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Flashcards in Neuro 1 Deck (71):
1

Which arteries feed the pons?

Basilar artery (also midbrain)
Anterior Inferior Cerebellar Artery (also parts of cerebellum)

2

What artery feeds the medulla?

Posterior Inferior Cerebellar Artery

3

What do the first-order neurons of the dorsal columns do? What do the second-order neurons do?

Enter at ipsilateral dorsal horn...ascend in fasciculus gracilis (lower body) and cuneatus (upper body)...synapse at nucleus gracilis and nucleus cuneatus...respectively

Decussate at medulla...ascend as medial lemniscus

4

What information do the nerves in the medial lemniscus carry?

Two-point discrimination*
Vibration
Proprioception*

5

What do the first-order neurons of the spinothalamic tract do? Second-order?

Originate in DRG, synapse in dorsolateral tract of Lissauer

Decussate in ventral white commissure...ascend in lateral spinothalamic tract

6

What information do the nerves in the lateral spinothalamic tract carry?

Pain
Temperature

7

What do the first-order neurons of the corticospinal tract do? Second-order?

Descend from internal capsule and midbrain...decussate in medullary pyramids...descend in corticospinal tract...synapse in ventral horn through interneurons

Exit through ventral horn

8

What information do nerves in the corticospinal tract carry?

Voluntary movement of striated muscle

9

A patient comes in presenting both lower motor involvement (weakness, cramps, fasciculations) and upper motor involvement (difficulty walking due to spasticity). What does this person likely have? What is affected?

Amyotrophic Lateral Sclerosis (ALS...AKA Lou Gehrig's)

Cerebral cortex, brain stem, spinal cord (corticospinal tract, ventral horn)

10

A patient comes in after 2-5 days of flu-like symptoms with asymmetric weakness and flaccid paralysis. What is likely going on? What is affected?

Poliomyelitis (poliovirus is a picornavirus)...can still happen after ORAL vaccine

Ventral horn

11

A patient comes in with lightening-pain shooting down thigh or abdomen and has had difficulty walking. On exam, his eyes don't react to light, but they do react to near test. What is the likely diagnosis? What is affected? What else could be going on with this patient?

Tabes dorsalis (tertiary syphilis)

Dorsal columns

Cardiac problems and/or gummatous syphilis (granulomatous infiltration of any organ [liver, skin])

12

A patient is brought in with bilateral flaccid paralysis and bilateral spastic paresis. On exam, it is determined that sense of pain and temp are also lost. What is likely diagnosis? What is affected?

Spinal artery syndrome

Corticospinal tract (at level of lesion)
Spinothalamic tract (one level below lesion)
Ventral horn (at level of lesion)
Lateral gray matter (at level of lesion)

13

A patient comes in with bilateral spastic paresis affecting her legs. On exam, she is found to have decreased since of vibration and two-point discrimination. What would you likely see on labs? What is affected?

Megaloblastic anemia...because this is B12 deficiency

Dorsal columns
Corticospinal tracts

14

A patient is brought in with bilateral flaccid paralysis. On exam, he is found to have lost send of pain and temp bilaterally almost as high as he feels weak. What is the likely diagnosis? What is affected?

Syringomyelia

Ventral horn
Ventral white commissure...where spinothalamic tract decussates

15

A patient is found to have loss of vibration and discriminatory sense, spastic paresis, and flaccid paralysis on one side; and loss of sense of pain and temp on the other side. What is the likely diagnosis? What is affected?

Brown Sequard syndrome (I think this is like a stabbing victim)

ALL tracts on one side

16

A patient has a headache, neck pain, AMS, positive Brudzinski and Kernig signs, and petechiae. What is the likely bug?

Neisseria meningitidis

17

What should always be done before doing an LP? Why?

Neuro exam

Increased intracranial pressure + LP = increased risk of uncal herniation

Increased intracranial pressure: papilledema, focal neurologic deficits, pupil asymmetry)

18

How is meningitis initially treated?

Third gen cephalosporin (ceftriaxone)

19

What should be given to close contacts of patient's with bacterial meningitis?

Rifampin or ciprofloxacin for Neisseria
Rifampin for H. influ in nonvaccinated kids

20

What viruses can cause meningitis?

Enterovirus
Echovirus
HSV
Lymphocytic choriomeningitis virus
Mumps virus

21

What is the most common cause of meningitis in newborns? What else can cause it?

GBS

E. coli, listeria, H. influ

22

What is the most common cause of meningitis in 1m-2yo? What else can cause it?

Strep pneumo and N meningitidis

GBS, Listeria, H. influ

23

What is the most common cause of meningitis in 2-18yo? What else can cause it?

N. meningitidis
Strep pneumo, Listeria

24

What is the most common cause of meningitis in 18-60yo? What else can cause it?

Strep pneumo

N. meningitidis, Listeria

25

What is the most common cause of meningitis in 60+yo? What else can cause it?

Strep pneumo

Listeria, gram- rods

26

An LP is done of a patient with expected meningitis, and results are: elevated WBC (lymphocytes), significantly elevated pressure, decreased glucose, and increased protein. What kind of meningitis is it? What should be given?

Fungal infection or TB

Fungal: Amphotericin B
TB: RIPE

27

What can cause encephalitis?

It is a viral infection

VZV, HSV, mumps virus, poliovirus, rhabdovirus (rabies), coxsackie virus, arbovirus (St. Louis and Cali strains), flavivirus (West Nile), and measles

28

A patient presents with severe pain kinda over cheeks and along the jaw. What should be considered? What is the treatment?

Trigeminal neuralgia

Carbamazepine, baclofen, phenytoin, gabapentin, valproate, clonazepam, or other anticonvulsants...surgical decompression of nerve may help

29

What are the most common causes of thrombotic strokes?

Atherosclerosis of carotid, basilar, or vertebral arteries

30

What is the most common cause of embolic stroke? Where does it most commonly occur?

Emboli originate in heart, aorta, carotid, or intracranial arteries

Middle cerebral artery

31

What distinguishes a TIA from a CVA?

Time...24hrs

32

Within what time frame should thrombolytic therapy be given for a stroke? (assuming no contraindications)

Within 3 hours of onset

33

When should heparin or LMWH be given?

For a progressive embolic stroke

34

How are hemorrhagic strokes treated?

Reversal of anticoagulation
Control BP
Control ICP (mannitol, hyperventilation, anesthesia)

Surgical decompression

Antiplatelets can be restarted after 2 weeks

35

A patient comes in with stroke like symptoms and a BP of 180/100. Should the BP be treated?

Not immediately...need to maintain cerebral perfusion

Would if >220/120 or if patient has CAD

36

What can all cause parenchymal hemorrhages?

HTN, AVM, brain aneurysm, or stimulant abuse

37

A person has a stroke of the ACA. What are the symptoms?

Contralateral lower extremity and trunk weakness

38

A person has a stroke of the MCA. What are the symptoms?

Contralateral face and upper extremity weakness and decreased sensation
Bilateral visual abnormalities
Aphasia (if dominant hemisphere)
Neglect
Inability to perform learned actions (if nondominant hemisphere)

39

A person has a stroke of the PCA. What are the symptoms?

Contralateral visual abnormalities
Blindness (if bilateral PCA involvement)

40

A person has a stroke of the lacunar arteries. What are the symptoms?

Focal motor or sensory deficits
Loss of coordination
Difficulty speaking

41

A person has a stroke of the basilar arteries. What are the symptoms?

Cranial nerve abnormalities
Contralateral full body weakness and decreased sensation
Vertigo
Loss of coordination
Difficulty speaking
Visual abnormalities
Coma

42

A non-contrast CT is done on a patient with the worst headache of his/her life, but it doesn't show anything. What should be done? What might be seen?

Get an LP

RBCs
Xanthochromia (yellowness)
Increased pressure

43

What kind of hemorrhage causes an epidural hematoma? How is it treated?

Meningeal arteries (middle most common)

Emergent drainage...stabilization of ICP and BP

44

What are some ways that an epidural can be distinguished from a subdural hematoma?

Epidural can cross midline and is convex

Subdural cannot cross midline and follows curvature of the brain

45

What causes a subdural hemorrhage? How is it treated?

Rupture of bridging veins (trauma)

Surgical drainage or supportive...depends on size

46

What should be done if a subdural hemorrhage is expected? What should not be done?

Get a CT without contrast

Do NOT get an LP...increased risk of herniation

47

A patient is brought in and he isn't saying much...and he is having a hard time coming up with words, but he can understand what you say. On exam he has face and arm hemiparesis and you notice he has a hard time chewing and drinking. What kind of aphasia is this? What is all injured?

Broca aphasia (expressive aphasia)

Inferior frontal gyrus
Dorsolateral frontal cortex
Anterior parietal cortex

48

A patient comes in and is pretty well talking gibberish and does NOT understand what you are saying. What kind of aphasia is this? What is all injured?

Wernicke aphasia (receptive aphasia)

Posterior superior temporal gyrus
Inferior parietal lobe

49

A patient comes in with fluid speech, but sometimes uses the wrong word and frequently attempts to correct words with word-finding pauses. What kind of aphasia is this? What is all injured?

Conduction aphasia

Supramarginal gyrus
Angular gyrus

50

A patient comes in speaking gibberish and cannot understand you; he also has limb ataxia. What kind of aphasia is this? What is all injured?

Global aphasia

Large infarcts of left cerebral hemisphere

51

A patient comes in with strange behavior, incontinence, and recent falls. What is likely going on? What would be seen on imaging? What is the treatment?

Normal pressure hydrocephalus (wacky, wet, and wobbly)

MRI: enlarged cerebral ventricles, white matter lesions, and aqueduct atrophy

Ventriculoperitoneal shunting

52

A patient is brought in because of brief periods of paresthesias, hallucinations, or repetitive/non-purposeful movements; but has NOT lost consciousness. What did this patient likely experience? What is involved? What would be seen on EEG?

Simple partial seizure

Focal cortical region of the brain

Distinct focal conductive abnormality

53

A patient is brought in because of episodes of hallucinations (auditory, visual, or olfactory), automatisms (repeated coordinated movements), or deja vu; patient has impaired consciousness and postictal confusion. What is going on? What is involved? What would be seen on EEG?

Complex partial seizure

Focal cortical region (most commonly temporal lobe)

Focal abnormalities in temporal lobe

54

A patient is brought in because of tonic, clonic, tonic-clonic, myoclonic (repetitive contractions), or atonic episodes; patient LOSES consciousness and has Todd paralysis (weakness that lasts hours). What is going on? What is involved? What would be seen on EEG?

Generalized convulsive seizure

Bilateral cerebral cortex

Generalized* electrical abnormalities

55

What is involved in an absence seizure? What is seen on EEG?

Bilateral cerebral cortex

Generalized three-cycle/second spike-and-wave pattern

56

Which antiepileptic drugs work by inhibiting voltage-gated sodium channels?

Carbamazepine
Phenytoin
Lamotrigine
Oxcarbazepine
Zonisamide

57

When is carbamazepine used? what are significant possible side effects?

Mono therapy for partial or generalized convulsive seizures

Hyponatremia, SJS, leukopenia

58

When is phenytoin used? what are significant possible side effects?

Mono therapy for partial or generalized convulsive seizures
Status epilepticus

Gingival hyperplasia, androgenic, lymphadenopathy, SJS

59

When is lamotrigine used? what are significant possible side effects?

Partial seizures
Second-line for for t-c seizures

Rash, SJS

60

When is oxcarbazepine used? what are significant possible side effects?

Mono therapy for partial or general convulsive seizures

Hyponatremia, rash

61

When is zonisamide used? what are significant possible side effects?

Second-line drug for partial or general convulsive seizures

Somnolence, confusion

62

How does ethosuximide work? When is it used?

Inhibition of neuronal calcium channels

Absence seizures

63

How do phenobarbital, benzodiazepines, and tiagabine work?

Enhance GABA activity

64

When is phenobarbital used? what are significant side effects?

Nonresponsive status epilepticus

General cognitive depression, rebound seizures

65

When are benzos (-zepam or -zolam) used? What are significant side effects?

Status epilepticus

Tolerance, rebound seizures

66

When is tiagabine used? What are significant side effects?

Second-line for partial seizures

Abdominal pain

67

What drug inhibits sodium channels and enhances GABA activity? When is it used? What are significant side effects?

Valproate

Mono therapy or second drug for partial and generalized seizures

Hepatotoxicity, weight gain, alopecia...teratogenic (spina bifida; abnormal face)

68

What antiepileptic inhibits NMDA-glutamate receptors and enhances GABA activity? When is it used? What are significant side effects?

Topiramate

Second-Ind drug for partial and generalized seizures

Wt. loss, cognitive impairment, heat intolerance, paresthesias

69

When is gabapentin used?

Mono therapy or second line drug for partial seizures

70

When is levetiracetam used?

Mono therapy for partial seizures
second-line for partial or generalized seizures

71

What causes status epilepticus?

Withdrawal of anticonvulsants
Alcohol withdrawal
Trauma
Preexisting seizure disorder
Metabolic abnormalities