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Flashcards in Neuro Deck (177):
1

Superior MCA stroke classic

Motor + sensory of arm and face
Spares legs

2

Inferior MCA stroke classic

Motor + sensory arm and face deficit
Spares legs
Hemianopsia
Hemineglect

3

Rt ACA stroke classic

Contralateral motor + sensory deficit of leg

4

Stoke management before CT

ABC
Oxygen
IVF

5

Role of steroids in strokes

No role

6

Stroke risk index?

CHADS2
C: CHF
H: HTN
A: age > 75
D: DM
S: 2ry prevention for prior event.

All 1 point, S has 2 points.
0 = low risk
1-2 = moderate
>3 = high

7

What's Anton's syndrome?

Patient believe they can see when they can't.
Unaware of blindness.

8

Anton's syndrome is secondary to?

Posterior cerebral artery occlusion

9

Rx of stroke?

1. < 3 hrs symptoms: tPA
2. > 3 hrs: ASA
If already on aspirin:
Add dipyridamole or switch to clopidogrel.

3. Hemorrhoid stroke = no Rx

10

Causes of Parkinson's

1. Idiopathic
2. Meds:
antipsychotic (thorazipine)
Reserpine
Metoclopromide

11

Rx of Parkinson's

1. Mild:
- Anticholinergic (benztropine, trihexyphenidyl)
- Amantadine

2. Sever:
- dopamine agonist (pramipexole, ropinirole)
- L-dopa / carbidopa
- COMPT (tolcapone, entacapone)
- MOAI (rasagiline, selegiline)

12

Rx restless leg syndrome

Sleep hygiene: warm bath, stretch, massage.

Dopamine agonists:
Pramipexole
Ropinirole
Carbidopa/Levodopa


Opioids

13

Drugs worsen restless leg

Haloperidol (dopamine antagonist)

Naloxone (opioid antagonist)

14

Dorsal column lesions classic

Loss of position and vibratory sensation ONLY.

Narrow base position + look down to compensate proprioception loss.

15

What's Romberg sign?

Fall of close their eyes.
Indicates loss of position / proprioception.

16

Walk in Parkinson's

Falls esp when turning.
Stopping
Freezing (difficulty initiating walks)
Shuffle

17

Cerebellar lesion walk

Wide base when standing.
-ve Romberg sign.
No vibration or position loss.

18

Normal pressure hydrocephalus Classic

Ataxia
Urinary incontinence
Dementia

19

Dx normal pressure hydrocephalus

MRI

20

Efficacy of cholinesterase inhibitors in vascular and Alzheimer's

Equal

21

Cholinesterase inhibitors

Donepezil
Rivastigmine
Galantamine

22

Effect of cholinesterase inhibitors on memory

Don't restore it
Prevent rapid loss of memory.

23

Long term effect of cholinesterase inhibitors

Delay nursing home placement by 1 year.

24

Drugs increase risk of falls in elderly

Benzodiazepines
Diphenhydramine

25

Phenytoin toxicity

Nystagmus
No coordination
Ataxia + slurred speech
Mental confusion

26

Butemporal heminopsia indicates?

Lesion in optic chiasm

27

What's picks disease

Frontotemporal dementia

28

Picks disease / frontotemporal dementia classic

Personality changes
Lack of judgment
Disinhibition
Memory intact 1st then deteriorates.

29

Dx fronto-temporal dementia

Wide gyri + narrow sulci (knife like)

Atrophy of frontal + temporal lobes.

30

When dose postherpetic neuralgia start?

3-6 mo after herpes zoster

31

How to decrease risk of post herpetic neuralgia?

Antiviral Rx w/in 72 HR

Amitriptyline Rx during infection.

32

GBS classic

1-3 weeks after infection
Ascending weakness
No reflexes
Spared sphincter
Resp paralysis = intubation

33

LP in Sub arachnoid hemorrhage?

Xanthochromia
WBC:RBC >1:1000

34

Syncope + exercise =

Cardiac output problem

i.e. Aortic stenosis

35

Vasovagal syncope classic

Associated with unpleasant event

Heat, hunger, blood loss, pain

36

Atrial myxoma syncope classic

Related to bending or lying down drone seated position
Turning over in bed

37

Essential tremor Rx

Primidone (older pts)
Propranolol (younger)

38

Lewy body dementia classic

Hallucinations
Vivid dreams
Sleep disorders
Day time sleep
Abnormal clock drawing (visuospatial deficit)

39

Dx seizures

EEG

40

Mode of inheritance in Huntington?

AD

41

Risk of disease in child of affected parent

50%

42

Causes of vertigo

Peripheral nerve
Vestibular system (CNS)

43

Physiological vertigo

With head extension
Height vertigo
Following a spin

44

Pathological vertigo

Benign paroxysmal positional vertigo

Meniere's

Vestibular neuritis

Acoustic neuroma

Vascular lesions

45

Differentiate central from peripheral vertigo?

Nystagmus persists during visual fixation = central.

No tinnitus = central.

46

Vertigo + nystagmus disappears with visual fixation?

Peripheral vertigo

47

Heatstroke def

Body temperature > 41 + neuro Sx
Esp. Confusion

48

Sx of multiple sclerosis

Oculomotor Sx
Parastheaia
Weakness
Spastic
Urinary incontinence

49

Horner syndrome

Miosis (small pupil)
Ptosis (drooping)
Anhidrosis

50

Cause of Horner syndrome

Interruption of sympathetic nerve

51

What dementia is cannot be treated?

Creutzfeldt-Jakob

52

Most common presentation of Parkinson's

Resting tremor

53

Pallor of optic disk in multiple sclerosis

Optic nerve disease

54

What's status epilepticus?

Seizures continuous with loss of consciousness > 20-30 min.

55

Rx of status epilepticus?

1. ABC
50ml bolus 50%D
100mg thiamine

2. Benzodiazepines (0.1-0.5 mg/kg lorazepam IV) wait 5 min

2. Fos phenytoin 15-20 mg 2x

3. Phenobarbital 15 mg/kg

4. GA + muscular block 1st (succinylcholine)

56

Maximum dose of morphine

No top dose.

57

Dx of post herpetic neuralgia

TCA: amitriptyline, noretriptyline.

Anticonvulsant: gabapentin.

Opioids: morphine or tramadol

58

Carbamazepine in post herpetic neuralgia

Not effective

59

Migraine prophylaxis

BB
CCB
Anticonvulsants: vampiric acid, topiramate, gabapentin
TCA: amitriptyline

60

Feature of temporal lobe epilepsy

Memory impairment
Aura
Deja vu
Rising epigastric sensation

61

Occipital lobe seizure

Visual hallucinations

62

Seizure vs pseudo-seizure

Seizure:
Open eye
High prolactin after seizure
Tongue bite
Postictal confusion
Aura

63

Dx of Parkinson's

No test = if must PET CT
Response to Rx

64

Most effective Rx in Parkinson's

Levodopa

65

Long-term SE of levodopa

Fluctuations
Dyskinesia

66

Which has more SE in Parkinson's:
Levodopa or dopamine agonists?

Dopamine agonists more SE

67

Uses of ginkgo biloba?

Delaying dementia > tinnitus

68

1st line prophylaxis in migraine

BB + TCA

69

Contraindication to using BB in migraine prevention

Asthma
CHF

70

Normal pressure hydrocephalus triad

Wacky, wet, wobbly.

Mental impairment
Urinary incontinence
Gait (broad-based shuffling)

71

Dx of normal pressure hydrocephalus

1. No papilledema
2. CSF removal (30-40 ml).

72

Wenicke-Korsakoff classic

Alcoholic
Apathy / confusion
Nystagmus
Ataxia

+/-
Confabulation
Ophthalmoplegia
Coma

73

What's wet beriberi?

Poly neuropathy
High output heart failure
Dementia + psychosis

In patients with high white rice or refined carb diet.

74

Rx of Wernicke-Korskoff?

IV or IM thiamine 100 mg for 3-7 days
Then orally

75

What's brown-sequard?

Hemisectional spinal injury
Results in:
1. Ipsilateral loss of proprioception and vibration
2. Ipsilateral spasticity
3. Ipsilateral increased DTR
4. Contralateral loss of pain and temperature.
5. Hemiparesis

76

Drugs cause dystonia

Dopamine antagonist:
Prochlorperazine
Metclopromide
Haloperidol

77

Rx of dystonia?

Diphenhydramine benztropine

78

Triggers of Guillain-Barré syndrome

Infection = c. Jejuni, HSV, mycoplasma.
Surgery
Vaccination

79

Homosexual + ocular Sx

Toxoplasmosis

80

Dx toxoplasmosis

CT to see multiple ring enhancing lesions

81

Results of babnski interpretation

Extensor plantar = UMNL above S1

Flexor response = normal.

82

Rx of temporal arthritis

High dose steroids

83

What's myasthenia graves?

Ab against acetylcholine nicotinic posts Taptic receptor at NMJ.

84

Myasthenia graves classic

Worse weakness at night

85

Dx myasthenia graves

Anti acetylcholine receptor antibodies.

86

Amyotrophic lateral sclerosis (ALS) classic

Upper and lower MNL.
Mixed:
Weakness + fasciculation
Spasticity + atrophy
Increased DTR and lost

Sphincters are intact

87

Opioids for pain control in ICU

Morphine
Hydromorphone
Fentanyl

88

Rx of pseudotumor cerebri

Acetazolamide
Weight reduction if obese

89

Dx of pseudotumor cerebri

Blurry optic disk
High opening pressure on LP w/normal CSF

90

What affects the results of mini mental state exam

Educational status

91

Test to screen for memory loss

Mini mental state exam

92

MCC of median nerve dysfunction

Carpal tunnel

93

Median nerve injury classic?

Abnormal sensation in thumb, index, middle and ring.

Weakness of hands
Dropping things
Difficult grasping objects.

94

What's Forment's sign?

For ulnar nerve
Hold a paper firmly between thumb and index (pinch grip) if examiner can pull the paper then it's positive.

95

Weak wrist extension indicates?

Radial nerve damage
Or C7 root

96

Atrophy of 1st dorsal interosseous muscle seen in?

Compression of Ulnar nerve.

97

What's triazolam
Its uses
are its side effects

Benzodiazepine

Used for sleep disorders

Fall, amnesia and confusion

98

Rx of trigeminal neurologia?

Carbamazepine 1st choice.

99

Cauda equine syndrome classic

Sphincter laxity
Perianal numbness
Low back pain
Leg weakness

100

Dx cauda equina syndrome

MRI of lumbosacral spine

101

Most important risk factor for post herpetic neurologia

Old age
1ry infection in trigeminal dermatome esp. V1

102

Who needs vaccination against shingles and why?

Elderly
Prevent post herpetic neuralgia

103

Acute intermittent porphyria pain is never associated with?
Why?

Never associated with tenderness

Its neurologic pain not inflammatory.

104

Sign of porphyria pain

Reduced by palpation (its neurologic)

105

Fragile X syndrome

Men
Big ears
Big testicles
Big jaw

106

MCC of mental retardation in men

Down
Fragile X

107

Expressive aphasia localization

Broca's area (can't talk)
Inferateral frontal lobe (left)

108

Posterior cerebral artery stroke

Occipital headache
Homonimous hemianopsia

109

Labs in restless leg syndrome

Low ferritin <50 men

110

SE of valporic acid

N/V
Headache
High bleeding time
Thrombocytopenia

111

Pleural lobe lesion classic

Rt-Lt disorientation
Can't calculate
Can't draw
Can't brush hair / dress

112

Peroneal nerve distribution

Lateral lower limb
Dorsal foot
Weak dorsiflextiom

113

L5 nerve damage

Weak ankle dorsiflexion
Weak eversion
Weak inversion
Weak hip

114

Dx of Bell's palsy

History
Paralysis in 1-2 days with maximal weakness in 3 wks.

115

Rx of Bell's palsy

Steroids
Anti virals

116

Dizziness + diplopia

Serious work up

117

Pain medication contraindicated in elderly?

Meperidine = causes seizures

118

CN3 or oculomotor supply

Extraocular muscles except lateral rectus (by CN6) + superior oblique (CN4)

119

MCC of CN3 palsy?

Berry aneurysm of circle of wills

120

Differentiate CN3 palsy of berry aneurysm vs microvaascular disease

Parasympathetic Sx (dilated pupil) + ptosis + lateral deviation in berrys

Ptosis + lateral deviation w/o pupil involvement in microvascular

121

Dx berrys aneurysm?

MRA

122

Association w/ pseudodementia?

Depression

123

Olfactory hallucinations + automatism (localization)

Temporal lobe

124

How to screen for phenytoin toxicity?

Ataxia

125

Analgesic contraindicated in seizure disorder

Tramadol

126

Prophylaxis for cluster headache

Verapamil (CCB)
Ergotamine
Lithium
Prednisolone
Indomethacin

127

Rx of cluster headache

100% oxygen
Triptan
Octreotide
Dihydroergotamine

128

Subdural hematoma classic

Crescent shaped
+/- midline deviation
After head trauma
Lucid interval hours after trauma

129

Foot drop indicates?

Lack of dorsiflexion
Peroneal nerve damage
L4-5 + S1-2

130

Peroneal nerve injury

Lack of dorsiflexion
Weakness
Numbness
High stepping walk (steppage gait)

131

1st line in tonic-clinic seizure

Valporic acid

132

Drug contraindicated in tonic-clinic seizure + kidney stones or high Vit C or Ca intake?

Topiramate = causes kidney stones

133

Cause of subdural hematoma

Trauma causes torn of bridging veins

134

When does delirium termens develop?

2-3 days after last drink
Peaks 4-5 days after last drink.

135

Delirium termens classic

Altered mental status
Agitation
Irrational believes
Sweating
Hyperthermia
Vitals instability
Tremor
Hallucinations
Sleep disturbance + nightmare

136

What predicts high risk of developing Alzheimer's

Apolipoprotein 4 genotype

137

Rapid correction of hyponatremua

Causes demyelination

138

Lower motor neuron

Flaccid paralysis
Fasciculation
Lost reflexes
Down babnski -ve

139

Upper motor neuron

Spasticity
Hyper reflexia
Up going babnski
Weakness

140

Extrapyramidal lesions

Rigidity
Normal reflexes
Down babnski
No weakness

Rigid and strong

141

Rx of delirium termens

IVF w/ NS (not D5W)
Lorazepam 12 doses 2-4 mg q4hr
Or
Diazepam 20mg PO q1-2hr
Diazepam 2-5mg IV q1hr

142

What's contraindicated in delirium termens

D5W before thiamine

Causes Wernickes crisis

143

What to r/o before Dx of Alzheimer's in elderly?

Thyroid dysfunction

144

Long term SE of dopamine agonists in restless leg

Early morning rebound / augmentation of Sx.

145

Imaging test in Parkinson's

PET or SPECT

146

What's a cerebellopontine angle tumor

Benign tumor of 8CN Schwann cells

147

Cerebellopontine angle tumor classic

Diminish corneal reflex
Hearing defects
+/- tinnitus or vertigo

148

Dx cerebellopontine angle tumor

Auditory evoked potential
MRI scanning

149

MCC of syncope

Vasovagal

150

MCC of Horner's?

Apical bronchogenic carcinoma
Pancoast tumor

151

Type of tremor in Parkinson's

Essential

152

What indicates benign positional vertigo

1. Provoked by change in position or head movement


2. Lasts for < 30 sec

153

MCC of spontaneous intracerebral hemorrhage

HTN

154

Absence seizure classic

School age child

Seconds of loss of consciousness

Eyelid flattering

Staring into space

155

Rx of absence seizure

1. Ethosuximide

2. Then valporic acid

156

What precipitate absence seizure?

Hyperventilation

157

Instructions in restless leg syndrome

Rx iron deficiency

Cut back in caffeine, alcohol, tobacco

Relaxation techniques

Mind occupying activities: reading, TV

158

Role of stretching exercise in restless leg?

None

159

What's not seen in brain death?

Hypothermia

160

Risk of AD disease inheritance if one parent is affected.

25%

161

Radial nerve palsy classic

Wrist drop
Numbness on dorsa of hands

162

What to do if patient who's addict is in sever pain and refuse physical exam?
Give them narcotic deposit their addiction or give less potent analgesics or move to investigation?

Treat pain with enough analgesics despite their addiction

163

Lewy bodies dementia classic

Fluctuating cognition
Visual hallucinations
Parkinsonism

164

What's shy-drager syndrome

Parkinsonism + orthostatic hypotension
Not responsive to L-dopa

165

Indication that a foot ulcer is of neuropathic origin?

Abnormal monofilament

166

Rx of diabetic neuropathy

TCA
Anticonvulsant
Prcegablin is safe in elderly
Amitriptyline not effective in elderly

167

Cholinergic toxicity

Warm
Sweaty
Low HR
Low BP
Constricted pupil
Teary eyes
Drooling

168

Antidote for cholinergic toxicity

Atropine and

169

Organophosphate toxicity pathophysiology

Ach esterase inhibition = high Ach

170

Korsakoff's psychosis / alcoholic amnesiac Sx

Immediate memory loss
Confabulation
Disorientation
Emotional changes

171

Pathophysiology of myasthenia graves

Ab against Ach receptors

172

Disease associated with myasthenia graves

Thyroiditis
RA
SLE
Vit B12
Thymoma

173

Drug cause hypothermia

Clonidine

174

Drug causes pseudo Parkinsonism

Chlorpromazine

175

What's sumatriptan

A 5-hydroxytryptamine (5-HTID) receptor antagonists.

176

Anticonvulsant not used in kidney stones

Topiramate

Not in Vit C or high Ca

177

Tramadol in seizures?

Contraindicated