PANCE Prep- Neuro Flashcards
1
Q
Management of Normal pressure Hydrocephalus
A
- Ventriculoperitoneal shunt
2
Q
What is the term for impaired performance of rapidly alternating movements and what does it mean
A
dysdiadochokinesia
*cerebellar pathology
3
Q
CN VII: ____ (S/M/B?)
Test by: ___
Abnormalities could mean: ___
A
CN 7: facial: B
Test: M: facial expression, S: taste anterior 2/3 of tongue
Abnormalities: Bells palsy, CN 7 palsy, Ramsay Hunt Syndrome
4
Q
Tx of Tension Headache
A
- tx like migraines- 1st NSAIDS, ASA, acetaminophen
2. Anti-migraine meds
5
Q
What are the following associated with:
1. Lewy bodies
A
- Lewy bodies= Parkinson disease
6
Q
The ability to put three words together, feed oneself well with a spoon and build a tower of seven cubes are milestones for what age?
A
24 months
7
Q
Clinical manifestations of Myasthenia Gravis
A
- Ocular Weakness (usually 1st presenting sx and more severe)
- EOM involvement, Diplopia***, ptosis (more prominent w/ upward gaze)
- Pupils are spared - Generalized muscle weakness w/ repeated muscle use– relieved w/ rest
- Bulbar (oropharyngeal) weakness w/ prolonged chewing
- Respiratory muscle weakness may lead to resp. failure= myasthenic crisis
*MC in young women
8
Q
Management of TIA
A
- Aspirin +/- dipyridamole or plavix
* *Thrombolytics contraindicated!!
* *avoid lowering BP unless >220/120 - Manage RF: DM, HTN, and Afib
9
Q
Symptoms of Restless Leg Syndrome (Willis-Ekbom Disease)
A
- uncomfortable itching, burning, paresthesias in the leg that creates an urge to move
- worse at night and prolonged period of rest/inactivity
- improved with movement
10
Q
What is Myerson’s sign
A
tapping the bridge of nose repetitively causes a sustained blink
*often seen in Parkinson Disease
11
Q
What is the most common and most aggressive of all the primary CNS tumors in adults
A
Glioblastoma (glioblastoma multiform) = Grade 4 astrocytoma
12
Q
What is Lhermittes sign
A
Neck flexion causing lightening shock type pain radiating from the spine down the leg
*seen in MS
13
Q
What makes up the diencephalon and where is it?
A
- Thalamus: deep in forebrain
2. Hypothalamus: below and ventral to thalamus
14
Q
Management of Restless Leg Syndrome (Willis-Ekbom Disease)
A
- Dopamine agonist (TX OF CHOICE) ex. Pramipexole, Ropinirole
- Alpha-2-delta calcium channel ligands ex. Gabapentin
- Benzos
- Iron supplementation in those w/ serum ferritin lower than 75mcg/L
15
Q
Valproic acid and Depakote SE
A
pancreatitis, hepatotoxicity
16
Q
SE of Levodopa/Carbidopa
A
- NV
- Hypotension
- Somnolence
- Dyskinesia and wearing off bradykinesia associated with LT use
17
Q
CN VI: ____ (S/M/B?)
Test by: ___
A
CN6: Abducens: M
Test: lateral rectus (lateral gaze), EOM
18
Q
Seizures that develop during adolescence and adult life are predominantly due to:
A
tumor, trauma, drug use, or alcohol withdrawal.
19
Q
This type of tremor is shortly relieved with alcohol ingestion
A
Essential Familial Tremor
benign intentional tremor
20
Q
Progressive, chronic intellectual deterioration: memory loss, loss of impulse control
A
Dementia
21
Q
CN X: ____ (S/M/B?)
Test by: ___
A
CN10, vagus, B
Test: M: voice, soft palate, gag
22
Q
Anterior CVA sx on right hemisphere and on left hemisphere
A
Right: apatial/time deficits, impulsivity, flat affect, apraxia
Left: aphasia, agraphia, decreased math comprehension
23
Q
What is Cushings reflex
A
- irregular respirations
- hypertension
- bradycardia
24
Q
Indications for Carbamazepine (Tegretol)
A
- Seizure disorders
- bipolar
- Trigeminal neuralgia (Drug of choice)
- central diabetes insipidus
25
Describe the presentation of Central cord syndrome
1. loss of motor function that is more severe in the UE than LE (more severe in hands)
2. hyperesthesia over the shoulders and arms
26
Etiologies of LMN lesions
1. Guillain Barre syndrome
2. Botulism
3. Poliomyelitis
4. Cauda Equina syndrome
5. Bell Palsy
27
s/s of Reye syndrome
- post-influenza or URI
- The patient develops lethargy, drowsiness, and vomiting. Babinski reflex is positive and hyperreflexia is noted. The liver is normal or enlarged.
28
On finger to nose testing, tremor increases as the target is approached
Intentional tremor (essential familial tremor)-- benign
29
With Myasthenia Gravis, how can you tell if the weakness and respiratory failure is from myasthenic crisis or cholinergic crisis (too much acetylcholine)?
- If flaccid paralysis improves w/ Tensilon--> myasthenic crisis
- If flaccid paralysis worsens w/ Tensilon--> Cholinergic crisis
30
What type of intracranial hemorrhage?
CT: convex lens, shaped
*does not cross suture lines
Epidural
31
What causes Parkinson's disease?
IDIOPATHIC loss of dopamine producing cells of the substantia nigra (in the basal ganglia)
*failure to inhibit acetylcholine in the basal ganglia (Ach is an excitatory CNS neurotransmitter and dopamine is inhibitory)
32
Cluster HA is diagnosed by:
Severe unilateral periorbital pain accompanied by one for more of the following:
ipsilateral. ..
1. nasal congestion
2. rhinorrhea
3. Lacrimation
4. redness of the eye
*Horners Syndrome: ptosis, miosis, anhydrosis
33
SE of Carbamazepine (Tegretol)
Hyponatremia (causes SIADH)
SJS,
blood dyscrasias
34
Phenytoin is the drug of choice for ___
seizure prophylaxis *does not cause CNS depresssion
35
When are anticholinergics indicated and CI for Parkinson Disease
Indicated: less than 70y/o w/ tremor predominance (doesn't improve bradykinesia)
CI: BPH, glaucoma
36
What is ALS
Amyotrophic Lateral Sclerosis "aka Lou Gehrig's Disease"
-Necrosis of BOTH upper and lower motor neurons--> PROGRESSIVE MOTOR DEGENERATION
37
Management of Cluster HA
1. 100% Oxygen (6-10L)
2. Anti-migraine meds: SQ sumatriptan
Prophylaxis: Verapamil (1st line**)
38
CN II: ____ (S/M/B?)
Test by: ___
Abnormalities could mean: ___
CN2: optic: S
Test: visual acuity, visual fields, pupillary light reflex
Abnormalities: optic neuritis, marcus Gunn
39
What are the functions of the Parietal Lobe
1. Perception/recognition of stimuli
2. Orientation
3. Movement
* body sensation and somatosensory
40
What type of intracranial hemorrhage?
CT: concave, crescent shape
*can cross suture lines
Subdural
41
What are the functions of the Medulla oblongata
1. Regulates vital body function (HR, breathing, autonomic fxn)
42
What is Marcus- Gunn pupil
During swinging flashlight test from the unaffected eye into the affected eye, pupils appear to dilate (due to less than normal pupillary constriction). The response is due to the brain perceiving the delayed conduction of affected optic nerve as if light was reduced
43
Management of Migraine HA
1. Symptomatic/Abortive: Triptans or Ergotamines: Serotonin 5HT-1 agonists
2. Dopamine blockers + Diphenhydramine (to prevent EPS, dystonic reactions)
3. IV fluids
Prophylactic: anti-HTN meds (BB, Ca+ channel blockers) TCAs, Anticonvulsants
44
What spinal nerve root is most likley affect in a patient with triceps weakness and paresthesias in the middle finger and diminished brachioradialis reflex
C7
45
___ are suppressible while ___ are not suppressible
Tics- suppressible
| Myoclonus- not suppressible
46
Berry Aneurysm MC occurs where?
| DX by ___
Circle of Willis (asymptomatic until SAH)
DX: angiography gold standard
47
___ presents w/ ptosis of the eyelid, meiosis or constriction of the pupil, and anhidrosis or reduced sweat secretion
-pupillary response to light and accommodation is preserved
Horner Syndrome
48
What type of intracranial hemorrhage?
| CT: star shapped
SAH
49
```
Epidural hemorrhage
Location:
MOI:
SX:
CT:
```
Location: Arterial bleed, btwn skull and dura
MOI: temporal bone fx and middle meningeal artery disruption
SX: LOC w. lucid interval
CT: Lens shape, does not cross suture lines, temporal bone fx
50
What is Alzheimer Disease
MC type of dementia
- loss of brain cells, amyloid deposition (senile plaques) in brain, neurofibrillary tangles (tau protein)
- Cholinergic deficiency
51
How do you manage an Essential Familial Tremor
* Tx not usually needed
1. Propranolol may help if severe or situational
2. Second line: Primidone (barbiturate)
3. Third line: Alprazolam (benzo)
52
What spinal nerve root is most likely affected in a patient with weak wrist extension, thumb and index finger paresthesias and diminished triceps reflex?
C6
53
Household contacts of a patient with bacterial meningitis are best treated with which of the following?
Rifampin, Cipro, Levaquin, Zithromax and Rocephin are the drugs of choice.
54
What is the cause of cerebral palsy
CNS disorder associated w/ muscle tone and postural abnormalities due to brain injury during perinatal or prenatal periods
55
What is the drug of choice for insomnia in the elderly
benzos
56
MC type of astrocytoma in children/young adults vs adults
Kids/young adults: Grade I Pilocytic astrocytoma (most benign)
Adults: Grade 4 Glioblastoma multiforme
57
Suspect ____ in younger patients with Trigeminal Neuralgia
Multiple Sclerosis
58
How does Phenytoin (Dilantin) help w/ seizures and what are its SE
-blocks Na+ channels in CNS
SE: gingival hyperplasia*, SJS*, rash, hirsutism, hypotension
- osteomalacia or demineralization w. LT use
59
Describe the following pupil findings:
1. Horner Syndrome
2. Adie pupil
3. Argyll Robertson pupil
4. Marcus Gunn pupil
5. Light-Near dissociation
1. Horner Syndrome: unilateral small pupil w/ mild ptosis +/- ipsilateral anhydrosis w/ preserved pupillary response to light and accommodation
2. Adie pupil: unilateral-dilated pupil that is sluggish to direct light stimuli
3. Argyll Robertson pupil: usually affects both eyes, irregular in shpae and poorly reactive to light
4. Marcus Gunn pupil: constricts slower to direct light stimulation than to the consensual stimulation
5. Light-Near dissociation: bilateral and consists of preserved constriction to accommodation but impaired to response to light
60
Describe the Lacunar infarcts
- small vessel disease
1. MC pure motor deficit
2. Hx of HTN 80%
3. CT: small punched out hypodense areas
61
Most CNS lymphomas are ____ and a big risk factor is
large B cell lymphoma (secondary)
EBV 90% of time
62
What is a TIA
TRANSIENT episode of neurological deficits WIHTOUT acute infarction. often lasting <24hr
*MC cause embolus
63
An 18 year-old male is involved in a motor vehicle accident with a question of cervical spine fracture. What is the imaging test of choice to initially evaluate this patient and clear his cervical c-spine?
Lateral radiograph
*MRI and CT of the spine may be performed in the setting of acute cervical spine injury when a major fracture or dislocation is identified.
64
When do the following reflexes disappear in infants:
1. Moro:
2. Grasp:
3. Parachute:
4. Tonic Neck:
1. Moro: 3-6 months
2. Grasp: 2 months
3. Parachute: Remains throughout life
4. Tonic Neck: 6-7 months
65
What is Tourette Syndrome?
Unknown exact etiology but may in part be to basal ganglia disorder (behavior/impulse control)
66
What is the most common cause of subclavian steal syndrome and how do they present
atherosclerosis
- most are asymptomatic
- sx of arm arterial insufficiency- BP difference between arms >15mmhg in affected arm
67
What are upper motor neuron signs
1. Spasticity
2. Stiffness
3. HYPERreflexia (increased DTR)
4. UPward babinski
68
Acute relapses of MS are treated with
a short course of IV methylprednisolone followed by oral prednisone.
69
Most abundant excitatory NT in CNS:
| Most abundant inhibitory NT in CNS:
Most abundant excitatory NT in CNS: Glutamate
| Most abundant inhibitory NT in CNS: GABA
70
How can you tell the difference btwn Myasthenia Gravis and Myasthenic syndrome (Lambert-Eaton)
Weakness improves w/ repeated use in Lambert Eaton
71
What are some dopamine antagonists?
(blocks dopamine)
1. Typical antipsychotics: Haloperidol
2. Atypical antispychotics: Clozapine, risperidone
3. Antiemetics: Promethazine
72
Management of CVA
1. Thrombolytics w/in 3 hrs of onset
2. rTPA (alteplase) if no hemorrhage-- only effective in ISCHEMIC stroke
3. Antiplatelet: ASA, Plavix
4. Lower BP if 185/110+ for thrombolytics or 220/120+ if no thrombolytics use
73
Sx of anterior cerebral artery stroke
1. contralateral sensory/motor/hemiparesis: LE>UE**
2. face spared
3. imparied judgement/personality changes (flat affect)
4. Urinary incontinence*
74
Management of Multiple Sclerosis
Acute exacerbation: IV corticosteroids*** and plasmapheresis if not responsive
Relapse-remitting disease: B interferon** or Glatiramer acetate
-Amantadine is helpful for the fatigue in MS
75
What is the diagnostic test of choice for MS
MRI (use McDonald diagnostic criteria)
76
Describe the CSF findings for:
1. MS:
2. Guillain Barre Syndrome:
3. Bacterial Meningitis:
4. Viral Meningitis:
5. Fungal or TV Mengitis
6. Pseudotumor Cerebri
7. SAH
1. MS: High IgG/Oligoclonal bands
2. Guillain Barre Syndrome: high protein w/ normal WBC/cell count
3. Bacterial Meningitis: high protein, high WBC (PMNs), decreased glucose
4. Viral Meningitis: high WBCs (lymphocytes), normal glucose
5. Fungal or TV Mengitis: Decreased glucose, high WBCs (lymphoctyes)
6. Pseudotumor Cerebri: increased CSF pressure otherwise nl
7. SAH: xanthocromia, blood in CSF
77
What are the Clinical manifestations of an Essential Familial Tremor
1. Intentional Tremor: postural, bilateral ACTION tremor of the hands, forearms, head, neck or voice--> MC in UE and head (titubation) (usually spares legs)
2. Tremor worsens w/ emotional stress and intentional movement
3. No other sign. neuro findings
78
Describe what CN control what eye movements
```
CN 3 (Oculomotor): superior rectus, inferior rectus, and medial rectus
CN 4 (Trochlear): Superior oblique
CN 6 (Abducens): Lateral rectus
```
SO4, LR6 and the remainder 3
(Superior oblique: CN 4-- Lateral rectus: CN 6)
79
Management of CP
1. Multidisciplinary approach
| 2. Improving Spasticity: Daclofen, diazepam
80
Clinical Manifestations of ALS
1. Muscle weakness: loss of ability to initiate and control motor movements
2. Mixed upper and lower motor neuron signs**
3. Bulbar sx: dysphagia, dysarthria, speech problems, resp. problems
4. Sensation, urinary sphincter and voluntary eye movements are spared*****
81
S/S of epidural hematoma
1. brief LOC followed by lucid interval
2. HA, vomiting, lethary,
3. ipsilateral anisocoria and contralateral hemiparesis
**Associated w/ temporal bone fracture w/ a laceration to the middle meningeal artery or vein
82
SX of
1. Viral Meningitis
2. Encephalitis
1. Viral Meningitis: meningeal Sx, normal cerebral fxn, no focal deficits
2. Encephalitis: profound lethargy, AMS, abnormal cerebral fxn, focal deficits (ex. CN), seizures
83
CN V: ____ (S/M/B?)
Test by: ___
Abnormalities could mean: ___
CN 5: Trigeminal:B
Test: M: muscles of mastication, S: light touch of face
Abnormalities: trigeminal neuralgia
84
How do you diagnose Guillain Barre Syndrome
1. CSF: high protein w normal WBC**-- albuminocytological dissociation
2. Electrophysiologic studies: decreased motor nerve conduction velocities and amplitude
85
What are the functions of the Frontal Lobe
1. Reasoning
2. Problem solving
3. Parts of speech
4. Movement
5. Emotion
86
What makes up the Cortex and what is its fxn
Frontal, parietal, tempora, occipital lobes
- fxns in higher brain processes such as thought and action.
- Controls all voluntary activity (w/ help of cerebellum)
87
What cord injury causes loss of proprioception and vibratory sense only
Posterior cord syndrome (rare)
88
What are lower motor neuron signs
1. Bilateral FASCICULATIONS
2. Muscle ATROPHY and WEAKNESS
3. HYPOreflexia (Decreased DTR)
4. Flaccidity/HYPOtonia
5. DOWNward Babinski
89
What types of hemorrhages are associated with:
1. head trauma w/ brief LOC followed by a lucid interval
2. worst HA/thunderclap HA
1. epidermal hematoma
| 2. subarachnoid hemorrhage
90
Twisting of the body, abnormal posturing (ex. torticollis, writers cramp)
Dystonia
91
What s/s occur in order of prevalence for an impending cerebral aneurysm rupture
1. HA (MC 48%)
2. Dizziness (10%)
3. Orbital pain (7%)
4. Sensory and motor disturbance (6%)
5. diplopia (4%)
92
What is the most appropriate initial disease-modifying treatment for a patient diagnosed with MS
1. Beta-interferon
93
Inhibition of acetylcholine release is sween w/
botulism
94
Describe the presentation of Brown-Sequard Syndrome
1. Weakness and loss of posterior column fxn on one side of the body distal to the lesion w/ contralateral loss of lateral spinothalamic fxn one to two levels below the lesion
95
Flexion teardrop fracture may cause ____.
| Extension teardrop fracture may cause ___.
anterior cervical cord syndrome
| central cord syndrome
96
What is the difference btween Viral meningitis and encephalitis
Meningitis: infection of MENINGES
Encephalitis: infection of BRAIN PARENCHYMA
97
You have just stuck yourself with a sharp needle. In order for you to be able to interpret this sensation, which of the following areas must be intact?
Lateral spinothalamic tract, thalamus, and sensory cortex
*Sensory impulses reach the sensory cortex from the spinothalamic tract or the posterior columns. Fibers transmit this to the thalamus which sends impulses to the sensory cortex of the brain
98
What are the functions of the Midbrain
1. Relays audio/visual info
| 2. Eye movement
99
What term is given to an ocular examination finding where small, irregular pupils are seen that react with near vision but not to light?
Argyll-Robertson
100
What is a flexion teardrop fracture and its MOI
anterior displacement of a wedge shaped fracture gragment of the anterio-inferior portion of the superior vertebra
MOI: severe flexion and compression
101
How to manage Huntington's Disease?
* *No cure-- usually fatal w/in 15-20 yrs after presentation
* *No medication stops the progression
1. Chorea management: antidopaminergics- typical and atypical antipsychotics- Tetrabenzine
102
Sustained contraction (muscle spasm) especially of antagonistic muscles (ex. simultaneous biceps and triceps contraction)
Dystonia
103
Localized brain degeneration of the frontotemporal lobes
| -marked personality changes (preserved visuospatial)
Frontotemporal Dementia (Picks Disease)
104
What is Bell Palsy
```
CN7 palsy (idiopathic)
-Strong association w/ HSV reactiviation****
```
105
What seizure medication is associated with gingival hyperplasia?
Phenytoin
*Also associated w/ anemia and hirsutism
106
Sudden, repetitive NONRHYTHMIC movements or vocals using specific muscle groups
Tics
107
CN III: ____ (S/M/B?)
Test by: ___
Abnormalities could mean: ___
CN3: oculomotor: M
Test: inferior rectus, ciliary body, EOM
Abnormalities: Oculomotor, dilated pupil
108
s/s of Ulnar nerve entrapment
1. tingling in the 4th and 5th digits
109
How do you diagnose Multiple Sclerosis
1. mainly clinical- at least 2 discrete episodes of exacerbations
2. MRI w/ gadolinium (test of choice to confirm MS)-- white matter plaques (hyperdensities)
3. LP w./ increased IgG (Oligoclonal bands) in CSF
110
Spinous process avulsion fx MC at the lower cervical C6 or C7
Clay-Shoverlers fracture
111
What is Unthoffs Phenomenon
MS sx worse in heat
112
What is the management of ALS
Riluzole: reduces progression for up to 6 months
*usually fatal w/in 3-5 yrs after onset
113
Management of Bell Palsy
* no tx is required and typically resovles in 1 month
1. Prednisodne if started w/in 72hrs of onset decreases nerve inflammation
2. Artificial tears
3. +/- acyclovir
114
s/s of thoracic outlet syndrome
1. pain that radiate from the point of compression to the base of the neck, axilla, arm, forearm, and hand
2. paresthesias to the volar aspect of the 4th and 5th digits
3. sensory sx may be aggravated at night or by prolong use
4. weakness and muscle atrophy
5. vascular/arterial ischemia
115
what is Charcots neurologic triad
1. Nyastagmus
2. Staccato speech
3. Intentional tremor
*seen in MS
116
A mother brings in her 4 year-old son with complaints that he falls frequently and he "stands funny". The mother also notes that he has lost the ability to easily stand from a seated position. She reports that he met developmental milestones as an infant. Which of the following is the most likely cause?
Muscular dystrophy age of onset is by age 5 and begins in the pelvic girdle.
117
A patient presents w/ left hand weakness and slurred speech. What test is most likely to determine the source of an arterial thrombus
Carotid US
*s/x consistent w/ pathology arising from anterior cerebral circulation including carotid arteries- a CT should be also ordered to r/o acute hemorrhage
118
Describe the anatomy of UMN and LMN
UMN: connects cortex to LMN in SC (NT: glutamate to active LMN)
LMN: in SC, links UMN to muslces (NT: Acetylcholine stimulates muscle contraction)
119
Describe Central Cord Syndrome
"Because MalefiCENT developed frostbite when she EXTENDED her hand to touch the cold window pane, she couldn't put on her SHAWL with her WEAK HANDS"
- Extension injuries
- Loss of pain and temp sensation
- UE>LE (especially hands)
- Shawl distribution
120
PE findings of Huntington's Disease
1. Restlessness
2. Fragility
3. Quick, involuntary hand movements
4. Brisk deep tendon reflexes
121
Where is the likely TIA?
| SX: amaurosis fugax** (monoocular vision loss- temporary "lamp shade down on one eye"), weakness, contralateral hand
anterior carotid artery
122
___ is vision loss due to a central lesion, anisocoria has unequal sized pupils, unilateral loss of vision due to multiple sclerosis
amaurosis fugax
123
Management of Alzheimer Disease
1. Ach-esterase inhibitors: Donepezil, Tacrine, Rivastigmine, Galantamine
2. NMDA antagonists: Memantine
124
What is Guillain Barre Syndrome
- acute/subacute acquired inflammatory demyelinating polyradicuopathy of the peripheral nerves (immune mediated)
- MC w/ Campylobacter jejuni or other antecedent respiratory or GI infections, or immunizations or post surgical
125
What is Multiple Sclerosis
Autoimmune, inflammatory demyelinating disease of CNS. Associated w/ axon degeneration of WHITE MATTER
-Relapsing-remitting disease is MC w/ episodic exacerbations
126
Describe Brown Sequard Syndrome
"I, the MVP on the WINNING side was oblivious 2 the STABBING HEAT of the PAIN of defeat from the LOSING side"
- Ipsilateral deficits: MVP= motor, vibratory, and proprioception deficits
- Contralateral deficits: pain and temp deficits usually at 2 levels below level of injury
- Mechanism: stabbing, penetration injury
127
Describe the nerve roots that are tested with each reflex testing
Achilles/ankle: S1-2
Knee: L3-4
Biceps: C5-6
Triceps: C7-8
128
Problems in the basal ganglia can lead to what type of disorders?
1. Movement disorders (dyskinesia, dystonias, Parkinsonism, Huntingtons)
2. Behavior control (Tourettes, Obsessive compulsive)
*Basal ganglia is involved in coordinated movement, emotion and cognition
129
What is Myasthenia Gravis
Autoimmune peripheral nerve disorder
-Inefficient skeletal muscle neuromuscular transmission due to autoimmune antibodies against acetylcholine nicotinic postsynaptic receptor--> decrease ACh receptors--> progressive weakness w/ repeated muscle use and recocer after periods of rest
- 75% have thymic abnormality (hyperplasia or thymoma)
- May occur postpartum
130
Sx of vertebral artery posterior stroke
1. vertigo
2. nystagmus
3. NV
4. diplopia
131
What makes up the brainstem and what is its fxn
Controls vital life functions (breathing, HR and BP)
1. midbrain
2. pons
3. medulla oblongata
132
How do benzos help with seizures
increases GABA- GABA is an inhibitory NT in the CNS
133
Where is the likely TIA?
SX: gait and propriocetion, dizziness, vertigo
-brainstem/cerebellar sx
Vertebrobasilar
134
With a ____ hemorrhage, do not perform an LP bc it may cause brain herniation
intracerebral hemorrhage (ICH)
135
What are the functions of the Temporal Lobe
1. Hearing (perception/recognition of auditory stimuli and speech)
2. Memory
136
CT scan: ring enhancement
| *infectious cause
Toxoplasma
137
What is Kernig's sign and Brudzinski's sign
Kernigs: inability to straighten knee w/ hip flexion
Brudzinskis: neck flexion produces knee/hip flexion
**seen w/ meningitis
138
Clinical Manifestations of CP
1. Spasticity (**Hallmark)-- varying degrees of motor deficits
2. Often associated w/ intellectual and developmental abnormalities
3. +/- seizures
4. HYPERreflexia
5. limb-length discrepancies
139
A 75 year-old male presents to the ER with the following stroke findings: right-sided hemiparesis (face and hand more affected than leg), homonymous hemianopsia of the right half of both visual fields, and aphasia. Where is the location of his stroke?
Middle Cerebral Artery
140
Management of Trigeminal Neuralgia
1. Carbamazepine (Tegretol) 1st line
| 2. Gabapentin
141
What are Lewy bodies
loss of pigment cells seen in the substantia nigra
| *seen in Parkinsons disease
142
Types of muscle spasms
1. Tonic: prolonged sustained contraction/rigidity
| 2. Clonic: repetitive rapid movement
143
MC cause of:
1. Viral Meningitis
2. Encephalitis
1. Viral Meningitis: Enterovirus (echovirus, coxsackie), Arboviruses
2. Encephalitis: HSV1
144
Describe the types of tremors
1. Resting tremor: at rest (Parkinsons disease)
2. Postural tremor: while holding position against gravity
3. Intentional tremor: during movement or when approaching nearer to target
145
What brain bleed is commonly associated with a temporal bone fracture
epidural hematoma
146
```
Subdural hemorrhage
Location:
MOI:
SX:
CT:
```
Location: venous bleed btwn dura nadn arachnoid due to tearing of cortical bridging veins
MOI: blunt trauma
SX: focal sx, MC in elderly
CT: crescent shaped, crosses suture lines
147
s/s of Niacin deficiency
aka Pellagra
1. symmetric hyperpigmented rash- similar in color to sunburn
2. red tongue
3. diarrhea and vomiting
148
Clinical manifestations of Bell Palsy
1. Sudden onset of ipsilateral hyperacusis (ear pain) and then unilateral facial paralysis (UNABLE TO LIFT AFFECTED EYEBROW OR WRINKLE FOREHEAD)
149
How do you assess narcolepsy
multiple sleep latency test
150
Clinical manifestations of Parkinson Disease
1. Resting tremor- "pill rolling" (MC)
2. Bradykinesia: slowness of voluntary movement (lack of swinging arms while walking and shuffling gait)
3. Rigidity: COGWHEEL, flexed posture
4. Fixed facial expressions
5. Postural instability-- "pull test"
151
What type of ligament injury is common with hyperextension and compression of neck?
transverse ligamental injury and axis fracture
152
Sx of Middle cerebral artery stroke
1. contralateral sensory/motor/hemiparesis: face and arms>LE**
2. gaze preference TOWARDS side of lesion
3. Dominant (L) hemisphere: Aphasia: Broca expressive, Wernicke senosry, poor math comprehension
4. Nondominant (R) hem: spatial deficitns, dysarhria,
153
Management of Tourette Syndrome
1. Habit reversal therapy: 50% have sx resolution by age 18
2. Dopamine blocking agents: haloperidol, risperidone
3. Alpha-adrenergics: clonidine, guanfacine
154
What are the functions of the Pons
1. Relay station between medulla and cerebrum (motor/sensory info)
2. Regulates breathing
155
Demyelination of peripheral nerves is seen w/
multiple sclerosis
156
Vascular dementia is most commonly due to ___
lacunar infarcts
157
Describe the GCS
```
Eye opening:
4- spontaneous
3- to verbal
2- to pain
1- no opening
```
```
Verbal response:
5- oriented
4- confused
3- inappropriate words
1- no words
```
```
Motor response:
6- obey commands
5- localizing response to pain
4- withdrawal from pain
3- flexion to pain
2- extension to pain
1- no motor response
```
158
Clinical Manifestations of Multiple Sclerosis
1. Sensory deficits- TRIGEMINAL neuralgai
2. Unthoff's Phenomenon: worsening sx with heat
3. Lhermittes sign: neck flexion causes lightening shock type pain radiating from the spine down the legs
4. Optic nerve neuritis: unilateral
5. Upper Motor neuron involvment (+ Babinski)
6. SC sx: bladder, bowel, sexual dysfunction
7. Charcots neurologic triad
159
What is the function of the basal ganglia
1. Voluntary movement
2. coordination
3. Cognition
4. Emotion
160
Clinical presentation of Normal pressure Hydrocephalus
Classic Triad
1. Dementia
2. Gait disturbance
3. Urinary incontinence
161
Clinical manifestations of Tourette Syndrome
1. Motor Tics: face, head and neck
2. Verbal or phonetic tics
3. Self-mutilating tics: hair pulling, nail biting, etc.
4. Onset 2-5y/o MC in boys
162
meningiomas are associated with ___ and most commonly arise from
neurofibromatosis
dura or sites of dural reflection
*usually benign
163
How do you dx TIA
CT**
Carotid doppler
CTA or MRA
164
Examples and SE of Dopamine Agonists
Bromocriptine, Pramipexole, Ropinirole
- Orthostatic hypotension/ dizziness
- Nausea
- HA
- Anorexia
165
Sx of Neuroleptic Malignant Syndrome
* decrease dopamine activity
1. AMS: delirium
2. Autonomic instability: hyper salivation, incontinence*
3. Hypertermia: fever
4. Muscle rigidity, bradykinesia, "lead pipe rigidity*", hypotonia
166
Management of Myasthenia Gravis
1. Acetylcholinesterase inhibitors: Pyridostigmine or Neostigmine (1st line) ((increases acetylcholine)
2. Immunosuppresion: plasmapheresis or IVIG used in myasthenic crisis for rapid response
***AVOID FLUOROQUINOLONES AND AMINOGLYCOSIDES (may exacerbate myasthenia)
167
Cognitive loss in Alzheimer's dementia may be delayed with which of the following medications?
Donepezil (Aricept) is a reversible cholinesterase inhibitor that leads to increased acetylcholine, which is necessary for learning and memory
168
Management of Parkinson Disease
1. Levodopa/Carbidopa (**Most effective treatment- levodopa is converted to dopamine)
2. Dopamine agonists: Bromocriptine, Pramipexole, Ropinirole (More useful in young patients to delay the use of Levodopa)
3. Anticholinergics
4. Amantadine
5. MAO-B Inhibitors
6. COMT (Catechol-O-Methyltransferase) inhibitors
169
Management of Guillain Barre Syndrome
1. Plasmapheresis best if done early (removes harmful circulating autoantibodies taht cause demyelination)
2. IVIG
**PREDNISONE IS CONTRAINDICATED
-Prognosis: 60% recover fully in 1 yr. (10-20% left w/ permanent disability)
170
Regulates breathing, serves as a relay station btwn the cerebral hemisphere and the medulla
Pons
171
Where is the Amygdala located, and what is its function
in temporal lobe
| -involved in memory, emotion and fear
172
Clinical Manifestations of Huntington's Disease
1. Sx appear 30-50y/o
2. Progressive sx Behavioral--> chorea--> dementia
3. Behavorial: personality, cognitive, intellectual, and psychiatric including irritability
4. Chorea: worse w/ voluntary movements and stress and usually disappears w/ sleep
5. Dementia
6. Gait abnormalities/ataxia
173
Huntington chorea is due to ____
caudate nucelus atrophy int he basal ganglia
174
What is a Jefferson Fracture and its MOI
aka atlas C1 Burst fracture
-bilateral fractures of the anterior and posterior arches of C1
MOI: vertical compression force through the occipital condyles
175
The source of pain experienced during a migraine headache is a result of activation of which nerve?
Trigeminal nerve
176
What is a odontoid fracture and its MOI
fracture of the dens (odontoid process) of the axis C2
MOI: head placed in forced flexion or extension in an anterior-posterior orientation (fall onto forehead)
**Type 2 is most common
177
Describe the presentation of anterior cord syndrome
1. paraplegia or quadriplegia
| 2. loss of lateral spinothalamic fxn w/ preservation of posterior column fxn
178
Etiologies of UMN lesions
1. CVA
2. MS
3. CP
4. Brain/SC damage
179
Most common presenting signs of multiple sclerosis
1. optic neuritis
| 2. transverse myelitis
180
Management of Pseudotumor Cerebri (Idiopathic intracranial HTN)
1. Acetazolamide +/- Furosemide +/- short course steroids
181
What is the most common etiology for a subarachnoid hemorrhage
Ruptured aneurysm (80%)
182
What is Huntington's disease?
Autosomal Dominant- mutation on chromosome 4
-Neurodegenerative disorder: neurotoxicity as well as cerebral, putamen, and caudate nucleus atrophy
183
What are the functions of the Cerebellum
1. Balance and coordination
| 2. Seat of motor control
184
What is a Hangman's Fracture and its MOI
aka C2/axis pedicle fracture
- Traumatic bilateral fractures (sponylolysis) of the pedicles or pars interarticularis of the axis vertebra C2
* may lead to spondylolisthesis btwn C2-C3
MOI: extreme hyperextension of skull, atlas and axis
**Dx w/ CT
185
What dermatome is at the umbilicus
T10
186
Rapid involunatry jerky, uncontrolled, purposeless movements
Chorea
187
CN XI: ____ (S/M/B?)
| Test by: ___
CN11, Accessory, M
| Test: shoulder shrug, turn head from side to side
188
What are the functions of the Occipital Lobe
1. visual processing
189
With SAH lower BP gradually with ___
Nicardipine**, Nimodipine, labetalol
190
MC type of anterior circulation ischemic stroke
Middle Cerebral artery
*anterior cerebral artery less common 2%
191
Injury to what nerve gives you a foot drop
Peroneal nerve injury
192
Clinical manifestations of Guillain Barre Syndrome
1. Ascending weakness and paresthesias (usually symmetric)
2. Decreased deep tendon reflexes
3. Autonomic dysfunction: tachycardia, hypotension, HTN, breathing difficulties**
193
Drug of choice for Absence seizures
Ethosuximide- CCB
194
SE of Lamictal (lamotrigine)
Rash, SJS,
195
What is an Essential Familial Tremor
* Benign
| - Autosomal Dominant inherited disorder of unknown etiology
196
What are the following seizure medications associated with:
1. Phenytoin:
2. Carbamazepine:
3. Clonazepam:
4. Ethosuximide:
5. Valproic Acid:
1. Phenytoin: gingival hyperplasia, anemia, hirsutism, osteomalacia or demineralization w. LT use
2. Carbamazepine: aplastic anemia, hyponatremia, leukopenia, agranulocytosis
3. Clonazepam: ataxia, sedation, slowed thinking
4. Ethosuximide: heptatoxicity, neutropenia, rash
5. Valproic Acid: hepatotoxicity, osteoporosis, pancreatitis
197
Describe the CSF in bacterial vs viral meningitis
bacterial meningitis: cloudy appearance, elevated protein, elevated WBCs (predominantely polymorphonuclear (PMN) leukocytes, LOW glucose
Viral: WBC ~1000/mL (predominately lymphocytes or monocytes), normal glucose,
198
Wilsons disease is associated with what serum findings
1. increase copper
| 2. low serum ceruloplasmin levels
199
What is the first-line treatment for acute inflammatory demyelinating polyneuropathy variant of Guillain- Barre?
IV immunoglobulin
200
CN VIII: ____ (S/M/B?)
Test by: ___
Abnormalities could mean: ___
CN8, acoustic, S
Test: hearing, weber and Rinne, Vestibular fxn w balance and proprioception
Abnormalities: Acoustic neuroma
201
What is the most common finding in a person with a brain abscess?
Headache (69%)
202
The following presentations are associated with what type of seizures?
1. Cessation of breathing and incontinence:
2. Loss of muscle tone and collapse to the ground:
3. Loss of consciousness with focal motor or autonomic sx or subjective sensory or psychic sx that may precede, accompany or follow the period of altered responsiveness
4. Focal motor, sensory, psychic and/or autonomiic sx but the patient does not lose consciousness
1. Tonic-Clonic
2. Atonic
3. Complex partial seizures (focal seizure with LOC)
4. Simple partial seizures (focal seizure w/o LOC)
203
What does the limbic system include
1. Thalamus
2. Hypothalamus
3. Amygdala
4. Hippocampus
204
What is the function of the hippocampus
1. learning/memory
| 2. converts short-term memory into longterm memory
205
CN IV: ____ (S/M/B?)
| Test by: ___
CN4: Trochlear: M
Test: Superior oblique rectus, EOM
206
Cardinal s/s of Complex regional pain syndrome (AKA reflex sympathetic dystrophy)
1. pain localized to an arm or leg
2. swelling of the involved extremity
3. disturbances of color and temp in the affected limb
4. dystrophic changes in the overlying skin and nails
5. limited ROM
6. radiograph: generalized osteopenia or demineralization
*often preceded by direct trauma, often of relatively minor nature, to the soft tissues, bone or nerve
207
CN XII: ____ (S/M/B?)
| Test by: ___
CN12, hypoglossal, M
| Test: tongue- look for fasciculations and asymmetry
208
How do you diagnose Pseudotumor Cerebri (Idiopathic intracranial HTN)
1. Papilledema
2. CT to r/o mass
3. LP w/ increased CSF pressure but otherwise normal
209
What are signs of Wernicke-Korsakoff
* vitamin B1 deficiency (thiamine)--> Commonly seen in chronic alcoholics
1. Horizontal nystagmus
2. opthalmoplegia
3. ataxia
3. Confusion
210
What is the Corpus callosum
bundle of axons that connects the 2 hemispheres.
211
a milestone of walking alone occurs at what age
15 months
212
Myasthenia gravis is due to
Antibodies directed at acetylcholine receptors
213
```
Subarachnoid hemorrhage
Location:
MOI:
SX:
CT:
```
Location: arterial bleed btwn arachnoid and pia
MOI: berry aneurysm rupture, AVM
SX: thunderclap HA, meningeal stiffness/delirium
CT: star shapped--> GET LP: xanthrochromia and increased ICP
214
CN IX: ____ (S/M/B?)
| Test by: ___
CN9, glossopharyngeal, B
| Test: M: swallow, gag S: taste, posterior 1/3 of tongue
215
S/s of Vit C deficiency
aka Scurvy
1. ecchymoses
2. bleeding gums
3. petechiae
4. hyperkeratosis
5. arthralgias
6. impaired wound healing
216
How do you diagnose Myasthenia Gravis
* 1. + Acetylcholine receptor antibodies and + MuSK antibodies
* 2. Edrophonium (Tensilon) Test: rapid response to short acting IV Edrophoium in limb
3. +/- CT or MRI shoing thymoma or thymus gland abnormality
4. Ice pack test: on eyelids for 10 min. ---> improvement of ptosis in ocular MG
217
Empiric tx of menigitis caused by:
1. <1month, GBS:
2. 1mon-50y/o, N. meningitidis or S. pneumo:
3. 50+, S. pneumo or listeria mnocytogenes:
1. <1month, GBS: Amp + Cefotaxime (Amp covers Listeria)
2. 1mon-50y/o, N. meningitidis or S. pneumo: Cefriazone + Vancomycin
3. 50+, S. pneumo or listeria mnocytogenes: Amp + Ceftriaxone +/- Vancomycin
218
Management of:
1. Absence (Petit mal) seizure:
2. Grand mal:
3. Status Epilecpticus:
4. myoclonus:
1. Absence (Petit mal) seizure: Ethosuximide 1st line
2. Grand mal: valproic acid, phenytoin, carbamazepine, lamotrigine
3. Status Epilecpticus: lorazepam or diazepam--> phenytoin--> phenobarbital
4. myoclonus: valproic acid, clonazepam
219
Describe Anterior Cord Syndrome
"Because ANT COULDN'T WALK to the bathroom in the TeePee, he peed his pants when his bladder busted into FLECKS"
- LE motor deficits
- Loss of temp and Pain sensation ("TeePee")
- bladder dysfunction, LE involvement
- Flexion compression injuries common mechanism
220
What is the difference btwn partial (focal) and generalized seizures?
-examples of each?
Partial: confined to small area of brain- one hemisphere
ex. Simple and complex
Generalized: diffuse brain involvement- both hemispheres
Ex. Tonic-Clonic (grand mal), Absence (petit mal), myoclonus, atonic
221
MC cause of bacterial meningitis in:
1. <1 month
2. 1month -18y/o
3. 18-50y/o
4. 50+
1. <1 month: GBS*, Listeria monocytogenes
2. 1month -18y/o: N. meningitis* (associated w/ petechial rash), S. pneumo
3. 18-50y/o: S. pneumo*, N. meningitis
4. 50+: S. pneumo, Listeria monocytogenes
222
How do you diagnose Huntington's Disease?
1. ***CT: cerebral and caudate nucleus atrophy****
2. Genetic testing
3. PET scan: decreased glucose metabolism in the caudate nucleus and putamen
223
How cna you differentiate seizures and pseudoseizures
Prolactin levels are increased in seizures
| *EEG help to x and localize lesions
224
Sx of Serotonin syndrome
1. AMS- agitation
2. Autonomic instability: tachy, BP fluctuations
3. Hyperthermia: fever
4. Neurologic changes: tremor, HYPERreflexia, Myoclonus
225
Sudden brief, sporadic involuntary jerking/twitching of 1 muscle or muscle group (not suppressible)
Myoclonus
226
Involuntary spasms, repetitive motions or abnormal voluntary movements
Dyskinesia
227
acute, abrupt TRANSIENT confused state due to an identifiable cause (ex. meds, infections)
Delirium
228
A 23 year-old patient presents with two days of fatigue, headache, fever and pain around the area in which she was bitten by a stray baby raccoon in an unprovoked attack 10 days ago. She cleaned the small wound thoroughly. Which of the following is the most appropriate intervention in this patient?
Rabies immunoglobulins and human diploid cell rabies vaccine given 5 times in a 1-month period
229
Reye syndrome is typically develops ____.
post-influenza or URI
230
How to diagnose Normal pressure Hydrocephalus
MRI or CT: enlarged ventricles
| -LP has normal CSF pressure
231
Spontaneous ICH is MC caused by ___ in ___
| DX by ___
HTN especially in basal ganglia
*LOC
DX: noncontrast CT-- do not perform LP if LCH is suspected!
232
A pain syndrome disproportioned to injury with continuing pain that is disproportionate to any inciting event
Presentation:
- Following trauma, injury
- Extremity pain and at least 1 other sensory, motor, vasomotor, edema, sudomotor symptom
Complex Regional Pain Syndrome
233
Tx of Complex regional pain syndrome
Stage 1: Neurontin, Elavil and bisphosphonates
Stage 2: Add steroids
Stage 3: Include pain management specialist
234
Tx of peripheral neuropathies
1. Gabapentin, amitriptyline, Topiramate, tramadol, NSAIDs.
| 2. Glycemic control
235
Hereditary neuropathy: Motor and sensory loss, loss of reflexes, hammer toes. “stork leg deformity”
Charcot-Marie-tooth
