Neuro Flashcards
(224 cards)
1
Q
Front
A
Back
2
Q
What are the 4 components of the neuromuscular unit?
A
1) Anterior horn cells of the spinal cord, 2) Peripheral nerve, 3) Neuromuscular junction, 4) Muscle innervated
3
Q
What is the pathophysiology of myasthenia gravis?
A
Autoantibodies against acetylcholine (ACh) receptors on the post-synaptic membrane causing blockage of ACh receptors and muscle fatigue
4
Q
What is one bedside diagnostic test for myasthenia gravis?
A
Ice bag test: Apply ice to affected eye for 2 minutes, improvement >2mm of ptosis is positive
5
Q
What are the precipitants of myasthenic crisis?
A
Infection, aspiration, medication changes, surgery, pregnancy, and specific medications (beta blockers, aminoglycosides, neuromuscular blockers)
6
Q
What is the difference between myasthenia gravis and Lambert-Eaton syndrome?
A
MG gets weaker with repeated stimulation, Lambert-Eaton gets stronger with repeated stimulation and is associated with small cell lung cancer
7
Q
What are the 4 types of botulism toxicity?
A
Food-borne, infantile, wound, inhalational/terrorism
8
Q
What is the mechanism of botulism toxicity?
A
Toxin irreversibly binds to presynaptic membrane inhibiting ACh release at peripheral nerve synapses
9
Q
What is the clinical presentation of botulism?
A
Descending symmetrical flaccid paralysis, diplopia, dysarthria, dysphagia, with intact pain and sensation
10
Q
What is tick paralysis?
A
Acute ascending flaccid paralysis from female tick attachment, similar to Guillain-Barré but with fixed dilated pupils
11
Q
What is the treatment for tick paralysis?
A
Supportive care and tick removal
12
Q
What are the features of transverse cord syndrome?
A
Complete loss of motor, sensory, and autonomic function distal to injury with no sacral sparing
13
Q
What is Brown-Sequard syndrome?
A
Hemisection of spinal cord: ipsilateral motor loss and vibration/proprioception loss, contralateral pain/temperature loss
14
Q
What is anterior cord syndrome?
A
Loss of motor function and pain/temperature sensation below the level, with preservation of posterior column function
15
Q
What is central cord syndrome?
A
Bilateral motor paresis with upper extremities > lower extremities, often from hyperextension injuries
16
Q
What distinguishes conus medullaris from cauda equina syndrome?
A
Conus: UMN signs, usually bilateral; Cauda equina: LMN signs, usually unilateral
17
Q
What is the arterial supply to the spinal cord?
A
Single anterior spinal artery (supplies anterior 2/3) and paired posterior spinal arteries, with radicular artery of Adamkiewicz
18
Q
What are the causes of spinal cord infarction?
A
Aortic dissection, post-surgical, global ischemia, lupus, vasculitis
19
Q
What are the 5 risk factors for spinal epidural abscess?
A
Diabetes, injection drug use, chronic renal failure, alcoholism, immunosuppression
20
Q
What are the common bacteria in spinal epidural abscess?
A
Staphylococcus aureus (>50%), streptococci, E. coli, Pseudomonas
21
Q
What is the difference between SEA and diskitis treatment?
A
SEA requires urgent surgery; diskitis usually treated with antibiotics only
22
Q
What is status epilepticus?
A
Seizure lasting >5 minutes OR recurrent seizures without return to baseline mental status
23
Q
What are the causes of status epilepticus?
A
Metabolic disorders, infections, withdrawal syndromes, CNS lesions, intoxication
24
Q
What is the first-line treatment for status epilepticus?
A
Benzodiazepines (lorazepam, diazepam, or midazolam)
25
What are the second-line treatments for seizures?
Phenytoin, fosphenytoin, valproic acid, levetiracetam
26
What are the third-line treatments for refractory seizures?
Pentobarbital, phenobarbital, midazolam infusion, propofol infusion
27
What is the antidote for isoniazid-induced seizures?
Pyridoxine 5g IV (adult) or 70mg/kg (pediatric)
28
What is the treatment for eclampsia seizures?
Magnesium IV loading dose 4-6g over 15-20 minutes, then 1-2g/h infusion
29
What are the CT findings predictive of abnormal results in seizure patients?
Focal neurological abnormality, malignancy, head injury, focal seizure onset, age >65, seizure duration >15 minutes
30
What are the legal implications of new-onset seizure?
Private driving restriction for 6 months or until neurologist clearance
31
What is Todd's paralysis?
Focal motor deficit (hemiplegia) after seizure, can last up to 24 hours, caused by focal cerebral hypoperfusion
32
What is a transient ischemic attack (TIA)?
Transient episode of neurologic dysfunction caused by focal brain, spinal cord, or retinal ischemia without acute infarction
33
What is the risk of stroke after TIA?
Approximately 10% within 3 months (half within first 2 days)
34
What is the ABCD2 score used for?
Risk stratification for stroke risk after TIA (Age
35
What are the inclusion criteria for tPA in stroke?
Clinical diagnosis of ischemic stroke with measurable deficit, onset <4.5 hours, age ≥18 years
36
What are the absolute contraindications for tPA?
ICH history, recent stroke/head trauma (3 months), active bleeding, BP >185/110
37
What is the dosing for tPA in stroke?
0.9 mg/kg IV (max 90mg): 10% bolus then 60-minute infusion
38
What are the BP targets for hemorrhagic stroke?
Systolic >160-180 mmHg or MAP >130 mmHg with parenteral agents
39
What are the 4 common sites of hypertensive ICH?
Putamen (44%), thalamus (13%), cerebellum (9%), pons (9%)
40
What is the ICH volume formula?
ABC/2 (A = length
41
What are the features of anterior cerebral artery stroke?
Altered mentation, leg weakness > arm weakness, incontinence, primitive reflexes
42
What are the features of middle cerebral artery stroke?
Motor and sensory deficits contralateral to lesion (arm and face > leg)
43
What are the features of vertebrobasilar stroke?
Wide variety: vertigo, diplopia, ataxia, crossed deficits, possible LOC
44
What are the 4 steps in the afferent pain pathway?
1) Pain detection, 2) Pain transmission, 3) Pain expression, 4) Pain modulation
45
What is the difference between acute and chronic pain?
Chronic pain lasts >3-6 months beyond normal healing time and causes prolonged stress response
46
What are the pain assessment tools by age?
Infants: FLACC scale; Preschool: FACES; Verbal children: visual analog; >11 years: numerical rating
47
What are the 4 side effects of NSAIDs?
GI bleeding, renal failure, anaphylaxis/TENS/SJS, platelet dysfunction
48
What increases risk of NSAID GI bleeding?
Dehydration, liver/renal disease, elderly, PUD history, warfarin use
49
What is the mechanism of local anesthetics?
Reversibly block sodium channels preventing depolarization; more effective in unmyelinated fibers
50
What are the two classes of local anesthetics?
Esters (procaine, tetracaine) and Amides (lidocaine, bupivacaine)
51
What is the toxic dose of lidocaine?
3-5 mg/kg (7 mg/kg with epinephrine)
52
What is the toxic dose of bupivacaine?
1.5 mg/kg (3 mg/kg with epinephrine) - more cardiotoxic
53
What are the signs of local anesthetic toxicity?
Circumoral paresthesias → dysarthria → lightheadedness → seizures → cardiac arrest
54
How is local anesthetic toxicity treated?
Benzodiazepines for seizures, ACLS, consider lipid emulsion therapy
55
What are 6 techniques to reduce injection pain?
Buffering with bicarbonate, slow injection, inject through wound edges, warming, topical anesthetic first, distraction
56
What topical anesthetics are used for different surfaces?
Intact skin: EMLA patch; Mucous membranes: 2-4% lidocaine; Open skin: LAT/LET
57
What is the sucrose dose for neonatal anesthesia?
2-10 ml of 24% solution
58
What are the motor strength grades?
5=Normal, 4=Weak but resists examiner, 3=Moves against gravity, 2=Moves but can't resist gravity, 1=Flicker, 0=No movement
59
What characterizes upper vs lower motor neuron lesions?
UMN: Increased DTRs, increased tone, no atrophy, Babinski present; LMN: Decreased DTRs, decreased tone, atrophy, fasciculations
60
What is the differential for ascending muscle weakness with ptosis?
Guillain-Barré, myasthenia gravis, botulism, Lambert-Eaton, tick paralysis, hypomagnesemia
61
What is neurogenic pulmonary edema?
Acute pulmonary edema after significant CNS insult due to catecholamine surge causing cardiopulmonary dysfunction
62
What is psychogenic non-epileptic seizure?
Functional neurological disorder with out-of-phase movements, pelvic thrusting, voluntary eye movements away from examiner
63
What are early CT findings in ischemic stroke?
Hyperdense artery sign, sulcal effacement, loss of insular ribbon, loss of gray-white interface, mass effect
64
What were the NINDS trial results?
tPA improved NIHSS scores in ischemic stroke within 3 hours but showed no survival benefit
65
What are risk factors for stroke in young patients?
Hypercoagulable states, pregnancy, oral contraceptives, cocaine, carotid dissection, sickle cell disease
66
What is the difference between Wernicke's and Broca's aphasia?
Wernicke's: receptive (can't understand); Broca's: expressive (can't speak effectively but understands)
67
What are the ECASS III exclusion criteria?
ICH, major infarct on imaging, NIHSS >25, seizure at onset, stroke/diabetes combination, anticoagulation
68
What are features that suggest seizure vs syncope?
Seizure: tonic-clonic activity, retrograde amnesia, post-ictal period, incontinence, tongue biting
69
What is the differential diagnosis for ischemic stroke?
Subdural hematoma, brain tumor, abscess, carotid dissection, migraine, hypoglycemia, Todd's paralysis
70
What are the etiologies of ischemic stroke?
In situ thrombosis (large/small vessel), embolic obstruction (cardiac/noncardiac)
71
What are the causes of hemorrhagic stroke?
Hypertensive vasculopathy, cerebral amyloid angiopathy, AVMs, aneurysms, drugs (cocaine)
72
What is the blood supply to the brain?
Anterior circulation (carotid): 80% of brain; Posterior circulation (vertebrobasilar): brainstem, cerebellum, occipital cortex
73
What is amaurosis fugax?
Sudden painless monocular blindness indicating anterior circulation (carotid) involvement
74
What are the NINDS stroke evaluation targets?
Door to doctor: 10 min; Door to CT: 25 min; Door to treatment: 60 min
75
What BP management is needed for tPA candidates?
Must reduce BP to <185/110 before tPA administration
76
What medications are used for BP reduction in stroke?
Labetalol 10-20mg IV, nicardipine infusion 5mg/hr titrated to 15mg/hr
77
When should BP be treated in non-tPA stroke candidates?
Only if systolic >220 or diastolic >120 or MAP >130 mmHg
78
What antiplatelet therapy is recommended after TIA/stroke?
ASA alone if not on antiplatelets; add clopidogrel if already on single agent
79
What are complications of ischemic stroke?
Cerebral edema, hemorrhagic transformation, GI bleeding, CHF, hospital complications, seizures
80
What are poor prognostic factors for ICH?
GCS 3-4 (2 points), ICH volume ≥30cm³ (1 point), IVH present (1 point), infratentorial origin (1 point), age ≥80 (1 point)
81
What reversal agents are used for anticoagulation in ICH?
Warfarin: Vitamin K + FFP/PCC; Dabigatran: Idarucizumab; Apixaban/Rivaroxaban: PCC
82
What are indications for neurosurgical consultation in ICH?
Clinical or radiographic evidence of elevated ICP for possible EVD or hematoma evacuation
83
When is surgical evacuation most helpful in ICH?
Cerebellar hemorrhage within 48 hours with sizable lobar hemorrhage and neurological deterioration
84
What is the post-ictal period?
Interval of altered mental status immediately following seizure
85
What defines refractory status epilepticus?
Seizure that doesn't terminate after benzodiazepine plus second antiepileptic drug
86
What are the exclusion criteria for 3-4.5 hour tPA window?
Age >80, severe stroke (NIHSS >25), oral anticoagulant use, diabetes + prior stroke history
87
What imaging is recommended for TIA evaluation?
Emergency neuroimaging, vascular imaging (carotid doppler, MRA, CTA), ECG, basic labs
88
What is the mechanism of tick paralysis?
Salivary toxin decreases ACh release from presynaptic membrane similar to botulinum toxin
89
What distinguishes tick paralysis from Guillain-Barré?
Tick paralysis may have fixed dilated pupils helping distinguish from Guillain-Barré syndrome
90
What are the features of polymyositis/dermatomyositis?
Proximal muscle weakness, difficulty rising from chairs, pain/tenderness, no fasciculations
91
What are the skin findings in dermatomyositis?
Periorbital heliotrope rash, erythema/swelling of extensor joint surfaces, photosensitive facial rash
92
What is the treatment for polymyositis/dermatomyositis?
Prednisone 1-2 mg/kg/day; if ineffective: azathioprine or methotrexate
93
What is periodic paralysis?
Acute painless myopathy with intermittent flaccid extremity weakness, hypokalemic form more common than hyperkalemic
94
What triggers hypokalemic periodic paralysis?
Weakness after large carbohydrate meal (increases insulin causing potassium shift intracellularly)
95
What is thyrotoxic periodic paralysis?
Acquired form with identical presentation to kalemic forms, look for hyperthyroidism symptoms
96
What characterizes neuropathy in the comparison table?
Recent infection with ascending weakness, normal/decreased strength (distal>proximal), decreased DTRs and sensation, with wasting
97
What characterizes neuromuscular junction disease?
Food/tick exposure with easy fatigability, normal strength that fatigues, normal DTRs and sensation, no wasting
98
What characterizes myopathy?
Thyroid disease or previous episodes, decreased strength (proximal>distal), normal DTRs and sensation, with wasting
99
What is syringomyelia?
Cavitary lesion in spinal cord substance, 90% have Chiari I malformation, causes cape-like sensory loss
100
What are the clinical features of syringomyelia?
Headache, neck pain, cape-like sensory changes, gait disorder, lower limb hyperreflexia, hand/arm weakness
101
What is transverse myelitis?
Heterogeneous inflammatory disorders affecting ascending/descending spinal pathways, often post-viral (30%)
102
What is spinal SAH?
Rare hemorrhage in epidural/subdural/subarachnoid/intramedullary layers, usually from AV malformation
103
What are the clinical features of spinal SAH?
Thunderclap excruciating back pain extending to flank, possible headache/neck stiffness, variable neurological deficits
104
What are the 6 intrinsic causes of spinal cord dysfunction?
MS, transverse myelitis, spinal AVM/SAH, syringomyelia, HIV myelopathy, spinal cord infarction
105
What are the 4 extrinsic causes of spinal cord dysfunction?
Spinal epidural hematoma, spinal epidural abscess, diskitis, neoplasm
106
What is the bulbocavernosus reflex?
Normal cord-mediated reflex involving anal sphincter contraction with glans squeeze or Foley tug
107
What indicates spinal shock is over?
Return of bulbocavernosus reflex; if absent
108
What are the respiratory criteria for mechanical ventilation in neuromuscular disease?
FVC <15 mL/kg or maximal NIF <15 mmH2O indicates potential need for mechanical ventilation
109
What are bedside tests for myasthenia gravis?
Edrophonium (tensilon) test and ice bag test can be useful for new MG diagnosis
110
What treatments are available for myasthenic crisis?
Plasma exchange therapy and IVIG are both useful, choice depends on availability and ICU preference
111
What is the key feature of infantile botulism?
Comes from spores germinating in high pH infant GI tract, honey should not be fed to infants
112
What are the key points about hypokalemic periodic paralysis?
Total body potassium not depleted, only shifted intracellularly; administer potassium with frequent monitoring
113
What should be evaluated in newly diagnosed hypokalemic periodic paralysis?
Patient should be evaluated and treated for hyperthyroidism if present
114
What is the treatment approach for acute neuromuscular weakness?
1) Evaluate airway/ventilation/oxygenation, 2) Determine lesion location, 3) Consider common disorders for that area
115
What characterizes motor neuron disease (ALS)?
Progressive difficulty swallowing/speaking/walking, decreased strength, increased DTRs, normal sensation, with wasting
116
What is the key difference in clinical presentation between central and Brown-Sequard syndromes?
Central: bilateral UE weakness > LE; Brown-Sequard: ipsilateral motor/proprioception loss, contralateral pain/temperature loss
117
118
Front
Back
119
What are the two components of consciousness?
Arousal (controlled by reticular activating system) and Cognition (controlled by cerebral cortex)
120
What GCS score requires intubation?
GCS <8
121
What change in GCS is considered significant?
Change >2 points
122
What does the DIMS mnemonic stand for in altered LOC?
Drugs, Infection, Metabolic, Structural
123
What are the "OB's 5Cs" critical drug causes of coma?
Opiates, Beta-blockers, Carbon monoxide, Cyanide, CCBs
124
Name 2 additional critical drug causes beyond the 5Cs
Cyclic antidepressants, Cardiac glycosides
125
What is the oculocephalic reflex also called?
Doll's eyes reflex
126
What is a normal oculocephalic reflex response?
Eyes maintain forward gaze despite turning the head (positive doll's eye reflex)
127
What does COWS stand for in cold calorics?
Cold Opposite, Warm Same (direction of nystagmus)
128
What happens with cold calorics if brainstem is intact?
Slow conjugate deviation toward cold ear for 30-120 seconds, with fast nystagmus beats away
129
What are the contraindications to oculocephalic testing?
C-spine precautions
130
What are the contraindications to cold calorics?
Perforated tympanic membranes, excessive earwax
131
What position is needed for cold calorics?
Elevate head 30 degrees OR reverse trendelenburg if c-spine precautions
132
What volume of ice water is used for cold calorics?
10-30cc
133
What is the initial management mnemonic for altered LOC?
MOVIE (monitors, oxygen, vitals, IV, environment)
134
What is the "coma cocktail"?
Dextrose, Oxygen, Narcan, Thiamine
135
What are common infant causes of altered mental status?
Infection, Trauma/abuse, Metabolic
136
What are common child causes of altered mental status?
Toxic ingestion
137
What are common adolescent/young adult causes of altered mental status?
Toxic ingestion, Recreational drug use, Trauma
138
What are common elderly causes of altered mental status?
Medication changes, Over-the-counter medications, Infection, Alterations in living environment, Stroke
139
What does the AEIOU TIPS mnemonic stand for?
Anaphylaxis/Altitude/Alcohol, Epilepsy/Environmental, Infection, Overdose, Underdose, Trauma/Tumor, Insulin, Psychogenic/Poisons, Stroke/Shock
140
What controls arousal?
Ascending reticular activating system (ARAS) in paramedian tegmental zone of dorsal brainstem
141
What controls cognition?
Cerebral cortex
142
What can cause depressed consciousness?
Anything impacting brainstem function or bilateral cortex
143
What are the three categories of processes that cause coma?
Metabolic derangements, Toxins, Mechanical injury
144
Name 3 metabolic pancreatic causes of coma
Hypoglycemia, DKA, HONK
145
Name thyroid causes of altered LOC
Hyperthyroidism, Hypothyroidism
146
Name kidney-related causes of altered LOC
Electrolyte derangements, kidney failure with uremic state
147
Name liver-related causes of altered LOC
Hepatic encephalopathy
148
Name 4 environmental causes of altered LOC
High altitude cerebral edema, Heat stroke, Hypothermia, Dysbarism
149
Name 5 intracranial catastrophes causing altered LOC
ICH, Stroke, Epidural hematoma, Subdural hematoma, SAH
150
Name 2 additional intracranial causes of altered LOC
Status epilepticus, acute hydrocephalus
151
Name 4 cardiac causes of altered LOC
ACS, Aortic Dissection, Cardiogenic shock, HTN crisis
152
What is the definition of syncope?
Sudden, transient loss of consciousness with loss of postural tone accompanied by rapid return to baseline
153
What is the lifetime prevalence of syncope?
1 in 5
154
Which syncope patients have the highest mortality?
Patients with known CAD who have syncope from any cause
155
Name 3 syncope risk factors
Known cerebrovascular disease, HTN, cardiac medications
156
Which types of syncope have no mortality unless trauma occurs?
Vasovagal, orthostatic, medication-induced
157
What is the pathophysiology of most syncope?
Bilateral hemispheric dysfunction or RAS dysfunction, majority from acute hypoperfusion
158
At what drop in cerebral perfusion pressure may syncope occur?
>35%
159
Name the 12 critical causes of syncope
MI, arrhythmia, thoracic aortic dissection, critical aortic stenosis, HOCM, pericardial tamponade, abdominal aortic aneurysm, PE, subarachnoid bleed, toxin mediated, severe hypovolemic shock, ruptured ectopic pregnancy
160
What are the 5 components of San Francisco Syncope Rule?
History of CHF, Hematocrit <30%, Abnormal ECG, SOB on history, SBP <90 at triage
161
What are the 4 absolute red flags requiring admission in syncope?
Chest pain, unexplained SOB, history of significant CHF or valvular disease, ECG evidence of ventricular dysrhythmias/ischemia/prolonged QT/new BBB
162
What are the 5 relative red flags for syncope admission?
Age >45, pre-existing cardiovascular/congenital heart disease, family history of sudden death (Brugada), serious comorbidities (diabetes), exertional syncope
163
Name 5 medication categories that can cause syncope
Cardiac meds, QT prolonging medications, Digitalis, Insulin/oral hypoglycemics, Recreational drugs
164
What is the difference between UMN and LMN reflexes?
UMN: hyper-reflexia, LMN: hypo-reflexia
165
What is the muscle tone difference between UMN and LMN lesions?
UMN: spasticity, LMN: flaccidity
166
What is the muscle bulk difference between UMN and LMN lesions?
UMN: normal muscle bulk, LMN: loss of muscle bulk
167
What are UMN-specific signs?
Pronator drift, Hoffmann's sign, Babinski's sign (upgoing toes)
168
What are LMN-specific signs?
Fasciculations
169
Where is the lesion in UMN weakness?
Cerebral cortex or corticospinal tract of brainstem and spinal cord
170
Where is the lesion in LMN weakness?
Anterior horn, nerve root, axon, or peripheral nerve
171
What pattern does UMN spasticity follow?
Extension in upper extremities, flexion in lower extremities
172
What are characteristics of NMJ lesions?
Slowly progressive or fluctuating signs, bulbar or ocular signs, mixed UMN/LMN pattern, bilateral proximal weakness
173
What are 6 warning signs of impending respiratory failure in neuromuscular weakness?
Climbing pCO2, decreased LOC, decreasing peak flows, tachypnea, respiratory distress with shallow respirations, accessory muscle recruitment
174
Name 7 non-emergent causes of peripheral neuropathy
Connective tissue disorder, External compression, Endocrinopathy (diabetes), Paraneoplastic syndromes, Toxins (alcohol), Trauma, Vitamin deficiency
175
What does tachypnea and shallow respirations signify in weakness?
Impending respiratory failure - prepare for positive pressure ventilation
176
What should sudden onset focal weakness be considered until proven otherwise?
Vascular cause (differentiate occlusion vs hemorrhage)
177
What suggests a compressive space-occupying lesion in weakness?
Severe headache with unilateral weakness OR midline back pain with lower extremity weakness
178
What are the 3 classic signs of cauda equina syndrome?
Saddle paresthesia, urinary retention, fecal incontinence (plus focal motor neuron deficit)
179
What suggests UMN lesion without other explanation?
Anorectal or bladder insufficiency
180
Which lab tests are useful exceptions in neuromuscular weakness?
CK in inflammatory myositis, potassium level in channelopathies
181
What are critical cerebral cortex/subcortical emergent causes of weakness?
Ischemic or hemorrhagic cerebrovascular accident (CVA)
182
What are critical brainstem emergent causes of weakness?
Ischemic or hemorrhagic CVA
183
What are critical spinal cord emergent causes of weakness?
Ischemia, compression (disk, abscess, or tumor), myelitis
184
What are critical peripheral nerve emergent causes of weakness?
Acute demyelination (Guillain-Barré syndrome)
185
What are critical neuromuscular junction emergent causes of weakness?
Myasthenic or cholinergic crisis, Botulism, Tick paralysis, Organophosphate poisoning
186
What are critical muscle emergent causes of weakness?
Rhabdomyolysis
187
What are emergent cerebral cortex/subcortical causes of weakness?
Tumor, abscess, demyelination
188
What are emergent spinal cord causes of weakness?
Demyelination (transverse myelitis), Compression (disk, spondylosis)
189
What are emergent peripheral nerve causes of weakness?
Compressive plexopathy (hematoma, aneurysm), Paraneoplastic vasculitis uremia
190
What are emergent muscle causes of weakness?
Inflammatory myositis
191
What are non-neurologic causes of weakness related to plasma volume?
Dehydration
192
What are non-neurologic causes of weakness related to plasma composition?
Glucose, electrolyte abnormalities
193
What are non-neurologic causes of weakness related to RBCs?
Anemia or polycythemia
194
What are non-neurologic causes of weakness related to cardiac function?
Myocardial ischemia
195
What are non-neurologic causes of weakness related to vascular resistance?
Vasodilatory shock from any cause
196
What are non-neurologic causes of weakness related to metabolic demand?
Local or systemic infection, endocrinopathy, toxin
197
What are non-neurologic causes of weakness related to mitochondrial function?
Severe sepsis or toxin-mediated
198
What are non-neurologic causes of weakness related to CNS depression?
Sedatives, stimulant withdrawal
199
What pediatric GCS verbal score corresponds to "oriented"?
Age-appropriate vocalization, smile, or orientation to sound, interacts (coos, babbles), follows objects
200
What pediatric GCS verbal score corresponds to "confused"?
Cries, consolable
201
What pediatric GCS verbal score corresponds to "inappropriate words"?
Persistently irritable
202
What pediatric GCS verbal score corresponds to "incomprehensible sounds"?
Restless, agitated
203
What pediatric GCS verbal score corresponds to "none"?
None
204
What pediatric GCS motor score corresponds to "obeys commands"?
Spontaneous movements (obeys verbal command)
205
What pediatric GCS motor score corresponds to "localizes pain"?
Withdraws to touch (localizes pain)
206
What pediatric GCS motor score corresponds to "withdraws"?
Withdraws to pain
207
What pediatric GCS motor score corresponds to "abnormal flexion"?
Abnormal flexion to pain (decorticate posture)
208
What pediatric GCS motor score corresponds to "abnormal extension"?
Abnormal extension to pain (decerebrate posture)
209
In the Glasgow Coma Scale, what does "V" represent and how many points?
Verbal response, 5 possible scores
210
In the Glasgow Coma Scale, what does "M" represent and how many points?
Motor response, Most (6) possible scores
211
What is the mnemonic for remembering oculovestibular reflex?
COWS - Cold Opposite, Warm Same
212
What does a positive doll's eye reflex indicate?
Normal brainstem function (eyes maintain forward gaze despite head turning)
213
What does an abnormal doll's eye reflex look like?
Eyes remain fixed/frozen in orbits when head is turned
214
What is the key difference between pre-syncope and syncope?
They are the same entity on a spectrum - pre-syncope, syncope, to coma
215
What medication classes are included in "cardiac meds" causing syncope?
Beta-blockers, vasodilators, calcium channel blockers, nitrates, ACE inhibitors, angiotensin receptor blockers, phenothiazines, phosphodiesterase inhibitors
216
What QT-prolonging agents can cause syncope?
Amiodarone, disopyramide, flecainide, procainamide, quinidine, sotalol
217
What are the key features that distinguish NMJ lesions?
Disrupted signalling from pre-synaptic motor neuron to post-synaptic muscle fiber
218
What is the significance of finding even one UMN sign?
Indicates a problem with the CENTRAL nervous system
219
What type of weakness pattern suggests cauda equina syndrome?
Lower extremity weakness with saddle paresthesia, urinary retention, and fecal incontinence
220
What is considered the most important clinical pearl for weak patients?
Tachypnea and shallow respirations signify impending respiratory failure
221
When should you suspect a vascular cause of weakness?
Sudden onset of focal weakness until proven otherwise
222
What suggests inflammatory myositis in weakness workup?
Elevated CK level
223
What suggests channelopathies in weakness workup?
Abnormal potassium level
224
What is the key pathophysiologic difference between syncope types?
Local cerebral vasoconstriction (SAH) vs systemic hypovolemia (diarrhea)
