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Neurology > Pre-Test > Flashcards

Pre-Test Flashcards

1
Q

1st workup for essential tremor

A

MRI brain and spine

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2
Q

Essential tremor tx

A

Primidone or propranolol

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3
Q

Onset of ET vs PD tremor

A

ET is immediate tremor, PD delayed a few seconds

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4
Q

What is cogwheel rigidity

A

Feeling of periodic resistance to passive movement felt by the examiner in a limb

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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)

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6
Q

Most common movement disorder

A

Essential tremor

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7
Q

Part of brain that lights up in PET scans with ET

A

Thalamus

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8
Q

Huntington’s repeat? Average age of onset

A

CAG on 4p16.3

Average age of onset is 40 years

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9
Q

Atrophy of what in HD

A

Atrophy of the head of the caudate nucleus and putamen

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10
Q

Two drugs for chorea in HD

A

Haloperidol and Tetrabenazine

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11
Q

What is opisthotonos

A

Great rigid spasm of the body with he back fully arched and the heels and head bent back

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12
Q

MCC of early onset generalized dystonia

A

DYT-1 dystonia

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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

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14
Q

What is trihexyphenidyl

A

Antimuscarinic anticholinergic

Can use in dystonia

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15
Q

3 cardinal features of PD

A

Tremor at rest, rigidity, and hypokinesia

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16
Q

Loss of what almost universal in PD

A

Loss of sense of smell

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17
Q

Inability to voluntarily look down likely

A

Progressive supranuclear palsy

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18
Q

Why levodopa and not dopamine in PD

A

Levodopa crosses the BBB

*With carbidopa to inhibit breakdown peripherally

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19
Q

COMT inhibitors

A

Entacapone and tolcapone

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20
Q

Dopa agonists

A

Pramipexole, ropinirole, bromocriptine

less risk of dyskinesias that dopa

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21
Q

MAO-B inhibitors

A

Selegiline and rasagiline

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22
Q

Drug to help levodopa-induced dyskinesias

A

Amantadine

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23
Q

Unilateral resting tremor is an early manifestation of

A

Parkinsons

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24
Q

Adult onset of ataxia think

A

Spinocerebellar ataxia

SCA 3 is most common

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25
Q

MRI of spinocerebellar ataxia

A

High T2 signal in the cerebellar cortex

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26
Q

Strongest risk factors for TD

A

Advanced age, female gender, and coexistent brain damage

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27
Q

Brown Sequard

A

Ipsilateral weakness and loss of fine touch and vibration
Contralateral loss of pain and temp below level of lesion
Spinal chord hemisection

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28
Q

Anterior cord sbdrome

A

Bilateral loss of spinothalamic tract function (pain and temp) as well as bilateral weakness (corticospinal tract) with preservation of dorsal column function

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29
Q

How does blood in the subarachnoid space usually appear

A

Hyper dense, and usually seen as a homogenous high density in the ventricular system

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30
Q

Hallmarks of delerium

A

Cognitive impairment, impaired attention, and fluctuating course

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31
Q

Most common delirium meds

A

Lorazepam, Haldol and risperidone

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32
Q

Concussion grades

A

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

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33
Q

Symptoms suggestive of posterior stroke

A

Diplopia, vertigo, crossed facial and body findings, and homonymous hemianopia

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34
Q

Preferred stroke ppx in a-fib

A

Anticoagulation rather than antiplatelet

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35
Q

Most alarming complication of aneurysmal subarachnoid hmehorrage

A

Vasospasm –> irritation causes constriction of amor cerebral arteries leading to infarction

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36
Q

When to clip an anuerysm

A

Within 48 hours or 2 weeks after to avoid greatest risk of vasospasm

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37
Q

Posterior communicating artery aneurysm bleed

A

Ipsilateral ptosis, pupil dilation, and opthalmoplegia

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38
Q

Most common site for cerebral aneurysm in PCKD

A

Anterior communicating artery

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39
Q

Carotid dissection often associated with?

A

Horners syndrome

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40
Q

Simple vs complex partial seizures

A

Simple has no LOC

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41
Q

How many patients with one seizure will never have another

A

3/4

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42
Q

Juvenile Myoclonic Epilepsy features

A

Quick little jerks of a limb usually in the morning after sleep deprivation

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43
Q

Internationally where is are partial seizures more common

A

Where cysticercosis is prevalent

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44
Q

In most partial complex seizures, it represents what

A

Underlying case of temporal lobe epilepsy

Do MRI in all of them to look for structural lesions

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45
Q

Neural tube defects with what anti-seizure meds

A

Valproate and phenobarbital

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46
Q

Lip smacking, chewing, and swallowing common in what kind of seizures

A

Complex partial

47
Q

What is catamenial epilepsy

A

When seizures get worse with periods

48
Q

When are seizures rarely organic

A

Bilateral shaking without any confusion after

49
Q

2 most important risk factors for pseudoseizures

A

History of sexual abuse or head trauma

50
Q

You should suspected what in new headaches over 60

A

Temporal arteritis

51
Q

Postcoital cephalgia tx

A

Ibuprofen before sex

52
Q

Triptan MOA? Contras?

A

5HT-1D serotonin receptor agonist

Contras are hx of CAD or HTN

53
Q

What is in midrin

A

Acetaminophen, dichloralphenazone (muscle relaxant), and isomethepthene mutate (vasoconstrictor)

54
Q

Right neck pain and left numbness likely?

A

Carotid dissection

55
Q

Only feature migraine headaches and tension headaches have in common usually

A

Nausea (but rarely vomiting)

56
Q

Memantine MOA

A

NDMA receptor antagonist

57
Q

Thing to go first is AD

A

Smelling

58
Q

Abnormal processing of what in AD

A

Amyloid precursor protein

59
Q

What is apraxia

A

Inability to perform tasks when asked, even though cognition is normal

60
Q

3 features of LBD that distinguish from alzheimers

A

1) fluctuations in cognitive function with varying levels of alertness and attention
2) Visual hallucinations
3) Parkinsonian motor features relatively early in LBD

61
Q

Atrophy of the midbrain suggestive of

A

Progressive supra nuclear palsy

62
Q

Loss of Ach in LBD vs AD

A

AD is Ach receptors

LBD is greater loss of Ach itself

63
Q

B12 def causes what disease name

A

Subacute combined degeneration –> edema and destruction of myelin

64
Q

Nerve conduction study in B12 def vs MS

A

B12 will have slowed nerve conduction studies

65
Q

B12 def affects

A

Peripheral nerves, dorsal column, and lateral corticospinal tracts –> syndrome of spasticity with ataxia

66
Q

Where is optic neuritis seen

A

2/3 anterior (optic nerve head)

1/3 retrobulbar w/ normal fundoycopic exam

67
Q

MS CSF? Tx for optic neuritis in this case

A 
Oligoclonal bands (Also seen with lupus, syphillis, etc)
Tx Interferon beta-1a
68
Q

2 drugs that can cause optic neuropathy

A

Amioderone and ethambutol

69
Q

Most common MS

A

Secondary progressive - initial relapsing-remitting course followed by increasing attacks

70
Q

What is facial myokymia

A

Wormlike movement of muscles that patient can feel but difficult for examiner to see

71
Q

MS lesions most likely to be where

A

Corpus callous and periventricular regions

72
Q

2 drugs that can cause optic neuropathy

A

Amioderone and ethambutol

73
Q

Most common MS

A

Secondary progressive - initial relapsing-remitting course followed by increasing attacks

74
Q

What is facial myokymia

A

Wormlike movement of muscles that patient can feel but difficult for examiner to see

75
Q

MS lesions most likely to be where

A

Corpus callous and periventricular regions

76
Q

What is mitoxantrone

A

Antineoplastic good for secondary progressive MS

77
Q

What is acute disseminated encephalomyelitis

A

Acute uniphasic syndrome that represents auto inflammation getting cerebellum and brainstem
1-3 weeks after infection or `immunization

78
Q

Heading getting worse + fever + slowness to respond

A

Meningitis until proven otherwise

79
Q

MCC of viral meningitis in US

A

Enterovirus family (Coxsacie and echo)

80
Q

Glucose normal (LP) in which meningitis

A

Viral

81
Q

Botulism paralysis pattern

A

Descending

82
Q

Best way to diagnose infantile botulism

A

Fecal specimens

Also do EMG with repetitive nerve stimulation

83
Q

What is normal in botulism

A

Sensation and cognitive function

84
Q

Classic presentation for tubes dorasalis

A

Lancinating pain with associated sensory ataxia, CN abnormalities, and impotence

85
Q

Most common finding with neurosyphillis

A

hyporeflexia

86
Q

Leading cause of focal CNS disease in aids patients

A

Toxo

87
Q

CNS toxo tx

A

Pyrimethamine

TMP-SMX for ppx

88
Q

PS eye muscle cell body location

A

Edinger-Westphal nucleus of upper midbrain (join CN III)

89
Q

What is Holmes-Adie syndrome

A

Unilateral benign unresponsive pupil (EOM intact though) and depressed DTR in legs
Pilocarpine will constrict –> cholinergic super sensitivity

90
Q

Most common visual presentation of papilledema

A

Transient visual obscuration or graying out/dimming of vision
Can see CN 6 palsy

91
Q

Double vision only on lateral gaze likely (when looking far off)

A

CN 6 palsy

92
Q

What causes binocular diplopia

A

Misalignment of the eye muscles on a target and commonly denotes an underlying primary neurology problem with the brain parenchyma

93
Q

What is Ramsay Hunt Syndrome

A

Herpes zoster oticus - vesicles in ear accompanied by facial nerve paralysis

94
Q

Forehead sparing in what kind of paralysis

A

Central paralysis (stroke) caused by bilateral cortical connections to facial nucleus in the brainstem

95
Q

What causes bells palsy most often

A

reactivation of the herpes zoster virus

96
Q

MG test

A

Ach receptor antibody
Post synaptic
Pyridostigmine – anti cholinesterase

97
Q

What herniation causes ptosis

A

Uncel

98
Q

BPPV nystagmus

A

Latent downbeat, rotary nystagmus that reverses with upright position and fatigues on repeat testing

99
Q

When should you suspect CIDP

A

Progressive symmetrical or asymmetrical polyneuropathy that is relapsing and remitting or progresses for more than 2 months
Segmental demyelination of nerve axons

100
Q

Hallmark exam for GB

A

Areflexia of LE

101
Q

Dermatomyositis often associated with

A

Underlying malignancy

102
Q

Most common acquired muscle disorder in persons over 50

A

Inclusion body myositis

103
Q

ALS drug

A

Riluzole (Rilutek)

104
Q

Test to determine pattern of ALS involvement

A

EMG/NCV

105
Q

Nerves causing foot drop

A

L4-L5 (superficial and deep peroneus muscles)

Common peroneal nerve

106
Q

Sciatic nerve makes up

A

Common peroneal and tibial nerve

107
Q

Auras are what kind of seizure

A

Simple partial

108
Q

Absences seizures are what kind of epilepsy

A

Primary generalized

109
Q

First step in febrile seizure workup

A

Look for source of fever

110
Q

When are febrile seizures complex

A

When they are focal in nature, last longer than 15 minutes, or recur within 24 hours

111
Q

Risk of recurrence if once febrile seizure

A

30% (90% of those recur within 2 years)

112
Q

What kind of headaches raise possibility of increased ICP

A

Chronic progressive

113
Q

Best peds migraine ppx

A

Sumatriptan nasal spray

Neurology (4 decks)

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