acute setting
14
Q
How long after alcohol withdrawal begins would an withdrawal-induced seizure occur?
A
Within 48 hours
15
Q
MCC of status epilepticus
A
Poor compliance with medications
16
Q
MCC of a TIA
A
Embolization
17
Q
If a patient has a TIA, under what circumstances would you consider admitting to the hospital?
A
- An ABCD2 score of > 3
- Patient is having a crescendo attack
- Hypercoagulable state
- Known cardiac source of emobli
18
Q
Patient presents with symptoms of a TIA. Arteriography reveals high grade stenosis of 85% in her right carotid. What procedure might she benefit from?
A
A carotid endarterectomy or other endovascular intervention
19
Q
Would a TIA patient with < 50% stenosis benefit from a carotid endarterectomy?
A
No
20
Q
What medications should be initiated if the source of a TIA is an embolization caused by Afib?
A
Anticoagulants
21
Q
If you suspect a noncardioembolic event as the cause of a TIA, how should you treat the patient?
A
- Daily ASA
- Dipyridamole with ASA (Aggrenox)
- Clopidogrel
22
Q
What ABCD2 score should a patient have if you admit them to the hospital?
A
> 3
23
Q
Patient is brought to ER because of a syncopal episode after they complained of the worse HA of their life. What do you suspect?
A
Subarachnoid hemorrhage
24
Q
What is most often the cause of a subarachnoid hemorrhage?
A
An aneurysm of an AVM
25
If you really suspect a patient has a subarachnoid hemorrhage, but their CT is negative, what can you do to confirm you suspicion?
Lumbar puncture to look for RBCs or xanthochromia
26
What will an occlusion of the opthalmic artery cause?
Can be symptomless or can cause amaurosis fugax
27
What will an occlusion of the anterior cerebral artery (distal to the anterior communicating artery) cause?
- Weakness and sensory loss of the contralateral leg and sometimes arm
- Rigidity
- Confusion
28
What will an occlusion of the anterior cerebral artery (proximal to the anterior communicating artery) cause?
Usually well tolerated because of the collateral circulation
29
What will an occlusion of both anterior cerebral arteries cause?
Memory disturbances and behavioral changes
30
What will an occlusion of the anterior main division of the MCA cause?
- Expressive dysphagia
- Contralateral paralysis
- Loss of sensation to the arm, face, and leg
31
What will an occlusion of the posterior main division of the MCA cause?
- Receptive aphagia
| - Homonymous hemianopia
32
What will an occlusion of both vertebral arteries cause?
- Coma
- Pinpoint pupils
- Flaccid quadriplegia
- Sensory loss
33
What will an occlusion of the basilar artery cause?
- Coma
- Pinpoint pupils
- Flaccid quadriplegia
- Sensory loss
34
Patient has a cerebral infarction 2 hours ago. How do you treat them?
- tPA
- ASA 325mg
- Prednisone/Mannitol for cerebral edema
35
Patient with atrial fibrillation presents with a cerebral infarction 1.5 hours ago. How do you treat them?
- tPA
- ASA 325mg
- Coumadin
- Predisione/Mannitol for cerebral edema
36
MCC of intracerebral hemorrhage
Secondary to HTN
37
Where is the most common location of an intracerebral hemorrhage?
In the basal ganglia
38
Is a CT or MRI the better study for an intracerebral hemorrhage that occurred < 48 hours ago?
CT
39
Which procedure is contraindicated in an intracerebral hemorrhage?
Lumbar puncture - can precipitate herniation
40
What type of medications are good to give patients with an intracerebral hemorrhage and why?
Seizure prophylaxis because blood is very irritating to the brain
41
At what types of vascular structures do saccular aneurymsms tend to occur?
At arterial bifurcations
42
Where are most aneurysms located?
On the anterior part of the circle of Willis
43
Imaging study for aneurysm
Angiography
44
We don't usually operate on aneurysms unless they're how large?
> 10 mm
45
Tx recommendation for an aneurysm < 10mm
Yearly CTA/MRA to monitor
46
Where are most supratentorial AVMs located?
In the territory of the MCA
47
Are small or large AVMs more likely to bleed?
Small
48
Imaging studies for AVMs
- CT without contrast
| - Arteriography
49
Pregnant patient presents to ER in a state of confusion and drowsiness. You determine that she has increase ICP and learn that she flew in yesterday from England. What do you suspect?
Intracranial venous thrombus
50
Tx recommendations for intracranial venous thrombus
- Seizure prophylaxis
| - Anticoagulation with Heparin, followed by Coumadin
51
What types of neoplasms are most likely to metastasize to the leptomeninges?
- Breast carcinoma
- Lymphoma
- Leukemia
52
What CSF changes would you expect to find in a patient with leptomeningeal metastasis?
- Cancer cells
- Decreased glucose
- Increased protein
- Increased CSF pressure
- Pleocytosis
53
Brain tumor that is rapidly progressing and is usually unable to be removed by surgery
Glioblastom
54
Brain tumor that is usually no able to be completely surgically excised, but may progress slowly (even over several years)
Astrocytoma
55
Brain tumor that usually originates from the dura or arachnoid mater and that can usually be surgically excised
Meningioma
56
8yo boy brought to ER by mother who says he is drowsy and can't seem to pay attention. You find out that he recently had a bad ear infection. What do you suspect?
Brain abscess
57
What study is contraindicated in a brain abscess?
Lumbar puncture
58
TX of a brain abscess
-IV abx for 6-8 weeks
-Then oral abx for 2-3 months
Dexamethasone/Mannitol for swelling
59
Young woman presents with HA and visual disturbances. You discover papilledema on retinal exam and ask about medications. She says she's on OCPs and is on Tetracycline for acne control. What do you suspect?
Pseudotumor cerebri
60
What will you find on a CT of a patient with pseudotumor cerebri
Small or normal ventricles
61
Tx of a young woman with pseudotumor cerebri
- Acetazolamide
- Topiramate
- Corticosteroids
62
Genetic mutation associated with neurofibromatosis type 1
NF1 gene on chromosome 17
63
Genetic mutation associated with neurofibromatosis type 2
NF2 gene on chromosome 22
64
What can happen if you leave pseudotumor cerebri untreated?
Vision loss from optic nerve atrophy
65
Genetic mutation associated with Parkinsonism
LRRK2 gene
66
Medications used to treat benign essential tremor
- Propranolol
| - Primidone (antiepileptic drug)
67
What do you need to be careful of if you're using Primidone to treat benign essential tremor?
Can cause serious withdrawal symptoms - so cannot stop it abruptly
68
Tapping over the bridge of the nose produces a sustained blink response (sign)
Myerson sign
69
Genetic mutation associated with Huntington's disease is on what chromosome?
4
70
41yo woman presents with chorea. Her husband says she's been acting weird and can't seem to remember things like she used to. What do you suspect?
Huntington's disease
71
What PET scan changes would you expect to find in a patient with Huntington's?
Decreased glucose utilization
72
Tx options for restless leg syndrome
- Long-acting dopamine agonists like Pramipexole and Ropinirole
- Benzodiazepines
- Gabapentin
73
Patient presents to clinic with a change in her gait. She says she feels like her feet are stuck to the floor like magnets. She also complains of urinary incontinence and feels like she can't remember things like she used to. What do you suspect?
Normal pressure hydrocephalus
74
72yo male is brought in by his wife because his behavior has become incredibly impulsive and she feels something's wrong. She also admits that his libido has been very active and he's constantly trying to encourage her to engage in intercourse with him. What do you suspect?
Behavioral variant of frontotemporal dementia
75
What cranial changes are present in the behavioral variant of frontotemporal dementia?
Right front lobe atrophy
76
Why is tx of dementia with Lewy bodies complicated?
Because neuroleptics exacerbate the movement disorder, and dopaminergic drugs exacerbate the psychiatric symptoms
77
If a patient has semantic frontotemporal dementia, what kind of cranial changes would you likely find?
Atrophy of the temporal lobes
78
If a patient is diagnosed wit progressive non-fluent frontotemporal dementia, what kind of cranial changes would you expect to find?
Atrophy of the left frontal lobe
79
Forms of multiple sclerosis
- Relapsing-remitting
- Secondary progressive
- Primary progressive
80
On an MRI of a patient with MS, what do hypointense "black holes" indicate?
Permanent axonal damage
81
On an MRI of a patient with MS, what do hyperintense lesions indicate?
New lesion
82
Coma patient is lying with her feet in plantar flexion and her arms/wrists brought in toward her chest. What position is this?
Decorticate
83
Coma patient is lying with her feet in plantar flexion and her arms and wrists by her side and facing away from her body. What position is this?
Decerebrate
84
Coma patient is lying in decerebrate position. Where is the lesion in her brain?
Midbrain or rostral pons
85
Coma patient is lying in decorticate position. Where is the lesion in her brain?
Rostra cerebral peduncle or the internal capsule
86
Coma patient's eyes conjugately move to "look" to one side. Where is the lesion?
- Ipsilateral hemispheric lesion
| - Or a contralateral pontine lesion
87
Coma patient's eyes both "look" down. Where is the lesion?
Mesencephalic lesion
88
Coma patient's eyes have dysconjugate deviation. Where is the lesion
Brainstem
89
Coma patient's eyes are moving like a doll's eyes. Where is the lesion?
Brainstem
90
Episodes of breathing alternating with apnea
Cheyene-strokes breathing
91
Cheyene-strokes breathing
Episodes of breathing alternating with apnea
92
What does cheyene-strokes breathing indicate?
Bihemispheric, diencephalic, or metabolic disease
93
Atactic breathing
Irregular breathing pattern
94
Irregular breathing pattern
Atactic breathing
95
What does atactic breathing indicate?
Lower pontine tegementum or medulla lesion
96
What does central neurogenic hyperventilation indicate?
Lesion in the brainstem tegmentum
97
What does apneustic breathing indicate?
Damage to the pontine
98
Prominent end-respiratory pauses in a coma patient
Apneustic breathing
99
Apneustic breathing
Prominent end-respiratory pauses
100
MCC of death in young people
Trauma
101
Signs of a basilar skull fracture
- Raccoon eyes
- Battle's sign
- CSF leak
102
What drug can you administer to a person with a CSF leak?
Acetazolamide
103
Is conduction velocity normal or slowed in axonal peripheral neuropathies?
Normal-slightly slowed
104
Is conduction velocity normal or slowed in demyelinating PNs?
Very slowed
105
Are we able to actually treat axonal or demyelinating peripheral neuropathies?
Demyelinating
106
Chromosome containing the genetic mutation associated with Charcot-Marie-Tooth
17
107
How do we describe the polyneuropathy distribution associated with diabetes?
"Stocking and glove"
108
Does uremic PN affect the upper or lower limbs more?
Lower
109
Describe the weakness that's associated with Guillian-Barre syndrome (where in the body)
Usually starts in the legs and then involves the arms and face
110
Patient presents with weakness of the legs and impaired sphincter function. You note tachycardia and HTN on physical exam and ask about her medical history and she said she just received a series of inoculations before starting PA school. What do you suspect?
Guillian-Barre syndrome
111
CSF changes associated with Guillian-Barre syndrome
High protein, but normal cell count
112
Tx options for Guillian-Barre syndrome
Plasmophoresis, IVIG
113
How does chronic inflammatory polyneuropathy (CIDP) differ from Guillian-Barre syndrome?
- CIDP is steadily progressive over months/years
| - Treatment
114
Patient presents with changes to her vision and upper lid lag that doesn't occur all the time. She says it's worse before she begins her menstrual cycle and gets better if she rests her eyes for a while. What do you suspect?
Myasthenia gravis
115
Tx for CIDP
- Steroids
| - IVIG
116
Carpal tunnel syndrome involves compression of which nerve?
Median nerve
117
What usually causes radial nerve neuropathy?
Injury in the axilla
118
Damaged lateral femoral cutaneous nerve
Meralgia paresthetica
119
Meralgia paresthetica involves what nerve?
Lateral femoral cutaneous nerve
120
Inflammatory reaction of the facial nerve at the exit site
Bell's Palsy
121
Bell's palsy tx
Steroids must be started within 5 days of onset!
122
Bell's palsy
Inflammatory reaction of the facial nerve at the exit site
123
Good way to tell the difference between myasthenia gravis and myasthenia syndrome from the patient's description of their symptoms
- MG: Weakness gets worse with use and improves with rest
| - MS: Weakness gets better with use
124
What medications should be avoided in myasthenia gravis?
Aminoglycosides
125
Drug tx for myasthenia gravis
- Anticholinesterase (Neostigmine or Pyridostigmine)
- Steroids if no response
- Azithioprine
126
Drug tx for myasthenia syndrome
-Prednisone, Azathioprine (immunosuppressive)
127
How does clostridium botulinum work?
Toxin prevents the release of acetylcholine and the NM junction and at autonomic synapses
128
What do you need to be made aware of before treating a botulism patient?
If the patient is allergic to horse serum or not
129
Botulism tx
- Trivalent antitoxin
| - Guanidine hydrochloride to facilitate the release of acetylcholine
130
Are periodic paralysis syndrome attacks that occur upon wakening, after exercise, or after a meal and last for days likely hypo-, hyper-, or normokalemic?
Hypokalemic
131
Are periodic paralysis syndrome attacks that occur after exercise and last for about an hour likely hypo-, hyper-, or normokalemic?
Hyperkalemic
132
Tx for normokalemic periodic parlaysis
Acetazolamide
