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neuroUworld Flashcards

1
Q

anterior disclocation of the humeral head damages what nerve

A

axillary and also possibly axilary artery

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2
Q

paralysis of delotoid and teres minor and loss of sensation over the lateral upper arm

A

axillary nerve lesion

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3
Q

causes of radial nerve injury

A

fracture of the humeral midshaft and use of improperly fit crutches

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4
Q

wrist drop and sensory loss on the posterior arm, forearm, and lateral dorsal hand

A

radial nerve

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5
Q

fracture of the medial epicondyle injurs what nerve

A

ulnar

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6
Q

deep lacerations of the anterior wrist

A

injure the ulnar nerve

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7
Q

long thoracic nerve innervates what

A

serratus anterior muscle

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8
Q

deep lacerations of the axillary region damage what

A

long thoracic nerve

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9
Q

scapular winging

A

damage to long thoracic nerve

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10
Q

tuberoinfundibular pathway

A

one of four major dopamine pathways in the brain; dopamine release at this site regulates prolactin secretion by the antpit; when antipsych block dopamine, they can affect this

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11
Q

mesocortical pathway

A

one of four dopamine pways in the brain; essential in cognitive control and emotional response

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12
Q

nigrostriatal pway

A

one of four dopamine pways; important in movement

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13
Q

mesolimbic pway

A

one of four dopamine pways; maybe the reward pway involved in drugs and also hallucinations in schizophrenia

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14
Q

2 drugs that are the first line treatment for generalized tonic clonic and partial seizures

A

carbamazepine, phenytoin

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15
Q

how do carbamazepine and phenytoin work

A

block the sodium channels

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16
Q

phenobarbitol target

A

GABA receptors

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17
Q

mixed seizures first line

A

lamotrigine

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18
Q

what are the second gen anti-psychotics? (which are actually first line)

A

rispiradone, olanzipine, quetiapine, aripiprazole, ziprasidone, paliperidone

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19
Q

gold standard for treatment resistant schizophrenia

A

clozapine; high risk of agranulocytosis, which is why it is reserved for those who have failed other treatemtn

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20
Q

sertraline

A

used for mood and anxiety disorders

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21
Q

headache, tenderness in temporal region, prox muscle weakness

A

temporal arteritis

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22
Q

triad of dementia, gait apraxia, and urinary incontinence

A

normal pressure hydrocephalus

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23
Q

causes of frontotemporal dementia

A

pick’s disease and other tau-pos etiologies

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24
Q

Lewy body dementia

A

like alzheimers but present with visual hallucinations, alterations in alertness, and extrapyramidal sx

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25
Q

type of memory loss in alzheimers

A

anterograde

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26
Q

choreathoid movments, behavioral distrubances, and dementia

A

huntigntons

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27
Q

dementia with megaloblastic anemia and dorsal spinal column sx

A

B12 def

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28
Q

most common cause fo b12 def

A

pernicious anemia

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29
Q

ataxia, opthalmoplegia, and confusion

A

wernicke

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30
Q

confabulation and amnesia plus wernicke’s

A

korsakoff

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31
Q

uncal herniation causes ipsilateral hemiparesis how?

A

compression of the contralat crus cerebri against the tentorial edge

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32
Q

mydriasis, ptosis, and down and out gaze during uncal herniation

A

compression of ipsilateral CN 3

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33
Q

contralateral homonymous hemianopsia in uncal herniation

A

compression of ipsilat posterior cerebral artery (causing ischemia of visual cortex)

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34
Q

how does uncal herniation cause loss of consciousness

A

compression of reticular formation

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35
Q

cushing’s reflex

A

hypertension, bradycardia, and resp depression; indicates elevated ICP

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36
Q

causes of accessory nerve dysfunction

A

lesions in the medulla, such as occlusion of PICA

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37
Q

abducens (CN 6) lesion in uncal herniation

A

happens later on; LR is out

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38
Q

where does the facial nerve originate?

A

pontomedullary junction; lesions there result in contralat lower facial droop

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39
Q

glossopharyngeal nerve lesion

A

dysfunction of carotid sinus lesion, leading to increased risk of syncope

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40
Q

ipsilateral hemiparesis, impsilateral mydriasis, ipsilateral strabismus and contralat hemianopsia and altered mentation

A

uncal herniation

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41
Q

amaurosis fugax

A

painless loss of vision that lasts a few seconds; usually vascular in origin

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42
Q

most common site of hypertensive hemorrhages

A

putamen; the internal capsule, which lies right next to it, is almost always involved, leading to dense contralat hemiparesis

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43
Q

complete paraplegia, followed by deep coma

A

pontine hemorrhage; pupils are pinpoint but reactive; decerebrate rigidity is present

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44
Q

causes of foot drop

A

trauma to the common peroneal nerve; or damage to any roots that contribute to the common peroneal nerve (L4-S2)

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45
Q

foot drop congenital

A

charcot-marie-tooth disease

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46
Q

tarsal tunnel syndrome

A

entrapment of posterior tibial nerve on the medial aspect of the ankle; numbness on plantar foot,

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47
Q

most common site for lacunar infarct

A

posterior internal capsule, producing a purely motor stroke;

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48
Q

posterior internal capsule

A

corticospinal and corticobulbar fibers run through it

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49
Q

campylobacter jejuni assoc with what

A

guillan barre

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50
Q

ascending muscle weakness wth absent or depressed DTRs; mild sensory sx

A

guillan barre

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51
Q

can you see bulbar sx and resp compromise in GB?

A

yes

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52
Q

treatment of MG

A

cyclosporine and pyridostigmine

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53
Q

riluzole used to treat what

A

ALS

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54
Q

optic neuritis

A

loss of central vision and afferent pupillary defect

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55
Q

scotoma

A

loss of central vision

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56
Q

normal pressure hydrocephalus

A

increaed ventricle size but normal ICP

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57
Q

donepezil

A

acetylcholinesterase inhib used to slow alzheimers

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58
Q

treatment for essential tremor

A

propranolol (the beta blocker)

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59
Q

akathisia

A

sensation of restlessness

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60
Q

cause of hemibalismus

A

due to damage to the contralateral subthal nuc

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61
Q

tyoical features of CJD

A

myoclonus, dementia, sharp triphasics on EEG

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62
Q

defect in aut dom gene on chrom 4

A

huntigtons

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63
Q

pick’s disease

A

neurodegenerative disease of the fronto-temporal lobes;resembles alzheimers but more common in women and personality changes are more prom than cognitive

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64
Q

Wallenberg (lateral medullary)

A

vestibulocerebellar symptoms; loss of pain and temp ipsilateral face and contralat body; ipsilat bulbar muscle weakness; ipsilat horners

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65
Q

lateral pontine vs lateral medullary infarcts

A

pontine is going to affect motor and sensory of CN5; lateral medulla affects CNs 9 and 10

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66
Q

medial medullary syndrome

A

contralat paralysis of arm and leg; tongue deviation toward the lesion; contralat loss of tactile and position sense can occur

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67
Q

medial mid-pontine infarction

A

contralat ataxia and hemiparesis of the face, trunk, and limbs;

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68
Q

what causes wallenberg syndrome

A

occlusion of PICA or vertebral

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69
Q

cavernous sinus

A

CNs 3,4, V1, V2, 6, internal carotid artery

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70
Q

tearing of bridging veins leads to what

A

subdural hematoma

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71
Q

small cell carcinoma of the lung is assoc with what

A

myasthenia or lambert-eaton

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72
Q

DTRs in myasthenia vs lambert-eaton

A

DTRs preserved in MG, not in Lambert-eaton

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73
Q

treatment of cluster headache

A

100% oxygen and sub-q sumitriptan

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74
Q

prevention of cluster headaches

A

verapamil, lithium, ergotamine

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75
Q

Unthoff’s phenomenon and Lhermitte’s sign

A

seen in MS

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76
Q

symptoms of anticholinergic excess

A

red as a beet, dry as a bone, mad as a hatter, hot as a hare, blind as a bat, full as a flask

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77
Q

trihexyphenidol

A

anti-anticholinergic used for parkinsons disease

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78
Q

sudden onset of pain, redness around the eye, and nausea and mid-dilated pupil

A

glaucoma; dx with ocular tonometry

79
Q

why CT of the chest whenever you dx someone with MG

A

a lot have a thymoma

80
Q

metoclopramide-induced dystonic reaction

A

this drug is a dopamine antag used to treat n/v. extrapyramidal symptoms can be seen

81
Q

neuroleptic malignant syndrome

A

caused by adverse reaction to neuroleptic or antipsych drug; characterized by muscle rigidity, fever, autonomic instability

82
Q

three cardinal signs of PD

A

rest tremor, rigidity, bradykinesia; presence of at least two of these confirms the dx

83
Q

first line treatment for RLS

A

dopamine ag; an alternate is gabapentin

84
Q

how do benzos work

A

enhance the inhib effect of GABA

85
Q

does GB have sensory findings

A

no, not usually

86
Q

why would a syringomyelia affect strength in the upper extremities more than lower

A

because the arms run medial in the tract (recall they come down and cross)

87
Q

spondylosis

A

degernative osteoarthritis of the joints of the spine

88
Q

causes of syringomyelia

A

Arnold-Chiari malformation and prior spinal cord injury

89
Q

arnold chiari malformation

A

downward displacement of the cerebellar tonsils causing non-communicating hydroceph

90
Q

edrophonium versus pyridostigmine

A

they are both acetylcholinesterase inhib, but edro is short acting and used for diagnostic purposes only

91
Q

vestibulotoxic drugs

A

aminoglycosides, esp gentamicin

92
Q

meniere’s disease

A

disease of the inner ear that presents with dizziness, hearing loss, and tinnitus

93
Q

cerebellar dysfunction

A

sway toward the side of the lesion

94
Q

rotator cuff

A

SITS; supraspinatus, infraspin, teres minor, subscapularis

95
Q

Popeye sign

A

rupture of tendon of long head of the biceps; biceps muscle belly becomes prominent in the mid upper arm; weakness with supination; forearm flex is preserved

96
Q

injury to long thoracic nerve

A

winged scapula due to damage to serratus anterior; most commonly caused by iatrogenic injury during axillary lymphadenectomy

97
Q

injury to lower brachial plexus

A

C8 and T1; klumpke’s paralysis;

98
Q

symptoms of hypokalemia

A

weakness, fatigue, muscle cramps, rhabdo, cardiac abnormalities

99
Q

flat T waves, U waves, ST depression, and premature ventricular beats

A

hypokalemia

100
Q

GBM on CT/MRI

A

butterfly appearance with central necrosis; serpiginous border means high grade;

101
Q

brain mets on CT/MRI

A

often multifocal; at the gray/white junction or watershed zones; usually spherical in shape

102
Q

how do patients with low grade astrocytoma usually present?

A

seizures

103
Q

people with hypothyroidism have increased risk of carpal tunnel

A

right

104
Q

entrapment of the median nerve at the forearm

A

called pronator teres syndrome

105
Q

median nerve entrapment at the elbow

A

deep flexors of the digits are affected, but cutaneous sensation is not affected

106
Q

alterations in consciousness, disorganized speech, hallucinations, extrapyramidal symptoms, and early compromise of executive function

A

Lewy body dementia

107
Q

key difference between lewy body dementia and parkinsons

A

earlier appearance of dementia in lewy body

108
Q

treatment of lewy body dementia

A

acetylcholinesterase inhib like rivastigmine (achesterase inhib also used to treat alzheimers remember- but not parkinsons)

109
Q

NFTs and senile plaques

A

alzheimers

110
Q

presenting sx of Huntington’s disease

A

mood disturbances, choreiform movements, dementia

111
Q

pick’s disease

A

similar to alzheimer’s but presents at an earlier age; more freq in females;

112
Q

immunocompromised patient with focal neuro deficits

A

PML; does not produce mass effect

113
Q

most common ring enhancing mass lesion in HIV pos patients

A

cerebral toxo

114
Q

symptoms of acute arterial occlusion

A

5 P’s- paresthesia, pain, palor, pulselessness, paralysis

115
Q

symptoms of cerebellar dysfunction

A

intention tremor on dysmetria, impaired rapid alternating movement; muscle hypotonia can be present (increased swinging of knee after eliciting DTR)

116
Q

clasp knife phenomenon

A

rapid decrease in resistance when trying to flex a joint; means UMN lesion

117
Q

what causes normal pressure hydrocephalus

A

decreased CSF absorption

118
Q

amyloid deposisiton in the brain

A

alzheimers

119
Q

where is the facial nerve nucleus

A

in the pons

120
Q

do cranial nerves cross?

A

no, clinical findings are always on the same side as the lesion; however, CN 4 does cross

121
Q

hyperacusis

A

facial nerve issue on that side; think stapedius

122
Q

typical presentation of cerebellar hemorrhage

A

ataxia, headache, vomiting, gaze palsy, facial weakness; can have 6th nerve paralysis, conjugate deviation, blepharospasm, and coma

123
Q

why facial weakness in cerebellar hemorrhage

A

pontine compression due to expanding hematoma from the cerebellum

124
Q

symptoms of putamen hemorrhage

A

the internal capsule lies right next to the putamen, so this is involved. Results in hemiparesis, hemisensory loss, homonymous hemianopsia, stupor, and coma

125
Q

what runs through the internal capsule?

A

motor (corticospinal and corticobulbar) and sensory

126
Q

pontine hemorrhage

A

deep coma and paraplegia; pupils are pinpoint and reactive; there are no horizontal eye movements; decrebrate rigidity

127
Q

PCA supplies what?

A

midbrain, basal gang, thalamus, mesial inferior temporal lobe, occipital and occipitoparietal cortices

128
Q

wernicke’s encephalopathy

A

AMS, gait instability, horizontal hystagmus, conjugate gaze palsy

129
Q

korsakoff’s syndrome

A

ireversible amnesia, confabulation, and apathy

130
Q

autonomic dysfunction in GB?

A

yes, in 70 percent of patients; but remember that sensory is mostly normal

131
Q

Descending paralysis (and therefore early CN involvement)

A

botulinum; pupillary abnormalities are common

132
Q

tick ascending paralysis

A

like GB but GB is more symmetrical

133
Q

treatment of paralysis due to spinal cord tumor

A

methylprednisone

134
Q

heat stroke versus heat exhaustion

A

heat stroke has a body temp over 105

135
Q

how to treat heat stroke

A

evaporation treatment (spray with warm water and turn on a fan); gastric lavage works too but it’s more involved

136
Q

how to differentiate a hypertensive intracerbral hemorrhagic stroke from ischemic, clinicall

A

hemorrhagic will have progressive losses as the hemorrhage expands and then patient will present with symptoms of increased ICP

137
Q

prophylaxis of cluster headaches

A

verapamil; also prednisone, ergotamine, indomethacin

138
Q

treatment of cluster headache

A

100 percent ox

139
Q

what is one disease in which typical anti-psychotics should not be used?

A

Lewy body dementia

140
Q

benzos are contraindicated in the elderly

A

that’s right

141
Q

what is amytriptiline used for

A

TCA used for depression, sleep disorders, and neuropathic pain

142
Q

memantine

A

used to treat moderate to severe Alzheimers; blocks the NMDA receptor

143
Q

dysarthria-clumsy hand syndrome

A

lacunar stroke in the basal pons

144
Q

pure motor hemiparesis

A

infarction in the posterior limb of the internal capsule;

145
Q

pure sensory stroke

A

stroke in the VPN of the thalamus; unilateral sensory deficits

146
Q

ataxic-hemiparesis

A

lacunar infarction in anterior limb of internal capsule; weakness more prominent in lower extremity and ipsil arm and leg incoordination

147
Q

conjugate eye deviation toward side of infarct

A

MCA occlusion

148
Q

contralateral hemiplegia and ipsilateral CN involvement

A

occlusion in vertebrobasilar system supplying the brain stem

149
Q

occlusion of ACA

A

contralateral hemiparesis and sens loss affecting mostly the lower extremity

150
Q

midbrain stroke

A

ipsilateral oculomotor paralysis and contralateral ataxia or hemiplegia

151
Q

MCA occlusion eye deviation

A

toward the side of the infarct; also, homonymous hemianopia (think radiating fibers)

152
Q

“alternate syndromes”

A

think brainstem

153
Q

meds for essential tremor

A

beta blocker or primidone (an anticonvulsant)

154
Q

primidone may cause what

A

acute intermittent porphyria

155
Q

acute intermittent porphyria

A

abdominal pain, neuro and psych abnormalities

156
Q

alcohol and ET

A

can be used, but not ideal

157
Q

beta blockers and ET

A

first line

158
Q

beta blockers contraind in what patients

A

bradycardic or severe COPD

159
Q

Lithium side effect

A

hypothyroidism

160
Q

arm not swinging

A

parkinsons

161
Q

pathogenesis of parkinsons

A

decreased dopaminergic neurons in the Substantia nigra leads to decreased dop and increased cholinergic

162
Q

cerebellar dysfunction

A

nystagmus, hypotonia, dysarthria, inability to perform RAM

163
Q

vestibular ataxia

A

minimal movements of the head during walking; staggering gate accompanied by vertigo and nystagmus

164
Q

gait in parkinsonism

A

is narrow based

165
Q

Shy-Drager syndrome (multiple system atrophy)

A

degernative disease, characterized by three features: parkinsonism, autonomic dysfunction, and widespread neuro signs

166
Q

treatment for shy-drager

A

parkinson drugs are ineffective; you want to replete fluids with fludrocortisone, alpha ags, and constrictive garments over the lower extremites

167
Q

Riley Day syndrome

A

gross dysfucntion of the autonomic nervous sytem with severe orthostatic hypotension; ashkenazim

168
Q

spinal cord compression- pain worse when?

A

at night (recumbent position) due to extension of the epidural venous plexus when lying down

169
Q

treatment for spinal cord compression

A

steroids and neurosurg consult

170
Q

malignancies that affect the spine

A

lung, renal, prostate, multiple myeloma

171
Q

DTRs in diabetic neuropathy versus myelopathy

A

absent in diabetic polyneuropathy, present in myelopathy

172
Q

facial nerve courses through what gland

A

parotid gland

173
Q

hoarsness can result from lesion of what

A

recurrent laryngeal nerve from the vagus; vulnerable to surgery of thyroid and parathyroid gland

174
Q

trigeminal neuralgia (tic douloureux)

A

short bursts of pain in V2 and V3 distribution; caused by external compression of trigeminal nerve

175
Q

jaw asymmetry caused by what

A

damage to nerve innervating the muscles of mastication (V3)

176
Q

V3 exits the skull through what hole

A

foramen ovale

177
Q

EBV in the CSF

A

primary CNS lymphoma; you will see ring enhancing lesions in the brain

178
Q

multiple rign enhancing lesions in the basal gang

A

consider toxo

179
Q

bulbar muscles

A

those involved in speech and swallowing (mouth and throat)

180
Q

pupils in botulism versus MG

A

pupils spared in MG, not in botulism

181
Q

NPH features but not

A

gait imbalance is the most important feature and it appears early in the course

182
Q

visual deficits early and memory deficits later

A

dementia with lewy body (opposite of alzheimers disease)

183
Q

gait in NPH

A

broad based and shuffling

184
Q

wernicke’s syndrome

A

ataxia and nystagmus

185
Q

SDH

A

tearing of bridging veins due to trauma

186
Q

alteplase

A

I think this is TPA

187
Q

what to give someone with a stroke that failed aspirin

A

aspirin plus dipyradimole OR clopidogrel

188
Q

what to give patient with stroke and evidence of A-fib

A

long term anticoag with warfarin, dabigatron, or rivaroxaban

189
Q

head tremor without dystonia

A

think essential tremor (though bilateral hand is more common); ET often affects head, chin, voice, and trunk

190
Q

tremor in cerebellar dysfunction

A

tremor increases as hand reaches target

191
Q

physiologic tremor

A

usually worse with movement

192
Q

cerebral wasting syndrome

A

may occur in patients with SAH; inapprop release of ADH causes water retention and then inapprop release of ANP/BNP which causes cerebral salt wasting; leads to hyponatremia

193
Q

what nerve can be damaged at the elbow because it lies in the medial epicondyle groove

A

ulnar- funny bone

Neuro (43 decks)

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