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Clin Med V and VI > Neurology > Flashcards

Neurology Flashcards

1
Q

Hemicrania continua - Definition and Treatment

A
  • Cluster headaches without remission

- Indomethacin

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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

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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

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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

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5
Q

Migraine accompanied by visual hallucination before or during

A

Classic migraine

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6
Q

Migraine with no associated prodrome

A

Common migraine

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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

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8
Q

Most common type of primary headache?

A

Tension headache

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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

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10
Q

Syndrome of cluster headaches with no period of remission

A

Hemicrania continua

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11
Q

How long does the tonic phase of a tonic-clonic seizure last?

A

< 1 minute

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12
Q

What hormone levels will be elevated in tonic-clonic seizures?

A

Prolactin

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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

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14
Q

How long after alcohol withdrawal begins would an withdrawal-induced seizure occur?

A

Within 48 hours

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15
Q

MCC of status epilepticus

A

Poor compliance with medications

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16
Q

MCC of a TIA

A

Embolization

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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
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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

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19
Q

Would a TIA patient with < 50% stenosis benefit from a carotid endarterectomy?

A

No

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20
Q

What medications should be initiated if the source of a TIA is an embolization caused by Afib?

A

Anticoagulants

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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
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22
Q

What ABCD2 score should a patient have if you admit them to the hospital?

A

> 3

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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

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24
Q

What is most often the cause of a subarachnoid hemorrhage?

A

An aneurysm of an AVM

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25
Q

If you really suspect a patient has a subarachnoid hemorrhage, but their CT is negative, what can you do to confirm you suspicion?

A

Lumbar puncture to look for RBCs or xanthochromia

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26
Q

What will an occlusion of the opthalmic artery cause?

A

Can be symptomless or can cause amaurosis fugax

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27
Q

What will an occlusion of the anterior cerebral artery (distal to the anterior communicating artery) cause?

A
  • Weakness and sensory loss of the contralateral leg and sometimes arm
  • Rigidity
  • Confusion
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28
Q

What will an occlusion of the anterior cerebral artery (proximal to the anterior communicating artery) cause?

A

Usually well tolerated because of the collateral circulation

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29
Q

What will an occlusion of both anterior cerebral arteries cause?

A

Memory disturbances and behavioral changes

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30
Q

What will an occlusion of the anterior main division of the MCA cause?

A
  • Expressive dysphagia
  • Contralateral paralysis
  • Loss of sensation to the arm, face, and leg
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31
Q

What will an occlusion of the posterior main division of the MCA cause?

A
  • Receptive aphagia

- Homonymous hemianopia

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32
Q

What will an occlusion of both vertebral arteries cause?

A
  • Coma
  • Pinpoint pupils
  • Flaccid quadriplegia
  • Sensory loss
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33
Q

What will an occlusion of the basilar artery cause?

A
  • Coma
  • Pinpoint pupils
  • Flaccid quadriplegia
  • Sensory loss
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34
Q

Patient has a cerebral infarction 2 hours ago. How do you treat them?

A
  • tPA
  • ASA 325mg
  • Prednisone/Mannitol for cerebral edema
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35
Q

Patient with atrial fibrillation presents with a cerebral infarction 1.5 hours ago. How do you treat them?

A
  • tPA
  • ASA 325mg
  • Coumadin
  • Predisione/Mannitol for cerebral edema
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36
Q

MCC of intracerebral hemorrhage

A

Secondary to HTN

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37
Q

Where is the most common location of an intracerebral hemorrhage?

A

In the basal ganglia

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38
Q

Is a CT or MRI the better study for an intracerebral hemorrhage that occurred < 48 hours ago?

A

CT

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39
Q

Which procedure is contraindicated in an intracerebral hemorrhage?

A

Lumbar puncture - can precipitate herniation

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40
Q

What type of medications are good to give patients with an intracerebral hemorrhage and why?

A

Seizure prophylaxis because blood is very irritating to the brain

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41
Q

At what types of vascular structures do saccular aneurymsms tend to occur?

A

At arterial bifurcations

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42
Q

Where are most aneurysms located?

A

On the anterior part of the circle of Willis

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43
Q

Imaging study for aneurysm

A

Angiography

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44
Q

We don’t usually operate on aneurysms unless they’re how large?

A

> 10 mm

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45
Q

Tx recommendation for an aneurysm < 10mm

A

Yearly CTA/MRA to monitor

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46
Q

Where are most supratentorial AVMs located?

A

In the territory of the MCA

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47
Q

Are small or large AVMs more likely to bleed?

A

Small

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48
Q

Imaging studies for AVMs

A
  • CT without contrast

- Arteriography

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49
Q

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?

A

Intracranial venous thrombus

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50
Q

Tx recommendations for intracranial venous thrombus

A
  • Seizure prophylaxis

- Anticoagulation with Heparin, followed by Coumadin

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51
Q

What types of neoplasms are most likely to metastasize to the leptomeninges?

A
  • Breast carcinoma
  • Lymphoma
  • Leukemia
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52
Q

What CSF changes would you expect to find in a patient with leptomeningeal metastasis?

A
  • Cancer cells
  • Decreased glucose
  • Increased protein
  • Increased CSF pressure
  • Pleocytosis
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53
Q

Brain tumor that is rapidly progressing and is usually unable to be removed by surgery

A

Glioblastom

54
Q

Brain tumor that is usually no able to be completely surgically excised, but may progress slowly (even over several years)

A

Astrocytoma

55
Q

Brain tumor that usually originates from the dura or arachnoid mater and that can usually be surgically excised

A

Meningioma

56
Q

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?

A

Brain abscess

57
Q

What study is contraindicated in a brain abscess?

A

Lumbar puncture

58
Q

TX of a brain abscess

A

-IV abx for 6-8 weeks
-Then oral abx for 2-3 months
Dexamethasone/Mannitol for swelling

59
Q

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?

A

Pseudotumor cerebri

60
Q

What will you find on a CT of a patient with pseudotumor cerebri

A

Small or normal ventricles

61
Q

Tx of a young woman with pseudotumor cerebri

A
  • Acetazolamide
  • Topiramate
  • Corticosteroids
62
Q

Genetic mutation associated with neurofibromatosis type 1

A

NF1 gene on chromosome 17

63
Q

Genetic mutation associated with neurofibromatosis type 2

A

NF2 gene on chromosome 22

64
Q

What can happen if you leave pseudotumor cerebri untreated?

A

Vision loss from optic nerve atrophy

65
Q

Genetic mutation associated with Parkinsonism

A

LRRK2 gene

66
Q

Medications used to treat benign essential tremor

A
  • Propranolol

- Primidone (antiepileptic drug)

67
Q

What do you need to be careful of if you’re using Primidone to treat benign essential tremor?

A

Can cause serious withdrawal symptoms - so cannot stop it abruptly

68
Q

Tapping over the bridge of the nose produces a sustained blink response (sign)

A

Myerson sign

69
Q

Genetic mutation associated with Huntington’s disease is on what chromosome?

A

4

70
Q

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?

A

Huntington’s disease

71
Q

What PET scan changes would you expect to find in a patient with Huntington’s?

A

Decreased glucose utilization

72
Q

Tx options for restless leg syndrome

A
  • Long-acting dopamine agonists like Pramipexole and Ropinirole
  • Benzodiazepines
  • Gabapentin
73
Q

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?

A

Normal pressure hydrocephalus

74
Q

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?

A

Behavioral variant of frontotemporal dementia

75
Q

What cranial changes are present in the behavioral variant of frontotemporal dementia?

A

Right front lobe atrophy

76
Q

Why is tx of dementia with Lewy bodies complicated?

A

Because neuroleptics exacerbate the movement disorder, and dopaminergic drugs exacerbate the psychiatric symptoms

77
Q

If a patient has semantic frontotemporal dementia, what kind of cranial changes would you likely find?

A

Atrophy of the temporal lobes

78
Q

If a patient is diagnosed wit progressive non-fluent frontotemporal dementia, what kind of cranial changes would you expect to find?

A

Atrophy of the left frontal lobe

79
Q

Forms of multiple sclerosis

A
  • Relapsing-remitting
  • Secondary progressive
  • Primary progressive
80
Q

On an MRI of a patient with MS, what do hypointense “black holes” indicate?

A

Permanent axonal damage

81
Q

On an MRI of a patient with MS, what do hyperintense lesions indicate?

A

New lesion

82
Q

Coma patient is lying with her feet in plantar flexion and her arms/wrists brought in toward her chest. What position is this?

A

Decorticate

83
Q

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?

A

Decerebrate

84
Q

Coma patient is lying in decerebrate position. Where is the lesion in her brain?

A

Midbrain or rostral pons

85
Q

Coma patient is lying in decorticate position. Where is the lesion in her brain?

A

Rostra cerebral peduncle or the internal capsule

86
Q

Coma patient’s eyes conjugately move to “look” to one side. Where is the lesion?

A
  • Ipsilateral hemispheric lesion

- Or a contralateral pontine lesion

87
Q

Coma patient’s eyes both “look” down. Where is the lesion?

A

Mesencephalic lesion

88
Q

Coma patient’s eyes have dysconjugate deviation. Where is the lesion

A

Brainstem

89
Q

Coma patient’s eyes are moving like a doll’s eyes. Where is the lesion?

A

Brainstem

90
Q

Episodes of breathing alternating with apnea

A

Cheyene-strokes breathing

91
Q

Cheyene-strokes breathing

A

Episodes of breathing alternating with apnea

92
Q

What does cheyene-strokes breathing indicate?

A

Bihemispheric, diencephalic, or metabolic disease

93
Q

Atactic breathing

A

Irregular breathing pattern

94
Q

Irregular breathing pattern

A

Atactic breathing

95
Q

What does atactic breathing indicate?

A

Lower pontine tegementum or medulla lesion

96
Q

What does central neurogenic hyperventilation indicate?

A

Lesion in the brainstem tegmentum

97
Q

What does apneustic breathing indicate?

A

Damage to the pontine

98
Q

Prominent end-respiratory pauses in a coma patient

A

Apneustic breathing

99
Q

Apneustic breathing

A

Prominent end-respiratory pauses

100
Q

MCC of death in young people

A

Trauma

101
Q

Signs of a basilar skull fracture

A
  • Raccoon eyes
  • Battle’s sign
  • CSF leak
102
Q

What drug can you administer to a person with a CSF leak?

A

Acetazolamide

103
Q

Is conduction velocity normal or slowed in axonal peripheral neuropathies?

A

Normal-slightly slowed

104
Q

Is conduction velocity normal or slowed in demyelinating PNs?

A

Very slowed

105
Q

Are we able to actually treat axonal or demyelinating peripheral neuropathies?

A

Demyelinating

106
Q

Chromosome containing the genetic mutation associated with Charcot-Marie-Tooth

A

17

107
Q

How do we describe the polyneuropathy distribution associated with diabetes?

A

“Stocking and glove”

108
Q

Does uremic PN affect the upper or lower limbs more?

A

Lower

109
Q

Describe the weakness that’s associated with Guillian-Barre syndrome (where in the body)

A

Usually starts in the legs and then involves the arms and face

110
Q

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?

A

Guillian-Barre syndrome

111
Q

CSF changes associated with Guillian-Barre syndrome

A

High protein, but normal cell count

112
Q

Tx options for Guillian-Barre syndrome

A

Plasmophoresis, IVIG

113
Q

How does chronic inflammatory polyneuropathy (CIDP) differ from Guillian-Barre syndrome?

A
  • CIDP is steadily progressive over months/years

- Treatment

114
Q

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?

A

Myasthenia gravis

115
Q

Tx for CIDP

A
  • Steroids

- IVIG

116
Q

Carpal tunnel syndrome involves compression of which nerve?

A

Median nerve

117
Q

What usually causes radial nerve neuropathy?

A

Injury in the axilla

118
Q

Damaged lateral femoral cutaneous nerve

A

Meralgia paresthetica

119
Q

Meralgia paresthetica involves what nerve?

A

Lateral femoral cutaneous nerve

120
Q

Inflammatory reaction of the facial nerve at the exit site

A

Bell’s Palsy

121
Q

Bell’s palsy tx

A

Steroids must be started within 5 days of onset!

122
Q

Bell’s palsy

A

Inflammatory reaction of the facial nerve at the exit site

123
Q

Good way to tell the difference between myasthenia gravis and myasthenia syndrome from the patient’s description of their symptoms

A
  • MG: Weakness gets worse with use and improves with rest

- MS: Weakness gets better with use

124
Q

What medications should be avoided in myasthenia gravis?

A

Aminoglycosides

125
Q

Drug tx for myasthenia gravis

A
  • Anticholinesterase (Neostigmine or Pyridostigmine)
  • Steroids if no response
  • Azithioprine
126
Q

Drug tx for myasthenia syndrome

A

-Prednisone, Azathioprine (immunosuppressive)

127
Q

How does clostridium botulinum work?

A

Toxin prevents the release of acetylcholine and the NM junction and at autonomic synapses

128
Q

What do you need to be made aware of before treating a botulism patient?

A

If the patient is allergic to horse serum or not

129
Q

Botulism tx

A
  • Trivalent antitoxin

- Guanidine hydrochloride to facilitate the release of acetylcholine

130
Q

Are periodic paralysis syndrome attacks that occur upon wakening, after exercise, or after a meal and last for days likely hypo-, hyper-, or normokalemic?

A

Hypokalemic

131
Q

Are periodic paralysis syndrome attacks that occur after exercise and last for about an hour likely hypo-, hyper-, or normokalemic?

A

Hyperkalemic

132
Q

Tx for normokalemic periodic parlaysis

A

Acetazolamide

Clin Med V and VI (5 decks)

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