Neuro Flashcards
(186 cards)
1
Q
MCC of SAH
A
rupture of berry aneurysm
2
Q
MC location for berry aneurysm
A
Middle Cerebral artery
3
Q
Give this stroke location:
Major deficit is in the LLE w/ minimal LUE involvement and no involvement of the face
A
R anterior cerebral artery
4
Q
Name the location for this stroke:
Pt presents with diplopia, CNS dysfxn, ataxia, vertigo, & BL motor & sensory changes
A
Vertebrobasilar artery
5
Q
Give this stroke location:
Pure motor stroke on the CONTRALATERAL side of the lesion, pure sensory stroke CONTRALATERAL to the lesion, & clumsy-hand dysarthria
A
Lacunar stroke
6
Q
Patient cannot identify friends and family around them
A
agnosia
7
Q
patient loses the ability to perform basic math fxns
A
Acalcula
8
Q
What type of memory loss is most pronounced in a pt w/ Alzheimer’s dz?
A
recent memory
9
Q
What type of protein deposits occur in the brain of a pt w/ Alzheimer’s dz?
A
beta amyloid deposits
10
Q
MC ophthalmologic problem that is seen w/ MS
A
optic neuritis
11
Q
What is the underlying infxn in a pt w/ Ramsay Hunt Syndrome?
A
Herpes zoster
12
Q
Paralysis or weakness of the muscles supplied by the FACIAL N., typically occurs UNILATERALLY, & is due to inflammation & swelling of the facial n.
A
Bell’s palsy
13
Q
What autoimmune dz has a destruction of myelin & or axons by anti-ganglioside Abs?
A
Guillain-Barre Syndrome (GBS)
14
Q
What is the most frequent cause of peripheral neuropathy in the developed world?
A
DM
15
Q
Dz assoc. w/ ptosis, diplopia, dysphonia, PROXIMAL LIMB WEAKNESS, DYSPHAGIA, & respiratory weakness
A
Myasthenia gravis
16
Q
What reflex is initially affected by the polyneuropathy in DM?
A
Achilles
17
Q
This is a demyelinating dz of PERIPHERAL NERVES that causes an acute progressive weakens, usu as an ASCENDING PARALYSIS
A
Guillain-Barre Syndrome (GBS)
18
Q
This is a disorder of NEUROMUSCULAR JXN resulting in pure motor sx w/ WEAKNESS & FATIGUE
A
Myasthenia Gravis
19
Q
What condition does the following medications tx: Zomig, Amerge, Maxalt, Frova, & Relpax?
A
Migraine HA (these are ALL triptans)
20
Q
Type of HA that is severe, UNILATERAL, & located in the periorbital area & temple that is assoc. w/ IPSILATERAL LACRIMATION, rhinorrhea, ptosis, miosis, & nasal congestion
A
Cluster HA
21
Q
W/o medication, the MC way a migraine HA’s pain is terminated…
A
sleep
22
Q
3 hormones that are thought to result in migraine HAs
A
- serotonin (biggest role)
- dopamine
- NE
23
Q
2 foods known to cause migraine HA
A
- Aged cheese
2. wine
24
Q
This type of HA is MCly described as dull, pressing, or BAND-LIKE that occurs upon arising or shortly thereafter
A
Tension HA
25
Category of medication that triptans occur
5HT-1 agonists (serotonin agonists)
26
This HA has pain in the OCCIPITO-FRONTAL areas of the heal along w/ tenderness of the neck & scalp muscles
Tension HA
27
What psychiatric condition is commonly present in those w/ daily HA or tension HA?
depression
28
MCC of endemic encephalitis that is related to a virus
HSV 1 & 2
29
MC enterovirus causing encephalitis
Coxsackie B
30
Medication of choice for treating HSV encephalitis
Acyclovir IV
31
2 MCCs of neonatal bacterial meningitis
1. Grp B & D strep
| 2. E coli
32
2 MCCs of adult onset bacteral meningitis
1. Strep. pneumoniae
| 2. H. influenzae
33
What is the ONLY neurodegenerative dz that is treatable long-term?
Parkinson's dz
34
Abx TOC for bacterial meningitis in those 0-4 wks of age
Ampicillin + 3rd gen cephalosporin (ex. Rocephin)
35
This condition involves an involuntary repetitive contraction of agonist & antagonist muscles producing rhythmic oscillation around a joint at a regular frequency
Tremor
36
MC condition resulting in a resting tremor
Parkinson's dz
37
TOC for MS
Immunomodulating meds such as INTERFERON
38
What MAO B inhibitor is MCly used in the mgmt of Parkinson's Dz?
Selegine (Eldeprel)
| -reversible w/ d/c of tx
39
The medication Tolcapone use in the mgmt of Parkinson's dz belongs to what class?
```
COMT inhibitor (catechol-o-methyl transferase)
- it reduces peripheral metabolism of levodopa permitting increased brain concentration of levodopa
```
40
The agents Pramipexole & Ropinirole use in the tx of Parkinson's dz & RLS belong to what classification?
Dopamine agonists
41
Sinemet is a combination of:
levodopa & carbidopa
42
Anticholinergics used in the tx of Parkinson's dz have their best activity against what Parkinson's sxs?
tremor & rigidity
43
This is an inherited dz characterized by DEMENTIA & CHOREA that has a gradual onset & SLOW PROGRESSION
Huntington's dz
44
Medication of choice used for dyskinesia &/or behavioral problems due to Huntington's dz?
Haloperidol (Haldol)
45
This is a recurrent, inflammatory progressive DEMYELINATION OF WHITE MATTER of the brain & spinal cord resulting in multiple & varied neurologic s/sx
Multiple Sclerosis (MS)
46
What imaging technique is considered to the the gold standard for identifying MS?
Gadolineum enhanced MRI
47
Radiofrequency rhizotomy is used for what condition?
Trigeminal neuralgia
48
Drug TOC for relapsing MS
Beta interferon, Copolymer (Copaxone)
49
TRANSIENT DISTURBANCE of cerebral fxn due to PAROXYSMAL DISCHARGE in the brain
seizure
50
3 types of generalized seizures
1. Absence (petit mal)
2. Myoclonic
3. Tonic-clonic (grand mal)
51
2 types of partial seizures
1. simple
| 2. complex
52
Type of seizure that is MCly assoc. w/ automatisms
Complex partial seizures
53
Name this seizure:
Pt. has impaired consciousness, sometimes w/ mild, clonic, tonic, or atonic components such as reduction or loss of postural tone
Absence (petit mal)
54
Abrupt onset of HA assoc. w/ STIFF NECK & PHOTOPHOBIA & may have the development of focal neurologic deficits is usu due to
Cerebral aneurysm
55
Gold standard diagnostic study for evaluation of a cerebral aneurysm
cerebral angiogram
56
Imaging modality of choice used in the evaluation of a cerebral aneurysm
non-contrast CT
57
What is the biggest risk factor for TIAs affecting the small, deep vessels of the brain (lacunar strokes)?
HTN
58
Name the 3 most important PE findings that are most specific to stroke syndromes
1. Facial paralysis
2. Arm drift
3. AMS
59
What biochemical markers may be found in a pt who has an intracranial hemorrhage?
```
Matrix metalloproteinases (MMP) & cellular fibronectin
- both are elevated in hemorrhage
```
60
3 MCCs of death in the US
1. CAD
2. cancer
3. stroke
61
Name the condition with the following assoc. sx:
sudden weakness or numbness one one side of the face or body; sudden confusion, trouble speaking or understanding; sudden trouble seeing in one eye; sudden trouble w/ walking, dizziness, loss of balance or coordination; & sudden severe HA w/o cause
stroke
62
DOC for trigeminal neuralgia
Oxycarbazepine (Trileptal)
63
2 main causes of hemorrhagic stroke
1. intracerebral hemorrhage
| 2. subarachnoid hemorrhage
64
Imaging study of choice in the initial evaluation of a pt suspected of having a stroke
non-contrast CT
65
Time frame in which thrombolytics can be given to a pt w/ an ischemic stroke
w/in 3 hrs of sx
66
What medication is considered to be the first-line agent to reduce stroke recurrence in pts who have prvious cardiac dz
Aggrenox (combination of dypridamole & Aspirin)
67
preferred agent of choice for stroke prevention in a pt who is at high risk for a stroke & who has a-fib
warfarin (coumadin)
68
2 non-antiplatelet medication classes that have been used as modifying risk factors for stroke
statins & ACE inhibitors combined w/ diuretics
69
sudden loss of muscle strength/tone w/ sudden LOC, immediate recovery after lasting only a few seconds
Atonic seizures
70
spike & wave pattern on EEG at 3 per second is classically seen w/ what type of seizure?
Absence seizure
71
Gold standard tx for pts w/ myoclonic seizures
Valproic acid (Depakote)
72
Type of seizure that is MCly assoc. w/ automatisms
complex partial seizures
73
part of the brain that is MCly assoc. w/ atonic seizures
Corpus callosum
74
MCC of status epilepticus
abrupt stoppage of antiepileptic medications
75
1st line antiepileptic medication (after the use of the fast-acting benzodiazepines) for pts with status epilepticus
Fosphenytoin (Cerebyx)
76
Muscular complication from status epilepticus
Rhabdomyolysis
77
coordinated, involuntary movements during a period of altered awareness that occurs during a seizure
automatism
78
What is the name of the condition in which there is temporary paralysis following a general seizure?
Todd's paralysis
79
What type of seizure disorder is MCly assoc w/ aura?
complex partial seizures
80
What type of seizure is assoc. w/ an ABRUPT ONSET, abrupt termination, lasts several seconds, & DOES NOT have a post-ictal state?
Absence seizures
81
Name 2 1st-line therapies for partial seizures
Carbamazepine (Tegretol) * Valproic acid (Depakote)
| Phenobarbital used in kids
82
What organ is MCly damaged in pts taking carbamazepine (Tegretol) & valproate (Depakote)?
liver
83
What SE is typically seen w/ topiramate (Topamax) that is not seen w/ other anti-seizure medications?
weight loss
84
Pt has nocturnal seizure, with UNILATERAL paresthesias of the tongue, lips, & cheeks, w/ UNILATERAL clonic or tonic activity of the face, lips or tongue & there is speech arrest & salivation. Name the condition.
Benign Rolandic Epilepsy
85
What anesthetic agent is MCly used in the mgmt of status epilepticus?
Midazolam (Versed)
86
What is the MC neurobehavioral disorder of childhood?
ADHD
87
2 hormones assoc. w/ the development of ADHD
1. dopamine
| 2. NE
88
What is the MC type of ADHD?
Combined (inattentive & hyperactive/impulse control)
89
Familial hemiplegic migraine has a genetic abnormality in what part of the brain?
Calcium channel
90
What category of medications does methylphenidate (Ritalin) belong?
stimulant
91
What is the MCC of episodic, disabling HA?
migraine
92
What is the ONLY FDA-approved medication for Adult ADHD?
strattera (atomoxetine)
93
Category of medication for atomoxetine (Strattera)
NE reuptake inhibitor
94
What is the typical presentation for an Arnold-Chiari lesion?
HAs
95
What neurologic motor problem may get worse w/ the use of stimulants in order to tx ADHD?
Tics
96
This type of HA presents acutely and the pt claims this is the worst HA of their life:
SAH due to ruptured aneurysm
97
phenomena seen w/ migraine HA that presents as sensitivity of the scalp when touched
cutaneous allodynia
98
What antiseizure medication is FDA approved for migraine prophylaxis?
Topamax (topiramate)
99
desire to move the legs that may abe assoc. w/ paresthesias w/ these sxs becoming overwhelming. These sensations occur when pt is inactive and this is relieved w/ moving the legs. These sxs are worse at night or in the evening. What is this condition?
Restless Leg Syndrome (RLS)
100
What hormone is used in the tx of RLS?
dopamine agonists (Sinemet MC used)
- Requip (Ropinirole), Mirapex (pramipexole) are also
used
101
What part of the trigeminal nerve is MCly involved w/ trigeminal neuralgia?
V2 - Maxillary Segment
102
What neurological condition is MCly seen w/ trigeminal neuralgia?
MS
103
MCC of dementia
Alzheimer's dz
104
Pt presents with mental status changes, ataxia, and urinary incontinence, name the condition
Normal pressure hydrocephalus
| pt's are "wacky, wet, & wobbly"
105
What class of meds is considered 1st-line therapy for Alzheimer's dz?
Acetylcholinesterase inhibitors (ex. donepezil [Aricept])
106
What type of dementia is helped by performing ventriculoperitoneal shunts?
Normal pressure hydrocephalus
107
What type of IRREVERSIBLE dementia is typified by having ht pt maintain a fluent speech but there is NO comprehension of written or verbal language?
Wernicke's aphasia
108
What is the most effective therapy for pain & spasm in an MS pt?
Baclofen or Tizanidine (Zanaflex)
109
Name this condition: pts have a non-progressive disorder of movement or posture that is a result of CNS abnormality that could have occurred prenatally, perinatally, or during the 1st 3 yrs of life
cerebral palsy
110
MCC of floppy baby syndrome
Cerebral palsy
111
Injury to the long thoracic nerve presents as
winged scapula
112
What never innervates the serratus anterior muscle
long thoracic nerve
113
What is the clinical manifestation of an injury to the radial nerve?
wrist drop
114
MC form of idiopathic facial paralysis?
Bell's palsy
115
A pt has a FLAT nasolabial fold, CANNOT close the eye, & CANNOT WRINKLE the FOREHEAD or raise the eyebrows. There are VESICLES IN THE EAR CANAL. What is this condition?
Ramsey Hunt Syndrome
116
MCC of Ramsey Hunt Syndrome
herpes virus infxn
117
What condition has hemisection of the spinal cord that causes loss of joint position sense & vibraiton sense on the same side as the lesion & pain & temperature on the opposite side a few levels below the lesion?
Brown-Sequard Syndrome
118
What is the typical pattern of sensory loss for a pt w/ a posterior column loss?
loss of joint position sense & vibration sense
119
Pt is able to recognize all sensation but localizes them poorly, has loss of 2-point discrimination, astereognosis, and sensory inattention. What area of the brain is damaged?
parietal lobe
120
MCC of acute flaccid paralysis in the world
GBS
121
MCC of acute GBS
Campylobacter jejuni
122
2 MCly utilized tx for GBS
1. plasmapheresis
| 2. infusions of high doses of human immunoglobulin
123
What disorder is assoc. w/ autoAbs to ACETYLCHOLINE receptor?
Myasthenia gravis
124
TOC for acute cluster HAs
high flow 100% O2 along w/ ergotamine or sumatriptan
125
What prophylactic regimen can be given for the prevention of cluster HAs?
CCBs
126
Young obese premonpausal woman presents with HA, diplopia, & peripheral visual field defect. Name the condition
Pseudotumor cerebri
127
What rheumatic condition may be associated w/ temporal arteritis?
polymyalgia rheumatica
128
What is the confirmatory test for temporal arteritis?
temporal artery bx
129
What clinical condition is classically described as having a wing-beating tremor?
Wilson's dz
130
What condition has loss of dopamine-producing neurons in the substantia nigra portion of the brain?
Parkinson's dz
131
phenomena by which MS sxs get worse w/ an increase in temperature
Uhthoff's phenomenon
132
MC subtype of MS
relapsing remitting MS
133
stroke that affects the CONTRALATERAL ARM & FACE more than leg weakness, have CONTRALATERAL hemisensory dysfxn, & have paresis of CONTRALATERAL conjugate voluntary gaze & speech is typically NOT affected; which artery is involved?
Middle cerebral artery
134
stroke that has deficits on the CONTRALATERAL leg, incontinence, & difficulty w/ stereognosis; which artery is involved?
Anterior cerebral artery
135
TOC for a pt who surives his/her first SAH?
surgical clipping of the involved blood vessel
136
MCC of epilepsy
idiopathic
137
What is the best neuroimaging test to perform in a pt who just had a seizure?
MRI of the brain
138
What medications are typically used in the mgmt of absence seizures?
ethosuximide (Zarontin) & valproic acid
139
Medication of choice for myoclonic seizures
Valproic acid
140
TOC for partial seizures
carbamazepine & phenytoin
141
What is the primary drug of 1st choice used in the mgmt of generalized tonic-clonic seizures?
valproic acid
142
What antiepileptic medication MCly causes gingival hyperplasia?
phenytoin (Dilantin)
143
How long must seizures last in order to be classified as status epilepticus?
at least 30 min
144
What is considered to be the medication of choice for status epilepticus?
lorazepam
145
What are the various dermatome levels and the sensory nerves that innervate them?
```
C2 - neck
T4 - nipples
T10 - umbilicus
L2 - lateral thigh
L3 - medial thigh/knee
L4 - medial calf
L5 - lateral calf down over big toe
S1 - lateral foot, heal, & back of calf
```
146
What sensory nerves supply the various reflexes?
```
C5 - biceps
C6 - brachioradialis
C7 - triceps
L2-4 - patellar
S1 - Achilles
```
147
What is the key to making the clinical diagnosis of Alzheimer's dz?
mental status exam
148
What is the primary dx for an infant who is slow to reach developmental milestones such as learning to walk, roll over, sit, & crawl?
cerebral palsy
149
patient presents with intermittent paresthesias in the palmar aspect of the thumb, middle, & index fingers, diminished grip strength & diminished sharp-dull discrimination in the affected digits. Name the condition.
Carpal tunnel syndrome
150
What nerve is involved w/ Carpal Tunnel Syndrome?
Median nerve
151
What is the classic triad of meningitis?
1. fever
2. HA
3. nuchal rigidity
152
intention tremors that occur only during movement
cerebellar tremor
153
action tremors that primarily affect the upper arms & may also involve the face & vocal cords. The tremor persists throughout the active ROM & increases w/ fine motor activity and stress.
essential tremor
154
What is the tx of essential tremor?
propranolol (Inderal)
| - can also be suppressed by alcohol
155
Pt presents with a resting tremor that does not affect the head along w/ bradykinesia. When walking, these pts will have a shuffling gait & loss of arm movements w/ postural instability
Parkinson's dz
156
MC precipitant of cluster HAs
alcohol use
157
Type of HA that is assoc w/ sentinel bleed
Subarachnoid bleed
158
HA type that is MCly assoc w/ jaw claudication
temporal arteritis
159
Procedure that must be done if subarachnoid HA is suspected & CT scan is negative for bleed
Lumbar puncture - will see gross bleeding or xanthrochromia
160
TOC for temporal arteritis
high dose, long-term corticosteroids
161
A 32-yo female pt presents w/ diplopia & ptosis, which are both worse by the end of the day. She also notes dysarthria if she has been talking a lot. What dx test is indicated for the evaluation of this pt?
edrophonium or Tensilon test
162
A 32-yo female pt presents w/ diplopia & ptosis, which are both worse by the end of the day. She also notes dysarthria if she has been talking a lot. What dx test is indicated for the evaluation of this pt?
edrophonium or Tensilon test
163
What is the TOC for myasthenia gravis?
pyridostigmine (Mestinon)
164
A 56-yo man presents w/ a mild-mod. dull HA that has steadily progressed over the past mth. The HA is worse when he gets up in the morning or w/ coughing & sneezing. He also notes the recent onset of N/V. Dx?
intracranial tumor
165
A 56-yo man presents w/ a mild-mod. dull HA that has steadily progressed over the past mth. The HA is worse when he gets up in the morning or w/ coughing & sneezing. He also notes the recent onset of N/V. Dx?
intracranial tumor
166
67-yo F complains of intermittent episodes of pain in her cheek & jaw that feel like a "lightning bolt hit her face". The pain is triggered by eating or touching her face. Her PE is negative. What is the dx?
Trigeminal neuralgia
167
MCC of meningitis in pts w/ AIDs?
Cryptococcus neoformans
168
MCC of meningitis in pts w/ AIDs?
Cryptococcus neoformans
169
Which pathogen assoc. w/ bacterial meningitis presents w/ a petechial & purpuric rash?
Neisseria meningitidis
170
What are the CSF findings in bacterial meningitis?
- Elevated WBC (>1000 cells/mm3)
| - Decreased CSF glucose (200 mg/dL)
171
What is the recommended Abx tx for an 18 yo pt w/ bacterial meningitis?
3rd gen. cephalosporin & vancomycin
172
What is the recommended Abx tx for a 60-yo adult w/ bacterial meningitis?
Ampillicin + 3rd gen. cephalosporin + vanc.
173
What is the recommended Abx tx for a 60-yo adult w/ bacterial meningitis?
Ampillicin + 3rd gen. cephalosporin + vanc.
174
Chronic & often lifelong syndrome consisting of motor &/or verbal tics
Tourette syndrome
175
1st line tx for severe Tourette syndrome?
Clonidine
176
The inability to perform rapid alternating movements
dysdiadochokinesias
177
A pt w/ MS describes an electric shocklike sensation that runs down her back to her legs when she flexes her neck fwd. What is this phenomenon called?
Lhermitte sign
178
A pt w/ MS describes an electric shocklike sensation that runs down her back to her legs when she flexes her neck fwd. What is this phenomenon called?
Lhermitte sign
179
What are the findings on exam of the CSF for a pt w/ MS?
Mild pleocytosis & the presence of oligoclonal bands
180
What is the TOC for an acute exacerbation of MS?
corticosteroids
181
What is the MCC of seizures in infants & children?
Febrile seizures
182
MCC of seizures in adults older than 65 yrs:
Cerebrovascular dz
183
A pt initially experience clonic movements of the hand, which then spread to involve the forearm & upper arm. What is this phenomenon called?
Jacksonian march
184
A pt initially experience clonic movements of the hand, which then spread to involve the forearm & upper arm. What is this phenomenon called?
Jacksonian march
185
A pt presents w/ the loss of vision in the L eye, which he describes as "someone pulling a shade down over his eye". The episode resolved spontaneously w/in 30 min. What is this neurological sx called?
Amaurosis fugax
186
A pt presents w/ the acute onset of quadriplegia. He is able to communicate only by blinking or moving his eyes up & down. What is the most likely dx?
Locked-in syndrome
| -consistent w/ a pontine stroke
