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Bloc J - Human Behavior > Clinical Neurology > Flashcards

Clinical Neurology Flashcards

(60 cards)

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1
Q

Someone presents with a loss of sensation and pain bilateral upper limb. What do you suspect?

A

Syringomyelia: enlargement of the central canal of spinal cord

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2
Q

What are the recommended investigations for first seizure?

A
  1. Brain imaging (CT or MRI)
  2. EEG
  3. Blood tests: blood counts, serum glucose, electrolytes
  4. Urine toxicology screen
  5. CSF: if infection suspected
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3
Q

Where are LP and spinal anaesthesia performed?

A

Below the L1-2 level in the adult, so below the cord

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4
Q

What is Charcot triad of MS?

A
  1. Scanning speech
  2. Intention tremor
  3. Nystagmus (medial longitudinal fasciculus syndrome)
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5
Q

What cord segment is tested in the knee jerk muscle strech relex?

A

L2-L4

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6
Q

Where does the needle go in a epidural anaesthesia?

A

Outside the dura

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7
Q

What is a Wernicke aphasia?

A

Fluent, paraphasia, and impaired comprehension

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8
Q

What is the treatement of trigeminal autonomic cephalalgias in the ER?

A

OXYGEN

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9
Q

Someone takes out his tongue and it deviates. What nerve is injured?

A

Hypoglossal (CN XII)

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10
Q

What are the treatement of primary headaches?

A
  1. Identify trigger factors
  2. Non-pharmacological treatment
  3. Abortive treatment
  • RIGHT when the headache stars but too frequent can cause rebound-headache
  • Tylenol, Advil, ASA, Triptans (Serotonin agonists), Metoclopramide IV in ER
  1. Prophylactic (preventive) treatment
  • Vitamin B2 (Riboflavin) 400 mg QD
  • Magnesium 600 mg QD
  • Cyproheptadine (Periactin) 4 mg TID for young kids < 10
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11
Q

What cord segment is tested in the triceps jerk muscle strech relex?

A

C7-8

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12
Q

How do venous infarction usually present?

A

Bilateral with mix of ischemia and hemorrhage

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13
Q

When DON’T we treat a first seizure?

A
  • No risk factors for recurrence
  • Normal exam
  • Normal brain imaging
  • Normal EEG
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14
Q

What vessels are the more at risk of stroke if you have chronic hypertension?

A
  1. Branches from the MCA
  2. Branches of the basilar artery
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15
Q

Someone presents with horizontal diplopia, what nerve do you suspect to be injured?

A

Abducens (CN VI)

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16
Q

What are the types of cerebral edema?

A
  1. Surrounding a tumour because of breakdown of BBB (vasogenic edema) –> responds to steroids
  2. Stroke
  3. Interstitial edema (caused by osmosis, usually related to hyponatremia)
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17
Q

Someone presents with unilateral frontal/retro-orbital headache with autonomic symptoms (pupils, tearing + redness of an eye and nasal secretion) that last 30-60 minutes. What’s your diagnosis?

A

Trigeminal autonomic cephalalgias

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18
Q

What is the best treatement for cerebral aneurysm?

A

Coiling is preferred to surgical clipping because it is less invasive (passing via the arteries, not the brain, to access the aneurysm).

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19
Q

What are the cardinal motor symptoms of Parkinson’s disease?

A
  1. Rest tremor
  2. Rigidity
  3. Bradykinesia
  4. Postural instability
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20
Q

Someone presents with facial numbness and pain (sharp, sudden, brief, electric-like). What nerve do you suspect to be injured?

A

Trigeminal (CN V)

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21
Q
  1. UMN below level
  2. Sensory loss below level
  3. Bladder Dysfunction
  4. No pain

What do you suspect?

A

Spinal Cord compression or injury

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22
Q

What are the most common causes of intraparenchymal Hemorrhage?

A
  • Chronic Hypertension (deep hemorrhage in the brain)
  • Cerebral Amyloid Angiopathy (superficial hemorrhage in the brain)
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23
Q

What cord segment is tested in the forearm jerk muscle strech relex?

A

C5-6

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24
Q

What are the elements of the ABCD2 score for stroke risk after TIA?

A

Age > 60

SBP >140 or DBP > 90

Clinical

  • Weakness
  • Language

Duration:

  • > 60 minutes
  • 10-59 minutes

Diabetes

Score > 2 21% and ≤ 2 4%

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25
Someone comes it with ptosis and eyes not aligned. What nerve do you suspect to be injured?
Oculomotor (CN III)
26
Someone has an absent gag reflex. What nerve can be injured?
Glosso-pharyngeal (IX): **a**fferent Vagus (CN X): **e**fferent
27
* Characteristic situation * Prodromal symptoms * Rapid recovery of consciousness and alertness What do you think is the cause of this LOC?
Syncope: 1. Orthostatic: hypovolemic 2. Neurally-mediated: vasovagal
28
1. No motor weakness 2. Sacral (perianal) sensory loss 3. Bladder Dysfunction 4. No pain What do you suspect?
Conus Medullaris problem (compression)
29
What are the components of the CHADS2 score for risk of stroke with A. Fib?
* CHF 1 point * HTN 1 point * Age \> 75 1 point * Diabetes 1 point * S2 Prior\* 2 points ## Footnote **Anticoagulate if ≥ 1**
30
What are the differential diagnosis for seizures in children?
* Sandifer’s syndrome: GERD after eating * Breath holding spells: after crying, associated with iron deficient anemia * Febrile seizures: occurring with fever in the absence of CNS infection or electrolyte imbalance (6 months and 6 years) * Absence seizures: NO aura, short and no post-Ictal fatigue * Epilepsy ALWAYS INVESTIGATE IF FOCAL
31
* Papilledema * Projectile vomiting * Sinus bradycardia * Hypertension * Decreased level of conscouiousness What's your diagnosis?
ICP --\> cerebral edema
32
1. Patchy motor weakness 2. Patchy sensory loss 3. Possible bladder Dysfunction 4. Possible pain What do you suspect?
Cauda Equina problem
33
What is the major cause of optic nerve (CN II) impairment?
Increased intracranial pressure
34
When should you order a CT scan for a headache?
1. New 2. Age \> 40 3. Abnormal exam 4. Change 5. Thunderclap Headache
35
Where does the needle go in a lumbar puncture?
Subarachnoid space
36
In what curcumstances would you suspect an Olfactory (CN I) injury?
1. Head trauma 2. Fronto-basal tumor
37
What is a Broca aphasia?
Impaired fluency but intact comprehension
38
Someone has diploplia when looking down (ex. when going down the stairs). What nerve do you suspect to be injured?
Trochlear (CN IV)
39
What cord segment is tested in the **ankle jerk** muscle strech relex?
S1
40
What is the most important thing to do to diagnose seizures?
A good history (focal onset or not?)
41
What is the Monroe-Kelley Hypothesis?
Increased ICP is due to either increase normal components (CSF, brain, blood) or addition of new components (tumor, pus, extravascular blood)
42
Dysarthria, dysphagia and hoarseness are signs of damage of which nerve?
Vagus (CN X)
43
What is the cause of Wernicke-Korsakoff Syndrome?
Thiamine deffciency (chronic alcoholism or bariatric surgery)
44
What is Syringomyelia?
There is a “central canal” of the spinal cord that is a potential space in adults. It can expand, usually either because of a developmental abnormality or post-trauma. Can cause numbness and tingling of limbs in suspended sensory loss (not below sensory level)
45
A child presents with abrupt onset of irritability and lethargy, mental status change and seizures with an history of recent infection. What's your diagnosis?
Acute disseminated encephalomyelitis: a demyelinating disease
46
What cord segment is tested in the **bicepts jerk** muscle strech relex?
C5-6
47
Someone presents with Bell’s palsy, what nerve is injured?
Facial (CN VII)
48
1. UMN lesions 2. Scanning speech 3. Intention tremor 4. Nystasgmus What's your diagnosis?
MS
49
* Past **cardiac history**, older person * Often **provoked**, usually by exertion or physical activity * Associated cardiac symptoms may occur (palpitations) * **Sudden and no warning** (unlike syncope) and no seizure-like manifestations What do you think is the cause of this LOC?
Cardiac cause: 1. Cardiac 2. Aortic stenosis 3. Arrhythmias
50
A patient presents with decreased lower extremity reflexes with rapidly evolving symetrical ascending muscle weakness and paresthesia without fever. What's your diagnosis?
Guillain-Barré Syndrome
51
What nerve is responsible for the corneal reflex?
V1 (ophtalmic) part of trigeminal (CN V)
52
What is the most important risk factor for stroke?
Hypertension
53
What are the obvious symptoms of Parkinson's disease that can help you diagnose it?
◼ Masked facies, reduced eye blink ◼ Change in voice ◼ Trouble arising from chair ◼ Difficulty turning in bed ◼ Trouble buttoning shirt ◼ Flexed posture with loss of arm swing ◼ Sialorrhea (hypersalivation) ◼ Change in handwriting
54
What are the red flags that indicate that the patient with a Parkinson's disease diagnosis DOES NOT actually have Parkinson's disease?
◼ Symmetrical presentation ◼ Rapid disease progression ◼ Poor response to levodopa ◼ Prominent, early speech or swallowing difficulties ◼ Pyramidal, cerebellar, autonomic signs ◼ Early gait disorder and falls ◼ “wheelchair sign”
55
What are the 2 common clinical presentations of a ruptured aneurysm (causing SAH)?
**“Sentinel bleed” with headache** * Sudden onset * Maximal at onset * “_Worst headache of my life_” * Constant for many hours **“Full” Rupture** * _Loss of consciousness_ * Seizure * Why? Not ischemic or pressure
56
* Vocalization, tonic stiffening, clonic movements for 1-2 minutes * Prolonged post-ictal period; unconscious then **confuse** * Urine **incontinence**, tongue biting What do you think is the cause of this LOC?
Seizure (neurologic cause)
57
What are the IMPORTANT non-motor symptoms of Parkinson's disease?
Psychiatric disturbance * Anxiety * Depression * Apathy Autonomic disturbance * Constipation * Erectile dysfunction * Urinary frequency * Orthostatic hypotension * (Pain) Cognitive Impairment * Dementia * Hallunications Sleep disturbance * Hyposomnia * REM sleep behaviour disorder * Excessive daytime sleepiness
58
1. Migraine 2. OCP 3. Smoking What are you worried about?
STROKE
59
Where does the needle go in a spinal anaesthesia?
Subarachnoid space
60
Someone presents with pain when eating. What nerve do you suspect to be injured?
Glosso-pharyngeal (CN IX)

Bloc J - Human Behavior (10 decks)

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