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**Neurology Case Files > Neurology case files > Flashcards

Neurology case files Flashcards

1
Q

Benign essential tremor next step

A

MRI brain and spine

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2
Q

Benign essential tremor management

A

Primodone or propanolol

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3
Q

6-12 Hz tremor

A

physiologic/essential

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4
Q

Parkinson’s tremor frequency

A

3-6 hz

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5
Q

Essential tremor labs to get

A

r/o: Cu, TFTs, propanolol trial

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6
Q

Huntington’s paph

A

AD CAG expansion repeats on ch 4 huntingtin gene

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7
Q

Huntington’s gross path

A

caudate and putamen atrophy

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8
Q

Juvenile Huntington’s AKA

A

Westphal variant

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9
Q

Inherited dystonia next step

A

MRI brain

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10
Q

Inherited dystonia management

A

Benadryl benztropine / DBS GPi

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11
Q

Primary dystonia paph

A

Ch 9 mutation of Torsin A gene DYT1 causes decreased thalamus inhibition

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12
Q

Parkinson’s Rx

A

Carbidopa-Levodopa. Selegiline/rasagiline. Entacapone/tolcapone (COMT). Bromocriptine, pramipexole, ropinerole

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13
Q

AD spinocerebellar ataxia presentation

A

Insidious onset of gait problems

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14
Q

Spinocerebellar ataxia paph

A

Trinucleotide repeat expansion in ataxin gene. many subtypes

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15
Q

Spinocerebellar ataxia vs Friedrichs

A

SCA is AD, Friedrich’s is AR and presents earlier

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16
Q

Spinal shock presentation

A

Immediate flaccid paresis with ANS signs and areflexia; proresses to spasticity with reflexes

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17
Q

Spinal shock presentation

A

Immediate flaccid paresis with ANS signs and areflexia; proresses to spasticity with reflexes

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18
Q

Localizing level of traumatic spinal injury

A

C5-T1: Above C5 is arm, C5-T1 is mixed arm/leg, below T1 = leg only

Above C3 = respiratory probs bc phrenic paralysis

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19
Q

Brown-Sequard presentation

A

Ipsi motor/sensory at level
Ipsi CST/epicritic
Contra pain below

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20
Q

Anterior cord tracts affected

A

CST and spinothalamic with intact dorsal column

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21
Q

Central cord lesion presentation

A

CST for arms and legs affected

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22
Q

Epidural artery

A

MMA - fast bc arterial bleed

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23
Q

What is Cushing’s response?

A

Inc BP
Dec HR
Dec RR

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24
Q

Concussion management

A

CT to r/o ICH; immobilization

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25
Q

MCL berry aneurysm

A

P comm (CN3 paralysis)

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26
Q

Diagnosis of vasospasm s/p SAH

A

Inc MVA velocity

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27
Q

SAH and hydrocephalus?

A

2/2 destruction of subarachnoid granules from blood - acute communicating

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28
Q

When does vasospasm happen after SAH

A

day 4-14

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29
Q

22 y/o presents with R horner’s syndrome after minor neck trauma next step?

A

Cerebral arteriogram - suspect carotid dissection

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30
Q

Cryptogenic ischemic stroke in a young person - cause?

A

PFO - get TEE

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31
Q

This category of medicine can trigger acute glaucoma

A

anti-cholinergics

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32
Q

This category of medicine can trigger acute glaucoma

A

anti-cholinergics

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33
Q

Reserpine MOA

A

D2 blocker

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34
Q

Tetrabenzine MOA

A

D2 blocker

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35
Q

Lewy body dementia area affected

A

SN of basal ganglia

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36
Q

Lewy body dementia tx

A

Anticholinesterase

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37
Q

Personality decline with sleep hallucinations, dementia, and EPS - dx

A

Subacute combined degeneration from B12 deficiency

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38
Q

How to confirm B12 deficiency neuropathy

A

MRI and nerve conduction study

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39
Q

Marcus Gunn Pupil?

A

APD - light in affected eye does not cause constriction, but light in other eye does cause constriction of first eye

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40
Q

What is ADEM?

A

Acute disseminated encephalomyelitis

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41
Q

causes of ADEM

A

Post-viral of post-vaccine

42
Q

Mechanism of ADEM

A

Perivascular demyelination with mononuclear cell infiltration

43
Q

Presentation of ADEM

A

Post-viral, now HA, AMS, CNS dysfunction

44
Q

MCC bacterial meningitis

A

GBS, GNR
Listeria (neonate)
After: PC, NM, H flu

45
Q

Kernig’s sign

A

Cannot fully extend leg due to pain

46
Q

Brudzinski sign

A

Neck flexion causes involuntary hip flexion

47
Q

Management of acute meningitis - rx

A

Ceftriaxone, vanv, acyclovir, dexamethasone

48
Q

What is the botulism toxin?

A

MMP cleaving V and T snares

49
Q

Botulism paph

A

Symmetrical descending paralysis with fever; prominent anticholinergic effects

50
Q

Botulism paph

A

Symmetrical descending paralysis with fever; prominent anticholinergic effects

51
Q

HIV dementia MRI

A

Frontotemporal cerebral atrophy - myelin pallor

52
Q

Tabes dorsalis timeframe

A

10-20 years after primary syphilis

53
Q

Tabes dorsalis presentation

A

Pain, sensory ataxia, bulbar symptoms, bowel/bladder problems, hyporeflexia

54
Q

Argyll Robertson pupil Ddx

A

MS, sarcoid, Lyme, tabes dorsalis

55
Q

What is a holmes-adie pupil?

A

Midbrain CN3 lesion s/p head trauma better with ice. an autonomic neuropathy. still reactive. give top pilocarpine

56
Q

Ischemic CN VI mononeuropathy presentation

A

Binocular horizontal diplopia with R lateral rectus palsy

57
Q

Herpes Zoster Opticus pres

A

R facial paralysis, r ear pain, r sensorineural hearing loss, blisters

58
Q

Cholesteatoma mech

A

epithelial debris in ear

59
Q

Herpes zoster opticus mech

A

Cerebellopontine angle > out to parotid gland

60
Q

Other weird MG antibody

A

anti-MUSK (membrane enzyme aggregating AcH-R)

61
Q

BPPV vs. Meniere’s

A

BPPV: acute episodes min-hours and no hearing loss
Menieres: episodes are days, pressure and hearing loss

62
Q

Meniere’s technical name

A

Acute labyrinth disease

63
Q

CIDP presentation

A

Slowly progressing SYMMETRIC weakness, stocking-glove pattern sensory loss, normal glucose

64
Q

CIDP unique things

A

Peripheral involvement, plus sensory deficits

65
Q

CIDP LP

A

shows cytoalbuminologic dissociation

66
Q

CIDP tx

A

IVIG for pure motor, steroids for long-term

67
Q

Fibrillations on an EMG indicate damage to:

A

Axons

68
Q

SLow conduction on EMG means:

A

myelin damage

69
Q

Botulism distinct things from AIDP

A

Descending paralysis, dilated pupils, droopy face

70
Q

Proximal muscle weakness, skin rash, Raynaud’s, dysphagia, SOB, arrythmias?

A

Dermatomyositis

71
Q

Dermatomyositis associated diseases

A

CHF, arrhythmias, ovarian cancer

72
Q

Dermatomyositis work-up

A

Anti-Jo Ab

73
Q

Dermatomyositis EMG

A

Decreased motor units

74
Q

Dermatomyositis vs. polymyositis biopsies

A

Dermato: CD4 perivascular vs. CD8 inside fascicle

75
Q

ALS etiology

A

90% sporadic from glutamate overexcitation; 10% hereditary from SOD ch 21

76
Q

ALS tx

A

Riluzole: NMDA antagonist that prevents further damage but doesn’t reverse

77
Q

Terminal care ALS

A

Decrease saliva and allow breathing with anticholinergics and ventilation

78
Q

Carpal tunnel nerve involved

A

Median nerve

79
Q

Carpal tunnel hand findings

A
  1. Thenar/lat 2 lumbrical atrophy
  2. Lateral 3.5 digit sensory loss
  3. ANS loss to most of hand
80
Q

JME symptoms

A

Intact consciousness with seizures related to sleep and sleep deprivation

81
Q

JME treatment

A

valproate

82
Q

west syndrome pres

A

infantile spasms, hypsarrhythmia, developmental regression

83
Q

Lennox gastaut pres

A

Multiple seizures with atypical slow spike 1.5-2 Hz EEG plus developmental delay

84
Q

Which idiopathic epilepsy disorder does NOT resolve on its own?

A

JME

85
Q

Partial seizure drugs to use

A

Phenytoin, carbamazepine, topiramate, levitiracetam, lamotrigine, lacosamide

86
Q

General seizures drugs to use

A

Valproate, ethosuxamide, topiramate, levitiracetam, lamotrigine, zonisamide

87
Q

Simple febrile seizure

A

3 mo-5 year, generalized,

88
Q

Complex febrile seizure

A

Focal, >15 min, >1 in 24h

89
Q

LP in febrile seizure when?

A
90
Q

Coprolalia

A

shouting obscenities

91
Q

Treatment of tourette’s

A

Haldol, pimozide+risperidone; SSRI for behavioral

92
Q

Benign rolandic epilepsy pres

A

Complex partial seizures with nocturnal involvement, inc salivation, loss of consciousness

93
Q

BRE EEG

A

Spikes in unilateral centro-temporal

94
Q

What is Miller-Dieker syndrome?

A

AKA Lissencephaly type 1; abnormal neuronal migration at 3-4 months leads to smooth cerebrum with agyria

95
Q

Miller-Dieker syndrome genetics

A

Chromosome 17 X linked or sporadic

96
Q

What is a glomus tumor?

A

Cerebellopontine angle tumor AKA paraganglioma from neuroepithelial cells

97
Q

MCC mets to brain?

A

Lung > breast > skin > colon > kidney (all hematogenous)

98
Q

MC location for brain mets

A

Supratentorial grey-white junction with hemorrhage and edema

99
Q

What is Werdnig Hoffman disease?

A

AKA spinal muscular atrophy, SMN1 gene testing needed; poor in utero spinal cord development > hip dislocation, LMN disease - low done, low reflexes

100
Q

Werdnig Hoffman in utero findings

A

Polyhydramnios

**Neurology Case Files (2 decks)

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