Nervous system Flashcards
1
Q
HSV encephalitis (CSF findings)
A
Lymphocytic pleocytosis
Elevated protein
Elevated RBCs
Normal glucose
2
Q
Bacterial meningitis (CSF findings)
A
Neutrophilis pleocytosis
Elevated protein
Low glucose
3
Q
Tuberculous meningitis (CSF findings)
A
Lymphocytic pleocytosis
Elevated protein
Very low glucose (e.g., 7)
4
Q
Leading causes of brain metastases
A
Melanoma
Lung cancer
Breast cancer
Renal cell carcinoma
5
Q
Amyotrophic Lateral Sclerosis
A
Upper motor neuron signs + lower motor neuron signs
Preserved sensation
May have cognitive dysfunction
Usually >40 years old
6
Q
Complex seizures
A
Involve loss of consciouness
7
Q
Partial seziures
A
Seizure activity with a focal origin within the brain
8
Q
Todd’s paralysis
A
Transient post-seizure neurologic symptom
Transient, focal weakness, usually affecting the appendages
Resolves within 48 hours
9
Q
Most important prognostic factors for astrocytomas
A
Patient age
Functional status
Tumor grade
10
Q
A
Gadolinium-enhanced brain MRI
Used to diagnose brain abscess
11
Q
Brain abscess
- Microbiology
- Pathogenesis
- Clinical manifestations
- Treatment
A
12
Q
Alzheimer disease
A
Early, insidious short-term memory loss
Language deficits and spatial disorientation
Later personality changes
13
Q
Vascular dementia
A
Stepwise decline
Early executive dysfunction
Cerebral infarction &/or deep white matter changes on neuroimaging
14
Q
Frontotemporal dementia
A
Early personality changes
Apathy, disinhibition & compulsive behavior
Frontotemporal atrophy on neuroimaging
15
Q
Dementia with Lewy body
A
Visual hallucinations
Spontaneous parkinsonism
Fluctuating cognition
16
Q
Normal-pressure hydrocephalus
A
Ataxia early in disease
Urinary incontinence
Dilated ventricles on neuroimaging
17
Q
Prion disease
A
Behavioral changes
Rapid progression
Myoclonus &/or seizures
18
Q
Cisplatin: Common adverse effects
A
Nephrotoxicity
Tinnitus and hearing loss
Electrolyte abnormalities
Severe nausea and vomiting
Neurotoxicity
19
Q
Typical chemo regimens for non small-cell lung cancer
A
- cisplatin + etoposide + docitaxel
or
- carboplatin + paclitaxel
20
Q
Juvenile myoclonic epilepsy
A
Progression from absence to myoclonic to generalized tonic-clonic seizures
Presents in teenage years
Occur upon awakening
Genetic basis
Symptoms can be worsened with sleep deprivation
21
Q
Parkinson’s disease
A
Dementia
Falls
Festinating gait
Slowed speech
Resting hand tremor
Cogwheel rigidity on passive range of motion
Caused by a loss of dopaminergic neurons in the substantia nigra
22
Q
CSF findings in Guillain-Barre Syndrome
A
Albuminocytologic dissociation:
- Elevated protein content
- Normal leukocyte count
23
Q
Spinal Epidural Absess
- Causes
- Classic triad
- Treatment
A
- Concurrent distant infection, injection drug use, or spinal procedure
- Fever, back pain, neurologic manifestations
- Broad-spectrum antiobiotics and aspiration/surgical decompression
24
Q
Treatment for epidural metastases
A
High-dose glucocorticoids
25
Botulism
1. Symptoms
2. Treatment
1. Descending bilateral paralysis beginning in the cranial nerves
2. Equine anti-toxin
26
Kernig sign
Budzinsks sign
Both suggestive of meningeal irritation
**Kernig sign**: Inability to extend the knee \>135 degrees when hip is flexed
**Brudzinsks sign**: Passive flexio of the neck results in flexion of the lower extremities
27
Migraine therapies
1. Abortives
2. Preventives
3. Co-administration caution
Coadministration of a triptan and an ergot derivative or an additional triptan after a first dose may result in prolonged vasospasm due to overactivation of serotonin receptors, which can lead to severe elevations in blood pressure, myocardial infarction, or stroke.
28
Amarosis fugax
Painless, sudden and transient (\<10 minutes) monocular vision loss
Retinal artery emboli originating from an ipsilateral carotid artery atherosclerotic plaque
29
Posterior uveitis
Painless vision loss and floaters
Produces choroidal infammation
Associated with systemic inflammatory disorders (IBS, ankylosing spondylitis) or infection (CMV)
30
Optic neuritis
Monocular vision loss over several weeks with painful eye movement
Afferent pupillary defect with optic disc swelling on fundoscopy
Often associated with MS
31
Temporal (giant cell) arteritis
Medium- to large-vessel vasculitis that affects adults age \>50
Can present with monocular vision loss
Unilateral headache
Jaw claudication
Constitutional symptoms (e.g., fever, fatigue)
Polymyalgia rheumatica (proximal muscle weakness/pain)
32
Postictal vision loss
Can result formoccipital lobe seizures
Preceding visual aura marked by flashes of light and color
33
Uhthoff phenomenon
Feature of MS, where heat exposure may exacerbate symptoms
34
Post-traumatic syringomyelia
3-4% of patients with spinal cord injuries
Often caused by whiplash
Englargement of the central canal of the spinal cord due to CSF retention
Impaired strength, impaired pain/temperature sensation in upper extremities
Preservation of dorsal colume function (light touch, vibration, position sense)
Diagnose with MRI
35
Cervical spondylosis
Patients over 40
Results from disk degeneration
Neck pain and stiffness
May lead to spinal stenosis
36
Sudden infant death syndrome
1. Risk factors
2. Prevention
SIDS: Unexplained death before the age of 1
Risk is decreased with:
smoke avoidance
pacifier use
sleeping in the supine position with firm bedding
room-sharing without bed-sharing
37
Criteria for thrombolytics in stroke
1. Inclusion criteria
2. Strict exclusion criteria
3. Relative exclusion criteria
38
Resting tremor
Low amplitude, low frequency (4-6 Hz) tremor that starts in one hand
Pill rolling tremor
Often presenting symptom of Parkinson's disease
Parkinsonian tremors are more pronounced with distractibility
39
Tremors
1. Essential
2. Parkinson's disease
3. Cerebellar
4. Physiologic
40
Essential tremor
Fine tremor
Suppressed at rest
Exacerbated at the end of goal-directed movements
41
Treatment for essential tremor
First line: Propranolol, especially if patient is hypertensive
Alternative medications: Primidone, topiramate
42
Building rapport with a psychotic patient with no insight
Nonjudgemental stance that acknowledges the patient's experience and perspective without endorsing specific delusions or hallucinations
43
Exertional heat stroke
Acute confusion
Extreme hyperthermia \> 105 F
Tachycardia
Coagulopathic bleeding
44
Central cord syndrome
Occurs with hyperextension injury in patients with pre-existing degenerative changes in the cervical spine.
Weakness is more pronounced in the upper extremities than the lower.
May have selective loss of pain and temp sensation in the arms due to damage to lateral spinothalamic tract.
45
Anterior ventral cord syndrome
Bilateral spastic motor paresis distal to the lesion.
Usually due to occlusion of the spinal artery.
46
Brown-Sequard syndrome
Caused by cord hemisection (due to penetrating injury)
**Ipsilateral**: Weakness, spasticity, loss of vibration sense and proprioception
**Contralateral**: Loss of pain and temperature sensation
47
Posterior cord syndrome
Bilateral loss of vibratory and proprioceptive sensation
Weakness, paresthesias, urinary incontinence or retention
MS or vascular disuption (e.g. vertebral dissection) may be causes
48
Differential diagnosis of neuromuscular weakenss
1. Upper motor neurons
2. Anterior horn cells
3. Peripheral nerves
4. Neuromuscular junction
5. Muscle fibers
49
Clinical features of multiple sclerosis
1. Features suggesting multiple sclerosis
2. Disease pattern
3. Diagnosis
50
MS
51
Brain death
Absence of cortical and subcortical function
The spinal cord is still functioning; Deep tendon reflexes may still be present
52
Uncal herniation
1. Lesion
2. Neurologic signs
53
Treatment of cancer pain
1. Mild
2. Moderate
3. Severe
54
Riluzole
Glutamate inhibitor approved for use in patients with ALS
55
Thymoma
56
Acetylcholinesterase inhibitors used to treat Alzheimer's
1. Donepezil
2. Rivastigmine
3. Galantamine
57
Management of patients suspected of having Guillain Barre syndrome
Assess patient's respiratory status by serial spirometry
58
Diagnostic pulmonary tests (Indications, disadvantages)
1. Spirometry
2. Peak flow meter
3. Chest x-ray
4. Chest CT
5. Pulse oximeter
6. Arterial blood gas
59
Multiple system atrophy
Shy-Drager syndrome
Degenerative disease characterized by:
1. **Parkinsonism**
2. **Autonomic dysfunction** (**postural hypotension**, abnormal sweating, disturbance of bowel or bladder control, abnormal salivation or lacrimation, impotence, gastroparesis)
3. **Widespread neurological signs** (cerebellar, pyramidal or lower motor neuron)
60
Galactosemia
Caused by galactose-1-phosphate uridyl transferase deficiency
Vomiting
Poor weight gain
Jaundice
Hepatomegaly
Convulsions
Cataracts
Increased risk for *E. coli* neonatal sepsis
Treat by removing galactose from diet
61
Acute causes of hemiplegia in children
1. Cause
2. Features
62
Reversal of bleeding due to warfarin
Intravenous vitamin K and prothrombin complex concentrate
(can use fresh frozen plasma if PCC not available)
63
Reversal of heparin
Protamine sulfate
64
Treatment for bleeding in patients with thrombocytopenia or taking anti-platelet therapy
Consider platelet transfusion
65
1. Pathogenesis
2. Risk factors
3. Clinical features
4. Diagnosis
5. Treatment
66
Clinical Features of Alzheimer's disease
1. Early findings
2. Late findings
67
Diagnostic features of Lewy Body Dementia
1. Central (required)
2. Core
3. Suggestive
4. Supportive
5. Conflicting (Make LBD less likely)
68
Lobar hemorrhage
Spontaneous lobar hemorrhage is most commonly caused by **cerebral amyloid angiopathy**, especially in the elderly.
69
Subdural hematoma
Results from **rupture of bridging veins**, most commonly from head trauma
70
Cardioembolic stroke
Patients have multiple ischemic infarcts at the grey-white junction
71
Ischemic stroke
Area of hypodensity affecting a vascular distribution
72
Epidural hematoma
Caused by tearing of the middle meningeal artery
Acute hemorrhage in a biconvex pattern that does not cross suture lines
73
Subarachnoid hemorrhage
Sudden onset of severe (thunderclap) headache and hyperattenuation of the sulci and basal cysterns on head CT
Caused by ruptured saccular (berry) anuerysms
74
Cephalohematoma
Subperiosteal hemorrhage
Presents a few hours after birth as scalp swelling limited to one cranial bone.
Most cases do not require any treatment and resorb spontaneously within 2 weeks to 3 months.
75
Caput succadeneum
Diffuse, sometimes ecchymotic, swelling of the scalp.
It usually involves the portion of the head presenting during vertex delivery.
May extend across the midline and across suture lines.
76
Clinical characteristics of major stroke subtypes
1. Ischemic (thombotic)
2. Ischemic (embolic)
3. Intracebral hemorrhage
4. Spontaneous subarachnoid hemorrhage
Embolic strokes usually have sudden onset with maximal symptoms at the beginning.
77
Neurologic findings according to location of intraparenchymal hemorrhage
1. Basal ganglia
2. Cerebellum
3. Thalamus
4. Cerebral lobe
5. Pons
78
Complications of infective endocarditis
1. Cardiac
2. Neurologic
3. Renal
4. Musculoskeletal
79
Myasthenic crisis
1. Precipitating factors
2. Signs/symptoms
3. Treatment
Precipitating medications:
Aminoglycosides, **fluoroquinolones**, macrolides, beta blockers
80
Treatment for normal pressure hydrocephalus
Large volume lumbar punctures
If successful, ventriculoperitoneal shunting
81
Initial diagnostic workup of a first-time seizure in an adult
**Basic blood Tests**
Serum electrolytes
Glucose
Calcium
Magnesium
CBC
Renal and Liver Function
**Tox Screen**
82
Myasthenia gravis
1. Epidemiology
2. Symptoms/signs
**3. Diagnosis**
**4. Treatment**
83
Clinical features of sellar masses
1. Causes
2. Clinical presentation
84
Visual field defects, Location of lesion, Possible causes
85
Acoustic neuroma
86
Cerebellopontine angle tumors
Acoustic neuromas, meningiomas
Headache
Hearing loss
Vertigo
Tinnitus
Balance problems
87
Complication of status epilepticus (seizure \> 5 min)
Cortical laminar necrosis
Can lead to persistent neurologic deficits and recurrent seizures
Result of excitatory cytotoxicity,
88
Pediatric brain tumor locations
89
Most common type of brain tumor in children
Atrocytoma
| (Pilocytic astrocytoma)
90
HIV-infected patient
Altered mental status
EBC DNA in CSF
Solitary, weakly ring-enhancing periventricular mass on MRI
Primary CNS lympoma
(EBV DNA in CSF is specific for primary CNS lymphoma)
91
Spinal epidural abscess
1. Epidemiology
2. Manfestations
3. Diagnosis
4. Treatment
92
Differential diagnosis of myopathy
(Disorder, Clinical features, ESR, CK)
1. Glucocorticoid-induced myopathy
2. Polymyalgia rheumatica
3. Inflammatory myopathies
4. Statin-induced myopathy
5. Hypothyroid myopathy
93
Spinal cord compression
1. Causes
2. Signs and symptoms: **Early and Late**
3. Management
94
Absence seizures
1. Clinical features
2. Diagnosis
3. Comorbidities
4. Treatment
95
Tuberous sclerosis
Genetic neurocutaneous disease
Cardiac rhabdomyomas
Renal angiomyolipomas
Epilepsy
96
AV malformation
Most common cause of intraparenchymal hemorrhage in children
97
Basal ganglia hemorrhage
Spontaneous deep intracerebral hemorrhage is typically caused by hypertensive vasculopathy involving the penetrating branches of the major cerebral arteries.
Common locations: basal ganglia, cerebellar nuclei, thalamus, pons.
98
Cerebrospinal fluid analaysis (WBC count, glucose, protein)
1. Normal
2. Bacterial meningitis
3. Tuberculosis meningitis
4. Viral meningitis
5. Guillain-Barre
99
Papillidema
100
Fetal hydrantoin syndrome
Midface hypoplasia, microcephaly, cleft lip and palate, digital hypoplasia, **hirsuitism**, and developmental delay
Caused by expsoure to anticonvulsant medications
Phenytoin, carbamazepine
101
Central retinal artery occlusion
102
Central retinal vein occlusion
103
Wernicke encephalopathy
1. Associated conditions
2. Pathophysiology
3. Clinical features
4. Treatment
Can be induced iatrogenically by administering glucose before thiamine, because glucose increases the body's requirement for thiamine (a cofactor for many enzymes).
Thiamine: B1
104
Classical triad of brain abscess
Fever
Headaches
Focal neurologic deficits
Congenital heart disease and recurrent sinusitis are risk factors.
