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Flashcards in Neurology Deck (74):
1

Factors that can cause/worsen idiopathic intracranial hypertension

GH, tetracyclines and excessive vitamin A and its derivatives (all-trans-retinoic acid, isotretinoin)

2

Initial tests to get in a patient with suspected myasthenia gravis?

EMG and anti-AChR antibody. If positive and the patient is

3

Level of sensation loss when it is due to spinal cord compression?

Typically ≥ 2 levels below the compression site.

4

What is the difference between cauda equina and conus medullaris syndrome?

Cauda equina has asymmetric, radiating pain with hyporeflexia and late onset bowel/bladder dysfunction.

Conus medullaris has symmetric back pain, hyperreflexia and early onset bowel/bladder dysfunction.

5

Central cord syndrome

Commonly seen with forced hyperextension (whiplash) and presents with burning pain, upper extremity paralysis and lower extremity sparing.

6

Most common CNS site of hypertensive hemorrhage

Putamen

7

Lambert-Eaton treatment

Plasmapheresis and immunosuppresion

8

Dysmetria

Tremor when attempting to touch an object

9

Dysdiadokinesia

Impaired rapid alternating movements

10

Which side does a patient tend to fall towards if they are symptomatic from a brain lesion compressing the cerebellum?

Towards the side of the lesion

11

Early findings seen in Alzheimer's disease

Memory, visuospatial, cognitive impairment and language difficulty.

12

Late findings in Alzheimer's disease

Personality, behavior, neuropsychiatric, incontinence, apraxia and noncognitive neurologic deficits.

13

Criteria for diagnosing Alzheimer's disease

MMSE 60 and absence of other neurologic disorder.

14

Anticholinergic symptoms

Hot as hare, dry as a bone, blind as a bat, mad as a hatter, red as a beet and full as a flask

15

Trihexylphenidyl and benztropine are what type of drugs?

Anti-cholinergics

16

Why might a patient get a headache and retro-orbital pain after taking trihexylphenidyl?

Acute angle glaucoma

17

What is classically the dominant brain hemisphere?

Left, it tends to command verbal and written language

18

Histologic hallmark of prolonged seizures

Cortical laminar necrosis

19

Chronic phenytoin use can cause what CNS problem?

Cerebellar atrophy

20

Symptoms of lacunar infarct

Pure motor hemiparesis, pure sensory stroke, dysarthria-clumsy hand and ataxic hemiparesis.

21

Why give a hemorrhagic stroke patient nimodipine?

Reduces the risk of cerebral vasospam 3-10 days after bleed

22

Tinnitus red flags

Unilateral, pulsatile or tinnitus associated with other unilateral otalgic symptoms.

23

Hearing loss seen in otosclerosis

Conductive

24

Symptom most specific for dementia vs. normal aging?

Functional impairment

25

Imaging study of choice in patients with a new unprovoked seizue?

MRI if nonemergent, CT if urgent

26

Normal age-related cognitive changes

Tiredness, forgetfulness, difficulty word finding and trouble falling asleep.

27

Most effective medication for trigeminal neuralgia?

Carbamazepine

28

Comorbidity with the strongest association with strokes

Hypertension > Diabetes and smoking

29

Core features that must be present for diagnosis of dementia with Lewy bodies

Fluctuating levels of attention/alertness

Hallucinations

Motor features of Parkinsonism

You need at least 2

30

Treatment of patients with MS exacerbation

High dose corticosteroids, if this fails move on to plasma exchange

31

Neuroimaging in:
Alzheimer's

Wilson's

Huntington's

Pick's

Alzheimer's = diffuse cortical atrophy

Wilson's = lenticular nucleus atrophy (putamen and globus pallidus)

Huntington's = caudate atrophy

Pick's = frontotemporal cortical atrophy

32

MMSE in patients with pseudodementia

Should improve as depression improves

33

How long until a patient with acute angle glaucoma lose their vision?

2-5 hours

34

Most common primary sites of brain mets

Lung (multiple), breast (single), unknown primary, melanoma (multiple) and colon (single)

35

Treatment of restless leg syndrome

Mild-intermittent: supplement iron if serum ferritin is ≤ 75, leg massage, heating pads, exercise and good sleep hygiene

Moderate-persistent: dopamine agonist (pramipexole, ropinirole) then alpha-2-delta Ca channel ligands (gabapentin)

36

How do you diagnose CJD?

Rapidly progressive dementia, periodic sharp wave complexes on ECG or positive 14-3-3 CSF assay and 2/4:

Cerebellar or visual disturbance

Akinetic mutism

Myoclonus

Pyramidal/extrapyramidal dysfunction

Definitive diagnosis is done with brain biopsy or positive PRNP genetic mutation

37

Drugs effective in treatment of patients with mild-moderate dementia

Acetylcholinesterase inhibitors: donepezil, galantamine and rivastigmine

38

Wernicke encephalopathy triad

Encephalopathy, ocular dysfunction and gait ataxia

39

Drugs used as monotherapy in patients with acute migraine attacks

Antiemetics like prochlorperazine, chlorpromazine or metoclopramide

40

Cushing reflex

HTN, bradycardia, respiratory depression

41

Tick-borne paralysis vs. Guillain-Barre

No autonomic dysfunction in tick-born paralysis

42

Demented patients can benefit from antipsychotics when they become delirious; however, what type of dementia has associated hypersensitivity to neuroleptics?

Lewy body

43

Characteristic features of brain death

Absent cortical and brainstem functions, spinal cord may remain intact

44

Side effects of metoclopramide

It's a dopamine antagonist and can result in extrapyramidal side effects like dystonia, tardive dyskinesia and Parkinsonism.

45

Tremor improved with intention? Worse?

Improved = Parkinson's

Worsened = Essential

46

Treatment of essential tremor

1) Propranolol, then primidone or topiramate

47

Early and late side effects seen in patients with Parkinson's treated with levo/carbidopa

Early: confusion, hallucinations, agitation, dizziness, somnolence and nausea

Late: movement disorders like dyskinesia and dystonia

48

Physical exam finding that is sensitive and specific for upper motor neuron disease

+Pronator drift (note that Romberg test is just them being able to stand without losing balance while eyes are closed and is a cerebellar test)

49

Strict exclusion for use of tPA in a stroke patient

Hemorrhage, CNS trauma/surgery 185/110, 1.7, PT > 15 or increased aPTT.

50

Only drug shown to reduce risk of early recurrence of ischemic stroke?

Aspirin, give within 24 hours. Give with dipyramidole if the patient stroked while on aspirin anyway.

51

LP in patients with Guillain-Barre

Elevated protein, normal cell count

52

Treatment of Guillain-Barre

IVIg or plasmapheresis

53

Parkinson's tetrad

Resting tremor, bradykinesia, rigidity and postural instability

54

Heat stroke definition

Core body temp > 40C and mental status changes

55

Uthoff phenomenon and Lhermette's sign

Uthoff: MS symptoms that worsen with heat

Lhermitte: electric shock sensation down spine when flexing neck

56

Imaging modality needed to confirm diagnosis of MS

T2 MRI

57

Brown-Sequard syndrome

Contralateral loss of pain and sensation ~ 2 levels below the lesion.

Ipsilateral loss of motor and proprioception

58

Factors that can precipitate a myasthenic crisis

Infection, surgery, pregnancy, medications (aminoglycosides, fluoroquinolones, macrolides and beta blockers).

59

Treatment for acute dystonic reaction to antipsychotics

Benztropine or diphenhydramine

60

Treatment for akathesia from antipsychotic use

Benzodiazepine

61

Side effects seen in patients on primidone for essential tremor

Acute intermittent porphyria (abdominal pain, neurologic and psychiatric symptoms)

62

What does primidone break down to after ingestion?

Phenobarbital and phenylethylmalonamide

63

Triad of Wernicke's encephalopathy

Encephalopathy, oculomotor dysfunction and ataxia

64

Which metal-overload condition results in basal ganglia dysfunction? How is this disease confirmed?

Wilson's. Confirm the dx with ceruloplasmin

65

Cupping of the optic disk

Seen in glaucoma

66

Edema of the optic disk

Seen in optic neuritis

67

CNIII fibers affected in diabetes

Somatic only (down and out + ptosis). Parasympathetics have better blood supply and are typically not as significantly affected by microvascular hyalinization.

68

Complications seen in patients with heat stroke

Rhabdomyolysis, coagulopathy, renal failure and ARDS.

69

Organisms that are most commonly involved in brain abscesses

S. viridans (direct extension from sinuses)

Staph and GNRs (distant spread)

70

Multiple system atrophy

Parkinsonism

Autonomic dysfunction

Widespread neurologic signs

71

Criteria needed for clinical diagnosis of Parkinson's disease

Tremor, rigidity and/or bradykinesia

72

Medication used for Parkinson's tremor in younger patients with tremor as their primary symptoms

Trihexylphenidyl

73

If pyridostigmine doesn't work for your patient with myasthenia gravis, what next?

Immunosuppress with corticosteroids, azathioprine or mycophenolate mofetil. If myasthenic crisis: steroids + plasmapheresis or IVIg if plasmapheresis is not possible.

74

Hallmark CSF finding in patients with Guillain-Barre syndrome

Albuminocyotologic dissociation (elevated protein and normal WBC)