neuroUworld Flashcards
(193 cards)
1
Q
anterior disclocation of the humeral head damages what nerve
A
axillary and also possibly axilary artery
2
Q
paralysis of delotoid and teres minor and loss of sensation over the lateral upper arm
A
axillary nerve lesion
3
Q
causes of radial nerve injury
A
fracture of the humeral midshaft and use of improperly fit crutches
4
Q
wrist drop and sensory loss on the posterior arm, forearm, and lateral dorsal hand
A
radial nerve
5
Q
fracture of the medial epicondyle injurs what nerve
A
ulnar
6
Q
deep lacerations of the anterior wrist
A
injure the ulnar nerve
7
Q
long thoracic nerve innervates what
A
serratus anterior muscle
8
Q
deep lacerations of the axillary region damage what
A
long thoracic nerve
9
Q
scapular winging
A
damage to long thoracic nerve
10
Q
tuberoinfundibular pathway
A
one of four major dopamine pathways in the brain; dopamine release at this site regulates prolactin secretion by the antpit; when antipsych block dopamine, they can affect this
11
Q
mesocortical pathway
A
one of four dopamine pways in the brain; essential in cognitive control and emotional response
12
Q
nigrostriatal pway
A
one of four dopamine pways; important in movement
13
Q
mesolimbic pway
A
one of four dopamine pways; maybe the reward pway involved in drugs and also hallucinations in schizophrenia
14
Q
2 drugs that are the first line treatment for generalized tonic clonic and partial seizures
A
carbamazepine, phenytoin
15
Q
how do carbamazepine and phenytoin work
A
block the sodium channels
16
Q
phenobarbitol target
A
GABA receptors
17
Q
mixed seizures first line
A
lamotrigine
18
Q
what are the second gen anti-psychotics? (which are actually first line)
A
rispiradone, olanzipine, quetiapine, aripiprazole, ziprasidone, paliperidone
19
Q
gold standard for treatment resistant schizophrenia
A
clozapine; high risk of agranulocytosis, which is why it is reserved for those who have failed other treatemtn
20
Q
sertraline
A
used for mood and anxiety disorders
21
Q
headache, tenderness in temporal region, prox muscle weakness
A
temporal arteritis
22
Q
triad of dementia, gait apraxia, and urinary incontinence
A
normal pressure hydrocephalus
23
Q
causes of frontotemporal dementia
A
pick’s disease and other tau-pos etiologies
24
Q
Lewy body dementia
A
like alzheimers but present with visual hallucinations, alterations in alertness, and extrapyramidal sx
25
type of memory loss in alzheimers
anterograde
26
choreathoid movments, behavioral distrubances, and dementia
huntigntons
27
dementia with megaloblastic anemia and dorsal spinal column sx
B12 def
28
most common cause fo b12 def
pernicious anemia
29
ataxia, opthalmoplegia, and confusion
wernicke
30
confabulation and amnesia plus wernicke's
korsakoff
31
uncal herniation causes ipsilateral hemiparesis how?
compression of the contralat crus cerebri against the tentorial edge
32
mydriasis, ptosis, and down and out gaze during uncal herniation
compression of ipsilateral CN 3
33
contralateral homonymous hemianopsia in uncal herniation
compression of ipsilat posterior cerebral artery (causing ischemia of visual cortex)
34
how does uncal herniation cause loss of consciousness
compression of reticular formation
35
cushing's reflex
hypertension, bradycardia, and resp depression; indicates elevated ICP
36
causes of accessory nerve dysfunction
lesions in the medulla, such as occlusion of PICA
37
abducens (CN 6) lesion in uncal herniation
happens later on; LR is out
38
where does the facial nerve originate?
pontomedullary junction; lesions there result in contralat lower facial droop
39
glossopharyngeal nerve lesion
dysfunction of carotid sinus lesion, leading to increased risk of syncope
40
ipsilateral hemiparesis, impsilateral mydriasis, ipsilateral strabismus and contralat hemianopsia and altered mentation
uncal herniation
41
amaurosis fugax
painless loss of vision that lasts a few seconds; usually vascular in origin
42
most common site of hypertensive hemorrhages
putamen; the internal capsule, which lies right next to it, is almost always involved, leading to dense contralat hemiparesis
43
complete paraplegia, followed by deep coma
pontine hemorrhage; pupils are pinpoint but reactive; decerebrate rigidity is present
44
causes of foot drop
trauma to the common peroneal nerve; or damage to any roots that contribute to the common peroneal nerve (L4-S2)
45
foot drop congenital
charcot-marie-tooth disease
46
tarsal tunnel syndrome
entrapment of posterior tibial nerve on the medial aspect of the ankle; numbness on plantar foot,
47
most common site for lacunar infarct
posterior internal capsule, producing a purely motor stroke;
48
posterior internal capsule
corticospinal and corticobulbar fibers run through it
49
campylobacter jejuni assoc with what
guillan barre
50
ascending muscle weakness wth absent or depressed DTRs; mild sensory sx
guillan barre
51
can you see bulbar sx and resp compromise in GB?
yes
52
treatment of MG
cyclosporine and pyridostigmine
53
riluzole used to treat what
ALS
54
optic neuritis
loss of central vision and afferent pupillary defect
55
scotoma
loss of central vision
56
normal pressure hydrocephalus
increaed ventricle size but normal ICP
57
donepezil
acetylcholinesterase inhib used to slow alzheimers
58
treatment for essential tremor
propranolol (the beta blocker)
59
akathisia
sensation of restlessness
60
cause of hemibalismus
due to damage to the contralateral subthal nuc
61
tyoical features of CJD
myoclonus, dementia, sharp triphasics on EEG
62
defect in aut dom gene on chrom 4
huntigtons
63
pick's disease
neurodegenerative disease of the fronto-temporal lobes;resembles alzheimers but more common in women and personality changes are more prom than cognitive
64
Wallenberg (lateral medullary)
vestibulocerebellar symptoms; loss of pain and temp ipsilateral face and contralat body; ipsilat bulbar muscle weakness; ipsilat horners
65
lateral pontine vs lateral medullary infarcts
pontine is going to affect motor and sensory of CN5; lateral medulla affects CNs 9 and 10
66
medial medullary syndrome
contralat paralysis of arm and leg; tongue deviation toward the lesion; contralat loss of tactile and position sense can occur
67
medial mid-pontine infarction
contralat ataxia and hemiparesis of the face, trunk, and limbs;
68
what causes wallenberg syndrome
occlusion of PICA or vertebral
69
cavernous sinus
CNs 3,4, V1, V2, 6, internal carotid artery
70
tearing of bridging veins leads to what
subdural hematoma
71
small cell carcinoma of the lung is assoc with what
myasthenia or lambert-eaton
72
DTRs in myasthenia vs lambert-eaton
DTRs preserved in MG, not in Lambert-eaton
73
treatment of cluster headache
100% oxygen and sub-q sumitriptan
74
prevention of cluster headaches
verapamil, lithium, ergotamine
75
Unthoff's phenomenon and Lhermitte's sign
seen in MS
76
symptoms of anticholinergic excess
red as a beet, dry as a bone, mad as a hatter, hot as a hare, blind as a bat, full as a flask
77
trihexyphenidol
anti-anticholinergic used for parkinsons disease
78
sudden onset of pain, redness around the eye, and nausea and mid-dilated pupil
glaucoma; dx with ocular tonometry
79
why CT of the chest whenever you dx someone with MG
a lot have a thymoma
80
metoclopramide-induced dystonic reaction
this drug is a dopamine antag used to treat n/v. extrapyramidal symptoms can be seen
81
neuroleptic malignant syndrome
caused by adverse reaction to neuroleptic or antipsych drug; characterized by muscle rigidity, fever, autonomic instability
82
three cardinal signs of PD
rest tremor, rigidity, bradykinesia; presence of at least two of these confirms the dx
83
first line treatment for RLS
dopamine ag; an alternate is gabapentin
84
how do benzos work
enhance the inhib effect of GABA
85
does GB have sensory findings
no, not usually
86
why would a syringomyelia affect strength in the upper extremities more than lower
because the arms run medial in the tract (recall they come down and cross)
87
spondylosis
degernative osteoarthritis of the joints of the spine
88
causes of syringomyelia
Arnold-Chiari malformation and prior spinal cord injury
89
arnold chiari malformation
downward displacement of the cerebellar tonsils causing non-communicating hydroceph
90
edrophonium versus pyridostigmine
they are both acetylcholinesterase inhib, but edro is short acting and used for diagnostic purposes only
91
vestibulotoxic drugs
aminoglycosides, esp gentamicin
92
meniere's disease
disease of the inner ear that presents with dizziness, hearing loss, and tinnitus
93
cerebellar dysfunction
sway toward the side of the lesion
94
rotator cuff
SITS; supraspinatus, infraspin, teres minor, subscapularis
95
Popeye sign
rupture of tendon of long head of the biceps; biceps muscle belly becomes prominent in the mid upper arm; weakness with supination; forearm flex is preserved
96
injury to long thoracic nerve
winged scapula due to damage to serratus anterior; most commonly caused by iatrogenic injury during axillary lymphadenectomy
97
injury to lower brachial plexus
C8 and T1; klumpke's paralysis;
98
symptoms of hypokalemia
weakness, fatigue, muscle cramps, rhabdo, cardiac abnormalities
99
flat T waves, U waves, ST depression, and premature ventricular beats
hypokalemia
100
GBM on CT/MRI
butterfly appearance with central necrosis; serpiginous border means high grade;
101
brain mets on CT/MRI
often multifocal; at the gray/white junction or watershed zones; usually spherical in shape
102
how do patients with low grade astrocytoma usually present?
seizures
103
people with hypothyroidism have increased risk of carpal tunnel
right
104
entrapment of the median nerve at the forearm
called pronator teres syndrome
105
median nerve entrapment at the elbow
deep flexors of the digits are affected, but cutaneous sensation is not affected
106
alterations in consciousness, disorganized speech, hallucinations, extrapyramidal symptoms, and early compromise of executive function
Lewy body dementia
107
key difference between lewy body dementia and parkinsons
earlier appearance of dementia in lewy body
108
treatment of lewy body dementia
acetylcholinesterase inhib like rivastigmine (achesterase inhib also used to treat alzheimers remember- but not parkinsons)
109
NFTs and senile plaques
alzheimers
110
presenting sx of Huntington's disease
mood disturbances, choreiform movements, dementia
111
pick's disease
similar to alzheimer's but presents at an earlier age; more freq in females;
112
immunocompromised patient with focal neuro deficits
PML; does not produce mass effect
113
most common ring enhancing mass lesion in HIV pos patients
cerebral toxo
114
symptoms of acute arterial occlusion
5 P's- paresthesia, pain, palor, pulselessness, paralysis
115
symptoms of cerebellar dysfunction
intention tremor on dysmetria, impaired rapid alternating movement; muscle hypotonia can be present (increased swinging of knee after eliciting DTR)
116
clasp knife phenomenon
rapid decrease in resistance when trying to flex a joint; means UMN lesion
117
what causes normal pressure hydrocephalus
decreased CSF absorption
118
amyloid deposisiton in the brain
alzheimers
119
where is the facial nerve nucleus
in the pons
120
do cranial nerves cross?
no, clinical findings are always on the same side as the lesion; however, CN 4 does cross
121
hyperacusis
facial nerve issue on that side; think stapedius
122
typical presentation of cerebellar hemorrhage
ataxia, headache, vomiting, gaze palsy, facial weakness; can have 6th nerve paralysis, conjugate deviation, blepharospasm, and coma
123
why facial weakness in cerebellar hemorrhage
pontine compression due to expanding hematoma from the cerebellum
124
symptoms of putamen hemorrhage
the internal capsule lies right next to the putamen, so this is involved. Results in hemiparesis, hemisensory loss, homonymous hemianopsia, stupor, and coma
125
what runs through the internal capsule?
motor (corticospinal and corticobulbar) and sensory
126
pontine hemorrhage
deep coma and paraplegia; pupils are pinpoint and reactive; there are no horizontal eye movements; decrebrate rigidity
127
PCA supplies what?
midbrain, basal gang, thalamus, mesial inferior temporal lobe, occipital and occipitoparietal cortices
128
wernicke's encephalopathy
AMS, gait instability, horizontal hystagmus, conjugate gaze palsy
129
korsakoff's syndrome
ireversible amnesia, confabulation, and apathy
130
autonomic dysfunction in GB?
yes, in 70 percent of patients; but remember that sensory is mostly normal
131
Descending paralysis (and therefore early CN involvement)
botulinum; pupillary abnormalities are common
132
tick ascending paralysis
like GB but GB is more symmetrical
133
treatment of paralysis due to spinal cord tumor
methylprednisone
134
heat stroke versus heat exhaustion
heat stroke has a body temp over 105
135
how to treat heat stroke
evaporation treatment (spray with warm water and turn on a fan); gastric lavage works too but it's more involved
136
how to differentiate a hypertensive intracerbral hemorrhagic stroke from ischemic, clinicall
hemorrhagic will have progressive losses as the hemorrhage expands and then patient will present with symptoms of increased ICP
137
prophylaxis of cluster headaches
verapamil; also prednisone, ergotamine, indomethacin
138
treatment of cluster headache
100 percent ox
139
what is one disease in which typical anti-psychotics should not be used?
Lewy body dementia
140
benzos are contraindicated in the elderly
that's right
141
what is amytriptiline used for
TCA used for depression, sleep disorders, and neuropathic pain
142
memantine
used to treat moderate to severe Alzheimers; blocks the NMDA receptor
143
dysarthria-clumsy hand syndrome
lacunar stroke in the basal pons
144
pure motor hemiparesis
infarction in the posterior limb of the internal capsule;
145
pure sensory stroke
stroke in the VPN of the thalamus; unilateral sensory deficits
146
ataxic-hemiparesis
lacunar infarction in anterior limb of internal capsule; weakness more prominent in lower extremity and ipsil arm and leg incoordination
147
conjugate eye deviation toward side of infarct
MCA occlusion
148
contralateral hemiplegia and ipsilateral CN involvement
occlusion in vertebrobasilar system supplying the brain stem
149
occlusion of ACA
contralateral hemiparesis and sens loss affecting mostly the lower extremity
150
midbrain stroke
ipsilateral oculomotor paralysis and contralateral ataxia or hemiplegia
151
MCA occlusion eye deviation
toward the side of the infarct; also, homonymous hemianopia (think radiating fibers)
152
"alternate syndromes"
think brainstem
153
meds for essential tremor
beta blocker or primidone (an anticonvulsant)
154
primidone may cause what
acute intermittent porphyria
155
acute intermittent porphyria
abdominal pain, neuro and psych abnormalities
156
alcohol and ET
can be used, but not ideal
157
beta blockers and ET
first line
158
beta blockers contraind in what patients
bradycardic or severe COPD
159
Lithium side effect
hypothyroidism
160
arm not swinging
parkinsons
161
pathogenesis of parkinsons
decreased dopaminergic neurons in the Substantia nigra leads to decreased dop and increased cholinergic
162
cerebellar dysfunction
nystagmus, hypotonia, dysarthria, inability to perform RAM
163
vestibular ataxia
minimal movements of the head during walking; staggering gate accompanied by vertigo and nystagmus
164
gait in parkinsonism
is narrow based
165
Shy-Drager syndrome (multiple system atrophy)
degernative disease, characterized by three features: parkinsonism, autonomic dysfunction, and widespread neuro signs
166
treatment for shy-drager
parkinson drugs are ineffective; you want to replete fluids with fludrocortisone, alpha ags, and constrictive garments over the lower extremites
167
Riley Day syndrome
gross dysfucntion of the autonomic nervous sytem with severe orthostatic hypotension; ashkenazim
168
spinal cord compression- pain worse when?
at night (recumbent position) due to extension of the epidural venous plexus when lying down
169
treatment for spinal cord compression
steroids and neurosurg consult
170
malignancies that affect the spine
lung, renal, prostate, multiple myeloma
171
DTRs in diabetic neuropathy versus myelopathy
absent in diabetic polyneuropathy, present in myelopathy
172
facial nerve courses through what gland
parotid gland
173
hoarsness can result from lesion of what
recurrent laryngeal nerve from the vagus; vulnerable to surgery of thyroid and parathyroid gland
174
trigeminal neuralgia (tic douloureux)
short bursts of pain in V2 and V3 distribution; caused by external compression of trigeminal nerve
175
jaw asymmetry caused by what
damage to nerve innervating the muscles of mastication (V3)
176
V3 exits the skull through what hole
foramen ovale
177
EBV in the CSF
primary CNS lymphoma; you will see ring enhancing lesions in the brain
178
multiple rign enhancing lesions in the basal gang
consider toxo
179
bulbar muscles
those involved in speech and swallowing (mouth and throat)
180
pupils in botulism versus MG
pupils spared in MG, not in botulism
181
NPH features but not
gait imbalance is the most important feature and it appears early in the course
182
visual deficits early and memory deficits later
dementia with lewy body (opposite of alzheimers disease)
183
gait in NPH
broad based and shuffling
184
wernicke's syndrome
ataxia and nystagmus
185
SDH
tearing of bridging veins due to trauma
186
alteplase
I think this is TPA
187
what to give someone with a stroke that failed aspirin
aspirin plus dipyradimole OR clopidogrel
188
what to give patient with stroke and evidence of A-fib
long term anticoag with warfarin, dabigatron, or rivaroxaban
189
head tremor without dystonia
think essential tremor (though bilateral hand is more common); ET often affects head, chin, voice, and trunk
190
tremor in cerebellar dysfunction
tremor increases as hand reaches target
191
physiologic tremor
usually worse with movement
192
cerebral wasting syndrome
may occur in patients with SAH; inapprop release of ADH causes water retention and then inapprop release of ANP/BNP which causes cerebral salt wasting; leads to hyponatremia
193
what nerve can be damaged at the elbow because it lies in the medial epicondyle groove
ulnar- funny bone
