NEUROLOGY Flashcards
(133 cards)
1
Q
Shortly after a pregnant pt receives a spinal block, she develops N/V, headache that worsens with sitting up, photophobia, diplopia, neck stiffness, and tinnitus. What is her DX?
A
postdural puncture headache. TX is epidural blood patch
2
Q
Brain MRI: multiple well-circumscribed lesions with vasogenic edema AT THE GRAY AND WHITE MATTER JUNCTION
A
brain cancer
3
Q
What cancer mets cause multiple lesions in the brain?
A
lung > melanoma
4
Q
CD4 count for cerebral toxoplasmosis
A
<100
5
Q
head CT/MRI: multiple ring-enhancing lesions
A
- toxoplasmosis in ADULTS (kids w/ congenital DZ do not have this finding)
- brain abscess (usually singular if spread from head/neck infx, multiple if spread hematogenously)
6
Q
TX for brain abscess
A
surgical excision or needle aspiration followed by IV abx
7
Q
Pt presents with headache, seizure, neurological sxs after recent history of dental infx.
A
Brain abscess
8
Q
Simple vs complex febrile seizure
A
- simple = generalized, <15min, resolve spontaneously, do NOT recur in 24hr period
- complex = focal, >15min, may recur in 24hr period
9
Q
What DX should you consider in a child with febrile seizure and preceding abx use (or febrile seizure and AMS)?
A
must r/o meningitis
10
Q
3-Hz spike wave on EEG. TX?
A
ethosuximide (absence seizure, most self-resolve before puberty)
11
Q
Abnormal brain activity in 1 cerebral hemisphere; presents as unilateral convulsing, writhing, stiffening
A
focal seizure
12
Q
Lack of sleep, flashing lights, emotional stress are triggers for
A
generalized seizure
13
Q
Pt presents to ED confused, after an episode of sudden LOC with urinary incontinence and perioral cyanosis. No hx of similar. What should you order?
A
- head CT w/o contrast (r/o bleed or mass)
- urine tox
- labs (r/o metabolic cause of seizure)
- MRI & EEG (any abnormalities = start AED)
14
Q
18y/o F presents to ED with Mom for evaluation of repeated episodes of head turning and hip thrusting. No confusion or sleepiness following these episodes. PMHX of epilepsy and depression. DX?
A
video EEG (psychogenic nonepileptic seizure; tx will be CBT)
15
Q
MCC Of breakthrough seizure
A
subtherapeutic drug levels –> check serum levels
16
Q
Pt w/ PMHx of epilepsy was previously well-controlled, but recently had a seizure. She wants to drive.
A
NO cannot x 3 months min. (depends on state law)
17
Q
4 types of generalized seizures
A
tonic clonic, myoclonic (jerking, no LOC or postictal), atonic (sudden LOC), absence
18
Q
Retrograde and anterograde amnesia, confabulation, hx of chronic alcoholism. Damage to mamillary bodies in the brain.
A
Korsakoff syndrome
19
Q
Acute oculomotor dysfx (nystagmus, eye muscle paralysis) with hx of chronic alcoholism.
A
Wernicke encephalopathy, TX w/ thiamine infusion
20
Q
Child w/ papilledema and intractable vomiting. High AST/ALT. Recent hx of cold.
A
likely Reye syndrome (no tx for this)
21
Q
MRI: temporal lobe edema
A
herpes encephalitis
22
Q
CSF: normal glucose, high protein, high WBC & RBC
A
viral meningitis
23
Q
CSF: low glucose, high protein, high WBC
A
TB meningitis OR fungal meningitis
24
Q
CSF: normal glucose, high protein, high RBC
A
traumatic tap
25
CSF: normal glucose, high protein, normal RBC & WBC
Guillain Barre
26
MC organism of bacterial meningitis
Strep pneumo
27
Bacterial meningitis TX ages 2-50
vanco + 3rd gen ceph (ceftriaxone, cefotaxime)
28
Bacterial meningitis TX age >50
vanco + 3rd gen ceph (ceftriaxone, cefotaxime) + ampicillin
29
Aside from abx, what else should you give for bacterial meningitis TX
dexamethasone (prevent hearing loss) -- d/c once cultures r/o strep pneumo infx
30
Dull headache, N/V, papilledema, focal neurologic deficits, sxs worse at night -- suspicious for?
brain tumor
31
Amenorrhea, galactorrhea, vision changes
pituitary adenoma
32
Window for TPA administration in an ischemic stroke
4.5 hours from symptom onset
33
TX for ischemic stroke with sxs that started 6 hours ago
ASA & statin
34
biggest RF for ischemic stroke
HTN
35
hemorrhage on CT. hx of ischemic stroke in the past 3 months. spinal lesion or recent brain/spine surgery. BP > 185/110. A/C use with INR >1.7. PLT < 100,000 or glucose <60
These are exclusion criteria for?
TPA use for ischemic stroke
36
Pure motor hemiparesis (no headache, seizures, aphasia, vision changes, AMS)
lacunar infarcts (noncortical stroke)
37
Where's the stroke: upper extremity weakness, hemineglect, aphasia
MCA
38
Where's the stroke: contralateral leg weakness
anterior cerebral artery
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Where's the stroke: visual deficits
posterior cerebral artery
40
Where's the stroke: ataxia, dizziness, nystagmus
cerebellum
41
Aphasia is a symptom of stroke involving the MCA, which supplies Wernicke's and Broca's areas in the frontal lobe. What types of aphasia do these areas cause, respectively?
Wernicke's = receptive aphasia (fluent but meaningless, "word salad")
Broca's = expressive aphasia (loss of language)
42
If CT w/o contrast is negative but there is still high suspicion for SAH, what test is next?
LP (+ = xanthochromia, elevated opening pressure)
43
BV involved in epidural hematoma
middle meningeal artery
44
Ipsilateral pupillary dilation ("blown") & contralateral hemiparesis -- after head trauma
SUSPECT UNCAL HERNIATION (complication of epidural hematoma that has expanded) -- neurological emergency
45
TX for epidural hematoma
emergency surgical evacuation if sxs (if no sxs or small, ICU observation)
46
BV involved in subdural hematoma
bridging veins
47
BV involved in SAH
posterior communicating artery (berry aneurysm)
48
TX for high ICP
mannitol, elevate head of bed
49
68y/o M tripped and had a minor fall hitting his head. Next steps?
head CT for ANYONE OVER 65y/o regardless of mechanism
50
What is the GCS cutoff for head CT
any abnormal score (<15) gets CT
51
Pt brought to ED after MVC, obtunded. CT: numerous punctate hemorrhages w/ blurring of gray-white matter.
diffuse axonal injury
52
Shuffling gait, cognitive decline, urinary incontinence.
normal pressure hydrocephalus
53
Preventive TX for cluster headache
verapamil
54
Hemiplegic migraines last only a few hours before resolving completely and are most common in
teenagers
55
Acute TX for migraine
acetaminophen -- if refractory, triptan OR ergotamine (NOT TOGETHER, will cause severe vasoconstriction)
56
Preventive TX for migraine
BB (propranolol, metoprolol) > antidepressants (TCAs, venlafaxine) or AEDs (topiramate, valproate)
57
Persistent motor tics AND vocal tic x 1 year
Tourette syndrome
58
Motor weakness, unilateral optic neuritis (blurry vision, painful eye), bladder/bowel dysfx, tingling in arms & back, HYPERreflexia
MS
59
Lhermitte sign and Uthoff phenomenon are associated with
MS
60
MRI: multifocal ovoid subcortical hyperintense lesions in WHITE matter
MS. T2-weighted
61
Suspect a pt has MS but imaging was unclear. What is your next test?
LP - shows oligoclonal IgG bands
62
Bilateral trigeminal neuralgia should raise suspicion for
MS
63
TX for acute MS flare
IV steroids -- plasmapheresis if refractory
64
TX for MS maintenance
interferon beta & glatiramer acetate (these are disease-modifying agents)
65
Degeneration of dopamine-producing neurons in the substantia nigra
Parkinson
66
Resting tremor, rigidity, shuffling gait ... then later dementia may develop. TX?
1. L-dopa or pramipexole (dopamine agonist)
2. if needed, can switch to selegiline (MAO inhibitor) or amantadine (NMDA antagonist)
67
Older pt w/ gradual progressive memory & cognitive decline. MRI: generalized cerebral atrophy. TX?
donepezil, rivastigmine (cholinesterase inhibitors) or memantine (NMDA antagonist)
68
Focal neurologic sxs and executive dysfunction that progresses step-wise. Hx of HTN, DM, smoking. MRI: white matter hyperintensities
Vascualar dementia
69
Cognitive decline, visual hallucinations, parkinsonism - develops all around the same time.
Lewy body dementia
** if parkinsonism develops FIRST, then parkinson disease w/ dementia **
70
Personality and behavior changes first, then memory deficits in a younger old person
frontotemporal dementia (progresses faster)
71
After injury to a joint: pain out of proportion to injury on exam, temp changes, color changes (blue mottled skin), swelling
complex regional pain syndrome
72
Older pt who did strenuous activity and now have weakness/sensory deficits following a dermatome or myotome. Test?
MRI C-spine (cervical radiculopathy)
73
Nerve root: tingling on lateral upper arm
C5
74
Nerve root: tingling on thumb & index finger
C6
75
Nerve root: tingling on dorsal forearm & middle finger
C7
76
Nerve root: tingling on ring & pinky fingers
C8
77
Nerve root: tingling on medial forearm
T1
78
Basophilic stippling, microcytic anemia, hyperuricemia.
lead poisoning
79
T/F: Avoid benztropine in older adults
T (risk of urinary retention and cognitive impariment)
80
TX cytomegalovirus
ganicyclovir
81
T/F: Avoid benzos in older adults
T (can worsen cognition) - if agitated, use antipsychotics
82
Ataxia indicates an issue w/ what part of the brain
cerebellum
83
Bell's palsy is CN __
7, involves the entire half of face including upper
84
TX trigeminal neuralgia
carbamazepine
85
Lambert-Eaton syndrome
progressive proximal muscle weakness -- paraneoplastic syndrome associated w/ small cell lung cancer
86
T/F: MG improves w/ rest and worsens w/ use
T
87
descending weakness/paralysis
botulism
88
immune-mediated demyelination of peripheral nerve fibers, causing ascending weakness & hyporeflexia
Guillain-Barre. *usually follows GI/respiratory infx*
89
Guillain Barre TX
IVIG or plasmapheresis. Monitor respiratory/autonomic fx
90
T/F: delirium is worse at night
T
91
When is the only time you should use benzos first line for elderly?
alcohol or opioid withdrawal
92
When is LP contraindicated
+signs of elevated ICP (could cause brain herniation) --> imaging to r/o high ICP first
** UNLESS pt is a baby w/ open fontanelles**
93
T/F: cerebral AV malformations are congenital and increase risk for spontaneous hemorrhage/seizures.
T
94
Flaccid paralysis is d/t lesions in: (peripheral or central NS)
peripheral
95
Spastic paralysis & hyperreflexia is d/t lesions in: (peripheral or central NS)
central (issue w/ upper motor neurons)
96
Carbamazepine S/E
liver failure (hyperammonia, hepatic encephalopathy, seizure)
97
If temp >104F, think
heat stroke
98
T/F: antipyretics are helpful for heat stroke
F - rapid cooling & IVF resuscitation are mainstay of tx
99
Diffuse rigidity and fever after anesthesia (ie. succinylcholine)
malignant hyperthermia
100
Obese women of childbearing age w/ frequent headache and visual disturbances and papilledema but head CT is negative. LP relieves sxs.
idiopathic intracranial hypertension
101
TX for idiopathic intracranial hypertension
weight loss & acetazolamide
102
Essential tremor is an action or resting tremor?
action
103
Describe parkinsonism tremor
resting tremor - on handwriting test, the letters get smaller
104
2 genetic abnormalities that can cause hypotonia in infancy
Down syndrome + Fragile X syndrome
105
NONfluctuant scalp swelling on an infant after birth trauma, does not cross suture lines. TX?
none, cephalohematomas resolve spontaneously
106
Diffuse fluctuant scalp swelling on an infant after birth trauma, crosses suture lines. TX?
admit to NICU - subgaleal hemorrhage can lead to massive blood loss & is life-threatening
107
Prolactinoma TX
dopamine agonist (ie. cabergoline)
* other pituitary adenomas get surgical resection*
108
When clinician flexes pt's neck, their knees & hips flex too
Brudzinski sign
109
When clinician flexes pt's hip and tries to extend the knee, this motion is resisted OR the other knee flexes in response
Kernig sign
110
MCC intracerebral hemorrhage in children
cerebral AV malformation
111
When sole of foot is stroked, toes fan out. This indicates...
CNS lesion (MS, stroke, etc.)
112
MCC nontraumatic intracerebral hemorrhage
HTN
113
Where is the hemorrhage: pinpoint pupils, decerebrate posturing, coma
pons
114
Causes of central vertigo (3)
stroke (cerebellar), MS, migraine
115
Central or peripheral vertigo: vertical nystamus, nonfatigable, cannot walk
central (remember vertigo can be in any direction)
116
Central or peripheral vertigo: multidirectional that stops w/ fixation of gaze, hearing loss
peripheral (can be any direction EXCEPT purely vertical)
117
What kind of meningitis presents with a petechial rash?
meningococcal
118
What does +Romberg test mean?
sensory/peripheral ataxia (vit B12 deficiency or syphilis)
119
Next steps for fever, severe focal back pain, bowel/bladder dysfx, sensory deficits in the legs following epidural administration. No PMHx of cancer or trauma.
MRI to eval for spinal epidural abscess
** CCS only recommended for suspected cauda equina 2/2 trauma or malignancy**
120
13y/o boy presents with new-onset myoclonic and tonic-clonic seizures that occur in the morning, especially when he has stayed up late the night before. Hx of absence seizures in childhood that self-resolved 3 years ago. He is otherwise healthy. DX?
juvenile myoclonic epilepsy (TX = valproate)
121
TX concussion
rest x 24 hours, then gradual return to normal activity
122
MRI: atrophy of caudate nucleus & putamen.
Genetic testing: autosomal dominant CAG repeats
Huntington DZ
123
Executive dysfunction, abrupt jerking movements of the extremities/face, FHX of similar (death in ~10 years)
Huntington DZ/chorea
124
What CN is most likely to be damaged in a temporal bone fracture w/ hemotympanum?
CN VII (facial n) -- runs by the cochlea
125
What CN is most likely to be damaged in a penetrating neck trauma or occipital bone fracture?
CN XII (hypoglossal)
126
What CN is most likely to be damaged in a acceleration-deceleration trauma?
CN I (olfactory)
127
T/F: Lithium causes a fine tremor that usually decreases over time
T
128
+jaw jerk reflex (tapping on the chin w/ mouth slightly open causes the jaw to close).
Increased muscle tone in extremities, atrophy of intrinsic hand/feet muscles.
ALS
129
Soft boggy swelling of the head present at birth, crosses suture lines.
caput succedaneum (benign, self-resolves in days)
130
Who should get a carotid endartectomy?
carotid stenosis >70% with symptoms (stroke, TIA)
131
Status epilepticus definition
5+ min of seizure activity OR 2+ seizures w/o recovering consciousness
132
Status epilepticus TX
BENZOS
(AEDS are added for refractory)
133
What CN is responsible for corneal reflex/sensation?
V1 branch of trigeminal (CN V)
