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Neuro Flashcards

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1
Q

How do you demonstrate brain death on exam?

A

Absence of deep brain reflexes

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2
Q

Can a brain dead patient move?

A

Yes, can have spontaneous movements from the peripheral nervous system or spinal cord

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3
Q

In myasthenia gratis, Ab attack what receptor?

A

Acetylcholine

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4
Q

Wernicke encephalopathy is d/t a deficiency in?

A

Thiamine

AMAS + oculomotor dysfunciton + ataxia

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5
Q

Pt is treated for Wernicke, now having retrograde amnesia and confabulation (making up stories). Why?

A

Korsakoff syndrome
Late stage complication of chronic thiamine deficiency
Mammillary body atrophy on MRI
The patients rarely improve

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6
Q

Kiddo with hearing loss and SubQ skin masses

A

Neurofibromatosis
Acoustic neuromas (from Schwann cells)
Schwann cells - myelinated PNS axons and CN axons

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7
Q

Side effect of carbamazepine (anti-eleptic)?

A

Neutropenia/bone marrow suppression
Elderly also get SIADH
Also - glaucoma, urinary retention, constipation

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8
Q

1st line therapy for prolactinoma (regardless of size)?

A

Dopaminergic receptor agonist (bromocriptine, cabergoline)

Can decease tumor size in a few days which can help visual symptoms

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9
Q

New onset depression at age >65 increases the pts risk of?

A

Alzheimer dz

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10
Q

Pt with acute severe unilateral HA
Dilated pupil on same side
Blurry vision on same side
Concerning for?

A

Carotid a. dissection
get a CTA head/neck
Gets compression on the superior cervical sympathetic ganglion

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11
Q

What should be measured in someone with Guillain Barre

A

Vital capacity to monitor respiratory status

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12
Q

Treatment of Guillain Barre?

A

Therapeutic plasma exchange or IVIG

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13
Q

Pt with new onset lower extremity weakness and loss of bowel/bladder control
Dx and what next?

A

Transvere myelitis
Different from GBS because they have flaccid paralysis, hyporeflexia
Need spinal MRI
Tx - steroids

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14
Q

Pt has symptoms of intracerebral hemorrhage + CN III palsy in the weeks before the event, where is the lesion?

A

PCA aneurysm

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15
Q

Pt has symptoms of intracerebral hemorrhage + ataxia. Where is the lesion?

A

Posterior inferior cerebellar a. aneurysm

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16
Q

Pt with lower extremity weakness, numbness, + Romberg, constricted pupils on exam

A

Late neurosyphilis
Tabes dorsalis - sensory ataxia, lancinating pains
Argyll Robertson pupils - constriction w/ accommodation but not with light

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17
Q

Most common cause of b/l diaphragmatic paralysis?

A 
ALS
Respiratory weakness (worse when supine), lower extremity atrophy, tongue fasciculation's
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18
Q

Young person with DVT now has a stroke. What should be part of the workup?

A

Bubble study to look for intracardiac shunt

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19
Q

Preferred test to dx MS?

A

MRI

ovoid periventricular white matter lesions

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20
Q

Tx for acute MS flare?

A

IV solumedrol
po steroids has high rate of recurrence
Can pursue plasmapheresis if no response to treatment

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21
Q

Long term tx for MS?

A

Beta-interferon or flatiramer
Decreases the frequency of exacerbations
Reduces the number of brain lesions in its with relapsing-remitting MS

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22
Q

How should you counsel a woman with MS that wants to get preggo?

A

Typically have lower disease activity during pregnancy
Higher activity in postpartum period
Most therapies are low risk of harm to fetus

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23
Q

What can you give a MS patient that is having a hard time with spasticity?

A

Baclofen

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24
Q

Cancers with high rate of metastasis to spine?

A 
prostate
breast
lung
non-Hodgkin's lymphoma
RCC
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25
``` Dementia + 2 or more of the following: Fluctuating cognition Visual hallucination Shuffling gait, increased tone Rapid eye movement during sleep ```
Dementia w/ Lewy bodies
26
What treatment can make a Lewy body dementia pt prone to orthostatic?
Anti-psychotics especially first generation
27
Dementia Difficulty walking, lower extremity parathesia Hyperreflexia
Vit B12 deficiency | Prone to hemolytic anemia d/t poor erythropoiesis
28
Pt with decreased sensation over anterolateral thigh but nl reflexes and strength
Meralgia paresthetica Lateral femoral cutaneous nerve entrapment Tx - weight loss and avoid tight clothing
29
Teenager presenting with symptoms of paralysis after campling
High suspicion for tick paralysis toxin is in tick saliva Six start 4-7 days after attachment Progressive gait ataxia and ascending paralysis exam: NL sensation, absent DTRs, afebrile Tx - remove the icky thing
30
Headache + papilledema. Now what?
MRI | don't do LP in use there is herniation
31
Premature infant, spasticity, hyperreflexia, not meeting gross motor milestones Dx and workup?
Suspicious for CP | Get an MRI
32
2 days after removal of a parathyroid adenoma pt has b/l facial asymmetry
Hungry bone syndrome | If unilateral think of an alternative dx
33
LP with high RBC w/o xanthochromia is?
A traumatic tap
34
High risk features of head trauma in a kid < 2
``` AMS LOC Severe mech (>3ft, MVA) Nonfrontal scalp hematoma Palpable skull fracture ```
35
How do you counsel people to return to sport after concussion?
rest for 24 hours after injury. After that gradually increase activity level each 24 hour period if asymptomatic. Maybe able to return to full play in 1 wk
36
Absent cremaster reflex but all other strength and sensation intact. C/f?
Isolated loss of Cremasteric reflex is suggestive of diabetic neuropathy L1-L2
37
Teenager Upper extremity twitching x months No GTC seizure Cx?
Juvenile myoclonic epilepsy Tx - Valproic acid can initially present as absence as well Aggrevated by sleep deprivation and alcohol EEG b/l polyspike and slow wave discharges during ictal period
38
Side effect of Valproic acid?
Thrombocytopenia Hepatotoxicity Teratogen --> NTD
39
Can brain dead people have DTRs?
Yes, because these are peripheral reflexes
40
infectious cause of SAH in a sexually active young adult?
Syphillis Causes intracranial arteritis Tx - PCN
41
Six of phenytoin toxicity?
Earliest - nystagmus on lateral gaze blurred vision, diplopia, ataxia, slurred speech, lethargy, AMS Late - coma
42
Best way to visualize head injury 2/2 trauma in an infant?
CT | no ultrasound - this is better for intraventricular hemorrhage in premies
43
1st line to prevent cluster HA?
Verapamil
44
Teenager describing feeling sleepy all the time, falls asleep at inappropriate times, hallucinations surrounding sleep, or cataplexy
c/f narcolepsy, needs a sleep study
45
1st line tx for narcolepsy
Modafinil | Sleep hygiene
46
Narcoleptic patient has cataplexy triggered by emotion. Dx?
Venlafaxine
47
ipsilateral face loss of pain/temperature Contralateral body loss of pain temp ipsilateral body weakness Vestibular syx - Nystagmus, vertigo, ipso limb ataxia, Horner's syndrom Face motor function spared What is this?
Wallenberg syndrome | Lateral medullary infarct d/t occlusion of PICA or vertebral a.
48
Tongue deviates toward lesion Contralateral body with paralysis Where is the lesion?
Medial Medullary syndrome (alternating hypoglossal hemiplegia) occlusion of vertebral or ACA
49
Contralateral ataxia Hemiparesis of face, trunk, limbs Where is the lesion?
Medial mid-pontine infarction | Ataxic hemiparesis
50
What should be ruled out if you are concerned about dementia?
Anemia Folate/B12 levels hypothyroidism Depression
51
Common age range for febrile seizure?
3month - 6 years
52
Progressive weakness following URI Loss of sensory, urinary retention Dx?
Transverse myelitis
53
Cushing's triad of intracranial hemorrhage
Bradycardia HTN Respiratory depression
54
eye with down and out palsy
CN III
55
dementia with lots of personality changes
Frontotemporal dementia
56
Tx for Parkinsons
``` Dopa agonist (pramipexole) or Levodopa Prefer pramipexole in younger pmts because of the long term side effects of levodopa ```
57
If you suspect NPH wait is the first step in management?
LP | If syx get better --> VP shunt
58
Pt has involuntary closing of R eye in response to bright light Dx, Tx?
Focal dystonia (blepharospasm) Older women are predisposed Tx - Botox
59
Pt has stroke symptoms and cannot lift the affect eyebrow or corner of mouth
``` Bells palsy (CN VII), CVA has preservation of forehead and eyebrow movements because upper motor portion of CN VII is in a different location than the lower branch ```
60
``` Unilateral lower extremity weakness Muscle cramping in same extremity Atrophy on exam, fasciculation's in face and tongue difficulty chewing Dx? ```
ALS
61
What is Riluzole?
ALS treatment Glutamate inhibitor Doesn't cure, but prolongs survival and delays need for trach
62
Cut off for carotid endarctectomy?
Symptomatic stenosis 70-99%and life expectancy > 5years
63
Infant with developmental delay, seizures, hypopigmented "ash-leaf spots"
Tuberous scleorsis AD de novo in 80% of cases EEG is indicated as their seizures worsen over time
64
Usual cause of death in tuberous sclerosis?
Neurologic problems | epilepsy
65
``` Pt with headaches lost pupillary reaction Vertical gaze restriction loss of balance while walking dx? ```
pituitary adenoma Parinaud's syndrome Some can also secrete HCG and cause precocious puberty in males
66
IF you suspect a brain bleed and pt has down and out eye finding, ptosis, anisocoria, where is the bleed likely to be?
PCA aneurysm | lesion in CN III
67
How do you assess respiratory effort in a pt suspicious for Guillain-Barre?
Check tidal volume and negative inspiratory force (vital capacity)
68
Who should receive plasma exchange in Guillain- Barre?
If non ambulatory and six present <4 wks | Shortens the time to full recovery
69
Most common complication in spina bifida?
Neurogenic bladder - nearly universal Result of folate deficiency during pregnancy Elevated alpha-fetoprotein on maternal screenings Over half of patients will have hydrocephalus after repair and require a VP shunt Neurogenic bowel also common and require a bowel regimen
70
Workup for suspected SAH
CT - can be negative especially if >6 hours since symptom onset followed by LP
71
b/l band HA without throbbing
Tension type HA
72
throbbing headache
Migraine
73
After a Carotid endarterectomy pt has tongue deviation. Which nerve is affected?
Hypoglassal
74
Pt has dysphonia after a carotid endarterectomy is d/t damage to?
Recurrent Laryngeal
75
Asymetric smile after carotid endarterectomy is damage d/t?
Facial nerve
76
Pt has absent CN. How do you confirm brain death?
Apnea testing
77
sudden onset but transient monocular blindness
Amaurosis fugax Caused by carotid archery atherosclosis Often have a carotid bruit Need carotid dopplers
78
Bells palsy + hepatosplenomegaly suggests?
Sarcoid | Can have uveitis, arthritis, CNS findings with infiltrate of organs
79
what confirms dx of sarcoid?
LN Bx with noncaseating granulomas
80
work up for reversible causes of dementia?
CBC CMP TSH B12
81
1st line tx for dementia?
Acetylcholinesterase inhibitors Donepezil, rivstigmine, galantamine 2nd line - NMDA receptor antagonist; memantine
82
h/o febrile seizures increases risk of?
Recurrence | Epilepsy
83
What is construction apraxia?
Pt is unable to copy a drawing. Lesion in non dominant parietal lobe Can also have dressing apraxia (difficulty putting on a coat or pants)
84
Unable to do math, name fingers, write, and confuses R/L | Dx and location of lesion?
Gerstmann syndrome | Dominant parietal lobe
85
deficit in visual field, unable to interpret complex sounds | Where is lesion?
non dominant temporal lobe
86
deficit in visual field aphasia Dx and location?
Wernicke's aphasia | Dominant temporal lobe
87
Parkinson's patient with psychomotor slowing and blunted affect. Tx?
Add SSRI, underlying depression
88
best way to dx epidural abscess?
MRI
89
what medications increase risk of pseudo tumor?
acne treatments, irsotretinoin and minocycline
90
leg with generalized spike and wave
absence sz
91
how is management after spa different from non spa cva
no anti platelet | keep bp <185/100 to avoid hemorrhagic conversion

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