✅NEUROLOGY Flashcards
1
Q
Cerebral Salt Wasting etx
A
⬇︎Brain adrenergic output to Kidney –> ⬇︎PCT Na+ Reabsorption–> hypOvolemic hypONatremia
2
Q
[Wernicke Korsakoff Syndrome] Clinical Presentation (3)
A
Wernicke problems come in a CAN of beer!
[Confusion & Confabulation]
Ataxia (Gait & Postural)
[Nystagmus + Oculomotor Dyf]
chronic alcoholism = most common cause
3
Q
[Wernicke Korsakoff Syndrome] MOD
A
Wernicke Problems come in a CAN of beer!
[Thiamine B1 Deficiency] from (below) –> BL circuit dysfunction between mammillary bodies & ANT Thalamus:
- Chronic Alcoholism = MOST COMMON
- Giving [Glucose that doesn’t have B1] to a B1-deficient pt (i.e. homeless malnutrition pt)
4
Q
Tx for [Wernicke Korsakoff Syndrome] (2)
A
[Thiamine B1 IV] ➜ Glucose
5
Q
What’s the major complication of [SubArachnoid Hemorrhage] during recovery?
________________
How do you tx this?
Usually in the Suprasellar Cistern
A
Severe Cerebral Vasospasm 4-12 days post SAH onset
________________
Prevent with [Nimodipine CCB]
Other complications: Rebleeding, SIADH, Seizures
6
Q
Describe the Demographic for the HA:
Migraine-2
Cluster
Tension
A
Migraine = Female and [Kids(will be bifrontal)]
Cluster = Male (100% O2 tx)
Tension = Female
7
Q
Describe the Onset for the HA:
Migraine
Cluster
Tension
A
Migraine = Variable but possibly during menstruation
Cluster = During Sleep (100% O2 tx)
Tension = When Stressed “think tense”
8
Q
Describe the Location for the HA:
Migraine
Cluster
Tension
A
Migraine = POUND = [Pounding/One-3 Day Duration /Unilateral/Nausea/Disabling] + photo vs. phonophobia & [flashing dots aura]
Cluster = Behind 1 eye (100% O2 tx)
Tension = [Bilateral & Band-like around the head]
9
Q
Describe the Character for the HA:
Migraine
Cluster (3)
Tension (2)
A
Migraine = POUND = [Pounding/One Day-3 day Duration/Unilateral/Nausea/Disabling] + photo vs. phonophobia & [flashing dots aura]
Cluster = [Excruciating, sharp & steady] (100% O2 tx)
Tension = Dull & tight
10
Q
Describe the Duration for the HA:
Migraine
Cluster
Tension
A
Migraine = POUND = [Pounding/One-3 Day Duration /Unilateral/Nausea/Disabling] + photo vs. phonophobia & [flashing dots aura]
Cluster = 15 - 90 MINUTES (100% O2 tx)
Tension = 30 min to 7 DAYS!!!! (Tammy’s Entire Work Week)
11
Q
Describe the Associated Sx for the HA:
Migraine
Cluster - 4
Tension
A
“VTAP the migraine BEFORE it gets comes, and SEND it on its way when it does! “
Migraine = POUND = [Pounding/One-3 Day Duration /Unilateral/Nausea/Disabling] + photo vs. phonophobia & [flashing dots aura]
________________
Cluster = [Sweating/ Pupil Change / Lacrimation / Rhinorrhea]
Tension = [Muscle “Tension” in Head, Neck or Shoulders]
12
Q
Which bone is associated with Epidural Hematoma?
A
Sphenoid
13
Q
Violent Infant Shaking —> ⬜ . This is characterized by what 3 things?
________________
How is this differentiated from similar conditions?
A
[AHT- Abusive Head Trauma]! =
- Subdural Hemorrhage (from tearing bridging veins between Dura and Arachnoid)
- [BL Retinal Vein Hemorrhages]
- POSTERIOR rib fractures
- ________________*
- Usually* Accidental Fall is not sufficient for Subdural Hemorrhage OR [BL Retinal Vein Hemorrhage]
- AHT is formely known as Shaken Baby Syndrome*
14
Q
What lab values differentiate seminomatous vs. NonSeminomatous Germ cell tumors?
A
seminomatous = ⬆︎bHCG
________________
NonSeminomatous(yolk sac/choriocarcinoma/embryonal) = [⬆︎bHCG AND AFP]
15
Q
[Thiamine B1] deficiency causes ⬜ and BeriBeri
________________
Describe BeriBeri (2)
A
[Wernicke Korsakoff Syndrome] and [BeriBeri]
________________
BeriBeri (Wet vs. Dry vs. BOTH) is associated with…
- Heart involvement = WET
- Symmetrical Peripheral Neuropathy = DRY
[Thiamine B1] is needed to Decarboxylate a-ketoacids (carb metabolism)
16
Q
Clinical Presentation for [Bells Palsy] (4)
A
Facial CN7 paralysis from inflammatory edema –> Loss of FACE
Loss of Facial m –> Unilateral Paralysis to ENTIRE HALF of face
Loss of Afferent somatics from Ear –> Hyperacusis
Loss of Crying 2/2 Loss of Parasympathetics to [Lacrimal/Salivary/Sublingual/Submandibular] glands
Loss of [Eating with Taste] 2/2 Loss of Taste to ANTERIOR 2/3 TONGUE
17
Q
Clinical Criteria for diagnosing Alzheimer’s -5
A
CLAV –> HANDU
- GOE 2 Cognitive deficits
- Worsening Memory
- Consciousness intact
- Onsets after 60 yo
- No other Systemic/Neuro DO to cause cognitive defects
18
Q
Normal Pressure Hydrocephalus Sx (3)
________________
Which is earliest to present?
A
⬇︎CSF absorption –> Wacky, Wobbly & Wet!
Wacky (memory loss)
Wet (Urinary Incontinence from compressing periventricular cortico-cortical white fibers traveling to sacral micturition center)
19
Q
What causes [Normal Pressure Hydrocephalus]? -2
________________
what does [Normal Pressure Hydrocephalus] do to overall [subarachnoid space volume]?
A
[Idiopathic episodic ⬇︎Arachnoid villi CSF absorption] vs obstruction
________________
NOTHING
[NPH does NOT ⬆︎ subArachnoid space volume]
________________
Wacky, Wobbly & Wet!
20
Q
ANY Clinical Suspicion of Stroke warrants _____. Why?-2
A
NonContrast Head CT; Ischemic stroke benefits from Thrombolytics vs ICH requires neurosurgery
21
Q
How do ICH (IntraCranial Hemorrhage) stroke appear on NonContrast Head CT?
________________
How long does this take?
A
[HYPERdense White]; IMMEDIATELY!
Ischemic Stroke = [hypOdense dark] and takes >24 hrs to appear
22
Q
Ethosuximide Indication
A
Sux to have Silent Seizures
Silent (Absent) Seizures
23
Q
Features of Absence Seizures -4
A
- Staring spells that pauses a pt mid-activity
- < 20 seconds
- Not responsive to external stimulation
- NO recollection
________________
- Provoked by Hyperventilation or photic stimulation / Dx = 3 Hz EEG spike*
- ADHD staring spells occur only DURING BOREDOM!*
24
Q
Name the 2 common triggers of Absence Seizures-2
________________
Dx?
A
- Hyperventilation
- photic stimulation
________________
3 Hz EEG spike
25
Why is it so important to recognize ⬜ in childen with epilepsy?
ADHD
**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**
⬆︎ quality of life
26
Newborn Galactosemia etx
[**ABSENCE OF {GALT}]** prevents conversion of [Galactose1P ➜ UDP Galactose] ➜ accumulation of [Galactose 1P] ➜ accumulation of [Galactose] ➜ [Aldose reductase alternatively converts excess Galactose ➜ **GALACTITOL**] ➜
**GALACTITOL** accumulates in [Brain/Eye/Liver/Kidney]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*(GALT) = [Galactose 1 Phosphate Uridyl Transferase]*
27
newborn Galactosemia affects (⬜#) major organs
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Describe how it affects each
4
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*Galactitol accumulation in*
[Brain ➜ convulsions & irritability]
[Eye ➜ BL cataracts]
[Liver ➜ hepatomegaly, jaundice, (E.Coli Sepsis), failure to Thrive, vomiting]
[Kidney ➜ urine with (reducing substance unmetabolized sugar)]
28
[Cavernous Sinus Thrombosis] etx
Infection of face vs teeth spreads thru facial veins --\> cavernous sinus
29
Lacunar Stroke etx
*lenticulostriate vessels perfuse [**B**e **TI****C**] (not Pons)*
Lacunar Stroke= [**Thrombotic** **HTN Arteriolosclerosis** & **Thrombotic** **microatheromas**] of lenticulostriate vessels --\> [cystic infarcts \< 15 mm] --\> Lacunar Syndrome
30
Describe the Lacunar **Syndrome** CP
*lenticulostriate vessels perfuse [**B**e **TI**p**C**] (not Pons)*
1A: **B**asal Ganglia--\>Hemi**B**allismus & involuntary writhing
1B: **T**halamu*S* VPL --\> *S*ensory Stroke CTL
1C: [**I**nternal Capsule-POST limb/**C**orona Radiata]--\> Motor stroke (ataxia vs. clumsy hand-dysarthria)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
* Lacunar Stroke= [Thrombotic HTN Arteriolosclerosis & Thrombotic microatheromas] of lenticulostriate vessels --\> [cystic infarcts \< 15 mm] --\> Lacunar Syndrome*
* VPL=VentroPosteroLateral nc*
31
What is Dejerine Roussy Syndrome
*lenticulostriate vessels perfuse [**B**e **T****IC**]*
S/p Lacunar Thalamus Sensory stroke eventually --\> Severe Paroxysmal BURNING worst w/light touch = Allodynia
32
Clinical Presentation of Congenital Syphilis -7
1. Frontal Bossing
2. Deaf
3. Saddle nose
4. Rhinitis
5. Hutchinson Mulberry Molars
6. Liver/Spleen Dz
7. Saber Shins
33
Clinical Presentation for Fetal Hydantoin Syndrome -9
**p HHH HHH en** (*"PHEN")*
## Footnote
1. [**p**alate and Lip Cleft]
2. **H**ead small with neuro deficits
3. **H**ypOplastic face
4. **H**eart defects
5. **H**ypOplastic digits
6. **H**ypOplastic nails
7. **H**irsutism
8. [**e**mbryopathy 2/2 phenytoin or carbamazipine intrauterine exposure]
9. [**n**eonatal bleeding 2/2 phenytoin ⬇︎ neonatal Vitk]
34
Classic signs of Fetal Alcohol Syndrome - 4
1. Microcephaly
2. Small Palpebral fissures
3. Long Smooth Philtrum
4. Thin Upper Lip
35
Sturge Weber Syndrome Clinical Presentation -5
1. **SEIZURES**
2. Red Facial Lesion (Port Wine Stain vs Red Nevus along CN5 territory = congenital UL cavernous hemangioma)
3. Glaucoma IPL
4. Homonymous Hemianopsia CTL
5. Hemiparesis
## Footnote
*Tramline Gyriform Calcifications on CT*
36
Sturge Weber Syndrome Dx
Tramline Gyriform Calcifications on CT
37
Sturge Weber Syndrome Tx -3
1. Seizure control
2. Glaucoma control (⬇︎Intraocular pressure)
3. [Red Facial lesion] control with Argon laser
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
* Tramline Gyriform Calcifications on CT*
* Red Facial Lesion = Port wine stain vs Red nevus along CN5 territory*
38
In [Neurofibromatosis **Type 1**], Fleshy cutaneous neurofibromas are made of ⬜, which embryologically come from ⬜.
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
These pts may also have hyperpigmented spots known as ⬜
**Schwann cells** ; **Neural _Crest_**.
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[**Cafe Au Lait Spots** (*image*)]
*Image: Cutaneous Neurofibromas & Cafe Au Lait Spots*
39
Main features of Narcolepsy -4
1. Paralysis upon Awakening
2. [sudden REM entry \> 3x/week & \>3 mo]
3. cataplexy
4. hypnaGOgic/hypnopompic hallucinations
* hypno**GO**gic = when **GO**ing to sleep*
40
Cataplexy may be treated with ⬜-suppressing drugs
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Name 2 examples
**REM Sleep**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[Sodium Oxybate] and Antidepressants
41
List the 3 main causes of HemipLegia in Kids
1. Seizure w/Todds Paralysis
2. Hemorrhagic Stroke 2/2 AVM
3. HemipLegic Migraine (Teens w/Fam hx, self-resolving)
42
Describe Todds Paralysis
focal (ipsilateral UE and LE) paralysis after seizure that **resolves naturally within 36 hours**
43
What Dz occurs from [Tetrahydrobiopterin BH4] deficiency?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Explain the etx
(PKU) Phenylketonuria
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Dihydropteridine Reductase becomes deficient w/out [Tetrahydrobiopterin BH4] cofactor --\> Inability to convert Phenylalanine --\> Tyrosine --\> **MESS** sx
*PKU smells a **MESS**!*
44
Phenylketonuria tx (2)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Why is Newborn screening important for these?
1. low phenylALAnine diet
2. [TetraHydroBiOpterin BH4] supplementation
**NEWBORN SCREENING--\> early dx --\> early tx --\> Normal lives!!**
**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**
*PKU smells a **MESS**!*
45
PKU-Phenylketonuria S/S (4)
*PKU smells a* ***MESS****!*
**M**usty Odor
**E**czema
**S**eizures
**S**low mentally (retard)
46
* Newborn screening is ESSENTIAL for early dx of PKU, which "smells a **MESS**"*
* \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_*
How do you diagnose PKU?
**Tandem mass spectrometry** of dried blood spots --\> detects PKU products
47
Name the classic complaint pts with Presbycusis will give regarding conversations - 2
Can hear **one-on-one** BUT can not hear if there's ANY background noise + BL tinnitus
## Footnote
*Sensorineural hearing loss secondary to age*
48
What conditions are associated with [Berry Saccular Aneurysm]? (5)
"**E**ating **A**pple*Berries* **C**an **S**ound **H**eavenly"
1. **ADPKD\*\***
2. [**E**hlers Danlos Syndrome]
3. **H**TN
4. **S**AH (from Trauma \> Berry Saccular Aneurysm)
5. **C**oarctation of Aorta (associated w/HTN)
*Image: Blood around Brainstem & Basal Cisterns*
49
[Communicating Hydrocephalus] cause
[Meningitis vs SAH vs Intraventricular hemorrhage] ➜ disruption of [Arachnoid Villi granulation] CSF reabsorption
50
[**SubArachnoid Hemorrhage**]
Dx-3?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Tx-2?
*Usually in Suprasellar Cistern*
Dx:
1. NonContrast Head CT
2. Lumbar Puncture revealing Xanthochromia (6 hrs after onset)
3. Cerebral Angiography
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Tx: [Endovascular Coiling/Stenting to stabilize aneurysm] + Nimodipine
*Xanthochromia comes from Blood breakdown products*
51
What's the major complication of [SubArachnoid Hemorrhage] **24 hrs post onset**?
**REBLEEDING WITHIN 6 HRS --\> MAJOR CAUSE OF DEATH!**
## Footnote
*Other complications: SIADH, Seizures*
52
Lumbar puncture with CSF pressure ⬜ = Intracranial HTN
\> 250 mmH20
53
PCiiH [Pseudotumor Cerebri Idiopathic Intracranial HTN] Tx - 3
Big Girl with PCiiH just **SAT** on her problems
1. **S**urgery (*Shunt vs Optic N sheath fenestration*)
2. **A**cetazolamide (*inhibits Choroid Plexus Carbonic Anhydrase*)
3. **T**opiramate (*will also --\> Wt loss :-)* )
*This HA will make you go Blind!*
54
[**Syringomyelia** central cord syndrome] etx
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
CP-2?
Formation of [CSF filled cavity = SYRINX] in **C8-T1** region of spinal cord --\> damage of STT [Ventral white commissure (crossing fibers)] --\>
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
1. [**BL Cape distribution Pain/Temp Loss in Arms & Hands**]
2. \*\*\*Eventually Ventral Horns are also destroyed --\> [LMN (**FAAW**)] - **F**asciculations / **A**trophy / **A**reflexia / **W**eakness
55
Parkinsonism Clinical signs (8)
**PARK** & **hamp**
[**P**ill Rolling Resting 4-6 Hz **unilateral** Tremor] worst with Rest & Mental Task
[**A**Reflexia posturally] --\>Shuffling Gait/Fall when turning or stopping
[**R**igidity Cogwheel]
Brady**K**inesia
+
- **h**ypOphonic speech
- **a**utonomic ⬇︎ (constipation / bladder problems / orthostatic hypOtension)
- **m**icrographia
- **p**oker masked face
* PARK = primary signs*
56
Name the Major UMN signs (5)
UMN signs = **W**eak **MESH**
## Footnote
**W**eakness
[**S**pastic Gait & Paralysis] (*partially from disproportionate Extensor weakness*)
[**E**xaggerated Reflexes (_Babinski_)]
**M**ental Status change
**H**emipLegia
57
Name the Lower Motor Neuron signs - 4
LMN signs (**FAAW**) - **F**asciculations / **A**trophy & **A**reflexia / **W**eakness
58
3 Main causes of Spinal Cord Compression
1. **DJD Disc Herniation** (Smoking risk factor)
2. [Epidural Staph a. Abscess (think IV drug user vs DM)]
3. Tumor (Prostate/Renal/Lung/Breast/Multiple Myeloma mets)
## Footnote
Dx = MRI, Positive Straight Leg, Classic S/S
*DJD=Degenerative Joint Disease*
59
Causes of [Anterior Spinal Cord Syndrome] - 2
**Thoracic** AAA Repair vs Vertebra Burst Fracture
60
Describe the 3 main sx for [**Brown Sequard Syndrome**]
1. Ipsilateral DCP Loss of **2TVP**-***2**point/**T**ouch/**V**ibration/[**P**osition Proprioreception]*
2*.* Ipsilateral CST Loss --\> [UMN (**W**eak **MESH**)]
3. **Contralateral** STT Loss of Pain/Temp **2 LEVELS BELOW ORIGINAL LESION**
61
Causes of [**Brown Sequard Syndrome**] - 3
1. [(Extramedullary Tumor]
2. Trauma
3. [DJD Disc Hernation (Smoking risk factor)]
62
[Cauda Equina Syndrome] etx
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Clinical Presentation - 5
(Compression of S2 - S4 n. roots) --\>
1. Saddle Anesthesia (*image*)
2. ⬇︎ **Ano**cutaneous Reflex (perianal pinpoint does NOT cause anal sphincter contraction)
3. Incontinence (urinary AND fecal)
4. uL Radiculopathy
5. **hypOreflexia** (*Conus Medullaris syndrome has HYPEReflexia*)
*Decompression required within 72 hours!!!*
63
Where does **Charcot Bouchard Aneurysms** occur (4)
**C**harcot **B**ouchard **T**ears **P**ink
* **B**asal Ganglia
* **C**erebellum
* **T**halamus (shown in image below)
* **P**ons
*Acute ICHH [Intraparenchymal CharcotBouchard HTN Hemorrhage] in image*
64
What causes Hemiballismus
Lacunar Stroke damage to [**Subthalamic nc.** of the Basal Ganglia] (important in modulating basal ganglia output) --\>
CTL Hemiballismus
*Note: Basal Ganglia is in Subcortical nuclei*
65
Huntington's Dz Clinical Presentation (2)
* "Hunting 4 food is way too **aggressive** & **dancey**"*
1st: **Aggressive** Dementia w/ strange behavior
2nd: **D****ance**-like Chorea mvmnts
* AUTO DOM = Affects BOTH sexes equally!!*
66
When does Huntington's Dz onset
30 - 50 y/o
## Footnote
*AUTO DOM = Affects BOTH Sexes Equally!!*
67
Parkinson's Dz Tx - 6
"Eat **SALADS** after you Park"
## Footnote
1. [**L**evodopa (Dopamine Precursor) + Carbidopa]
2. **A**mantidine
3. **A**nticholinergics
4. [**D**opamine PostSynaptic Agonist] (NonErgot: Ropinirole vs. Pramipexole) & (Ergot:Bromocriptine)
5. **S**elegiline
6. **S**urgery
- Pallidotomy: Destructive of [Globus Pallidus:internal]
- SubThalamic nuc. inhibition with electrode
- ANT Choroidal a ligation
68
Lesch Nyhan etx
**MALE** DO in which HGPRT deficiency --\> ⬆︎ Purine --\> Uric Acid accumulation
## Footnote
*--\> **CROUG** ( **UE Self-Injury (Biting)** / **C**horeoathetosis / **R**etardation / **G**out / **O**bstructive Nephropathy*
69
Lesch Nyhan Clinical Presentation - 7
[6 mo old Male] with [hypOtonia + vomiting] eventually --\> **CROUG**
**C**horeoathetosis
**R**etardation
[**O**bstructive nephropathy]
[**UE SELF-INJURY (BITING)**]
**G**out
70
Dx for **Multiple Sclerosis** - 5
1. Clinical (SLUM SiiiN)
2. T2 MRI: [**Periventricular** white matter demyelinating plaques with lipid laden macrophages]
3. T1 MRI Black holes
4. CSF Oligoclonal IgG bands
5. Visual conduction velocity test
## Footnote
*Sx will be disseminated in time and space*
71
CP for [**MIOS**-**M**LF **I**nternuclear **O**phthalmoplegia **S**yndrome] (3)
[**MIOS**-**M**LF **I**nternuclear **O**phthalmoplegia **S**yndrome]
\*[Impaired **ADD**uction of affected eye]
+
[Normal **ADD**uction of affected eye during [near reflex convergence]
+
\*[Nystagmus of **UN**affected eye when attempting to ABduct]
*Image: L MIOS*
72
Clinical Manifestation of **Multiple Sclerosis** (9)
Charcot classic triad of MS is a [**SLUM** **SiiiN**] !
## Footnote
**S**ensory sx (think BL Trigeminal Neuralgia)
**L**hermittes sign = "electric tingling" down spine into arm & legs when chin is touched to chest
**U**hthoff phenomenon (sx ⬆︎ during heat)
**M**otor sx
**S**canning Speech
[**I**nternuclear Ophthalmoplegia (MIOS)] / **I**ntention Tremor / **I**ncontinence
**N**euritis Optic - (uL eye pain + vision loss + Marcus Gunn afferent pupillary defect) = ALSO RISK FACTOR
73
Which drugs are used to treat Multiple Sclerosis Exacerbation?-2
1st: [Methylprednisolone IV High Dose]
2nd: [Plasmapharesis (Refractory)]
74
Which drugs are used to treat Multiple Sclerosis maintenance?-3
1. β-interferon
2. Glatiramer acetate
3. Natalizumab
75
Myotonia Dystrophy Clinical Manifestation - 6
**My T**onia, **My T**oupee, **My T**V Viewers, **My T**hroat, **My T**icker, **My T**esticles,
**T**onia = Myo**T**onia = [⬇︎ relaxation after volitional muscle contraction with Weakness & Atrophy] (*cant let go of doorknob*)
**T**oupee = Frontal Balding
**T**V viewer = Cataracts
**T**hroat = SEVERE DYSPHAGIA --\> Aspiration PNA
**T**icker = Arrhythmia
**T**esticle = Testicular Atrophy
*[AUTO DOM C****T****G Repeat]*
76
Main features of Duchenne Muscular Dystrophy - 5
1. [**CALF PSEUDOHYPERTROPHY** requiring gower manuever + teenage wheelchair]
------------
2. [Xp21 deletion] *(X-link recessive deletion on Chromo Xp21)*
3. Scoliosis
4. [peds onset **at 2 yo**]
5. [cardiomyopathy ➜ **20-30 yo DEATH**]
77
Main features of Becker Muscular Dystrophy - 4
1. [Xp21 deletion] *(X-link recessive deletion on Chromo Xp21)*
2. Scoliosis
3. [peds onset **at 5 yo**]
4. [cardiomyopathy ➜ **4****0-50 yo DEATH**]
78
Frontotemporal Pick's Dementia
Sx -2
Prounouced Frontal & Temporal lobe atrophy --\>
[**Socially inappropriate** Behavior] + aphasia
*OCCURS MORE IN FEMALES!!!*
79
Dementia with Lewy Bodies (DLB) CP - 3
DLB at the **DMV**
1. **D**ementia confusion periodically
2. **M**ichaelJFox Parkinsonism (PARK + hamp) tht **does NOT respond to dopaminergic tx**
3. **V**isual Hallucinations
*Lewy Body= [**LABS** (**L**ewy **α**-synuclein **B**odie**S**)] that are Eosinophilic intracytoplasmic accumulations*
80
*Tick Paralysis and Gullain Barre both present with ascending paralysis*
What differentiates Tick Paralysis? - 3
Tick Paralysis has...
1. NO Autonomic Dysfunction
2. Normal CSF (GBS CSF=High Protein \> 40)
3. Can be **A**symmetrical (GBS=Symmetrical)
81
CP of Cerebellar Damage - 7
Cere is def on **GRINDRR**
**G**ait Ataxia IPSILATERAL
**R**apid alternating mvmnt impairment
**I**ntention tremor/Dysmetria IPSILATERAL
**N**ystagmus IPSILATERAL (medial AND Lateral Vermis)
**D**ysarthria (Lateral Vermis only)
**R**ebound phenomenon (pt hits themself in face if flexing bicep and examiner releases arm-*image*)
**R**eflex Pendular (knee swings \>4x after Deep tendon reflex is elicited)
*Vermis is midline*
82
Describe the "Clasp Knife" phenomenon
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
What disease is this related to?
**Rapid SPASTIC** **RESISTANCE** to passive mvmnt of limb
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
UMN (Weak ME**S**H) Pyramidal Tract dz
* Pyramidal Tract = Corticospinal and Corticobulbar*
* Pronator Drift also indicates Pyramidal Tract Dz*
83
Dx for Creutzfeldt Jakob disease - 6
1. [PRNP prion protein] genetic testing
2. EEG Biphasic vs Triphasic **sharp wave complexes**
3. Postmortem brain biopsy
4. ⬆︎CSF 14-3-3 proteins
5. MRI Cortical Ribbons
6. MRI basal ganglia hyperintensity
84
[Creutzfeldt Jakob Dz] etx
PrP (prion protein), normally in neurons as [α -helical structure] converts--\> [**INFECTIOUS** **Beta pleated sheets**] --\> Protease resistance --\>
Vacuoles in [**Gray** Matter Neurons & Neutrophils] develop --\> Cyst = [**Spongiform** Gray Matter]
85
[Creutzfeldt Jakob Dz] CP - 2
[**RAPIDLY** Progressive Dementia] + [STARTLE Myoclonus] --\> DEATH
## Footnote
*Can be Acquired vs. Inherited*
86
[Amyotrophic Lateral Sclerosis] (Lou Gehrig's) etx - 2
1. Rare = [Superoxide Dismutase gene mutation] --\> copper-zinc dysfunction ---\>[Upper **AND** Lower Motor Neuron Disease!]
2. Common = Idiopathic
## Footnote
*UMN Dz includes loss of neurons in motor nc. 5/9/10/12*
87
*DDx of Neuromuscular Weakness has 5 origins*
Describe **Upper Motor Neuron** causes of Neuromuscular weakness - 4
88
*DDx of Neuromuscular Weakness has 5 origins*
Describe **Anterior Horn Cell** causes of Neuromuscular weakness - 4
89
*DDx of Neuromuscular Weakness has 5 origins*
Describe **Peripheral Nerves** causes of Neuromuscular weakness - 5
90
*DDx of Neuromuscular Weakness has 5 origins*
Describe **Neuromuscular** **JUNCTION** causes of Neuromuscular weakness - 4
91
*DDx of Neuromuscular Weakness has 5 origins*
Describe **Muscle Fibers** causes of Neuromuscular weakness - 5
92
Guillain Barre Tx - 2
IVIG vs Plasmapheresis
## Footnote
*Guillain Barre CSF = HIGHLY ELEVATED Protein \> 40*
93
Postconcussive syndrome can occur \_\_*(length of time)*\_\_ after any TBI (Traumatic Brain Injury).
Describe CP for Postconcussive Syndrome - 4
hours-days;
1. Continued Confusion/Amnesia
2. HA
3. Mood changes
4. Vertigo
*This is Self-Resolving*
94
In pts with Traumatic Brain Injury (TBI), what's the major cause of morbidity?
**Diffuse axonal injury** at Gray-White matter junction *(since this is where density difference is highest)*
USE MRI FOR DX
95
How long does it take ketoralac to reach Max efficacy
3 hours
*Dose = q4-6 hrs*
96
*You suspect a baby has ingested Botulinum **spores***
What's the Clinical Presentation? - 4
1. Descending Flaccid Paralysis *(Floppy Baby)*
2. Ptosis
3. Poor Suck & Gag Reflex w/drooling
4. Constipation
## Footnote
Tx = IMMEDIATE Botulinum Ig
97
**Spinal Muscular Atrophy** etx and CP
[ANT Horn Cell degeneration] from [*Chromo 5* SMN1 and 2 gene mutations]--\> LMN signs of FAAW- ***W**eakness/[**a**trophy & **a**reflexia] /**F**asciculations*
98
**Spinal Muscular Atrophy**
What's the difference between Infant type and Adult type
*\**Infantile onset = (**Werdnig Hoffman**) --\> [Auto Recessive FATAL condition --\> *Floppy Baby* from defuse [Distal muscle atrophy]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\*Milder childhood/adult onset types --\> [Non-fatal Chronic Disability]
99
Why are Multiple Sclerosis pts at risk for BL Trigeminal Neuralgia
Demyelination may occur at Trigeminal **nucleus** --\> **BILATERAL** neuralgia
## Footnote
*Sx will be disseminated in space and time*
100
*After Getting Labs, NonContrast Head CT is next for dx unprovoked seizures*
When would MRI be the better option?
elective NONemergent situations
101
*After Getting Labs, NonContrast Head CT is next for dx unprovoked seizures*
Name structural causes of epilepsy-7
Temporal Sclerosis-*shown in image*
Cortical Dysplasia
TBI (Traumatic Brain Injury)
Vascular Malformation
Infection
Tumor
Infarction
102
[**LEMS** - Lambert Eaton Myasthenic Syndrome] etx
[Autoimmune attack against (Presynpatic Ca+ channel)--\> No ACh release]
103
What other condition is [**LEMS** - Lambert Eaton Myasthenic Syndrome] associated with?
"**LEMS** has a good **SOLC**(soul)"
**SOLC**-**S**mall **O**at cell **L**ung **C**arcinoma
104
Name 4 Differentiating Factors for Myasthenia Gravis vs. [Lambert Eaton Myasthenic Syndrome]
1. [LEMS] improves with exercise/exertion during the day!
2. [LEMS] will show **no imprvmnt** with [Tensilon Edrophonium] injection OR ice pack
3. [LEMS] nerve testing shows **INC** muscle responses
4. [LEMS] has autonomic dysfunction (orthostasis, dry mouth, impotence)
105
What other condition is [Myasthenia Gravis] associated with?
May cause Thymoma (thymic hyperplasia)
106
[Myasthenia Gravis] etx
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Demographic?-2
Autoantibodies block and degrade [**postsynpatic** _nicotinic_ ACh Receptors]] --\> [⬇︎ motor end plate potential]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*Presents in [Women 20-30] and [Men 60-80]*
107
[Myasthenia Gravis] Clinical Presentation (5)
"*Give me Mya's* **P DDD F**"
[**P**tosis
[**D**iplopia from Disconjugate gaze]
**D**ysarthria-*bulbar dysfunction*
**D**ysphagia w/nasal regurgitation-*bulbar dysfunction*
[**F**ATIGABLE Weakness Muscularly (Extraocular/RESP/Proximal/limbs/worst w/repetition)]
*Tx: Pyridostigmine AChesterase inhibitor*
108
[**LEMS** - Lambert Eaton Myasthenic Syndrome] Clinical Presentation - 3
1. **Weakness of [Proximal limbs and trunk]** mimicking myopathy, better with exercise
2. Autonomic sx (Dry mouth /Orthostasis / Impotence)
3. ⬇︎Deep Tendon Reflexes
109
*You suspect a pt had an ischemic Stroke*
After FIRST, ruling out Hemorrhagic stroke with ⬜ , what thrombolytic therapy should be given?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
When should you give it?
NonContrast Head CT; IV Alteplase
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
**WITHIN 4.5 HOURS OF SX ONSET!**
110
How are HTN and DM mngmnt related to Acute CVA/TIA - 2
BP \> 185/110 in setting of stroke can --\> ICH - so Use Labetalol
&
Hyperglycemia augments brain injuries (*so ONLY use **Non**Dextrose IVF*)
111
What is Therapeutic hypOthermia often used for?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
How low of temp can you go?
Prevents hypoxic Brain injury in pts with [**out of hospital** cardiac arrest]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
32C
112
*Therapeutic hypOthermia prevents [hypoxic Brain injury] in pts with [**out of hospital** cardiac arrest]*
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
SE of this?-4
;
1. HYPERKalemia
2. ⬇︎Cardiac Output
3. ⬆︎Coagulation
4. Immunosuppression
113
Homocystinuria Clinical presentation-5
auto recessive [Cystathionine synthase] deficiency --\> Thromboembolism--\> Stroke
1. Marfanoid habitus (elongated limbs, arachnodactyly, scoliosis) - MH
2. Ectopia Lentis - MH
{3. Retarded -h}
{4. Fair Hair & Eyes -h}
{5. Stroke -h}
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
* MH = MARFAN and HOMOCYSTINURIA*
* h = homocystinuria only*
114
Homocystinuria tx -2?
auto recessive [Cystathionine synthase] deficiency --\> Thromboembolism--\> Stroke
tx = [Pyridoxine B6] + AntiCoag
115
Homocystinuria dx-2
auto recessive [Cystathionine synthase] deficiency --\> Thromboembolism--\> Stroke
[Homocysteine⬆︎] and [Methionine⬆︎]
116
Name the Differences in cp between Marfan and Homocystinuria - 3
Marfan **DO** **NOT HAVE**
1. Retardation
2. Fair Complexion
3. Strokes
117
Tay-Sachs etx ; CP-3
auto recessive B-hexosaminidase A deficiency --\>
1. **Cherry Red Macula**
2. Seizures
3. Retarded
118
Pronator Drift is a good indicator of what type of disease?
UMN Pyramidal Tract Dz (think stroke)
* Pyramidal Tract = Corticospinal and Corticobulbar*
* Clasp Knife phenomenon also indicates Pyramidal Tract Dz*
119
Etx of Parkinsons Disease
[**LAB** (**L**ewy **α****-**synuclein**B**odies)] accumulate in [substantia nigra pars compacta] --\>degeneration --\> of [substantia nigra pars compacta] --\> ⬇︎Dopamine to stimulate the [Striatum blocker] which --\> unblocked [Globus pallidus internal] continuously inhibiting [VA/VL Thalamus] from stimulating motor cortex
120
Alzheimer's Dz etx (3)
Alzheimers etx = **CHA**
\*\***C**leavage, **H**emorrhage, (**A**Ch⬇︎) \*\*
1. **C**leavage of [**chromo 21** transmembrane amyloid precursor glycoprotein] --\> [β-**amyloid**] which accumulates--\> [Neuritic Senile plaques] in temporal lobe early on.
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
2. **H**emorrhages Spontaneously occur in **Occipital/Parietal** lobes (*image*) from [β-**amyloid**] deposition in cerebral vessels
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
3. **A**Ch ⬇︎ in the [Basal nc. of Meynert & Hippocampus] 2/2 [β-amyloid] accumulation causing defective [Choline Acetyltransferase] in those areas --\> Alzheimer Sx (CLAV--\>HANDU)
121
What type of Hemorrhage is shown in image ; What is this typically associated with?
**Lobar** Hemorrhage (parietal) ; Amyloid Angiopathy 2/2 Alzheimers
122
Hypokalemic periodic paralysis CP-2
## Footnote
*Occurs right after vigorous activity*
1. **SUDDEN** generalized muscle weakness +
2. ⬇︎ Deep Tendon Reflexes
## Footnote
*Occurs right after vigorous activity*
123
Benzos can cause an *uncommon* SE known as **Paradoxical Agitation**. Describe this
[⬆︎Agitation, confusion and disinhibition] within a hour of benzo admin. GIVING MORE BENZOS WILL WORSEN THIS!
124
What is a Cephalohematoma? Tx?
Neonatal SubPeriosteal Hemorrhage **limited to 1 cranial bone (i.e. does NOT cross suture lines)** that onsets **hours** after birth and presents as scalp swelling +/- ⬆︎jaundice;
Tx = Nothing, since it self-resorbs within 2 weeks-3 mo.
125
Cerebellar infarction of **medial** vermis presents as \_\_\_\_\_-2
1. Nystagmus
2. Vertigo
126
Cerebellar infarction of **Lateral** vermis presents as \_\_\_\_\_-6
Cere is def on **GRINDRR**
**G**ait & Coordination Ataxia - IPSILATERAL
**R**apid alternating mvmnt impairment
**I**ntention tremor/Dysmetria - IPSILATERAL
**N**ystagmus (medial AND Lateral Vermis infarcts)
**D**ysarthria (Lateral Vermis only)
**R**ebound phenomenon
**R**eflex Pendular (knee swings \>4x after Deep tendon reflex is elicited)
*Intention tremor = worst as finger moves closer to target*
127
Describe Features of **BENA** (**Brocas Expressive NonFluent Aphasia)** -4
1. Right Hemiparesis
2. Nonfluent speech
3. Impaired Repetition
4. Impaired Naming
## Footnote
*BENA = Dominant Inferior Frontal*
128
Describe Features of **Wernickes Aphasia** - 3
1. R SUP homonymous quadrantanopia
2. Comprehension problems
3. Impaired Repetition
## Footnote
*Conductive AND Wernicke Area = Dominant SUP Temporal*
129
Describe Features of **CONDUCTION** **Aphasia**
**VERY POOR** Repetition
## Footnote
*This is in addition to Fluent but many phonemic errors*
130
Status Epilepticus clinical criteria?-2
1. Single seizure \> **5** min OR
2. Cluster of Seizures w/ no return to baseline in between episodes
## Footnote
*Image showing Cortical Laminar Necrosis s/p Status Epilepticus*
131
What is the long term outcome of status epilepticus on the brain? ; Dx for this?
Cortical laminar necrosis ; MRI w/cortical **hyper**intensity
132
What is the most common cause of ICH in kids?
ArterioVenous Malformation
133
Tx for Cluster HA *- 1st, 2nd and 3rd choice*
**1st = 100% O2 Nasal Canula**
2nd = Sumatriptan
3rd = NSAIDs
Px = Verapamil
134
Px for Cluster HA
Verapamil
## Footnote
*Also Px for Migraines*
135
Neonatal Intraventricular Hemorrhage occurs in premies **less than** ⬜ weeks gestation or **less than** ⬜ grams
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Px?
\< 30 weeks vs 1500g
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Antenatal Maternal Corticosteroids
* Normal Gestation = 37-42 WG*
* Image: BL IVH & Dilated Vt*
136
What is the Etx of Intraventricular Hemorrhage in premature babies less than ⬜ weeks or less than ⬜ grams
\< 30 weeks vs 1500g
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Subependymal germinal matrix contains thin-walled vessels that easily rupture. Normally, these migrate before birth, but in premies they never have the chance which --\> IVH --\> ⬇︎Arachnoid CSF absorption --\> Communicating Hydrocephalus
* Normal Gestation = 37-42 WG*
* Image: BL IVH & Dilated Vt*
137
Choroid plexus cyst are identified ⬜ trimester and a marker for ⬜ in babies
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
How do they affect the baby?
2ND
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Aneuploidy
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
does NOT affect baby. Regressess spontaneously and is benign
*Dark holes = Cyst*
138
What are the 7 major complications of Newborn Prematurity
## Footnote
*Less than 32 weeks gestation specfically*
"*Premies stay* **BURPPIN***"*
## Footnote
**B**ronchopulmonary Dysplasia
**U**cantBreathe (Neonatal Respiratory Distress Syndrome)
**R**etinopathy
* *P**atent Ductus Arteriosus
* *P**alsy CEREBRAL
**I**ntraventricular Hemorrhage
**N**ecrotizing Enterocolitis (⬆︎gastric residual volume with abd distension)
139
How do Traumatic Carotid Injuries occur?-3 ; Dx-2
## Footnote
*Image: Carotid Dissection*
1. Penetrating Trauma
2. Oropharyngeal trauma (falling w/object in mouth)
3. Neck Strain (yoga, sports)
Dx = CT angio vs MR angio
*These will present like Strokes*
140
[DLB (Dementia with Lewy Bodies)] Tx
**Rivastigmine** AChinesterase inhibitor
141
What are the hallmark pathological findings for Alzheimers-2
[**Tau** Neurofibrillary tangles] & [Neuritic Senile Plaques]
142
Most serious complication of Guillain Barre? How do you determine when this complication gets really bad?
Respiratory Failure; FVC ≤ **20** mL/kg via **SPIROMETRY** means intubate!
## Footnote
*HR, BP, Quadriparesis, FACIAL palsy are other serious complications*
143
***Levodopa** is used to treat Parkinson's Disease*
Early SE?-3 ; Late SE
Early SE *(HAD)* = Hallucinations/Agitation/Dizziness
Late SE (5-10 yrs post tx) = Involuntary mvmnts
144
Dx for VitB12 deficiency - 3
1. [⬆︎ **Methylmalonic Acid levels**]
2. CBC showing Macrocytic Anemia
3. Serum Vitamin levels
145
*There are 3 Main causes of Spinal Cord Compression*
Dx for Spinal Cord Compression-3
1. MRI
2. Classic S/S (BLE weakness, Worst w/spinal extension, better w/flexion, UMN signs)
3. Positive Straight Leg
## Footnote
*Note: In Acute Cord Compression, pts will have spinal SHOCK x3days = AReflexia and Flaccid paralysis*
146
HemiNeglect Syndrome
Stroke in **R Parietal Cortex (NonDominant hemisphere)** --\> Neglect of anything on the Left side
## Footnote
*This is only in R handed people. It's opposite for L handed*
147
[Juvenile Myoclonic Epilepsy] CP
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Demographic?
Generalized Seizures +/- Absence seizures, **most frequently in 1st hour after waking**
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Teens
148
Lennox Gastaut CP-2
**L**ennox **G**astaut
1. **L**ala Land Retarded before 5 yo
2. **G**eneralized Tonic Clonic Seizures SEVERE
149
Lennox Gastaut Dx?
Slow Spike-Wave EEG
## Footnote
**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**
***L**ennox **G**astaut*
150
[Glioblastoma Astrocytoma] Radiographic Findings - 2
1. **Butterfly lesion** from crossing Corpus Collosum
2. Midline shift from Lateral Vt Compression
* GBM is usually a HIGH GRADE Astrocytoma*
151
List the n. roots associated with Common Peroneal n.
L4-S2
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
foot is drop**PED** (**P**eroneal **E**verts & **D**orsiflexes)
* Commonly caused by L**5** Radiculopathy*
* Dx: Knee MRI vs EMG*
152
List the n. roots associated with Tibial n.
L4-S3 (**T**hree)
## Footnote
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
can't walk on **TIP**toes (**T**ibial **I**nverts & **P**lantarflexes)
*Commonly caused by L5 Radiculopathy*
153
A: List the n. roots associated with [SUP Gluteal n.]
B: Associated Injury (2)
C: Sensory deficit
D: Motor Deficit (2)
**[SUP Gluteal nerve]**
A: L4-S1
B: [Superomedial Butt injection] vs. POST Hip dislocation
C: none :-)
D: [Trendelenburg gait] & [No Thigh ABduction]
154
A: List the n. roots associated with [inferior Gluteal n.]
B: Associated Injury (2)
C: Sensory deficit
D: Motor Deficit
**[inferior Gluteal nerve]**
A: L4-S2
B: Butt injection vs. POST Hip dislocation
C: none :-)
D: [No Thigh Extension]
155
Which grade Astrocytoma is this? How can you tell? CP?
**LOW** grade astrocytoma; it has NO CONTRAST ENHANCEMENT ; Seizures
156
Which disorder results in a Waddling gait and why?
Muscular dystrophy; Gluteal m weakness
## Footnote
*Waddling Gait = walks like Penguin from Batman*
157
Describe En-Bloc Gait ; What type of ataxia is this?
Minimal mvmnt of head while walking w/staggering gait; Vestibular Ataxia
## Footnote
*Will be accompanied w/Vertigo & Nystagmus*
158
How does hypOthyroidism affect Neuro system - 4
1. it causes ⬇︎ in DTR
2. ⬇︎ motor relaxation phase
3. Mood ∆
4. Dementia
159
Long term SE of **resolved** Bacterial Meningitis - 3
1. ⬇︎ Cognition (Retardation, Milestone regression)
2. Hearing loss
3. Seizures
160
What is the main factor for differentiating Seizure vs Syncope
Seizure will have **DELAYED RETURN to baseline 2/2 postictal state** (confusion, focal neuro deficits, lethargy)
## Footnote
*Seizure may also have olfactory aura & tongue lacerations*
161
Pts with Myasthenia Gravis may develop Myasthenia CRISIS, which presents clinically as ⬜ !!!
What are precipitants of this?-3
**P DDD F**
Respiratory Failure!
Precipitants = FIS:
1. Fluoroquinolones
2. Infection
3. Surgery
*Crisis Tx: [Intubate + Plasmapharesis + IVIG + Steroids]*
162
Memantine MOA
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Indication
Blocks Glutamate from binding to NMDA Receptor
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Moderate to Severe Alzheimer's
163
*Vascular Dementia presents with ⬇︎executive function and dementia just like other Neuro Disorders*
What is the differentiating factor for separating Vascular Dementia from other Neuro Disorders? - 2
VaD has [**asymmetric, focal neuro ⬇︎**]and is **abrupt**
164
What causes **Charcot Bouchard Aneurysms**?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Rupture of Charcot Bouchard Aneurysm leads to ⬜ ?
**C**harcot **B**ouchard **T**ears **P**ink
Uncontrolled HTN ; [Intraparenchymal HTN Hemorrhage]
165
*Charcot Bouchard Aneurysms occur 2/2 ____ and in 4 distinct locations*
Describe CP for Charcot Bouchard Aneurysm ruptured in Basal Ganglia? - 3
Uncontrolled HTN --\> Charcot Bouchard Aneurysm --\> [Intraparenchymal HTN Hemorrhage]
**C**harcot **B**ouchard **T**ears **P**ink
**B**asal Ganglia
1. CTL Hemiparesis
2. CTL ⬇︎ Sensory
3. Eye Deviation **TOWARD** side of lesion
*Acute [Intraparenchymal HTN Hemorrhage] in image*
166
*Charcot Bouchard Aneurysms occur 2/2 ____ and in 4 distinct locations*
Describe CP for Charcot Bouchard Aneurysm ruptured in Cerebellum? - 7
Uncontrolled HTN --\> Charcot Bouchard Aneurysm --\> [Intraparenchymal HTN Hemorrhage]
**C**harcot **B**ouchard **T**ears **P**ink
**C**erebellum
Cere is def on **GRINDRR**
**G**ait & Coordination Ataxia - IPSILATERAL
**R**apid alternating mvmnt impairment
**I**ntention tremor/Dysmetria - IPSILATERAL
**N**ystagmus (medial AND Lateral Vermis)
**D**ysarthria (Lateral Vermis only)
**R**ebound phenomenon
**R**eflex Pendular (knee swings \>4x after Deep tendon reflex is elicited
*Acute [Intraparenchymal HTN Hemorrhage] in image*
167
*Charcot Bouchard Aneurysms occur 2/2 ____ and in 4 distinct locations*
Describe CP for Charcot Bouchard Aneurysm ruptured in Thalamus? - 3
Uncontrolled HTN --\> Charcot Bouchard Aneurysm --\> [Intraparenchymal HTN Hemorrhage]
**C**harcot **B**ouchard **T**ears **P**ink
**T**halamus
1. CTL Hemiparesis
2. \*\*Eye Deviation **T**oward Hemiparesis\*\*
3. **Nonreactive** Miosis
*Acute [Intraparenchymal HTN Hemorrhage] in image*
168
*Charcot Bouchard Aneurysms occur 2/2 ____ and in 4 distinct locations*
Describe CP for Charcot Bouchard Aneurysm ruptured in Pons? - 3
Uncontrolled HTN --\> Charcot Bouchard Aneurysm --\> [Intraparenchymal HTN Hemorrhage]
**C**harcot **B**ouchard **T**ears **P**ink
**P**ons
1. **P**inpoint REACTIVE pupils (*damaged descending sympathetic fibers*)
2. Coma
3. Total Paralysis
*Acute [Intraparenchymal* *HTN Hemorrhage] in image*
169
Genetic cause for [Fragile X]
[CGG repeat] --\>[FMR1 gene Methylation] on [X Chromo long arm] --\>small gap near tip of [X Chromo long arm]
170
Fragile X CP - 5
**X**-Large...
## Footnote
1. Personality (Autism, ADHD)
2. Ears
3. Forehead
4. Chin (long face)
5. Testes
*Etx: C-GG repeat*
171
Deficency of which Vitamin mimics Friedreich Ataxia
Vitamin **E** (will also have Hemolytic anemia)
## Footnote
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Fri**E**dreich Ataxia *[Chromo 9 Auto Recessive]*
*SuBACute Combined Degeneration affects SAME 3 columns*
172
Describe Friedreich Ataxia (8)
Fri**E**dreich is **Fratastic**! He's your fav., **twisted,** **frat** brother, always **studdering** and **falling**, but has a **sweet**, **big heart**
Fri**E**dreich = [Vitamin **E** Deficiency] mimics it
**Fratastic** has 9 letters = [Chromo 9 Auto Recessive GAA repeat]
**twisted** = Kyphoscoliosis @ childhood
**frat** = [**frataxin** (**iron binding protein**) defect]
**studdering** = Dysarthria
**falling** = [Falls & Ataxia + (Pes Cavus High Foot Arch)]
**sweet** = DM
**big heart** = Hypertrophic Cardiomyopathy = COD
*Involves Degeneration of [Dorsal, Lateral CST & SpinoCerebellar]*
173
Friedreich Ataxia Mode of Inheritance
Fri**E**dreich Ataxia
[Chromo 9 Auto Recessive]
*SuBACute Combined Degeneration affects SAME 3 columns*
174
[Shy Drager Multiple System Atrophy] CP - 3
1. Multiple System Atrophy
2. [Parkinsonism **tht doesnt respond to dopaminergic rx**]
3. [Autonomic Dysfunction (orthostasis, impotence, incontinence)]
## Footnote
* Tx = intravascular volume expansion to treat orthostasis*
* DO NOT CONFUSE WITH [RILEY DAY FAMILIAL DYSAUTONOMIA] WHICH HAS NO PARKINSONISM*
175
[Riley Day Familial Dysautonomia] CP
Autonomic Dysfunction (orthostasis, impotence, incontinence)
## Footnote
*auto recessive in kids of Ashkenazi Jewish decent*
176
[Riley Day Familial Dysautonomia] Mode of inheritance ; demographic
auto recessive ; kids of Ashkenazi Jewish decent
177
[Myasthenia Gravis] Dx-5
P DDD WF
1. **ACh R Ab Assay**
2. **MuSK** (**Mu**scle-**S**pecific tyrosine **K**inase) **Ab Assay** (only if #1 is neg)
3. [**Tensilon Edrophonium**]--\> Improves all sx
4. **Ice Pack** to eyelids --\> Improves Ptosis by inhibiting ACh breakdown at NMJ
5. *BE SURE TO GET **CT CHEST** AFTER DX TO COVER FOR THYMOMA, POSSIBLE THYMECTOMY!!!!*
178
Amaurosis Fugax CP ; etx
Painless, transient ( \< 10 min) monocular vision loss characterized as curtain being descended over eye
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Carotid Artery atherosclerotic emobil
179
Ocular Tonometry indication
Measuring intraocular pressure in acute [closed angle glaucoma]
## Footnote
*Image: Acute [Closed Angle Glaucoma]*
180
Name the 3 components of **EPS**-**E**xtra**P**yramidal**S**ymptoms
EPS = **DAD**
[**D**rug-induced Parkinsonism]
**A**kathisia (restlessness)
**D**ystonia (sudden twisted posture worst with activity)
*Tx = Benztropine vs Diphenhydramine*
181
What is **EPS** caused by, and which drugs are the most likely to cause it?
[Blocking Nigrostriatal D2]; [1st generation Antipsychotics (Haloperidol/Fluphenazine)]
182
Congenital Torticollis etx
**Malpositioning of Head in Utero vs During birth** --\> constant contraction of SCM--\>Lateral Neck swelling
## Footnote
*Torticollis also possible in Adults*
183
Describe Athetosis ; What disease is it seen in?
Slow, writhing mvmnts of hands & feet often occuring **with** Chorea (*Choreoathetosis*) ; Huntington's
184
*Neonate comes in with Hydrocephalus, delineated by bulging fontanelles*
Dx?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Tx?
Head CT
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Ventricular Shunt
185
Describe the difference between Cyanotic and Pallid [Breath Holding Spells]. ; Demographic for these?
**_C_**yanotic: ****_C_**rying** --\> Breath Holding, **_C_**yanosis, [LOC 2/2 syncope]
**_P_**allid: ****_P_**ain from m****inor trauma** --\> Breath Holding, pallor, diaphoresis & [LOC 2/2 syncope]
6 mo - 2 yo
*sometimes associated w/ iron deficiency anemia*
186
ACA occlusion CP-3
1. CTL Weakness worst in LE
2. CTL Numb worst in LE
3. Urinary Incontinence
187
ASA occlusion CP-2 ; Which syndrome is this?
*AKA MEDIAL Medullary Syndrome*
1. CTL UE & LE **Weakness**
2. Ipsilateral hypoglossal loss
188
In comparing Ischemic Stroke to Hemorrhagic Stroke CP, both have \_\_\_\_\_. What are the differentiating factors?-2
Both = Focal neuro ∆
Hemorrhagic Stroke ALSO has [worsening **HA** + **AMS** from ⬆︎ICP]
*Remember: ANY Suspicion of Stroke warrants NonContrast Head CT*
189
Benztropine & Trihexyphenidyl are in what class of drugs?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
How can pts on these develop Retro-Orbital HA during OD?
Anticholinergics; OD can --\> Acute Glaucoma --\> RetroOrbital HA
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
* Red as a beet, Dry as a bone, Hot as a hare, Blind as a bat, Mad as a hatter, Bowel & Bladder lose their tone, and the Heart runs alone*
* Image: Acute Closed Angle Glaucoma*
190
How do you treat *Refractory* Serotonin Syndrome
Cyproheptadine
(antihistamine with anti-serotonergic properties)
191
Stiff Person Syndrome etx
**RARE** autoimmune Disorder
192
What is the most common cause of Fatal Sporadic Encephalitis in the U.S.? Should you use CT or MRI for dx?
Herpes Encephalitis ; MRI **(and then CSF PCR=Gold Standard Dx)**
193
Between DM, Smoking and HTN, which carries the GREATEST STROKE Risk?
**HTN**
194
A: Describe **Opsoclonus-Myoclonus Syndrome**
B: What Childhood tumor is it associated with?
A: [Non-Rhythmic Conjugate Eye mvmnts] with myoclonus= "**Dancing Eyes and Feet**"
B: Neuroblastoma (onset 2 y/o)
*Arises from Neural crest*
195
Neuroblastoma Dx - 3
1. Calcifications on Radioimaging (Xray/CT)
2. ⬆︎ VMA and Homovanillic acid catecholamines
3. Amplification of N-myc protoOncogene
196
Metanephros is the precursor to ⬜
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
What tumor is this associated with?
Me**T**anephros
Renal Parenchyma **T**issue
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Wilms' tumor
197
Me**S**onephros is precursor to ⬜ ⬜ and ⬜
**S**eminal Vesicles / Ejaculatory ducts / Vas Ductus Deferens
198
ParaMesonephron is the precursor of the ⬜(3)
Fallopian Tubes / Uterus / Part of Vagina
199
Name the classic sx of IntraCranial Hypertension - 4
1. Positional HA **worst at night/morning**
2. Papilledema / vision ∆
3. AMS
4. NV
200
S/S of Acute [Closed angle glaucoma] - 3
1. RetroOrbital HA w/⬇︎Vision
2. Conjunctival Erythema
3. Dilated pupil poorly responsive to light
## Footnote
*Occurs in Pts \> 60 yo*
201
Identify
image
202
Identify
A: Thalamus
B: Dorsal Midbrain
C: Pons
D: Dorsal Medulla
E: Cerebellum
203
Diagnostic Criteria for Febrile Seizure - 5
1. 6 mo - 6 yo
2. Temp \> 38C
3. No hx of **A**febrile seizures
4. No CNS infection
5. No acute metabolic cause of seizure (*pt would have dehydration*)
*Tx = Reassurance only!*
204
Sx of mild hypOkalemia?-2
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Sx of SEVERE hypOkalemia?-5
Mild: Weakness + Muscle Cramps
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
SEVERE ( \< 2.5):
1. Flaccid Paralysis
2. hypOreflexia
3. tetany
4. Rhabdo
5. Arrhythmia
205
Meniere's Disease etx
⬆︎endolymphatic fluid in inner ear--\> Membranous labyrinth swelling and rupture --\> [**KRE**- **K**+ **R**ich **E**ndolymph] leak into [Na+ rich perilymph] --\> abnormal hair cell function --\> **VTH** sx
## Footnote
\*\***V**ery **T**errible **H**earing \*\*
206
Indication of Head Thrust Test ; Describe how to do the test
differentiates in nystagmus pts between peripheral & central vertigo;
pt looks at fixed target and their head is rapidly turned from the target. Normally, eyes remained fix on target, but in [**Peripheral** vestibular dysfunction pts] eyes move w/head and then horizontal saccade back to target after
207
BPPV (Benign Paroxysmal Positional Vertigo) etx and CP-3
Ca+ otoliths accumulated within semicircular canals --\> Dizzines, Nystagmus and Nausea only
208
**Normal Pressure Hydrocephalus** etx-2
Wacky, WOBBLY & Wet!
## Footnote
[⬇︎**Arachnoid villi CSF absorption** vs **Obstructive Hydrocephalus**] --\> transient ⬆︎in Vt pressure --\> Enlarges Vt --\> After while, Vt Pressure NORMALIZES to the enlarged Vt
209
Riluzole MOA ; Indication
Inhibits release of Glutamate ; ALS
## Footnote
*SE: ⬆︎Transaminases, Wt loss, Dizziness*
210
Identify disease process
Central Retinal A. occlusion
## Footnote
*Note the Retinal Whitening!*
211
Px for Migraine HA - 4
**VTAP** the migraine BEFORE it comes, and **SEND** it on its way when it does!
1. **V**erapamil
2. **Topiramate**
3. **A**mitryptyline
4. **P**ropranolol
212
Tx for Acute Migraine HA - 4
**VTAP** the migraine BEFORE it comes, and **SEND** it on its way when it does!
1. **S**umatriptan
2. **E**rgots (Bromocriptine)
3. **N**SAIDs
4. **D**2 Blockers (Metaclopramide/Prochlorperazine)
213
*Cerebral Palsy is a group of clinical syndromes generally characterized as \_\_\_\_\_\_*
What are the 3 types? What's the greatest risk factor for Cerebral Palsy?
Nonprogressive motor dysfunction ;
## Footnote
Cerebral Palsy is just **SAD**
1. **S**pastic
2. **A**taxic
3. **D**yskinetic
Greatest RF = prematurity ( \< 32 wks gestation) but EtOH is second
214
*Cerebral Palsy is a group of clinical syndromes generally characterized as \_\_\_\_\_\_*
How does it present? - 3
Nonprogressive motor dysfunction (Prematurity\>EtOH = RF) ;
## Footnote
Cerebral Palsy is **SAD**
1. BL equinovarus club feet (image)
2. UMN signs LE \>UE
3. Mental Retardation
*Greatest RF = prematurity ( \< 32 wks gestation)*
215
CP for Chemotherapy Peripheral Neuropathy - 4
1. **Stocking Glove** **symmetrical** paresthesias starting at toes/fingers and spreading proximal
2. Early loss of ankle jerk reflex
3. Loss of Pain/Temp
4. Motor weakness
## Footnote
*Drug Culprits: Cisplatin / Paclitaxel / Vincristine*
216
*SIDS is sudden infant death that can't be explained*
What are 4 major ways to ⬇︎ risk of SIDS?
1. **Supine** Sleeping position
2. NO second hand smoke
3. Use Pacifier during sleep
4. ROOM sharing (NOT bed sharing)
217
Causes of [Magnetic "Frontal" Gait Apraxia] ? - 2
## Footnote
*Inability to walk on command and feels like feet are magnets*
1. Normal Pressure Hydrocephalus
2. Frontal Lobe Degeneration
218
CP of Conversion Disorder -2
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Demographic-3?
[Sudden Vision Loss] + [**Pseudo**Seizures idiopathic]!
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
1. Teens WITH WITNESSES AROUND
2. Physically abused
3. Depressed pts
219
*Edinger Westphal nucleus provides* ⬜ *to the* ⬜ *ganglion*
CP of a pt with R damaged EW nucleus
PreGanglionic [ParaSympathetic efferent OUTflow] to ciliary ganglion
**R** (Ipsilateral) FIXED DILATED pupil not reactive to light
220
What are the major functions of [Vagus CN10] - 5
**VAGUS**
**V**ocal Cord Phonation
[**A**ortic baro/chemoreceptor Parasympathetics]
[**G**ag reflex - EFFerent (loss of Gag = CN9 problem)]
**U**'ll COUGH reflex- *when vagus receives signal* afferently
[**S**wallowing & Palate Elevation]
*Image: **Left** Ipsilateral CN10 palate dysfunction*
221
Tx for Clostridium Botulinum poisoning - 3
1. Equine Heptavalent Antitoxin (passive immunity)
2. Botulinum Ig
3. Guanidine
222
Describe Physiologic Tremors
benign [**12-14 Hz** **high freq**] tremor that occurs posturally (i.e. when holdings arms out), activated w/emotion or caffeine
223
A lesion in the **Upper** Thoracic Spinal Cord produces what CP - 4
1. Sensory loss nipples downward
2. Paraplegia
3. Bladder Incontinence
4. Fecal Incontinence
224
A lesion in the **Lower** Thoracic Spinal Cord produces what CP
Sensory loss Umbilicus downward
225
A: What are **Craniopharyngioma****s**
B: What type of tissue do they arise from
A: Suprasellar tumors (Mostly in Kids but NOT ALWAYS)
B: Remnants of Rathke's Pouch (Embryonic Precursor of ANT Pituitary)
226
Loss of **Gag Reflex** indicates what cranial nerve damage
Glossopharyngeal CN9 *Ipsilateral*
227
**Dysphagia** indicates what n. damage (2)
[Glossopharyngeal CN9] and [Vagus CN10]
228
**Dysphonia/Hoarseness** indicates what n. damage
[Vagus CN10]
229
Atomoxetine Indication
**Non**Stimulant ADHD Rx
230
Explain why a child presenting with Migraine s/s is no major concern ; Where do these occur in kids?
Migraine HA are most common HA in peds and occur before 20 yo in 50% ; Bifrontal *(if occipital, be suspicious!)*
231
Tx of **Pediatric** Migraine - 3
1. Dark Quiet Room +
2. NSAID
3. Triptans (refractory)
## Footnote
*Triggers = stress/lights/odors/foods*
232
Parkinson's Disease Dx
**PHYSICAL EXAM!** revealing **at least 2/4** of PARK
233
How is Carotid Artery Dissection associated with Horner Syndrome?
Carotid A Dissection --\> **Partial** Horner (Ptosis + Miosis only) 2/2 postganglionic sympathetic fiber damage
234
CP of **Craniopharyngioma****s** - 3
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Demographic?-2
1. BiTemporal Hemianopsia
2. HA
3. Pituitary Hormonal Deficiencies (i.e. ⬇︎Libido)
Demographic: **MOSTLY KIDS**, but some adults
235
How long does it take pts with Subdural hematoma to have sx? Why is this a problem for elderly?
1-2 days; Elderly may have insidious subdural bleeds for weeks after injury --\> Confusion/Somnolence/HA/FOCAL Neuro ∆
## Footnote
*Image: L **Chronic** Subdural Hematoma*
236
Step-Wise Tx to Restless Leg Syndrome - 4
1st: NonPharm (Leg Massage/Heat/Exercise/Iron Supplement)
2nd: Dopamine Agonist NonErgots (Pramipexole/Ropinirole)
3rd: Gabapentin (if pt also has insomina vs chronic pain)
4th: Opioids
237
Which medications should be given to a pt with stroke and no prior antiplatelet tx?-2 ; When should it be given?
ASA + Statin ; **Within 24 hrs** of onset
238
Which medications should be given to a pt with acute ischemic stroke and on ASA already? - 2
## Footnote
*Give within 24 hr of onset*
*Make sure ASA is first*
[Clopidogrel 75 QD vs Dipyridamole 200 BID]
239
Why is Heparin NOT USED in pts with Acute Stroke?
⬆︎Bleeding Risk if stroke turns out to be Hemorrhagic
240
Which disease process does this patient have?
*Keeps R arm ADDucted and swings R leg outward in semicircle as they walk*
**Hemiparesis** 2/2 stroke
241
What are the Afferent and Efferent nerves for Corneal Reflex?
242
What are the Afferent and Efferent nerves for Lacrimal Reflex?
243
A: **Primary CNS Lymphoma** is the ⬜ most common cause of ⬜ in HIV pts
B: What *virus* is this associated with?
C: What WBCs would you expect to see in the brain tissue
A: **2nd** most common cause of **ring enhancing lesions** in HIV pts (*1st = Toxoplasmosis Gondi*)
B: **EBV**
C: B-lymphocytes
244
What is [Hydrocephalus **Ex Vacuo**] and which pts do you see it in?
Ventricular Enlargement **only because of cortical atrophy**, typically found in HIV pts (cortical atrophy is normal sequelae in HIV)
*True Hydrocephalus is actual build up of CSF (obstruction vs. hyperproduction**)*
245
*PML Clinically Presents like Multiple Sclerosis*
Describe **PML-P**rogressive **M**ultifocal **L**eukoencephalopathy
Opportunistic infection 2º to [John Cunningham PolyomaVirus]----\> [**multiple white** matter lesions] (***Hyperintense Flair signal on radiology***) --\> Death vs. Severe Neuro injury
246
Describe 2 neuro conditions associated with HIV
1. **HIV Encephalopathy** which = [microglial nodule GREY MATTER ENCEPHALITIS] in pts with ~**CD4 \< 200** ---\> Subactue HIV associated Dementia (HAD) + parkinsonism
2. **HIV Meningitis***--\>*Persistent Pleocytosis, neuro sx and Dementia via _Direct_ Viral invasion vs. _inDirect_ inflammation
## Footnote
*HIV LeukoEncephalopathy is the same thing but with White matter instead*
247
What Dx should you suspect in a *Young HIV Pt witih Dementia*?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Pgn?
**AIDS Dementia**= slow cognitive & behavioral decline with POOR PGN . *Note: This presentation is Similar to [SuBACute Combined Degeneration]*
*HIV LeukoEncephalopathy is the same thing but with White matter instead*
248
*PML (**P**rogressive **M**ultifocal **L**eukoencephalopathy) Clinically Presents like Multiple Sclerosis*
Where does PML typically occur in the brain? - 2
[SubCortical White Matter] or [Cerebellar Peduncles]
## Footnote
*Usual Demographic: HIV pts (reversal of immunosuppresion stops JC Polyoma virus progression)*
249
*PML (**P**rogressive **M**ultifocal **L**eukoencephalopathy) Clinically Presents like Multiple Sclerosis*
How is **PML** related to the drug, Natalizumab?
Also can be a **Rare Side Effect** of Natalizumab (MS drug) in pts who are also JC Virus positive
## Footnote
*Usual Demographic: HIV pts (reversal of immunosuppresion stops JC Polyoma virus progression)*
250
Parinaud Syndrome etx ; How does it clinically present?-3
"Parinaud loved his **PUP**"
Direct Compresion of [Midbrain Pretectum SUP Colliculi] (possibly from Germinoma) --\>
1. **P**tosis
2. **U**pward Gaze paralysis (can NOT look up)
3. **P**upil ∆
*these can also cause obstructive hydrocephalus*
251
*Pt comes in with Foot Drop*
What are the 2 main DDx?
Common Peroneal n compression vs L**5** Radiculopathy(*will be accompanied with shooting back pain*)
## Footnote
*Dx: Knee MRI vs EMG*
252
Status Epilepticus Mngmt - 5
1st: ABCs!
2nd: Ativan IV bolus 0.1mg/kg = 4-8 mg (repeat in 5-10 min if needed)
3rd: **Fos**Phenytoin IV 20 units/kg (no faster than 150 mg/min) (Continuous IV Phenytoin --\>Purple Glove Syndrome and so is alternative)
4th (if still status): [Alternate Diazepam Levatiracetam]
5th (if still status): Pentobarb coma
*Image showing Cortical Laminar Necrosis s/p Status Epilepticus*
253
DDx for Intra**cerebral** Hemorrhage - 5
1. **HTN** (Charcot Bouchard aneurysm vs Cocaine)
2. Warfarin OD
3. Tumor Metz (Papillary Thyroid/Renal/Melanoma/Testicular)
4. AVM
5. Hemorrhagic Conversion of [Ischemic infarct 3-5 days prior]
254
Key points for mngmt of Intra**cerebral** Hemorrhage - 5
1. BP \< 140 (Use Labetalol & Nifedipine, not Hydralazine)
2. ⬇︎ICP with Mannitol vs [23% Hypertonic Saline] vs Hyperventilate
3. Osm Goal = 300-320
4. Na+ **\>\>\>\>\>\>** 145
5. Repeat CT after 6 hours
255
Ulnar Nerve Syndrome tx-3
1. Elbow Protectors
2. Avoid direct elbow pressure or mvmnt
3. Surgery
## Footnote
*May also occur at forearm in DM pts*
256
Ulnar Nerve Syndrome Risk Factors - 3
1. Surgery Malpositioning
2. Male
3. DM
## Footnote
*May also occur at forearm in DM pts*
257
Tx for Bell's Palsy - 4
1. [CTS PO within 3 days of onset] (self resolves within 6 mo.)
2. Valacyclovir 500 mg BID (HSV may be inciting factor)
3. Artificial Tear to affected eye **during day**
4. Ophthalmic ointment to affected eye **at night**
258
Where is the hypoglossal nucleus located?
Dorsomedial Medulla
259
*Isolated Hypoglossal CN12 palsy is not common*
What's the most common cause of this **when it's isolated**? What are other causes?-6
1. **TUMOR**
2. Guillain Barre
3. Multiple Sclerosis
4. Surgery
5. Infection
6. Trauma
260
*Pt has CHRONIC burning tingling dysthesia*
Tx? - 3
1. TCA (Amitriptyline or Nortriptyline)
2. Gabapentin
3. Carbamazepine
## Footnote
*dysthesia = unpleasant sensation*
261
Top DDx for CHRONIC Sensory Neuropathy - 5
1. VitB12 deficiency
2. Sjogren's Syndrome (check SSA Ro and SSB La)
3. [Pyridoxine B6] toxicity
4. Cisplatin toxicity
5. Inflammatory ganglionopathy (viral vs immune)
262
Where do most disc herniations occur? - 2 ; Risk factor for disc hernation?
between
* L4 - L5 OR
* L5 - S1
SMOKING = Risk factor
*Positive **Crossed** Straight Leg = **Lumbar** Disc hernation*
263
What 4 locations is pain radiated to in L5 Radiculopathy?
1. Lower Back
2. Butt
3. Lateral Thigh
4. LateralAntero Calf
## Footnote
*L5 Radiculopathy can also cause Foot dropPED*
264
Which reflexes are **spared** in L5 Radiculpathy? - 2
Patellar and Ankle Jerk
265
DDx for an expanding intramedullary mass? - 6
## Footnote
*Image: Intramedullary mass + expanding edema*
1. Sarcoidosis
2. Ependymoma (usually in 4th vt)
3. Meningioma benign
4. Demyeliating Disease (Multiple Sclerosis)
5. Metastasis
6. Transverse Myelitis
## Footnote
*Image: Intramedullary mass + expanding edema*
266
Tx for Sarcoid Myelopathy
## Footnote
*Image: Intramedullary mass + expanding edema*
Corticosteroids
*Image: Intramedullary mass + expanding edema*
267
What regions of the spinal cord does the Anterior Spinal Artery perfuse? - 3
1. ANT horns
2. Lateral Corticospinal Tract
3. Lateral Spinothalamic Tract
## Footnote
*POST Spinal Artery perfuses Dorsal Column*
268
What is Aphasia?
⬇︎Language Processing (speech/writing vs comprehension + repetition)
269
HYPERdensity on CT represents what? - 3
1. Blood
2. Bone
3. Calcification (normal and often seen in choroid plexus)
270
Most common cause of Spinal Cord Ischemia?-2 ; Other causes?-3
[**Aortic** Disease (thromboembolic)] or [**Aortic** Surgery]
Others= Hematomyelia, AVM, Fracture/Dislocation
271
When is [CEA-Carotid Endarterectomy] indicated?
**Only** when pt has a [**SYMPTOMATIC** 70-99% Stenosis]
272
The VertebroBasilar arterial system (Posterior Circulation) perfuses which major structures? - 4
1. Brainstem
2. Cerebellum
3. Spinal Cord
4. Labyrinths
273
What areas of the brain are involved in **CONDUCTION** Aphasia? - 4
**VERY POOR** Repetition
1. Arcuate Fasciculus = MOST COMMON
2. Supramarginal Gyrus
3. Auditory Cortex
4. Large Posterior Perisylvian area
274
Main Features of TIA - 2
1. Transient ( No more than 1 day long but typically **\< 20 min**)
2. Leaves NO residual deficits or radiomanifestations
275
CP of VertebroBasilar TIA - 4
Brainstem: **Diplopia**, **Dysarthria**
Cerebellum: **BL Clumsiness**
Spinal Cord: **BL Weakness**
Labyrinths
276
*Surgery is a LAST OPTION for treating Essential Tremor*
List the Surgical Procedures available-2 ; What is the goal of the surgery?
1. Stereotactic VIM Thalamotomy
2. VIM Thalamic Stimulation
## Footnote
Goal = VIM (Ventralis InterMedius) thalamic nc
*Onsets at 45 yo and 50% cases are AUTO DOM*
277
Both Mannitol and [Hypertonic Saline (3%/5%/23%)] are used to ⬇︎ ICP
List advantages of using Hypertonic saline? - 3
1. Anti-Inflammatory
2. Does NOT cross into interstitial space like Mannitol does eventually (Mannitol causes rebound edema!)
3. Expands systemic volume
## Footnote
*Hypertonic Saline can ONLY be given via Central line :-(*
278
*Myasthenia Gravis, LEMS and [Myopathies (polymyositis/dermatomyositis)] can be similar*
How can you differentiate these based on reflexes?
**Myopathies[polymyositis/dermatomyositis]** and **LEMS** have ⬇︎ Reflexes.
## Footnote
Myasthenia is normal
279
How are migraines associated with Pregnancy?
Migraines commonly start **2nd** **trimester** of Pregnancy
## Footnote
*But also be suspicious of [Pseudotumor Cerebrii]*
280
*Memory depends on a BL 4-way circuit*
What is this circuit?-4
"***H**aving **F**un **M**emories **A**round"*
[**H**ippocampus temporal lobe] --\> **F**ornix --\> **Mammillary Bodies** ---\> **ANT Thalamus**
281
*Memory depends on a BL 4 way-circuit*
How is this Memory circuit often damaged?-3
*"**H**aving **F**un **M**emories **A**round"*
[Hippocampus temporal lobe] --\> Fornix --\> **Mammillary Bodies** --\> **ANT Thalamus**
1. [Thiamine B1 deficiency] --\> disruption between [Mammillary Bodies] and [ANT Thalamus]
2. Anoxia --\> BL [Hippocampus temporal lobe] damage
3. HSV --\> BL [Hippocampus temporal lobe] damage
282
Describe Constructional Apraxia ; Describe Dressing Apraxia
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
What causes both of these?
* Constructional Apraxia = Can't Construct a Drawing (i.e. copy a house)
* Dressing Apraxia = Can't get Dressed
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Both caused by **Parietal** Lobe lesion
283
Name 2 examples of Frontal Lobe release signs?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
When is this normal? When is it abnormal?
1. Sucking examiner finger when corner mouth is lightly stroked
2. Toes latching onto examiner finger when rubbed
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
normal = during infancy when [descending inhibitory pathway myelination] is still incomplete
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Abnormal = in Adults and means Frontal lobe damage
284
What is Anton's syndrome
Unawareness of Vision loss from Occipital lobe damage --\> Denial of vision loss
## Footnote
*"Anton didn't know he was blind!"*
285
What's the only imaging modality for diagnosing Alzheimer's Disease?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Which areas does it reveal this in? - 3
**CLAV --\> HANDU**
PET scan revealing [**PIB**-Pittsburgh Compound B] binding to β-amyloid and being taken up in
1. PreFrontal
2. Temporal
3. Parietal
286
Which 3 Neuro Diseases Cross the Corpus Callosum?
1. Gliomas (*AGE - i.e. Glioblastoma*)
2. Multiple Sclerosis
3. CNS Lymphoma
287
20% of patients with ⬜ go on to develop Multiple Sclerosis
[**SLUM** **SiiiN**]
**N**euritis Optic - (uL eye pain + vision loss + Marcus Gunn afferent pupillary defect) = ALSO RISK FACTOR
*Image: T1 MRI Black Holes Dx*
288
*SAH usually occur in **Suprasellar** Cistern*
289
*Usually Simple Partial Seizures originate in a **single** hemisphere*
What happens when Simple Partial seizures involve **BOTH hemispheres** (i.e. COMPLEX Partial Seizure)? - 2
ONLY If BOTH hemispheres _become_ involved --\>
1. **IMPAIRED BUT NOT LOST OF consciousness** (won't follow commands and will have postictal amnesia)
2. **+/-automatisms** (repetitive chewing, sucking, swallowing)
=COMPLEX Partial Seizure
290
*Usually Simple Partial Seizures originate in a **single** hemisphere*
What happens when Simple Partial seizures spread **DIFFUSELY** to **bilateral cortex areas** - 3
= *Secondary* GENERALIZED TONIC CLONIC
1. **Generalized** Convulsions
2. **LOST** of Consciousness may occur
3. Postictal Amnesia
291
List the difference between Primary and Secondary Generalized Tonic Clonic Seizures
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*Seizure **ATTaCK***
*Primary* GTC occur when electrical discharge simultaneously comes from **diffuse bilateral cortical areas** (i.e. Absence)
vs
*Secondary GTC* comes from the spread of a [simple partial seizure]
292
List the sequence of events for a Seizure - 5
Seizure **ATTaCK**
## Footnote
1st: **A**ura (nausea/dizziness) vs Simple Partial
2nd: **T**onic: Sudden Stiffness--\>Falling and cry out
3rd: [**T**ime Out: **a**PNEA] --\> Cyanotic, dusky face
4th: **C**lonic **c**onvulsions + oral involvement
5th: [**K**razed: Postictal Amnesia (pt only recalls aura) + Lethargy + incontinence]
293
Describe NonEpileptic Pseudoseizures
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Demographic-2?
Episodic jerking movements that occur **WITH NO** **cortical discharge** (falls under conversion disorder)
## Footnote
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
1. Teens WITH WITNESSES AROUND
2. Physically abused pts
3. Depressed pts
294
What are the major triggers of [Partial Seizures and *Secondary* GTC] - 3
1. Infarct
2. Tumor
3. Viral Encephalitis
295
*Pt just fell and started GTC seizing right in front of you!*
How should you manage them? - 4
Seizure **ATTaCK**
## Footnote
1st: Roll pt onto side
2nd: Stabilize Head BUT NOT THEIR MVMNTS
3rd: KEEP THINGS OUT OF MOUTH OR AROUND PT
4th: ER if \> 5 min
296
Carbamazepine, Phenytoin, Gabapentin are **only** used to treat what type of seizures? - 3
1. Simple **Partial**
2. Complex **Partial**
3. Simple/Complex **Partial** convert --\> *Secondary* GTC
297
Name the CNS Neoplasms that are of **Glial** Origin (i.e. Glioma) - 3
**AGE** comes from Glia
1. **A**strocytoma (i.e. Glioblastoma)
2. Oligodendro**Gli**oma (adult frontal lobe)
3. **E**pendymoma (*ependymal cells line ventricles*)
*These stain positive for **GFAP***
298
What should be used to treat **edema** surrounding brain tumors?
## Footnote
*Image: MRI showing Tumor with Hyperdense surrounding edema*
Dexamethasone
## Footnote
*NOT effective in ⬇︎ICP during Stroke*
299
What is Meningeal Carcinomatosis?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Tx?
Spread of CA to **CSF** which diseminates to Meninges, Cortex, Cranial n, spinal nerve roots
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Tx = Intrathecal Chemo
300
Explain how collateral blood flow to a "complete" circle of willis help prevent ischemic CVA/TIA?
[External Carotid: Opthalmic A] can retrogradedly perfuse Circle of Willis when Internal Carotid is blocked
301
What structures does the **lenticulostriate vessels** perfuse (4)
lenticulostriate vessels perfuse everything in [**B**e **TI**P**C**] EXCEPT PONS!
**B**asal Ganglia
**T**halamus = pure sensory stroke
[**I**nternal Capsule / / **C**orona Radiata] = pure motor stroke
302
*Describe the likely regions involved for the following deficits*
## Footnote
A: Weakness of Face and UE
B: Weakness of LE
C: Numbness of Face and UE
D: Numbness of LE
A: CTL Precentral MCA territory (*Face and UE weak*)
B: CTL Precentral ACA territory (*LE weak*)
C: CTL PostCentral MCA terrtory (*Face and UE numb*)
D: CTL PostCentral ACA territory (*LE numb*)
303
Which imaging should be obtained for CVA/TIA w/u? - 4
1. NonContrast Head CT
2. TTEchocardiography (evaluate for cardioembolism)
3. Carotid cervical US
4. CTA/MRA (CTA shown in image-evaluate for Vertebrobasilar abnormalities)
304
Why is Altered mental status in a pt who had a large **ischemic** stroke 4 days prior alarming? - 2
Within 3-5 days (below) can develop:
1. Hemorrhagic conversion of infarct
2. Brain Edema
305
What's the most common cause of SubArachnoid Hemorrhage?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
What's the 2nd?
*Usually in the Suprasellar Cistern*
**Trauma** \> [Berry Saccular Aneurysm]
306
What is Prosody?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
A stroke in what part of the brain creates [Sensory receptive Aprosody]?
Using changes in vocal pitch/inflection to convey language (i.e. You gave this to me? vs You gave this to me)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[**NonDominant** Cortex opposite to Wernicke's area]
*example: Sensory receptive Aprosody*
307
What is [Sensory receptive aprosody]?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
How does it occur?
Inability of pt to understand prosody/vocal inflections **by other people**
**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**
Damage to [**NonDominant** Cortex opposite to Wernicke's area]
308
What is the action of the Inferior Oblique m?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
What is the action of the Superior Oblique m?
**IOUO SODO**
**I**nferior**O**blique = **U**p and **O**ut
**S**uperior**O**blique (*innervated by Trochlear CN4*) = **D**own and **O**ut
309
What is unique about [Trochlear CN4]?
Only cranial nerve to exit **DORSAL** midbrain and then decussate and innervate **CTL** Superior Oblique muscle
## Footnote
IOUO SODO
310
What is the difference in clinical presentation between [neuro nystagmus (cerebellum/vestibular)] vs drug nystagmus? -2
neuro nystagmus = **asymmetrical(slow jerk toward side of lesion)** & **occurs only with certain eye positions**
vs
drug nystagmus = **symmetrical** & **occurs all the time**
311
What does the PPRF have to do for **Right** Horizontal Gaze
* Activate **Right** Abducens nc in Pons
* Activate **Left** EdingerWestphal in Dorsal Midbrain
* MLF connects all this, leaving R PPRF, decussating and then joining L oculomotor nc*
* Image: Left MIOS*
312
A: **MIOS** seen in Younger pts indicates ⬜
B: **MIOS** seen in OLDER pts indicates ⬜
C: What is the purpose of the MLF
[**MIOS**-**M**LF **I**nternuclear **O**phthalmoplegia **S**yndrome]
1) Younger pts= Multiple Sclerosis
2) Older pts= [Pontine a. lacunar stroke]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
MLF coordinates CN3 with CN6
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*Image: Left MIOS*
313
Explain [Relative Afferent Pupillary Defect]
**partial** optic n vs retinal lesion --\> pupils BOTH constrict when light is shown in normal eye BUT when light is *swung* to **lesioned** eye BOTH eyes Dilates since lesioned eye has ⬇︎ afferent input
314
Recall the Oculosympathetic Horner's pathway - 9
1. Hypothalamus
2. Passes as hypothalamospinal tract in **lateral medulla**
3. [IML C8-T1 Cilospinal Center of Budge]
4. Under Subclavian Artery as sympathetic trunk
5. Lung Apex
6. SUP cervical ganglion near carotid bifurcation
6A. Facial Sweat Glands
6B. carried with CN5B1 **thru cavernous sinus** & then **SUP orbital fissure** to Pupil Dilator
6C. Innervates [Muller's superior tarsal muscle]
*2 / 5 / 6 / 6B are most common sites of Horner's syndrome*
315
What would a [**R** **Partial Retinal lesion**] manifest as
R Monocular scotoma
316
Lesion at which letter would result in [**R Nasal Hemianopia**]
D
317
Lesion at which letter would result in [**L Pie on the Floor (Homonymous INF quadrantanopia)**] lesion
G
318
Parkinsonism is often caused by ⬜ or ⬜
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Name 2 *rare* causes of Parkinsonism
Common = [Substantia nigra pars compacta degeneration] vs [D2 Blocker Drugs]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
rare = [Toxic levels of CO2] or [ManGanese]
***PARK** & **hamp***
319
Risk Factors for Migraines - 2
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
***VTAP** the migraine BEFORE it comes, and **SEND** it on its way when it does!*
1. Fam Hx
2. Menstruation (hormones during cycle ⬆︎ risk)
320
Migraine etx
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
How are the Trigeminal nerves associated-2
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
***VTAP** the migraine BEFORE it comes, and **SEND** it on its way when it does!*
Genetic [GainOfFunction mutation in *excitatory NMDA receptor*]--\>burst of cerebral activity _when triggered_---\>hyperemia (*usually occipital lobe*)--\> sx. Burst is followed by **Cortical Depolarization** tht has slow but deliberate forward advance --\> Triggers Trigeminal pathway
Trigeminal afferents :
1. send impulses--\>[Brain Stem APCTZ] & hypothalamus--\> Nausea/Photophobia/Phonophobia
2. retroactively depolarize--\>release of substance P --\> neurogenic inflammatory pain + vasoDilation
321
*Pt has advancing foot crossing over opposite foot similar to closing scissor blades*
What causes Scissors Gait?
UMN (Corticospinal Tract spasticity) lesions
## Footnote
**S**pasticity causes **S**cissors Gait
322
What causes a Broad based Ataxic gait? - 2
Cerebellar vs [Dorsal Column Pathway] dysfunction
323
Tx for **EPS**-**E**xtra**P**yramidal**S**ymptoms - 2
EPS = **DAD**
Benztropine vs Diphenhydramine
324
How do you differentiate Tunnel Vision 2/2 [Glaucoma or Retinal Degeneration] from Psychiatric etiology?
As examiner moves further away ...
## Footnote
[Glaucoma or Retinal degeneration] = Tunnel Vision **enlarges** in cone pattern
vs
Psychiatric = Tunnel vision stays Tunnel
325
Which Artery of the Base of Brain can cause unilateral hearing loss if occluded?
**AICA**
## Footnote
*Other causes: [Petrous bone trauma]*
326
Meniere's Disease CP-3?
\*\***V**ery **T**errible **H**earing \*\* *that is* ***recurrent***
1. **V**ertigo
2. **T**innitus
3. **H**earing loss which --\> Permanent eventually
327
Acute Labyrinthitis CP - 4?
\*\***V**ery **T**errible **N**ystagmus & **H**earing \*\*
1. **V**ertigo
2. **T**innitus
3. **N**ystagmus
4. **H**earing loss which --\> Permanent eventually
328
What is the [**ARAS** (**A**scending **R**eticular **A**ctivating **S**ystem)] important for?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Lesions of the ⬜ where ARAS is located leads to what? - 2
**A****RAS**(**A**lways**R**etaining**A**wake**S**tate) = keeps you awake!
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
lesions of **upper brain stem** --\> Somnolence or Coma
329
DSM5 Criteria For Narcolepsy (2)
[Recurrent and sudden entry into **REM** sleep **at least (3 x/week) x 3 mo.**]
+
1 of the following:
a. Cataplexy
b. [Low CSF hypOcretin1 orexin A]
c. [REM latency ≤ 15 min] (*goes into REM in less than 15 min*)
330
What is Hypocretin 1 and 2 also known as, and what is their function?
[Hypocretin 1 (Orexin A)[and [Hypocretin 2 (Orexin B)] are [Lateral hypothalamus neuropeptides] that promote wakefullness & inhibit [REM sleep-related phenomena]
## Footnote
*These are deficient in Narcolepsy*
331
Tetanus takes ⬜ days to onset after exposure to endospores
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Tx? - 4
**2** days;
1. Mechanical ventilation ICU
2. Human Tetanus Immune Globulin
3. Abx
4. Diazepam
*Comes from puncture wound vs burn*
332
DDx for Clostridium Botulinum - 4
*Also consider...*
1. Myasthenia Gravis
2. Atypical Guillain Barre
3. Tick Paralysis
4. Brain Stem infarct
*Adult tx: Equine Heptavalent Antitoxin (passive immunity)*
333
How do Adults present after Lead Poisoning?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
How do Children present after Lead Poisoning?-2
Adults: [Workplace paint vs. lead battery] --\> Peripheral neuropathy
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Children: [ingeting lead paint flakes] --\> [Encephalopathy + Abd pain]
334
What part of the cerebellum is affected by Alcoholic degeneration?
ANT SUP vermis
## Footnote
*Explains Dysmetria of LE \> UE*
335
Which areas of the brain are affected by [HSE-Herpes Simplex Encephalitis]? - 2
1. Medial temporal
2. Inferior frontal
336
Brain Contusions are superficial hemorrhages in which lobe regions? - 3
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
What type of motion causes these?-2
1. Basal
2. [Ventral Frontal]
3. [Ventral ANT Temporal]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Angular or Rotational (NOT LINEAR)
337
[Dorsal tectal midbrain] lesions selectively involve [⬜(*Sympathetic vs Parasympathetic*)] fibers
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
How does this affect Pupils?
ParaSympathetic ;**FIXED** Dilated BL Pupils from unopposed Sympathetics
338
How is the [Oculocephalic Dolls eye Reflex] used to assess brainstem function?
Eyes should **remain stationary** **and fixed** as head is rotated = normal brain stem function
339
Describe **Pseudoexacerbation** of Multiple Sclerosis
[**SLUM** **SiiiN**]
Infection in MS pt --\>⬆︎ Body temp --\> ⬇︎Conduction in [Remyelinated healed CNS areas] --\> clinically **APPEARS** to be MS exacerbation BUT REALLY ISN'T!
*Image: T1 MRI Black Holes Dx*
340
Nerve roots for Ankle Jerk Reflex
*"1, 2 buckle my shoe - 3, 4 kick the door - 5, 6 pick up sticks - 7, 8 lay down straight"*
S**1** - S**2**
341
Nerve roots for Patellar Reflex
*"1, 2 buckle my shoe - 3, 4 kick the door - 5, 6 pick up sticks - 7, 8 lay down straight"*
L**3** - L**4**
342
Nerve roots for Biceps Reflex
*"1, 2 buckle my shoe - 3, 4 kick the door - 5, 6 pick up sticks - 7, 8 lay down straight"*
C**5** - C**6**
343
Nerve roots for Triceps Reflex
*"1, 2 buckle my shoe - 3, 4 kick the door - 5, 6 pick up sticks - 7, 8 lay down straight"*
C**7** - C**8**
344
Sciatica etx ; Clinical Presentation - 3
"Having Sciatica makes you break **LAWS**"
* [**L**ower Back pain w/radiation down POSTERIOR thigh --\> lateral foot]
* **A**nkle jerk reflex ABSENT (this can occur naturally with age!)
* **W**eak Hip Extension
* [**S**1 n PosteroLateral compression at L4-5 or L5-S1] --\> UMN signs
345
**Neonatal Abstinence Syndrome**
Classic Signs - 5
**TYT D**oes **H**eroin
1. **T**remors
2. **Y**awning
3. **T**achypnea
4. **D**iarrhea
5. **H**igh Pitched Cry
*Caused by maternal opioid (**H**eroin) use during pregnancy*
346
Major causes of Altered Mental Status-20
**AEIOU TIPS**
347
Where do most Medulloblastomas occur?
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
How does this present clinically?
Cerebellar VERMIS
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Truncal ataxia
348
Meniere's Disease tx - 5
1st: Diet change (restrict Na+, caffeine, Nicotine, EtOH)
2nd: Benzo, antihistamines, antiemetics
3rd: Diuretics for long term
Sx = VTH (Vertigo, Tinnitus, Hearing loss)
349
Alcoholic cerebellar degeneration causes damage to the ⬜
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
How can you differentiate Alcoholic cerebellar damage from other causes of cerebellar damage?
[Purkinje cells of cerebellar vermis]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Alcoholic cerebellar damage **LEAVES LIMB COORDINATION INTACT** (no intention tremor)
Cere is def on **GRINDRR**
350
What are the neurological manifestations of DM in the extremities
Symmetrical loss of **2TVP** (2point,Touch,Vibration,Proprioception) distally
GAIT IS INTACT
351
Sciatica tx -2
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Sciatica dx
"Having Sciatica makes you break **LAWS**"
NSAIDs + APAP = 1st line as Sciatica sx are self limited
Dx = **CLINICAL** (Only use MRI for confirmation of disc herniation if sensory/motor deficit, cauda equina syndrome sx or epidural abscess r/o)
352
*Brain Death is a clinical diagnosis and involves absent cortical and brain stem functions*
What are the legal complications of disabling articial life support for a pt who is newly diagnosed with Brain Death?
None - Brain death is a legally acceptable definition of death
353
Brachial Plexus damage of
[Radial C7 n]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
causes -3
1. [Crutches/Axilla damage]
2. \< [Supracondylar Fall onto outstretched arm] ➜ [proximal humerus antero**LATERAL** displacement] \>
3. Midshaft Humerus
354
Brachial Plexus damage of
[Radial C7 n]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
clinical presentation? -2
[Saturday night palsy wrist drop]
[No Tricep Reflex]
355
Brachial Plexus damage of
[Axillary C7 n]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
causes -3
1. [Surgical NECK humerus]
2. [ANTERIOR humerus displacement]
3. Shoulder Injury
356
Brachial Plexus damage of
[Axillary C7 n]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
clinical presentation?
[Deltoid paralysis]
357
Brachial Plexus damage of
[long thoracic C5-T1 n]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
causes -2
- STABS
- [MASTECTOMY AXILLARY NODE DISSECTION]
358
Brachial Plexus damage of
[long thoracic C5-T1 n]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
clinical presentation? -2
[winged scapula]
[inability to **AB**duct shoulder \> 90º]
359
Brachial Plexus damage of
[ULNAR C8-T1 n]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
clinical presentation?
[ULNAR *PARTIAL CLAW* (4th and 5th digit flexed **AT REST**)]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
([hyperextension of 4th MCP and 5th MCP] + [flexion of 4th PIP and 5th PIP])
360
Brachial Plexus damage of
[ULNAR C8-T1 n]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
cause -3
1. [FALL ONTO FLEXED ELBOW ➜ **POSTERIOR** PROXIMAL HUMERUS DISPLACEMENT]
2. [MEDIAL EPICONDYLE]
3. [BICYCLIST HOOK OF HAMATE INJURY = GUYAN CANAL SYNDROME]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*[Ulnar Partial claw (4th and 5th digits flexed AT REST)]*
361
Brachial Plexus damage of
[median C5-T1 n]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
clinical presentation?
[Pope's Blessing Thumb Paralysis]
362
Brachial Plexus damage of
[median C5-T1 n]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
cause?
[Supracondylar Humeral Fall onto outstretched arm] ➜ [antero**MEDIAL** proximal humerus displacement]
363
Brachial Plexus damage of
[*DISTAL* median C5-T1 n]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
clinical presentation? -2
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
(DISTAL to elbow)
median claw
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[1st and 2nd digits FLEXED AT REST]
+
[Thumb thenar palsy ➜ thenar atrophy]
364
Brachial Plexus damage of
[*proximal* median C5-T1 n]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
clinical presentation? -2
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
(proximal to elbow)
Pope's blessing
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
[4th and 5th digits **FLEX ALONE WHEN FISTING** (Pope's Blessing)]
+
[Thumb thenar palsy ➜ thenar atrophy]
365
Brachial Plexus damage of
[musculocutaneous C5-C6 n]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
clinical presentation? -2
[elbow flexion ⬇︎]
[variable sensory loss]
366
Brachial Plexus damage of
[posterior cord C7]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
clinical presentation?
[wrist drop]
367
Brachial Plexus damage of
[lower Trunk C8-T1]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
cause -3
1. \< [extra rib / thoracic outlet syndrome] ➜ UE paresthesia + UE weakness \>
2. [sudden upward arm stretch]
3. [CABG surgery]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
*[klumpke palsy claw hand]*
368
Brachial Plexus damage of
[lower Trunk C8-T1]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
clinical presentation?
[klumpke palsy claw hand]
369
Brachial Plexus damage of
[Upper Trunk C5-C6]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
cause
[Baby Delivery lateral neck pull]
370
Brachial Plexus damage of
[Upper Trunk C5-C6]
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
clinical presentation?
[Erb Palsy Waiter's Tip]
371
Demonstrate Sensory Innervation of the Hand
Ulnar nerve
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Median nerve
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Radial nerve
