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USMLE Step 3 > UWorld Neurology > Flashcards

Flashcards in UWorld Neurology Deck (60):
1

Diastolic heart murmur

aortic insufficiency or mitral stenosis
- related to ischemic CVA

2

Systolic heart murmur

aortic stenosis or mitral regurgitation or tricuspid regurgitation
- related to heart failure

3

Acute retinal vein thrombosis

extensive hemorrhage of the retina

4

Optic disc symptoms of ischemia

paleness

5

Damage to the recurrent laryngeal nerve

change in voice quality

6

Ansa hypoglossus nerve innervation

strap muscles of the neck

7

Symptoms of median nerve entrapment between two heads of pronator teres

Pain in volar forearm

8

Radial nerve inflammatory symptoms

sensory findings in the dorsal aspect of the forearm and hand

9

Cannabis withdrawal

abdominal pain, sweating, shakiness, fever, chills, headache, irritability, anxiety, insomnia, decreased appetite, restlessness, depressed mood

10

Vasovagal syncope

tunnel vision, diaphoresis, nausea, and pallor

11

Amyotrophic lateral sclerosis

involves both lower (neurons of the anterior horns in the spinal cord and brainstem neurons innervating the bulbar muscles) - weakness and atrophy and upper motor neurons - spasticity, increased DTRs
- Ocular motility, sensory, bowel, bladder, and cognitive function are preserved

12

Binswanger's disease

form of vascular dementia with white matter infarcts
Symptoms: apathy, agitation, bilateral corticospinal or bulbar signs

13

Riluzole

glutamate inhibitor; may prolong survival and delay tracheostomy

14

Causes of papilledema

- mass lesions
- cerebral edema
- increased CSF production
- decreased CSF outflow (venous thrombosis)
- Idiopathic intracranial hypertension (pseudotumor cerbri)

15

Construction apraxia

Involve the nondominant (often right) parietal lobe
- Confusion, difficulty copying simple things, and difficulty dressing

16

Damage to dominant parietal lobe (especially inferior portion)

Gerstmann syndrome:
acalculia - difficulty performing simple arithmatic
finger agnosia - difficulty naming individual fingers
agraphia - impaired writing
right-left confusion - difficulty distinguishing left side from right side

17

Damage to nondominant temporal lobe

visual disorders - homonymous upper quadranopia
auditory agnosia - impaired perception of complex sounds

18

Damage to dominant temporal lobe

homonymous upper quadranopia
aphasia (Wernicke's) - difficulty creating meaningful language

19

Phenytoin toxicity

presence of nystagmus on far lateral gaze
blurred vision, diplopia, ataxia, slurred speech, dizziness, drowsiness, lethargy, decreased mentation, progression to coma
- side effect development is very patient specific - some will develop side effects within normal drug levels

20

OCPs and phenytoin

OCPs do not affect phenytoin levels, but phenytoin can increase metabolism of OCPs, making them less effective

21

How to manage phenytoin toxicity

reduce drug levels and watch for symptom resolution
- to stop, gradually taper drug

22

Brain death

- Patient must not be hypothermic when this determination is made (must be >36 C)
- Absent respiratory drive after 8-10 mins off the ventilator
PaCO2 >60 and pH <7.28
- Patient can have spontaneous limb movements (peripheral nerves and spinal reflexes)

23

Myasthenia gravis

autoantibodies against acetylcholine receptors
- Associated with thymoma

24

Febrile seizure

- Often a family history
- Typically seen in 3 months-6 yrs
- no previous afebrile seizure
- abortive therapy if >5 mins
- <5% epilepsy

25

Clonidine

alpha 2 adrenergic agonist

26

Guillan Barre syndrome

Typically develops after a GI or respiratory illness
- Antibdodies to antigens mimic peripheral nerves
- Symmetric muscle weakness, dysautonomia, parasthesias, decreased DTRs
- Have to monitor respiratory status with frequent measurement of vital capacity (looks at muscular function)

27

When should patients with GBS be treated with IVIG

- nonambulatory
- within 4 weeks of symptom onset

28

GBS time course

2 weeks of progressive motor weakness that can lead to paralysis
-2-4 weeks of plateaued symptoms
- Slow spontaneous recovery over months

29

How does IVIG help GBS

shortens time to recovery by 50%

30

Cauda equina syndrome

severe low back pain, urinary or bowel incontinence, motor weakness or sensory loss, saddle anesthesia

31

Cremastaric reflex

- corresponds to L1-L2 (also hip flexion and adduction)

32

Tabes dorsalis

Trepenema pallidum spirochetes directly damage the dorsal sensory roots and cause secondary degeneration of the dorsal columns
Symptoms: sensory ataxia, lancinating pains, neurogenic urinary incontinence, Argyll-Robertson pupils

33

Positive Romberg test

Due to problem with sensation

34

Vitamin B12 deficiency neurologic

Peripheral neuropathy and/or subacute combined degeneration

35

Subacute combined degeneration

Posterior spinal column disease and lateral cortical spinal disease (spastic paresis and hyperreflexia)

36

Clinical criteria for diagnosis of brain death

1. Clinical/brain imaging evidence of devestating known cause
2. Absence of confounding factors (sedatives, metabolic)
3. No evidence of drug intoxication or poisoning
4. Core temperature >36 C and systolic BP >100

37

Neurologic exam findings suggesting brain death

1. coma
2. absent brain-originating motor response (flexor and extensor posturing)
3. absent oculovestibular response (caloric testing)
4. absent cough with tracheal suctioning
5. absent pupillary light and corneal reflexes
6. absent rooting or sucking reflexes
7. absent gag reflex
8. Apnea test
9. Silence on EEG
10. absence of cerebral blood flow

38

Lewy body dementia

REM sleep disorder (vivid dreams)
Severe neuroleptic sensitivity
SPECT or PET showing low dopamine transporter uptake in basal ganglia
severe autonomic dysfunction
- Usually don't have tremor of Parkinson's disease

39

Dopamine agonists in Lewy body dementia

- Can increase visual hallucinations

40

Treatment of Lewy body dementia

Dopamine agonsts
Cholinesterase inhibitors

41

Benign essential tremor

Most common cause of postural tremor
Autosomal dominant inheritance pattern
Tremor worsens with action

42

Treatment of benign essential tremor

- Should be delayed if not immediately necessary
- Use propranolol

43

Cushing's triad

Manifestations of intracranial hypertension:
- bradycardia
- hypertension
- respiratory depression

44

Late signs of elevated intracranial pressure

transtentorial herniation of brain tissue, altered level of consciousness, dilation of ipsilateral pupil, third cranial nerve palsy, hemiparesis, decerebrate posturing, respiratory arrest

45

Hyperventilation for elevated ICP

Increases PCO2 leading to vasoconstriction and reduced cerebral blood flow, decreasing ICP
- contraindicated in patients with trauma because it can lead to further neurologic loss

46

First-line therapy in Alzheiemer's disease

acetylcholinesterase inhibitor (patients have decreased acetylcholine due to degeneration of basal nucleus of Meynert
- Donepizil is first-choice drug

47

Parkinson's disease diagnosis

Clinical diagnosis
- Improvement with dopaminergic medications
- Unilateral onset and persistent asymmetry support the diagnosis
- Striatal dopamine transporter scan - used in patients with equivocal PE, same sensitivity as exam
Bradykinesia in addition to tremor or rigiditiy
- MRI should be obtained to rule out other conditions

48

Treatment of Parkinson's disease

In patients under 65 yrs, dopamine agonists are usually tried first (pramipexole, bromocriptine)
In patients >65 levodopa might be first, but it has more side effects (dyskinesia)
- May hasten destruction of substantia nigra cells

49

Entacapone

COMT inhibitor that can increase effectiveness of levodopa

50

Indirect hyperbilirubinemia in B12 deficiency

Megaloblastic transformation of the bone marrow with intramedullary hemolysis
- absent reticulocyte response

51

Abusive head trauma clinical features

subdural hemorrhages
retinal hemorrhages
diffuse brain injury

52

Imaging for abusive head trauma

emergency CT scan to determine if neurosurgical evaluation is needed
- Typically have mixed-density pattern

53

Carotid artery dissection etiologies

Traumatic: Trauma, high-velocity chiropractic manipulation of the spine
Spontaneous: severe atherosclerotic disease, poorly controlled HTN, collagen vascular disorders, fibromuscular dysplasia, autosomal polycystic kidney disease

54

Signs and symptoms of carotid dissection

- Head/neck pain with severe thunderclap headache
- Partial Horner's syndrome (ptosis and miosis but no anhydrosis) - due to disruption of the sympathetic nerves, but anhydrosis is absent because sweat fibers travel along external carotid artery
- TIAs, ischemic or embolic strokes
- Transient visual loss due to retinal artery occlusion or ischemic optic neuropathy

55

Diagnosis of carotid artery dissection

CT angiography
MRA
catheter angiography

56

Treatment of carotid artery dissection

Antithrombotic therapy
Stroke can complicate
Tight blood pressure control is not indicated

57

Focal dystonia treatment

Botulinum toxin injections

58

Diagnosis of sleep disorders

Overnight polysomnography

59

Diagnosis of narcolepsy

polysomnography, multiple sleep latency

60

Carbamazepine complications

Fulminent hepatic failure with hyperammonemia, hepatic encephalopathy and seizure