Flashcards in Neurology Deck (97)
A pt presents with sensation of creeping and crawling sensation in legs and involuntary movements during sleep reported by spouse most likely suffers from ...
Restless leg syndrome
What is the treatment for restless leg syndrome?
(pramipexole or ropinirole)
A pt presenting with band-like back pain without radiation, bowel/bladder incontinence or retention in the setting of hx of cancer or recent trauma most likely suffers from ....
spinal cord compression
What is the most accurate test for spinal cord compression?
MRI of spine
(CT myelogram if MRI contraindicated)
What is the best initial treatment for suspected spinal cord compression?
high dose steroids
(radiation if cancer, decompression if disk herniation/ abscess)
A pt presents with impaired pain and temperature in cape like distribution (across neck and arms) most likely suffers from ....
What disease is Syringomyelia associated with?
Arnold Chiari malformations
A pt presents with distal spastic paresis (UMN injury), ataxia, impaired vibration and proprioception loss, hyperreflexia and plantar extension most likely suffers from ... due to ....
Subacute combined degeneration; vitamin B12 deficiency
A pt presents with flaccid paralysis (LMN injury) and impaired pain and temperature sens but vibration and pain sense are spared most likely suffers from ...
anterior spinal artery occlusion
What neurologic tract is responsible for pain and temperature sense?
spinothalamic tract (located centrally)
What neurologic tract is responsible for proprioception and vibration sense?
dorsal columns (fasciculus gracilis and fasciculus cuneatus)
What neurologic tract is responsible for upper motorneurons?
A pt presents with ipsilateral loss of all sensation at level of injury, ipsilateral spastic paresis below injury, ipsilateral proproception and vibration loss below injury and contralateral pain and temperature loss 2 segments below injury most likely suffers from ...
Brown-Sequard Syndrome (hemisection)
What is the best initial test for a pt presenting with sudden onset focal neuro deficit?
CT scan without contrast (detect hemorrhage)
A pt presenting with contralateral weakness and sensory loss that affects their leg more than their upper extremity most likely suffers from ...
anterior cerebral artery stroke
A pt presenting with contralateral weakness and sensory loss that affect their upper extremity and face more than their legs, with associated aphasia and/ or visuospatial defects most likely suffers from ....
middle cerebral artery stroke
What direction do the eyes deviate in a pt with a middle cerebral stroke?
toward the cortical lesion
A pt presenting with ipsilateral facial sensory loss and contralateral extremity sensory loss, with associated ataxia, vertigo, dyphagia and Horner's syndrome most likely suffers from ...
Wallenberg syndrome (posterior inferior cerebellar artery infarct)
A pt presenting with quadriparesis with intact vertical eye movements most likely suffers from ...
Locked in syndrome (due to occlusion of basilar arteries)
A pt presenting with cranial nerve 3 palsy with contralateral hemiplegia most likely suffers from ...
Weber syndrome (due to occlusion of penetrating branch of posterior cerebral artery)
A pt presenting with cranial nerve 3 palsy with contralateral ataxia/ athetosis (slow involuntary writing movements) most likely suffers from ...
Benedikt syndrome (due to occlusion of penetrating branch of posterior cerebral artery)
What is the treatment for stroke in the sequence given?
1. tPA (w/in 3 hours of onset)
2. aspirin (24 hours after tPA)
What is the next best step in management of a pt with recurrent stroke while on aspirin?
1. add dipyridamole to aspirin
2. switch to plavix
What is the treatment for subarachnoid hemorrhage?
nimodipine (to decrease risk of ischemic stroke)
When should an unruptured cerebral aneurysm be repaired?
if > 10 mm in size
When should carotid endartectomy be done for carotid artery stenosis?
1. > 70% occlusion and symptomatic
2. > 60% occlusion in asymptomatic man < 60 y/o
A pt presents with episode of convulsing and jerking movements that lasted a few minutes, incontinence, tongue biting, and disorientation after the episode most likely suffers from ....
.... are seizures characterized by tonic contraction of muscles throughout body followed by intermittent relaxation of muscles
generalized tonic-clonic (grand mal)
What is the best treatment for absence seizures?
(valproic acid is alternative)
.... are seizures in kids characterized by sudden, brief loss of conscousness without loss of postural tone
What is the characteristic pattern on EEG for absence seizures?
symmetric 3- Hz spike and wave discharge pattern
What is the treatment for status epiletpticus in sequence of adminstration? (4)
1. lorazepam/ diazepam
4. midazolam/ propofol (sedation)
What are side effects of phenytoin? (4)
1. CNS effects (diplopia, dizziness, ataxia)
2. gum hyperplasia
When should anticonvulsant therapy be initiated in a pt with first time seizure? (4)
1. abnormal neuro exam
2. presented w/ status epilepticus
3. strong family hx
4. abnormal EEG
What is the treatment of choice for myoclonic seizures (sudden, brief muscle contraction)?
What is the treatment of choice for atonic seizures (sudden loss of postural tone lasting seconds)?
What test should be done before stopping anticonvulsant therapy in a pt who has been free from seizures for 2-3 years?
A pt presents with "worst headache of their life" in which is has a rapid onset reaching peak severity rapidly, and nuchal rigidity most likely suffers from ....
Subarachnoid hemorrhage (thunderclap headache)
A pt presenting with deep, dull aching headache that disturbs sleep most likely suffers from ...
A pt with headache induced by coughing, lifting or bending or with vomiting preceding the headache by number of weeks most likely suffers from ...
posterior fossa tumor
A pt presenting with unilateral pounding headache associated with visual disturbances, jaw claudication, scalp tenderness and polymyalgia rheumatica most likely suffers from ...
What is the initial step in management for a pt with suspected temporal arteritis?
start steroids immediately (then obtain temporal artery biopsy)
A pt presenting with pulsatile, throbbing, unilateral headache that is aggravated by minor movement and associated with photophobia and/or phonophobia most likely suffers from ...
What is the definition of a complicated migraine?
severe neuro deficits persist after resolution of head pain
A pt presenting with tight, band like headache that is described as bilateral pressure and associated with neck tightness most likely suffers from ...
Tension type headaches
(tx: relaxation, NSAIDs, muscle relaxant)
A pt presenting with unilateral excruciating periorbital headches associated with rhinorrhea, lacrimation, congestiopn, and/or eye reddening most likely suffers from ..
What are abortive treatments used acutely for migraines?
What are prophylactic treatments used to prevent future episodes of migraine?
1. beta blocker
2. valproic acid
4. verapamil, TCAs, SSRIs
What is the treatment for acute episodes of cluster headaches?
100% oxygen (or triptans)
What is used as prophylactic treatment for cluster headaches?
calcium channel blocker
An obese women presents with headaches that are worse when lying down, visual disturbance and sixth cranial nerve palsy in association with use of OCPs and vitamin A for acne most likely suffers from ...
Pseudotumor Cerebri (Benign Intracranial Hypertension)
What is the most accurate test for Pseudotumor Cerebri (benign intracranial hypertension)?
lumbar puncture (normal except elevated opening pressure)
What is the treatment for Pseudotumor Cerebri?
1. weight loss (and stop offending agent)
3. repeated lumbar puncture
4. VP shunt (definitive tx)
A pt presenting with sudden, severe sharp pain on once side of the face that last seconds and can be triggered by touch/ chewing/ movement most likely suffers from ...
Trigeminal Neuralgia (Tic douloureux)
What disease is Trigeminal Neuralgia associated with?
What is the treatment for Trigeminal Neuralgia?
2. surgery (decompress trigeminal nerve)
A pt present with bilateral ascending weakness, sensory disturbances (pain, tingling), autonomic instability, and areflexia after suffering from a diarrheal illness weeks prior most likely suffers from ....
Guillain Barre Syndrome
What is the best initial test for Guillain Barre Syndrome?
Lumbar Puncture (albumino-ctylogic disassocation; elevated protein without elevated cellc count)
What is the treatment for Guillian Barre Syndrome?
IV immunoglobulin and plasmapheresis
What is the most accurate test for Guillian Barre Syndrome?
EMG (demyelination of peripheral nerves)
What is the most important step in management of a pt with Guillian Barre syndrome?
monitor vital capacity (to detect respiratory failure)
A pt presents with muscle weakeness, fatiguability, and diplopia/ ptosis that gets worse at the end of the day with associated nasal/ mushy voice and snarling muscle weakness of face while reflexes are intact most likely suffers from ...
A pt presenting with increasing muscle strength on repetitive contraction and has a history of small cell lung cancer most likely suffers from ....
Lambert Eaton Syndrome (Calcium channel blockers)
What is the best initial test for Myasthenia gravis?
acetylcholine receptor antibody test
What is the most accurate test for Myasthenia gravis?
EMG (decremental decrease in muscle fiber contraction)
What disease presents similiar to Myasthenia gravis (weakness worse at end of the day) but has incremental increase in muscular fiber contraction?
What is the best initial treatment for Myasthenia gravis?
Anticholinesterase (pyridostigmine or neostigimine)
What are other treatments for Myasthenia gravis if anticholinesterase do not work?
2. plasmaphersis and IV immunoglobulin (for acute myasthenic crisis)
3. Thymectomy (if thymoma present or if pustpubertal pt younger than 60 y/o)
A pt presenting with upper motor signs (spasticity, hyperrefelxia) and lower motor signs (muscle wasting, atrophy, fasciculations) along with bulbar signs (dysphagia, dysarthria, increased salivation) and preserved cognitive function most likely suffers from ...
Amoytrophic Lateral Sclerosis (ALS)
What is the most accurate test for amyotrophic lateral sclerosis?
EMG (diffuse axonal disease)
What is the treatment for Amoytrophic lateral sclerosis?
Riluzole (slows the progression of disease)
A female presenting with multiple neurologic complaints that can not be explained by presence of 1 CNS lesion and occur at different times throughout life most likely suffers from ....
What is the most accurate test for Multiple Sclerosis?
MRI with clinical criteria
What is treatment for relapsing remitting Multiple Sclerosis?
1. interferon B1a
2. Interferon B1b
3. GLatiramer acetate
What can be found on lumbar puncture in a pt with Multiple Sclerosis?
pleocytosis (elevation in cells) with oligoclonal bands (IgG)
What is the treatment for secondary progressive multiple sclerosis?
1. interferon B1b
2. mitoxantrone (avoid if low ejection fraction)
What disease is associated with the use of Natalizumab?
progressive multifocal leukoencephalopathy (PML)
What is the treatment for an acute exacerbation of multiple sclerosis?
2. plasma exchange
What disease is associated with Multiple Sclerosis?
A pt presents with personality changes (social/ interpersonal/ emotional abnormality) that precedes memory loss most likely suffers from ...
A pt presenting with rapidly progressive dementia with associated myoclonus, atxia and presence of 14-3-3 protein in CSF most likely suffers from ....
CJD (prion disease)
A pt presenting with step-wise progression of dementia (memory loss and other cognitive impairments) most likely suffers from ...
A pt presenting with cognitive impairment, ataxia and urinary incontinence and has dilated ventricles on CT scan most likely suffers from ...
Normal pressure hydrocephalus (NPH)
What test should be done to rule out reversible causes of dementia?
3. LFTs (uremia)
6. vitamin B12
7. RPR (syphilis)
What are treatments used for Alzheimer's disease?
1. donepezil, rivastigmine, galantamine (ACHase inhibitors)
2. Memantine (for advance disease)
A pt presents with chorea (spontaneous movements), ataxia, and behavioral changes in the setting of family history of early death with dementia most likely suffers from ...
What is the diagnostic test for Huntington Disease?
genetic testing for CAG trinucleotide DNA repeat expansion
What can be used to treat the chorea associated with Huntington Disease?
What is the finding on CT scan associated with Huntington disease?
atrophy of caudate nucleus
A pt presenting with bradykinesia, cogwheel rigidity, postural instabilty, resting tremor and shuffling gait with decreased arm swing most likely suffers from ....
A pt with parkinson's disease and vertical gaze palsy suffers from ...
A pt with parkinson's disease and prominent ataxia most likely suffers from ...
A pt with parkinson's disease and prominent orthostatic hypotension most likely suffers from ...
Shy-Drager syndrome (Multiple system atrophy)
What is the best initial treatment for a pt with Parkinson's disease whose functional status is intact and the main symptoms is tremor?
1. Anticholinergics (if pt < 60 y/o: benzotropine, trihexyphenidyl)
2. Amantadine (if pt > 60 y/o)
What is the best initial treatment for a pt with Parkinson's disease whose functional status is impaired and has significant bradykinesia?
(dopamine agonist- pramipexole/ ropinirole has less dyskinesia)
(can add COMT inhibitors- talcapone/ entacapone or selegiline to reduce response fluctuations)
A pt presenting with shaky hands (action tremor) that improves with alcohol and worsen with caffeine or beta agonist in the setting of a family history of tremor most likely suffers from ...
Benign Essential tremor