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Flashcards in 2014-03-07 USMLE Neuro - USMLE Neuro Deck (224):
1

Onset of delerium

acute and dramatic

2

Onset of dementia

chronic and insidious

3

Common causes of delerium

illness, toxic, withdrawl

4

Common causes of dementia

Alzheimer disease, multi-infarct dementia, HIV/AIDS

5

Is delerium reversible?

usually

6

Is dementia reversible

usually not

7

Describe attention in delerium

poor

8

Describe attention in dementia

usually unaffected

9

Describe arousal level in delerium

fluctuates

10

Describe arousal level in dementia

normal

11

Memory impairment in dementia

in early dementia remote memory is usually spared

12

Memory impairment in delerium

globally impaired

13

What is pseudodementia

depression, usually in elderly, usually treatable

14

Which is associated with hallucinations, illusions, delusion, orientation difficulties and sundowning...delerium or dementia?

both

15

More common treatable causes of dementia

- Vit B12 deficiency
- endocrine disorders (esp. thyroid and parathyroid)
- uremia
- syphilis
- brain tumors
- normal pressure hydrocephalus
- Parkinson's (tx may improve)

16

Wernicke's encephalopathy is from what deficiency?

thiamine

17

Ataxia, ophthalmoplegia, nystagmus and confusion =

Wernicke's encephalopathy

18

An alcoholic with confabulation and anterograde amnesia likely has

Korsakoff syndrome

19

2 key features of Korsakoff syndrome

- anterograde amnesia
- confabulation

20

How do you avoid ppt Wernicke's encephalopathy in an alcoholic when they show up in your ER?

give glucose before thiamine

21

Most common cause of headaches

tension

22

Recurrent frontal/occipital bilateral headache with stiffness is likely what type?

tension

23

General treatment of stress headaches

- stress relief
- NSAIDs/acetaminophen

24

Headache that is unilateral, severe, tender, with watery eyes

cluster

25

Treatment of cluster headaches

oxygen

26

True or false: migraines often have a family history?

true

27

Headaches with aura, photophobia, nausea and vomiting are likely

migrain

28

Typical age of onset for migraine

10-30 years

29

Morning headaches with projectile vomiting are concerning for

tumor

30

What do you order for headache with papilledema?

CT or MRI with contrast

31

Likely diagnosis of morning headache in obese young woman with nausea and negative CT scan

pseudotumor cerebri

32

LP in pseudotumor cerebri

elevated opening pressure, otherwise normal

33

Possible causes of pseudotumor cerebri

- megadoses of vitamin A
- tetracyclines
- withdrawl from corticosteroids

34

Pseudotumor cerebri without treatment may lead to

permanent vision loss

35

Treatment of pseudotumor cerebri

- supportive
- weight loss
- shunt/repeated LPs

36

Worst headache of your life -

subarachnoid hemorrhage

37

Diagnostic test for subarachnoid hemorrhage

- noncontrast CT
- LP

38

2 major causes of subarachnoid hemorrhage

- ruptures berry aneurysm
- trauma

39

Give 4 eye causes of headache

- optic neuritis
- eyestrain from refractive error
- iritis
- glaucoma

40

Give 2 ear causes of headache

- otitis media
- mastoiditis

41

List 8 general causes/types of headache

- tension
- cluster
- tumor
- migraine
- pseudotumor cerebri
- meningitis
- subarachnoid hemorrhage
- extracranial causes

42

What is Kallman syndrome?

- anosmia with hypogonadisms due to gonadotropin-releasing hormone

43

anosmnia + hypogonadism =

Kallman syndrome

44

tic douloureux =

trigenimal neuralgia

45

CNI =

olfactory

46

CNII=

optic

47

CNIII =

oculomotor

48

CN IV =

trochlear

49

CN V =

trigeminal

50

CN VI =

abducens

51

CN 5 innervates

- muscles of mastication
- facial sensation
- afferent corneal relex

52

unilateral shooting facial pain in older adults =

trigeminal neuralgia

53

Treatment of trigeminal neuralgia

antiseizure meds like gabapentin and carbamezepine are most effective

54

CN VII =

Facial

55

CN VII innervates

- muscle of facial expression
- taste of ant 2/3 tongue
- dkin external ear
- lacrimal gland
- salivary (not parotid) gland
- stapedius muscle

56

Flat forehead means CNVII is injured where?

lower motor neuron lesion

57

CN VIII =

vestibulocochlear

58

CN VIII lesions usually manifest as

- deafness
- tinnitus
- vertigo

59

CN IX =

glossopharyngeal

60

CNIX innervates

- pharyngeal muscles
- mucous membranes
- afferent gag
- parotid gland
- taster post 1/3 tongue
- skin external ear
- carotid body/sinus

61

CN X =

vaugs

62

CN X innervates

- muscles of palate
- muscles of pharynx
- muscles of larynx
- efferent gag
- taste at base of tonge
- abdominal viscera
- skin external ear

63

Major things to think of in CNX lesions

- aortic aneurysms
- tumors (such as pancoast)

64

Common things with CNX lesions

- hoarseness
- dysphagia
- loss of gag
- loss of cough

65

CN XI =

spinal accessory

66

CN XI innervates

- sternocleidomastoid
- trapezius

67

Muscle findings in CN XI lesions

- trouble with contralateral head turn
- ipsilateral shoulder drop

68

CN XII =

Hypoglossal

69

CN XII innervates

muscle of the tongue

70

Lesion of CN XII causes

deviation of tongue to affected side

71

6 Main types of seizures

- simple partial
- complex partial
- absence
- tonic clonic
- febrile
- secondary

72

key feature of simple partial seziures

conciousness is not impaired

73

Seizure where consciousness not impaired =

simple partial

74

Treatment of simple partial seizures

- phenytoin
- valproate
- carbamazepine

75

3 examples of simple partial seizures

- motor (Jacksonia march)
- hallucinations
- cognitive/affective

76

Simple partial seizure followed by altered consciousness =

complex partial seizure

77

Seizure where people perform purposeless movements and may become aggressive if restrained

complex partial seizure

78

First line agents for treatment of complex partial seziures

- phenytoin
- volproate
- carbamazepine

79

Typical age of onset of absense seizures

before age 20

80

absence seizures are a type of _________ seizure

generalized

81

Duration of absence seizures

10-30 seconds

82

Seizure with a loss of consciousnes with eye flutterings =

absence seizure

83

Is there a post-ictal state in absence seizures?

No. This is why people will stare and then pick up a sentence where they left off

84

First line agents for treatment of absence seizures

- ethosuximide
- valproate

85

Type of seizure that classically has an aura

tonic clonic

86

Typical duration of tonic clonic seizures

2-5 minutes

87

4 common features of the post-ictal state of tonic clonic seizures

- drowsiness
- confusion
- headache
- muscle soreness

88

First line agents for treatment of tonic-clonic seizures

- phenytoin
- valproate
- carbamazepine

89

Age for febrile seizure

6 months - 5 years

90

Type of seizure that usually happens with febrile seizure

tonic-clonic

91

Treatment of febrile seizure

nonspecific
- treat underlying cause if possible
- acetaminophen

92

Mass causes of seizure

- tumor
- bleed

93

Classic metabolic causes of seizure

- hypoglycemia
- hypoxia
- phenylketonuria

94

Classic toxic causes of seizure

- lead
- cocaine
- carbon monoxide

95

Classic drug withdrawl causes of seizure

- alcohol
- barbituates
- benzos
- too rapid off anticonvulsants

96

Classic cerebral edema causes of seizure

- severe hypertension
- eclampsia

97

Classic CNS infections causing seizure

- meningitis
- encephalitis
- toxoplasmosis

98

2 important "positioning" things to remember for seizures

- secure the airway
- roll onto side to prevent aspiration

99

Most common cause of seizures in South America

cysticercosis

100

Cysticercosis is caused by

Taenia solium (larval form of pork tape worm)

101

Cysticercosis is most commonly seen in

- people with AIDS
- immigrants (S America)

102

Treatment of cysticercosis

- niclosamide
- praziquantel

103

What test should you do before starting any anticonvulsant?

Pregnancy

104

Most common cause of neurologic disability in US

CVA

105

Third leading cause of death in US

CVA

106

3 classic causes of CVA

- ischemia from atherosclerosis
- a fib with emboli
- endocarditis with septic emboli

107

First imaging performed in suspected CVA is _____

noncontrast CT (rule out bleed)

108

CT in CVA is often negative for the first _____ hours

24-36

109

Focal neuro deficit lasting seconds to hours =

TIA

110

Define transient ischemic attack (TIA)

focal neuro deficit lasting seconds to hours that resolves spontaneously

111

TIAs typically last

2-3 minutes

112

This % of right-handed people are left hemisphere dominant

99%

113

This % of left-handed people are left hemisphere dominat

60-70%

114

Apathy is concerning for lesion in what part of the brain?

frontal lobe

115

Inattention is concerning for lesion in what part of the brain?

frontal lobe

116

Uninhibited behavior is concerning for lesion in what part of the brain?

frontal lobe

117

Labile affect is concerning for lesion in what part of the brain?

frontal lobe

118

Broca (motor) aphasia is concerning for lesion in what part of the brain?

dominant frontal lobe

119

Dominant frontal lobe damage causes which type of aphasia?

Broca

120

Wernicke (sensory) aphasia is concerning for lesion in what part of the brain?

Dominant temporal lobe

121

Dominant temporal lobe damage causes which type of aphasia?

Wernicke

122

memory impairment is concerning for lesion in what lobe of the brain?

temporal

123

aggression is concerning for lesion in what part of the brain?

temporal lobe

124

hypersexuality is concerning for lesion in what part of the brain?

temporal lobe

125

Inability to read, write or name is concerning for lesion in what part of the brain?

Dominant parietal lobe

126

Unilateral neglect is concerning for lesion in what part of the brain?

Nondominant parietal lobe

127

Nuclei of CN III and IV are in the

Midbrain

128

Nuclei of CN V, VI, VII and VIII are in the

Pons

129

Nuclei of CN IX, X, XI and XII are in the

Medulla

130

Cerebellar CVAs/lesions classically cause these 6 problems

- ataxia
- dysarthria
- nystagmus
- intention tremor
- dysmetria
- scanning speech

131

resting tremor is usually from a lesion in the

basal ganglia

132

chorea is usually from a lesion in the

basal ganglia

133

2 classic findings in basal ganglia lesions

- resting tremor
- chorea

134

Classic finding in lesion to subthalamic nuclei

hemiballismus

135

Hemiballismus may be caused by a lesion here:

subthalamic nuclei

136

Heritability of Huntington disease

autosomal dominant

137

Age of onset of Huntington disease

35-50

138

Irregular, spasmodic, involuntary movements of limb/face are called _____ and are found in _____

- choreiform movements
- Huntington disease

139

Cognitive deficits in Huntington disease

- progressive intellectual deterioration
- dementia
- psychiatric disturbances

140

CT/MRI finding in Huntington disease

atrophy of caudate nucleus

141

Treatment of Huntington disease

- supportive
- antipsychotics may help

142

Bradykinesia, rigidity, resting tremor and postural instability =

Parkinson's disease

143

Classic tetrad in Parkinson's disease

- bradykinesia
- rigidity
- resting tremor
- postural instability

144

Characteristics of the "pill rolling tremor"

- goes away with movement
- goes away when asleep

145

Mean age of onset of Parkinson's

60`

146

Drug treatments of Parkinson's

- levodopa/carbidopa
- bromocriptine
- pergoline
- MAOB inhibitors (selegiline)
- amantadine
- anticholinergics (trihexyphenidyl, benztropine)
- antihistamines

147

Treatment of Parkinsonian side effects from antipsychotics...

- anticholinergics (benztropine, trihexyphenidyl)
- antihistamines (diphendydramine)

148

Heredity of benign tremor?

autosomal dominant

149

Treatment of benign essential tremor?

b-blockers

150

4 "other" important causes of resting tremor

(other than Parkinsons)
- hyperthyroidism
- anxiety
- drug withdrawl/intoxication
- benign essential tremor

151

What is hepatolenticular degeneration?

Wilson disease (this is why there's a tremor)

152

Childhood causes of intention tremor

- cerebelar astrocytoma
- medulloblastoma
- hydrocephalus (prior menigitis, Arnold-Chiari, Dandy-Walker)
- Friedreich ataxia
- ataxia-telangiectasia

153

Heritability of Friedreich ataxia

autosomal recessive

154

Age of onset of Friedreich ataxia

5-15 years

155

Adult causes of intention tremor

* cerebellar disorders
- alcoholism
- tumor
- ischemia/hemorrhage
- MS

156

Cause of amyotrophic lateral sclerosis

idiopathic

157

ALS =

Amyoptrophic lateral sclerosis

158

Lesions of ALS are located here

Both upper and lower motor neurons

159

Is ALS more common in men or women?

men

160

Mean age of onset of ALS?

55 years

161

List 3 UMN lesion signs

- spasticity
- hyperreflexia
- Babinski

162

List 3 LMN lesion signs

- fasciculations
- atrophy
- flaccidity

163

(Very) general prognosis of ALS

50% of patients die within 3 years of onset

164

Do not perform an LP acutely in these situations

- acute head trauma
- signs of high ICP
(risk of uncal herniation)

165

Give normal profile of CSF for cells, glucose, protein and pressure

- cells: <3
- glucose: 50-100
- protein:20-45
- pressure (mmHg):100-200

166

Give typical profile of CSF in bacterial meningitis for cells, glucose, protein and pressure

- cells: >1000 (PMNs)
- glucose: 200

167

Give typical profile of CSF in viral/aspeptic meningitis for cells, glucose, protein and pressure

- cells: >100 lymphs
- glucose:40-100
- protein: 20-45+
- pressure: 100-200+

168

Give typical profile of CSF in pseudotumor cerebri for cells, glucose, protein, pressure

- cells: 3
- glucose: 50-100
- protein: 20-45
- pressure: >200

169

Give typical profile of CSF in Guillain-Barre syndrome for cells, glucose, protein, pressure

- cells: 0-100 lymphs
- glucose: 50-100
- protein: >100
- pressure: 100-200

170

Give typical profile of CSF in subarachnoid hemorrhage for cells, glucose, protein, pressure

- cells: RBCs
- glucose: 50-100
- protein: >45
- pressure: >200

171

Give typical profile of CSF in multiple sclerosis for cells, glucose, protein, pressure

- cells: 0-3+
- glucose: 50-100
- protein: 20-45+
- pressure: 100-200

172

Normal opening pressure in LP

100-200 mmHg

173

These LP results indicate:
- cells: 3
- glucose: 75
- protein: 30
- pressure: 150

normal LP

174

These LP results indicate:
- cells: 1,000 PMNs
- glucose: 40
- protein: 100
- pressure: 250

Bacterial meningitis

175

These LP results indicate:
- cells: 100 lymphs
- glucose: 75
- protein: 50
- pressure:210

Viral meningitis

176

The LP results indicate:
- cells: 3
- glucose: 75
- protein: 40
- pressure: 300

Pseudotumor cerebri

177

These LP results indicate:
- cells: 100 lymphs
- glucose: 75
- protein: 150
- pressure: 150

Guillain-Barre

178

These LP results indicate:
- cells: RBCs
- glucose: 75
- protein: 60
- pressure: 250

subarachnoid hemorrhage

179

These LP results indicate:
- cells: 5
- glucose: 75
- protein: 50
- pressure: 150

MS (generally normal but sometimes slightly elevated cells and protein)

180

Abnormal lab results in CSF with MS

- oligoclonal bands
- myeline basic protein (during active demyelination)

181

Classic stain for crypotcoccal meningitis

India Ink

182

LP in AIDS with high lymphocytes, worry about...

- TB meningitis
- Fungal meningitis

183

Is MS more common in men or women?

women

184

Typical age of onset of MS

20-40

185

List 6 common presenting features of MS

- paresthesias
- weakness/clumsiness
- visual disturbances
- gait disturbances
- incontinence/urgency
- vertigo

186

2 classic symptoms of MS

- internuclear ophthalmoplegia
- scanning speech

187

Reflex related finding in MS

often + babinski

188

Most sensitive tool to show demylinating plaques in MS

MRI with and without contrast

189

Symmetrical LE weakness distally, lost reflexes and viral illness =

Guillain-Barre'

190

Sensory changes in Guillain-Barre'

Mild or absent

191

You may make a Guillain-Barre' patient worse if you give them...

steroids

192

Treatment of Guillain-Barre'

- plasmapharesis
- time

193

Watch Gauillain-Barre' patients carefully for

ascending weakness that involves respiratory muscles

194

Lower motor neuron disease is associated with this finding on EMG

fasciculations/fibrillations at rest

195

Most common cause of syncope

vasovagal

196

If a person passes out when they have a stroke, where is the likely lesion (vessel)

posterior circulation; syncope is generally uncommon in stroke

197

Important common causes of altered mental status in the ER

- hypoglycemia
- opiod overdose
- thiamine defeciency
- alcohol
- drugs
- DKA
- CVA
- seizure

198

Treatment of opiod overdose

naloxone

199

6 important general causes of peripheral neuropathy

- metabolic
- nutritional
- toxic/meds
- immune related
- trauma
- infection

200

3 metabolic causes of peripheral neuropathy

- diabetes
- uremia
- hypothyroidism

201

4 vitamin defeciencies that cause peripheral neuropathy

- B12
- B6
-Thiamine (dry beriberi)
- Vitamin E

202

Patient with B6 defeciency presents with neuropathy. What med were they likely on?

Isoniazid

203

Peripheral neuropathy with wrist drop and foot drop is classically caused by

lead poisoning

204

4 drugs that classically cause peripheral neuropathy

- lead/heavy metals
- isoniazid
- vincristine
- ethambutol (optic)

205

6 autoimmune disorders that are associated with peripheral neuropathy

- Guillain-Barre'
- Lupus
- Polyarteritis nodosa
- Scleroderma
- Sarcoidosis
- Amyloidosis

206

3 common causes of peripheral neuropathy associated with trauma

- carpal tunnel
- pressure paralysis (radial nerve in alcoholics)
- fractures

207

5 infections that cause peripheral neuropathy

- lyme disease
- diphtheria
- HIV
- tick bite
- leprosy

208

Pathology of myasthenia gravis

autoimmune disease attacks acetylcholine receptors

209

Typical age and gender for myasthenia gravis

women age 20-40

210

3 classic features of presenation of myasthenia gravis

- ptosis
- diplopia
- generalized muscle fatiguability

211

What is Tensilon?

edrophonium (a short acting anticholinesterase)

212

Edrophonius is also known as

Tensilon

213

What is Tensilon used for

diagnosis of myasthenia gravis

214

Describe the Tensilon test for myasthenia gravis

- symptoms improve with injection Tensilon (short active anticholinesterase)

215

Most patients with myasthenia gravis also have this removed

the thymus

216

Treatment of myasthenia gravis

- plasmapheresis in acute attack
- Long acting anticholinesterase (pyridostigmine, neostigmine)

217

How can you differentiate myasthenia gravis from Eaton Lambert syndrome?

Eaton Lambert spares the extraoccular muscles

218

Eaton Lambert syndrome is associated with what?

small cell lung cancer (paraneoplastic syndrome)

219

Mechanism of disease of Eaton Lambert syndrome

impaires release of acetylcholine from the nerves

220

What effect does repetitive activity have on Eaton Lamber?

Weakness improves

221

Poisoning with miosis, excessive bronchial secretions, urinary urgency, diarrhea

Organophosphate poisoning (parasympathetic effects)

222

Treatment of orhanophosphate poisoning

- atropine
- pralidoxime

223

Describe the myasthenic type effects of aminoglycosides

- in high doses causes weakness similar to myasthnia gravis
- prolong the effects of musculr blackage in anesthsia

224

Findings in Sturge-Weber syndrome

- Port wine stain over divisions of V2 and V3
- glaucoma
- seizures