Neuro Flashcards
1
Q
Superior MCA stroke classic
A
Motor + sensory of arm and face
Spares legs
2
Q
Inferior MCA stroke classic
A
Motor + sensory arm and face deficit
Spares legs
Hemianopsia
Hemineglect
3
Q
Rt ACA stroke classic
A
Contralateral motor + sensory deficit of leg
4
Q
Stoke management before CT
A
ABC
Oxygen
IVF
5
Q
Role of steroids in strokes
A
No role
6
Q
Stroke risk index?
A
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
Q
What’s Anton’s syndrome?
A
Patient believe they can see when they can’t.
Unaware of blindness.
8
Q
Anton’s syndrome is secondary to?
A
Posterior cerebral artery occlusion
9
Q
Rx of stroke?
A
- < 3 hrs symptoms: tPA
- > 3 hrs: ASA
If already on aspirin:
Add dipyridamole or switch to clopidogrel. - Hemorrhoid stroke = no Rx
10
Q
Causes of Parkinson’s
A
- Idiopathic
- Meds:
antipsychotic (thorazipine)
Reserpine
Metoclopromide
11
Q
Rx of Parkinson’s
A
- Mild:
- Anticholinergic (benztropine, trihexyphenidyl)
- Amantadine - Sever:
- dopamine agonist (pramipexole, ropinirole)
- L-dopa / carbidopa
- COMPT (tolcapone, entacapone)
- MOAI (rasagiline, selegiline)
12
Q
Rx restless leg syndrome
A
Sleep hygiene: warm bath, stretch, massage.
Dopamine agonists:
Pramipexole
Ropinirole
Carbidopa/Levodopa
Opioids
13
Q
Drugs worsen restless leg
A
Haloperidol (dopamine antagonist)
Naloxone (opioid antagonist)
14
Q
Dorsal column lesions classic
A
Loss of position and vibratory sensation ONLY.
Narrow base position + look down to compensate proprioception loss.
15
Q
What’s Romberg sign?
A
Fall of close their eyes.
Indicates loss of position / proprioception.
16
Q
Walk in Parkinson’s
A
Falls esp when turning.
Stopping
Freezing (difficulty initiating walks)
Shuffle
17
Q
Cerebellar lesion walk
A
Wide base when standing.
-ve Romberg sign.
No vibration or position loss.
18
Q
Normal pressure hydrocephalus Classic
A
Ataxia
Urinary incontinence
Dementia
19
Q
Dx normal pressure hydrocephalus
A
MRI
20
Q
Efficacy of cholinesterase inhibitors in vascular and Alzheimer’s
A
Equal
21
Q
Cholinesterase inhibitors
A
Donepezil
Rivastigmine
Galantamine
22
Q
Effect of cholinesterase inhibitors on memory
A
Don’t restore it
Prevent rapid loss of memory.
23
Q
Long term effect of cholinesterase inhibitors
A
Delay nursing home placement by 1 year.
24
Q
Drugs increase risk of falls in elderly
A
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
