UWorld - Step 2 CK "Nervous System" Flashcards
When is plasmapheresis indicated in the treatment of MS?
When a patient with MS has disabling symptoms, you first treat with corticosteroids. If the steroids fail, then you administer plasmapheresis.
Trigeminal neuralgia is caused by ______________.
demyelination secondary to compression of the nerve
The ____________ nerve arises from the posterior cord and travels posterior to the humerus.
axillary
It is the unique pathway behind the humerus that makes it susceptible to injury in anterior dislocations.
Epidural hematoma is treated with _______________.
emergent craniotomy
A single brain abscess is most likely one of two organisms: ______________.
Staphylococcus aureus or Streptococcus viridans
Note: this usually results from infection of adjacent structures (teeth or sinuses).
Charcot-Bouchard aneurysms are the product of _________________.
hypertensive vasculopathy (typically bleeding into the basal ganglia or internal capsule)
To qualify as a febrile seizure, there needs to be no _____________.
identifiable cause of the seizure (such as meningitis, encephalitis, electrolyte abnormality, or mass)
What percent of those who’ve had one febrile seizure will develop epilepsy?
Less than 5%
What two studies would you order to help diagnose Guillain-Barré?
- LP (which will show high protein content with all other values normal)
- NCS (which will show decreased NCV)
What unique vital sign abnormality might those with Guillain-Barré have?
Orthostatic hypotension
List the triad of symptoms that suggest Wernicke encephalopathy.
- Gait disturbances
- Nystagmus
- Encephalopathy
For severe pain from cancer, give _____________.
short-acting opioids; for moderate pain, however, NSAIDs are more appropriate
What gait problems are associated with NPH?
Slow, broad-based, shuffling gait
Once again, what is the frequency of a Parkinsonian tremor?
4 to 6 Hz
How could you differentiate between an ACA stroke and a lacunar stroke that selected for the lower limb?
Lacunar strokes are so small that they generally are either pure motor or pure sensory, whereas ACA strokes are more often sensory and motor. Also, ACA strokes are more likely to induce urinary incontinence.
What is the first line treatment for IIH?
Acetazolamide +/- furosemide
Serial lumbar punctures can provide relief, but they are not preferred due to their risk of complications.
List the two big differences in the physical exams of cauda equina syndrome and conus medullaris syndrome?
- Conus medullaris syndrome affects the spinal cord and thus presents with upper motor neuron signs (hyperreflexia), while cauda equina syndrome affects the lower motor neurons and thus causes LMN signs (hyporeflexia, fasciculations).
- CES is asymmetric while CMS is symmetric.
Those with ____________ are more likely to develop ADHD.
absence seizures
NPH is thought to be caused by ________________.
the decreased absorption of CSF
Explain breath holding spells (BHS).
BHS occur in children ages 6 months to 2 years. They are episodes of breath holding after crying (often in response to an emotional stressor) during which the child passes out and turns blue. They are benign.
Cerebellar signs and T-wave inversions?
Friedrich’s ataxia
In uncal herniation, compression of the _____________ produces depression in consciousness.
reticular formation
Seizures are more typical of ________-tentorial masses, while clummsiness is more typical of _________-tentorial masses.
supra; infra
What kind of imaging might you do for a patient with café-au-lait spots?
Optic/orbital MRI (to evaluate for optic gliomas in NF-1)
If a patient with Parkinson’s presents with autonomic symptoms, then ___________ is a likely diagnosis.
Shy-Drager, also called multi-system atrophy
“Mouth is DRY? Think SHY!”
Describe the most common type of cerebral palsy.
Caused by prematurity, the most common form of cerebral palsy presents with bilateral equinovarus feet with spasticity.
A man presents with paralysis after a hike. What is the likely cause?
Tick-borne paralysis
In this disorder, ticks release a neurotoxin after feeding for 4-7 days. It causes paralysis without autonomic dysfunction (which does occur in Guillain-Barré syndrome). Importantly, this occurs without a prodromal or concomitant illness.
The most common side effects of Sinemet are _____________.
hallucinations, confusion, and dizziness – all CNS manifestations
How is botulism treated?
Equine antitoxin
The big worry about falling with an object in your mouth is ________________.
carotid dissection, which can result from oropharyngeal trauma
Remember, the oculomotor nerve has ____________ on the outside.
parasympathetics; this is why diabetic ischemic neuropathy can cause disrupted motor function (in the middle of the nerve, far from the arteries) without parasympathetic disruption (on the periphery, close to the arteries)
Headache, nausea, and eye pain are suggestive of _______________.
acute angle-closure glaucoma
Which is the more complicated presentation, galactokinase deficiency or galactose-1-phosphate uritdyl transferase deficiency?
G1PUTD
Galactokinase presents with only cataracts.
Remember, hypertensive vasculopathy presents with __________________.
isolated pure weakness or pure sensory loss
Hypertensive vasculopathy is also called lacunar stroke.
Hyporeflexia, weakness, and arrhythmia in an older person on a diuretic might indicate ____________.
hypokalemia
Bloodstream infection with lower-extremity paralysis might indicate _______________.
spinal epidural abscess
