Pre-Test Flashcards
1
Q
1st workup for essential tremor
A
MRI brain and spine
2
Q
Essential tremor tx
A
Primidone or propranolol
3
Q
Onset of ET vs PD tremor
A
ET is immediate tremor, PD delayed a few seconds
4
Q
What is cogwheel rigidity
A
Feeling of periodic resistance to passive movement felt by the examiner in a limb
5
Q
What is lead pipe rigidity
A
Hypertonicity felt in parkinsonian limb throughout the range of movements of a joint (increased tone in all muscles around a joint)
6
Q
Most common movement disorder
A
Essential tremor
7
Q
Part of brain that lights up in PET scans with ET
A
Thalamus
8
Q
Huntington’s repeat? Average age of onset
A
CAG on 4p16.3
Average age of onset is 40 years
9
Q
Atrophy of what in HD
A
Atrophy of the head of the caudate nucleus and putamen
10
Q
Two drugs for chorea in HD
A
Haloperidol and Tetrabenazine
11
Q
What is opisthotonos
A
Great rigid spasm of the body with he back fully arched and the heels and head bent back
12
Q
MCC of early onset generalized dystonia
A
DYT-1 dystonia
13
Q
Low activity of what part of brain causes dystonia
A
Gps and substantia nigra pars reticulata
Deep brain stimulant of these parts best tx
14
Q
What is trihexyphenidyl
A
Antimuscarinic anticholinergic
Can use in dystonia
15
Q
3 cardinal features of PD
A
Tremor at rest, rigidity, and hypokinesia
16
Q
Loss of what almost universal in PD
A
Loss of sense of smell
17
Q
Inability to voluntarily look down likely
A
Progressive supranuclear palsy
18
Q
Why levodopa and not dopamine in PD
A
Levodopa crosses the BBB
*With carbidopa to inhibit breakdown peripherally
19
Q
COMT inhibitors
A
Entacapone and tolcapone
20
Q
Dopa agonists
A
Pramipexole, ropinirole, bromocriptine
less risk of dyskinesias that dopa
21
Q
MAO-B inhibitors
A
Selegiline and rasagiline
22
Q
Drug to help levodopa-induced dyskinesias
A
Amantadine
23
Q
Unilateral resting tremor is an early manifestation of
A
Parkinsons
24
Q
Adult onset of ataxia think
A
Spinocerebellar ataxia
SCA 3 is most common
25
MRI of spinocerebellar ataxia
High T2 signal in the cerebellar cortex
26
Strongest risk factors for TD
Advanced age, female gender, and coexistent brain damage
27
Brown Sequard
Ipsilateral weakness and loss of fine touch and vibration
Contralateral loss of pain and temp below level of lesion
*Spinal chord hemisection*
28
Anterior cord sbdrome
Bilateral loss of spinothalamic tract function (pain and temp) as well as bilateral weakness (corticospinal tract) with preservation of dorsal column function
29
How does blood in the subarachnoid space usually appear
Hyper dense, and usually seen as a homogenous high density in the ventricular system
30
Hallmarks of delerium
Cognitive impairment, impaired attention, and fluctuating course
31
Most common delirium meds
Lorazepam, Haldol and risperidone
32
Concussion grades
1: no LOC and all better w/in 15 minutes
2: no LOC but lasting g longer than 15 minutes
3: LOC for any period of time
33
Symptoms suggestive of posterior stroke
Diplopia, vertigo, crossed facial and body findings, and homonymous hemianopia
34
Preferred stroke ppx in a-fib
Anticoagulation rather than antiplatelet
35
Most alarming complication of aneurysmal subarachnoid hmehorrage
Vasospasm --> irritation causes constriction of amor cerebral arteries leading to infarction
36
When to clip an anuerysm
Within 48 hours or 2 weeks after to avoid greatest risk of vasospasm
37
Posterior communicating artery aneurysm bleed
Ipsilateral ptosis, pupil dilation, and opthalmoplegia
38
Most common site for cerebral aneurysm in PCKD
Anterior communicating artery
39
Carotid dissection often associated with?
Horners syndrome
40
Simple vs complex partial seizures
Simple has no LOC
41
How many patients with one seizure will never have another
3/4
42
Juvenile Myoclonic Epilepsy features
Quick little jerks of a limb usually in the morning after sleep deprivation
43
Internationally where is are partial seizures more common
Where cysticercosis is prevalent
44
In most partial complex seizures, it represents what
Underlying case of temporal lobe epilepsy
| *Do MRI in all of them to look for structural lesions*
45
Neural tube defects with what anti-seizure meds
Valproate and phenobarbital
46
Lip smacking, chewing, and swallowing common in what kind of seizures
Complex partial
47
What is catamenial epilepsy
When seizures get worse with periods
48
When are seizures rarely organic
Bilateral shaking without any confusion after
49
2 most important risk factors for pseudoseizures
History of sexual abuse or head trauma
50
You should suspected what in new headaches over 60
Temporal arteritis
51
Postcoital cephalgia tx
Ibuprofen before sex
52
Triptan MOA? Contras?
5HT-1D serotonin receptor agonist
| Contras are hx of CAD or HTN
53
What is in midrin
Acetaminophen, dichloralphenazone (muscle relaxant), and isomethepthene mutate (vasoconstrictor)
54
Right neck pain and left numbness likely?
Carotid dissection
55
Only feature migraine headaches and tension headaches have in common usually
Nausea (but rarely vomiting)
56
Memantine MOA
NDMA receptor antagonist
57
Thing to go first is AD
Smelling
58
Abnormal processing of what in AD
Amyloid precursor protein
59
What is apraxia
Inability to perform tasks when asked, even though cognition is normal
60
3 features of LBD that distinguish from alzheimers
1) fluctuations in cognitive function with varying levels of alertness and attention
2) Visual hallucinations
3) Parkinsonian motor features relatively early in LBD
61
Atrophy of the midbrain suggestive of
Progressive supra nuclear palsy
62
Loss of Ach in LBD vs AD
AD is Ach receptors
| LBD is greater loss of Ach itself
63
B12 def causes what disease name
Subacute combined degeneration --> edema and destruction of myelin
64
Nerve conduction study in B12 def vs MS
B12 will have slowed nerve conduction studies
65
B12 def affects
Peripheral nerves, dorsal column, and lateral corticospinal tracts --> syndrome of spasticity with ataxia
66
Where is optic neuritis seen
2/3 anterior (optic nerve head)
| 1/3 retrobulbar w/ normal fundoycopic exam
67
MS CSF? Tx for optic neuritis in this case
```
Oligoclonal bands (Also seen with lupus, syphillis, etc)
Tx Interferon beta-1a
```
68
2 drugs that can cause optic neuropathy
Amioderone and ethambutol
69
Most common MS
Secondary progressive - initial relapsing-remitting course followed by increasing attacks
70
What is facial myokymia
Wormlike movement of muscles that patient can feel but difficult for examiner to see
71
MS lesions most likely to be where
Corpus callous and periventricular regions
72
2 drugs that can cause optic neuropathy
Amioderone and ethambutol
73
Most common MS
Secondary progressive - initial relapsing-remitting course followed by increasing attacks
74
What is facial myokymia
Wormlike movement of muscles that patient can feel but difficult for examiner to see
75
MS lesions most likely to be where
Corpus callous and periventricular regions
76
What is mitoxantrone
Antineoplastic good for secondary progressive MS
77
What is acute disseminated encephalomyelitis
Acute uniphasic syndrome that represents auto inflammation getting cerebellum and brainstem
1-3 weeks after infection or `immunization
78
Heading getting worse + fever + slowness to respond
Meningitis until proven otherwise
79
MCC of viral meningitis in US
Enterovirus family (Coxsacie and echo)
80
Glucose normal (LP) in which meningitis
Viral
81
Botulism paralysis pattern
Descending
82
Best way to diagnose infantile botulism
Fecal specimens
| *Also do EMG with repetitive nerve stimulation*
83
What is normal in botulism
Sensation and cognitive function
84
Classic presentation for tubes dorasalis
Lancinating pain with associated sensory ataxia, CN abnormalities, and impotence
85
Most common finding with neurosyphillis
hyporeflexia
86
Leading cause of focal CNS disease in aids patients
Toxo
87
CNS toxo tx
Pyrimethamine
| *TMP-SMX for ppx*
88
PS eye muscle cell body location
Edinger-Westphal nucleus of upper midbrain (join CN III)
89
What is Holmes-Adie syndrome
Unilateral benign unresponsive pupil (EOM intact though) and depressed DTR in legs
*Pilocarpine will constrict --> cholinergic super sensitivity*
90
Most common visual presentation of papilledema
Transient visual obscuration or graying out/dimming of vision
*Can see CN 6 palsy*
91
Double vision only on lateral gaze likely (when looking far off)
CN 6 palsy
92
What causes binocular diplopia
Misalignment of the eye muscles on a target and commonly denotes an underlying primary neurology problem with the brain parenchyma
93
What is Ramsay Hunt Syndrome
Herpes zoster oticus - vesicles in ear accompanied by facial nerve paralysis
94
Forehead sparing in what kind of paralysis
Central paralysis (stroke) caused by bilateral cortical connections to facial nucleus in the brainstem
95
What causes bells palsy most often
reactivation of the herpes zoster virus
96
MG test
Ach receptor antibody
*Post synaptic*
Pyridostigmine -- anti cholinesterase
97
What herniation causes ptosis
Uncel
98
BPPV nystagmus
Latent downbeat, rotary nystagmus that reverses with upright position and fatigues on repeat testing
99
When should you suspect CIDP
Progressive symmetrical or asymmetrical polyneuropathy that is relapsing and remitting or progresses for more than 2 months
*Segmental demyelination of nerve axons*
100
Hallmark exam for GB
Areflexia of LE
101
Dermatomyositis often associated with
Underlying malignancy
102
Most common acquired muscle disorder in persons over 50
Inclusion body myositis
103
ALS drug
Riluzole (Rilutek)
104
Test to determine pattern of ALS involvement
EMG/NCV
105
Nerves causing foot drop
L4-L5 (superficial and deep peroneus muscles)
| Common peroneal nerve
106
Sciatic nerve makes up
Common peroneal and tibial nerve
107
Auras are what kind of seizure
Simple partial
108
Absences seizures are what kind of epilepsy
Primary generalized
109
First step in febrile seizure workup
Look for source of fever
110
When are febrile seizures complex
When they are focal in nature, last longer than 15 minutes, or recur within 24 hours
111
Risk of recurrence if once febrile seizure
30% (90% of those recur within 2 years)
112
What kind of headaches raise possibility of increased ICP
Chronic progressive
113
Best peds migraine ppx
Sumatriptan nasal spray
