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3rd year_Neurology > Q-Bank > Flashcards

Q-Bank Flashcards

1
Q

Signs of spinal cord lesion?

A

UMN lesion signs – spasticity, hyperreflexia, etc.

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2
Q

Signs of peripheral nerve lesion?

A

LMN signs – lack of muscle tone/bulk, hyporeflexia, fasciculations

Sensory loss

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3
Q

Signs of muscle fiber lesion?

A

Lack of bulbar symptoms

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4
Q

Myasthenia Gravis Sx?

A
  • Extra-ocular muscle weakness (diplopia, pstosis)
  • Symmetrical, PROXIMAL weakness of extremities (UPPER more than lower), neck (flexors/extensors), & bulbar muscles (dysarthria, dysphagia)

** usually have NORMAL reflexes, muscle bulk/tone, & autonomic function

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5
Q

ALS – patient population?

A

Typically in men ages 40-60

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6
Q

ALS symptoms?

A

Upper & Lower motor neuron signs
- Asymmetric muscle atrophy, bulbar signs, muscle weakness (DISTAL&raquo_space; proximal), hyperreflexia, spasticity, fasciculations

**Usually NO sensory or ocular deficits

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7
Q

Statin-induced myopathy presentation?

A

Proximal muscle weakness & myalgias

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8
Q

Electrolyte abnormality that causes weakness, fatigue, & muscle cramps?

A

Hypokalemia

When severe can lead to paralysis & arrhythmia

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9
Q

Hypokalemia – ECG?

A

U waves, broad & flat T waves, & PVCs

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10
Q

Hypokalemia-induced myopathy – presentation?

A

Muscle weakness, fatigue, & muscle cramps.
If severe, can lead to paralysis & arrhythmia

ECG shows U waves, broad & flat T waves, & arrhythmias

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11
Q

How to test respiratory function in GBS?

A

Peak INSPIRATORY pressure
or
Forced Vital Capacity

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12
Q

Dx?

DOuble vision, difficulty chewing, & weak limb muscles worse @ the end of the day

A

Myasthenia Gravis

ACh-antibodies or Edrophonium test

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13
Q

Myasthenia Gravis – best initial Tx?

A

Neostigmine or Pyridostigmine

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14
Q

Charcot-Marie Tooth disease – Most accurate test?

A

Electromyography

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15
Q

Peripheral Neuropathy – best initial Tx?

A

Pregabalin or Gabapentin

TCAs, Phenytoin, or Carbamazepine are effective in some ppl

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16
Q

Bell Palsy – best initial Tx?

A

Prednisone

although 60% of ppl recover w/out therapy

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17
Q

When is re-bleeding common after SAH?

A

In first 24 hours

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18
Q

WHen is vasospasm common after SAH?

A

After 3 days

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19
Q

Major complications after SAH?

A
  • Rebleeding (first 24 hrs)
  • Vasospasm/infarction (3-10 days after)

Later:

  • Hydrocephalus
  • Seizures
  • Hyponatremia (from SIADH)
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20
Q

Benign Positional Vertigo – Sx?

A

Recurrent, acute-onset vertigo that’s precipitated by head movement
– Nystagmus, nausea, & vomiting W/OUT hearing loss or tinnitus

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21
Q

Drug that can cause vertigo (sensation of world spinning to-and-fro)?

A

Aminoglycosides (ototoxicity)

    • especially Gentamicin
    • can also cause nephrotoxicity
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22
Q

Dementia w/ Lewy Bodies – presentation?

A

Parkinsonian movement sx (rigidity, gait)

  • gradually progressive dementia w/ fluctuations in cognitive function
  • Persistent & well-formed visual hallucinations w/ extrapyramidal symptoms

– memory deficits occur later in disease onset, in contrast to Alzheimer’s where they occur early on

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23
Q

NPH – presentation?

A

Abnormal gait, urinary incontinence, & dementia

– Gait imbalance is most prominent symptom & appears early (broad-based & shuffling)

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24
Q

Red flag symptoms for cavernous sinus thrombosis?

A

Severe headache, bilateral periorbital edema, & CN 3, 4, 5, & 6 deficits

(facial infection can cause this b/c facial/ophthalmic venous system is valveless)

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25
Q

Idiopathic Intracranial Hypertension – Tx?

A
  1. Acetazolamide (inhibits choroid plexus carbonic anhydrase, decreasing CSF production)
    - - Furosemide can be added if Sx continue
  2. Surgical intervention w/ optic sheath decompression OR lumboperitoneal shunting
  3. Serial LP or short term corticosteroids
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26
Q

What suggest Embolic vs. Thrombotic stroke?

A

Embolic = A. fibrillation, endocarditis, Bruits (carotid atherosclerosis)

  • onset abrupt & maximal at start
  • multiple infacts w/in multiple diff. territories

Thrombotic = risk factors (HTN, HLD, DM) & sx that fluctuate w/ periods of improvement

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27
Q

Stroke type?

  • Symptoms progress over min-hrs
  • focal neuro sx appear early, followed by features of increased ICP (vomiting, headache, bradycardia, reduced alertness)
A

Intracranial bleed

SAH = focal sx UNcommon, severe headache at onset, meningeal irritation

28
Q

Spontaneous SAH – etiologies?

A

Ruptured saccular (“berry”) aneurysm
OR
AVM

29
Q

Cerebellar hemorrhage – presentation?

A

Ataxia, vomiting, occipital headache, gaze palsy, & facial weakness

  • *there is NO hemiparesis
  • *Tx = emergent surgical decompression
30
Q

Parkinson’s Tremor?

A
  • Bilateral, decreases w/ movement
  • Usually involves legs & hands

*facial involvement LESS common

31
Q

Essential Tremor?

A
  • Bilateral action tremor of hands (usually NO leg involvement)
  • Possible isolated head tremor w/out dystonia
  • Usually no other neuro sx & relieved by alcohol
32
Q

Essential Tremor – Tx?

A

Propranolol
- also can use Primidone or Topiramate (anticonvulsants)

  • Benzos (not rec’d b/c of dependence)
33
Q

Spinal roots that contribute to the Common Peroneal Nerve that can cause “foot drop”?

A

L4-S2

**most commonly due to L5 damage

34
Q

Symptoms of Cerebellar dysfunction 2/2 alcohol degeneration?

A
  • Gait instability
  • Truncal ataxia,
  • Difficulty w/ rapid, alternating movements
  • Hypotonia
  • Intention tremor
35
Q

Dx?

  • EBV DNA found in CSF
  • Ring-enhancing lesion on MRI
A

Primary CNS Lymphoma

36
Q

Acute glaucoma – Sx?

A

Sudden onset of photophobia, eye pain, headache, & nausea

- Non-reactive, mid-dilated pupil

37
Q

Acute glaucoma – best Dx’ic test?

A

Tonometry – shows elevated intraocular pressure

38
Q

Hallmark neurologic lesion 2/2 >5min seizure activity?

A

Cortical laminar necrosis

permanent damage 2/2 excitatory toxicity

39
Q

Shy-Drager Syndrome – presentation?

A

“Multiple System Atrophy”

    • Parkinsonism
    • Autonomic dysfunction (abnormal sweating/salivation/lacrimation, incontinence, postural hypotension, etc.)
    • Widespread neurologic signs (cerebellar, pyramidal, LMN)
40
Q

Cluster headache – prophylaxis?

A

Verapamil

41
Q

Abortive Therapy for migraines?

A

Ergotamine or one of the Triptans

42
Q

Abortive Therapy for Cluster headaches?

A
  • Ergotamines or Triptans

- 100% oxygen, prednisone, & lithium

43
Q

Duchenne’s Muscular Dystrophy – clinical features of muscle weakness?

A

Muscle weakness is progressive, symmetric, & starts in childhood

    • PROXIMAL muscles primarily affected (pelvic girdle)
    • Eventually involves respiratory muscles
44
Q

Duchenne’s Muscular Dystrophy – Tx?

A
  1. Prednisone

2. Surgery to correct scoliosis

45
Q

Poliomyelitis – classic presentation?

A

Asymmetric muscle weakness (legs more commonly involved)

  • Absent DTRs
  • Flaccid, atrophic muscles
  • Normal sensation
46
Q

Meniere’s Disease – Tx?

A

Sodium restriction & diuretics

47
Q

Central vs. Peripheral vertigo?

A

Peripheral has more sudden onset & more severe symptoms

Central has concurrent neuro sx & worse prognosis (2/2 tumors, etc.)

48
Q

Most common causes of brain abscess from sinuses, mastoids, or middle ear?

A
  • Aerobic & anaerobic Streptococci

- Bacteroides (anaerobic)

49
Q

Creutzfeldt-Jakob Disease – presentation?

A

Older patient (50-70) w/ :

  • Rapidly progressive dementia
  • Myoclonus
  • Sharp (high voltage) wave complexes on EEG

**Brain biopsy shows cortical spongiform changes

50
Q

Pathology of Parkinsons?

A

α-synuclein deposition in Substantia Nigra pars compacta

51
Q

Causes of Torsades de Pointes as Syncope etiology?

long QT-syndrome

A
  • Hypokalemia
  • Hypomagnesemia
  • Meds that cause prolonged QT interval
52
Q

How does Syncope present when it’s due to valvular heart disease (i.e. aortic stenosis)?

A

Usually occurs w/ physical activity

53
Q

Amantadine – AEs?

A

Ankle edema & Livedo reticularis

54
Q

Bromocriptine, Pramipexole, Ropinirole – AEs?

A
  • Somnolence, hypotension, & confusion

- Hallucinations (in older patients)

55
Q

Selegilline – AEs?

A

Insomnia & confusion (elderly patients)

MOA = MAO-B inhibitor

56
Q

Primidone – AEs?

A

Acute intermittent porphyria (abdominal pain, neurologic & psychologic abnormalities)

**used as Tx for essential tremor (either this or β-blockers)

57
Q

Trihexyphenidyl – AEs?

A

Cholinergic toxicity:

Dry skin, dry mouth, constipation, urinary retention, flushing, vision changes, confusion

58
Q

Myasthenia crisis – Tx?

A
  • Intubation (if resp function declining)
  • Plasmapheresis OR IVIG
  • Glucocorticoids

**usually briefly hold AChE-inhibitors to avoid excess secretions

59
Q

WIll 7th nerve lesions above the Pons cause paralysis of full half of the face or just lower 2/3 of the half involved?

A

Above Pons = UMN lesion = lower 2/3 paralyzed

Below Pons = LMN lesion = full facial hemiparesis

60
Q

Metoclopramide – AEs?

A
  • Agitation & loose stools
  • Extra-pyramidal symptoms
  • rarely: neuroleptic malignant syndrome

(MOA: DA-agonist used to increase GI activity, i.e. treat nausea, vomiting, & gastroparesis)

61
Q

Pathology of NPH?

A

Decreased CSF absorption OR permanent ventricular dilatation that causes periventricular damage

62
Q

Feared complication of pseudotumor cerebri/IIH?

A

Blindness

63
Q

Glucocorticoid-induced myopathy – presentation?

A

Progressive proximal muscle weakness & atrophy w/out pain or tenderness
- LOWER extremity muscles are more involved

(normal ESR & CK)

64
Q

Inflammatory myopathies – presentation?

A

Muscle pain, tenderness, & PROXIMAL muscle weakness

  • Skin rash & inflammatory arthritis present
  • ESR & CK elevated
65
Q

Statin-induced myopathy – presentation?

A

Muscle pain & tenderness, w/ or w/out weakness

  • Rare rhabdomyolysis
  • Elevated CK, normal ESR

3rd year_Neurology (8 decks)

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