U-World: NEUROLOGY Flashcards
What dz’s do you see tau protein in but what types of aggregates?
Alzheimer’s - NFTs of tau
Pick’s - round aggregates of tau
Best INITIAL test for MG? Most ACCURATE for: MG? Polymyosistis? Guillain-Barre?
ACh receptor antibody
single fiber EMG
Muscle biopsy
Nerve conduction velocity
Acute occipital headache, gait ataxia/vertigo, repeated vomiting in hypertensive patient. Dx? Tx?
Cerebellar hemorrhage, evacuative craniotomy
[can present with blepharospasm, 6th nerve palsy, conjugate deviation, and coma in severe cases]
(FEVER IS COMMON IN ANY BRAIN HEMORRHAGE!)
a) Anterior shoulder dislocation nerve injury?
b) Radial head fracture/dislocation?
c) Surgical Neck of the humerus?
d) Midshaft humeral fracture?
e) Medial epicondyle of humerus fracture?
f) Saturday Night Palsy? Crutch injury?
g) Dorsal wrist laceration/compression?
h) Supracondylar humeral fracture?
a) Axillary
b) Radial (preserved triceps, but) only weakened extension of digits
c) Axillary
d) Radial (but triceps preservation!)
e) Ulnar
f) Radial
g) Radial (but no motor deficits since radial n. doesn’t innervate any muscles in the hand. Only sensory loss here)
h) Median
explain the following [a,c,e are the dopamine antagonistic effects of antipyschotics]:
a) decreased dopamine activity in MESOLIMBIC pathway
b) increased dopamine activity in MESOLIMBIC pathway
c) decreased dopamine activity in NIGROSTRIATAL pathway
d) increased dopamine activity in NIGROSTRIATAL pathway
e) decreased dopamine activity in TUBEROINFUNDIBULAR pathway
f) increased dopamine activity in TUBEROINFUNDIBULAR pathway
a) this is what makes antipsychotics efficacious
b) delusions/hallucinations in schizophrenia; euphoria from drug use
c) extrapyramidal side effects from antipsychotics: acute dystonia, akathisia, parkinsonism
d) chorea, tics
e) hyperprolactinemia: amenorrhea, galactorrhea, sexual dysfunction, gynecomastia
f) hypOprolactinemia
Extreme fever, epistaxis (2/2 coagulopathy), rhabdomyolysis, renal failure, ARDS?
these are complications of heat stroke
Name two things you can find in the CSF in Guillain-Barre? What does this mean?
ALBUMINO-CYTOLOGIC dissociation (increased protein but normal cell count)
Elderly with UTI presents with agitated delirium.
- What to use for the acute tx of the agitation?
- When would this be contraindicated?
- What other drug is contraindicated in this setting?
Tx - low-dose haloperidol
ci in lewy-body dementia (can exacerbate)
BENZO’S ARE CONTRAINDICATED! (they can even cause this delirium in the first place)
3 drugs in the initial tx of mild-to-moderate alzhemier’s and their class!
1 drug for moderate-to-severe?
donepezil
rivastigmine
galantamine
(reversible) ACETYLCHOLINEESTERASE INHIBITORS
-aka-
PRO-CHOLINERGICS
[alzheimer’s has loss of cholinergic!]
memantine (N-methyl-D-aspartate receptor antagonist)
4 types of lacunar infarcts and their sequelae
verify IL vs CL
HTN predisposes any of the 4 lacunar infarcts:
a) posterior limb of internal capsule infarct
- NO SENSORY/CORTICAL SIGNS
- pure motor, hemiparesis (CL face, arm, leg equally)
- no visual field defects, no neuropsychiatric
- (mild dysarthria)
b) VPL thalamus infarct
- pure sensory
- ipsilateral paresthesia/numbness, hemisensory
c) ataxic-hemiparesis (Anterior limb of internal capsule infarct)
- weakness that is more prominent in the lower limb
- ipsilateral arm and leg incoordination
d) dysarthria clumsy-hand syndrome (lacunar stroke at basis pontis)
- NO SENSORY
- hand weakness
- mild motor aphasia
Imaging finding in schizophrenia?
Autism?
PTSD?
Anxiety disorder?
OCD?
Enlargement of the lateral ventricles
Increased brain volume
Decreased volume of hippocampus
Decreased volume of amygdala and left temporal lobe
Structural abnormalities in the orbitofrontal cortex and basal ganglia
How would the following be injured?
What are their segmental innervations?
Examples of injuries?
a) intrinsic shoulder muscles (deltoid, rotator cuff, teres major)?
b) intrinsic hand muscles (thenar, hypothenar, interossei, lumbricals)?
a) C5-C6 [upper trunk, axillary]; forceful separation of head from shoulder, fall off bike/horse, birth canal (erb’s waiter’s tip)
b) C8-T1 [lower trunk, ulnar]; upward traction, thoracic outlet syndrome, cervical rib (klumpke’s claw)
a) pathophys of “ape hand”
b) Pathophys of “hand of benediction”, “benediction claw” and “a-ok claw” (3)
c) “ulnar deviation” vs “radial deviation” upon attempted wrist flexion?
d) “full claw hand”
a) Median nerve injury (at wrist) - loss of THUMB OPPOSITION
b) Median nerve injury (at elbow) - when you ask patient to make a fist, digits 4 and 5 CAN be flexed bc of .5 FDP innervation from intact ulnar nerve but 2 and 3 CAN’T bc affected .5 FDP from median nerve injury. Thumb CAN’T be flexed either
- or- AT REST, ulnar nerve injury which reverses z-position in lumbricals 3+4 (digits 4+5), BUT THUMB CAN BE FLEXED
- vs- AT REST, median nerve injury can lead “ok” sign from reversed z-position in lumbricals 1+2 (digits 2+3)
c) median nerve injury (at elbow) - FCU acts unopposed but FCR is paralyzed
- vs- ulnar nerve injury (at elbow) - opposite
d) INFERIOR TRUNK C8-T1 injury (essentially median and ulnar both) - AT REST! all lumbricals paralyzed, so over time, z-position get reversed, leading to full claw
Vision loss elicited with change in position?
Papilledema
Short term vs long term side effects of Levodopa/Carbidopa
Selegiline?
trihexyphenidyl, benztropine?
-capones
Short term: hallucinations
Long term: involuntary movements
Insomnia
(anti-cholinergic: dry, blurry vision)
[orthostatic hypotension]
anti-coag reversal guidelines
If SERIOUS BLEEDING, GIVE FFP!
INR9, stop warfarin, give ORAL vit K
Hemineglect? Define and explain pathophys
vs!?
Lesion in the RIGHT, NON-DOMINANT parietal lobe, in which the patient ignores the left side of a space
vs
Gerstmann’s syndrome, lesion in LEFT, DOMINANT parietal lobe, in which patient has acalculia, agraphia, finger agnosia (inability to distinguish fingers)
Botulism progression of symptoms
Descending paralysis with early CN involvement
Two common causative agents of bacterial brain abcess and classically when do they present? How to they both appear on imaging? Ddx?
Viridans streptococcus - assoc. sinusitis
Staph aureus - otherwise. extension of other existing infections, surgical instruments, etc.
Rhizopus - mucormycosis in DM
Toxoplasmosis - immunocompromised
Loss of balance when turning or stopping
Focal back pain, “cauda-equina” type picture, but fever
Parkinson’s
Spinal epidural abscess (MRI, CT-guided drainage/culture to guide abx, surg decompression w/in 24 hours)
suspect epidural abscess with drug abusers (even without fever)
CN III -opathy variations
DM - ischemia to MOTOR fibers leading to “down and out” [unopposed trochlear and abducens action]; accommodation is spared
Compression - BOTH motor AND parasympathetic leading to down and out and “blown” ; no accommodation
Triad of craniopharyngioma. Dx Tx.
1) bitemporal hemianopsia
2) headaches
3) hypopituitarism (growth retardation in kids, decreased libido in adults)
Dx. MRI/CT
Tx. Surgery and radiation
- Bupropion MoA
- name 2 contraindications and why
Norepinephrine, serotonin, and dopamine re-uptake inhibitor
ci in epilepsy (bupropion reduces seizure threshold) and anorexia/bulimia (anorexics typically have electrolyte derangements that can lead to seizures as well so this would add fuel to fire)
Migrainous vertigo vs brainstem/cerebellar stroke vs vestibular neuritis
which of the vertigos is the only one to cause tinnitus
all cause vertigo, none have auditory symptoms
recurrent vs persistent vs single episode
migraine symptoms vs other neuro symptoms vs patient falls towards side of lesion
meineir’s is the only tinnitus
Gabapentin MoA
binds to alpha-2-delta Ca++ channels
Most frequent location of amyloid angiopathy and venous sinus thrombosis? vs SAH?
Lobar hemorrhage vs SAH in the cisterns
How to distinguish Polymyositis from LEMS
polymyositis doesn’t have absent reflexes while LEMS does
Alexia without agraphia
vs
Alexia WITH agraphia
Aphasias vs Dysprosodias
left PCA infarct with lesion in splenium of corpus callosum (and bitemporal hemianopsia w/ macular sparing)
dominant, left, gerstmann’s
Aphasias happen from dominant, left lesions
Dysprosodias happen from non-dominant, right lesions (“same” areas); inability to either express emotion or comprehend emotion
(kaplan is money)
Homonymous anopsia could be two things. How do you distinguish.
Could be either
optic tract lesion (pupillary reflex deficit)
-or-
full optic RADIATION lesion (no pupillary deficit)
note: non full: upper meyer’s (temporal) loop. (UPPER DEFICIT, gets lower retina info)
Corneal reflex tests? (3)
trigeminal nerve (afferent, senses crude touch) facial nerve (efferent, BL blink)
spinal nucleus of 5 responsible for crude touch, pain, temp
Pseudodementia. DDX? Tx? prognosis?
Major depressive episodes in the elderly can be mistaken for dementia. It’s pseudodementia and should be tx with SSRI’s
Impairments are reversible
Which med (besides atropine) can give a myasthenia picture?
AMINOGLYCOSIDE ABX
aka gentamicin
