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Review course > Neuro > Flashcards

Neuro Flashcards

1
Q

Tx of absence seizures

A

ethosuximide

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2
Q

What is akathesia?

A

Motor restlenssness characterized by the need to constantly be moving.

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3
Q

patient with polyneuropathy. His nerve conduction study reveals a predominantly demyelinating injury process. - cause?

A

Hepatitis B or C

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4
Q

patient with polyneuropathy. His nerve conduction study reveals a predominantly axonal injury process. - cause?

A

Diabetes

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5
Q

What is the most common cause of unilateral hearing loss?

A

Cerumen impaction

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6
Q

An increase in Endolymph is associated with what disease

A

Minieres

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7
Q

Most common type of headache

A

tension

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8
Q

charachteristics of idiopathic intracranial hypertension

A

Papilledema, young, obese women of childbearing age, vit A toxiicty, transient visual disturbances, elevated opening pressure,

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9
Q

treatment for IIH

A

Serial lumbar punctures, acetazolamide and diuretics.

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10
Q

passive flexion of a patient’s neck causes a reflexive flexion of his hips and knees

A

Brudzinski sign

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11
Q

What cerebrospinal fluid (CSF) findings are seen in bacterial meningitis?

A

High protein, low glucose, presence of polymorphonuclear cells.

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12
Q

flexing the hip and knee to 90° and then attempting to extend the knee

A

Kernig’s sign

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13
Q

In an MRI for a patient with MS will it show hypointensities or hyperintensities

A

hypo

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14
Q

What is the most common acquired neurologic disability in young adults?

A

MS

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15
Q

Diagnostic test of choice for MS

A

MRI

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16
Q

Tx of choice for MS

A

Steroids

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17
Q

CSF in MS

A

CSF: ↑ IgG protein, WBC pleocytosis

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18
Q

What is Lhermitte phenomenon

A

spinal electric shock sensation with neck flexion

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19
Q

Tx for TIA

A

administer aspirin and dipyridamole; admit to stroke unit

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20
Q

On a brain MRI this shows significant atrophy of the basal ganglia.

A

Huntingtons

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21
Q

this is an Autoimmune destruction of Ach receptors

A

Myesthenia Gravis

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22
Q

Myesthenia is made better or worse with cold

A

Better

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23
Q

What is a fatal complication of myasthenia gravis?

A

respiratory failure

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24
Q

tx of choice for trigeminal neuralgia

A

carbamazepine

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25
Q

What systems need to be monitored for side effects from carbamazepine?

A

Hematologic (CBC) and hepatic (liver function tests).

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26
Q

organisms causing SBI in neonates

A

Group B Streptococcus, Escherichia coli, and Listeria monocytogenes.

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27
Q

tx of choice for essential tremmors

A

propranalol

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28
Q

What is Lambert-Eaton syndrome

A

is associated with small cell lung cancer in about 50% of cases, and symptoms improve with repetitive use.

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29
Q

tx of myesthenia

A

pyridostigmine

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30
Q

medication used for migraine treatment is contraindicated in patients with coronary or peripheral vascular disease?

A

Sumatriptan- causes vasoconstriction

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31
Q

tx for acute MS exacerbation

A

High dose steroids

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32
Q

Most common type of MS

A

Relapsing remitting

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33
Q

What is the hallmark of myasthenia gravis?

A

Muscle weakness that worsens with activity and improves with rest.

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34
Q

Xanthochromia on LP is indiciative of

A

RBC break down

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35
Q

metoclopramide (neuroepileptics) antidote

A

Benztropine

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36
Q

you see bilateral retinal hemorrhages in an infant

A

shaken baby syndrome

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37
Q

what is Meralgia paresthetica

A

clinical syndrome of pain or dysesthesias, or both in the anterolateral, proximal thigh, due to a compressive neuropathy of the lateral femoral cutaneous nerve

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38
Q

What level does the spinal cord terminate in adults?

A

L1 L2

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39
Q

Where does the spinal cord terminate in children

A

L3

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40
Q

the best approach for a lumbar puncture

A

L3-L4, L4-L5 or L5-S1 interspace.

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41
Q

are miagraines improved or worsened in pregnancy

A

improved

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42
Q

why use hyperbaric oxygen therapy for carbon monoxide poisoning?

A

reduces risk of neurologic sequelae

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43
Q

What is a complication of cluster headaches?

A

Horners syndrome

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44
Q

physical exam techniques can be used to confirm the diagnosis of benign paroxysmal positional vertigo?

A

Dix- Hallpike

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45
Q

particle repositioning maneuver used in the treatment of benign paroxysmal positional vertigo

A

Epley

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46
Q

What disease presents with symptoms of vertigo, sensorineural hearing loss and tinnitus?

A

Meniere disease.

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47
Q

What headaches need imaging

A 
sudden onset, sever, thunderclap
First headache 50
Worsening HA
Focal neurological findings
Fever
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48
Q

Acute and prophylactic therapy for cluster HA

A

Acute- O2, Triptans, Ergotamine

Prophylactic- CCB

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49
Q

MCC of encephalitis

A

HSV

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50
Q

What do patients with encephalitis present with

A

AMS

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51
Q

In a patient with encephalitis what is the emperic tx

A

acyclovir

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52
Q

What are the main eitiologies of Meningitis

A

streptococcus, neisseria meningitidis, HIB and listeria

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53
Q

what meningitis is associated with a peticheiae rash and palpable purpura

A

Neisseria meningitides

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54
Q

How do you decide if a patient with suspected meningitis should recieve a CT before an LP

A
  1. immunosuppresed (Toxo can cause herniation)
  2. Papilledema
  3. Focal neurologic finding on exam
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55
Q

IF you cannot obtain a LP for whatever reason in a patient with suspected meningitis what should you do

A

BC x 2 and treat emperically

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56
Q

What is the emperical treatment for meningitis

A

dexamethasone, ceftriaxone and vancomycin

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57
Q

Lab findings for bacterial meningitis

A

WBC>1000 (neutrophils)
Increased protein
Decreased glucose

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58
Q

On gram stain of CSF you see gram positive cocci -

A

streptococcus

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59
Q

On gram stain of CSF you see gram negative cocci

A

Neisseria

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60
Q

Treatment for huntingtons

A

chorea- tertrabenazine

Psychosis- quetiapine

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61
Q

cause of parkinsons

A

decrease in dopamine in the substantia nigra

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62
Q

pathology of parkinsons

A

Lewy bodies found within neclei of neurons

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63
Q

Classic characteristics of parkinsons

A

Pill rolling tremor (worse at rest, better with movment)
Bradykinesia
Cogwheel rigidity
Postural Instability (orthostatic hypotension)

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64
Q

Treat my parkinsons If I am 1) young, 2) >65 more advance disease or 3) <65 for more advanced disease

A

1) Anticholinergics
2) Levodopa
3) Dopamine agonist

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65
Q

What does lewy body dementia consist of

A

parkinsons, hallucinations and dementia

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66
Q

What can you do to improve the effectivness of levadopa

A

carbidopa - it blocks the conversion of dopamine before crossing the BBB

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67
Q

Most common location for a berry aneurysm

A

anterior circle of willis

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68
Q

MCC of SAH

A

Berry aneurysms

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69
Q

What age and sex is SAH most common in

A

Women 40-60

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70
Q

diseases assoiated with SAH

A

Polycystic kidney diseases, HTN

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71
Q

Most important modifiable risk factor of SAH

A

Smoking

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72
Q

Diagnostic tests to be done if someone has a thunderclap headache

A

CT w/o contrast then LP if no results from CT

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73
Q

What will LP show in a SAH

A

RBC’s and possibly xanthochromia

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74
Q

MCT of stroke

A

Ischemic (80%)

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75
Q

Diagnostic test for suspected stroke

A

Non contrast CT

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76
Q

Pt presents with contralateral hemiparesis, homonymous hemianopsia, weakness in upper extremities and aphasia - where is the infarct

A

MCA

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77
Q

Pt presents with AMS, confusion, incontinence and contralateral weakness worse in the lower extremities- where is the infarct

A

ACA

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78
Q

Pt presents with ipsilateral cranial nerve deficit and contralateral motor defects - where is the infarct

A

PCA

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79
Q

How does a hemorrhagic stroke present

A

LOC, N/V

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80
Q

Should you lower BP in a patient with stroke

A

Yes IF::

1) Hemorrhagic and above 200
2) Malignant HTN
3) Myocardial ischemia
4) BP >185/110 if TPA will be administered

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81
Q

After stroke therapy

A

ASA, Statin, smoking cessation, DVT prophylaxis

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82
Q

Who should be admited with a TIA TIA

A 
ABCD2 >3
A- age over 60 (1pt)
B- BP >140/90 (1pt)
C-Clinical feature - unilaeral weakness (2pts) - speach disturbance (1pt)
D- Duration >60mins (2pts) <60mins (1pt)
D- Diabetes (1pt)
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83
Q

Tx of TIA

A

Asprin, and dipyridamole or clopidogrel

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84
Q

MCT of Guillian-barre syndrome

A

Acute inflammatory demyelinating polyneuropathy

other type is axonal

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85
Q

MCC of guillian-barre syndrome

A

Campylobacter jejuni

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86
Q

Tx of guillian-barre syndrome

A

IVIG or plasma exchange transfusion (steroids can be used but little effect on outcomes)

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87
Q

LP findings for guillian-barre

A

elevated protein and normal WBC

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88
Q

MCC of dementia

A

alzheimers

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89
Q

what is the main finding in alzheimers

A

memory impairment

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90
Q

what score on the mini-mental correlated to dementia

A

<24

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91
Q

diagnostic work-up for dementia

A

TSH, B12 and a CT or MRI in all

92
Q

Diagnostic work-up for delerium

A

CBC, LFTs, glucose, renal function, electrolytes, U/A, urine tox, MRI, CT

93
Q

tx for dementia 1) mild, 2) Moderate, 3) severe

A

1) Cholinesterase inhibitors (donepezil)
2) Memantine
3) Combo of the 2

94
Q

most common presenting symptoms for MS

A

Sensory symptoms or optic neuritis

95
Q

MAinstay or tx for MS

A

Interferon beta

96
Q

dx criteria for MS

A

2 or more clinically distinct episoides of CNS dysfunction separated by space and time

97
Q

What vitamin can help with dementia symptoms

A

Vit E

98
Q

Does guillian- barre affect central or peripheral nervous system

A

peripheral

99
Q

What will LP show in MS

A

Oligoclonal bands

100
Q

tx for myasthenia gravis

A

anticholinesterase inhibitors- pyridostigmine

101
Q

jacksonian march refers to

A

a partial seizure

102
Q

tx sequence of status epilepticus

A

benzo–>phenotoyin –>phenobarbitol

if unstable intubate and use propafol

103
Q

I had my first seizure do you prescribe me medication

A

No - not unless I have more than 1

104
Q

If I am put on anti-epileptics what should you tell me if im a girl

A

1) Meds are teratogenic

2) OCP will not be effective

105
Q

If I am put on anti-epileptics what should you tell me if im a girl

A

1) Meds are teratogenic

2) OCP will not be effective

106
Q

If I am put on anti-epileptics what should you tell me if im a girl

A

1) Meds are teratogenic

2) OCP will not be effective

107
Q

If I am put on anti-epileptics what should you tell me if im a girl

A

1) Meds are teratogenic

2) OCP will not be effective

108
Q

What is the responsibility of the frontal lobe

A

Frontal- reasoning, problem solving, speech, movement

109
Q

Tempotal lobe?

A

Temporal- memory, perception/ recognition of auditory stimuli & speech

110
Q

PArietal

A

Parietal- perception of stimuli, orientation, recognition of stimuli & movement

111
Q

occipital

A

Occipital- visual processing

112
Q

What is the difference between white and grey matter

A

Grey- cerebral cortex(they have neuronal cell bodies)

White- neuronal axons coated with meylin (nervd can travel through there better)

113
Q

role of hypothalmus

A

homeostasis

114
Q

Describe upper motor neuron pathways

A

cell bodies originate in cerebral cortex, axons synapse with motor nuclei in brainstem (cranial nerves) and spinal cord (peripheral nerves)

115
Q

Describe lower motor nerons

A

cell bodies in the spinal cord, transmit impulses into peripheral nerves, termination into neuromuscular junction

116
Q

Describe lower motor nerons

A

cell bodies in the spinal cord, transmit impulses into peripheral nerves, termination into neuromuscular junction

117
Q

test cranial nerve 1

A

smell

118
Q

test cranial nerve 2

A

snellen chart/visual acuity /visial fields

119
Q

Test cranial nerve 3

A

EOMs

120
Q

TEst cranial nerve 4

A

EMO (SO)

121
Q

TEst cranial nerve 5

A

sensation of face and motor function of jaw clenceched , corneal reflex

122
Q

Test cranial nerve 6

A

EMO (LR)

123
Q

test cranial nerve 7

A

Facial expressions- raise eyebrows, puffout cheeks, purse lips, smile

124
Q

test cranial nerve 8

A

Hearing - webber rinne

125
Q

Test cranial nerve 9

A

gag reflex

126
Q

Test cranial nerve 10

A

gag reflex

127
Q

Test cranial nerve 11

A

shrugg shoulders

128
Q

Test cranial nerve 10

A

Ahh- uvula

129
Q

Test cranial nerve 10

A

Ahh- uvula

130
Q

example of spinal reflex

A

Deep tendon reflex

131
Q

Nerve root for ankle

A

sacral

132
Q

Nerve root for knee reflex

A

L2, 3, 4

133
Q

Supinatr (brachioradialis) reflex nerve root

A

C5+6

134
Q

Biceps reflex

A

C5+6

135
Q

Triceps reflex

A

C6 +7

136
Q

Abdominal relexes - upper and lower

A

upper-T8,9,10

lower-T10, 11, 12

137
Q

Plantar reflex

A

L5 S1

138
Q

Anal reflex

A

S 2, 3, 4

139
Q

what is alertness to patient

A

Speak to patient in normal tone

140
Q

What is lethargy in a patient

A

Speak to patient in loud voice

141
Q

Obtunded refers to a patient who is

A

Shake the patient Gently

142
Q

Stupur refers toa patient who is

A

Apply painful stimulus (i.e. pinch a
rub the sternum, roll a pencil across a
nail bed)

143
Q

Coma refers to a patient who is

A

Repeates stimuli with no response

144
Q

Coma refers to a patient who is

A

Repeates stimuli with no response

145
Q

Risk factors for ischemic stroke

A

age, htn, af, dm, hl, CAD, sickle cell, polycythemia vera, hypercoaguable state

146
Q

How are embolic strokes difference than throbotis

A

paid, within seconds and deficits are maximal initially and can get better

147
Q

What is an example of a lacunar stroke

A

pure sensory (thalmus) pure motor (internal capsule)

148
Q

do you give ASA if you are going to give TPA

A

nope

149
Q

can you give a patient with a stroke heparin or coumadin in the acute setting of a stroke

A

nope

150
Q

Most common location for ICH

A

BAsal ganglia

151
Q

Most common location for ICH

A

BAsal ganglia

152
Q

What is a common endocrin disorder associated with ICH

A

SIADH

153
Q

How can you reduce the ICP

A

Mannitorl- but only if there is ICP present at the time of administration

154
Q

What is the most effective parkinsons drug

A

carbidopa

155
Q

name a dopamine agonist

A

bromocriptine

156
Q

what are the side effects of cabidopa-levadopa

A

Dyskinesias

157
Q

What is the most effective parkinsons drug

A

carbidopa-levadopa (sinemet

158
Q

what are the side effects of cabidopa-levadopa

A

Dyskinesias

159
Q

What will MRI show with huntingtons

A

atrophy of the caudate neucleus

160
Q

Confirmitory test of huntingtons

A

DNA testing

161
Q

What chromosome is affected in huntingtons disease

A

4 CAG repeates

162
Q

aquired ataxia

A

alcohol intoxication, B12 deciciency or thiamine deficiency, tertiary syphillis

163
Q

Tx of tourettes

A

clonidine ,haldol

164
Q

Tx of tourettes

A

clonidine ,haldol

165
Q

features of Normal pressure hydrocepheles

A

Incontinence, dementia, gait dsturbance

166
Q

what is the 3rd MCC of death in the US

A

Stroke

167
Q

What is the 4th MCC of death in the US

A

Alzheimers

168
Q

Common metabolic disorders causing dementia

A

thyroid, B12, thiamine, korsakoffs niacin

169
Q

CT/MRI findings in alzheimers

A

cortical atrophy w/ enlargement of ventricles

170
Q

These can be seen on an audtopsy of a patient with alzheimers

A

senile plaques

171
Q

These can be seen on an audtopsy of a patient with alzheimers

A

senile plaques

172
Q

common causes of dementia by infections

A

HIV syphillis cryptococcal creuzfelt-jackob,

173
Q

Causes o delerium

A 
SMASHED
S: Structural brain pathology
M: Meningitis, Mental Illness
A: Alcohol, Acidosis
S: Seizures
H: Hyper capnia, hyperglycemia, Hyperthermia, Hynatremia: Hypo”
E: Endocrine causes
Drugs
174
Q

What type of drug should be avaoided in dementia

A

antichoinergics

175
Q

E of glasgow-coma scal

A

1- does not open eyes
2- opens to painful stimuli
3- opens to voice
4- opens spontaneously

176
Q

M of the glasgow-coma scale

A 
1- no movement
2- decrebrate posture
3- decorticate posture
4- withdrawls from pain
5- localizes painful stimuli
6- obeys comands
177
Q

V of glasgow-coma scale

A 
1- no sounds
2- incomprehensible sounds
3- inapproprate words
4- appropriate but confused
5- appropriate and oriented
178
Q

What are brain stem reflexes

A

pupilary light eflex, eye movements (doll’s eyes)

179
Q

IF a patients eyes follow you while moving there head do they have intact brain function

A

probably not eyes should stay facing up

180
Q

IF a patients eyes follow you while moving there head do they have intact brain function

A

probably not eyes should stay facing up

181
Q

does MS affect the white or grey matter

A

white

182
Q

Where will you see plaques on MRI of CT in MS

A

Plaques at lateral angles of ventricles

183
Q

weakness and spaciticity are upper or lower motor neurons

A

upper

184
Q

symptomatc tx for MS

A

Baclofen- spacticity

Carnamazepine or gabapentin- pain

185
Q

diagnostic test of choice for MS

A

MRI- white matter leisons (should have 2)

186
Q

most common CSF findings in transverse myelitis?

A

Mildly elevated protein and pleocytosis are seen in 60% of cases

187
Q

Peak inciedence of Myesthenia

A

20-30 women

188
Q

MC inital sx of myasthenia

A

ptosis, diplopia or blorred vision

189
Q

Most specific test for myasthenia

A

acetylcholin receptor antibody

190
Q

Test for myasthenia

A

tensilon test

191
Q

what is the main presenting symptom of DMD

A

pelvic girdle weakness- enlarged calf muscles (replaced by fat).

192
Q

what is gowers maneuver

A

DMD- used hands to get up from flor due to lower pelvic girdle weakness

193
Q

diagnosis for DMD

A

DNA testing- serum CK will be elevated

194
Q

Tx for DMD

A

predinisone and PT

195
Q

What is tuberous sclerosis

A

cognitive impairment, epilepsy, skin lesions, rhabdomyomas of heart

196
Q

port wine spots and epilepsy

A

sturge-weber syndrome

197
Q

Spinal ijnury with contralateral loss of pain and temperature and ipsilateral hepiparesis and loss of position and vibration

A

Brown Sequard syndrome

198
Q

When does transverse myelitis happen

A

after viral infection

199
Q

when does brown sequard syndrom occur

A

after a trauma

200
Q

pt presents with pitosis, miosis and anhidrosis

A

horners

201
Q

MC of horners syndrome

A

idiopathic

202
Q

What does polio affect

A

LMN, and anterior horn

203
Q

3 major causes of dizziness

A

presucope, vertigo, Multisensory overload

204
Q

tx BPV

A

meclizine or eply mauever

205
Q

triad of tinnitus, vertigo ad hearing loss

A

menieres

206
Q

I have vertigo and I just had a viral infection

A

labrynthitis

207
Q

causes of central vertigo

A

MS, vertebrobasilar insufficiency and miagraine associated

208
Q

what is the MCC of syncope

A

vasovagal

209
Q

medical way to elicit vasovagal syncope

A

tilt table test

210
Q

I have ataxia, gait unsteadiness, nystagmus, hearing loss and tinnitus

A

acoustic neuroma (schwannoma)

211
Q

name some ototoxic drugs

A

fourosimide, gentamycin

212
Q

i passed out without any warning - why

A

arrythmias and cardiac causes

213
Q

TIA in the vertebrobasilar circulation can cause

A

drop attacks

214
Q

What do you need to obtain in all patients with syncope

A

ECG

215
Q

partial seizures contibute to what % of all seizures

A

70..wow

216
Q

Describe a simple partial seizure

A

no loss of consciousness - remain localized

217
Q

Describe a complex partial seizure

A

stilll do not involve the entire body but consciousness is impaired olfactory hallucinations are common

218
Q

Decribe a grand mal or generalized siezure

A

loss of consciousness and whole body is involved

219
Q

drug of choice for partial seiqzures

A

phenatoin

220
Q

what is the hallmark sign of ALS

A

upper and lower motor neuron loss

221
Q

What is the hallmark feature of ALS

A

progressive muscle weakness (starts in arms and legs)

222
Q

Describe wernickes aphasia

A

impaired comprehension of skpoken language (use the wrong words)

223
Q

Describe brocas aphasia

A

expressive aphasia (slow speach) assocated with right hemiparesis

224
Q

trigeminal neuralgia tx

A

carbamezapine

225
Q

tx of bells palsy

A

steroids and acyclovir –but not if you think it may be lyme

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