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Step 2 Big Time Study Deck > Week 4 > Flashcards

Week 4 Flashcards

1
Q

if you lesion the right MLF what way can you not adduct

A

your right eye will not be able to ADDuct when looking to the left. INO= Ipsilateral adduction failure Nystagmus Opposite

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2
Q

what cancer is most associated with paraneoplastic cerebellar degeneration

A

breast cancer

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3
Q

if a patient has loss of pain and temp in their arms where is the lesion

A

central spinal cord like a syringomyelia bc it compresses the anterior commissure first

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4
Q

etiologies of central cord syndrome

A

syringomyelia, hyperextension of the neck (like from a fall), tumors

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5
Q

what does wrong way eyes mean

A

this means that the eyes are down and out towards the opposite way of the lesion. Meaning they are towards the same side as the weakness.

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6
Q

where is the hemorrage if there is wrong way eyes

A

thalamus always!

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7
Q

what test can you do to dx central retinal vein occlusion

A

fluorecein angiography

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8
Q

what is the drug of choice for delerium in patients

A

haloperidol

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9
Q

what is the drug of choice for delerium tremens

A

benzos

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10
Q

what is associated with ankylosing spondyloarthritis

A

sacroilitis, achilles tendon insertion site pain, morning stiffness that improves with activity, reduced spinal mobility, dactylitis, etc.

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11
Q

what is the first line treatment for tension headaches prevention

A

amitriptyline

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12
Q

what is first line treatment of migrains prophylaxis

A

topiramate or propanolol –> amitriptyline –> verapamil

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13
Q

what is the first line treatment for cluster headache prophylaxis

A

verapamil

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14
Q

what is the differences in clinical presentation of menieres vs. acoustic neuroma

A

hearing loss, vertigo, tinnitus, all are similar. However menieres has stronger more severe vertigo attacks and ear fullness whereas

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15
Q

what are some neurological manifestations of hypothyroidism

A

poor concentration, muscle weakness (proximal > distal), hyporeflexia, truncal and gait ataxia, obstructive and central apnea etc

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16
Q

what can get damaged when correct Na imbalance

A

low to high your pons will die, high to low your brains will blow

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17
Q

what is subacute combined degeneration

A

this is just B12 deficiency!

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18
Q

what clinical signs are involved in subacute combined degeneration

A

paresthesias especially of lower extremities (due to demyelination of the dorsal columns), spastic paresis of lower limbs bc of demyelination of LCST

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19
Q

what is the antibody for cerebellar degeration

A

anti-yo

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20
Q

what cancer is associated with anti NMDA antibodies

A

ovarian teratoma

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21
Q

what should be suspected as the possible etiology of a younger patient with a stroke

A

antiphospholipid syndrome; especially if they do not have any clear risk factors

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22
Q

what antibodiesa are associated with antiphospholipid syndrome

A

anti-cardiolipin, lupus anticoagulant, anti-beta2-glycoprotein

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23
Q

what is a neurological effect of sarcoid

A

myopathy, mono- or poly- neuropathies, radiculopathies, myelopathy, neuroendocrine dysfunction

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24
Q

what skin condition is a sign of sarcoid

A

erythema nodosum

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25
Q

what is TME

A

toxic metabolic encephlaopathy and this is when there is global cerebral dysfunciton in absence of structural cause

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26
Q

what can cause TME

A

metobolic disturbances, infection (systemic), drugs, commonly seen in the ICU

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27
Q

how do diagnose TME

A

EEG, will show global dysfunction via a slow background rhythm, and triphasic waves

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28
Q

enxyme missing in neiman pick and notable features

A

sphingomyelinase, YES HSM, cherry red spot

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29
Q

enzyme missing in gaucher and notable features

A

glucocerebrocidase, cherry red spot, gaucher cells in bm

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30
Q

enzyme missing in Krabbe and notable features

A

galactosylceramide P-galactosidase, globoid cells with PAS+granules

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31
Q

enzyme missing in hurler and notable features

A

a-L-iduronidase, clouding of the cornea, characteristic facies and dwarfism

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32
Q

enzyme missing in hunter and notable features

A

iduronidase sulfatase, Xlinked, no clouding

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33
Q

metachromatic leukodystrophy enzyme and features

A

arylsulfatase, cherry red spot, demyelinating disorder, schizophrenia in adults

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34
Q

adrenoleukodystrophy enzyme and features

A

VLCFA oxidation, x linked

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35
Q

what brain tumor is associated with von hippel-lindau syndrome

A

hemangioblastoma

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36
Q

glioblastoma pathology

A

central necrosis, round and highly pleomorphic cells, palisading

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37
Q

what is a good mutation for glioblastomas to have

A

MGMT methyl transferase

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38
Q

common treatment for glioblastoma

A

surgical resection and then temozolomide (cytotoxic alkylating agent)

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39
Q

presentation of oligodendroglioma

A

mostly seizures

40
Q

good mutation for prognosis of oligodendroglioma

A

IDH mutant

41
Q

pathology of oligodendroglioma

A

derived from oligodendrocytes, chicken wire capillaries, fried egg appearance

42
Q

ependymoma epidemiology

A

mostly children

43
Q

ependymoma pathology

A

pseudorosettes

44
Q

meningioma presentation

A

often nothing, but if in falx cerebri can have leg paresis

45
Q

meningioma pathology

A

whirled pattern, progesterone receptors

46
Q

medulloblastoma location

A

mostly in the 4th ventricle

47
Q

medulloblastoma pathology

A

anaplastic small blue cells and homer-wright rosettes

48
Q

medulloblastoma metastasis relation

A

can drop mets to the spinal cord

49
Q

Schwannoma associated features clinically

A

hearing loss, vestibular symptoms, facial symptoms (CNVII is right there)

50
Q

how do you get Primary CNS lymphoma

A

has to be from EBV and is associated with immunodeficiency

51
Q

what are clinical signs of craniopharyngioma

A

hypopituitarism, headache, bitemporal hemianopia, vomiting, hyperprolactinemia

52
Q

what are the clinical signs of pituitary adenoma

A

most of them are prolactinomas so galactorrhea, amenorrhea, reduced bone density, headache, bitemporal hemianopia, impotence

53
Q

what is the first line treatment for postherpetic neuralgia

A

first is a tricyclic antidepressant but this is contraindicated in patients with heart conditions, then gabapentin

54
Q

what does a hypodense area on CT scan mean in terms of stroke

A

it means something happened about 24 hours ago

55
Q

how can you tell if someone is volume depleted

A

elevated BUN:Creat ratio indicating a pre-renal azotemia from lack of perfusion

56
Q

what are signs of heatstroke

A

rhabdomyolysis, temps super high, acute kidney injury, DIC

57
Q

what is complex regional pain syndrome

A

this is when you have severe pain along with cool limbs but still have normal pulses and everything. pain is more severe than should be. motor dysfunctions

58
Q

what is propagnosia

A

inability to recognize faces but can identify parts of the face like nose mouth teeth etc

59
Q

what area is lesioned if the patient has propagnosia

A

the right posterior superior temporal cortex

60
Q

neurological signs of polycythemia vera

A

strokes! bc you have way too many RBCs they can clump together and cause a clot

61
Q

treatment of polycythemia vera

A

frequent phlebotomy

62
Q

what is an adverse drug effect of levodopa

A

orthostatic hypotension

63
Q

what does adding carbidopa help do

A

this inhibits the peripheral conversion of levodopa to dopamine via dopamine decarboxylase which decreases orthostatic hypothension

64
Q

what is the treatment for vascular dementia

A

cognitive training

65
Q

in patients with afib, what drug should they be on to prevent stroke/TIA

A

an anticoag drug like rivaroxaban

66
Q

what are the signs that you should not do a lumbar puncture (pneumonic)

A

FAILS: focal neurological signs, altered mental status, immunocomprimised/ICP elevated, lesions in skin near brain or LP site, seizures

67
Q

do patients with NPH have increased ICP

A

often no, so they wont have papilledem

68
Q

how do we get tetanus toxin

A

from trauma/rusty nails

69
Q

what does tetanus toxin inhibit

A

this inhbits GABA/glycine release so there is excess glutamate which causes spasticity

70
Q

what are the signs of botulism toxin

A

descending paralysis, especially starting with swallowing, weakness in the arms etc

71
Q

what structure is compressed in a pancoast tumor that causes horners

A

the stellate ganglion

72
Q

what is the mode of inheritance for neurofibromatosis

A

autosomal dominant

73
Q

does a CT scan have to show evidence of SAH for it to be a SAH

A

NO, a small bleed wont show, can do an LP

74
Q

what are signs of vertebrobasialar disfunction

A

often vestibulocerebellar signs (dizziness, vertigo, blurry vision), ipsilateral cranial nerve palsies, contralateral paresis

75
Q

signs of tethered cord syndrome

A

back pain, gait abnormalities, dimple/tuft of hair at sacrum, diminished reflexes

76
Q

best way to manage cauda equina syndrome

A

lubosacral laminectomy

77
Q

how soon do you see demylination in GBS vs. CIDP

A

GBS is ascending within days vs. CIDP is more chronic over weeks

78
Q

what is the pathophys of idiopathic intracranial HTN aka pseudotumor cerebri

A

this is due to lack of CSF absorption

79
Q

what type of bleed does a ruptured berry aneurysm lead to

A

SAH

80
Q

what type of bleed can hypertension lead to

A

intracerebral hematoma

81
Q

signs of krabbe disease

A

hypotonia, babinski sign, fevers, optic nerve pallor vision loss, spasticity

82
Q

pathophys/enzyme missing in Krabbe

A

degeneration of white matter, galactocerebrecidase

83
Q

how are acute relapses of MS treated

A

corticosteroids–> IV methylpredisolone

84
Q

what are soem DMARDS for MS

A

interferon beta 1a and 1b, Glatiramer, Natalizumab

85
Q

what is the target of natalizumab

A

mab against alpha-4-integrin

86
Q

what is a side effect of natalizumab

A

PML from JC virus

87
Q

what is ADEM

A

acute disseminated encephalomyelitis –> where you have multiple white matter lesions like MS but they are more spread out

88
Q

what is brudzinskis sign and kernigs sign

A

this is when you are moving the leg or flexing the neck and it elicits pain

89
Q

if there are multiple brain abcesses what is the route of transmission

A

hematoginously

90
Q

what is the most common virus that causes meningitis

A

enterovirus (cosackievirus)

91
Q

what are clinical signs of HSV encephalitis

A

complex partial seizures of the temporal lobe origin, olfactory hallucinations, memory distubances

92
Q

HSV encephalitis CSF findings

A

elevated RBC count and leukocytosis

93
Q

what is the endemic area of coccidiodies

A

southwest US and mexico

94
Q

where is blastomycoses

A

mississippi river valley

95
Q

histoplasma loci

A

ohio river valley

96
Q

what fungus can cause meningitis

A

cryptococcus especially in the immunocomprimised

97
Q

what gives us neurocysticercosis

A

taenia solium from central and south america seen in immigrant populations

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