Neuro Flashcards Preview

Step 2 CK > Neuro > Flashcards

Flashcards in Neuro Deck (163):
1

gait with circumduction of one extended leg and flexed elbow and hand

hemiplegic gait

2

gait with wide spaced legs and falling to left

What gait? Where is the lesion?

cerebellar gait
lesion on the left (where they are falling)

3

abduction of legs during gait with tiptoes

diplegic - cerebral palsy gait

4

gait where someone waddles side to side

myopathic gait.

5

gait with high steps due to foot drop

neuropathic gait
(steppage gait)

6

pronator drift test tests

upper motor neuron disease affecting this limb

7

2 time cutoffs for tPA

3 hours IV
6 hours intraarterial

8

gait w/parkinson's

hypokinetic

9

muscular dystrophy gait

waddling (weak gluteals)

10

vestibular ataxia gait (describe)

minimal head movement staggering w/nystagmus, vertigo

11

eye differences in thalamus vs pons hemorrhage

pupils and gaze (pons, pupils only)

Thalamus, nonreactive meiotic, gaze Towards hemiparesis
Pons, Pinpoint reactive pupils

12

lobe affected for receptive aphasia

L. temporal lobe

13

lobe affected for L. hemineglect

R. parietal lobe

14

back and leg pain exacerbated by extension, alleviated by flexion

spinal stenosis

15

etiology of DM CN III palsy

ischemic

16

HIV patient w/periventricular ring
EBV virus in CSF

primary CNS lymphoma

17

1st sx of normal pressure hydrocephalus

gait disturbance

18

sequence of 2 complications from subarachnoid hemorrhage

rebleeding = less than 24 hours
vasospasm = days 3-10

19

15 yo with ataxia, skeletal deformities and cardiomyopathy

Friedrich ataxia

20

MMSE score indicative of dementia

less than 24

21

pt w/central scotoma, afferent pupillary defect, chenges in color perception and acuity, and swollen disc

optic neuritis (common in MS)

22

athetosis

slow writhing movement of hands/feet

23

amantadine MOA and use

dopamine agonist
parkinson's

24

1st line class in Alzheimers

cholinesterase inhibitors

25

man w/parkinsonism w/orthostasis, or other autonomic signs

multi system atrophy (shy-drager syndrome)

26

1st line drugs in Parkinon's

class is OK

benztropine or trihexyphenidyl

(anticholinergics)

27

best initial tx for severe Parkison's (class is OK)

pramipexole and ropinerole
dopamine agonists

28

adjuvant to stop on/off phenomena of carbidopa/levodopa

COMT inhibitors
tolcapone, entacapone

29

Only drugs to reduce progression of Parkinon's

MAO inhibitors
rasagiline, selegiline

30

cause of curtain falling down on visual field (amaurosis fougoux)

emboli (atherosclerosis)

31

1st sx in Frontotemporal dementia

Personality goes first in Pick Dz (PP)

32

pathogenesis of vascular dementia

suddenly declines due to CVA

33

test to differentiate coma vs PVD (persistent vegetative state)

EEG - normal in coma

34

brainstem reflex tests (3)

-corneal reflex
-cold water test
- doll's eyes

35

tumor in a kid with "sun setting sign" (downward gaze)

pinealoma

36

gene defect in marfan's

fibrillin-1

37

part of the brain atrophied with Wilson's dz

lenticular nucleus

38

sudden loss of vision, pale retina, dark macula

retinal artery occlusion

39

tx of retinal artery occlusion (3)

oxygen
acetazolamide
thrombolytic

40

loss of vision, with extravasation blood into fundus

retinal vein occlusion

41

mutated proteins in NF1 vs NF2

NF1 = neurofibromin
NF2 = merlin

42

which one is serious? preseptal cellulitis vs orbital cellulitis

orbital cellulitis - and much more likely to have opthalmaplegia

43

4 midline cranial nerves

3,4,6,12

44

facial droop means ? artery and syndrome

AICA's pooped
lateral pontine syndrome

45

hypoglossal dysfunction
artery and syndrome

ASA
medial medullary syndrome

46

hoarseness
artery and syndrome

PICA
lateral medullary syndrome (Wallenburg)

47

pronator drift tests for...

upper motor neuron lesion

48

neck hyperextension
weakness of upper extremities
syndrome?

central cord syndrome

49

hallmark sx (2 each) of dominant MCA (left) vs nondominant MCA (right) stroke?

left = aphasia
right = hemineglect or anosognosia

50

anosognosia

lack of awareness of illness

51

dopamine affects sx of mesolimbic pathway (1) vs tuberoinfundibular pathway (1)

mesolimbic: psychosis
tuberoinfundibular = prolactin

52

eye disorder with distortion of wavy lines

macular degeneration

53

timeline when dyskinesias show up after initiating carbidopa-levidopa therapy

after 5 years

54

lambdoidal suture

unites parietal bones with occipital bone

55

squamosal suture

unites squamoid portion of temporal bone with parietal bone

56

2 types of therapy for essential tremor
(1 category, 1 specific drug)

beta blockers
primidone (anti-seizure)

57

parkinson drug that alleviates levidopa dyskinesias

amantadine

58

2 antiemetics that can cause drug-induced PD

metoclopromide
prochlorperazine (compazine)

59

T1 vs T2 images

WW2
water white on T2 (fat white T1)

60

4 drugs for tardive dyskinesia

tetrabenazine
benzoes
baclofen
vitamin E

61

wormlike movement of facial muscles, sensed by pt, but difficult for examiner to see

facial myokymia

62

bad MLF side of internuclear ophthalmoplegia exam

side that cannot adduct is the side of lesion (eye that is in nystagmus is good).

63

time cutoff for status epilepticus

5 mins

64

Frequency of awake eeg on posterior with eyes closed

Alpha, 8-13 hz

65

Eeg waveform absence seizure

3 hz spike and wave.

66

absence seizure provoked by

hyperventilation

67

toxicity of valproic acid (depakote) (3)

tremor
weight gain
hair loss

fat, bald, shaky

68

duration of tx in status epilepticus

forever

69

lifetime prevalence seizure

10%

70

problem with loading phenytoin

arrythmia - needs to be done in ICU (prefer fosphenytoin)

71

best loading drug

Keppra (leviteracetam)

72

administering lamotrigine

do slowly (over weeks)

73

how long after seizure should someone not drive

3 mos (in mn, md can recommend earlier if source, etc)

74

depakote

valproic acid

75

when does neural tube close?

2 weeks

76

lamotrigine with birth control

makes birth control less effective

77

dilantin

phenytoin

78

3 nonmedicine options for seizure

vagus nerve stimulator
surgery
ketogenic diet

79

status epilepticus that doesn't resolve with one loading dose of lorazepam

phenobarb- induce coma

80

BP cutoff for tPA

greater than 185

81

risk of bleeding with tPA if ischemic stroke

4%

82

percent of ischemic stroke patients that get better on own

25%

83

percent of ischemic stroke patients improved by tPA

10%

84

2 side effects of tPA

bleeding
angioedema

85

weber test. louder in one ear which means (2)

sensorineural (louder in unaffected ear)
conductive (louder in affected ear - consider sticking cotton in ear canal - your voice is louder)

86

exerciser w/ptosis, miosis

partial horner syndrome (no anhidrosis)
carotid artery dissection (CN III - levator palpabrae lesion)

87

location of area of brain that is responsible for noncommunicating hydrocephalus

aqueduct of sylvius (between 3rd and 4th ventricles)

88

dysdiadochokinesia

inability to do rapid alternating movements

89

meningiomas, bilateral acoustic neuromas. Include chromosome #.

NF2, chromosome 22

90

NF with skin lesions, include chromosome #

NF1, chromosome 17

91

location of corticospinal tracts

pyramidal - posterior lateral

92

primary vs secondary progressive MS

primary gets worse from the beginning
secondary starts as relapsing, remitting, and then gets worse

93

sensory stroke location

thalamus

94

weakness strokes location

internal capsule (lacunar)

95

titubation

nodding of head or body

96

med to retard ALS

riluzole

97

primary lateral sclerosis

disease of the corticospinal tracts (without wasting and fasciculations). Goes on to be ALS....

98

Cerebral finding in Sturge-Weber Syndrome

leptomeningeal angiomas (meningeal angiomas)

99

nucleus of larynx, IX, X

nucleus ambiguus

100

location nucleus ambiguus

ventrolateral medulla

101

side effect of the dopamine agonists (besides hallucinations)

gambling/hypersexuality

102

entacapone MOA

COMT inhibitor

103

parkinsonism
-unawareness/control of body
abnormal tau proteins
-alien hand syndrome
-cortical myoclonus

corticobasal degeneration

104

parkinsonism
-gait probs
abnormal tau proteins
-upward eye paralysis overcome by head movements
backwoods falls

progressive supranuclear palsy

105

parkinsonism
-autonomic dysregulation. passing out, etc. orthostatic hypoT, urinary probs. Not as good a response to meds.

multisystem atrophy

106

4 hallmarks of PD

TRAP

Tremor
Rigidity
Akinesia bradykinesia
Postural instability

107

2 meds for essential tremor

propranolol
primidone

108

med for chorea

tetrabenazine
blocks dopa release

109

after infection
chorea

sydenham's chorea
(post-strep)

110

hereditary ataxia
looks intoxicated. Father or mother has it.

cerebellar ataxia

111

supplementation for RLS (or nighttime urges) (2)

iron, gabapentin
(usually better than dopa agonists)

112

etiology of narcolepsy

orexin deficiency from lateral hypothalamus

113

3 early signs of parkinson dz

REM sleep behavior disorder
anosmia
constipation

114

2 causes optic neuritis

MS
neuromyelitis optic (Devic dz)

115

side effects amiodarone and ethambutol

optic neuropathy

116

2 weeks after viral illness or vaccination
MS-like presentation, maybe behavioral changes
no oligoclonal bands.

acute disseminated encephalomyelitis (ADEM)

117

epilepsia partialis continua

status focal motor seizure

118

2nd line tx absence seizure

valproic acid

119

basilar migraine

severe!
neuro deficits

120

Wernicke's with an intact repetition

transcortical sensory aphasia

(sensory = wernike's w/intact repetition)
(motor = broca's w/intact repetition)

121

fast phenytoin infusion causes

arrythmia

122

timing of ETOH w/d seizure

1-2 days (DT's are 2-4 days)

123

kid with multiple seizure types
mental dysfunction
1-2 hz spike on EEG

Lennox-Gastaut Syndrome

124

Lateral optic radiation responsible for which field of vision?

upper

125

jacksonian march

spread of seizure along homonculus

126

aneurysm
3rd nerve palsy
localization?

Posterior communicating artery

127

Triptans contraindicated in this type of migraine

w/aura

128

localization of tonic gaze deviation
(lobe)

contralateral frontal lobe

129

aphasia with real but meaningless words. no comprehension. intact repetitions

transcortical sensory aphasia
(sensory = wernike's w/intact repetition)
(motor = broca's w/intact repetition)

130

rim-enhancing lesions in AIDS patient (2)

primary lymphoma
toxoplasma

131

CSF test for primary lymphoma in brain

EBV PCR

132

infant w/constipation
ptosis/CN findings
descending weakness/hypotonia/hyporeflexia

botulism

133

most common source of brain abscess in AIDS

toxoplasma

134

encephalitis in immunocompromised
white matter lesions
inclusion bodies in oligodendrocytes

PML

135

complication of normal pressure hydrocephalus shunting operation

subdural hematoma

136

language abnormality w/Alzheimer's

transcortical sensory aphasia

137

spastic paresis, and hx of tropical travel
(ALS-like)

HTLV-1
spastic paresis

138

alien hand syndrome in an AIDS pt

PML

139

woman with blepharospasm
jaw openings, neck contractions, tongue thrusting

no med hx

meige syndrome

140

natlizumab pt (MS) with new sx
multiple foci of white matter abnormalities,
particularly in posterior regions

PML

141

type of dz of guillian barre

peripheral

142

person w/hx of optic neuritis
transverse myelitis sx onset

NMO

143

anti-NMO IgG is antibody against?

an aquaporin

144

what is spored in spinal cord stroke

dorsal columns (sensation)

145

eye devation in stroke vs seizure

L MCA stroke = L gaze
L seizure = R gaze

146

innervation inferior oblique

3

147

innervation superior oblique

4

148

distinct finding of 3rd nerve palsy in DM

no mydriasis

149

artery in cavernous sinus

ICA

150

nerves in side of cavernous sinus (5)
specify what is next to ICA

3,4,V1,V2
6 is right next to ICA

151

hemiparetic on one side
3rd nerve palsy on other side.
localization?

midbrain (ipsilateral to 3 palsy)

152

Horner syndrome

ptosis
meiosis
anhydrosis

153

relative afferent pupillary defect AKA

marcus gunn pupil

154

bilateral CN palsies
2 common causes

sarcoid
lyme

155

pupil accomodation on
3rd nerve palsy?
Holmes-Adie pupil?

3rd nerve palsy = absent
Holmes-Adie pupil = present

156

localization of bad ear in BPPV

fast beat is away from bad ear.
on dix-hallpike, bad ear is down causing nystagmus

157

75 year old
cranial nerve palsies
segmental demyelination of nerves

CIDP
chronic inflammatory demyelinating polyneuropathy

158

location where dorsal columns decuss

medulla

159

anti-epileptic drug assoc w/weight loss

topiramate

160

inferior and superior MCA branches associated with what aphasias?

superior = wernicke
inferior = broca

161

etiology of parkinsonism in person with severe liver dz

manganese toxicity
(lack of biliary excretion)

162

part of MOA that makes topiramate effective in pseudotumor cerebri

carbonic anhydrase activity

163

1 yo, retardation, motor delay, infantile spasm, dysmorphic features

miller-dieker lissencephaly