Neurology Flashcards Preview

Step 2 > Neurology > Flashcards

Flashcards in Neurology Deck (112)
Loading flashcards...
1

UMN vs LMN lesion

UMN: contralateral paralysis lower face
LMN: ipsilateral paralysis upper and lower face

2

CN XI

Accessory: Head turning, shoulder shrugging

3

CN XII

Hypoglossal: Tongue movement

4

CN XI

Glossopharyngeal: Taste post 2/3 tongue, swallow, salivation (parotid) carotid body, gag reflex

5

Innervation swallowing

CN IX, X

6

Innervation salivation

CN VII (submand, subling), XI (parotid)

7

Innervation tongue

Sensation: V, VII (taste ant 2/3), IX (taste post 1/3)
Movement: XII

8

Innervation carotid body, arch, sinus

CN IX: carotid body and sinus chemo and baro
CN X: cartoid arch chem and baro

9

Lateral corticospinal tract

Movement contralateral limbs

10

Dorsal column

Fine touch, vibration, conscious proprioception

11

Spinothalamic

Pain, temperature (crosses at level of spinal courd)

12

Clinical reflexes:
Biceps
Triceps
Patella
Achilles
Babinski

Biceps: C5, 6
Triceps: C7,8
Patella: L3,4
Achilles: S1,2
Babinski: UMN, normal first year

13

Presents with: Aphasia or neglect, contralateral paresis and sensory loss face and arm, gaze towards lesion, homonymous hemianopsia

MCA infarct

14

Presents with: Contralateral paresis and sensory loss in leg, cognitive or personality changes

ACA infarct

15

Presents with: Homonymous hemianopsia, memory deficit, dyslexia/alexia

PCA infarct

16

Presents with: Coma, "locked in" syndrome, CN palsies, apnea, crossed weakness and sensory loss of face/body

Basilar artery infarct

17

Presents with: Pure motor or sensory stroke, dysarthria-clumsy hand syndrome, ataxic hemiparesis

Basal ganglia lacunar infarct

18

Imaging for stroke

Emergent CT without contrast (rule out bleed)

19

Mnemonic: 4Ds of posterior circulation strokes

Diplopia
Dizziness
Dysphagia
Dysarthria

20

When can tPA and intraarterial thrombolysis be administered?

tPA: within 3 hrs
intraarterial thrombolysis: within 6 hrs

21

What can decr morbidity mortality within 48hrs of stroke

ASA

22

Treatment if incr ICP after stroke

Mannitol, hyperventilation

23

Target INR for AF and prosthetic valve

AF: INR 2-3
Prosthetic valve: INR 3-4

24

Drug for long term prevention after stroke

ASA, clopidogrel

25

Presents as: abrupt-onset, intensely painful thunderclap headache: dx, etiologies

SAH
Trauma, berry aneurysm, AVM

26

When is carotid endarterectomy indicated?

>60% in symptomatic
>70% in asymptomatic
contraindicated in 100% occlusion

27

What is associated with CNIII palsy with pupillary involvement

Berry aneurysm

28

What are first or second diagnostic procedures if SAH suspected?

1. CT without contrast
2. If neg, LP (Look for RBC, xantochromia)

29

Complications after SAH and prevention

Vasospasm: 5-7 days after, Ca channel blockers
Rebleeding: keep BP

30

Definitive treatment for cerebral aneurysm

Surgical clipping

31

What imaging if intracerebral hemorrhage suspected

Noncontrast CT- look for mass effect or edema to predict herniation

32

Subdural vs Epidural: etiology and appearance

Subdural: rupture of bridging vein; elderly and alcoholic; Crescent shape
Epidural: tear of middle meningeal artery, skull fracture; concave/lens shape

33

Presents as trauma then lucid interval followed by altered consciousness

Epidural hematoma

34

Treatment of epidural hematoma

Emergent neurosurgical evacuation

35

What compressed in cingulate herniation

Frontal lobe

36

What compressed and symptoms transtentorial herniation

Midbrain
Rapid change mental status, Bilaterally small reactive pupils, cheyne-strokes, flexor-extensor posturing

37

Presents as Rapid change mental status, Bilaterally small reactive pupils, cheyne-strokes, flexor-extensor posturing

Transtentorial herniation (compression midbrain)

38

What compressed and symptoms uncal herniation

CNIII entrapped (down and out pupil)
Cerebral peduncle: ipsilesional hemiparesis

39

What compressed and symptoms cerebellar tonsillar herniation herniation

Medullary compression
respiratory arrest

40

What aspects of new headache are concerning? How work up?

Abrupt onset: CT and LP, r/o SAH
Focal neuro deficits: CT or MRI

41

Presents with headache, jaw claudication

Temporal arteritis

42

Abortive therapy vs prophylaxis for migraines

Abortive: Triptans, metoclopramide (after NSAID fail)
Ppx:Anticonvulsant (gabapentin, topiramate), TCAs, bblock, CCBs

43

What headache location is concerning?

Posterior headache (esp children)

44

Typical headache length for migraine?

>2, 72hr

45

Presents as headache, orbital pain, edema, diplopia, fever: dx and etiology

Cavernous sinus thrombosis
etiology: Septic thrombosis of cavernous sinus, esp S. aureus

46

Diagnostic studies cavernous sinus thrombosis

CBC, blood culture, LP, MRI (with gad, MR venogram)= confrmatory

47

Treatment cavernous sinus thrombosis

penicillinase-resistant penicillin (nafcillin, oxacillin)
3rd or 4th gen cephalosporin (ceftriaxone, cefepime)

48

What serum marker is consistent with epileptic seizure?

Incr prolactin

49

Simple vs complex partial seizures

Simple: No loss of consciousness

50

Evaluation of focal seizure

EEG
MRI or CT to rule out focal lesion

51

Treatment of acute seizure

>2 min
IV benzo, phenytoin

52

What are 2 hallmarks of tonic-clonic seizure

incontinence, tongue biting

53

How long do tonic-clonic seizures typically last?

1-2min

54

First line anticonvulsant for partial seizure, children

Phenobarbital

55

EEG findings tonic-clonic seizure

10hz during tonic phase, slow waves clonic phase

56

Treatment for primary tonic-clonic seizure

Phenytoin

57

EEG and findings absence seizure

2hz spike and wave discharges
ethosuximide (valproic acid= second line)

58

Definition and dx workup of status epilepticus

lasts > 10 min or repetitive without return to baseline consciousness
EEG, head CT (rule out intracranial hemorrhage)

59

Treatment for status epilepticus
-Initial + if continues

Thiamine, glucose, naloxone
IV benzodiazepine, loading dose fosphenytoin
If continues: intubate + phenobarbital

60

Presents as tonic, bilateral, symmetric jerks of head, trunk and extremeties in clusters within 6mo

West syndrome (infantile spasm)

61

Diagnostic maneuver for BPPV, maneuver to resolve

Dix-Hallpike (turn head + sit to supine)- reproduce nystagmus
Epley: resolve

62

Presents as recurrent episodes of severe vertigo, hearing loss, tinnitus, ear fullness: dx and tx

Menieres
Low-sodium diet, diuretic

63

Vertigo- characteristics concerning for central lesion

last >1 min, gait disturbance, nausea vomiting out of proportion to nystagmus

64

Presents as acute onset of severe vertigo, head-motion intolerance, gait unsteadiness with nausea, vomiting, nystagmus

Acute peripheral vestibulopathy (labyrinthitis, vestibular neuritis)

65

What stroke mimics labyrinthitis

lateral pontine/ cerebellar: AICA territory

66

Treatment of Acute peripheral vestibulopathy

corticosteroids within 72hrs

67

Workup for syncope

telemetry to rule out arrhythmia
ECG and cardiac enzymes to rule out MI
EEG to rule out seizure

68

Presents as fluctuant fatiguable ptosis or double vision, proximal muscle weakness: dx and tx

Myasthenia gravis
Edrophonium: anticholinesterase leads to rapid improvement
Ice test
EMG
Tx: Anticholinesterase (pyridostigmine), Prednisone

69

Etiology of myasthenia gravis, associated disorders

Postsynaptic Ach Receptor antibodies
+ thyrotoxicosis, thymoma

70

Drugs to be avoided in myasthenia gravis

abx (eg aminoglycosides)
b blockers

71

Malignancy associated with lambert-eaton

Small cell lung carcinoma

72

Etiology of Lambert-Eaton

Antibodies against presynaptic calcium channel of NMJ

73

Diagnosis and tx of Lambert-Eaton

Dx: Incremental response after repetitive nerve stimulation
Tx: 3,4-diaminopyridine or guanidine; corticosteroids and azathioprine

74

What is radiologic characteristic of MS?

Enhance with gadolinium

75

Therapy for MS:
-Acute exac
-First line
-Second line

Acute exac: corticosteroids
First line: immunomodulators: ifnb (avonex, betaseron), copolymer (copaxone)
Second line: Natalizumab, Mitoxantrone

76

CSF and tx for GBS

CSF protein >55mg/dL, little or no pleocytosis
plasmapheresis or IVIG

77

Treatment for ALS

Riluzole

78

Characteristic onset of vacular dementia

Abrupt

79

EEG findings show pyramidal signs, periodic sharp waves

CJD

80

What should be ruled out for alzheimers?

Depression
Hypothyroidism
Vit B12 def
Neurosyphilis

81

Treatment alzheimers

Cholinesterase inhib (donepizil, rivastigmine, galantamine, tacrine)
NMDA Rec antag (Memantine)

82

Pick's disease: typical presentation and imaging

Significant early changes in behavior and personality
Atrophy of frontal and temporal lobes

83

Presents with dementia, gait apraxia, urinary incontinence (disease + etiology)

NPH- impaired CSF outflow

84

Presents as subacute dementia with ataxia or startle-induced myclonic jerks: dx and workup

CJD
CSF 14-3-3 and tau protein

85

Presents with chorea, altered behavior, dementia: dx, area affected, tx

Huntington
Caudate and putamen
Reserpine or tetrabenazine for movement, SSRI for depression

86

Parkinson's tetrad

Resting tremor
Rigidity
Bradykinesia
Postural instability

87

Etiology of Parkinson's

Dopamine depletion of substantia nigra

88

NPH vs parkinson's

NPH- preservation of arm swinging

89

Treatment of parkinson's

Levodopa/carbidopa
Dopamine agonist
Selegiline (MAO-B inh)
COMT inhibitors
Amantadine

90

Most common primary locations of brain metastases

Lung
Breast
Kidney
GI
Melanoma
(Lung and Skin go to the BRain)

91

Presents with ipsilateral tinnitus, hearing loss, vertigo

Acoustic neuroma

92

Suprasellar tumor in children, typical presentation

Craniopharyngioma- typically calcified

93

Medulloblastoma vs Ependymoma (Grade and location)

Both typically arise 4th vent
Medulloblastoma- highly malignant
Ependymoma- low grade

94

Workup for neurofobromatosis

MRI brain, brainstem, spine with gad
Optho, derm, auditory testing

95

Malignancy associated with NFI

optic glioma

96

Presents with convulsive seizures, ash leaf lesions, mental retardation

Tuberous sclerosis

97

Workup for Tuberous sclerosis

Head CT (calcified tubers, malignant astrocytoma)
ECG (Rhabdomyoma)
Renal ultrasound
Renal CT
CXR (pulm lesions, rhabdo)

98

Treatment of seizures in tuberous sclerosis

oxcarbazepine or carbamazepine

99

Broca vs Wernicke aphasia (symptom and location)

Broca= expressive aphasia, posterior inferior frontal gyrus
Wernicke= receptive aphasia, left posterior superior temporal gyrus

100

Etiology of broca and wernicke aphasia

Broca: L superior MCA stroke
Wernicke: L inf/post MCA stroke

101

What is the area of dysfunction for coma?

Bilateral dysfunction both cerebral hemispheres or brainstem (pons or higher)

102

Presents as symmetric paresthesias, stocking-glove sensory neuropathy, leg stiffness, spasticity, paraplegia, bowel and bladder dysfxn, sore tongue

B12 deficiency

103

Presents as encephalopathy, ophtalmoplegia, ataxia

Wernicke encephalopathy (thiamine)

104

Upper vs Lower quadrantic anopsia location

upper: contralateral temporal lesion (Meyer's loop)
Lower: Contralateral parietal lesion (dorsal optic radiation)

105

Presents with painful eye, hard read eye, dilated nonreactive pupil

Closed-Angle glaucoma

106

Location closed vs open angle glaucoma

Closed: Iris and lens push together, disrupts flow to ant chamber
Open:Limited flow through trabecular meshwork

107

Presents with gradual loss perpipheral vison, frequent need for lens changes, cupping of optic nerve head

Open angle glaucoma

108

Treatment Closed-angle glaucoma vs open angle glaucoma

Closed: Eye drops (timolol, pilocarpine, apraclonodine)
Systemic (acetoxolamide, mannitol)
Laser peripheral iridotomy
Open:
topical b-blocekers
carbonic anydrase inhib

109

Presents with painless loss of central vision

macular degenration

110

Atrophic vs exudative AMD treatment

Atrophic: no treatment, Vit E
Exudative: VEGF inhib, photodynamic therapy

111

Presents with painless, unilateral blindness; sluggish pupil, cherry-red spot on fovea

Central retinal artery occlusion

112

Treatment of Central retinal artery occlusion vs central venous

Arterial: Intra-arterial thrombolysis within 8h
Venous: laser photocoagulation