Neurology Shelf Questions – Flashcards
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MC location of ulnar nerve entrapment
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Elbow, where the ulnar nerve lies at the medial epicondylar grove
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Acute MS treatment
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Corticosteroids
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MS treatment to reduce frequency of exacerbations
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Beta interferon or glatriamer acetate
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Most common cause of drug induced myopathy
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Steroids
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Most common site of hypertensive hemorrhage
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The putamen, internal capsule is adjacent and is almost always involved
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The best way to monitor respiratory function Guillian Barre syndrome
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Vital capacity
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Common antibiotics that cause vestibular toxicity
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Aminoglycosides
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Creutzfeldt-Jakob disease EEG characteristics
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Sharp triphasic synchronous discharges
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Acute agitation treatment in the elderly
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Typical and atypical antipsychotics, a.k.a. haloperidol and quetiapine
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Trihexyphenidyl
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Medication for Parkinson's disease that has anticholinergic effects, like benztropine
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Multiple system atrophy
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Parkinsonism, autonomic dysfunction, widespread neurologic signs
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Pathophysiology of hyponatremia in subarachnoid hemorrhage
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Inappropriate secretion of vasopressin and increased secretion of atrial/brain natriuretic peptide
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Type of it MRI to view demyelination
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T-2 weighted
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ENG
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Characterizes nystagmus and disturbances of eye movements that involve relatively fast I movements
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Why facial nerve lesion causes sensitivity to sound
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Visual learner innervates the stapedius muscle of the middle ear, undamped transmission of acoustic signals across the bone produces hyperacusis
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Level of radiculopathy with loss of ankle jerk
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S1
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Direction of nystagmus when warm waters put into the ear canal
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Nystagmus toward the ear that is stimulated, eyes deviate slowly away from the ear that is stimulated
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Why Bell's palsy recovery can lead to involuntary twitching
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Aberrant regeneration of the facial nerve
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Site most likely to produce a noncommunicating hydrocephalus
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Aqueduct of Sylvius, connects the third and fourth ventricle
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Most common site for meningiomas
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Tentorium cerebelli
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NF2 chromosome mutation
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22
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Wave seen on EEG with relaxed person
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Alpha wave, 8-13 hz
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Lesion in pure sensory strokes
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Postereoventral nucleus of the lateral thalamus
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Wallenberg syndrome
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Lesion of the structures of the lateral medulla including: nucleus and descending tract of the 5th nerve, nucleus ambiguus, lateral spinothalamic tract, inferior cerebellar peduncle, descending sympathetic fibers, vagus, and glossopharyngeal nerves
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Nucleus ambiguus
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Contains the motor neurons that contribute to the ninth and 10th cranial nerves
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Artery infarct that produces Wallenburg syndrome
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Occlusion of the vertebral artery, PICA also possible
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Most common cause of lobar hemorrhage in elderly patients without hypertension
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Amyloid
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Mycotic aneurysm
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Form over cerebral convexity with subacute bacterial endocarditis, from infected embolus lodging in the arterial wall
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Drug of choice for seizure prophylaxis in the hemorrhage
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Phenytoin, Lamotrigene gene poor choice because it is slowly titrated over many weeks
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Sturge-Weber syndrome
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Congenital disturbance that produces facial cutaneous angiomas with the distinctive and easily recognizable appearance along with intracranial abnormalities like leptomeningeal angiomas
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Sex that is more susceptible to symptomatic aneurysms after 40
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Females
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How to interpret red glass test
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The eye is not moving with a red image appears to be
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Artery aneurysm that causes third nerve palsy
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Posterior communicating artery
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Drug use to prevent vasospasm after a bleed
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Nimodipine
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Indications for carotid endarterectomy
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Symptomatic stenosis of the internal carotid by more than 70%
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Why lorazepam is a good choice for status epilepticus
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Rapid acting but more slowly cleared from the body
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Risk of high load of phenytoin
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Conduction block or cardiac arrhythmia
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Days from alcohol where alcohol withdrawal seizure is greatest risk
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First day after drinking cessation
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Lennox-Gaustaut syndrome
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Combination of retardation and slow spike and wave discharges on ECG, many children have history of infantile spasms
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Prophylaxis for seizures in a head injury
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Phenytoin
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Jacksonian March
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Focal seizure activity that is primarily motor and spreads
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Epilepsia partialis continua
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Persistent focal motor seizure activity
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Drug of choice for complex partial seizure without secondary generalization
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Carbamazepine
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West syndrome, generalized seizure disorder characterized by recurrent spasm treatment
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adrenocorticotropic hormone
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absence seizure treatment
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Ethosuximide or valproic acid
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Basilar migraine symptoms
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Complete blindness, frank psychosis, transient quadriplegia, stupor, syncope, coma
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Treatment for trigeminal neuralgia
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Carbamazepine, phenytoin, gabapentin
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Causes of symptomatic trigeminal around
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Multiple sclerosis, basilar artery aneurysms, acoustic schwannomas, posterior fossa meningiomas
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A typical facial pain
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Constant deep usually bilateral, sensitive to antidepressant medication
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Cluster headache
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Men>women, pain in the eyes for the temporal area, autonomic phenomena
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Sensory distribution of the median nerve
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Palmar surface of the thumb and 1st 4 digits
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Where is the ulnar nerve run
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Superficially at the elbow at the ulnar groove
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Manifestation of damage to the ulnar nerve at the cubital
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Weakness in the interosseous and lumbrical muscles of the hand, causes claw deformity
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Nerve often damaged fractures of the humorous
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Musculocutaneous nerve
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Musculocutaneous nerve innervation
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Biceps brachii, brachialis, coracobrachialis muscles; sensory information from lateral cutaneous nerve of the forearm
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Why subacute subdural hematoma is not seen on CT
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Fluid collection too small to produce substantial deformation of the underlying hemisphere
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Lobes commonly involved in traumatic brain injury
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temporal and inferior frontal lobes
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How S Mansoni invades the nervous system
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Eggs in the valveless veins of Baston, drains the intestines and lumbro-sarcal cord, granulomas develop around the spinal cord
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First step in suspected meningitis
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Antibiotics, then MRI, then LP; ceftriaxone + amp good choice
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Common cause of recurrent meningitis
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CSF leak, usually through the nose or ear
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EEG activity in herpes encephalitis
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periodic epileptiform discharges
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HIV and CMV brain infection pathology
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Microglial nodules
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MCC bug in brain abscesses
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aerobic and anaerobic strep
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MCC fungal malignant otitis externa and osteomyelitis of the base of the skull
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Aspergillus
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Encephalitis lethargica
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Disturbed eye movements, unremetting parkinsonism in the setting of fevers, lethargy and HA
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MC neurologic injury in sarcoid
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facial paralysis
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Listeria meningitis epi
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Renal transplant, chronic renal disease and immunosuppressed
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MC symptom of brain abscess
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HA, develops within a few weeks
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Protein that is highly sensitive and specific to prion disease
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14-3-3 proteinase inhibitor
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SSPE epi
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children, rarely seen after 18, 6-8 years after an episode of measles
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SSPE CSF studies
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increased gamma globulin fraction and presence of oligoclonal bands
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cat-scratch encephalitis
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encephalitis, increased signal intensity in the pulvinar
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MC neurologic infection in the world
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Cysteicercosis, Taenia solium
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Echinococcosis vs cysteicercosis
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Children more likely to have echinocococis and the cycs have major cysts with multiple compartments
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Most common primary brain tumor in adults
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Astrocytoma
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Other name for grade 4 astrocytoma
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Glioblastoma multiforme
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Three most common brain tumors before puberty
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Medulloblastoma, ependymoma, and cerebellar gliomas
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Tumor that causes hyper ostosis of the school
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Meningioma
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Tumor from von Hippel-Lindau syndrome
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Hemangioblastoma
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Von Hippel-Lindau presentation
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Multiple angiomatosis of the retina and cysts of the kidney and pancreas
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Metastatic malignancy that causes bleeds in the brain
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Melanoma and choriocarcinoma
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Most common presentation of a colloid cyst
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Persistent obstruction of the flow of CSF
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Hypothalamic car Matoma presentation
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Neuroendocrine symptoms; precocious puberty or acromegaly; cause gelastic seizures which are peroxysms of laughter
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Type of herniation from posterior fossa mass
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Transtentorial or transforaminal
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Location of medulloblastoma
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Cerebellum
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Tumors in an NF1
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Optic nerve tumors, cutaneous and subcutaneous tumors
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Perinaud syndrome
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Loss of vertical gaze, loss of pupillary light reflex, lid retraction, and convergence retraction nystagmus
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Convergence retraction nystagmus
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Isaac Trichitt jerk back into the orbit unattended upgaze
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Location of lesion in Parinaud syndrome
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Dorsal midbrain in the region of the superior colliculus
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Tumors that can cause Parinaud syndrome
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Pineocytoma's, germ cell tumors, teratomas , and gliomas
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paraneoplastic cerebellar degeneration cancer types
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Lung, ovarian, and lymphoma
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Antibodies present in paraneoplastic cerebellar degeneration
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Anti-Purkinje cell antibodies also called anti-yo that are found in women with breast cancer and other gynecologic malignancies
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Hypercalcemia presentation
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Fatigability, lethargy, generalized weakness, and areflexia
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Distinctive feature Lambert Eaton syndrome
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Increase in strength briefly after repeated muscle activation
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Polyneuropathy in multiple myeloma
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Chronic distal symmetrical sensory or sensorimotor neuropathy
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Tay-Sachs deficiency
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Hexosaminidase A
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Long-standing liver disease encephalopathy neuron changes
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Increase in Alzheimer's type II astrocytes; large cells
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CSF in uremic encephalopathy
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Protein greater than 60
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Type of peripheral neuropathy commonly developed with chronic renal failure
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Symmetric, distal, mixed sensorimotor neuropathy
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Agents for RLS
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Clonazepam, gabapentin, L-dopa, opiates
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Vision change in B12 deficiency
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Blind spot enlarges and extends into central vision
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Vitamin deficiency optic nerve injury
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Probably B1, B12 and riboflavin
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Vitamin D deficiency neurologic presentation
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Spinocerebellar degeneration, polyneuropathy, and pigmentery retinopathy
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Pickwinian syndrome
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Obesity associated with hypersomnia; sleeping attacks
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Abortive treatment for cluster headache
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100% oxygen
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Cerebellar hemorrhage presentation
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Ataxia, vomiting, occipital headache, gaze palsy, and facial weakness
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Four lacunar stroke syndromes
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Pure motor, sensory, ataxic hemiparesis, dysarthria - clumsy hand syndrome (no sensory)
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Riluzole
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Glutamate inhibitor currently approved for patients with ALS
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Initial workoup of delirium
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UA and serum electrolytes before imaging
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Physical exam of pseudotumor cerebri
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HA, blurry vision, papilledema, vision loss, and CN palsies (VI most common)
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Neurologic side effect of isoretinoin
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psuedotumor cerebri
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Acute angle closure glaucoma presentation
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Eye pain, redness, dilated pupil with poor response to light
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Acute angle closure glaucoma differential
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migrain, cluster HA, temporal arteritis and keratoconjunctivitis
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Initial tx for myasthenia gravis
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Oral anticholinesterase (pyridostigmine)
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Isolated, round, smooth-bordered, ring enhancing lesion on CT in immunocompetent person
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Brain abscess
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MC causative organisms in brain abscess
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Aerobic and anaerobic strep and bacteriodes
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Best diagnostic test for suspected glaucoma
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tonometry
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One of the few conditions to cause BTL trigeminal neuralgia
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MS
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Contraindications to triptan use
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1) Familial hemiplegic migraine 2) Uncontrolled HTn 3) CAD 4) Prinzmetal angina 5) Pregnancy 6) Ischemic stroke 7) Basilar migraine
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Side effects levodpoa/carbidopa
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Somnolence, confusion, hallucinations, and dyskinesias (later)
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Amantadine side effects
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Ankle edema and livedo reticularis
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Entacapone side effects
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Dyskinesia, hallucinatsion, confusion, nausea, orthostatic hypotension
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Screening test if you dx MG
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CT chest for thymoma
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Medial medullary infarction
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contralateral paralysis with contralateral loss of DC pathway, tongue deviation to the injured side
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lateral pons lesion presentation
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impaired seonsry and motor function of CN V
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medial pons lesion presentation
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ipislateral limb ataxia, contralateral eye deviation, and paralaysis of face, arm and leg
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Heat stroke definition
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Temp>40 and AMS
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Complications of heat stroke
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Rhabdo, renal failure, ARDS, and bleeding
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Primidone side effects
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Precipitates acute intermittent porphyria, manifests as abdominal pain, neruologic and psychiatric abnormalities
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RLS treatment
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Dopamine agonists: pamiprexole and ropinerole
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PML MRI
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multiple demyelinating, non-enhancing lesions with no mass effects
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Fingers involved in carpal tunnel syndrome
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first 3 and 1/2 digits and occasionally thenar eminence
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Large cerebellar hemorrhage manifestations other than cerebellar signs
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6th nerve paralysis, conjugate deviation and blepharospasm
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Diagnostic test for pseudodementia
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Dexamethasone suppression test, 50% positive
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Heatstroke treatment
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Induction of evaporative cooling to reverse hyperthermia
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EEG of Alzheimer's disease
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Slowing normal alpha activity (8 to 12 Hz)
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Common consequence of ventriculoperitoneal shunt for normal pressure hydrocephalus
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Subdural hematoma as the brain pulls away from its covering on the meninges
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Medication shown to delay progression of Alzheimer's disease
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Vitamin E
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Language deficits in Alzheimer's
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Decreased fluency, dysnomia, and transcortical sensory aphasia
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Transcortical sensory aphasia
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Reduction in the ability to understand complex linguistic structures
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Rett syndrome today
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X-linked genetic disorder that only affects girls, male version fatal
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Rett syndrome presentation
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Rapid regression in cognitive status and early childhood; loss of language skills an eye contact; Stereotypic eye movement
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Motor manifestation of neurosyphilis
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General paresis
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Cognitive manifestations of hypothyroidism
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Headache, dementia, psychosis, and decreased consciousness
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Motor manifestations of hypothyroidism
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Myopathic weakness, delay in the relaxation phase of reflexes, cerebellar ataxia
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Medication to decrease parkinsonism from neuroleptic use
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Trihexyphenidyl, anticholinergic
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Drugs for treatment of Tourette's syndrome
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Haloperidol, pimozide, trifluoperazine, and fluphenazine
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Meigs' syndrome
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Focal dystonia characterized by blepharospasm, forceful jaw opening, id protraction , neck contractions, tongue thrusting
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Abnormal evoked response in MS
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Visual evoked response
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Common trigger for symptoms of demyelinating disease
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Increased temperature
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Neuromyelitis optica
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Symptoms of bilateral optic neuritis in association with transverse myelitis
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Adrenal dysfunction with progressive degeneration of white matter
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adrenoleukodystrophy
