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Flashcards in Neuro and optho Uworld Deck (199):
1

lacunar infarct causes what

pure unilateral motor impairment
pure sensory stroke
no visual field abnormalities

2

middle cerebral a occlusion signs

contra somatosensory loss contra motor loss
conjugate eye deviation toward infarct side
homonymous hemianopia
aphasia (if left hemisphere aka dominant)
hemineglect of the non dominant hemisphere (right)

3

anterior cerebral artery occlusion signs

contra somatosensory and motor deficit
mainly in lower legs
dyspraxia, emotional disturbances and urinary incontinence

4

most common cuases syringomyelia

spinal cord injury and arnold chiari malformations

5

what nerve controls hip and knee flexion

femoral

6

what causes intracranial HTN

trauma, space occupying lesions, hydrocephalus, impaired CNS venous outflow and idiopathic(pseudotumor cerebri)

7

patient with otitis and now mastoiditis, next step?

Brain CT to look for brain abscess, likely temporal

8

what type of neuronal signs in ALS

upper and lower

9

symptoms and signs of friedreich ataxia

necrosis and degeneration cardiac muscle fibers, myocarditis, myocardial fibrosis, cardiomyopathy
T wave inversion

10

T wave inverison alone is suggestive of what pathologie

myocarditis, MI, old pericarditis, Myocardial contusion and dig toxicity

11

what can cause carotid artery dissection

penetrating trauma
fall with object in mouth
neck maniputlation (yoga and sports)

12

personality change means that what lobe is affected

frontal

13

CT/MRI findings glioblastoma

butterfly appearance with central necrosis

14

what happens with prolonged seizures

cortical laminar necrosis

15

pronator drift is sensitive and specific for what

UMN injury

16

main risk factory for CP

prematurity

17

phenytoin use during pregnancy, child will have

fetal hydantoin syndrome
midfacial hypoplasia, microcephaly, cleft lip and palate, digital hypoplasia, hirsutism and developmental delay

18

Aminoglycoside adverse effect

ototoxicity

19

what is used for absence seizures

ethosuximide and valproic acid

20

shakey baby syndrome will cause what inside

shearing subdural veins and retinal hemorrhages

21

course of presentation for intracerebral hemorrhage

focal neurologic symptoms early
later develop nausea and vomiting from ICP

22

brain death, still have preserved what function sometimes

DTRs

23

what dementia can cause visual hallucinations

lewy body

24

multuple circumscribed lesions on both sides of brain along junction grey and white matter

secondary mets
likely lung or melanoma

25

solitary brain masses are usually from what CA

breast, colon or renal cell

26

what is primidone used for

essential tremor
it converts into phenylethylmalonamide and phenobarbital

27

primidone may precipitate what

acute intermittent porphyria

28

how does acute intermittent porphyria present

abdominal pain, neuro and psychiatric abnormalities

29

how do Dx acute intermitten porphyria

check for urine porphobilinogen

30

Tx viral conjunctivitis

cool moist compresses

31

immediate manamgent of central retinal artery occlusion

ocular massage and high flow O2

32

Tx exertional heat stroke

immersion in ice water after stabilized with IV fluids

33

what are signs of uncal herniation

compression of contralateral crus cerebri causes ipsi hemiparesis
compression ipsi occulomotor nerve cause mydriasis ptosis and down out gaze
compression ipsi posterior a causes contralateral homonymous hemianopsia
compression reticular formation will cause LOC and coma

34

transtentorial uncal herniations can be secondary to what

space occupying lesions like epidural bleed

35

cushings reflex

HTN bradycardia and respiratory depression all from increased ICP

36

findings on MRI of meningioma

extra-axial well circumscribed and homogenously enhancing dural based mass

37

signs of niemann pick

loss of motor milestones, hypotonia, feeding difficulties cherry red macula
!! different the tay sachs because also will have hepatosplenomegaly and Areflexia
tay sachs has hyperreflexia

38

niemann pick is deficiency in what

spingomyelinase

39

next step for enlarging head circumference in child

CT of brain

40

complications of prematurity

RDS
PDA
bronchopulmonary dysplasia
intraventricular hemorrhage
necrotizing enterocolitis
retinopathy

41

NPH is due to

decreased CSF absorption

42

how to check for phenylketonuria

quantitative aa analysis
or tandem mass spectrometry

43

signs phenlyketouria

severe intellecual disability
seizures
musty odor
hypopigmentation involing hair skin eyes and brain nuclei

44

incidence of Intraventricular hemorrhage is inversely proportional to what

birth weight

45

first line for migraines assoc with vomiting

prochloperazine (antiemetic)

46

presence of EBV DNA in CSF

primary CNS lymphoma

47

MRI of CNs lymphoma

ring enhancing mass that is solitary and periventricular

48

wallenberg syndrome

vertigo, fall to side of lesion
diplopia and nystagmus
ipsi limb ataxia

abnormal facial sensation or pain
loss of pain and temp ipsi face contra trunk and limbs

dysphagia and aspiration
hoarseness
ipsi horners
intractable hiccups
lack of automatic respiration

49

what artery occlusion causes wallenbergs

intracranial vertebral artery

50

side effects trihexyphenidyl

anticholinergic: blurred vision, constipation, vomiting
headache, dizziness, tachycardia

51

Tx myasthenic crisis

plasma exchange

52

CMV retinitis signs

yellow whiteish patches retinal opacification and retinal hemorrhages

53

Tx CMV retinits

ganciclovir or foscarnet

54

presentation sturge weber

focal or generalized seizures, mental retardation and port wine stain along trigeminal nerve
can have hemianopia, hemiparesis and hemisensory disturbances

55

intracranial calcifications resembling tramline

sturge weber

56

bilateral loss central vision

macular degeneration

57

HTN hemorrhage with contralateral hemiparesis and hemianesthesis and conjugate gaze deviation to side of lesion

putamen (basal ganglia bleed) because affects internal capsule

58

effects of parietal hemorrhage

contralateral hemi sensory loss

59

Cauda equina syndrome

compression spinal nerve roots from metastatic prostate CA
can lose anal sphincter innercation, lose parasympathetic to bowel and bladder
LMN Sx

60

conus medullaris syndrome

sudden onset with severe back pain and have hyperreflexia

61

signs hypokalemia

weakness, fatigue, muscle cramps
flaccid paralysis hyporeflexia, tetany and rhabdomyolysis
EKG shows broad T waves and U waves, ST depression and PVC

62

periodic sharp waves on EEG

prion disease

63

rapidly progressing dementia and myoclonus

prion disease

64

gradually worsening severe low back pain that is worse at night laying down and have symmetric weakness with absent DTRs early on. later develop hyperreflexia and babinski

spinal cord compression

65

Tx spinal cord compression

EM MRI
IV glucocorticoid
rad/onc or neurosurg consults

66

first line for alzheimers

cholinesterase inhibitors like donepezil, galantamine, rivastigmine

67

what is sympathetic opthalmia

immune mediated inflammation of one eye after penetrating injury to other. "uncover hidden Ag"

68

Shy Drager syndrome

multiple system atrophy
parkinsonism, autonomic dysfunction and widespread neurologic signs including cerebellar, pyramidal and LMN

69

patient with parkinsonism has othostatic hypotension incontinence and other ANS Sx

suspect shy drager

70

infant with fialure to thrive, bilateral cataracts jaundice an dhypoglycemia

Galactose 1 phosphate uridyl transferase deficiency aka Galactossemia

71

patient with galactossemia are at increased risk for what

E coli neonatal sepsis

72

gradual loss peripheral vision

open angle glaucoma

73

atrophy caudate

huntingtons

74

baby crying goes pale and passes out

breath holding spell, normal in 6 mo - 2 yr

75

side effect expected early on after initiation levodopa/carbidopa

hallucinations and dyskinesia

76

amantadine side effects

ankle edema and livedo reticularis

77

Wernicke encephalopathy

encephalopaty, ocular dysfunction, gait ataxia
from alcohol

78

Tx wernicke

thiamine and glucose

79

drug for trigem neuralgia

carbamazepine

80

prophylaxis for cluster HA

verapamil, lithium, and ergotamine

81

treatment for acute cluster HA

100% O2 and subcutaneous sumatriptan

82

transient pain in right UE and LE. right hemianesthesia, mild athetosis right hand
strength is preserved in all 4
lesion is where?

thalamus "thalamic pain phenomenon"

83

Tx for migrain in children

supportive like laying in dark and then administration of acetominophen or NSAID

84

gonococcal conjunctivitis

copious exudates and eyelid swelling at age 2-5

85

Tx gonococcal conjunctivitis

hospitalization
dose of ceftriaxone or cefotaxime

86

NF1 characteristics

cafe au lait spots, macrocephaly, feeding problems, short stature and learning disabilities

87

acute ischemic stroke, hemorrhage rule out, next step?

fibrinolytic therapy if within 3-4.5 hours

88

Leschy nyhan mutation

x linked recessive. hypoxanthin guanin phosphoribosyl transferase

89

glucocorticoid induced myopathy

progressive muscle weakness and atrophy without pain
lower extremity more common

90

arm helf in external rotation cannot internall rotate

axillary nerve damaged

91

triad epidural abscess

fever, severe focal back pain and neuro deficits
progressive symptoms of radiculopathies and motor/sensory deficits

92

Dx spinal epidural abscess

MRI spine with gadolinium

93

Tx spinal epidural abcess

immediate surgical decompression

94

what pathogen is assoc with guillain barre

Campylobacter jejuni

95

high velovit injury to the high has a higher probability for what

globe penetration an intraocular foreign body so use fluorescein to look

96

causes of delerium

drugs
infection
electrolytes
metabolic derrangments
systemic illness
CNS

97

Sx of facial palsy upper and lower

cannot do brow movements
cannot close eyes

98

visual hallucinations are in what dementia

lewy body

99

what is trachoma

caused by chlamydia trachomatis, cuase blindness worldwide

100

sigsn trachoma

follicular conjunctivitis and pannus(neovascularization) in cornea

101

Tx trachoma

topical tetracycline and oral azithromycin

102

acute angle closure

more common in asian women
severe eye pain with halos around lights
pupil is dilated and poorly responds to light
HA with nausea and vomiting

103

Tx pseudotumor cerebri

acetazolamide is first line
inhibits choiroid plexus carbonic anhydrase

104

diffuse cortical and subcortical atrophy in temporal and parietal lobes

alzheimer

105

Dx vasospasm post subarachnoid hemorrhage

CTA

106

how to prevent vasospams post subarachnoid hemorrhage

nimodipine

107

tremor in parkinsons

4-5 Hz. better with intention. resting tremor

108

straight lines now appear wavy

macular degeneration

109

HIV patient with ekratitis fundoscoy show pale peripheral retinal lesions and central necrosis of retina

Herpes simplex

110

most common predisposing factor to orbital cellulitis

bacterial sinusitis

111

signs orbital cellulitis

proptosis, ophthalmoplegia and diplopia

112

affect of young child with meningtisi

regression of milestones

113

most common cause lumbar spine stenosis

degenerative joint disease

114

signs lumbar spine stenosis

worse when walking downhill because extends spine. weakness, senory loss, numness
confirm by MRI

115

male with sudden onset red left eye with photophobia nausea and severe HA. no trauma. nonreactive mid dilated left pupil

acute angle closure glaucoma

116

what medication can precipitate acute angle closure

decongestants

117

trigem neuralgia is common in what population

women with MS

118

sensory of cornea is innervated by

trigeminal nerve, V1

119

pathogens causing brain abscesses

strep viridans
staph aureus
gram negative

120

solitary ring enhancing lesion on brain CT with fluid collection in ethmoid sinus

brain abscess

121

why are patients with Digeorge higher risk brain abscess

have the VSD which provides access to brain arterials without going through lung first, escaping lung mechanisms to rid infections and pathogens.
if vignette says child with multiple sinusitis, suspect brain abscess

122

auras are indicative of what type seizure

focal area so partial seizure

123

complex partial seizure

automatisms with the LOC

124

partial seizure iwth secondary generalization

tonic clonic manifestations like diffuse muscle aches and elvated CPK

125

treatment trigeminal neuralgia

carbamazepine

126

adverse effect carbamazepine

aplastic anemia, need routine CBC

127

Fetal alcohol syndrome characteristics

small palpebral fissures
smooth philtrum
thin vermilion border

can have microcephaly

128

long narrow face, prominent forehead and chin
large ears
macrocephaly
macroorchidism

fragile X syndrome

129

causes of hemiplegia in children

seizure, intracranial hemorrhagic, ischemic stroke, hemiplegic migraine

130

Signs craniopharyngioma

remnants of rathke pouch
can cause bitemporal hemianopsia
can cause endocrinopathies from compression pituitary stalk
suprasellar calcified mass on imaging

131

what is opthomalogic manifestation NF1

optic glioma

132

gait distrubance with medulloblastoma

truncal ataxia

133

bitemporal hemianopsia and decreased libido

likely craniopharyngioma

134

Tx restless leg syndrome

first line is dopamine agonist pramipexole
alternate is alpha 2 delta Ca channel ligands like gabapentin

135

presbyopia

loss of lens elasticity
needed to focus on near objects

136

DM II with fatigue urinary frequency and increased blurry vision and leg cramps. all after respiratory infection. high BP. dry mucous membranes urine + glucose negative for ketones
whats causing vision blurriness?

hyperosmolarity from non ketotic hyperglycemia causing osmotic diuresis and dehydration

137

postconcussive syndrome

HA confusion, amnesia, difficulty concentrating with multitasking, vertigo, mood alteration, sleep disturbance and anxiety

138

side effect metoclopramide

dystonic reaction because it is a dopamine R antagonist
can cause agitation, tardive dyskinesia and dystonic reactions and parkinsonism

139

how to counteract dystonic reaction from metoclopramide

benztropine or diphenhydramine

140

basal ganglia hemorrhage signs

contralateral hemiparesis and hemisensory loss
homonoymous hemianopsia
gaze palsy

141

thalamus hemorrhage signs

contra hemiparesis and hemi sensory
nonreactive miotic pupils
upgaze palsy
eyes deviate towards hemiparesis

142

pinpoint reactive pupils. where is hemorrhage

pons

143

most common etiology of basal ganglia hemorrhage

HTN vasculopathy

144

best Dx acoustic neuroma

MRI with gadolinium

145

homocystinuria

intellecual disability
thrombosis
megaloblastic anemia
fair complexion
tall stature
join hyperlaxity
scoliosis

146

What is mechanism of diabetic oculomotor nerve neuropathy

ischemic of the somatic fibers, does not affect parasympathetic so reactive to light still

147

conjuctival appearance in allergic conjunctivits

follicular or bumpy conjunctival edema (chemosis)

148

lacunar strokes affect what areas

basal ganglia
internal capsule
pons

149

risk factor lacunar strokes

HTN
DM smoking, age, and high LDL
cause lipohyalinosis

150

painful eye with very red sclera and opacification and ulceration of the cornea

contact lens assoc keratitis
usually due to pseudomonas and serratia
medical EM

151

Tx pseudomonal keratitis

topical broad spectrum antibiotics

152

Anterior cord syndrome

burst fracture in vertebrae
lose motor below and loss pain and temp on both sides below lesion
get MRI

153

NF patient with HA nausea and vomiting. next step

order brain and orbital MRI

154

another name for vasovagal syncope

neurocardiogenic

155

loss of conjugate gaze

MLF disruption

156

what meds can cause pseudotumor cerebri

hypervitaminosis A (acne)

157

most important risk factor for stroke

HTN >smoking

158

central cord syndrome

weakness in UE more than lower. selective loss of pain and temp in arms from damage to spinothalamic tract

159

type of injury for central cord syndrome

hyperextension

160

mutation in fragile X

CCG repeats causing abberant methylation

161

what is maintained in anterior cord syndrome

position vibration and touch

162

LP results in GBS

increased protein. normal everything else

163

what causes decreased glucose in LP analysis

bacterial meningitis or TB meningitis

164

what is pathology benight paroxysmal positional vertigo

crystalline deposits in semicircular canals that disrupt flow

165

Lambert Easton

autoAb against voltage gated Ca Ch in presynaptic motor nerve terminal, defective release Ach

166

tick borne paralysis

rapidly progressive ascending paralysis, can be asymmetrical and there are no sensory abnormalities and CSF is normal

167

complication of untreated pseudotumor cerebri

blindness

168

chalazion

painful swelling progress to nodular rubbery lesion

169

recurrent chalazion, next step

histopath examination

170

finding on patient with alcoholic cerebellar degeneration

gait dysfunction, truncal ataxia, nystagmus and intention tremor or dysmetria

171

pain and decreased visual acuity post cataract surgery

postop enopthalmitis
need humor sent for culture and gram stain

172

patient falling toward side of lesion

cerebellar tumor

173

2 year old with fever, irritability and lethargy, intermittend abdominal discomfort and losing weight. firm nodular mass in right flank with no bruits
multiple calcifications in renal area and increased homovanillic and VMA

neuroblastoma from neural crest cells

174

mets of neuroblastoma

bones, skull bone marrow liver, lymph nodes and skin

175

fundoscopy shows zones of whitened edematous retina and disctribution of retinal arterioles

displaced retinal embolus

176

Von Gierkes

glucose 6 phosphotase deficiency, type I glycogen storage disease

177

Sx von gierkes

hypoglycemia and lactic acidosis
hyperuricemia
hyperlipidemia
doll like face, thin extremities and short stature with protuberant abdomen

178

vitreous hemorrhage

sudden loss of vision and floaters. from diabetic retinopathy
loss of fundus details, and dark red glow

179

lab value increase in Vit B12 deficiency

methylmalonic acid

180

swelling over one cranial bone post birth with no discoloration

cephalohematoma

181

diffuse bruised swelling of newborn scalp

caput succedaneum

182

first line for acute angle closure glaucoma

mannitol IV

183

how does pilocarpine decrease inraocular P

open canals of schlemm to allow drainage

184

how dose timolol help IOP

decrease production aqueous humor

185

most common adult onset muscular dystrophy

steinert disease. musc dystrophy type 1

186

mutation in aduld onset musc dystrophy

auto dominant
CTG trinucelotide repease in DMPK gene on chrom 19q

187

signs of sadult onset musc dystrophy

facial weakness, weak handgrip
myotonia and dysphagia
testicular atrophy

188

inheritance duchenne and becker

x linked recessive

189

onset musc dystrophy age 2-3

duchenne

190

onset musc dystrophy age 5-15

becker

191

girl recently brok up with bF and passes out. slightly disoriented after

seizure. not syncope

192

what is riluzole

glutamate inhibitor used in ALS

193

NF2 mutation

chrom 22. nonsense of tumor supressor gene

194

wilsons disease labs

elevated LFTs
low ceruloplasm

195

signs of wilsons

tremor, rigidity, depression, paranoia, catatonia

196

insect bite to cheek. now both eyes swollen, no appetite, vomiting with fever. erythema and EOM restricted
tender to palpation over forehead

cavernous sinus thrombosis

197

dacrocystitis

infection lacrimal sac

198

changes in color perception. pain on eye movement

optic neuritis

199

psuedodementia

seem severely depressed without memory loss