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Flashcards in Exam 1 Deck (241):
1

Is horizontal or vertical nystagmus more often pathological?

vertical

2

Does a cortical stroke affect the frontalis muscle?

no

3

Which grade is muscle strength against only gravity?

three

4

What is the only toe that matters for Babinski?

Big toe

5

What does a crossed brainstem injury mean?

sensory on one side and motor on the other

6

Prominent dysarthria could manifest as a lesion where in the CNS?

cerebellum

7

What two systems get involved with a myelopathy?

bladder and bowel

8

When would a person with M.G. feel stronger?

morning

9

Does a neuropathy effect proximal or distal vessels?

distal

10

Does a myopathy effect proximal or distal vessels?

proximal

11

Do both or one hemisphere have to be affected to cause coma?

both

12

Is the Reticular Activating System in the anterior or posterior pons?

posterior

13

The neurological exam in a comatose patient is designed to evaluate what?

brainstem

14

Respiration requires what two parts of the CNS to be intact?

forebrain and brainstem

15

What is the rate during central neurogenic breathing?

25+

16

Is Cheyne-Stokes a problem in the brainstem?

no

17

What do the pupils look like with a thalamic stroke?

small but reactive

18

What do the pupils look like with a midbrain stroke?

midposition and fixed

19

What do the pupils look like with a pontine stroke?

pinpoint but reactive

20

What do the pupils look like with an uncal stroke?

dilated and UNSYMMETRIC and fixed

21

Do the eyes move towards or away during cold water during caloric testing?

towards

22

Do the eyes move towards or away during warm water during caloric testing?

away

23

Does decorticate posturing cause flexion or extension of the upper extremities?

flexion

24

Does decorticate posturing cause flexion or extension of the lower extremities?

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