Yellow Pages Review Flashcards
gradual unilateral hearing loss
acoustic schwannoma
hearing loss and V and VII nerve dysfunction
cerebellopontine angle meningioma
episodes of tinnitus, vertigo and low frequency hearing loss occurring abut 3x/year for 2 years
meniere’s disease
profound dizziness, dysarthria, ataxia over a 10 day period… unable to sit or stand without assistance and has bilateral dysmetria of upper and lower extremities
anti-Yo paraneoplastic syndrome
-associated with small cell lung, gynecologic, and non Hodgkin’s lymphoma
momentary vertigo, diplopia, numbness around mouth.. transiently unable to walk and the symptoms then resolve
vertebrobasilar TIA
Parkinson-like sxs with autonomic insufficiency (ex. postural hypotension, constipation)
multiple system atrophy (shy-drager)
slow shuffling gait, difficulty with turns, urinary incontinence… recovered from meningitis 5 years ago
communicating hydrocephalus (NPH) -enlarged ventricles due to obstruction of arachnoid granulations (esp after meningitis, SAH, or head trauma)
how to tx NPH
high volume tap –> if gait improves, then shunt him
what is it called when ventricles are dilated due to brain atrophy, such as in Alzheimer’s disease?
hydrocephalus ex vacuo
2 places that would cause spastic paraparesis
- spinal cord (would probably have sensory sxs)
- parasagittal meningioma (no sensory sxs)
tingling in arms and legs, sensation that limbs are “swollen”, steady on legs esp in the dark –> weakness and SOB
-on exam: no DTRs, absent proprioception and vibration in the limbs, mild bilateral facial weakness
GBS
pupils react to accommodation but not to direct light… what is this called and what is it assoc with?
argyll robertson pupils of neurosyphilis
agitated, disoriented, anterograde amnesia, FLAIR abnormality in both hippocampi but it’s not herpes encephalitis….
anti-Ma paraneoplastic syndrome
-assoc with testicular malignancy
man comes in with difficulty “multi-tasking’ after a coronary artery bypass surgery
- hypoxic ischemic encephalopathy, “pump head”
- multiple micro-emboli as possible pathophysiology
- sxs likely to improve
sleep disturbance, mood change, poor concentration and memory, lightheadedness, nausea after head trauma
concussion
personality change, disinterested/apathetic, dysarthria, exaggerated startle response, difficulty navigating hallways over course of 3 months
CJD
- posterior hemisphere DWI abnormalities
- 14-3-3 protein in CSF
paranoia, hoarding behavior, visuospatial deficits
-what sedative would you use?
early AD
-quetiapine
discontinuation of care… who gets the say?
spouse
cognitive impairment involving more than memory AND
severe enough to interfere with occupational or social functioning
dementia
amnestic or nonamnestic (one non memory domain) dysfunction that does NOT impair occupational and social functioning
mild cognitive deficit (MCI)
disease modifying drugs for early AD and maybe MCI (3)
galantamine (razadyne)- AChE inhibitor
donepezil (aricept)- AChE inhibitor
rivastigmine (exelon)- AChE inhibitor
potent enzyme inducer…this AED makes OCPs less effective
phenytoin… also oxcarbazepine
chemotherapy associated with cerebellar ataxia (2)
cytosine arabinoside, 5-FU
chemo associated with peripheral neuropathy (4)
paclitaxel
docetaxel
vincristine
platinum
RPLS/PRES associated with which drugs…
chemo drugs
cyclosporine
tacrolimus
HTN, confusion, seizures, visual changes in transplant population or in cancer patients
PRES/RPLS
HTN, confusion, seizures, visual changes in pregnant hypertensive
RPLS, eclampsia, cerebral venous thrombosis
how to tx dystonia brought on by haldol or other antipsychotic
anticholingergic (diphenhydramine/benadryl)
drugs that cause dystonic rxn (4)
antipsychotics
metoclopramide (reglan)
valproic acid (depakote)
amphotericin B
patient is on steroid and AED… develops rash and psychosis… what’s happening
- Stevens Johnson rxn to AED in context of steroid taper
- psychosis from the steroids –> may need to tx with neuroleptics
neural tube defects, hair loss, weight gain, Parkinson-like dystonic rxn
depakote (valproic acid)
what abx interacts with carbamazepine?
erythromycin causes elevated levels of carbamazepine
-ataxia, nystagmus, diplopia (also assoc with high levels of phenytoin and oxcarbazepine)
which AED causes hyponatremia
oxcarbazepine, esp when combined with keppra or thiazide diuretics
which antidepressant lowers the seizure threshold
bupropion
tachycardia, blurred vision, fever, AMS, urinary retention in older patients
anticholinergics
TCAs have significant anticholinergic effects
agitation, tachycardia… is what withdrawal
benzos
tremor agitation, tachycardia, tachypnea, hyperthermia… what two meds interacting
serotonin syndrome (SSRI + triptans)
what causes neuroleptic malignant syndrome
DA antagonist
what causes malignant hyperthermia
inhalational anesthetics
adrenal insufficiency and bitemporal hemianopsia after giving birth
pituitary apoplexy (Sheehan syndrome)
chronic steroid use can cause this in the eye
cataracts
this type of HA occurs more often with men than women
cluster headache
fancy term for lay eye or poor vision due to disuse of the eye
amblyobia ex anopia
causes of INO in young and old
young- MS
old- stroke of the paramedic pontine perforating vessel
pain on eye movement with central scotoma
optic neuritis
fundus exam of optic neuritis
normal fundus with poor vision
fundus exam of papilledema
enlarged blindspot and highly abnormal fundus
polymyalgia rheumatic associated with ______ (headaches) and _____ which causes blindness
giant cell/temporal arteritis
central retinal artery occlusion
dizziness, slurred speech, double vision –> severe HA and vomiting
- in young person?
- in old person?
- young: basilar migraine
- old: vertebrobasilar TIA
painful, pupil-involving 3rd nerve palsy
what is it and what are the next steps
deterioration in first 24 hours
deterioration in 3 days… how to tx?
PCOM aneurysm
- CT, LP, angiography, clipping or coiling
- first 24 hours: rebreeding
- 3 days later: vasospasm –> tx with nimodipine
drug that precipitates angle closure glaucoma
topiramate
Meyer’s loop
optic radiations subserving superior visual fields in the temporal lobe
visual field does not change as you change distance from the testing screen
tunnel vision… conversion disorder or malingering
neurofibromatosis 1… what eye finding?
optic glioma
raised ICP causing papilledema causes what visual field disturbance
- transient visual obscurations
- pulsatile tinnitus
- enlargement of the blindspot and then a “nasal step” of field loss eventually leading to concentric peripheral constriction
cortical blindness but pupils are reactive
PRES/RPLS- HTN, confusion, seizures, vision
retina has a dual blood supply… both are derived from ______
ophthalmic artery of the ICA
- choroidal/ciliary: choroid, outer retinal layers, optic nerve head
- central retinal artery: inner retinal layers
ischemic optic neuropathy often presents with an _______ defect
altitudinal (ex. pie in the sky)
risk factors for ischemic optic neuropathy
amiodarone, interferon alpha, nasal decongestants, PDE inhibitors, spinal surgery in prone position, systemic blood loss, diabetes, HTN
ischemic optic neuropathy is generally (stable/improving/deteriorating)
stable
trigeminal neuralgia/tic douloureux tx
carbamazepine… concern for MS
jaw claudication, anemia, HA
temporal arteritis
MOA of the triptans
serotonin 1B/1D agonist
who should NOT receive triptans
uncontrolled HTN, coronary artery disease
RBC and WBC in CSF, b/l temporal lobe abnormalities
how to tx
HSV encephalitis
acyclovir
infection with really high opening pressure (in the 30s at least)… how to tx
cryptococcal meningitis
amphotericin B and flu cytosine
hearing loss and visual loss with this type of meningitis
bacterial… low glucose and super high PMNs
multiple cranial neuropathies, raised ICP, hydrocephalus.. what kind of meningitis?
basilar meningitis due to TB… low glucose
normal CSF except high protein
albuminocytologic dissociation… GBS
CN VII palsy, red lesions in external auditory canal, red tympanic membrane, pain in ear, taste loss in ant 2/3 of tongue, dry mouth and eyes
Ramsay Hunt syndrome due to VZV… tx with acyclovir
associated with primary CNS lymphoma
EBV
bilateral facial weakness after camping
lyme (borrelia burgdorferi)
how to dx cryptococcal meningitis
cryptococcal antigen
most common cause of epilepsy in 3rd world
neurocysticercosis… tx with albendazole
ppx for bacterial meningitis
rifampin or ciprofloxacin
how to tx bell’s palsy
prednisone within first 48 hours
valcyclovir, acyclovir, or famcyclovir
hearing loss, spasticity, microcephaly, retardation, hyper intensities along the ventricular margins on MRI in a new born
congenital CMV
raw honey to a newborn
tetanus?? botulism
gait disorder in 6 year old; hyperreflexia, Babinski, heel cord contracture, upper limb writhing
cerebral palsy
_______ fibers are preferentially affected in Charcot Marie Tooth
myelinated (proprioception and vibration)
myoclonic dystrophy is associated with a variety of systemic signs including (4)
type II diabetes
frontal balding
ptosis
slow relaxation of grip (myotonia)
skin lesions, dumbbell enhancing lesion in spinal cord, pain radiating to thumb and 1st finger
NF1 (10x more common than NF2)
autism, seizures, subependymal nodules around foramen of Monro
tuberous sclerosis
tx for Tourette’s (2)
haloperidol or risperidone (APD)
weak, areflexic, decreased pinprick in stocking glove pattern, abdominal pain, constipation
AIP
drugs that cause AIP
sulfonamides, hormones, barbiturates
how to tx AIP
IV hematin
muscle cramping, weakness, dark urine after exercise
McArdle’s disease (glycolysis problem)
kyphoscoliosis, pes cavus, gait difficulty, retinitis pigmentosa-associated visual loss, spinocerebellar signs (limb ataxia, dysarthria), DM, cardiac conduction issues, asymmetric septal hypertrophy
- major pathways affected: posterior columns, dorsal and ventral spinocerebellar tracts, lateral corticospinal tracts
- autosomal recessive
Friedreich’s ataxia
chromosome and gene in Friedreich’s ataxia
9q13, frataxin
tx of Friedreich’s ataxia
idebenone
AD disease assoc with failure of muscles to relax, ptosis, DM2, hypothyroidism, frontal balding, slow course in mid-adult life
myotonic dystrophy
numbness and tingling in legs, diminished proprioception and vibration to mid calf with absent DTRs in the setting of taking TB meds (esp isoniazid)
B6/pyridoxine deficiency
farmer with nausea, vomiting, diaphoretic, diffusely weak, pinpoint pupils
organophosphate intoxication, sarin gas
how to treat organophosphate poisoning
atropine (anti muscarinic) and pralidoxime (anti nicotinic)
excess of vitamin _____ can cause pseudo tumor cerebri
A
_______ poisoning can cause HA, nausea, forgetfulness, and globes pallidus necrosis
CO poisoning
Wernicke’s triad
dementia/confusion, gait ataxia, ophthalmoplegia
recent weight loss, broad based ataxic gait, can’t stand with feet together even when eyes are open, absent ankle reflexes, diminished proprioception at toes and ankles, no Babinski
spinal and cerebellar signs –> vitamin E deficiency
abdominal pain, constipation, microcytic anemia, weakness of limbs esp involving the extensor muscles = __________ poisoning
lead
subacute combined degeneration
posterior and lateral column dysfunction due to B12 deficiency
pt receiving TPN, cog wheeling, stiffness
Manganese intoxication
- T1 signal in the basal ganglia
- cirrhosis, excess manganese consumption
nausea, vomiting, tinnitus, oval skin patches, decreased pinprick sensation, gray lines on nails
arsenic poisoning
smells sweet and causes profound peripheral nerve and cranial nerve dysfunction
ethylene glycol (antifreeze)
localization of hemiballismus
STN
easier to walk uphill, relief of pain when bending over
spinal stenosis
ankle reflex relies on this spinal cord level
S1
syringomyelia is associated with _________
slow evolution of pain and kyphoscoliosis
arnold chiari malformation
type I- cerebellar tonsils are low
type II- meningomyeloceles
axillary nerve function and where its injured
shoulder abduction
clavicular or shoulder injury
anterior interosseous nerve
inability to make a pinch with thumb and index, normal sensation
how to dx myasthenia gravis
edrophonium or tensilon test
tx myasthenia
AChE inhibitors- pyridostigmine
-consider thyroid dz and thymoma
pathophys of Lambert Eaton syndrome
antibodies to pre-synaptic Ca channels
pathophys of botulism
presynaptic (failure of ACh release)
patellar reflex… what level is it?
L4
pain in lateral thigh and anterolateral leg with sensory loss primarily in the dorsal aspect of the foot, inversion is affected
L5 radiculopathy
incorrect positioning during surgery –> weakness of right hand
probably brachial plexus injury
acute tx for suspected spinal cord compression
high dose methylprednisolone
where do you do DBS for Parkinson tremors
STN
eating disorder (overeating like crazy)… where is the lesion
supraoptic nucleus of the hypothalamus
muscle weakness that improves with repeated muscle strength testing… normal sensation
Lambert Eaton Syndrome
pathophys of Lambert Eaton syndrome
antibodies to presyn Ca channels
Lambert Eaton syndrome assoc with what malignancy
small cell lung cancer
when you’re not guarding an injured joint…what is it called?
Charcot joint
pure motor hemiparesis stroke… where is the lesion? and how do you tx (aspirin, warfarin, CEA, other)
lacune in the internal capsule
tx with aspirin and probably a statin as well
IV drug user with sudden severe headache and decrease in alertness… right leg appears to move less than left leg
hemorrhagic stroke to the ACA…. do NOT anticoagulate him, give him abx
alcoholic man wakes to find weak elbow, finger, and wrist extension… with no sensory loss
Saturday night palsy (radial nerve palsy)
tx with wrist splint
sudden vertigo, dysphagia, left facial numbness, right arm and leg numbness, left palatal paresis, left Horner’s, and right beating nystagmus
what is it and how do you tx it?
wallenberg (lateral medullary) syndrome
- lower CN dysfunction and crossed sensory signs
- mechanism: vertebral artery occlusion or PICA occlusion
- would probably anticoagulate this person with warfarin
major indications for anticoagulation
valvular afib mechanical prosthetic valves cerebral venous sinus thrombosis decreased EF mural thrombus venous thromboembolism
65 M with 2 days of fluctuating facial and arm numbness
- for last 12 hours, weak in face/arm/leg of symptomatic side and has a significant sensory deficit on that side as well
- where is the stroke and what do you tx him with?
internal carotid occlusion
-tx with aspirin
stroke with agitation, inferior quadrantanopsia, and sensory neglect
-where is the lesion?
nondominant parietotemporal (inferior MCA branch) stroke
which scoring system predicts risk of stroke in the setting of TIAs
ABCD2
treatment for essential tremor
propranolol and topiramate
how to tx cerebral sinus thrombosis
anticoagulation
biggest risk factor for stroke
HTN
what to give for dissection
heparin
awake without being alert
persistent vegetative state
-it takes 6 weeks to formally meet the criteria
tx for cataplexy
modafinil (provigil)
what is REM sleep disturbance a harbinger of?
Parkinson’s
after getting haldol –> hyperthermia (around 104), rigidity, masked facies, resting tremor
what is this and how do you tx it?
neuroleptic malignant syndrome
-tx with dantrolene (direct skeletal muscle relaxant) or with benzos
Parkinson sxs + eye movement abnormalities (limited vertical gaze)
progressive supranuclear palsy
detrusor hyperreflexia
small capacity, upper motor neuron bladder
how to treat detrusor hyperreflexia
oxybutynin (ditropan)
tolterodine (detrol)
*beware cognitive problems on anticholinergics in patients with or without pre-existing cognitive dysfunction
Severe right sided headache for 3 weeks –> MRI shows heterogeneously enhancing mass in right temporal lobe… What med do you give?
Dexamethasone to reduce swelling
Tx for neuropathic pain
Gabapentin
Pregabalin
Duloxetine
TCA like amitriptyline
Findings consistent with myopathy on EMG
EMG findings
- no insertional fibrillations
- low amplitude motor units
- early recruitment but normal interference pattern
EMG findings for neuropathy
- insertional fibrillations
- large motor units
- decreased interference when patient asked to contract
Tx for toxoplasmosis
Pyrimethamine and sulfadiazine
Which cholinergic nucleus might be affected in Alzheimer’s
Nucleus basalis of meynert
Stuck in mine. After awakening slowly, he has significant bilateral tremor
Globus pallidus necrosis due to CO poisoning
Pathology of hemiballismus
STN
Thiamine deficiency can cause lesions in this structure
Mammillary bodies
HA, unreactive dilated pupils, can’t look up, when she tried to look up refractory nystagmus occurs
Parinauds or dorsal midbrain syndrome: pathology in pineal region
