Neurology Flashcards
(99 cards)
1
Q
Anterior Cerebral Artery (ACA)
A
Contralateral lower extremity and face
2
Q
Middle Cerebral Artery (MCA)
A
Aphasia, contralateral hemiparesis, sensory loss and hyperreflexia
3
Q
Vertebral/basilar (Posterior fossa, pons)
A
Ipsilateral: ataxia, diplopia, dysphagia, dysarthria, and vertigo. Contralateral: homonymous hemianopsia with basilar - PCA lesions
4
Q
Lacunar - Internal capsule
A
Pure motor hemiparesis
5
Q
Lacunar - thalamus
A
Pure sensory deficit
6
Q
Lacunar - pons
A
dysarthria, clumsy hand
7
Q
Stroke: Best initial test
A
CT scan head without contrast
8
Q
Degree of carotid stenosis
A
carotid duplex U/S
9
Q
Definitive test for identifying stenosis of vessels of H and N, and for aneurysms?
A
MRA - magnetic resonance arteriogram
10
Q
Screen all patients with carotid duplex U/S who have –
A
Carotid bruit, PVD, and CAD
11
Q
Stroke in young patients < 50 yr old
A
look for vasculitis, hypercoagulable state, thrombophilia, H/o cocaine addiction
12
Q
Tx within 3 h of stroke
A
tPA; do not give aspirin for the first 24 h if the patient received tPA
13
Q
Tx after 3 h of stroke
A
Aspirin only
14
Q
If patient cannot take apsirin
A
Give clopidogrel
15
Q
If patient cannot take either aspirin or clopidogrel, the next option is —>
A
Ticlopidine
16
Q
If carotid artery stenosis > 70% and symptomatic-Tx
A
carotid endarterectomy
17
Q
In carotid stenosis and asymptomatic patient-Tx
A
reduction of atherosclerotic risk factors and aspirin
18
Q
CT scan head with no contrast in stroke -
A
Ischemic stroke - dark area; Hemorrhagic stroke - white area
19
Q
CT scan head with no contrast in stroke -
A
differentiates ischemic from hemorrhagic infarction
20
Q
Pupillary findings in intracerebral hemorrhage and corresponding level of involvement –>
A
pinpoint pupils- pons; poorly reactive pupils - thalamus; dilated pupils - putamen
21
Q
Polycystic kidney disease is associated with –>
A
Berry/saccular aneurysms
22
Q
SAH
A
“the worst headache of my life!” - extremely rapid onset, presents like meningitis (fever, photophobia, and neck stiffness), loss of consciousness
23
Q
SAH - best initial test
A
CT scan head no contrast
24
Q
SAH - immediate next step after CT scan
A
Ophthalmic exam to rule out papilledema before doing a Lumbar puncture (to prevent herniation)
25
If no papilledema -- the most appropriate next test
Lumbar puncture - blood in the CSF is a hallmark of SAH; Xanthochromia (yellow color of the CSF) is the gold standard for the diagnosis of SAH.
26
Definitive test to detect the site of bleeding in SAH
Cerebral angiogram
27
Progressive Supranuclear Palsy (PSP)
A degenerative condition of the brainstem, basal ganglia, and cerebellum
28
PSP - s/s
Like Parkinson disease - bradykinesia, limb rigidity, and cognitive decline; Unlike Parkinson - does NOT cause tremor and does cause ophthalmoplegia
29
Huntington chorea
CAG leads to a loss of GABA-producing neurons in the striatum
30
Huntington chorea MRI finding -
atrophy of the head of Caudate nuclei
31
Essential tremor is markedly decreased by
Alcohol use
32
Normal Pressure Hydrocephalus (NPH)
Dementia, gait disturbance, and urinary incontinence
33
Bilateral, fixed, dilated pupils
severe anoxia
34
Unilateral, fixed, dilated pupils
herniation with CN III compression
35
Pinpoint pupils
Narcotics, Intracerebral hypertension (ICH)
36
Locked in Syndrome
Infarction or hemorrhage of the ventral pons; basilar artery stroke
37
Locked in Syndrome
fully aware of the surroundings BUT completely paralyzed with sparing of muscles of respiration, blinking and vertical eye movement, feel pain.
38
Clinically Definite MS
2 episodes of symptoms + evidence of 2 white matter lesions (imaging or clinical)
39
Lab-supported Definite MS
2 episodes of symptoms + evidence of at least 1 white matter lesion on MRI + abnormal CSF (oligoclonal bands in CSF)
40
Probable MS
2 episodes of symptoms + either 1 white matter lesion or oligoclonal bands in CSF
41
Abrupt onset with rapidly ascending weakness/paralysis of all four extremities with h/o infection (e.g. Compylobacter jejuni, CMV, hepatitis, and HIV) -->
Guillian-Barre Syndrome (GBS)
42
GBS - diagnostic tets
CSF analysis, Nerve conduction studies
43
Myasthenia gravis - pathophysiology?
autoantibodies against muscle-type nAChRs within the NM junction
44
Myasthenia gravis (MG) - s/s
muscle weakness exacerbated by use and improved by rest (i.e. symptoms worsen toward the end of the day)
45
Myasthenia gravis (MG) - most common initial symptoms --
ptosis, diplopia, and blurred vision
46
Myasthenia gravis (MG) -- preserved modalities
sensation and reflexes
47
Lambert-Eaton Myasthenic Syndrome - pathology
autoantibodies against presynaptic Ca channels
48
Lambert-Eaton Myasthenic Syndrome - CF?
proximal muscle weakness and hyporeflexia (unlike MG where Reflexes are Normal)
49
Lambert-Eaton Myasthenic Syndrome -- key CF
Symptoms improve with repeated muscle stimulation (but worsen in MG)
50
Medications that exacerbate S/o MG --->
Antibiotics - aminoglycosides and tetracyclines; B-blockers; Antiarrhythmics - quinidine, procainamide, and lidocaine
51
Tuberous sclerosis - CF
cognitive impairment, epilepsy, and skin lesions (facial angiofibromas, adenoma sebaceum), retinal hamartomas, renal angiomyolipomas, cardiac rhabdomyoma.
52
Sturge-Weber Syndrome -CF
Facial vascular nevi (Port-wine stain), capillary angiomatoses of the pia mater, epilepsy, and mental retardation.
53
von Hippel-Lindau Disease - CF
cavernous hemangiomas of the brain or brainstem, renal angiomas, and cysts in multiple organs. Associated with renal cell carcinoma, pheochromocytoma
54
GBS - imp. drug contraindication ---
NO STEROIDS for GBS!!!!!!!!!
55
Syringomyelia - pathology
central cavitation of the cervical spinal cord involving lateral spinothalamic tract
56
Syringomyelia - CF
bilateral loss of pain and temperature sensation over the shoulders in a cape-like distribution
57
Brown - Sequard Syndrome - pathology
spinal cord hemisection
58
Brown - Sequard Syndrome - CF
contralateral loss of pain and temperature; ipsilateral hemiparesis, and ipsilateral loss of position/vibration
59
Horner Syndrome -
Ipsilateral Ptosis, Anhydrosis, and Miosis (PAM is Horny!)
60
Meniere Disease - CF
Vertigo, tinnitus, and hearing loss
61
Meniere Disease - Tx
Sodium restriction and diuretics
62
Syncope is uncommon in setting of stroke, unless -->
--- the vertebrobasilar system is involved.
63
If the patient has no heart disease and syncope is unexplained, the most important test is --->
--- Tilt-table testing (for evaluation of vasovagal syncope)
64
Status epilepticus - Drug Tx
IV diazepam, IV phenytoin, IV dextrose. Treat resistant cases with IV phenobarbital
65
Wallenberg Syndrome is characterized by --
severe hiccups
66
Wallenberg Syndrome - CF
Contralateral sensory (pain/temp) loss of the trunk, ipsilateral sensory loss of the face, dysphagia, slurred speech, loss of gag reflex, ataxia, vertigo, diplopia, nystagmus, vomiting, Horner syndrome
67
Weber syndrome -CF
Ipsilateral CN III palsy + contralateral hemiplegia
68
Benedikt syndrome - CF
Ipsilateral CN III palsy + cotralateral ataxia
69
Cerebral vein thrombosis (sagittal venous sinus occlusion) pathology
pregnancy, hypercoagulable states
70
Cerebral vein thrombosis - most accurate test
Magnetic Resonance Venography
71
Cerebral vein thrombosis - the most effective therapy
Heparin
72
A drug given routinely to all patients with SAH to prevent ischemic stroke due to vasospasm --
Nimodipine (CCB)
73
Standard care for SAH is --
Platinum wire coiling, Nimodipine, and Shunting if hydrocephalus
74
In SAH --
steroids and anti-epileptics are INCORRECT answers
75
If cord compression is clearly present - the most appropriate next step in management is ---
to give steroids such as dexamethasone without waiting for the next step i.e. MRI
76
The most common cause of spinal epidural abscess is --
Staphylococcus aureus
77
Anterior spinal artery infarction
loss of everything (sensory + motor) except position and vibration (dorsal column preserved)
78
Tropical spastic paraparesis
HTLV-1 infection that mimics MS; Caribbean patient; weakness exclusively of the lower extremities, hyperreflexia, painful spasticity; unlike MS absent optic neuritis.
79
If migraine occur 4 or more time a month ---
Prophylactic Propranolol
80
Cluster headache - best initial therapy -
Sumatriptan or ergotamine
81
Cluster headache - most appropriate next step in management if initial therapy fails --
100 % Oxygen
82
Pseudotumor cerebri (idiopathic intracranial hypetension) - CF
Severe headache, diplopia with papilledema, normal CT scan of head; elevated CSF pressure on LP with normal cell count, glucose and protein
83
Pseudotumor cerebri - CN involvement
CN VI (Abducens) palsy (LR-6)
84
Pseudotumor cerebri - best initial therapy --
carbonic anhydrase inhibitor - acetazolamide
85
Pseudotumor cerebri - if acetazolamide fails - the most appropriate next step is ---
Prednisone
86
Bell (CN VII) palsy - best initial therapy --
Prednisone
87
Myasthenia gravis - best initial tests ---
anti-nAChRs antibodies, if negative then, antibodies against muscle specific tyrosine kinase
88
Myasthenia gravis - best initial test-- if anti-nAChRs antibodies are not in the choice ---
Edrophonium test (observe improvement in muscle strength)
89
MG - the most accurate test --
Single fiber electromyography
90
MG - what imaging study is most likely to benefit patient?
Chest X-ray/CT/MRI (to look for thymoma)
91
MG - best initial therapy ---
anti-cholinesterase medications - pyridostigmine, neostigmine
92
MG - if anti-cholinesterase medications do not control -- the most appropriate next step in management is --
Thymectomy (if age < 60 yr), or Prednisone (if age > 60 yr; thymectomy in older patients will not work) until other immunosuppressive drugs have time to take effect.
93
MS - the best initial and most accurate test -->
MRI
94
Mild Parkinsonism - Tx
If younger (< 60 yr): anticholinergics - benztropine, trihexyphenidyl, or procyclidine OR DA agonists - Ropinirole or pramipexole; If older (> 60 yr): Amantadine
95
Tx for psychosis with hallucinations in PD --
Quetiapine or olanzapine or clozapine
96
Antipsychotic drug with smallest risk in Parkinson's --
Quetiapine
97
Clozapine caution --
Neutropenia
98
Essential tremor - characteristics -
worsened by beta-agonists and caffeine and is improved with alcohol
99
Restless leg syndrome -- best therapy --
Direct-acting DA agonists: Ropinirole or Pramipexole (r/o iron deficiency with a serum ferritin test).
