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*******Neuro clerkship > Uworld > Flashcards

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

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2
Q

Fine tremor typically suppressed at rest and exacerbated at then end of goal-directed movements?

A

essential tremor

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3
Q

Options to tx essential tremor other than propranolol?

A

primidone (barbiturate anticonvulsant)

topiramate

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4
Q

Most common EARLY side effects of carbidopa/levidopa?

A

hallucinations, confusion, agitation, dizziness, somnolence, nausea

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5
Q

LATER onset side effects of carbidopa/levidopa?

A

invol movements (dyskinesia, dystonia); usually after 5-10 yrs of tx

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6
Q

define dyskinesia

A

abnormality or impairment of voluntary movement

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7
Q

Anticholinergic Parkinson’s drugs

A

Trihexyphenidyl

benztropine

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8
Q

Dopamine agonists that can be used in Parkinsons’

A

apomorphine, bromocriptin, pramipexole, ropinirole

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9
Q

COMT inhibitors useful in Parkinsons’

A

entacapone (acts peripherally), tolcapone (acts centrally and peripherally)

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10
Q

SE of amantadine?

A

ankle edema, livedo reticularis

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11
Q

MAO B inhibitor used for Parkinsons? and SE?

A

selegiline (decreases dopamine metabolism)

- insomnia/confusion in elderly

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12
Q

SE of COMT inhibitors?

A

dyskinesia, hallucinations, confusion, nausea/orthostatic HoTN

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13
Q

What is amaurosis fugax?

A

painless, rapid, transient (<10 min) monocular vision loss

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14
Q

MCC of amaurosis fugax?

A

retinal ischemia due to atherosclerotic emboli from ipsi carotid artery

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15
Q

Uncommon causes of transient monocular visual loss?

A

cardioembolic disease, giant cell arteritis, retinal vein occlusion, retinal vasospasm, papilledema

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16
Q

Secondary causes of restless legs syndrome?

A
  • Fe def anemia
  • uremia (ESRD, CKD)
  • MS, Parkinson
  • pregnancy
  • drugs (antidep, metoclopramide)
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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)
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18
Q

Treatment for persistent/severe restless leg syndrome?

A

1st line: dopamine agonists (pramipexole)

alt: alpha2delta calcium channel ligans (gabapentin enacarbil)

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19
Q

Most sig cause of morbidity in pts with TBI?

A

diffuse axonal injury

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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)

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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

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22
Q

Can CT show MS lesions?

A

NO; only MRI

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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

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24
Q

Mechanism and use for riluzole?

A

glutamate inhibitor used for ALS; prolongs survival/time to tracheostomy

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25
Q

SE of riluzole

A

dizziness, nausea, wt loss, elevated liver enzymes/skeletal weakness

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26
Q

CSF findings w/ idiopathic intracranial hypertension (pseudotumor cerebri)

A

increased CSF opening pressure

otherwise normal

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27
Q

triptan mechanism

A

serotonin 5HT1b,d AGONISTS in blood vessels -> constriction

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28
Q

best way to dx acoustic neuroma?

A

MRI w/ gadolinium

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29
Q

Cholinesterase inhibitors shown to be effective in pts w/ mild-mod dementia?

A
  • donepezil (aricept)
  • galantamine/galantamine ER
  • rivastigmine (exelon)
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30
Q

NMDA receptor antagonist approved for dementia?

A

memantine

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31
Q

Indications to refer corneal abrasion pt to ophtho?

A
  • ulceration
  • pus
  • decreased visual acuity
  • lack of healing in 3-4 days
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32
Q

Facial nerve responsibilities

A
  • facial movement
  • taste: ant 2/3 tongue
  • salivation (chorda tympani)
  • eyelid closure
  • sensory to external ear
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33
Q

responsibility of vagus nerve

A
  • 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
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34
Q

DOC for agitation in elderly?

A

low dose haloperidol

alt = quetiapine, risperidone-

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35
Q

When are typical antipsychotics absolutely CI in elderly pts?

A
  • if they have Lewy Body demenita - may have neuroleptic hypersensitivity -> severe parkinsonism/AMS
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36
Q

What meds can ppt myasthenic crisis?

A
  • aminoglycosides
  • fluoroquinolines
  • macrolides
  • beta blockers
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37
Q

Why should acetylcholinesterase inhibitors be temporarily held during myasthenic crisis?

A
  • reduce excess airway secretions and risk of aspiration
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38
Q

What is the preferred treatment for myasthenic crisis?

A
  • plasmapheresis (preferred)
  • alt: IVIG
    AND corticosteroids
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39
Q

Multiple system atrophy

A

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)
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40
Q

tx for multiple system atrophy?

A
  • intravascular volume expansion w/ fludrocortisone, salt, alpha agonists, constrictive garments
  • anti-parkinsonism drugs INEFFECTIVE
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41
Q

define transverse myelitis

A
  • 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
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42
Q

When is stereotactic radiosurgery used for brain metastasis?

A
  • pt not a candidate for sx
  • lesion is sx inaccessible
  • metastasis is small (<3 cm)
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43
Q

With what conditions would you see spastic gait?

A
  • spinal cord injury
  • cerebral palsy
    (UMN lesions)
    gait = slow, stiff, effortful
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44
Q

Condition w/ waddling gait?

A

muscular dystrophy (weakness of gluteal folds)

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45
Q

What kind of ataxia goes along w/ the cerebellar vermis?

A

TRUNCAL ataxia

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46
Q

define torticollis

A

focal dystonia (sustained muscle contraction -> twisting, rep movements, abnormal postures) of SCM

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47
Q

Common causes of torticollis?

A

meds: typical antipsychotics, metoclopromide, prochlorperazine

48
Q

Akathisia vs athetosis

A

akathisia = sense of restlessness causing pts to move frequently

athetosis = slow, writhing movements, typically affecting hand and feet; typical of HD

49
Q

What is the location of the lesion w/ receptive aphasia?

A

dominant temporal lobe (Wernicke’s area)

50
Q

MOA of metoclopromaide

A

dopamine receptor antagonist for N/V/gastroparesis;

SE: extrapyramidal symptoms

51
Q

Sources of botulinum toxin and its action?

A
  • poorly canned foods, aged seafood (cured fish)

- toxin inhibits presynaptic ACh release at NMJ

52
Q

botulism presentation and tx

A
  • acute onset w/in 36 hrs
  • bilateral CN neuropathies
  • symmetric decending muscle weakness
    tx: equine antitoxin
53
Q

What does Cushing reflex consist of and what does it suggest?

A

triad: 1. HTN 2. bradycardia 3. resp depression

suggests brainstem compression

54
Q

Red flag symptoms for cavernous sinus thrombosis?

A
  • severe HA
  • bilateral periorbital edema
  • CN III,IV, V, VI deficits
55
Q

What MMSE score is suggestive of dementia?

A

<24

56
Q

heat stroke definition

A

core temperature >40C

AMS

57
Q

Wernicke encephalopathy triad

A

encephalopathy
oculomotor dysfxn
gait ataxia

58
Q

symptoms of cerebellar infacrction of MEDIAL vermis?

A

vertigo

nystagmus

59
Q

symptoms of cerebellar infarction of LATERAL?

A

dizziness, ataxia, weakness

60
Q

How is CNIII palsy unique in diabetes (as opposed to compression)

A

it is ischemic -> affects only somatic fibers (PS have separate blood supply) so pupillary light rxn is intact

61
Q

Causes of CN III palsy from compression?

A
  • transtentorial (uncal) herniation

- PCA aneurysm

62
Q

What is the mechanism of lacunar stroke of posterolateral thalamus?

A

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
Q

What is thalamic pain syndrome?

A

aka Dejerine-Roussy syndrome

- severe paroxysmal burning pain over affected area, w/ allodynia (exacerbated by light touch)

64
Q

What would see you on EEG with CJD?

A
  • sharp, triphasic, synchronous discharge
65
Q

What med is used in PD in younger pts whose predominant symptom is tremor?

A

trihexyphenidyl

66
Q

What happens w/ cerebral vasospasm involving brainstem?

A

basilar migraine

- basilar aura symptoms (vertigo, dysarthria, tinnitus, diplopia) w/o motor weakness followed by migraine-type HA

67
Q

MCC of brain abscess?

A

viridans strep, or s. aureus

68
Q

Core features for dx of dementia w LB:

A

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
Q

features that are not essential but can support dx of DLB?

A
  • repeated falls
  • syncope
  • transient LOC
  • neuroleptic sensitivity
  • systematized delusions
70
Q

Which cord syndrome is associated w/ burst fx of vertebra?

A

anterior cord syndrome

71
Q
  • muscle PAIN & STIFFNESS in shoulder/pelvic girdle
  • tenderness w/ dec ROM at shoulder, neck, hip
  • rapid response to glucocorticoids
  • increased ESR, normal CK
A

polymyalgia rheumatica

muscle strength is NORMAL; no weakness

72
Q
  • prog prox muscle WEAKNESS and ATROPHY without pain/tenderness
  • LE muscles more involved
  • normal ESR, CK
A

glucocorticoid-induced myopathy

73
Q

muscle pain, tenderness, prox muscle weakness
skin rash & inflamm arthritis
inc ESR and CK

A

inflamm myopathy

74
Q

prom muscle pain/tenderness with or without weakness

rhabdo (rare); inc ESR, CK

A

stain induced myopathy

75
Q
  • muscle pain, cramps & weakness involving prox muscles
  • delayed tendon reflexes & myoedema
  • occasional rhabdo
  • features of hypothyroidism
  • normal ESR, inc CK
A

hypothyroid myopathy

76
Q

What causes idiopathic orthostatic hypotension?

A

degeneration of postganglionic sympathetic neurons

77
Q 
dx:
Parkinsonism
orthostatic HoTN
impotence
incontinence
autonomic symptoms
A

multiple system atrophy

Shy-Drager syndrome

78
Q

initial tests in w/u for first-time seizure in adult?

A 
serum electrolytes
glucose
calcium, magnesium
CBC
renal fxn tests, LFTs
tox screen
then consider neuroimaging EEG
79
Q

What can occur w/ prolonged carbamezapine use?

A

aplastic anemia -> get routine CBCs

80
Q

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)
A

lateral medullary infarction (Wallenburg syndrome)

81
Q

localize lesion:
weakness of muscles of mastication, diminished jaw jerk reflex, impaired tactile/position sensation over face (involvment of ipsi trigem nuc)

A

lateral mid-pontine lesion

82
Q

localize lesion:
- contralat paralysis of arm/leg
- tongue deviates toward lesion
+/- contralat loss of tactile/position sense

A

medial medullary syndrome (alternating hypoglossal hemiplegia)

83
Q

what usually causes medial medullary syndrome?

A

branch occlusion of vertebral or anterior spinal artery

84
Q

localize the lesion:

  • contralateral ataxia
  • hemiparesis of face, trunk and limbs (ataxic hemiparesis)
  • variable loss of contralateral tactile/position sense
A

medial mid-pontine infarction

85
Q

How could trihexyphenidyl precipitate HA and retro-orbital pain as SE?

A

precipitation of acute glaucoma due to anticholinergic effect

86
Q

order of MC metastatic brain tumors in terms of frequency?

A

lung > breast > unknown primary > melanoma >colon

87
Q

MCC of solitary brain mets

A

breast, colon, RCC

88
Q

MCC of multiple brain mets

A

lung, melanoma

89
Q

MCC of “steppage gait”

A

L5 radiculopathy or neuropathy of common peroneal nerve

90
Q

MCC of “magnetic gait”

A
  • 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
Q

What is given to dec risk of vasospasm in SAH?

A

nimodipine

92
Q

NMS tetrad

A

AMS, rigidity, fever, autonomic dysregulation

93
Q

serontonin syndrome triad

A

AMS, autonomic instability, neuromuscular excitability (tremor, hyperreflexia, myoclonus)

94
Q

What is a pendular knee reflex indicative of?

A

muscle hypotonia, can be secondary to cerebellar dysfxn

95
Q

Signs of cerebellar dysfunction

A

gait dysfxn, truncal ataxia, nystagmus, intention tremor, dysmetria, dysdiadochokinesia

96
Q

When do you give plasmapheresis in MS?

A

if acute flare is refractory to glucocorticoids

97
Q

What is flumazenil used for?

A

benzo OD (competitive antagonist of GABA/benzo receptor)

98
Q

What is a common complication of prolonged seizures/status epilepticus?

A

cortical laminar necrosis (cortical hyperintensity on DWI suggesting infarction)

99
Q

Can you still see DTRs w/ brain death?

A

YES; SC may still be fxning

100
Q

What does pronator drift indicate?

A

UMN or pyramidal/corticospinal tract disease

101
Q

Are autonomic disturbances common in guillain-barre?

A

YES; can include tachy, brady, HTN, orthostatic HoTN, urinary retention

102
Q

What exactly are lewy bodies?

A

eosinophilic intracytoplasmic inclusions representing accumulations of alpha-synuclein protein

103
Q

What is the most significant complication of benign intracranial HTN (pseudotumor cerebri)

A

blindness

104
Q

What is the most important risk factor for stroke (has strongest assn w/ strokes)

A

HTN

105
Q

What is the timeline for re-bleeding after SAH?

A

w/in first 24 hours

106
Q

What is the timeline for vasospasm after SAH?

A

after 3 days (day 3-10)

107
Q

Which way do the eyes deviate with MCA occlusion?

A

TOWARD the side of the lesion (look at your lesion)

108
Q

What SE can be observed in patients on valproic acid?

A

hyperammonemia (encephalopathy, bradykinesia, asterixis)

109
Q

What causes choroidal rupture and how does it present?

A
  • blunt ocular trauma
  • central scotoma, retinal edema, hem. detachment of macula, subretinal hem, crescent-shaped streak concnetric to optic nerve
110
Q

What is astigmatism and how does it present?

A
  • due to nonspherical cornea

- blurry vision at distance and up close

111
Q

Dendritic ulcers in cornea. Dx?

A

herpes simplex keratitis

112
Q

What meds can trigger acute angle closure glaucoma in predisposed pts?

A

decongestants, antiemetics, anticholinergics

113
Q

How to distinguish b/w cataracts and ARMD?

A

ARMD: peripheral fields and navigational vision always maintained

114
Q

MCC of contact-lens associated keratitis?

A

gram negatives, like pseudomonas or serratia

115
Q

Does conjunctivitis affect vision?

A

No

116
Q

What should be done first in tx of acute angle glaucoma?

A

given mannitol IV

*******Neuro clerkship (8 decks)

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