Uworld Flashcards
1
Q
define dystonia
A
involuntary muscle contractions that cause slow repetitive movements or abnormal postures; may be painful/assoc w/ tremor or other features
2
Q
Fine tremor typically suppressed at rest and exacerbated at then end of goal-directed movements?
A
essential tremor
3
Q
Options to tx essential tremor other than propranolol?
A
primidone (barbiturate anticonvulsant)
topiramate
4
Q
Most common EARLY side effects of carbidopa/levidopa?
A
hallucinations, confusion, agitation, dizziness, somnolence, nausea
5
Q
LATER onset side effects of carbidopa/levidopa?
A
invol movements (dyskinesia, dystonia); usually after 5-10 yrs of tx
6
Q
define dyskinesia
A
abnormality or impairment of voluntary movement
7
Q
Anticholinergic Parkinson’s drugs
A
Trihexyphenidyl
benztropine
8
Q
Dopamine agonists that can be used in Parkinsons’
A
apomorphine, bromocriptin, pramipexole, ropinirole
9
Q
COMT inhibitors useful in Parkinsons’
A
entacapone (acts peripherally), tolcapone (acts centrally and peripherally)
10
Q
SE of amantadine?
A
ankle edema, livedo reticularis
11
Q
MAO B inhibitor used for Parkinsons? and SE?
A
selegiline (decreases dopamine metabolism)
- insomnia/confusion in elderly
12
Q
SE of COMT inhibitors?
A
dyskinesia, hallucinations, confusion, nausea/orthostatic HoTN
13
Q
What is amaurosis fugax?
A
painless, rapid, transient (<10 min) monocular vision loss
14
Q
MCC of amaurosis fugax?
A
retinal ischemia due to atherosclerotic emboli from ipsi carotid artery
15
Q
Uncommon causes of transient monocular visual loss?
A
cardioembolic disease, giant cell arteritis, retinal vein occlusion, retinal vasospasm, papilledema
16
Q
Secondary causes of restless legs syndrome?
A
- Fe def anemia
- uremia (ESRD, CKD)
- MS, Parkinson
- pregnancy
- drugs (antidep, metoclopramide)
17
Q
Tx for mild/intermittent restless leg syndrome?
A
- supplement iron when serum ferritin <= 75
- supportive measures (leg massage, heating pad, exercise)
- avoid aggravating factors (sleep deprivation, meds)
18
Q
Treatment for persistent/severe restless leg syndrome?
A
1st line: dopamine agonists (pramipexole)
alt: alpha2delta calcium channel ligans (gabapentin enacarbil)
19
Q
Most sig cause of morbidity in pts with TBI?
A
diffuse axonal injury
20
Q
What causes diffuse axonal injury?
A
sudden accel-decel -> rotational forces -> affect areas with greatest density difference (gray white jxn mult. punctate hem)
21
Q
clinical features of diffuse axonal injury?
A
- out of proportion with CT (MRI more sens than CT)
- immediate LOC, later persistent vegetative state
22
Q
Can CT show MS lesions?
A
NO; only MRI
23
Q
At what level would you expect to see loss of contralat pain and temp relative to the lesion?
A
lesion = 2 levels above area of damage
aka damage occurs two levels below lesion; if lesion is at T10, damage felt at T12
24
Q
Mechanism and use for riluzole?
A
glutamate inhibitor used for ALS; prolongs survival/time to tracheostomy
25
SE of riluzole
dizziness, nausea, wt loss, elevated liver enzymes/skeletal weakness
26
CSF findings w/ idiopathic intracranial hypertension (pseudotumor cerebri)
increased CSF opening pressure
| otherwise normal
27
triptan mechanism
serotonin 5HT1b,d AGONISTS in blood vessels -> constriction
28
best way to dx acoustic neuroma?
MRI w/ gadolinium
29
Cholinesterase inhibitors shown to be effective in pts w/ mild-mod dementia?
- donepezil (aricept)
- galantamine/galantamine ER
- rivastigmine (exelon)
30
NMDA receptor antagonist approved for dementia?
memantine
31
Indications to refer corneal abrasion pt to ophtho?
- ulceration
- pus
- decreased visual acuity
- lack of healing in 3-4 days
32
Facial nerve responsibilities
- facial movement
- taste: ant 2/3 tongue
- salivation (chorda tympani)
- eyelid closure
- sensory to external ear
33
responsibility of vagus nerve
- swallowing
- palate elevation
- phonation
- taste in epiglottis/sensation from parts of external ear
- afferent limb of cough reflex
- efferent limb of gag reflex
- PS outflow to thoracoabdominal viscera including aortic arch baro/chemoreceptors
34
DOC for agitation in elderly?
low dose haloperidol
| alt = quetiapine, risperidone-
35
When are typical antipsychotics absolutely CI in elderly pts?
- if they have Lewy Body demenita - may have neuroleptic hypersensitivity -> severe parkinsonism/AMS
36
What meds can ppt myasthenic crisis?
- aminoglycosides
- fluoroquinolines
- macrolides
- beta blockers
37
Why should acetylcholinesterase inhibitors be temporarily held during myasthenic crisis?
- reduce excess airway secretions and risk of aspiration
38
What is the preferred treatment for myasthenic crisis?
- plasmapheresis (preferred)
- alt: IVIG
AND corticosteroids
39
Multiple system atrophy
aka Shy-Drager syndrome
1. parkinsonism
2. autonomic dysfxn (orthostasis, abnormal sweating, disturbance in bowel/bladder fxn, abn salivation/lacrimation, impotence, gastroparesis
3. widespread neuro signs (cerebellar, pyramidal, LMN)
40
tx for multiple system atrophy?
- intravascular volume expansion w/ fludrocortisone, salt, alpha agonists, constrictive garments
- anti-parkinsonism drugs INEFFECTIVE
41
define transverse myelitis
- motor and sensory loss below level of lesions w/ bowel/bladder dysfxn
- initial flaccid paralysis (spinal shock), then spastic paralysis w/ hyperreflexia
- can be assoc w/ MS
42
When is stereotactic radiosurgery used for brain metastasis?
- pt not a candidate for sx
- lesion is sx inaccessible
- metastasis is small (<3 cm)
43
With what conditions would you see spastic gait?
- spinal cord injury
- cerebral palsy
(UMN lesions)
gait = slow, stiff, effortful
44
Condition w/ waddling gait?
muscular dystrophy (weakness of gluteal folds)
45
What kind of ataxia goes along w/ the cerebellar vermis?
TRUNCAL ataxia
46
define torticollis
focal dystonia (sustained muscle contraction -> twisting, rep movements, abnormal postures) of SCM
47
Common causes of torticollis?
meds: typical antipsychotics, metoclopromide, prochlorperazine
48
Akathisia vs athetosis
akathisia = sense of restlessness causing pts to move frequently
athetosis = slow, writhing movements, typically affecting hand and feet; typical of HD
49
What is the location of the lesion w/ receptive aphasia?
dominant temporal lobe (Wernicke's area)
50
MOA of metoclopromaide
dopamine receptor antagonist for N/V/gastroparesis;
| SE: extrapyramidal symptoms
51
Sources of botulinum toxin and its action?
- poorly canned foods, aged seafood (cured fish)
| - toxin inhibits presynaptic ACh release at NMJ
52
botulism presentation and tx
- acute onset w/in 36 hrs
- bilateral CN neuropathies
- symmetric decending muscle weakness
tx: equine antitoxin
53
What does Cushing reflex consist of and what does it suggest?
triad: 1. HTN 2. bradycardia 3. resp depression
| suggests brainstem compression
54
Red flag symptoms for cavernous sinus thrombosis?
- severe HA
- bilateral periorbital edema
- CN III,IV, V, VI deficits
55
What MMSE score is suggestive of dementia?
<24
56
heat stroke definition
core temperature >40C
| AMS
57
Wernicke encephalopathy triad
encephalopathy
oculomotor dysfxn
gait ataxia
58
symptoms of cerebellar infacrction of MEDIAL vermis?
vertigo
| nystagmus
59
symptoms of cerebellar infarction of LATERAL?
dizziness, ataxia, weakness
60
How is CNIII palsy unique in diabetes (as opposed to compression)
it is ischemic -> affects only somatic fibers (PS have separate blood supply) so pupillary light rxn is intact
61
Causes of CN III palsy from compression?
- transtentorial (uncal) herniation
| - PCA aneurysm
62
What is the mechanism of lacunar stroke of posterolateral thalamus?
atherothrombotic occlusion of small, penetrating (thalamogeniculate) branches of the PCA -> pure sensory stroke (but can also have transient hemiparesis, athetosis or ballistic movment if neighboring BG/internal capsule affected)
63
What is thalamic pain syndrome?
aka Dejerine-Roussy syndrome
| - severe paroxysmal burning pain over affected area, w/ allodynia (exacerbated by light touch)
64
What would see you on EEG with CJD?
- sharp, triphasic, synchronous discharge
65
What med is used in PD in younger pts whose predominant symptom is tremor?
trihexyphenidyl
66
What happens w/ cerebral vasospasm involving brainstem?
basilar migraine
| - basilar aura symptoms (vertigo, dysarthria, tinnitus, diplopia) w/o motor weakness followed by migraine-type HA
67
MCC of brain abscess?
viridans strep, or s. aureus
68
Core features for dx of dementia w LB:
need 2 of 3
1. fluctuating cognition w/ variable attention/alertness.
2. recurrent visual hallucinations - usually well-formed, detailed
3. spontaneous motor features of parkinsonism
69
features that are not essential but can support dx of DLB?
- repeated falls
- syncope
- transient LOC
- neuroleptic sensitivity
- systematized delusions
70
Which cord syndrome is associated w/ burst fx of vertebra?
anterior cord syndrome
71
- muscle PAIN & STIFFNESS in shoulder/pelvic girdle
- tenderness w/ dec ROM at shoulder, neck, hip
- rapid response to glucocorticoids
- increased ESR, normal CK
polymyalgia rheumatica
| **muscle strength is NORMAL; no weakness**
72
- prog prox muscle WEAKNESS and ATROPHY without pain/tenderness
- LE muscles more involved
- normal ESR, CK
glucocorticoid-induced myopathy
73
muscle pain, tenderness, prox muscle weakness
skin rash & inflamm arthritis
inc ESR and CK
inflamm myopathy
74
prom muscle pain/tenderness with or without weakness
| rhabdo (rare); inc ESR, CK
stain induced myopathy
75
- muscle pain, cramps & weakness involving prox muscles
- delayed tendon reflexes & myoedema
- occasional rhabdo
- features of hypothyroidism
- normal ESR, inc CK
hypothyroid myopathy
76
What causes idiopathic orthostatic hypotension?
degeneration of postganglionic sympathetic neurons
77
```
dx:
Parkinsonism
orthostatic HoTN
impotence
incontinence
autonomic symptoms
```
multiple system atrophy
| Shy-Drager syndrome
78
initial tests in w/u for first-time seizure in adult?
```
serum electrolytes
glucose
calcium, magnesium
CBC
renal fxn tests, LFTs
tox screen
then consider neuroimaging EEG
```
79
What can occur w/ prolonged carbamezapine use?
aplastic anemia -> get routine CBCs
80
localize the lesion:
- vestibulocerebellar symptoms (vertigo, fall to side of lesion, difficulty sitting up, diplopia, horizontal/vertical nystagmus, ipsi limb ataxia)
- sensory symp (loss of pain temp on ipsi face, contra body)
- ispi bulbar muscle weakness (dysphagia, aspiration, dysarthria, dysphonia, hoarseness)
- autonomic dysfunction (ispi Horner's, intractable hiccups, lack of automatic respiration esp during sleep)
lateral medullary infarction (Wallenburg syndrome)
81
localize lesion:
weakness of muscles of mastication, diminished jaw jerk reflex, impaired tactile/position sensation over face (involvment of ipsi trigem nuc)
lateral mid-pontine lesion
82
localize lesion:
- contralat paralysis of arm/leg
- tongue deviates toward lesion
+/- contralat loss of tactile/position sense
medial medullary syndrome (alternating hypoglossal hemiplegia)
83
what usually causes medial medullary syndrome?
branch occlusion of vertebral or anterior spinal artery
84
localize the lesion:
- contralateral ataxia
- hemiparesis of face, trunk and limbs (ataxic hemiparesis)
- variable loss of contralateral tactile/position sense
medial mid-pontine infarction
85
How could trihexyphenidyl precipitate HA and retro-orbital pain as SE?
precipitation of acute glaucoma due to anticholinergic effect
86
order of MC metastatic brain tumors in terms of frequency?
lung > breast > unknown primary > melanoma >colon
87
MCC of solitary brain mets
breast, colon, RCC
88
MCC of multiple brain mets
lung, melanoma
89
MCC of "steppage gait"
L5 radiculopathy or neuropathy of common peroneal nerve
90
MCC of "magnetic gait"
- NPH (damage to cortico-cortical white matter fibers of frontal lobe)
- > difficulty in initiation of forward movement of feet when in contact w/ ground
91
What is given to dec risk of vasospasm in SAH?
nimodipine
92
NMS tetrad
AMS, rigidity, fever, autonomic dysregulation
93
serontonin syndrome triad
AMS, autonomic instability, neuromuscular excitability (tremor, hyperreflexia, myoclonus)
94
What is a pendular knee reflex indicative of?
muscle hypotonia, can be secondary to cerebellar dysfxn
95
Signs of cerebellar dysfunction
gait dysfxn, truncal ataxia, nystagmus, intention tremor, dysmetria, dysdiadochokinesia
96
When do you give plasmapheresis in MS?
if acute flare is refractory to glucocorticoids
97
What is flumazenil used for?
benzo OD (competitive antagonist of GABA/benzo receptor)
98
What is a common complication of prolonged seizures/status epilepticus?
cortical laminar necrosis (cortical hyperintensity on DWI suggesting infarction)
99
Can you still see DTRs w/ brain death?
YES; SC may still be fxning
100
What does pronator drift indicate?
UMN or pyramidal/corticospinal tract disease
101
Are autonomic disturbances common in guillain-barre?
YES; can include tachy, brady, HTN, orthostatic HoTN, urinary retention
102
What exactly are lewy bodies?
eosinophilic intracytoplasmic inclusions representing accumulations of alpha-synuclein protein
103
What is the most significant complication of benign intracranial HTN (pseudotumor cerebri)
blindness
104
What is the most important risk factor for stroke (has strongest assn w/ strokes)
HTN
105
What is the timeline for re-bleeding after SAH?
w/in first 24 hours
106
What is the timeline for vasospasm after SAH?
after 3 days (day 3-10)
107
Which way do the eyes deviate with MCA occlusion?
TOWARD the side of the lesion (look at your lesion)
108
What SE can be observed in patients on valproic acid?
hyperammonemia (encephalopathy, bradykinesia, asterixis)
109
What causes choroidal rupture and how does it present?
- blunt ocular trauma
- central scotoma, retinal edema, hem. detachment of macula, subretinal hem, crescent-shaped streak concnetric to optic nerve
110
What is astigmatism and how does it present?
- due to nonspherical cornea
| - blurry vision at distance and up close
111
Dendritic ulcers in cornea. Dx?
herpes simplex keratitis
112
What meds can trigger acute angle closure glaucoma in predisposed pts?
decongestants, antiemetics, anticholinergics
113
How to distinguish b/w cataracts and ARMD?
ARMD: peripheral fields and navigational vision always maintained
114
MCC of contact-lens associated keratitis?
gram negatives, like pseudomonas or serratia
115
Does conjunctivitis affect vision?
No
116
What should be done first in tx of acute angle glaucoma?
given mannitol IV
