UWorld Flashcards
Absence - post seizure finding
automatisms
Marfan syndrome vs homocysturia
Both: joint+skin hyperlaxity, tall, pectus deformity
Marfan: aortic root dilitation
Homocysturia: intellectual disability, thrombosis
TBI pts - most common morbidity
Diffuse axonal damage at gray-white junction
Myotonic dystrophy vs Duchenne and Becker
MD - Autosomal dominant, testicular atrophy, balding
D/B - X-linked Recessive
Aminoglycoside toxicity
- hearing problems
- VOR can elicit vestibular problems from gentamicin
- pts can get oscillopsia (see objects moving around vision)
lacunar stroke
provides blood to deep brain structures (ex: subcortical, lenticulostriae)
Peripheral nerve compression can have intermittent symptoms
Peripheral nerve compression can have intermittent symptoms
Pronator drift vs Romberg
- Palms up, if pronation occurs =
- UMN sign in pyramidal/corticospinal tracts
Romberg: stand with eyes closed, this tests posterior tracks and proprioception
Absence seizure comorbidities
ADHD, anxiety
Status epilepticus/continuous brain seizing - Cx
cortical laminar necrosis - due to chronic excitatory toxicity, leads to chronic neurologic deficits and more seizures
Traumatic carotid injuries (internal carotid)
- sports, falls with toothbrush in mouth
- Sx: gradual oneste hemiplegia, aphasia, neck pain, “thunder-clap” headache
“curtain descending over visual field”
amaurosis fugax - retinal ischemia from atherosclerotic emboli from ipsilateral carotid artery. Get a neck Doppler! (ICA)
NF 1
- Auto-Dom
- Café-au-lait spots
- optic glioma
- neurofibroma
- lisch nodules
- freckles (axillary, inguinal)
Multi-infarct dementia
vs
AD
Multi-infarct dementia = abrupt, step-wise deterioration in memory, strokes accumulate. *exec function worse than memory eary
AD = memory worse initially. poor speech = difficulty finding words. cognitive decline. Late findings: Neuropsych, lack of insight, non-cognitive neuro deficits: seizure, clonus
Most common causes of syringomyelia:
- old spinal cord injuries, Arnold Chiari malformations
- symptoms develops months-years after initial injury and onset is gradual (why see hand muscle wasting)
cervical spondylosis
- degenerative changes over the age of 40
- neck pain and stiffness are most common Sx
- may develop spinal stenosis –> neurologic deficits
Posterior cord vs
Central cord vs
Anterior cord syndromes
Posterior cord - posterior columns/vibration/proprioception
Central anterior spinal cord - hyper extension injuries in elderly, or prior degeneration of cervical spine… results in corticospinal tracts for upper extremities, lateral spinothalamic tracts (legs would be fine)
Anterior cord - bilateral motor spastic paresis distal to the lesion (anterior spinal artery)
Trihexyphenydil can cause acute angle-closure glaucoma
bc is an anti-cholinergic
Brain tumors and differentiations: craniopharyngioma ependymoma glioblastoma medulloblastoma neuroblastoma pilocytic astrocytoma
craniopharyngioma - bitemporal hemianopsia
ependymoma - 4th ventricle, supratentorial
glioblastoma - cerebral hemispheres, seizures
medulloblastoma - cerebellar vermis, infratentorial
neuroblastoma - symp ganglion cells, from abd mass
pilocytic astrocytoma - #1 child tumor
anterior vs posterior tumor locations
anterior - seizure, weakness, sensory changes
posterior - cerebellar dysfunction
AD vs Vascular Dementia
AD - early short term memory loss, late personality changes
Vascular Dementia - step wise decline. abrupt decline in exec function. objective neurologic deficits (left hemiparesis, Romberg sign, pronator drift –> may suggest ischemic stroke on top of vascular dementia)
Cerebral Palsy - Risk factors, Sx/Comorbidites
- Prenatal brain insults before 32 weeks gestation (most important factor–many things cause insults)
- spastic diplegia is commonly seen in toddlers (no leg use, use arms to crawl instead)
- Intellectual disability, epilepsy, strabismus, scoliosis
Intraparenchymal hemorrhage -locations, desc order
- basal ganglia (putamen)(contralat hemiparesis/sensory loss, gaze preference)
- cerebellar nuclei (NO HEMIPARESIS!)
- thalamus (contra hemiparesis, eyes deviate towards)
- pons (Pinpoint* reactive pupils)
- cerebral cortex (Sx depends on location)
-gradual onset Sx (min-hr)
Intraparenchymal hemorrhage vs embolic stroke
Intraparenchymal hemorrhage = will have focal findings that then progress to show increased ICP (vomiting)
Embolic stroke - abrupt and Sx are maximal from the start
neurogenic claudication vs cauda equine vs vascular claudication/PVD
- neurogenic claudication = spinal stensosis, secondary to DJD –> worse Sx by spinal extension, relived by flexion (going uphill) still painful when standing still
- cauda equine syndrome = saddle anesthesia, ANS sx
- vascular claudication/PVD = worsened by walking, relived by standing still
Greatest CVA risk factor
-having HTN (not sedentary lifestyle or Fhx)
DiGeorge Syndrome - mnuemonic + neuro risk
- thymic aplasia (T cell deficiency)
- hypocalcemia (no parathyroid development)
- tetralogy of Fallot (PROVe)
- neuro risk: from recurrent sinusitis -> brain abscess (triad: fever, nocturnal/morning headaches, neurologic findings)
Pseudo dementia and MDD
Pseudo dementia and MDD
Evaluation head trauma 2-18 yo
- no CT needed if only minor head trauma without other sx (vomiting)
- otherwise, CT non-con
Single vs multiple brain abscesses
Single = direct spread (otitis, sinusitis, dental infection) multiple = hematogenous spread (endocarditis, osteomyelitis)
Most common single brain lesion species
- virdans streptococci, staph aureus
- direct spread (otitis, sinusitis, dental infection)
- focal brain lesion: enhancing with central necrosis
Subacute Combined Degeneration
- B12 deficiency Cx
- starts with dorsal/posterior tracts –> dec vib/proprio, then gait
- Dz progression: cortico-spinal tract degeneration UMNs, spastic paresis, hyperreflexia
- Other Cx: peripheral neuropathy, memory loss, dementia
Example of how uncal herniation can occur
MVC -> Epidural hematoma -> uncal herniation -> CN 3 issues/hemiplegia and hemisensory loss
Cushin’s Reflex:
1 - HTN
2 - Bradycardia
3 - Respiratory depression
vasovagal/neuro-mediated syncope vs
orthostatic hypotension
vasovagal syncope = prolonged standing, emotional stress, painful stimuli (prodromal Sx: warmth, nausea, diaphoresis)
orthostatic syncope = postural changes
MS - CSF
- Nrm opening pressure
- Nrm cell count (inc T-cell)
- Nrm total protein (IgG elevated)
Albuminocytologic dissociation = in GBS
Work up for distribution of weakness and numbness
- start with distribution
- localize by muscle or reflex
- localize further by dermatomal distribution
Viral meningitis CSF -odd finding
protein is <100
Tx for pseduotumor cerebri / IIH
Tx = Acetazolamide (inhibits CSF production via choroid plexus carbonic anhydrase) +/- furosemide
(TX IS NOT MANNITOL!)(Mannitol is for severely obtunded pts/those with severe cerebral edema)
Cushing Reflex
HTN, bradycardia, respiratory depression –> concerning for brainstem compression
Intracranial HTN (pseudo tumor cerebri)
- Sx: can be HA, mental status changes, blurred vision
- PEx: +/- papilledema
- Tx: weight loss / acetazolamide
Wernicke Encephalopathy vs alcohol cerebellar degeneration
- due to Thiamine deficiency-neuronal loss
- Sx: gait ataxia, oculomotor dysfunction (horizontal nystagmus), encephalopathy
- alcohol cerebellar degeneration: purkinje damage to cerebellar vermis.
- Sx: slowly progressive ambulation difficulties (ex: wide-based gait)
GTC pt no severe risk factors w/u algo:
1 - basic blood tests, check urine drug screen (rule out toxic/metabolic 1st)
2 - then, maybe get MRI for seizure
