Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

USMLE STEP 3 Top 1% > Neuro > Flashcards

Neuro Flashcards

(94 cards)

Start Studying
1
Q

ACA compressed in which hernation

A

Cingulate (subfalcine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Talk about central (transtentorial herniation)

A

Brainstem is displaced which ruptures the paramedian basilar arteries and causes durets hemorrhage. Fatal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Kernohans

A

In the uncial (transtentorial hernation), early on we get ipsi blown pupil and contr hemiparesis. Later we get the compression of the brainstem against kernohans notch, causing the opposite: contra blow pupil and ipsi hemiparesis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Dura gets nerve supply from where

A

CN V anterior and middle fossa areas. CN X posterior fossa area.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Route of needle through spine to do LP

A

Skin, facial and fat, supraspinous lig, interspinous lig, flavum, epidural space, dura, arachnoid, SAS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Head tilt which way if the right trochlear nerve gone

A

Head tilts contra. Trcohlear usually intorts. Use hands to simulate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Syringomyelia can cause which famous neuro issue… if late on

A

Horners

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How does a central cord syndrome occur usually

A

Sudden hyperextension of the neck in older patients. Or spinal tumours.

Catches the CS tract (arms central in the SC > legs), And loss of pain sense.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Abortive Tx for migraine…. Think first line, if emergency department etc.

A

NSAID first, Triptan can start after and is best. Can even give together. IV metoclo in ED. CGRP antagonist can be considered too

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What time of day do clusters often occur in

A

Night

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

First episode of cluster may need what? Invx wise

A

MRI, carotid artery US…. Because these patients look like they have horners (carotid dissection) or other structural issues.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Tension headache in >65 year old patient…. What invx needed

A

ESR, just because its risk for GCA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

CT -ve, but symptoms of SAH… next invx

A

LP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Bilateral TG neuralgia?

A

MS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

MCA on dom side give aphasia… what about non dom side

A

Neglect

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

PCA stroke to LFT. Classical causes what?

A

Alexia without agraphia (cant read but can write). Which makes sense, since PCA is sight, and reading is more to do with sight… not writing.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Wallenberg syndrome Overview

A

PICA stroke. Lateral medullary. Sensation issues, which crossed sign (ipsi face, contra body). Ipsi bulbar palsy. Ipsi Horner’s. Some CN VIII issues too.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Some lacunar infarct stroke symptoms

A

Pure motor or sensory. Rousey clumpsy hand syndrome. Ataxia issues.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

CI for tPA…. Here we go

A

TIA in last 6 mo, Stroke in last 3 mo, MI in last 3 mo, GI OR GU bleed in past 3 wk, Sx in past 2 wk. Seizure in stoke. TCP. Any ICH Hx. BP above 180…. Lower first. Very high or low glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

CT and LP dont show SAH…. But its very sus

A

CTA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Post SAH… has neuro symptoms within 24 hours after Tx….. vs if the symptoms occur days after

A

Within 24 hours, is a rebleed. After days is probably vasospasm.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Acute subdue al vs chronic subdural Tx difference??

A

Acute, we will do Sx to evacuate the blood, even if no symptoms. Chronic, we only evacuate if symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Difference between brocas/wernickes and transcorticle Morton or sensory

A

Th former cannot repeat… the latter can

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Brain MRI in what kind of seizures

A

Focal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Spike and wave discharge seen in which seizure
Absence
26
What waves seen in tonic and clonic phases on grand mals
10 hz and then slow waves
27
Prolactin measurement in seizure?
High
28
Nystagmus Pure torsional or pure vertical….. means what
Central cause
29
Signs that a nystagmus/vertigo is central
Mild, vertical or pure rotational, positions dont change it, not Fatigable.
30
Apo E2 vs Apo E4, which the risk for alz
Apo e4 is the risky one, apo e2 protective
31
Put these alz symptoms in order of them happening Socially disengaged Language issues Aggressive Short term memory Long term memory Excec dysfunction Incontinent Motor dysfunction Visuospatial impairment
Roughly Declarative recent episodic memory → Short-term memory impairment → Language issues → Visuospatial impairment → Executive dysfunction → Long-term memory → Social withdrawal → impairment Motor dysfunction → peronality change → Incontinence → Aggressive behavior
32
Pathology overview of alz
IC neurofib tangles (tau), EC amyloid plaque (amyloid), hirano bodies
33
Tx for alz:
Mild/mod = AchEI (done riva gala) Mod/sev = NMDA antag (memantine) Vit e Avoid antiCh drugs
34
Primary progressive aphasia FTLD
Insidious onset of speech and language issues
35
Main symptom in NPH
Gait…. The first and main one!! Needed for dx
36
If you plan to do a VP shunt for NPH…. Must do what? And what predicts a good Px for this patient?
LP drainage trial, over a few days. To see if the VP shunt is worth doing. Only having gait issues is good, dementia is a bad sign
37
My two LP tests for CJD
14-3-3 protein and real time quaking (which is a real time detection of proteins becoming prions in CSF)
38
Hockey stick sign on MRI
CJD
39
One year rule for the two Lewy body dementias
PDD: Lewy body are in the SN mainly. Therefore dementia symptoms must occur at least a year onwards DLB: Lewy body go everywhere, so expect dementia and movement at the same time, or within a year of each other.
40
Dementia part of LBD, Tx
Done riva gala. (Only for alz and lbd)
41
Huntingtons pathophysiology
AD, CAG repeats in the HTT gene. Glu excitotox via NMDA receptor. Degen of the caudate and putamen. Causing chorea, memory and psych issues.
42
We know there is chore in HTT disease. What occurs later on
Hypokinesis.
43
HTT Tx overview
No cure, genetic counselling. Mood: SSRI If chorea and psych issue: atypical antipsychotic, If chorea and no mood or psych: tetrabenezine (VMAT inhibition)
44
Shy Drager syndrome
Dysautomnia form of Multi system atrophy (MSA-P)
45
Drugs causing parkinsonian symptoms
Typical antipsychotic (more than atypical), metoclo, tetrabenezine, zine anti H, MPTP, Li, phenytoin or valproate (rare)
46
Tx this PD patient: Above 65 and some form of dysfunction in daily life
Dopa carbidopa
47
Tx this PD patient: Mild symptoms and no impact of daily life… for any age
MAO B inhib (gilines)
48
Tx this PD patient: Mild symptoms and impact of daily living and less than 65
DA ag (pramipexole, ropinirole, rotigotine) This point we would do dopa for >65
49
Tx this PD patient: Moderate to severe symptoms and less than 65
Levodopa carbidopa
50
Tx this PD patient: Tremour predom
Anti muscarinic The reason we have tremour in PD, is because the lack of DA, means increase Ach activity. This causes the tremour. So giving trihex or benztropine, is perfect for this. Same drugs we give in acute dystonic reaction.
51
Two boosting agents for patients on dopa carbidopa
MAO B inhib or COMT inhib.
52
If have to give antipsych to PD patient, which one to give?
Quietapine
53
What is pseudobulbar affect
Pseudobulbar palsy is the UMN lesion causing symptoms that appear like the LMN CN (9, 10) issues. These UMN issues can also causes CNS dysfcutnion such as inappropriate laughing and crying = helps localise the UMN element
54
Why is bulbar involvement a diagnostic help in ALS
Because the big differential is spinal cord pathology. ALS can affect the brain and bulbar involvement proves that
55
Tx overview for ALS
Supportive, baclofen for spasm, PFT, NPPV if needed, riluzole deyals the glu excitotox (2-3 month survival improvement).
56
For restless leg syndrome, we can cure IDA if the cause. But what can be indicated: 1. If mild/intermittent 2. If severe and persistent
1. Massage, excersize, heating pad, stop causes 2. DA agonist (pramipexole, ropinrole), gabapentin
57
Three types of action tremour
Physiological (postural) Essential (kinetic) Intention (kinetic) Action tremour is just any tremour occurring with movement Postural means against gravity Kinetic means with proper movement
58
59
Wilsons syndrome…. Causes what kidney issues
Fanconi
60
Spine issue seen in NF1
Kyphoscoliosis
61
NF2 facts
2 ears 2 eyes (bilateral acoustic neuromas) MISME (schwannoma, meningioma, ependymoma) And maybe cafe au lait
62
Things to screen for in NF1 patients
MRI brain and spine Derma exam OPTHO exam Bone eval Auditory testing Renal artery stenosis eval Under age of 6 = carefully screen for optic nerve glioma
63
Infantile spasms? Facts
Caused by IC issues (avm, neurocutaneous syndromes, Chr issues, IU issues, issues at birth, metabolic issues). Raising arms, flexing neck, colic, increase startle response, head bobbing, random movements DO eeg to see abnormality and DX Vigabatrin or ACTH good
64
Sturge Weber syndrome Pathophysiology, Dx and Tx
GNAQ somatic mosaic mutation. Port wine in V1, and leptomeninieal capillary venous malf (causing the port wine). Brain may atrophy in area and get calcium deposits. Seizures, stoke, retardation occur. Do MRI, to see the tramline calcification. Photothermolyse port wines, aspirin low dose an anti convulsant
65
Why do audio exam on VHL patients
Endolyphatic sac tumours
66
If cannot resect tumours in VHL… can do what
Belzutifan (HIF inhibitor)
67
Ataxia telangiectasia patients symptoms and rule of A
Ataxia, ATM mut, AFP high, aberrant blood vessels, IgA def, a big risk for cancer, humoural infections common
68
69
When to do surgery in IIH patients. What surgery do we do
We do optic nerve sheath fenestrations. Or CSF shunting procedures. Do when medical Managment doesn’t help (CAIs, weight loss) or visual loss occurring
70
Both labryinthitis and vestibular neuritis can mimic stokes. Which strokes?
Labyrinthitis can mimic AICA (lateral pontine), because hearing is lost. But the stokes will usually have headache, ataxia, somatosensory deficits. Vestibular neuritis can mimic PICA stroke (Wallenberg), as hearing is usually ok. But would have dysphagia, sensory loss, Horner’s.
71
Main way to diagnose Cavernous venous thrombosis
MRI or MRV
72
Tx of cavernous venous thrombosis
Abx (vanco, foxy etc.), metro if dental or sinus source, antifungal if sus. All for about a month Heparin If not helping in 24 hours, surgical drain.
73
Vestibular neuritis Tx
CSS and anti emetics.
74
Meneriere cuases high or low freq hearing loss
Low
75
HINTS test meaning
Head impulse test, which is testing the vestibule ocular reflex. Patient faces dr and turn head while keeping eyes on drs nose. Peripheral vertigo will have eyes going with head, but then eyes correct to the nose (+)… also abnormal Central vertigo will have eyes able to stay on drs nose (-)
76
Which HIV drug do we avoid if there are HIV dementia signs
Efavirenz
77
Miller Fischer syndrome symptoms
**Opthalmoplegia**, ataxia, absent reflexes
78
If CS dont work for acute MS attack
Plasma exchange
79
Ascending paralysis and normal CSF! And maybe been hiking somewhere
Tick borne paralysis
80
Which electrolyte is a Px indicator in GBS
Na
81
Amifampridine is used for what? What else can we give for this disease
Lambert Eaton syndrome Decreases the K efflux, and increases depol. Can also give ACEI, IVIg, immunosuppressants CURE UNDERLYING CA
82
Which cancer causes LEMS
Small cell lung CA
83
Name some drugs that worsen myasthenia crisis
Aminoglyc (TONNE mnemonic), flouroquinolone (nerve tox), chloroquine (nerve damage), BB
84
What is edrophonium
AChE antag…. Can improve MG symptoms (for Invx purposes, not Tx)
85
The Tx for cerebral toxoplasmosis
PO pyrimethimen and sulfadiazine. Leucovorin for folate to prevent hepatic tox. 1-2 month tx, then keep going on low dose until mri shows resolution. CD4 < 100 in hiv patient with toxo igg + (can therefore reactivate) give prophlx TMP SMX
86
Brain abcess vs enceph symptoms triad difference
Abcess = fever, focal neuro Enceph = confusion and AMS
87
Cryptococcal meningitis Tx
Induction - amphotericin and flucytosine Consolidation - fluconazole Maintenance - fluconazole, until CD4 >100 and no viral load for a few months
88
Meningitis empiric abx… what do we add to vanco and foxy, if the patient is above 50, alcoholic, chronic illness, immunocompromised
Ampicillin to cover listeria
89
Meningococcal close contact tx
Rifampin or foxy is best Floxacin can also do (not for preg) And the vx
90
Less than one month old, empiric abx for meningitis
Ampi, genta
91
Gamma globulin in CSF is high in which pathology
MS mainly…. Not GBS
92
Brain abscess Tx (not toxo)
Metronidazole and foxy.vanco. Covers anaerobe and main bacteria. Give for 2 months. Do serial CT/MRI. Sx drain if big or causing neuro issues. If edema, do dexameth and other high ICP Tx. Anticonvulsant should be given
93
Chronic MG Tx Start with best inital (and what we should give with it). Then additions
Pyridostigmine (ACEI) and glycopyrrolate (antiM to stop side effects). Steroids are oft needed, with steps up to azathioprine. Sx for thymoma too
94
BP rules in stroke in regards to tPA
Before starting tPA, have less than 185/110. But dont have too low, we like permissive HTN. If a thrombolytic success, SBP < 140, if failed > 150.

USMLE STEP 3 Top 1% (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions