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PANCE > PANCE_neurology 7% > Flashcards

PANCE_neurology 7% Flashcards

1
Q

(CME)
“Which of the following is the most common organism to cause neonatal meningitis?
a) Escherichia coli
b) Streptococcus pneumoniae
c) Group B Streptococcus
d) Neisseria meningitidis
e) Mycoplasma pneumoniae”

A

“C) GROUP B STREPTOCOCCUS”

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2
Q

(CME)
“The day after Christmas a 68 y/o widow is brought by ambulance to the ER being delirious. On exam, pt appears malnourished, has nystagmus, a 6th CN palsy and ataxia. What is your initial diagnosis?”

A

THIAMINE DEFICIENCY

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3
Q

(CME)
“Which of the following is the LEAST likely trigger for a migraine headache?
a) chocolate
b) caffeine
c) beer
d) nitrates
e) ASA”

A

E) ASA

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4
Q

(CME)
“Which artery feeds the basilar artery?
f) ant cerebral artery
g) middle cerebral artery
h) internal carotids
i) vertebral arteries
j) ant communicating artery”

A

I) VERTEBRAL ARTERIES

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5
Q

(CME)
“Which medication is FDA approved for absence (petit mal) seizures?
a) carbamazepine
b) phenytoin
c) valproic acid
d) pregabalin
e) topiramate”

A

C) VALPROIC ACID

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6
Q

(CME)
“A 21 y/o girl c/o increasing weakness, difficulty swallowing and some slight double vision. CT scan shows a large thymoma. All of the following may be treatments EXCEPT
f) daily pyridostigmine
g) corticosteroids
h) plasmapheresis
i) thyroidectomy
j) IV immunoglobulin”

A

I) THYROIDECTOMY

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7
Q

(RR)
define epidural hematoma

A

blood b/w dura and inner table of skull

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8
Q

(RR)
MC source of bleeding of epidural hematoma

A

“tear of the middle meningeal artery”

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9
Q

(RR)
CT scan presentation of epidural hematoma

A

hyperdense BICONVEX LENS-SHAPED collection of blood, margins do not cross suture lines

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10
Q

(RR)
presentation of a pt with epidural hematoma is often:

A

“hx of a head injury with a LOC followed by a lucid interval”

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11
Q

(RR)
presentation of cauda equina syndrome

A

acute onset of lower back pain with
pain, weakness, numbness affecting multiple levels and both legs

URINARY RETENTION = most consistent exam finding

other findings = saddle anesthesia, decreased rectal tone, fecal incontinence

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12
Q

(RR)
MC cause of cauda equina syndrome

A

herniated disc

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13
Q

(RR)
first steps in evaluation of suspected spinal epidural abscess

A

MRI of spine w/ contrast

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14
Q

(RR)
classic clinical triad of spinal epidural abscess

A

fever
back pain
neurologic deficits

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15
Q

(RR)
RF for spinal epidural abscess

A

IV DRUG USE
also,
recent bac infection
recent spinal procedure
presence of chronic indwelling catheter
immunocompromised
hx of DM

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16
Q

(RR)
what pathogen most frequently causes a spinal epidural abscess?

A

S. aureus

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17
Q

(RR)
what do labs tend to show on spinal epidural abscess?

A

elevated ESR

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18
Q

(RR)
you suspect a pt has Guillain-Barre syndrome….what CSF analysis findings are highly specific?

A

ELEVATED PROTEIN with only a MILD PLEOCYTOSIS
(termed ALBUMINOCYTOLOGIC DISSOCIATION)

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19
Q

(RR)
next steps after confirming diagnosis of Guillain-Barre syndrome?

A

neurology consult
IVIG therapy or plasma exchange

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20
Q

(RR)
what is the treatment for acute dystonic reaction secondary to metoclopramide?

A

ADMIN OF ANTICHOLINERGIC AGENTS such as DIPHENHYDRAMINE or BENZTROPINE

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21
Q

(RR)
dystonic reaction - usually caused by what two classes of drugs?

A

antipsychotics
antidopaminergics

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22
Q

(RR)
three main causes of intention tremor

A

cerebellar or brain stem disease (such as MS w/ cerebellar plaques)

Wilson’s disease

drug toxicity

(these are associated with cerebellar signs)

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23
Q

(RR)
who does NOT get triptan medications for their migraines?

A

pts with CV or cerebrovascular disease, angina, severe HTN, peripheral vascular disease

(triptans have adrenergic-agonistic properties)

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24
Q

(RR)
what should never be combined with triptan meds?

A

ergot-derivatives

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25
Q

(RR)
“chronic migraine is strongly associated with which disorder?”

A

“medication overuse (rebound phenomenon or rebound headaches)”

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26
Q

(RR)
distinguishing features of W. Nile encephalitis

A

LEUKOPENIA with a pronounced and PROLONGED LYMPHOPENIA

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27
Q

(RR)
W. Nile encephalitis is caused by what kind of pathogen?

A

an arthropod-borne virus (arbovirus)

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28
Q

(RR)
what is complex regional pain syndrome?

A

CHRONIC PAIN IN A BODY REGION, most commonly THE EXTREMITIES

characterized by PAIN, SWELLING, SKIN CHANGES, VASOMOTOR INSTABILITY, LIMITED ROM, PATCHY BONE DEMINERALIZATION

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29
Q

(RR)
common events that lead to complex regional pain syndrome

A

soft tissue injury
surgery
vascular event such as MI or CVA

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30
Q

(RR)
allodynia = ?

A

pain from a stimulus that does not usually provoke pain (i.e. pain felt from a nonpainful stimulus, such as clothes or bed sheets on skin)

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31
Q

(RR)
distinguishing features of complex regional pain syndrome

A

LIGHT TOUCH CAUSES EXTREME PAIN

ALLODYNIA

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32
Q

(RR)
“In the initial diagnostic evaluation of a patient with undifferentiated polyneuropathy, [what] approaches [are] most appropriate?”

A

“ELECTRODIAGNOSTICS, then LABORATORY TESTING”

“lab studies can be ordered based on electrodiagnostic testing results and hx and exam findings”

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33
Q

(RR)
for those with significant acute symptoms of MS, what is the treatment of choice?

A

high-dose corticosteroids

“TREATMENT WITH HIGH-DOSE IV METHYLPREDNISOLONE (more than 500 mg/day for at least 3 days) is a typical recommended treatment”

34
Q

(RR)
what is Uhthoff phenomenon?

A

heat sensitivity seen in MS

35
Q

(RR)
what is Lhermitte’s sign?

A

electric shock-like sensation that occurs with flexion of neck

commonly seen in MS

36
Q

(RR)
four characteristics of Lewy Body Dementia

A

HALLUCINATIONS
PARKINSONIAN FEATURES
EXTRAPYRAMIDAL SIGNS
cognitive dysfunction common to all dementias

37
Q

(RR)
pts with Lewy Body Dementia are very sensitive to what drugs?

A

NEUROLEPTIC AND ANTIEMETIC MEDICATIONS that affect dopaminergic and cholinergic systems

–> they respond w/ CATATONIA, loss of cognitive fxn, develop life-threatening m. rigidity

38
Q

(RR)
reversible causes of dementia

A

depression
B12 deficiency
syphilis
hypothyroidism
NPH
drug use
intracranial mass

39
Q

“A patient presents with right-sided homonymous hemianopia. [What] is the location of the suspected lesion?”

A

LEFT optic tract

40
Q

(RR)
“what is the most common etiology of homonymous hemianopia?”

A

STROKE

41
Q

(RR)
moderate to severe traumatic brain injury in coup-contrecoup injury patterns results in what?

A

DIFFUSE AXONAL INJURY

occurs from shearing forces along white matter tracts causing focal cerebral contusions and hematomas

42
Q

(RR)
in terms of closed head injury/TBI, with what GCS score do you intubate?

A

<= 8

GCS less than or equal to eight, intubate

43
Q

(RR)
“A 77-year-old man presents with left sided weakness. The patient woke this morning with difficulty moving his left side. On examination, his leg is weaker than his arm. Which vascular structure is likely responsible for this stroke?”

A

ANTERIOR CEREBRAL ARTERY

44
Q

(RR)
paralysis of contralateral foot and leg
sensory loss over toes, foot and leg
impairment of gait and stance
cognitive impairment
——what is the likely impaired vascular structure?

A

ANTERIOR CEREBRAL ARTERY

“CONTRALATERAL weakness and sensory loss leg>arm, frontal lobe dysfunction”

45
Q

(RR)
upper extremities are affected more than the lower extremities
significant motor & sensory loss on the opposite side of the lesion
—–what is the likely impaired vascular structure?

A

MIDDLE CEREBRAL ARTERY

46
Q

(RR)
“What is the upper age limit for tPA administration up to 4.5 hours?”

A

80 years (relative exclusion)

47
Q

(CME)
“Which of the following is a test of CN V function?
a) close eyes tightly
b) move chin from side to side
c) smile
d) move eyes to lateral gaze”

A

B) MOVE CHIN FROM SIDE TO SIDE

from KenHub “Muscles of mastication, mylohyoid, anterior belly of digastric, tensor tympani muscles”

48
Q

CN I

A

olfactory

sensory

49
Q

olfactory, sensory

A

CN I

50
Q

CN II

A

optic

sensory

51
Q

optic

sensory

A

CN II

52
Q

CN III

A

oculomotor

motor

53
Q

oculomotor

motor

A

CN III

54
Q

CN IV

A

trochlear

motor

55
Q

trochlear

motor

A

CN IV

56
Q

CN V

A

trigeminal

both

57
Q

trigeminal

both

A

CN V

58
Q

CN VI

A

abducens

motor

59
Q

abducens

motor

A

CN VI

60
Q

CN VII

A

facial

both

61
Q

facial

both

A

CN VII

62
Q

CN VIII

A

auditory

sensory

63
Q

auditory

sensory

A

CN VIII

64
Q

CN IX

A

glossopharnygeal

both

65
Q

glossopharyngeal

both

A

CN IX

66
Q

CN X

A

vagus

both

67
Q

vagus

both

A

CN X

68
Q

CN XI

A

spinal accessory

motor

69
Q

spinal accessory

motor

A

CN XI

70
Q

CN XII

A

hypoglossal

motor

71
Q

hypoglossal

motor

A

CN XII

72
Q

(CME)
cluster headaches RF

A

being male

males:females, 8:1

73
Q

miosis

A

pinpoint pupils

little word, little pupils

74
Q

mydriasis

A

wide pupils

big word, big pupils

75
Q

(CME)
preventive treatment for cluster HA

A

verapamil
lithium
topiramate
steroids

76
Q

(CME)
four possible treatments for trigeminal neuralgia

A

carbamazepine
phenytoin
baclofen
surgery

77
Q

(CME)
subarachnoid hemorrhage (SAH) and subdural hematoma: which is arterial? which is venous?

A

SAH = arterial bleed (may be an aneurysm)

subdural hematoma = venous bleed

78
Q

(CME)
classification of seizures

A

GENERALIZED (whole brain) vs FOCAL/PARTIAL (pt of brain)

Generalized –> convulsive vs nonconvulsive

Focal/Partial –> with LOC (“complex”) or without LOC (“simple”)

79
Q

(CME)
three treatments for nonconvulsive seizures

A

valproic acid
ethosuximide
clonazepam

80
Q

What CN is responsible for taste on the anterior 2/3 of the tongue?

A

CN VII

facial n.

81
Q

What CN is responsible for taste on the posterior 1/3 of the tongue?

A

CN IX

glossopharyngeal n.

82
Q

(CME)
“formula” for remembering the CN’s of the eye

A

LR6(SO4)3

Lat Rectus VI
Sup Oblique IV
everything else III

PANCE (13 decks)

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