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Neurology Clerkship > Random > Flashcards

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1
Q

How do you diagnose creutzfeld-jakob disease?

A

EEG shows 1 Hz discharges

CSF shows 14-3-3 protein

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2
Q

Triad of Normal pressure hydrocephalus?

A
  • Apraxic gait
  • dementia
  • urinary incontinence
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3
Q

Triad of wernicke’s encephalopathy

A
  • confusion
  • ataxia
  • oculomotor involvement (nystagmus, gaze palsy)
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4
Q

How do you treat wernicke’s encephalopathy?

A

IV thiamine BEFORE glucose

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5
Q

How do you diagnose brain death?

A
  • unresponsiveness (coma)
  • brainstem death as evidenced by absent BST reflexes and absent spontaneous breathing (apnea test)
  • must ensure all variables are accounted for (temperature, electrolytes, oxygenation)
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6
Q

What is the difference between coma and persistent vegetative state?

A

persistent vegetative state has sleep-wake cycles and coma does not

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7
Q

Where do the eyes deviate in cold and warm caloric testing?

A

COWS
Cold = opposite
Warm = same
nystagmus

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8
Q

what is the treatment for ET?

A

beta-blockers

primidone

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9
Q

what structure will be highlighted in PET scan of ET?

A

thalamus

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10
Q

When does the tremor come out in ET compared to parkinson?

A 
Et = 1-2 seconds
PD = 9 seconds
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11
Q

how many repeats needed for huntington disease to be clinical?

A

> 40 usually

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12
Q

what chromosome is huntington on?

A

CAG 4

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13
Q

Treatment for huntington disease

A

haloperidol and sometimes tetrabenazine
SSRIs for depression
PEG tube for swallowing and aspiration

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14
Q

Choreaform movements in child

A

Huntington disease wetphal variant that presents like parkinsonism

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15
Q

what is the most effective treatment for generalized dystonia?

A

high frequency stimulation of globus pallidus pars interna by DBS

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16
Q

whats a good treatment for DYT-1?

A

trihexyphenidyl

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17
Q

Clinical features of DYT-1

A

abnormal movements in association with action early in course of disease

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18
Q

how can you prevent peripheral breakdown of L-dopa?

A 
Carbidopa (dichlorosioprenaline)
COMT inhibitors (entacapone and tolcapone)
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19
Q

what are the dopamine agonist drugs and what receptor do they work on?

A

pramipexole, ropinirole, bromocriptine

D2 type receptors

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20
Q

What are the MAO-B inhibitors used in PD?

A

selegiline and rasagiline

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21
Q

What is amantadine?

A

NMDA receptor antagonist

helps alleviate tremor and dystonia especially levodopa–induced dyskinesia

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22
Q

What 3 classes of drugs are most likely to induce parkinsonism and what are some examples?

A
  • DA receptor blocking agents (prochlorperazine, metoclopramide)
  • dopamine depleting agents (reserpine, tetrabenazine)
  • atypical antipsychotic agents
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23
Q

what is the tetrad of parkinsonism?

A

resting tremor, rigidity, bradykinesia, postural instability

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24
Q

what is seen on MRI of SCA patients?

A

high T2 signal in cerebellar cortex

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25
Q

what is seen on MRI of MSA?

A

high signal lateral to striatum

high signal “hot cross bun” sign in the brainstem

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26
Q

what are the risk factors for developing tardive dyskinesia?

A

advanced age, female gender, coexistent brain damage

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27
Q

what are the key characteristics of tardive dyskinesia?

A

arching of the back and neck

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28
Q

what is the treatment for tardive dyskinesia?

A

benzodiazepines
baclofen
vitamin E

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29
Q

which dopamine depleting agents have been shown to cause tardive dyskinesia?

A

reserpine or tetrabnazine

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30
Q

Where are the inclusions in Parkinsons disease?

A

Intracytoplasmic

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31
Q

What location are the lesions in parkinson disease

A

substantia nigra
locus coeruleus
substantia innominata

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32
Q

what drug can be used to help reverse drug induced parkinsonism?

A

trihyxyphenidyl (anti-cholinergic)

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33
Q

what is Meige syndrome?

A 
focal dystonia with:
blepharospasm
forceful jaw opening
lip retraction
neck contractions
tongue thrusting
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34
Q

injury to which structure causes hoarseness and dysphagia?

A

nucleus ambiguous

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35
Q

occlusion of which artery causes lateral medullary syndrome?

A

vertebral artery

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36
Q

what is the most common cause of lobar hemorrhage in elderly patients without hypertension?

A

cerebral amyloid antipathy (congophilic angiopathy)

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37
Q

what is another name for post-ictal paralysis?

A

todd paralysis

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38
Q

what would be found on CT scan of a person with Sturge weber/ encephalofacial angiomatosis?

A

leptomeningeal angiomas

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39
Q

aneurysm of which arteries can compress the oculomotor nerve?

A

Posterior communicating artery

Superior cerebellar artery

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40
Q

what is anomic aphasia?

A

isolated word finding deficit

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41
Q

what is transcortical sensory aphasia?

A

similar to wernicke aphasia with exception that patient is able to repeat phrases in transcortical sensory aphasia

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42
Q

What is transcortical motor aphasia?

A

similar to broca aphasia with exception that patient is able to repeat phrases in transcortical motor aphasia

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43
Q

what is shown on EEG for primary generalized epilepsy of childhood?

A

3 Hz spike and wave pattern

44
Q

when is the greatest risk for alcohol withdrawal seizures?

A

first day of drinking cessation

45
Q

when is the greatest risk for delerium tremens?

A

days 2-4

46
Q

when do all signs of withdrawal usually resolve?

A

7-14 days

47
Q

What are the features of Lennox-Gastaut syndrome?

A

mental dysfunction, multiple seizure types, 1-2 hz generalized spike-wave discharges on EEG

48
Q

what are the features of Lendau-Kleffner syndrome?

A

loss of language function

abnormal EEG during sleep

49
Q

where do gustatory auras originate?

A

hippocampus or perihippocampal gyrus

50
Q

what is west syndrome? Treatment?

A

generalized seizure disorder of infants characterized by spasms, EEG of hypsarrhythmia, and retardation
Tx with ACTH

51
Q

what drugs worsen generalized seizures?

A

phenytoin
carbamazepine
(both sodium channel blockers)

52
Q

what is the treatment for seizures in ecclempsia?

A

magnesium sulfate

53
Q

what drug should be given to patients with spine injury within 8 hours?

A

high dose methylprednisolone

54
Q

What are the hallmarks of delirium?

A

cognitive impairment
impaired attention
fluctuating course

55
Q

what drugs are used to treat delirium?

A

lorazepam
halloo
risperidone

56
Q

what structure is responsible for wakefulness?

A

ascending reticular-activating system (ARAS)

57
Q

what is aphasia?

A

impariemtn of ability to use or comprehend words

58
Q

what is agnosia?

A

loss of ability to recognize objects, persons, sounds, shapes or smells

59
Q

what is apraxia

A

loss of ability to execute or carry out learned purposeful movements

60
Q

what do cortical symptoms in a stroke suggest territory?

A

carotid

61
Q

what do brainstem or cerebellar findings in stroke territory suggest?

A

vertebrobasilar territory stroke

62
Q

best way to prevent vasospasm after SAH?

A

Triple H therapy
- hypertensive hypervolemic hemodilution
and nimodipine

63
Q

what type of dissection is associated with horner syndrome?

A

carotid artery dissection

64
Q

Treatment for partial seizures

A 
carbamazepine
valproate
gabapentin
lamotrigine
topiramate
phenytoin
levetiracetam
gabapentin
pregabalin
oxcarbazepine
zonisamide
lacosamid
65
Q

treatment for primary generalized

A 
valproate
topiramate
lamotrigine
zonisamide
levetiracetam
66
Q

Treatment for absence seizure

A 
valproate
lamotrigine
ethosuximide
zonisamide
topiramate
67
Q

treatment for myoclonic seizures

A 
valproate
conazepam
levetiracetam
topiramate
zonisamide
68
Q

treatment for tonic seizures

A 
valproate
felbamate
clonazepame
topiramate
zonisamide
69
Q

where do schistosome mansoni eggs deposit?

A

the spinal cord on veins that drain the intestines and the lumbosacral spinal cord

70
Q

how do you treat JC virus PML?

A

HAART

71
Q

what is the most common form of acute encephalitis?

A

herpes encephalitis

72
Q

what types of lesions are seen with patients with HIV and CMV?

A

Microglial nodules

73
Q

what EEG findings would be seen in herpes encephalitis?

A

bilateral periodic epileptiform spikes

74
Q

where do most brain abscesses come from?

A

hematogenous spread

75
Q

where do abscess mostly form in the brain?

A

gray-white matter junction

76
Q

what is important about subacute sclerosing pan encephalitis (SSPE)

A

associated with measles virus, –> demyelination. Occurs before 18, die 1-3 years after onset

77
Q

what is the most common primary adult brain tumor?

A

astrocytoma

78
Q

the most common source of primary adult brain tumors?

A

glial cells

79
Q

what are the most common brain tumors in children?

A

astrocytomas and medulloblastomas

80
Q

where do mets to the brain usually form?

A

the gray-white matter junction

81
Q

cancer mets with the worst prognosis. why?

A

malignant melanoma or choriocarcinoma

because they like to hemorrhage

82
Q

precocious puberty, uncontrollable laughter followed by seizure

A

hypothalamic hamartoma

83
Q

what is parinaud syndrome

A

loss of vertical gaze
loss of pupillary light reflex
lid retraction
convergence-retraction nystagmus (eyes jerk up into the orbit on upward gaze)

84
Q

what causes parinaud syndrome?

A

pineocytoma

85
Q

what is paraneoplastic cerebellar degeneration?

A

subacute and relentlessly progressive ataxia, dysarthria, and nystagmus

86
Q

what are the most commonly associated tumors with paraneoplastic cerebellar degeneration?

A

lung
ovarian
lymphoma
(in that order of prevalence)

87
Q

accumulation of glucosylceramide

A

gauche disease or B-glucosidase deficiency

88
Q

Changes in what cells of the brain are seen in chronic alcoholics?

A

alzheimer type II astrocytes

89
Q

what is seen in the CSF of hypertensive encephalopathy?

A

increased protein but below 100

90
Q

what neurological symptom do patients with chronic renal failure exhibit?

A

peripheral neuropathy

91
Q

Treatment for restless leg syndrome

A 
clonazepam
gabapentin
L-dopa
dopamine agonists (pramipexole, ropinirole)
opiates
92
Q

What drugs make restless leg syndrome worse?

A

neuroleptics
CCBs
caffeine

93
Q

what is the most common visual defect in vitamin B12 deficiency?

A

centrocecal scotoma

94
Q

ocular disturbances from tobacco smoking and alcohol use term

A

deficiency amblyopia

95
Q

pickwikian syndrome?

A

weight gain, smoking leading to sleeping episodes during the day
Hypersomnia

96
Q

what kind of language problems do alzheimers patients develop?

A

transcortical sensory aphasia

97
Q

What are the features of Rett syndrome?

A

loss of language skills once learned, loss of eye contact and wringing movement of hands, or patting, tapping, or hand-mouth movements
no treatment, unknown etiology

98
Q

what is general paresis associated with?

A

neurosyphilis

99
Q

what is alien hand syndrome associated with?

A

JC virus infection in immunocompromised leading to progressive multifocal leukoencephalopathy

100
Q

what are the features of Canavan disease?

A

macrocephaly
defect in N-acetylaspartic acid metabolism
developmental regression at 6 months of age, spongiform like degeneration

101
Q

What is leber optic atrophy?

A

when a centrocecal scotoma forms (loss of central vision)

mutation in mitochondrial DNA

102
Q

Pelizaeus-Merzbacher disease

A

symptomatic first months of life, myelin islands around blood vessels

103
Q

what are the most common agents of bacterial meningitis in children under the age of 6 months?

A

H influenza
S pneumonias
N meningitides

104
Q

What is most common agent of bacterial meningitis in children under 3 months?

A

Listeria monocytogene
E coli
GBS

105
Q

how do you treat trigeminal neuralgia?

A

carbamazepine
baclofen
phenytoin

106
Q

hartnup disease has a decrease in what?

A

nicotinamide

107
Q

what is seen on CT of sturge-weber?

A

railroad track pattern on cerebral gyri

Neurology Clerkship (6 decks)

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