Neurology: PreTest Flashcards
1
Q
Imaging to look at demyelinating disorder
A
T2-weighted MRI
2
Q
Can Parkinson’s be one-side dominant/focal?
A
yes
3
Q
Cause of tremor in the hands: most obvious when the patient is awake and trying to perform an action
A
Cerebellum
4
Q
Phenytoin toxicity presentation
A
- nystagmus
- ataxia
- dysarthria
- impaired judgement
- lethargy
5
Q
CN injury that leads to increased sensitivity to sound
A
- CNVII
- facial nerve innervates the stapedius muscle of the middle ear
- m. paralysis ==> undamped transmission of acoustic signals ==> hyperacusis
- hyperacusis = damage to the facial n. close to its origin bc branch to stapedius muscle is one of the first
6
Q
Fasciculations under the tongue ==> CN injury?
A
CN XII
can occur w/brainstem dz (stroke or bulbar ALS) vs. transection of CN XII
7
Q
Warm water in ear canal ==>
A
- warm water indicates to brain that the head is moving to the side that is being warmed
- eyes deviate to the opposite side to maintain fixation on their targets
- reflex nystagmus toward the ear that is being stimulated develops as the brain tries to establish refixation while the vestibular signals repeatedly prompt deviation of the eyes contralateral to the warm stimulus.
8
Q
Bell’s palsy complication
A
- injury to facial n. ==> abberant regeneration
- ==> fibers intended for certain areas are mixed up ==> abnormally coordinated facial movements (i.e. mouth twitch with wink/blink)
9
Q
Tentorium cerebelli =
A
fold of meninges
10
Q
Calcified vs. vascular lesions of CT
A
- Calcified masses appear hyper- dense without contrast enhancement
- vascular lesions may appear dense w/intravenous contrast
11
Q
Dydiadochokinesia testing/cause
A
- rapid tapping of one side of hand/tapping heel or toe-heel tapping
- 2/2 cerebellar damage
12
Q
EEG wave in relaxed, closed eyes adult
A
- α wave activity 8 to 13 Hz over the posterior aspects of head
- α activity disappears with eye opening,less obvious as drowsiness increases
13
Q
Test for inflammatory myopathy
A
- CPK
- EMG
- M. biopsy
14
Q
CSF in Guillain-Barre
A
- xanthochromic (i.e., yellow) because of the high protein content of the fluid
- viscous 2/2 protein
- protein up to/> 1g
- normal cell count
15
Q
CSF in subarachnoid hemorrhage
A
- yellow
- RBCs +++
- slightly elevated WBC count
- elevated protein
- slightly elevated opening pressure
16
Q
Sx/presentation of subarachnoid hemorrhage
A
- sudden severe H/A
- head trauma/LOC
- neck stiffness
- photophobia
- vomiting
17
Q
pure sensory stroke is most likely with damage to the?
A
thalamus
18
Q
pure motor stroke is most likely with damage to the?
A
internal capsule
19
Q
Nucleus ambiguus locations/nerves
A
- ventrolateral medulla
- motor neurons ==> CNIX and CNX
20
Q
Nucleus ambiguus injury ==> deficits?
A
- hoarseness
- dysphagia
21
Q
Wallenberg syndrome definition
A
- lateral medullary syndrome -infarction involving some or all of the structures @ lateral medulla:
- nucleus and descending tract of CNV
- nucleus ambiguus
- lateral spinothalamic tracts
- inferior cerebellar peduncle
- descending sympathetic fibers, vagus, and glossopharyngeal nerves.
22
Q
Deficits in Wallenberg/lateral medullary syndrome
A
- ipsilateral ataxia and ipsilateral Horner syndrome
- CNV ==> ipsilateral loss of facial pain and temperature + ipsilateral impairment of the corneal reflex
- lateral spinothalamic ==> pain and temp disturbances contralateral to the injury @ the limbs/trunk
- n. ambiguus ==> dysphagia and dysphonia
23
Q
Most common cause of Wallenberg/lateral medullary syndrome
A
vertebral artery occlusion
24
Q
Most common cause of cerebral hemorrhage in pt.s w/out HTN
A
Cerebral amyloid angiopathy (CAA) (congophilic angiopathy)
25
Typical presentation of Cerebral amyloid angiopathy (CAA) (congophilic angiopathy)
- deposition of β-amyloid protein (the same as that found in Alzheimer’s disease) in brain blood vessels ==> disruption of the vessel walls
- age 70+ and may present with multiple cortical hemorrhages (might be detected with gradient echo MRI)
- with or without a history of dementia
26
Lesion that is the same on enhanced and unenhanced CT = ?
hematoma
27
Mycotic aneurysm characteristics
- small aneurysm that develops from an infected embolus from endocarditis
- bleeding usually ==> subarachnoid space
28
Brain/neuro abnormality assoc. w/Sturge-Weber
- leptomeningeal angiomas
| - hemiparesis or hemiatrophy on the side of the body opposite the port-wine nevus
29
Hemangioblastoma associations
1. Polycystic kidney disease
| 2. VHL/telangiectasia of the retina
30
Charcot-Bouchard aneurysm characteristics
-small/microscopic
-assoc. w/chronic HTN
-most commonly @ lenticulostriate
==> putamen hematoma OR @ dentate nucleus of cerebellum
31
A lesion at which vessel will ==> CNIII palsy
post. communicating artery
32
Presentation of internal carotid artery disease
episodes of ipsilateral transient monocular blindness (amaurosis fugax) and contralateral transient ischemic attacks consisting of motor weakness
33
Evaluation of TIA w/vision impairment + contralateral weakness
Carotid a. doppler US
34
Adverse effects of phenytoin infusion
cardiac arryhthmia
35
Carbamazepine: oral vs. IV
IV
36
Adverse effects of phenobarbitol infusion
hypotension
respiratory depression/arrest
less effects on cardiac activity
37
Initial eval in new simple partial seizure
imaging: preferably MRI
38
Most common complication of temporal lobectomy
- visual field defect due to interruptions of fibers from optic tract
- sup. quadrantanopsia > hemianopsia
39
Characteristics of Jacksonian march
- sequential seizure,
- focal seizure activity (mostly motor) that spreads
- often secondarily generalizes, ==> generalized TC seizure
- hand/face = common site for the start
40
Good drug in complex partial seizures w/out gen. in a young person
carbamazepine
41
Characteristics of West syndrome
- generalized seizure disorder of infants characterized by recurrent spasms
- EEG pattern = hypsarrhythmia, and retardation
- assoc. w/other dz including tuberous sclerosis
42
Tx for infantile spasms
Adrenocorticotropic hormone
43
Absence sz. tx
1. ethosuximide
| 2. divalproez sodium
44
Classic vs. Basilar migraine
- character and severity of neurologic deficits assoc. w/basilar migraine are distinct.
- visual change ==> blindness
- irritability ==> psychosis
- mild hemiparesis ==> transient quadriplegia
- Stupor, syncope, and even coma may appear and persist for hours
45
Causes/assoc. w/trigeminal neuralgia
- MS
- basilar artery aneurysms
- acoustic schwannomas
- posterior fossa meningiomas
46
trigeminal neuralgia vs. atypical facial pain
- trigeminal = paroxysmal, lancinating vs. atypical = deep, constant
- trigeminal = unilater vs. atypical unilateral or bilateral
47
Cluster H/A characteristics
-clustered in time/season
-origin @ eye ==> temporal area
-men > women
-
48
trauma to elbow ==> n. imjury? ==> deficits?
-ulnar n. injury
| ==> weakness @ interosseus and ulnar lumbrical m. of hand ==> clawhand deformity
49
humerus injury + inability to flex elbow ==> dx?
musculocutaneous n. injury
50
wristdrop ==> n/ injury?
radial n.
51
tx of neuro problems assoc. w/epidural hematoma
craniotomy
52
eldery person w/minor trauma followed by progressive dementia ==> dx?
chronic subdural hematoma
53
Common site of injury in MVC with head hitting windshield
- temporal lobe
- cribiform plate
- middle cranial fossa
54
Common long-term CN deficit after traumatic head injury (e.g. MVC)
anosmia +/- ageusia 2/2 avulsion of olfactory n. rootlets
55
Most common neuro injury associated w/sarcoid
CNVII ==> facial paresis
56
Most common cause of fungal meningitis
cryptococcus
57
Neurologic lesion associated with Schistosoma mansoni
- S.mansoniisendemicin Puerto Rico and may produce a subacutely evolving paraparesis
- granulomatous lesions around fluke ova crush the cord
58
Characteristics of taenia echinococcus infection
- Echinococcosisisusually acquired by eating tissue from infected sheep
- Children > adults
- ==> encephalic hydatidosis = major cyst w/multiple compartments w/smaller cysts
- hydatid cyst can be ~tumor ==> focal deficits
59
Imaging if suspected mass or infection?
Contrast CT = greater sensitivity than noncon CT for tumor or abscess
60
Characteristics/tx of PML
- common in HIV/immunosuppressed
- caused by JC virus
- no antiviral tx; use HAART in HIV
61
Typical location of herpes encephalitis
- HSV-1
| - typically @ medial temporal or orbito-frontal
62
Lesions caused by toxoplasmosis in AIDS patients
granulomas and abscesses
63
CNS infections of both HIV and CMV ==> ?
microglial nodules
64
Most common CN injury with Lyme dz?
CNVII ==> facial paralysis
65
The medication most appropriate in patients with CNS involvement by B. burgdorferi is ?
Ceftriaxone
66
most common site for abscess formation in the brain?
gray-white jxn
67
fungal malignant external otitis and osteomyelitis of the base of the skull in HIV patients is most commonly caused by ?
aspergillus
68
Characteristics of spongiform encephalopathy?
- usually Creutzfeldt-Jakob dz
- dementia, tremor, ataxia, and myoclonus
- MRI = a subtle increase in signal @ basal ganglia bilaterally
- EEG = disorganized background activity with periodic sharp-wave discharges bilaterally
- normal CSF
- can be transmitted from human brain tissue (grafts) or growth hormone
69
Tabes dorsalis characteristics
- treponema pallidum
- leptomeningitis ==> degen. of posterior columns of the spinal cord and dorsal root ganglia
- gait ataxia and positive Romberg sign
- loss of Bladder and bowel control
- argyll robertson pupils
70
Subacute sclerosing panencephalitis characteristics
- occurs in children/young adults who had measles
- demylenating dz ==> death in 1-3yrs
- CSF: increased gamma globulin/oligoclonal bands
71
Bartonella hensalae characteristics
- cat-scratch dz
- regional adenitis, freq. w/epitrochlear nodes
- ==> meningitis
72
most common sources of primary brain tumors = ?
glial cells
73
most common type of primary brain tumors = ?
astrocytoma
74
tumor type that is common in patients with AIDS, but otherwise extremely rare = ?
primary lymphoma
75
Characteristics of hypothalamic hamartoma
- nonneoplastic malformation of neurons and glia @ ~hypothalamus
- ==> neuroendocrine changes: prec. puberty, acromegaly
- assoc. w/paroxysms of laughter
76
Complication of tumor @ posterior fossa
herniation
77
Complication of NF1
optic tumors (e.g. optic glioma)
78
Complication of lung cancer that ==> lethargy, weakness, areflexia
- hypercalcemia
- 2/2 parathyroid-related peptide secreted by tumor
- can ==> convulsions, coma
79
B-glucosidase deficiency ==> ?
- ==> Gaucher dz
- glucosulceramide accumulation
- ==> HSM, CNS dz
80
Anatomic change in brain 2/2 hepatic dz
- increased alz. type II astrocytes
| - EtOH/thiamine def. ==> decreased purkinje cells @ cerebellum
81
(CSF) protein content with either uremic encephalopathy or hypertensive encephalopathy = ?
usually ~60-10
82
most common neurologic complication of chronic renal failure = ?
peripheral neuropathy
83
Tx of restless leg syndrome
clonazepam, gabapentin, L-dopa, and opiates
84
visual field cut most often seen with vitamin B12 defi- ciency = ?
Centrocecal scotoma
85
Onset of benzodiazepine w/drawal
may be early but can be delayed by 7-10 days
86
Vitamin E deficiency ==> ?
- onset @ childhood
- spinocerebellar degeneration, polyneuropathy, and pigmentary retinopathy
- common sx = ataxia
87
Characteristics of Pickwickian syndrome
Obesity associated with hyper- somnia qualifies as Pickwickian syndrome if the patient exhibits other characteristic features, such as sleep apnea.
88
Cleaning fluid ingestion ==>
hepatic toxicity
89
Characteristics of normal pressure hydrocephalus
- wet, wacky, wobbly
- chronic, communicating form of hydrocephalus affecting elderly adults
- may relate to prior episodes of trauma, infection, or subarachnoid hemorrhage
- triad of gait disturbance, dementia, and incontinence
90
Complication of VP shunt placement
subdural hematoma (2/2 decreased pressure ==> shearing of bridging veins)
91
Med shown to slow progress/improve outcomes in alzheimers dz?
- donepezil
| - Vitamin E
92
Clinical features of Alzheimer's dz?
- memory impairment, aphasia, apraxia, and neuropsychiatric impairment
- language disturbance: decreased fluency, dysnomia, and transcortical sensory aphasia,
93
CJD characteristics
ataxia, clumsiness, or dysarthria, as well as diplopia, distorted vision, blurred vision, field defects, changes in color perception, and visual agnosia
94
Caudate atrophy in huntington's dz ==> ?
- deformation of frontal tip of lateral ventricle
| - lateral ventricle = ~rhomboid
95
Lewy bodies = ?
intracytoplasmic inclusion bodies
96
Trihexyphenidyl (Artane): MOA, use
- anticholinergic drug
| - decrease signs of parkinsonism caused by drugs that interfere with dopamine
97
Miegs' syndrome characteristicsq
focal dystonia characterized by blepharospasm, forceful jaw opening, lip retrac- tion, neck contractions, and tongue thrusting
98
CSF in MS
-Persistently elevated IgG, even between flares
99
evoked response pattern that is most often abnormal in patients with early MS = ?
-visual evoked response 2/2 optic neuritis commonly occuring early in dz
100
Canavan's dz characteristics
- developmental regression @ ~ 6 months of age
- defect in N-acetylaspartic acid metabolism ==>
- macrocephaly
- extensor posturing and rigidity
- myoclonic seizures
101
What worsens MS?
hot weather, fatigue, illness
102
Leber’s optic atrophy characteristics
- centrocecal scotoma
| - mitoDNA inheritance
103
White matter dz assoc. w/adrenal dysfxn?
- adrenoleukodystrophy
- some x-linked
- presents in childhood
- limb ataxia, nystagmus, mental retardation
104
Triorthocresyl phosphate poisoning ==> ?
- in rat poison/roach powder/insecticide
- ==> HA, vomiting, abdominal cramps, sweating, wheezing, twitching
- massive motor polyneuropathy ==> death
105
Acute lead poisoning in children ==>
massive brain edema
106
Mercury poisoning ==> ?
- "mad hatter" (felt/hat manufacture)
| - personality changes, tremor, and ataxia
107
Arsenic poisoning ==> ?
- TC seizures vs. encephalopathy
- hemolysis
- polyneuropathy
108
Ergot poisoning ==> ?
- Ergot = vasoconstricting agent derived from the rye fungus, Claviceps purpurea
- degeneration of the posterior columns and dorsal roots + peripheral neuropathy
109
Manganese poisoning ==> ?
~wilson's disease
| -parkinsonism
110
Agents that can induce parkinsonism
- phenothiazines
- butyrophenones
- metoclopramide (Reglan)
- manganes
111
Tunnel vision vs. concentric constriction
- @ CC: area perceived enlarges as the test screen is moved farther away from the patient, but the overall visual field is always smaller than the normal visual field
- @ TV: same size field even as the test screen is removed further away = conversion d/o
112
Characteristics of retinitis pigmentosa
- most common form of retinal degen.
- hereditary degenerative disease @ retinal receptors and adjacent pigment cells ==> pigment accumulation at periphery
- ==> optic disc pallor
113
Absent red reflex ==> dx?
- congenital cataracts
| - white reflex = Rb?
114
acute/abrupt central scotoma = dx?
methyl alcohol intoxication
115
Papillitis vs. papilledema
- papillitis = inflammation of optic n. head ==> vision loss + pain with eye movement
- papilledema = elevated ICP, no major visual loss
116
Injuries to the macula or fovea centralis ==> ?
severe loss of visual acuity
117
Pt w/double vision. that disappears if she covers either eye ==> dx?
- CN 6 palsy
| - most common oculomotor palsy
118
Most common CN involved in facial zoster?
CN IV (because shares n. sheath w.opthalmic division of trigeminal)
119
Evidence of internuclear ophthalmoplegia (INO) indicates ??
mesenchephalic or pontine injury
120
ocular bobbing characteristics and inidication
- ocular bobbing = rapid downward deviation of both eyes followed by slow upward conjugate eye movements probably
- develops with pontine damage (or occ. cerebellar damage)
121
Characteristics of retinal a. occlusion
- retina appears cloudy and grayish yellow with narrowed arterioles
- fovea appears cherry red
- vessels appear to have segmented columns of blood
122
Characteristics of benign tonic pupillary dilatation
- poorly responsive, dilated pupils @ young, healthy woman
- no change in vision
- +/- absent reflexes
123
Argyll Robertson Pupil
- 2/2 neurosyphilis
| - reacts poorly to light but accommodates well
124
Optic neuritis ==> visual field cuts?
loss of both visual fields in a single eye
125
Damage to L. occipital lobe ==> visual field cuts?
right homonymous hemianopsia
126
Lesion impinging on optic chiasm from one side ==> visual field cuts?
- field cut in the contralateral field of the contralateral eye
- ipsilateral eye may exhibit little more than an enlarged blind spot that impinges on central vision = "centrocecal scotoma"
