Neuro Flashcards
(128 cards)
1
Q
A lesion to which artery will result in motor/sensory deficits of the LE and trunk?
A
Anterior cerebral artery
2
Q
A lesion to which artery will result in motor/sensory deficits of the face and UE and aphasia?
A
Middle cerebral artery
3
Q
A lesion to which artery will lead to impaired vision?
A
Posterior cerebral artery (supplies the occipital lobe)
4
Q
What is Wallenberg syndrome? What vessel is affected?
A
- loss of pain and temp on the CONTRALATERAL body.
- loss of pain/temp on the IPSILATERAL face
- cerebellar defects
-PICA (posterior inferior cerebellar artery) –> supplying the lateral medulla.
5
Q
Lesion of the non dominant parietal lobe (normally the right)?
A
Contralateral (normally left) hemispatial neglect
6
Q
Lesion of the dominant parietal lobe (normally the left)?
A
Gerstmann syndrome (agraphia, acalculia, finger agnosia)
7
Q
Lesion of the bilateral amygdalae?
A
Kluver-Bucy syndrome (disinhibition, loss of fear, hyperorality/hyperphagia, hyper sexuality)
8
Q
Lesion of the sub thalamic nucleus?
A
Hemiballismus
9
Q
Positive Romberg indicates a lesion where?
A
Dorsal columns (NOT cerebellum)
10
Q
Spastic paralysis and fasciculations?
A
ALS (UMN and LMN lesions)
11
Q
Impaired proprioception and pupils that accommodate but do not react to light?
A
Tabes Dorsalis (tertiary syphilis)
12
Q
Bilateral loss of pain and temp below the lesion and hand weakness?
A
Syringomyelia (damage to the anterior white commissure)
13
Q
Bilateral loss pf pain/temp below the lesion, bilateral spastic paralysis below the lesion and bilateral flaccid paralysis at the level of the lesion?
A
Anterior spinal artery syndrome (lose all but the dorsal columns)
14
Q
Organism causing meningitis with CSF showing gram-positive diplococci?
A
S. pneumonia
15
Q
Organism causing meningitis with CSF showing gram-negative diplococci?
A
Neisseria meningitidis
16
Q
Organism causing meningitis with CSF showing small gram-negative coccobacilli?
A
Haemophilus influenzae
17
Q
Organism causing meningitis with CSF showing Gram-positive rods?
A
Listeria
18
Q
Empiric ABX for meningitis in neonates (
A
-ampicillin and gentamicin +/- cefotaxime
19
Q
Empiric ABX for meningitis in infants (1-3 months) and adults (
A
3rd gen cephalosporin and Vancomycin (to cover resistant S. pneumo)
20
Q
Empiric ABX for meningitis in adults >50yo?
A
- Ampicillin (covers Listeria)
- Vanco
- Cefotaxime or ceftriaxone
21
Q
When should dexamethasone be given for meningitis?
A
- S. pneumo
- child with HiB
- TB meningitis
- Give steroids BEFORE or WITH first dose of ABX
22
Q
Suspected cause of fungal meningitis in HIV? How is it diagnosed? Tx?
A
Cryptococcal
- Cryptococcal antigen or India ink.
- Tx: IV amphotericin and Flucytosine x 2 weeks then oral fluconazone x 8 weeks
23
Q
Who should receive prophylactic ABX if someone has Neiserria meningitidis? Which ABX?
A
- Close contacts (droplet spread)
- Rifampin, cipro or ceftriaxone are acceptable
24
Q
What is the pathogen that causes neurocysticercosis? What is normally the presenting symptom? How do you diagnose it?
A
- Taenia soluim (after ingestion of the eggs that were excreted from a human carrier)
- new onset seizures
- CT or MRI –> multiple cysts with scolex inside the cyst –> calcified when collapses
25
Where does HSV-1 normally cause meningitis?
Temporal lobe
26
How do you treat a patient that has been bitten by an animal suspected of having rabies or an animal that cannot be observed for 10 days?
Rabies vaccine and rabies immunoglobulin
27
What type of meningitis is associated with CSF showing elevated WBC (lymphocytes), elevated protein and normal glucose?
viral
28
What type of meningitis is associated with CSF showing elevated WBC (lymphocytes), elevated protein and decreased glucose?
Fungal or TB
29
Jaw muscle pain with chewing?
Temporal arteritis
30
Obese woman with papilledema?
Idiopathic intracranial HTN (IIH) (used to be pseudo tumor cerebrii)
31
Headache with extra ocular muscle palsies?
Cavernous sinus thrombosis
32
Headache responsive to 100% oxygen?
Cluster
33
What is the recommended treatment for TIA?
- Antiplatelet therapy (clopidogrel and aspirin/dipyridamole preferred or ASA alone)
- anti-lipid (high intensity statin)
- BP
34
What are the surgical indications for carotid endarterectomy?
- Symptomatic its with narrowing 70-99%
- Symptomatic MEN 50-69%
-Asymptomatic patients with narrowing 60-99%, provided the life expectancy is > 5 years and the surgeon has a preoperative complication rate of
35
What imaging is recommended for a pt with a recent TIA?
- carotid US
| - echocardiogram
36
When must thrombolytics be given in the setting of an ischemic stroke?
3-4.5 hours (up to 6 hours if you can inject directly into the clot)
37
What are the contraindications to thrombolytic therapy?
- Hemorrhage on CT
- recent surgery
- Anticoagulation
- Recent hemorrhage (including GI)
- BP >185/100
38
When should BP be treated in an ischemic stroke?
BP>220/120
| -allow permissive HTN in these patients to allow increased blood flow to the area surrounding the damaged tissue
39
Treatment for hemorrhagic stroke?
- Stop anticoagulants and reverse if possible (FFP and Vit K)
- Keep BP
40
What medication should be given ASAP for an ischemic stroke?
Aspirin
41
What type of hemorrhage do you suspect in a patient taking warfarin that falls and bumps his head?
Subdural
42
What type of hemorrhage do you suspect in a patient with a sudden onset severe headache, vomiting and meningismus?
SAH
43
What type of hemorrhage do you suspect in a patient with a brief loss of consciousness following a head trauma with a rapid clinical deterioration hours later?
Epidural
44
What type of hemorrhage do you suspect in a elderly patient with a mild headache for 2 weeks, now becoming lethargic?
Subdural
45
What type of hemorrhage do you suspect in a patient with a unilateral hemiparesis and BP of 220/130?
Parenchymal hemorrhage
46
What type of hemorrhage do you suspect in a patient with a ruptured AVM?
Parenchymal hemorrhage or SAH
47
Biconvex-shaped (lens-shaped) hematoma?
Epidural
48
Crescent-shaped hematoma?
Subdural
49
What are the 2 most common locations of aneurysms of the Circle of Willis?
Anterior communicating artery and posterior communic ating artery
50
What is the treatment for a subarachnoid hemorrhage?
- Clip the ruptured aneurysm.
- Stop anticoagulants
- SBP
51
Which type of seizure will show 3 cycle per second spike and wave pattern? Tx?
Absence
| -Ethosuximide
52
What is status epilepticus? How is it treated?
- life-threatening seizure that lasts longer than 5 minutes.
- Tx: 1. ABCs. 2. Benzos, 3. phenobarbital ((if intubated)
- Phenytoin will prevent recurrence.
53
Which anti-epileptics are teratogens?
- Phenytoin
- Carbamazepine
- Valproic acid (can cause spina bifida)
54
What drugs cause agranulocytosis?
- Carbamazepine
- Clozapine
- Colchicine
- PTU and Methimizole
55
Which anti-epileptics are hepatotoxic?
Valproic acid and carbamazepine
56
What brain lesion is seen in patients with Huntington disease?
atrophy of the caudate nucleus
57
What is the BEST diagnostic test to diagnose ALS? What will it show?
EMG
| -widespread acute and chronic muscular degeneration and reinnervation
58
What medication is used to treat ALS?
Riluzole
| use riLUzole to treat Lou Gehrigs
59
What medication is most commonly used to treat Huntington disease?
Tetrabenazie (DA antagonist)
60
What are the C's associated with Huntington disease?
- CAG repeat
- Chromosome Cuatro (4)
- Choreiform movement
- Cognitive decline
- Caudate nucleus atrophy
- Cuarenta (40)=age of onset.
61
What is the typical initial presenting symptom of ALS? What is NOT affected in ALS?
- Asymmetric limb weakness
- Bulbar dysfunction (dysarthria or dysphagia)
-Sensation is not affected, just movement
62
What are eosinophilic inclusions of alpha-synuclein and ubiquitin? What are these associated with?
- Lewy bodies
| - Parkinsons
63
What are the signs of optic neuritis?
- Acute eye pain that is worse with eye movement
- central vision loss
- Afferent pupil defect (Marcus Gunn pupil: No constriction in either pupil when light is shone in the affected eye; both pupils constrict when light is shone into the unaffected eye)
- Common finding in MS
64
What is Lhermitte's sign? What is it associated with?
- Neck flexion that causes electrical shock-like tingling radiating down the back of the neck and into the extremities
- MS
65
What is the Internuclear ophthalmoplegia?
- Damage to the medial longitudinal fasciculus
- Ispilateral eye cannot ADDUCT on lateral gaze.
- Horizontal nystagmus in the contralateral eye during lateral gaze. Normal convergence.
- Seen in MS
66
What is the most sensitive test for MS?
- MRI of the brain and orbit
- MRI of the spine
- Will show demyelinating lesions of varying age
67
What is the treatment for an acute MS flare? What about maintenance?
- acute: high-dose glucocorticoids
| - maintenance: Interferon beta (decreases the frequency of exacerbations)
68
What is the main PE finding in syringomyelia?
- Loss of pain and temp in 1-3 segments below the syrinx.
| - 2/2 compression of the spinothalamic tract in the anterior white commissure.
69
What is the treatment for Alzheimer disease?
- Cholinesterase inhibitors (Donepezil, Galantine, Rivastigmine)
- Memantine
70
What type of dementia is associated with visual hallucinations and frequent falls?
Demential with Lewy Bodies
71
Dementia with inappropriate social behavior or progressive aphasia?
Frontotemporal dementia (Pick disease)
72
What is the cause of normal pressure hydrocephalus? What is the triad often seen with this?
- Impaired reabsorption of the CSF by the arachnoid granules --> CSF builds up
- Presentation: Wacky, wobbly, wet.
73
What are the two most common causes of delirium?
- Drugs (Benzos, anticholinergics, antihistamines, glucocorticoids, EtOH and drugs of abuse)
- UTI
74
How can you differentiate vascular dementia from Alzheimer?
MRI showing previous infarct in vascular dementia
75
Which cause os syncope is consistent with occurring while shaving?
carotid sinus hypersensitivity
76
Syncope while standing and singing in choir concert?
Vasovagal
77
Syncope with prolonged loss of consciousness?
Likely a cerebrovascular cause
78
Syncope proceeded by palpitations?
cardiogenic (likely 2/2 arrhythmia)
79
With an intact brainstem, which way should the patient's eyes move with I've water infusion into the ear canal?
Towards the ear with the ice water
-with nystagmus away
80
What is the differential for loss of consciousness?
```
AEIOUTIPS
Alcohol
Epilepsy
Insulin
Overdose/Opioids
Uremia
Trauma
Infection
Psychogenic
Stroke
```
81
What initial therapy should be considered with a patient coming into the ER with a loss of consciousness?
- Thiamine
- then glucose (don't want to worsen wernicke's)
- naloxone
82
What is the oculocephalic maneuver? What result indicates brain death?
- Doll's eye test: Move the patient's head side to side. Pt's eyes should stay fixed on a set point straight ahead
- If braindead, the eyes will move with the head
83
What medications are first-line treatment for restless leg syndrome?
DA agonists
| -Pramiprexole and Ropinirole
84
When do night terrors occur?
N3 sleep
85
What is the treatment for narcolepsy?
- Regular sleep schedule (nap)
- Improve daytime sleepiness: Modafinil, armodafinil, amphetamines
- Reduce REM: Venlafaxine, fluoxetine, atomoxetine
- Severe symptoms: sodium oxybate
86
What are the brain tumors seen in adults?
MGM Studios
- Metastasis
- Glioblastoma
- Meningioma (peripheral, resectable)
- Schwannoma (CN8)
87
What are the brain tumors seen in children?
"Animal kingdom, Magic kingdom, Epcot"
- Astrocytoma
- Medulloblastoma
- Ependymoma
88
Which pediatric brain tumors compress the 4th ventricle?
Medulloblastoma and Ependymoma
89
Characteristic findings in Neurofibromatosis type 1?
- cafe-au-lait spots
- axillary or inguinal freckling
- Lisch nodules (hamartomas of iris)
- Neurofibromas
- Optic pathway gliomas
90
Characteristic finding of Neurofibromatosis type 2?
Bilateral vestibular schwannoma
91
How is myasthenia gravis diagnosed? What is the next step that should be done?
- (+) Ach Receptor Antibodies
(or Endophonium or Tension test)
-CT Chest* -> associated with thymoma and neoplasm of the thymus
92
What is lambert-eaton associated with 60% of the time?
Small cell lung cancer
93
What is the treatment for Lambert-Eaton and Myasthenia Gravis? How do the differ?
- LE: plasmapheresis or IVIG
| - MG: acetylcholinesterase inhibitors (neostigmine , pyridostigmine)
94
Treatment of Bell's Palsy?
- Acyclovir
- Glucocorticoids
- Eye care
95
What is the treatment for tics (verbal or motor)?
DA antagonists (fluphenazine, pimozide, tetrabenazine)
96
Ptosis, mitosis and anhidrosis? Associated with what?
- Horners syndrome
| - Pancoast tumor (non-small cell lung cancer)
97
Where is the lesion if someone presents with left anopia?
Left optic nerve
98
Where is the lesion if someone presents with bitemporal hemianopia?
Optic chiasm
99
Where is the lesion if someone presents with right homonymous hemianopia?
Left optic tract
100
Where is the lesion if someone presents with right upper quadratic anopia?
Left temporal lobe
101
Where is the lesion if someone presents with right lower quadratic anopia?
Left parietal lobe
102
Where is the lesion if someone presents with right hemianopia with macular sparing?
Left occipital lobe
103
The most common cause of blindness age >55?
Macular degeneration
104
The most common cause of blindness less than 55yo?
Diabetes
105
The most common cause in blacks of any age?
Glaucoma
106
If someone presents with left sided strabismus, which eye should be patched?
-the left (bad) eye to prevent amblyopia
107
Loss of central vision in an old person?
Age-related macular degeneration
108
Painless, sudden vision loss? Often flashing lights and floaters and then a "curtain pulled over the eye"?
Retinal detachment
109
Acute, painless vision loss in a patient with a h/o atherosclerosis, HTN, a fib, DM? What will the fundoycopic exam show?
- Central retinal artery occlusion
| - Pale retina with a cherry red spot
110
Sudden onset of unilateral eye pain, blurred vision and colored halos that encircle light sources, "rock-hard" eye, and a fixed, mid-dilated pupil?
Acute angle-closure glaucoma
111
Main cause of anterior uveitis? Posterior?
- Anterior=systemic inflammation (seronegative spondyloarthropathies)
- Posterior=infections (HSV, CMV, toxoplasma,
112
What is herpes simple keratitis? What is a worrisome complication of it?
- HSV infection of the cornea.
| - corneal ulceration
113
Night blindness or bitot spots (areas of abnormal squamous cell proliferation and keratinization of the conjunctiva)?
Vit A deficiency
114
Exam finding in open-angle glaucoma?
cup-to-disc ration >50%
115
What is the treatment for acute angle-closure glaucoma?
- ophthalmology referral
- Timolol, apraclonidine and pilocarpine drops (decrease pressure)
- Acetazolamide
- if refractory, IV mannitol
- Pt needs laser iridotomy
116
What are some characteristic features of orbital cellulitis?
- proptosis
- pain with eye movement
- ophthlmoplegia --> diploplia
117
First-line treatment for acute otitis media?
Amoxicillin (ABX always for kids
118
Treatment for otitis external?
-Topical ABX: ofloxacin, ciprofloxain, polymyxin B/neomycin
119
What type of vertigo is caused by otoliths being dislodged in the inner ear?
BPPV
| -Tx: Epley maneuvers
120
What is the cause of Meniere's disease? Tx?
- excessive fluid in the inner ear.
- tx: limit intake of salt, caffeine, nicotine and EtOH.
- Diuretics (HCTZ)
121
Weber is midline, Left Rinne AC>BC, Right Rinne AC>BC. diagnosis?
Normal
122
Weber lateralizes right, Left Rinne AC>BC, Right Rinne BC>AC. diagnosis?
Right conductive hearing loss
123
Weber lateralizes left, Left Rinne AC>BC, Right Rinne AC>BC. diagnosis?
Right sensorineural hearing loss
124
Weber is midline, Left Rinne BC>AC, Right Rinne BC>AC. diagnosis?
Bilateral conductive hearing loss
125
Albuminocytologic dissociation in the CSF is seen with what condition?
-Guillan barre syndrome
126
What is the goal BP for an ischemic stroke?
127
What is the goal BP for an intracerebral hemorrhage?
SBP
128
What is the goal BP for SAH?
SBP
