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step3 > 2014-03-07 USMLE Neuro - USMLE Neuro > Flashcards

2014-03-07 USMLE Neuro - USMLE Neuro Flashcards

1
Q

Onset of delerium

A

acute and dramatic

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2
Q

Onset of dementia

A

chronic and insidious

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3
Q

Common causes of delerium

A

illness, toxic, withdrawl

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4
Q

Common causes of dementia

A

Alzheimer disease, multi-infarct dementia, HIV/AIDS

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5
Q

Is delerium reversible?

A

usually

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6
Q

Is dementia reversible

A

usually not

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7
Q

Describe attention in delerium

A

poor

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8
Q

Describe attention in dementia

A

usually unaffected

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9
Q

Describe arousal level in delerium

A

fluctuates

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10
Q

Describe arousal level in dementia

A

normal

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11
Q

Memory impairment in dementia

A

in early dementia remote memory is usually spared

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12
Q

Memory impairment in delerium

A

globally impaired

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13
Q

What is pseudodementia

A

depression, usually in elderly, usually treatable

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14
Q

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

A

both

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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)
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16
Q

Wernicke’s encephalopathy is from what deficiency?

A

thiamine

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17
Q

Ataxia, ophthalmoplegia, nystagmus and confusion =

A

Wernicke’s encephalopathy

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18
Q

An alcoholic with confabulation and anterograde amnesia likely has

A

Korsakoff syndrome

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19
Q

2 key features of Korsakoff syndrome

A
  • anterograde amnesia

- confabulation

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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

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21
Q

Most common cause of headaches

A

tension

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22
Q

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

A

tension

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23
Q

General treatment of stress headaches

A
  • stress relief

- NSAIDs/acetaminophen

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24
Q

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

A

cluster

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25
Q

Treatment of cluster headaches

A

oxygen

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26
Q

True or false: migraines often have a family history?

A

true

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27
Q

Headaches with aura, photophobia, nausea and vomiting are likely

A

migrain

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28
Q

Typical age of onset for migraine

A

10-30 years

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29
Q

Morning headaches with projectile vomiting are concerning for

A

tumor

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30
Q

What do you order for headache with papilledema?

A

CT or MRI with contrast

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31
Q

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

A

pseudotumor cerebri

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32
Q

LP in pseudotumor cerebri

A

elevated opening pressure, otherwise normal

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33
Q

Possible causes of pseudotumor cerebri

A
  • megadoses of vitamin A
  • tetracyclines
  • withdrawl from corticosteroids
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34
Q

Pseudotumor cerebri without treatment may lead to

A

permanent vision loss

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35
Q

Treatment of pseudotumor cerebri

A
  • supportive
  • weight loss
  • shunt/repeated LPs
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36
Q

Worst headache of your life -

A

subarachnoid hemorrhage

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37
Q

Diagnostic test for subarachnoid hemorrhage

A
  • noncontrast CT

- LP

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38
Q

2 major causes of subarachnoid hemorrhage

A
  • ruptures berry aneurysm

- trauma

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39
Q

Give 4 eye causes of headache

A
  • optic neuritis
  • eyestrain from refractive error
  • iritis
  • glaucoma
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40
Q

Give 2 ear causes of headache

A
  • otitis media

- mastoiditis

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41
Q

List 8 general causes/types of headache

A
  • tension
  • cluster
  • tumor
  • migraine
  • pseudotumor cerebri
  • meningitis
  • subarachnoid hemorrhage
  • extracranial causes
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42
Q

What is Kallman syndrome?

A
  • anosmia with hypogonadisms due to gonadotropin-releasing hormone
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43
Q

anosmnia + hypogonadism =

A

Kallman syndrome

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44
Q

tic douloureux =

A

trigenimal neuralgia

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45
Q

CNI =

A

olfactory

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46
Q

CNII=

A

optic

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47
Q

CNIII =

A

oculomotor

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48
Q

CN IV =

A

trochlear

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49
Q

CN V =

A

trigeminal

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50
Q

CN VI =

A

abducens

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51
Q

CN 5 innervates

A
  • muscles of mastication
  • facial sensation
  • afferent corneal relex
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52
Q

unilateral shooting facial pain in older adults =

A

trigeminal neuralgia

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53
Q

Treatment of trigeminal neuralgia

A

antiseizure meds like gabapentin and carbamezepine are most effective

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54
Q

CN VII =

A

Facial

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55
Q

CN VII innervates

A
  • muscle of facial expression
  • taste of ant 2/3 tongue
  • dkin external ear
  • lacrimal gland
  • salivary (not parotid) gland
  • stapedius muscle
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56
Q

Flat forehead means CNVII is injured where?

A

lower motor neuron lesion

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57
Q

CN VIII =

A

vestibulocochlear

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58
Q

CN VIII lesions usually manifest as

A
  • deafness
  • tinnitus
  • vertigo
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59
Q

CN IX =

A

glossopharyngeal

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60
Q

CNIX innervates

A
  • pharyngeal muscles
  • mucous membranes
  • afferent gag
  • parotid gland
  • taster post 1/3 tongue
  • skin external ear
  • carotid body/sinus
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61
Q

CN X =

A

vaugs

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62
Q

CN X innervates

A
  • muscles of palate
  • muscles of pharynx
  • muscles of larynx
  • efferent gag
  • taste at base of tonge
  • abdominal viscera
  • skin external ear
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63
Q

Major things to think of in CNX lesions

A
  • aortic aneurysms

- tumors (such as pancoast)

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64
Q

Common things with CNX lesions

A
  • hoarseness
  • dysphagia
  • loss of gag
  • loss of cough
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65
Q

CN XI =

A

spinal accessory

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66
Q

CN XI innervates

A
  • sternocleidomastoid

- trapezius

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67
Q

Muscle findings in CN XI lesions

A
  • trouble with contralateral head turn

- ipsilateral shoulder drop

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68
Q

CN XII =

A

Hypoglossal

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69
Q

CN XII innervates

A

muscle of the tongue

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70
Q

Lesion of CN XII causes

A

deviation of tongue to affected side

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71
Q

6 Main types of seizures

A
  • simple partial
  • complex partial
  • absence
  • tonic clonic
  • febrile
  • secondary
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72
Q

key feature of simple partial seziures

A

conciousness is not impaired

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73
Q

Seizure where consciousness not impaired =

A

simple partial

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74
Q

Treatment of simple partial seizures

A
  • phenytoin
  • valproate
  • carbamazepine
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75
Q

3 examples of simple partial seizures

A
  • motor (Jacksonia march)
  • hallucinations
  • cognitive/affective
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76
Q

Simple partial seizure followed by altered consciousness =

A

complex partial seizure

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77
Q

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

A

complex partial seizure

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78
Q

First line agents for treatment of complex partial seziures

A
  • phenytoin
  • volproate
  • carbamazepine
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79
Q

Typical age of onset of absense seizures

A

before age 20

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80
Q

absence seizures are a type of _________ seizure

A

generalized

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81
Q

Duration of absence seizures

A

10-30 seconds

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82
Q

Seizure with a loss of consciousnes with eye flutterings =

A

absence seizure

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83
Q

Is there a post-ictal state in absence seizures?

A

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

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84
Q

First line agents for treatment of absence seizures

A
  • ethosuximide

- valproate

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85
Q

Type of seizure that classically has an aura

A

tonic clonic

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86
Q

Typical duration of tonic clonic seizures

A

2-5 minutes

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87
Q

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

A
  • drowsiness
  • confusion
  • headache
  • muscle soreness
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88
Q

First line agents for treatment of tonic-clonic seizures

A
  • phenytoin
  • valproate
  • carbamazepine
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89
Q

Age for febrile seizure

A

6 months - 5 years

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90
Q

Type of seizure that usually happens with febrile seizure

A

tonic-clonic

91
Q

Treatment of febrile seizure

A

nonspecific

  • treat underlying cause if possible
  • acetaminophen
92
Q

Mass causes of seizure

A
  • tumor

- bleed

93
Q

Classic metabolic causes of seizure

A
  • hypoglycemia
  • hypoxia
  • phenylketonuria
94
Q

Classic toxic causes of seizure

A
  • lead
  • cocaine
  • carbon monoxide
95
Q

Classic drug withdrawl causes of seizure

A
  • alcohol
  • barbituates
  • benzos
  • too rapid off anticonvulsants
96
Q

Classic cerebral edema causes of seizure

A
  • severe hypertension

- eclampsia

97
Q

Classic CNS infections causing seizure

A
  • meningitis
  • encephalitis
  • toxoplasmosis
98
Q

2 important “positioning” things to remember for seizures

A
  • secure the airway

- roll onto side to prevent aspiration

99
Q

Most common cause of seizures in South America

A

cysticercosis

100
Q

Cysticercosis is caused by

A

Taenia solium (larval form of pork tape worm)

101
Q

Cysticercosis is most commonly seen in

A
  • people with AIDS

- immigrants (S America)

102
Q

Treatment of cysticercosis

A
  • niclosamide

- praziquantel

103
Q

What test should you do before starting any anticonvulsant?

A

Pregnancy

104
Q

Most common cause of neurologic disability in US

A

CVA

105
Q

Third leading cause of death in US

A

CVA

106
Q

3 classic causes of CVA

A
  • ischemia from atherosclerosis
  • a fib with emboli
  • endocarditis with septic emboli
107
Q

First imaging performed in suspected CVA is _____

A

noncontrast CT (rule out bleed)

108
Q

CT in CVA is often negative for the first _____ hours

A

24-36

109
Q

Focal neuro deficit lasting seconds to hours =

A

TIA

110
Q

Define transient ischemic attack (TIA)

A

focal neuro deficit lasting seconds to hours that resolves spontaneously

111
Q

TIAs typically last

A

2-3 minutes

112
Q

This % of right-handed people are left hemisphere dominant

A

99%

113
Q

This % of left-handed people are left hemisphere dominat

A

60-70%

114
Q

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

A

frontal lobe

115
Q

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

A

frontal lobe

116
Q

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

A

frontal lobe

117
Q

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

A

frontal lobe

118
Q

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

A

dominant frontal lobe

119
Q

Dominant frontal lobe damage causes which type of aphasia?

A

Broca

120
Q

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

A

Dominant temporal lobe

121
Q

Dominant temporal lobe damage causes which type of aphasia?

A

Wernicke

122
Q

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

A

temporal

123
Q

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

A

temporal lobe

124
Q

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

A

temporal lobe

125
Q

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

A

Dominant parietal lobe

126
Q

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

A

Nondominant parietal lobe

127
Q

Nuclei of CN III and IV are in the

A

Midbrain

128
Q

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

A

Pons

129
Q

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

A

Medulla

130
Q

Cerebellar CVAs/lesions classically cause these 6 problems

A
  • ataxia
  • dysarthria
  • nystagmus
  • intention tremor
  • dysmetria
  • scanning speech
131
Q

resting tremor is usually from a lesion in the

A

basal ganglia

132
Q

chorea is usually from a lesion in the

A

basal ganglia

133
Q

2 classic findings in basal ganglia lesions

A
  • resting tremor

- chorea

134
Q

Classic finding in lesion to subthalamic nuclei

A

hemiballismus

135
Q

Hemiballismus may be caused by a lesion here:

A

subthalamic nuclei

136
Q

Heritability of Huntington disease

A

autosomal dominant

137
Q

Age of onset of Huntington disease

A

35-50

138
Q

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

A
  • choreiform movements

- Huntington disease

139
Q

Cognitive deficits in Huntington disease

A
  • progressive intellectual deterioration
  • dementia
  • psychiatric disturbances
140
Q

CT/MRI finding in Huntington disease

A

atrophy of caudate nucleus

141
Q

Treatment of Huntington disease

A
  • supportive

- antipsychotics may help

142
Q

Bradykinesia, rigidity, resting tremor and postural instability =

A

Parkinson’s disease

143
Q

Classic tetrad in Parkinson’s disease

A
  • bradykinesia
  • rigidity
  • resting tremor
  • postural instability
144
Q

Characteristics of the “pill rolling tremor”

A
  • goes away with movement

- goes away when asleep

145
Q

Mean age of onset of Parkinson’s

A

60`

146
Q

Drug treatments of Parkinson’s

A
  • levodopa/carbidopa
  • bromocriptine
  • pergoline
  • MAOB inhibitors (selegiline)
  • amantadine
  • anticholinergics (trihexyphenidyl, benztropine)
  • antihistamines
147
Q

Treatment of Parkinsonian side effects from antipsychotics…

A
  • anticholinergics (benztropine, trihexyphenidyl)

- antihistamines (diphendydramine)

148
Q

Heredity of benign tremor?

A

autosomal dominant

149
Q

Treatment of benign essential tremor?

A

b-blockers

150
Q

4 “other” important causes of resting tremor

A

(other than Parkinsons)

  • hyperthyroidism
  • anxiety
  • drug withdrawl/intoxication
  • benign essential tremor
151
Q

What is hepatolenticular degeneration?

A

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

152
Q

Childhood causes of intention tremor

A
  • cerebelar astrocytoma
  • medulloblastoma
  • hydrocephalus (prior menigitis, Arnold-Chiari, Dandy-Walker)
  • Friedreich ataxia
  • ataxia-telangiectasia
153
Q

Heritability of Friedreich ataxia

A

autosomal recessive

154
Q

Age of onset of Friedreich ataxia

A

5-15 years

155
Q

Adult causes of intention tremor

A
  • cerebellar disorders
  • alcoholism
  • tumor
  • ischemia/hemorrhage
  • MS
156
Q

Cause of amyotrophic lateral sclerosis

A

idiopathic

157
Q

ALS =

A

Amyoptrophic lateral sclerosis

158
Q

Lesions of ALS are located here

A

Both upper and lower motor neurons

159
Q

Is ALS more common in men or women?

A

men

160
Q

Mean age of onset of ALS?

A

55 years

161
Q

List 3 UMN lesion signs

A
  • spasticity
  • hyperreflexia
  • Babinski
162
Q

List 3 LMN lesion signs

A
  • fasciculations
  • atrophy
  • flaccidity
163
Q

(Very) general prognosis of ALS

A

50% of patients die within 3 years of onset

164
Q

Do not perform an LP acutely in these situations

A
  • acute head trauma
  • signs of high ICP
    (risk of uncal herniation)
165
Q

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

A
  • cells: <3
  • glucose: 50-100
  • protein:20-45
  • pressure (mmHg):100-200
166
Q

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

A
  • cells: >1000 (PMNs)

- glucose: 200

167
Q

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

A
  • cells: >100 lymphs
  • glucose:40-100
  • protein: 20-45+
  • pressure: 100-200+
168
Q

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

A
  • cells: 3
  • glucose: 50-100
  • protein: 20-45
  • pressure: >200
169
Q

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

A
  • cells: 0-100 lymphs
  • glucose: 50-100
  • protein: >100
  • pressure: 100-200
170
Q

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

A
  • cells: RBCs
  • glucose: 50-100
  • protein: >45
  • pressure: >200
171
Q

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

A
  • cells: 0-3+
  • glucose: 50-100
  • protein: 20-45+
  • pressure: 100-200
172
Q

Normal opening pressure in LP

A

100-200 mmHg

173
Q

These LP results indicate:

  • cells: 3
  • glucose: 75
  • protein: 30
  • pressure: 150
A

normal LP

174
Q

These LP results indicate:

  • cells: 1,000 PMNs
  • glucose: 40
  • protein: 100
  • pressure: 250
A

Bacterial meningitis

175
Q

These LP results indicate:

  • cells: 100 lymphs
  • glucose: 75
  • protein: 50
  • pressure:210
A

Viral meningitis

176
Q

The LP results indicate:

  • cells: 3
  • glucose: 75
  • protein: 40
  • pressure: 300
A

Pseudotumor cerebri

177
Q

These LP results indicate:

  • cells: 100 lymphs
  • glucose: 75
  • protein: 150
  • pressure: 150
A

Guillain-Barre

178
Q

These LP results indicate:

  • cells: RBCs
  • glucose: 75
  • protein: 60
  • pressure: 250
A

subarachnoid hemorrhage

179
Q

These LP results indicate:

  • cells: 5
  • glucose: 75
  • protein: 50
  • pressure: 150
A

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

180
Q

Abnormal lab results in CSF with MS

A
  • oligoclonal bands

- myeline basic protein (during active demyelination)

181
Q

Classic stain for crypotcoccal meningitis

A

India Ink

182
Q

LP in AIDS with high lymphocytes, worry about…

A
  • TB meningitis

- Fungal meningitis

183
Q

Is MS more common in men or women?

A

women

184
Q

Typical age of onset of MS

A

20-40

185
Q

List 6 common presenting features of MS

A
  • paresthesias
  • weakness/clumsiness
  • visual disturbances
  • gait disturbances
  • incontinence/urgency
  • vertigo
186
Q

2 classic symptoms of MS

A
  • internuclear ophthalmoplegia

- scanning speech

187
Q

Reflex related finding in MS

A

often + babinski

188
Q

Most sensitive tool to show demylinating plaques in MS

A

MRI with and without contrast

189
Q

Symmetrical LE weakness distally, lost reflexes and viral illness =

A

Guillain-Barre’

190
Q

Sensory changes in Guillain-Barre’

A

Mild or absent

191
Q

You may make a Guillain-Barre’ patient worse if you give them…

A

steroids

192
Q

Treatment of Guillain-Barre’

A
  • plasmapharesis

- time

193
Q

Watch Gauillain-Barre’ patients carefully for

A

ascending weakness that involves respiratory muscles

194
Q

Lower motor neuron disease is associated with this finding on EMG

A

fasciculations/fibrillations at rest

195
Q

Most common cause of syncope

A

vasovagal

196
Q

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

A

posterior circulation; syncope is generally uncommon in stroke

197
Q

Important common causes of altered mental status in the ER

A
  • hypoglycemia
  • opiod overdose
  • thiamine defeciency
  • alcohol
  • drugs
  • DKA
  • CVA
  • seizure
198
Q

Treatment of opiod overdose

A

naloxone

199
Q

6 important general causes of peripheral neuropathy

A
  • metabolic
  • nutritional
  • toxic/meds
  • immune related
  • trauma
  • infection
200
Q

3 metabolic causes of peripheral neuropathy

A
  • diabetes
  • uremia
  • hypothyroidism
201
Q

4 vitamin defeciencies that cause peripheral neuropathy

A
  • B12
  • B6
  • Thiamine (dry beriberi)
  • Vitamin E
202
Q

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

A

Isoniazid

203
Q

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

A

lead poisoning

204
Q

4 drugs that classically cause peripheral neuropathy

A
  • lead/heavy metals
  • isoniazid
  • vincristine
  • ethambutol (optic)
205
Q

6 autoimmune disorders that are associated with peripheral neuropathy

A
  • Guillain-Barre’
  • Lupus
  • Polyarteritis nodosa
  • Scleroderma
  • Sarcoidosis
  • Amyloidosis
206
Q

3 common causes of peripheral neuropathy associated with trauma

A
  • carpal tunnel
  • pressure paralysis (radial nerve in alcoholics)
  • fractures
207
Q

5 infections that cause peripheral neuropathy

A
  • lyme disease
  • diphtheria
  • HIV
  • tick bite
  • leprosy
208
Q

Pathology of myasthenia gravis

A

autoimmune disease attacks acetylcholine receptors

209
Q

Typical age and gender for myasthenia gravis

A

women age 20-40

210
Q

3 classic features of presenation of myasthenia gravis

A
  • ptosis
  • diplopia
  • generalized muscle fatiguability
211
Q

What is Tensilon?

A

edrophonium (a short acting anticholinesterase)

212
Q

Edrophonius is also known as

A

Tensilon

213
Q

What is Tensilon used for

A

diagnosis of myasthenia gravis

214
Q

Describe the Tensilon test for myasthenia gravis

A
  • symptoms improve with injection Tensilon (short active anticholinesterase)
215
Q

Most patients with myasthenia gravis also have this removed

A

the thymus

216
Q

Treatment of myasthenia gravis

A
  • plasmapheresis in acute attack

- Long acting anticholinesterase (pyridostigmine, neostigmine)

217
Q

How can you differentiate myasthenia gravis from Eaton Lambert syndrome?

A

Eaton Lambert spares the extraoccular muscles

218
Q

Eaton Lambert syndrome is associated with what?

A

small cell lung cancer (paraneoplastic syndrome)

219
Q

Mechanism of disease of Eaton Lambert syndrome

A

impaires release of acetylcholine from the nerves

220
Q

What effect does repetitive activity have on Eaton Lamber?

A

Weakness improves

221
Q

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

A

Organophosphate poisoning (parasympathetic effects)

222
Q

Treatment of orhanophosphate poisoning

A
  • atropine

- pralidoxime

223
Q

Describe the myasthenic type effects of aminoglycosides

A
  • in high doses causes weakness similar to myasthnia gravis

- prolong the effects of musculr blackage in anesthsia

224
Q

Findings in Sturge-Weber syndrome

A
  • Port wine stain over divisions of V2 and V3
  • glaucoma
  • seizures

step3 (10 decks)

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