Neuro Flashcards
(163 cards)
1
Q
gait with circumduction of one extended leg and flexed elbow and hand
A
hemiplegic gait
2
Q
gait with wide spaced legs and falling to left
What gait? Where is the lesion?
A
cerebellar gait
lesion on the left (where they are falling)
3
Q
abduction of legs during gait with tiptoes
A
diplegic - cerebral palsy gait
4
Q
gait where someone waddles side to side
A
myopathic gait.
5
Q
gait with high steps due to foot drop
A
neuropathic gait
steppage gait
6
Q
pronator drift test tests
A
upper motor neuron disease affecting this limb
7
Q
2 time cutoffs for tPA
A
3 hours IV
6 hours intraarterial
8
Q
gait w/parkinson’s
A
hypokinetic
9
Q
muscular dystrophy gait
A
waddling (weak gluteals)
10
Q
vestibular ataxia gait (describe)
A
minimal head movement staggering w/nystagmus, vertigo
11
Q
eye differences in thalamus vs pons hemorrhage
pupils and gaze (pons, pupils only)
A
Thalamus, nonreactive meiotic, gaze Towards hemiparesis
Pons, Pinpoint reactive pupils
12
Q
lobe affected for receptive aphasia
A
L. temporal lobe
13
Q
lobe affected for L. hemineglect
A
R. parietal lobe
14
Q
back and leg pain exacerbated by extension, alleviated by flexion
A
spinal stenosis
15
Q
etiology of DM CN III palsy
A
ischemic
16
Q
HIV patient w/periventricular ring
EBV virus in CSF
A
primary CNS lymphoma
17
Q
1st sx of normal pressure hydrocephalus
A
gait disturbance
18
Q
sequence of 2 complications from subarachnoid hemorrhage
A
rebleeding = less than 24 hours vasospasm = days 3-10
19
Q
15 yo with ataxia, skeletal deformities and cardiomyopathy
A
Friedrich ataxia
20
Q
MMSE score indicative of dementia
A
less than 24
21
Q
pt w/central scotoma, afferent pupillary defect, chenges in color perception and acuity, and swollen disc
A
optic neuritis (common in MS)
22
Q
athetosis
A
slow writhing movement of hands/feet
23
Q
amantadine MOA and use
A
dopamine agonist
parkinson’s
24
Q
1st line class in Alzheimers
A
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
