2014-03-07 USMLE Neuro - USMLE Neuro Flashcards
(224 cards)
1
Q
Onset of delerium
A
acute and dramatic
2
Q
Onset of dementia
A
chronic and insidious
3
Q
Common causes of delerium
A
illness, toxic, withdrawl
4
Q
Common causes of dementia
A
Alzheimer disease, multi-infarct dementia, HIV/AIDS
5
Q
Is delerium reversible?
A
usually
6
Q
Is dementia reversible
A
usually not
7
Q
Describe attention in delerium
A
poor
8
Q
Describe attention in dementia
A
usually unaffected
9
Q
Describe arousal level in delerium
A
fluctuates
10
Q
Describe arousal level in dementia
A
normal
11
Q
Memory impairment in dementia
A
in early dementia remote memory is usually spared
12
Q
Memory impairment in delerium
A
globally impaired
13
Q
What is pseudodementia
A
depression, usually in elderly, usually treatable
14
Q
Which is associated with hallucinations, illusions, delusion, orientation difficulties and sundowning…delerium or dementia?
A
both
15
Q
More common treatable causes of dementia
A
- Vit B12 deficiency
- endocrine disorders (esp. thyroid and parathyroid)
- uremia
- syphilis
- brain tumors
- normal pressure hydrocephalus
- Parkinson’s (tx may improve)
16
Q
Wernicke’s encephalopathy is from what deficiency?
A
thiamine
17
Q
Ataxia, ophthalmoplegia, nystagmus and confusion =
A
Wernicke’s encephalopathy
18
Q
An alcoholic with confabulation and anterograde amnesia likely has
A
Korsakoff syndrome
19
Q
2 key features of Korsakoff syndrome
A
- anterograde amnesia
- confabulation
20
Q
How do you avoid ppt Wernicke’s encephalopathy in an alcoholic when they show up in your ER?
A
give glucose before thiamine
21
Q
Most common cause of headaches
A
tension
22
Q
Recurrent frontal/occipital bilateral headache with stiffness is likely what type?
A
tension
23
Q
General treatment of stress headaches
A
- stress relief
- NSAIDs/acetaminophen
24
Q
Headache that is unilateral, severe, tender, with watery eyes
A
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
