Exam 1 Flashcards
(241 cards)
1
Q
Is horizontal or vertical nystagmus more often pathological?
A
vertical
2
Q
Does a cortical stroke affect the frontalis muscle?
A
no
3
Q
Which grade is muscle strength against only gravity?
A
three
4
Q
What is the only toe that matters for Babinski?
A
Big toe
5
Q
What does a crossed brainstem injury mean?
A
sensory on one side and motor on the other
6
Q
Prominent dysarthria could manifest as a lesion where in the CNS?
A
cerebellum
7
Q
What two systems get involved with a myelopathy?
A
bladder and bowel
8
Q
When would a person with M.G. feel stronger?
A
morning
9
Q
Does a neuropathy effect proximal or distal vessels?
A
distal
10
Q
Does a myopathy effect proximal or distal vessels?
A
proximal
11
Q
Do both or one hemisphere have to be affected to cause coma?
A
both
12
Q
Is the Reticular Activating System in the anterior or posterior pons?
A
posterior
13
Q
The neurological exam in a comatose patient is designed to evaluate what?
A
brainstem
14
Q
Respiration requires what two parts of the CNS to be intact?
A
forebrain and brainstem
15
Q
What is the rate during central neurogenic breathing?
A
25+
16
Q
Is Cheyne-Stokes a problem in the brainstem?
A
no
17
Q
What do the pupils look like with a thalamic stroke?
A
small but reactive
18
Q
What do the pupils look like with a midbrain stroke?
A
midposition and fixed
19
Q
What do the pupils look like with a pontine stroke?
A
pinpoint but reactive
20
Q
What do the pupils look like with an uncal stroke?
A
dilated and UNSYMMETRIC and fixed
21
Q
Do the eyes move towards or away during cold water during caloric testing?
A
towards
22
Q
Do the eyes move towards or away during warm water during caloric testing?
A
away
23
Q
Does decorticate posturing cause flexion or extension of the upper extremities?
A
flexion
24
Q
Does decorticate posturing cause flexion or extension of the lower extremities?
A
extension
25
Lesions causing decorticate posturing occuring above what brainsteam structure?
midbrain
26
Does decerebrate posturing cause flexion or extension of all extremities?
extension
27
In what two structures does cerebrate posturing occur?
midbrain or pons
28
A headache caused by what could wake a person up at night?
tumor
29
Progressive frequency and duration is indicative of what type of headache caused by what?
mass
30
Perform what procedure if the CT is negative for blood during an SAH?
lumbar tap
31
A meningitis headache is similar to what other type of headache?
migraine
32
When does a post-LP headche go away?
when patient lies down
33
Bilateral trigeminal neuralgia is specific for what disease?
multiple sclerosis
34
What does CADASIL stand for?
cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy
35
What does HaNDL stand for?
headache with neurological deficit and lymphocytosis
36
What is a better imaging modality for headache, CT or MRI?
MRI
37
What is a better imaging modality for bleeding, CT or MRI?
CT
38
What are the four criteria that a patient needs two of to be Dx with Migraine?
unilateral
throbbing
worsened by movement
moderate/severe
39
What are the three criteria that a patient needs one of to be Dx with Migraine?
photophobia
phonophobia
nausea/vomiting
40
What are the three substances implicated in Migraine?
CGRP
Substance P
Nitrix oxide
41
Pain in the neck can be indicative of what type of headache?
migraine
42
Is chronic sinusitis a cause of headache?
no
43
Which two receptors do Triptans target? Inhibit the release of what?
5HT1B and 5HT1D
triptans
44
How many weeks may it take for migraine prophylaxis to become effective?
8 to 12 weeks
45
What are three choices for symptom relief of cluster headaches?
10-15 L of oxygen
dihydroergotamine
triptans
46
What class of meds are cluster headaches bridged with? Before being treated with?
steroids
verapamil
47
What is the drug for paroxysmal hemicrania?
indomethacin
48
What is the most common risk factor for daily chronic headaches? How many days per month?
acute use of daily meds
> 15
49
Is jerk nystagmus pathological or physiological?
path
50
Is pendular nystagmus pathological or physiological?
physiological
51
Does peripheral or central jerk nystagmus have latentcy?
peripheral
52
Does peripheral or central jerk nystagmus adapt?
peripheral
53
Does peripheral or central jerk nystagmus fatigue?
peripheral
54
Which two pathways proximally feed into the Medial Geniculate Nucleus?
superior olive
inferior colliculus
55
Which part of the brainstem is the olive in?
pons
56
Which part of the brainstem is the olive inferior colliculus?
midbrain
57
When does peripheral vertigo occur?
with movement
58
Which type of vertigo occurs with movement and rest?
central
59
What two structures compose the meninges?
pia and arachnoid
60
What is meningoencephalitis?
inflammation of brain and meninges
61
What is myelitis?
inflammation of spinal cord
62
What is Kernigs Sign?
resistance to passive extension of the knee
63
What is Brudzinskis sign?
flexion of hips and knees when neck is extended
64
Does S. penumo cause meningitis in adults or young adults?
adults
65
Does Neisseria cause meningitis in adults or young adults?
young adults
66
Would imaging precede LP with new onset seizure?
yes
67
Would imaging precede LP with immunocompromised?
yes
68
Would imaging precede LP with focal findings?
yes
69
Would imaging precede LP with decreased level of consciousness?
yes
70
What do steroids decrease during bacterial meningitis?
mortality
71
What is the most common type of meningitis?
viral
72
What type of tick carries Lyme?
deer
73
What is the imaging modality of chronic meningitis?
MRI with contrast
74
What infectious disease has caused an increase in CNS TB?
HIV
75
What specific structure is threatened during CNS TB?
cranial nerves
76
Which immune cell is present during TB Meningitis?
lymphocyte
77
Which aminoglycoside can be used for TB?
streptomycin
78
Which protein is elevated during CJD?
14-3-3
79
Which specific lobe houses semantic memory?
lateral temporal
80
Which circuit becomes disrupted during Amnesia?
Papez
81
Which lobe does Herpes start in?
temporal
82
Does Gertsman Syndrome occur in the dominant or non-dominant lobe? Which lobe? Which specific area?
dominant/parietal
cingulate gyrus
83
Which lobe would cause neglect? Dominant or non-dominant?
non-dominant, parietal
84
What is Anosagnosia? Which lobe?
defect of self-awareness
non-dominant parietal
85
What is Apraxia?
inability to perform learned purposeful movements
86
What is Prosopagnosia? Where is the lesion?
inability to recognize known faces
occipito-temporal
87
What does visual agnosia occur?
occipito-temporal junction
88
Does Broca's Aphasia occur in the dominant or non-dominant frontal lobe?
Broca's
89
Which two areas are considered Subcortical?
basal ganglia and white matter
90
Is prosopagnosia unilateral or bilateral?
bilateral
91
Which lobe does apraxia occur?
non-dominant parietal
92
Which lobe does Alzheimers originally manifest?
temporal
93
Which protein is found in Lewy Body Dementia?
alpha-synuclein
94
Which protein is found in Fronto-Temporal Dementia?
spherical tau
95
What is the imaging modality of choice for dementia?
MRI
96
Which drug can decrease the absorption of B12?
PPI's
97
Which ApoE molecule carries an increased risk of dementia?
ApoE4
98
Is amyloid intracellular or extracellular?
extra
99
Is Tau intracellular or extracellular?
intra
100
Which chromosome is ApoE4 on?
chromosome 19
101
What is the most under diagnosed form of dementia?
fronto-temporal
102
What type of dementia would a REM sleep disorder be indicative of?
Lewy Body
103
What gene may be affected during Vascular Dementia?
NOTCH 3
104
What are the three AchE Inhibitors used to treat alzheimers?
Donepezil
Galantamine
Rivastigmine
105
What vitamin for Alzheimers?
Vitamin E
106
Which atypical antipsychotic for dementia related psychosis?
Quietapine
least anti-dopaminergic
107
How many seizures need to manifest to diagnose epilepsy?
two
108
Where do generalized seizures come from?
both hemispheres
109
Where do partial seizures come from?
one hemisphere
110
Is consciousness lost during a simple partial seizure?
no
111
Is consciousness lost during a complex partial seizure?
yes
112
What can provoke an absence seizure?
hyper-ventilation
113
What is the pattern of Absence Seizure on EEG?
3 Hz spike and slow wave discharge
114
What two drugs if ethosuximide fails?
valproate or lamotrigine
115
What characterizes a rolandic seizure?
drooling
116
How are the extremities affected during a Rolandic seizure?
unilateral paralysis
117
In what two situations does a Rolandic seizure precipitate?
during sleep or awakening
118
What does a Rolandic seizure look like on EEG?
centrotemporal spikes
119
Is rolandic seizuring normal or abnormal?
normal
120
What are the two drugs of Rolandic seizuring?
carbamazepine or oxacarbamazepine
121
What type of movements does Juvenile Myoclonic Epilepsy manifest with? Progress to?
myoclonic
grand mal seizures
122
What is the EEG of Juvenile Myoclonic Epilepsy?
3-6 Hz polyspikes and waves
123
What is the drug of choice for Juvenile Myoclonic Epilepsy?
valproate
124
Dont use valproate for what age group during Juvenile Myoclonic Epilepsy?
adolescent girls
125
What two drugs if valproate fails for Juvenile Myoclonic Epilepsy?
Levetiracetam
Lamotrigine
126
What is the most common seizure in kids?
febrile seizure
127
Is a Simple Febrile Seizure generalized or partial?
generalized
128
How long must a Simple Febrile Seizure last less than?
15 minutes
129
How often can a Simple Febrile Seizure occur in 24 hours?
once
130
Which two vacciantions can cause a Complex Febrile Seizure?
MMR and TDP
131
LP should be initiated for kids with a febrile seizure if they havent been vaccinated for which two bugs?
Strep. pneumo and HiB
132
What family of drugs are used to ablate a Simple Febrile Seizure? If the seizure lasts longer than?
benzo
five minutes
133
What is infantile spasm considered?
severe epileptic encephalopathy
134
What can Infantile Spasm occur in?
clusters
135
What is the most common cause of Infantile Spasm?
tuberous sclerosis
136
What does the EEG look like during Infantile Spasm?
hypsarrhythmia
137
Drug of choice for Infantile Spasm?
ACTH
138
Drug of choice for Tuberous Sclerosis?
Vigabatrin
139
What is the EEG of Lennox Gastaut Syndrome?
less than 2.5 spike and slow wave
140
Two drugs of choice for Infantile Seizure?
phenobarbital
Fosphenytoin
141
How can a jitter be differentiated from a seizure?
holding a limb wont stop a seizure movement
142
What is present in the CSF during GBS?
Albuminocytological dissociation
143
What is the most sensitive and specific test for GBS?
nerve conduction study
144
Two drugs for GBS?
IVIG and plasmapharesis
145
What is the mode of inheritance for DMD?
X-linked recessive
146
What is the most common cause of death during GBS?
respiratory distress
147
What two drugs may slow the progression of DMD?
prednisolone and deflazacort
148
What are the three most common causes of ataxia in kids?
post-infectious cerebellar ataxia
intoxication
GBS
149
What brain imaging modality is needed to rule out infectious etiology of ataxia in kids?
MRI
150
Does ataxia in kids spontaneously resolve?
yes
151
What type of injury is concusion?
diffuse axonal injury
152
WHat ions can be implicated in concussion?
potassium and calcium
153
Excess of what neurotransmitter may be implicated in concussion? Causing increase flux in which ion?
glutamate
potassium
154
Does the brain require more or less glucose during a concussion?
more
155
What happens to cerebral perfusion during concussion?
decrease
156
What happens to oxidative metabolism during concussion?
decrease
157
Which two genes for concussion?
ApoE and Tau
158
What is the only agreed upon risk factor for concussion?
previous concussions
159
Which lobe is most likely to be affected during concussion?
temporal
160
What is the leading cause of death regarding head injury?
subdural hematoma
161
Which type of cerebral hemorrhage shows xanthochromia?
subarachnoid
162
Which two lobes are most affected by Intracerebral Hemorrhage?
frontal and temporal
163
What is the most important step to initially evaluate in concussion?
ABCs
164
Is the helmet removed in football?
no
165
Is the helmet removed in hockey?
yes
166
What cerebellar test on the sideline?
pronator drift
167
Do symptoms get better or worse with head injury over time?
worse
168
Use who to corroborate a patients concussion symptoms?
family member
169
What is the standard of care for concussion management?
physical and cognitive rest until symptoms resolve
170
Which two OTC anto-inflammatories are contraindicated during concussion healing? Why?
aspirin and NSAIDs
bleeding
171
Does second impact syndrome occur in mature or immature brains?
immature
172
Which group of meds may help during 'post-concussion' syndrome?
SSRIs
173
Do helmets prevent concussion?
no
174
Do mouth guards prevent concussion?
no
175
Within how many years of life does Cerebral Palsy develop?
3
176
Does Cerebral Palsy have axial hypertonia or hypotonia?
hypotonia
177
Does Cerebral Palsy have peripheral hypertonia or hypotonia?
hypertonia
178
What is the skin manifestation of Cerebral Palsy?
skin ulcer
179
Is a migraine unilateral or bilateral in children?
bilateral
180
What drug can be used for migraine prophylaxis in kids?
cyproheptadine
181
What type of drug is cyproheptadine?
anti-histamine
182
Topiramate is good for which two groups of kids?
obese and epileptic
183
Is Optic Glioma NF1 or NF2?
NF1
184
What is the skin manifestation of tuberous sclerosis?
ash leaf spot
185
What is the facial manifestation of tuberous sclerosis?
facial angiofibroma
186
What develops in the eye of Tuberous Sclerosis?
retinal hamartoma
187
What is the name of the growth in Sturge Weber? Where?
leptoangioma
brain
188
What happens to the meinges during Sturge Weber?
calcified
189
What happens to the eyes during Sturge Weber?
unilateral glaucoma
190
What is a disorder of language called?
dysphagia
191
What is a disorder of motor speech called?
dysarthria
192
What is the most reported trigger of migraine?
stress
193
What specific lobe does praxis manifest in? What is apraxia?
dominant parietal
difficulty with motor planning
194
Are imaging modalities normal or abnormal during concussion?
normal
195
What two lobes show hypometabolism during concussion?
frontal and temporal
196
Where does 80% of Epidural hematomas have a skull fracture?
tempo-parietal
197
What mental exam on the sideline for concussion?
SCAT
198
Does GBS have a normal or abnormal WBC count in CSF fluid?
normal
199
What is the most common cause of ataxia in children?
post infectious ataxia
200
Which disease affects the diencephalon disrupting the Papez circuit?
Korsakoff
201
If a patient cant over-power resistance on muscle testing, what grade does that make them?
three or less
202
Clonus is what grade?
four
203
Is seizure cortex or subcortex?
cortex
204
Are quadrantanopia and hemianopia cortical or subcortical sings?
subcortical
205
Do radiculopathies follow dermatomal patterns?
yes
206
What structure does the reticular activating system activate immediately? Where does this structure send fibers?
thalamus
bilateral cortex
207
Do respirations become more normal or abnormal as you go down the brainstem?
more abnormal = further down
208
Is nystagmus driven by hemisphere or brainstem?
hemisphere
209
Can permanent vision loss occur in Pseudotumor Cerebri?
yes
210
What class of drugs treats pseudotumor cerebri?
diuretics
211
What drug treats trigeminal neuralgia?
Carbamazepine
212
What percent of migraine has an aura?
20%
213
Which cortex can migraine arise in?
occipital
214
Migraine can be mediated by what type of leukocyte?
mast cell
215
Which neurotransmitter can be involved in migraine?
dopamine
216
Is nystagmus defined by the fast phase or slow phase?
fast
217
Does Lyme produce lymphocytic or bacterial meningitis?
lymphocytic
218
What may be the presenting sign in GBS?
facial diplegia
219
Do steroids help GBS?
no
220
Is the prognosis better for kids or adults in GBS?
kids
221
What causes the spastic diplegia?
periventricular leukomalacia
222
Are nausea and vomiting more common in kids and adults during migraine?
kids
223
What relieves migraine in kids?
sleep
224
Is migraine with aura more or less common?
common
225
What three drugs for a migraine in kids in ER?
valproate
diphenhydramine
ketoralac
226
What anti-epileptic for kids with migraine?
topiramate
227
What tricyclic for kids with migraine?
amitriptyline
228
Which beta-blocker for adolescent migraine?
propranalol
229
Where are freckles during NF1?
axillary or inguinal
230
Which two bones during NF1?
sphenoid and long
231
What type of relative for NF1?
first degree
232
What structure causes the seizures during Tuberous Sclerosis?
cortical tubers
233
What happens to the cardiac rhabdomyoma during Tuberous Sclerosis?
spontaneously resolves
234
What does the cognitive outcome of Tuberous Sclerosis depend on?
severity of epilepsy
235
Apraxia manifests with damage to what lobe specifically? Dominant or non-dominant?
posterior parietal
dominant
236
Which two drugs for moderate migraines in kids?
tylenol or ibouprofen
237
Do concussions resolve spontaneously?
yes
238
Does the brain require more or less glucose following a concussion?
more
239
Is EEG needed for simple febrile seizure?
no
240
Is EEG needed for complex febrile seizure?
possibly
241
Do neonates have generalized seizures? Why?
no
incomplete myelination
