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Neurology Clerkship > Last Week Prep > Flashcards

Last Week Prep Flashcards

1
Q

Triad of normal pressure hydrocephalus

A
  1. Subcortical dementia (attentional deficit, apathy)
  2. Gait dysfunction
  3. Urinary incontinence
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2
Q

First-line for migraine prophylaxis during pregnancy

A

Propranolol or metoprolol

Beta blockers have a great safety profile for pregnancy

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3
Q

Characteristics of PML on imaging

A

Ultimately, PML is a demyelinating disease

On MRI, this will appear hyperintense.

On CT, this will appear hypodense and non-enhancing.

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4
Q

Features of catatonia

A
  • Triad of:
    • Immobility
    • Mutism (with or without echolalia)
    • Negativism (proportional resistance to passive movement)
  • Occurs in the context of:
    • Mood disorder
    • Psychotic disorder
    • Autism
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5
Q

Treatment of catatonia

A

1st line: Benzodiazepines (IV lorazepam)

Refractory: Electroconvulsive therapy

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6
Q

Cavernous sinus thrombosis symptoms

A
  • Unilateral:
    • Headache
    • Ocular palsy
    • Periorbital edema
    • V1/V2 distribution sensory changes (hypo- or hyper-esthesia)
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7
Q

Infection resulting in cavernous sinus thrombosis

A

Since the facial/ophthalmologic venous system is valveless, skin infection of the face can secondarily result in CST

This will look like some initial infection which then acutely worsens with headache, CN3-6 abnormalities, V1/V2 sensory abnormalities, and papilledema on exam

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8
Q

Diagnosis of normal pressure hydrocephalus

A
  • Suspected with CT showing enlarged ventricles in the appropriate clinical context
  • Normal pressure on large-volume LP and post-LP improvement in symptoms is diagnostic – if elevated, something else should be suspected
  • Definitve therapy is with shunt placement
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9
Q

Treatment of a myasthenic crisis

A
  • Cirtocisteroids + (Plasma exchange or IVIG)
  • Intubation
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10
Q

Spindylolithesis

A
  • Form of back pain that presents in adolescents
  • Due to increased lumbar lordosis during growth spurts
    • Playing a sport w/ repetitive back flexion/extension is a risk factor
  • May have neurologic signs/symptoms beneath lesion
  • Palpable step-off on exam
  • Pain exacerbated by lumbar extension
  • Dx: Lumbar radiograph
  • Tx: Limit activity, physical therapy, analgesia. If this fails or there are disabling neurologic deficits, surgery.
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11
Q

What are we trying to rule out by doing MRI prior to LP in suspected IIH?

A
  • Non-communicating hydrocephalus
  • Tumors
  • Venous sinus thrombosis
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12
Q

Subependymal nodules

A
  • Visualized on CT as small bilateral calcifications along the ventricles
  • Often present in tuberous sclerosis patients who present with seizure
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13
Q

What should you consider when it looks like a small child had a stroke?

A

Sickle cell anemia

Treat w/ plasma exchange transfusion

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14
Q

How to think of CIDP

A

Chronic Gullian Barre

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15
Q

Spinocerebellar tracts

A
  • First-order neurons deliver information from Golgi tendons to the posterior horn of the spinal cord
  • From there, this information is relayed to second-order neurons divided between two tracks:
    • The dorsal spinocerebellar tract carries information ipsilaterally to the cerebellum through the inferior cerebellar peduncles
    • The ventral spinocerebellar tract carries carries information ipsilaterally and contralaterally to the cerebellum through the superior cerebellar peduncles
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16
Q

Flow of information through the red nucleus

A
17
Q

Rubrospinal tract

A
18
Q

Lateral brain slice showing deep gray structures

A
19
Q

Glabellar sign

A

Failure of blinking reflex to extinguish

Form of frontal release sign

Sign of Parkinson’s

20
Q

Hockey stick sign

A
21
Q

Two cases where syringomyelia is usually seen

A
  • Arnold-Chiari type I malformation
  • Cervical spinal injury
22
Q

Von Hippel Lindau

A

Additionally, patients with VHL may have elevated blood pressure at baseline due to catecholamine overproduction

23
Q

Associated tuberous sclerosis tumors

A
  • Hamartomas
  • Subependymal nodules
  • Cardiac rhabdomyomas
24
Q

Risk reduction of Alzheimer’s disease

A

Managing chronic medical conditions well can delay onset of Alzheimer’s

25
Q

Basic picture of Friedrich ataxia

A
  • Subacute combined degeneration picture (dorsal column and UMN signs)
  • Scoliosis
  • Cardiomyopathy
  • Diabetes mellitus
26
Q

Oculogyric crisis

A

A form of dystonic reaction that may be observed in patients on neuroleptics

Forced upward gaze deviation

Treat with anticholinergics (ex. trihexyphenidyl, benztropine)

27
Q

Choroid plexus papilloma

A
  • Basically an intraventricular papilloma that secretes CSF and raises the ICP
  • Occurs most commonly in infants
  • Associated signs
    • “Vomits after waking up from a nap”
    • Hydrocephalus
28
Q

Thalamic pain syndrome

A

Occurs following a thalamic lacunar stroke

The affected sensory distribution regains some sensation, but has hyperesthesia with allodynia

29
Q

Restless leg syndrome in pregnancy

A

Common and progresses throughout the pregnancy

Due to increased iron needs

Can treat with supplemental iron. Resolves after delivery.

30
Q

Stroke in a young adult patient without risk factors

A

Think cocaine or amphetamines

Check the vitals and the pupils

31
Q

Inheritance patterns of muscular dystrophies

A

Duschene’s: X-linked

Becker’s: X-linked

Myotonia: Autosomal dominant

32
Q

How test makers trick you into thinking that a patient has ADPKD when they have VHL

A

VHL can have multiple clear cell carcinomas, which can appear “polycystric” on ultrasound.

So, if a patient has hemangioblastomas and a VHL-like presentation, don’t be tricked by “polycystic kidneys” into thinking that they have ADPKD.

33
Q

___ may be a non-epileptic sequela of bacterial meningitis that can mimic absence epilepsy

A

Hearing loss may be a non-epileptic sequela of bacterial meningitis that can mimic absence epilepsy

In fact, all patients (particularly children) with bacterial meningitis should undergo audiologic testing after completing therapy.

34
Q

Malignant hemispheric infarction

A

When a large stroke causes cerebral edema and/or hemorrhagic transformation

Usually occurs in first 48 hours, but may occur up to 1 week post large infarct.

Dx: Emergent non-contrast CT

Tx: Emergent decompressive craniotomy

35
Q

How cortical vs peripheral blindness are described

A

In peripheral blindness, it is like there is a “curtain over your vision”. The radiations also fall into this category.

If cortical blindness, it is like the that part of your field of vision just isn’t there

36
Q

Serotonin syndrome symptoms

A

May present mildly as someone who appears anxious and jittery when taking a new serotonergic medication

37
Q

Two things to know about pediatric astrocyoma

A
  1. It s the most common pediatric CNS tumor
  2. It can appear anywhere in the cortex, most commonly frontal/parietal
38
Q

Autonomic dysreflexia in spinal cord injury

A
  • May happen in any spinal cord injury. Occurs in the context of a noctious stimulus (distended bladder, pain, etc).
  • Due to dissociation between primary sympathetic and modulating parasympathetic responses.
    • Above the lesion, the parasympathetic response predominates, causing bradycardia and facial flushing.
    • Below the lesion, the sympathetic response predominates, causing severe hypertension.
39
Q

Most likely auerysms to compress CN3?

A

Most commonly PICA aneurysm, sometimes internal carotid aneurysm.

In contrast, CN6 is rarely ever compressed by an aneurysm. Instead, it is a false localizing sign in elevated ICP. Both CN3 and CN6 may be affected in cavernous sinus syndrome.

Neurology Clerkship (60 decks)

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