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**Neurology Case Files > Neurology case files > Flashcards

Neurology case files Flashcards

1
Q

Benign essential tremor next step

A

MRI brain and spine

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2
Q

Benign essential tremor management

A

Primodone or propanolol

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3
Q

6-12 Hz tremor

A

physiologic/essential

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4
Q

Parkinson’s tremor frequency

A

3-6 hz

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5
Q

Essential tremor labs to get

A

r/o: Cu, TFTs, propanolol trial

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6
Q

Huntington’s paph

A

AD CAG expansion repeats on ch 4 huntingtin gene

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7
Q

Huntington’s gross path

A

caudate and putamen atrophy

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8
Q

Juvenile Huntington’s AKA

A

Westphal variant

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9
Q

Inherited dystonia next step

A

MRI brain

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10
Q

Inherited dystonia management

A

Benadryl benztropine / DBS GPi

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11
Q

Primary dystonia paph

A

Ch 9 mutation of Torsin A gene DYT1 causes decreased thalamus inhibition

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12
Q

Parkinson’s Rx

A

Carbidopa-Levodopa. Selegiline/rasagiline. Entacapone/tolcapone (COMT). Bromocriptine, pramipexole, ropinerole

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13
Q

AD spinocerebellar ataxia presentation

A

Insidious onset of gait problems

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14
Q

Spinocerebellar ataxia paph

A

Trinucleotide repeat expansion in ataxin gene. many subtypes

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15
Q

Spinocerebellar ataxia vs Friedrichs

A

SCA is AD, Friedrich’s is AR and presents earlier

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16
Q

Spinal shock presentation

A

Immediate flaccid paresis with ANS signs and areflexia; proresses to spasticity with reflexes

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17
Q

Spinal shock presentation

A

Immediate flaccid paresis with ANS signs and areflexia; proresses to spasticity with reflexes

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18
Q

Localizing level of traumatic spinal injury

A

C5-T1: Above C5 is arm, C5-T1 is mixed arm/leg, below T1 = leg only

Above C3 = respiratory probs bc phrenic paralysis

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19
Q

Brown-Sequard presentation

A

Ipsi motor/sensory at level
Ipsi CST/epicritic
Contra pain below

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20
Q

Anterior cord tracts affected

A

CST and spinothalamic with intact dorsal column

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21
Q

Central cord lesion presentation

A

CST for arms and legs affected

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22
Q

Epidural artery

A

MMA - fast bc arterial bleed

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23
Q

What is Cushing’s response?

A

Inc BP
Dec HR
Dec RR

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24
Q

Concussion management

A

CT to r/o ICH; immobilization

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25
MCL berry aneurysm
P comm (CN3 paralysis)
26
Diagnosis of vasospasm s/p SAH
Inc MVA velocity
27
SAH and hydrocephalus?
2/2 destruction of subarachnoid granules from blood - acute communicating
28
When does vasospasm happen after SAH
day 4-14
29
22 y/o presents with R horner's syndrome after minor neck trauma next step?
Cerebral arteriogram - suspect carotid dissection
30
Cryptogenic ischemic stroke in a young person - cause?
PFO - get TEE
31
This category of medicine can trigger acute glaucoma
anti-cholinergics
32
This category of medicine can trigger acute glaucoma
anti-cholinergics
33
Reserpine MOA
D2 blocker
34
Tetrabenzine MOA
D2 blocker
35
Lewy body dementia area affected
SN of basal ganglia
36
Lewy body dementia tx
Anticholinesterase
37
Personality decline with sleep hallucinations, dementia, and EPS - dx
Subacute combined degeneration from B12 deficiency
38
How to confirm B12 deficiency neuropathy
MRI and nerve conduction study
39
Marcus Gunn Pupil?
APD - light in affected eye does not cause constriction, but light in other eye does cause constriction of first eye
40
What is ADEM?
Acute disseminated encephalomyelitis
41
causes of ADEM
Post-viral of post-vaccine
42
Mechanism of ADEM
Perivascular demyelination with mononuclear cell infiltration
43
Presentation of ADEM
Post-viral, now HA, AMS, CNS dysfunction
44
MCC bacterial meningitis
GBS, GNR Listeria (neonate) After: PC, NM, H flu
45
Kernig's sign
Cannot fully extend leg due to pain
46
Brudzinski sign
Neck flexion causes involuntary hip flexion
47
Management of acute meningitis - rx
Ceftriaxone, vanv, acyclovir, dexamethasone
48
What is the botulism toxin?
MMP cleaving V and T snares
49
Botulism paph
Symmetrical descending paralysis with fever; prominent anticholinergic effects
50
Botulism paph
Symmetrical descending paralysis with fever; prominent anticholinergic effects
51
HIV dementia MRI
Frontotemporal cerebral atrophy - myelin pallor
52
Tabes dorsalis timeframe
10-20 years after primary syphilis
53
Tabes dorsalis presentation
Pain, sensory ataxia, bulbar symptoms, bowel/bladder problems, hyporeflexia
54
Argyll Robertson pupil Ddx
MS, sarcoid, Lyme, tabes dorsalis
55
What is a holmes-adie pupil?
Midbrain CN3 lesion s/p head trauma better with ice. an autonomic neuropathy. still reactive. give top pilocarpine
56
Ischemic CN VI mononeuropathy presentation
Binocular horizontal diplopia with R lateral rectus palsy
57
Herpes Zoster Opticus pres
R facial paralysis, r ear pain, r sensorineural hearing loss, blisters
58
Cholesteatoma mech
epithelial debris in ear
59
Herpes zoster opticus mech
Cerebellopontine angle > out to parotid gland
60
Other weird MG antibody
anti-MUSK (membrane enzyme aggregating AcH-R)
61
BPPV vs. Meniere's
BPPV: acute episodes min-hours and no hearing loss Menieres: episodes are days, pressure and hearing loss
62
Meniere's technical name
Acute labyrinth disease
63
CIDP presentation
Slowly progressing SYMMETRIC weakness, stocking-glove pattern sensory loss, normal glucose
64
CIDP unique things
Peripheral involvement, plus sensory deficits
65
CIDP LP
shows cytoalbuminologic dissociation
66
CIDP tx
IVIG for pure motor, steroids for long-term
67
Fibrillations on an EMG indicate damage to:
Axons
68
SLow conduction on EMG means:
myelin damage
69
Botulism distinct things from AIDP
Descending paralysis, dilated pupils, droopy face
70
Proximal muscle weakness, skin rash, Raynaud's, dysphagia, SOB, arrythmias?
Dermatomyositis
71
Dermatomyositis associated diseases
CHF, arrhythmias, ovarian cancer
72
Dermatomyositis work-up
Anti-Jo Ab
73
Dermatomyositis EMG
Decreased motor units
74
Dermatomyositis vs. polymyositis biopsies
Dermato: CD4 perivascular vs. CD8 inside fascicle
75
ALS etiology
90% sporadic from glutamate overexcitation; 10% hereditary from SOD ch 21
76
ALS tx
Riluzole: NMDA antagonist that prevents further damage but doesn't reverse
77
Terminal care ALS
Decrease saliva and allow breathing with anticholinergics and ventilation
78
Carpal tunnel nerve involved
Median nerve
79
Carpal tunnel hand findings
1. Thenar/lat 2 lumbrical atrophy 2. Lateral 3.5 digit sensory loss 3. ANS loss to most of hand
80
JME symptoms
Intact consciousness with seizures related to sleep and sleep deprivation
81
JME treatment
valproate
82
west syndrome pres
infantile spasms, hypsarrhythmia, developmental regression
83
Lennox gastaut pres
Multiple seizures with atypical slow spike 1.5-2 Hz EEG plus developmental delay
84
Which idiopathic epilepsy disorder does NOT resolve on its own?
JME
85
Partial seizure drugs to use
Phenytoin, carbamazepine, topiramate, levitiracetam, lamotrigine, lacosamide
86
General seizures drugs to use
Valproate, ethosuxamide, topiramate, levitiracetam, lamotrigine, zonisamide
87
Simple febrile seizure
3 mo-5 year, generalized,
88
Complex febrile seizure
Focal, >15 min, >1 in 24h
89
LP in febrile seizure when?
90
Coprolalia
shouting obscenities
91
Treatment of tourette's
Haldol, pimozide+risperidone; SSRI for behavioral
92
Benign rolandic epilepsy pres
Complex partial seizures with nocturnal involvement, inc salivation, loss of consciousness
93
BRE EEG
Spikes in unilateral centro-temporal
94
What is Miller-Dieker syndrome?
AKA Lissencephaly type 1; abnormal neuronal migration at 3-4 months leads to smooth cerebrum with agyria
95
Miller-Dieker syndrome genetics
Chromosome 17 X linked or sporadic
96
What is a glomus tumor?
Cerebellopontine angle tumor AKA paraganglioma from neuroepithelial cells
97
MCC mets to brain?
Lung > breast > skin > colon > kidney (all hematogenous)
98
MC location for brain mets
Supratentorial grey-white junction with hemorrhage and edema
99
What is Werdnig Hoffman disease?
AKA spinal muscular atrophy, SMN1 gene testing needed; poor in utero spinal cord development > hip dislocation, LMN disease - low done, low reflexes
100
Werdnig Hoffman in utero findings
Polyhydramnios

**Neurology Case Files (2 decks)

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