Neurology Flashcards
(209 cards)
1
Q
How does cranial nerve XII deficit present?
A
Weakness on the ipsilateral side and protrusion of the tongue toward the affected side - CN XII = Hypoglossal nerve
2
Q
How does cranial nerve XI deficit present?
A
Weakness with turning of head - CN XI = Spinal accessory nerve
3
Q
How does cranial nerve X deficit present?
A
Focal: Aphonia dysphagia dysarthria - Systemic: (cardiac and GI most affected) - CN X = Vagus nerve
4
Q
How does cranial nerve IX deficit present?
A
Dysphagia and dysarthria - CN IX = Glossopharyngeal nerve
5
Q
How does cranial nerve VIII deficit present?
A
Positional vertigo - Tinnitus - Rarely hearing loss - CN VIII = Vestibulocochlear nerve
6
Q
How does cranial nerve VII deficit present?
A
Complete or partial paralysis of the face - CN VII = Facial nerve
7
Q
How does cranial nerve VI deficit present?
A
Medial turning of affected eye - CN VI = Abducens nerve
8
Q
How does cranial nerve V deficit present?
A
Anesthesia of the forehead - Corneal drying - Decreased salivation - CN V = Trigeminal nerve
9
Q
How does cranial nerve IV deficit present?
A
Vertical diplopia - CN IV = Trochlear nerve
10
Q
How does cranial nerve III deficit present?
A
Outward and downward deviation of the eye - Ptosis of the eyelid - Dilation of the ipsilateral pupil in complete palsy -CN III - Oculomotor nerve
11
Q
How does cranial nerve II deficit present?
A
Partial or complete blindness - CN II = Optic nerve
12
Q
How does cranial nerve I deficit present?
A
Loss of smell - CN I = Olfactory nerve
13
Q
Medication added to cholinesterase inhibitors in the treatment of Alzheimer’s?
A
Memantine
14
Q
First line class of drugs used to treat Alzheimer
A
cholinesterase inhibitors
15
Q
Beta amyloid plaques and neurofibrillary tangles?
A
Alzheimer’s findings on autopsy
16
Q
Most common form of dementia?
A
Alzheimer’s disease
17
Q
Slowly progressive impairment of memory reasoning and orientation?
A
Dementia
18
Q
Common causes of delirium?
A
Medical illness - Sun downing - Substance intoxication or withdrawal - Sepsis
19
Q
Short term/temporary confusion or altered mental state?
A
Delirium
20
Q
Acute meningitis associated with a purpuric rash?
A
Meningococcal meningitis (N. Meningiditus)
21
Q
Most common cause of Reye Syndrome?
A
Salicylates (e.g. aspirin Pepto Bismol etc.)
22
Q
Rapidly progressive encephalopathy with hepatic dysfunction?
A
Reye Syndrome
23
Q
In what disorder are negri bodies found in neurons?
A
Rabies
24
Q
What are the most common symptoms of encephalitis?
A
Fever - Headache - Nausea - Vomiting - Altered mental status
25
Most common severe complication of measles?
Encephalitis
26
Viral meningitis is associated with predominance of what cell in the CSF?
Lymphocytes (Note: bacterial meningitis has neutrophils)
27
Name the sign: Inability to allow full extension of knee when hip is flexed 90 degrees.
Kernig’s sign
28
Name the sign: Flexion of hips on passive neck flexion.
Brudzinski's sign
29
What disorder are fever, headache, neck stiffness with initially normal brain function most concerning for?
Meningitis
30
Treatment for Cerebral Palsy?
Speech physical and occupational therapy - Aspiration precautions - Anti-spasmodics
31
Non-progressive disorder characterized by spastic rigidity and slow writhing movements?
Cerebral Palsy
32
Treatment of acute exacerbations of MS?
Glucocorticoids
33
What ophthalmology disorder is seen frequently in patients with multiple sclerosis (MS)?
Optic Neuritis
34
Most common demyelinating disorder mainly in women age 20-50?
Multiple Sclerosis
35
Radiating electrical sensation down the spine with neck flexion seen in patients with multiple sclerosis?
Lhermitte's phenomenon
36
Patients with Myasthenia Gravis have antibodies to what?
Acetylcholine receptors
37
Treatment for Myasthenia Gravis?
Pyridostigmine
38
Diagnostic test for Myasthenia Gravis?
Edrophonium (Tensilon) test
39
Proximal to distal motor weakness?
Myasthenia Gravis
40
Treatment for Guillain-Barre?
Intravenous immunoglobulins - Plasma exchange
41
Typical cerebral spinal fluid findings with Guillain-Barre?
Albuminocytologic dissociation
42
Most common organism causing Guillain-Barre?
Campylobacter jejuni
43
Ascending symmetrical paralysis/weakness with absent or decreased deep tendon reflexes?
Guillain-Barre Syndrome
44
Treatment for chorea + psychosis?
Haloperidol olanzapine or risperidone
45
Treatment for Huntington’s chorea?
Tetrabenazine
46
Mode of inheritance for Huntington’s?
Autosomal dominant
47
Inherited neurodegenerative disorder characterized by chorea?
Huntington's
48
Rapid involuntary irregular jerking motion of the hands face and feet?
Chorea
49
What disorder has bradykinesia pill rolling tremor masked facies and cogwheel rigidity?
Parkinson's
50
Preferred initial treatment for Parkinson’s after age 65?
Levodopa + carbidopa
51
Causes of intention tremors?
Multiple sclerosis - Brain trauma - Cerebellar disease
52
Tremor that increases in severity as it reaches its target?
Intention tremor
53
Treatment for essential tremors?
Propanolol and primidone
54
Tremor with movement but no tremor at rest?
Essential tremor
55
Tremor associated with caffeine intake anxiety and lithium therapy?
Physiologic tremor
56
Preferred first line treatment for Parkinson’s prior to age 65?
Dopamine agonists (bromocriptine - pramipexole - ropinirole)
57
What disorder has a resting tremor which goes away with movement?
Parkinson's
58
When can an athlete return to play after one concussion?
After 1 week with no symptoms
59
When can an athlete return to play if they have suffered 2 or more concussions in one year?
The following season
60
Headaches irritability loss of memory or concentration after a concussion?
Post Concussive Syndrome
61
Concussions are characterized by what Glasgow Coma Score 30 min after injury?
13-15
62
Mild traumatic brain injury due to contact or acceleration/deceleration injury?
Concussion
63
Medical treatment for complex seizures?
Phenytoin
64
Medical treatment for partial seizures?
Carbamazepine or lamotrigine
65
Pathophysiology of vasovagal (neurocardiac syncope)?
Bradycardia - Vasodilation
66
Medical treatment for status epilepticus?
IV lorazepam may follow with IV phenytoin
67
Single nonstop seizure lasting longer than 5 minutes or frequent seizures without a return to baseline?
Status Epilepticus
68
Seizure in which body is stiff and rigid followed by limb jerking then a post ictal phase?
Tonic-Clonic Seizures
69
Medical treatment for absence seizures?
Ethosuximide or valproic acid
70
Seizure common in children in which patient is conscious but not aware (staring)?
Seizure common in children in which patient is conscious but not aware (staring)?
71
Seizure limited to part of one hemisphere with impaired consciousness?
Complex partial seizure
72
Seizure limited to part of one hemisphere with consciousness fully maintained?
Simple partial seizure
73
Acute medical treatment for increased intracranial pressure (ICP)?
Head elevation - Hyperventilation - Osmotic diuresis (mannitol)
74
Appearance of a subdural hematoma on a CT scan?
Crescent shaped
75
Vessels involved in a subdural hematoma?
Bridging veins
76
Most common cause of subdural hematoma?
Head trauma
77
Appearance of an epidural hematoma on a CT scan?
Lens-shaped
78
Most common artery affected in an epidural hematoma?
Middle meningeal artery
79
Transient loss of consciousness after a lucid interval most often due to skull fracture?
Epidural Hematoma
80
Which brain tumor may present with endocrine signs and symptoms?
Pituitary tumor (may also occur with paraneoplastic syndrome e.g. SC lung CA)
81
Which brain tumor may present with cranial nerve palsy?
Brain stem tumor (may also occur with cerebral aneurysm and diabetic ischemic neuropathy)
82
Which brain tumor may present with visual hallucinations?
Occipital lobe tumor (may also occur with migraine and EtOH withdrawal)
83
Which brain tumor may present with seizures or sensory loss?
Parietal lobe tumor
84
Which brain tumor may present with lip smacking olfactory or gustatory hallucinations?
Temporal lobe tumor
85
Which brain tumor may present with personality or intellectual change?
Frontal lobe tumor
86
Most common primary tumors that spread to the brain?
Breast, lung, GI (colorectal) and kidney
87
Disorder in which AV malformations in the brain are common?
Hereditary hemorrhagic telangiectasia (AKA: Osler-Weber Rendu Syndrome)
88
List the causes of hemorrhagic stroke.
Uncontrolled HTN - SAH - Tumors - AV malformation - Anticoagulants - Thrombolytics
89
Treatment for subarachnoid hemorrhage (SAH)?
Observation - Clip/coil - Seizure prophylaxis (anticonvulsants)
90
Diagnostic test for subarachnoid hemorrhage (SAH)?
Non-contrast CT of head
91
Worst headache ever followed by nausea vomiting and impaired consciousness?
Subarachnoid Hemorrhage
92
Treatment for cerebral aneurysm?
Treatment for cerebral aneurysm?
93
Diagnostic test for cerebral aneurysms?
Magnetic resonance angiography (MRA) or CT angiography (CTA)
94
Diseases associated with cerebral aneurysms?
Ehlers-Danlos - Polycystic kidney disease - Coarctation of the aorta
95
Loss of cerebellar function such as slurred speech vertigo ataxia and/or nystagmus?
Posterior stroke
96
Contralateral paralysis motor function but still can wrinkle forehead?
Anterior stroke
97
Reduced blood flow to the brain resulting in tissue damage?
Ischemic Stroke
98
Treatment for carotid stenosis of 70-99%?
Cortaid endarterectomy
99
Treatment for TIA in a patient with CAD who is in sinus rhythm?
Clopidogrel
100
Initial treatment of TIA in a patient without CAD who is in sinus rhythm?
Aspirin (aspirin/dipyridamole better if available)
101
Brief episode of focal neurologic symptoms such as hemiparesis loss of strength or sensation?
TIA
102
Initial treatment for Bell’s Palsy?
Corticosteroids
103
Facial paralysis occurring on the ipsilateral side as herpes zoster?
Ramsay Hunt Syndrome
104
Unilateral facial paralysis most often caused by Herpes simplex virus?
Bell's Palsy
105
Hereditary peripheral neuropathy which affects both motor and sensory?
Charcot-Marie Tooth
106
Acute treatment for Guillain-Barre Syndrome?
Plasma exchange - IV immune globulin
107
Type of polyneuropathy that is predominantly motor?
Myelinating
108
Type of neuropathy that is symmetric and initially sensory?
Axonal
109
Treatment for daily RLS (restless leg syndrome)?
Dopamine agonists (e.g. ropinirole) - If iron deficient: Iron replacement
110
Conditions associated with restless leg syndrome (RLS)?
Parkinson’s - Iron deficiency anemia - Diabetes - Multiple Sclerosis - Pregnancy
111
Spontaneous leg movements/paresthesias present at rest and relieved with movement?
Restless Leg Syndrome
112
Medical treatment for peripheral neuropathy? (3)
Gabapentin pregabalin or amitriptyline
113
Stocking glove distribution of chronic polyneuropathy?
Diabetic neuropathy and renal failure related neuropathy due to chronic uremia
114
Initial diagnostic test for peripheral neuropathy?
Electromyography (Nerve conduction study) (aka EMG and NCS)
115
Symmetric distal sensory loss burning or weakness?
Peripheral Neuropathy
116
Treatment for Complex Regional pain syndrome?
Anti convulsants (e.g. gabapentin) - Tricyclic antidepressants (e.g. Amitriptyline - Agents to increase bone mineral density (e.g. alendronate)
117
Unilateral burning pain in a cyanotic cool extremity may be associated with urinary urgency?
Complex Regional Pain Syndrome (AKA: Reflex Sympathetic Dystrophy)
118
Preferred prophylaxis for cluster headache?
Verapamil
119
Acute treatment for cluster headaches?
Subcutaneous or intranasal sumatriptan and inhaled 100% oxygen
120
Unilateral Ptosis Miosis and Anhydrosis?
Horner Syndrome
121
Are males or females more likely to suffer from cluster headaches?
Males
122
Headache with unilateral periorbital pain with rhinorrhea and conjunctival injection?
Cluster headaches
123
Migraine prophylaxis?
Beta blockers unless > 60 y.o. asthmatic or smoker (commonly propranolol) - Verapamil - Tricyclic antidepressants
124
Acute treatment for Migraines?
NSAIDs or "Triptans" (e.g. sumatriptan)
125
Most common type of migraine aura?
Visual: Bright spots
126
Unilateral throbbing headache with or without an aura?
Migraine
127
1st line Treatment for Tension headache?
Non- Aspirin NSAIDs
128
Episodic bilateral headache with pericranial muscle tenderness and normal neuro exam.
Tension headache
129
A previously healthy elderly patient with no past medical history presents with acute onset altered mental status to the emergency room. What do you suspect?
Delirium - Consider underlying causes such as: Sepsis (UTI common)
130
What class of medications is often used to treat Alzheimer's patients?
Cholinesterase inhibitors
131
What is the difference between delirium and dementia?
Delirium is an acute syndrome caused by a medical condition - Dementia is a long-term impaired memory disease process such as Alzheimer's
132
What finding on autopsy confirms the diagnosis of Alzheimer's?
Beta amyloid plaques and neurofibrillary tangles
133
What is the most common cause of dementia in an adult after the age of 60?
Alzheimer's
134
A 94 year old male, hospitalized for a UTI, becomes confused and is seeing things in his room every evening. What type of delirium do you suspect?
Sun downing
135
What is the GCS for a patient who only responds to your verbal commands, is confused and localizes to pain?
GCS = 12 Responsive to verbal = 3 - Confused = 4 - Localizes pain = 5
136
What is the GCS for a patient who does not open his eyes, does not respond to verbal commands, and has no motor response?
GCS = 3 Does not open eyes = 1 - Does not respond to verbal = 1 - No motor response= 1
137
What is the Glasgow Coma Score (GCS) for a patient who has spontaneous eye-opening, is oriented and obeys commands?
GCS = 15 Spontaneous eye-opening = 4 - Oriented = 5 - Obeys commands= 6
138
What is the classic triad of meningitis?
Nuchal rigidity - Headache - Fever (Note: nuchal rigidity and headache without fever is suggestive of subarachnoid hemorrhage)
139
Negri bodies are pathognomonic for what disease process?
Rabies
140
Which organisms most commonly cause bacterial meningitis in neonates?
Group B Streptococcus and E. Coli
141
A child with the flu is given Tylenol for his fever and Pepto-Bismol for his upset stomach. He is noted by the parents to become confused and lethargic. What do you suspect?
Reyes syndrome (Pepto-Bismol has salicylates)
142
What is the difference between encephalitis and meningitis?
Impaired mental status in encephalitis
143
What are the two most common causes of community acquired meningitis?
Streptococcus pneumoniae - Neisseria meningitidis
144
What is the recommended treatment for a patient with multiple sclerosis having a severe attack?
Plasma exchange
145
A patient was found to have oligoclonal bands on lumbar puncture. What do you suspect?
Multiple sclerosis
146
A young woman with history of optic neuritis presents with left foot weakness and difficult walking. What is your suspected diagnosis?
Multiple sclerosis
147
What type of progression occurs in patients with cerebral palsy?
Generally none, however, some patients can later develop involuntary movements
148
What procedure can help with myasthenia gravis in patients under the age of 60?
Thymectomy
149
What tests are used to diagnose myasthenia gravis?
Edrophonium or Tensilon test and antibodies to acetylcholine receptor and tyrosine kinase
150
A young woman presents to the office with bilateral eye ptosis and difficulty keeping her head erect. What do you suspect?
Myasthenia gravis
151
What is the treatment of choice for Guillain-Barre?
Plasma exchange, intravenous immunoglobulin, and supportive care in the ICU for severe cases
152
A 55 year old male begins to get weakness in all four of his limbs. He has no past medical history and recently had a flu shot. What do you suspect?
Guillain Barre
153
At what age is Huntington's disease most commonly diagnosed?
Age 40 to 50 years old - The defining symptom is chorea
154
What childhood disease process may be diagnosed with the onset of chorea?
Rheumatic fever
155
What adult disease process is most commonly diagnosed with the onset of chorea?
Huntington's Disease
156
What disease processes have an intention tremor?
Multiple sclerosis, cerebellar disease and strokes
157
What is an intention tremor?
There is no tremor at rest, however with movement the tremor starts and increases in severity as a hand moves closer to its target
158
What medication class is used to treat Parkinson's disease in patients younger than 65 or without advanced disease?
Dopamine agonist, such as bromocriptine
159
What disease condition has a resting tremor that goes away with movement?
Parkinson's
160
What is a resting tremor?
A tremor that is seen at rest but goes away with movement
161
What is the most common cause of tremor in a healthy young adult?
Caffeine is the most common cause of physiologic action tremors
162
What is the Glasgow Coma Score (GCS) range found in patients with concussions?
13 to 15 GCS Ranges from 3 (worst) to 15 (normal)
163
A football player is post-concussion and is having frequent headaches, a fuzzy feeling and difficult concentrating. What is the next step?
MRI of the brain (CT if suspect acute bleed)
164
How long after a second concussion in the same season should a player have to wait before resuming sports?
They are out for the rest of the season
165
How long after the first concussion should a player be made to wait?
One week without any symptoms
166
Define status epilepticus
A single nonstop seizure lasting longer than 5 to 10 minutes or frequent seizures without a return to baseline
167
What is the main treatment for patients with neurogenic syncope?
Patient awareness and education
168
What is the Bezold-Jarisch reflex?
Transient loss of consciousness due to a reflex response of vasodilation and/or bradycardia
169
What medication used to treat epilepsy requires regular blood draws to monitor therapeutic levels?
Phenytoin
170
What is the acute treatment for an active grand mal seizure?
Benzodiazepines (lorazepam)
171
What is the treatment choice for simple partial and complex partial seizures?
Carbamazepine
172
What is the difference between simple partial and complex partial seizures?
Impaired consciousness in complex partial but not in simple partial
173
What is the recommended treatment for a subdural bleed that is causing symptoms?
Burr holes or craniotomy
174
A man is hit in the head and knocked unconscious. He gets up after a minute and feels fine, in 20 minutes he is drowsy with headache. What do you suspect?
Epidural hematoma
175
A man hits his head but he appears unhurt. In the two weeks since, he has had persistent headaches and lightheadedness. What do you suspect?
Subdural hematoma
176
What artery is most commonly involved in epidural bleed?
Middle meningeal artery
177
CT of the brain demonstrates blood in crescent shaped appearance. What do you suspect?
Subdural hematoma
178
CT of the brain demonstrates blood in a biconvex lens shaped appearance. What do you suspect?
Epidural
179
Which modality is better for diagnosis of a brain tumor? CT - MRI or nuclear medicine test
MRI
180
What do an aneurysm, AVM and brain tumor all have in common?
They can all lead to hemorrhagic stroke and blood in the cerebral spinal fluid
181
A patient in ER has the "worst headache ever". CT of the brain is negative but you're concerned about a subarachnoid hemorrhage. What is the next step?
Lumbar puncture
182
What is the treatment for a cerebral aneurysm?
Intracranial coiling or clipping
183
What syndrome is often associated with arteriovenous malformations in the brain
Osler-Weber-Rendu syndrome
184
What are the common signs seen in a patient with a subarachnoid hemorrhage post rupture?
Nuchal rigidity and meningeal signs
185
A patient with polycystic kidney disease has sudden onset of the "worst headache ever". What is the suspected cause?
Ruptured cerebral aneurysm
186
A patient status post TIA has a carotid ultrasound which shows a lesion of 79% in the left internal carotid. What is the recommended therapy?
Carotid endarterectomy
187
A patient that had a TIA and has a history of coronary disease should be placed on what antiplatelet therapy?
Clopidogrel
188
What test should be ordered to determine the source of a TIA in a patient with an irregular heartbeat?
Echocardiogram will determine the source, EKG will only demonstrate atrial fibrillation
189
What is the mainstay of treatment for bell's palsy?
Steroids
190
Define Ramsay Hunt syndrome.
Herpes zoster plus bells palsy
191
A 23 year old female presents with facial droop, ptosis and a change in her taste sensation. She has no other focal findings. What is your suspected diagnosis?
Bell's palsy
192
What medication is used to treat restless leg syndrome?
Treatment is like Parkinson's using dopamine agonists like pramipexole
193
A trial of what medication should be given to all patients with restless leg syndrome?
Trial oral iron therapy
194
An obese patient with peripheral neuropathy may benefit from what medication to help with the neuropathy and weight loss?
Topiramate
195
A woman complains of aching pain in her legs that is deep inside. It is worse at night when she lays still and feels better when she moves her legs around. What is the likely diagnosis?
Restless leg syndrome
196
The patient with Charcot-Marie-Tooth has both motor and sensory loss. What type of sensory loss do they have?
Loss of proprioception and loss of vibration
197
A 12 year old has difficulty running. On exam she has distal muscle weakness, diminished proprioception and vibration as well as hammer toes. What is your suspicion?
Charcot-Marie-Tooth
198
What type of neuropathy often presents in a stocking glove distribution?
Axonal (sensory) Peripheral neuropathy
199
A 24 year old male is complaining of increasing symptoms from complex regional pain syndrome and is taking Neurontin. What is the next step in his management?
Steroids
200
A patient with a history of trauma has severe burning pain, cyanosis and cool skin to his left arm. X-rays show patchy demineralization of the bone. What condition do you suspect?
Complex regional pain syndrome also known as reflex sympathetic dystrophy
201
What medication used in the treatment of tension headaches often has an abuse potential?
Opiates are commonly used to treat tension headaches
202
In regards to activity, what is the difference between a migraine and a cluster headache?
Migraine sufferers prefer quiet and laying down while cluster headache patients are restless and tend to pace
203
What medication is used as prophylaxis for cluster headaches?
Calcium channel blockers such as verapamil
204
A 44 year old male presents with a severe unilateral headache that seems to be located behind his eye. What type of headache do you suspect?
Cluster headache
205
What 3 symptoms define Horner syndrome?
Ptosis - Miosis - Anhydrosis
206
What is the difference between a migraine headache and a TIA regarding symptoms?
TIA will never have aura. Migraine can have aura and, in severe cases, transient loss of motor function
207
Red wine is a common trigger for what type of headache?
Migraine headache
208
A 30 year old female presents with a unilateral throbbing headache that was preceded by a colorful aura. What medication is recommended?
Sumatriptan
209
What medication can be used to prevent tension headaches?
Tricyclic antidepressants such as amitriptyline
