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389 Cards in this Set
- Front
- Back
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What percentage of strokes are ischemic vs. hemorrhagic?
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85% ischemic
15% hemorrhagic |
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How long do the neurologic deficits tend to last in TIAs?
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Usually less than 30 minutes but no more than 24 hours
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What is the 5-year risk of developing a stroke after suffering a TIA?
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30%
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What are the risk factors for TIAs in young patients?
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Oral contraceptives
Hypercoagulable states (Protein C, S deficiencies) Cocaine or amphetamine use Polycythemia Sickle cell disease |
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What are the two causes of carotid bruits?
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Murmurs referred from the heart
Turbulence in the internal carotid artery |
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What are common symptoms of a TIA in the carotid system?
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Temporary loss of speech
Paralysis or paresthesias Amaurosis fugax |
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What are common symptoms of a TIA in the vertebrobasilar system?
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Dizziness
Double vision Vertigo Numbness of face and limbs Dysarthria Dysphagia |
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Where is the brain lesion if a patient suffers a pure motor lacunar stroke?
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Internal capsule
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Where is the brain lesion if a patient suffers a pure sensory lacunar stroke?
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Thalamus
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A stroke in which artery would cause contralateral lower extremity and face deficits?
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ACA
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A stroke in which artery would cause aphasia and contralateral hemiparesis?
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MCA
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A stroke in which artery would cause ataxia, diplopia and dysarthria?
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Vertebral/basilar
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Do ischemic areas appear dark or pale on CT scans?
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Dark
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Should thrombolytic therapy be administered after a stroke?
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Yes, if its within 3 hours, is an ischemic stroke, and there are no contraindications
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If a patient comes to the ER with findings suggesting acute stroke, what tests should be ordered?
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Noncontrast CT
ECG CBC, electrolytes PT, PTT Carotid ultrasound |
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Should anticoagulants be given to a patient with an acute ischemic stroke?
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No, they have not been shown to be effective
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Should carotid endarterectomies be performed on most patients with stenosis >70%?
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No, only on symptomatic patients
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What is the best way to prevent lacunar strokes?
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Control HTN
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What is the most significant risk factor for developing hemorrhagic stroke?
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HTN - especially a sudden increase in BP
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What medications can be given to reduce ICP?
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Mannitol
diuretics |
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Where is the hemorrhage in a patient with hemorrhagic stroke with Pinpoint pupils?
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Pons
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Where is the hemorrhage in a patient with hemorrhagic stroke with Dilated pupils?
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Putamen
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Where is the hemorrhage in a patient with hemorrhagic stroke with Poorly reactive pupils?
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Thalamus
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What is the gold standard of diagnosing subarachnoid hemorrhage?
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Xanthochromia - yellow color of the CSF
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What are the clinical features of subarachnoid hemorrhage?
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Worst headache of my life
Sudden transient loss of consc. Vomiting Retinal hemorrhages - 35% pts |
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How is the diagnosis of Parkinson's disease made?
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Clinically - no lab tests
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What is Shy Drager syndrome?
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Parkinsonism and autonomic insufficiency
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Characterize the tremor of Parkinson's disease -
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Pill rolling tremor at rest - goes away while performing tasks
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What are some typical features of Parkinson's disease?
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Pill rolling tremor
Bradykinesia Rigidity Masked facies |
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Which classes of medications can have parkinsonian side effects?
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Neuroleptics
Metoclopramide Reserpine |
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Do Parkinson's patients with tremor as the major feature have a better or worse prognosis than patients with bradykinesia as the main symptom?
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Better
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What is the most effective Parkinson's drug?
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Levodopa combined with carbidopa
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What are the side effects of levodopa-carbidopa?
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Dyskinesias
Nausea/vomting/anorexia HTN Hallucinations |
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What drug is commonly initiated first when Parkinson's is diagnosed?
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A dopamine agonist like Pramipexole to delay the need for levodopa
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Parkinson's patients with what feature may benefit from anticholinergic drugs?
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Patients with tremor as a major feature
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What is the single most helpful differentiating feature between dementia and delirium?
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Time course of the disorder -
acute or subacute in delirium chronic in dementia |
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Define astereognosis -
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Patient cannot identify an object placed in the hand
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Define allesthesia -
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Misplaced localization of a tactile stimulus
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What syndrome is characterized by dysarthria, dysphasia, hyperactive jaw jerk and gag reflex, and uncontrollable laughter or crying?
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Pseudobulbar palsy
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What lesion results in pseudobulbar palsy?
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Bilateral interruption of the corticobulbar and corticospinal tracts
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What cause of acute confusional state may be suggested by an abnormal PT/PTT?
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Hepatic encephalopathy
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What two situations may be suggested by red blood cells in the CSF?
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SAH
Traumatic Tap |
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What is the treatment for delirium tremens?
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Diazepam IV
Correction of fluid, electrolyte, glucose Maybe B-blockers as well |
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What is the maximum rate of Na correction for a patient with hyponatremia (in mmol/L/day)?
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8 mmol/L/day
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What is the treatment for severe hypercalcemia?
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Vigorous IV hydration with .45% or .9% saline
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What is the classic triad of Wernicke encephalopathy?
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Ophthalmoplegia
Ataxia Confusional state |
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What are the most common ocular abnormalities in Wernicke encephalopathy?
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Nystagmus
Abducens nerve palsy Vertical/Horizantal gaze palsy |
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What is the Lhermitte sign?
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An electric-shocklike sensation along the spine precipitated by neck flexion
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What is the treatment for hepatic encephalopathy?
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Oral or rectal lactulose to decrease ammonia absorption
Maybe neomycin as well |
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What are some neurologic signs of uremia due to renal failure?
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Tremor
Asterixis Myoclonus Tetany |
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What is the mechanism of respiratory encephalopathy?
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Hypoventilation leading to acidosis
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What are the three most common etiologic agents causing bacterial meningitis in infants <3 mo?
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S. agalactiae
E. coli L. monocytogenes |
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What are the three most common etiologic agents causing bacterial meningitis in children 3mo-8yrs?
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N. meningitidis
S. pneumonia H. influenza |
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What are the two most common etiologic agents causing bacterial meningitis in patients older than 50yo?
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S. pneumonia
L. monocytogenes |
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How is Lyme disease diagnosed definitively?
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Serology for B burgdorferi by ELISA followed by Western Blot
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What is the treatment of Lyme disease with meningitis or other CNS involvement?
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IV ceftriaxone
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What are the two most common etiologies of viral meningitis?
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Coxsackievirus B (40%)
Echovirus (30%) |
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What is the mortality rate for HSV encephalitis in patients receiving acyclovir?
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25%
70-80% for untreated patients |
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What should you suspect in a patient with AIDS with one or more intracerebral mass lesions that do not respond to toxoplasmosis treatment?
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Lymphoma - should undergo brain biopsy
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What is the treatment for toxoplasmosis infection of the CNS?
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TMP-SMX
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What is the treatment for cysticercosis involving the CNS?
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Albendazole is the preferred therapy
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How is neoplastic meningitis diagnosed?
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Finding malignant cells in the CSF
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What is the first-line therapy for treating hypertensive encephalopathy?
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Sodium nitroprusside continuous IV infusion
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Does muscle tone tend to increase or decrease with old age?
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Increases
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Name some reversible causes of dementia -
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NPH
Intracranial mass lesions B12 deficiency Hypothyroidism Neurosyphilis |
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What structure is the principle origin of cortical cholinergic innervation in the brain (it is degenerated in Alzheimer disease)?
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Nucleus basalis of Meynert
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How is frontotemporal dementia differentiated from Alzheimer disease?
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Generally earlier onset
More prominent behavioral disturbances Atrophy of frontal and temporal regions on CT/MRI |
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What is the presumed anatomic cause of nonobstructive hydrocephalus?
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Impaired CSF absorption from arachnoid granulations in the subarachnoid space
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What is Marchiafava Bignami syndrome?
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Necrosis of the corpus callosum and subcortical white matter occurring most often in malnourished alcoholics
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What are the pain sensitive structures in the cranial vault?
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Meninges, blood vessels, cranial nerves
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What is required to exclude the diagnosis of SAH?
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LP
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What type of headache is suggested when accompanied by ipsilateral rhinorrhea and lacrimation?
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Cluster headache
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At what time of day is pain maximal when headaches are due to mass lesions?
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Maximal on awakening
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Where in the head is headache associated with LP typically located?
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Occipital headache
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When after an LP does post-LP headache typically present?
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Comes on 24-48 hours after the procedure and lasts 1-2 days
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What are the typical S&S of pseudotumor cerebri?
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Headache
Papilledema Pulsatile tinnitus Visual loss Diplopia due to abducens palsy |
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What is idiopathic intracranial hypertension also known as?
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Pseudotumor cerebri
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What is the mainstay of treatment for pseudotumor cerebri?
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Acetazolamide or furosemide
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What is the typical treatment for trigeminal neuralgia?
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Carbamazepine or oxcarazepine
Phenytoin and lamotrigine are also sometimes used |
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Which type of headache is typically unilateral and pulsatile in quality?
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Migrane
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Which type of headache can be temporarily relieved at the bedside by compressing the temporal artery or ipsilateral carotid artery?
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Migrane
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Name some precipitating factors for migrane headache -
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Certain foods (cheeses, meats, chocolate, caffiene)
Fasting Emotion Menses Drugs Bright Lights |
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What is the first type of medicine to try for acute treatment of migranes?
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NSAIDs first, and triptans if those don't work
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What are some drugs that are prophylactic against migranes?
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Propranalol
Amitriptyline Valproate Ca channel blockers |
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How long do cluster headaches typically last?
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A few minutes to 2 hours
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Are cluster headaches usually bilateral or unilateral?
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Unilateral, almost always
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What time of day do cluster headaches normally present?
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Commonly occur at night, often waking patients from sleep
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What therapies are used as acute treatment for cluster headaches?
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100% oxygen
Sumatriptan Dihydroergotamine |
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What is oscillopsia?
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A visual illusion of moving back and forth
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Is nystagmus always present in central vertigo or peripheral vertigo?
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Always present in peripheral
Sometimes present in central |
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What are the names of the pathways that carry proprioceptive nerves from the arms and legs?
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Arms - Cuneate fasciculus
Legs - Gracile fasciculus |
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With a vestibular lesion, do patients fall towards or away from the side of the lesion during the Romberg test?
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Typically they fall towards the side of the lesion
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What is the result of the Romberg test in a patient with cerebellar ataxia?
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They are unstable both with eyes open and eyes closed (not a positive Romberg)
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During the Weber test, does a patient with sensorineural hearing loss hear better in the affected or unaffected ear?
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Unaffected
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During the Weber test, does a patient with conductive hearing loss hear better in the affected or unaffected ear?
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Affected
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During the Rinne test, does a patient with conductive hearing loss hear better through air or bone?
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Bone
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During the Rinne test, does a patient with sensorineural hearing loss hear better through air or bone?
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Air
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Describe the typical characteristics of Meniere disease -
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Repeated episodes of vertigo lasting from minutes to days accompanied by tinnitus and progressive sensorineural hearing loss
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What is the most common presenting complaint of Cerebellopontine angle tumor?
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Hearing loss of insidious onset
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Name some drugs that can produce vertigo by their effects on the vestibular system -
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Alcohol
Aminoglycosides Salicylates Quinine/Quinidine Cisplatin |
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Infarction of which area of the brain causes Wallenburg syndrome?
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Lateral Medulla
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What is the name of the syndrome that features vertigo, dysphagia, hoarseness, nystagmus, ipsilateral Horner, limb ataxia, and impaired sensation over the face?
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Wallenburg syndrome - infarction of lateral medulla
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What are the three arteries that supply the cerebellum?
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Superior cerebellar
Anterior inferior cerebellar Posterior inferior cerebellar |
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What is the name of the syndrome with ipsilateral medial rectus palsy with a fixed dilated pupil and contralateral limb ataxia?
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Benedikt syndrome - paramedian midbrain infarction
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What is the classic clinical picture of hypertensive cerebellar hemorrhage?
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Sudden headache
Gait ataxia Impaired consciousness |
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What chromosome contains the CAG repeat in Huntington's disease?
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Ch 4
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What part of the brain shows atrophy in a patient with Huntington's disease?
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Caudate
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What is the best way to confirm the diagnosis of Huntington's disease?
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DNA testing
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What is the best medication to treat essential tremor?
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Propranolol
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What is the DD for acquired ataxia?
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alcohol intoxication
vit B12 or B1 def Cerebellar infarction/neoplasm Demyelinating disease (MS) Tertiary syphilis |
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What percent of dementia is accounted for by Alzheimer's disease?
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About 66%
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What is the name of the dementia of insidious onset that is due to diffuse subcortical white matter degeneration after long standing HTN?
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Binswanger's disease
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What percentage of people over 80 have dementia?
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30%
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What is the role of anticholinergic medications in Alzheimer's disease?
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Don't use them!
AChE inhibitors (donepezil) are used to increase cholinergic activity |
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In which dementia do visual hallucinations predominate in the early stages?
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Lewy Body dementia
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What cause of coma is suggested in a comatose patient with bilateral fixed, dilated pupils?
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Severe anoxia
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What cause of coma is suggested in a comatose patient with a unilateral fixed dilated pupil?
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Herniation of the brainstem with CN III compression
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What brain lesion causes "locked in syndrome"?
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Infarction or hemorrhage of the ventral pons
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What geographic areas have a higher incidence of MS?
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Higher latitudes
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What CSF finding is suggestive of MS?
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oligoclonal bands
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Describe the features of Intranuclear ophthalmoplegia -
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Ipsilateral medial rectus palsy on attempted lateral gaze and horizantal nystagmus of the abducting eye due to an MLF lesion
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What is the diagnostic study of choice for MS?
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MRI
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What is the treatment for an acute attack of MS?
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High dose corticosteroids can shorten attacks
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What is found in the CSF in a patient with Guillain Barre?
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Elevated protein but normal cell counts
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What is the most important management for a patient with suspected Gullian Barre?
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Hospitalize and monitor pulmonary function
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Which CNS tumors are typically amenable to resection and which are not?
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Gliomas are not
Meningiomas, Pituitary adenomas and Schwannomas are |
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What is the differential diagnosis of an intracranial ring enhancing lesion?
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Metastatic cancer
Brain abscess Glioblastoma multiforme Lymphoma Toxoplasmosis |
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What are the top five tumors that metastasize to the brain?
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Lung
Breast Skin Renal GI |
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Name 4 signs of basilar skull fracture -
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Raccoon eyes - periorbital ecchymosis
Battle's sign - postauricular ecchymoses Hemotympanum CSF rhinorrhea/otorrhea |
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What are coup and contrecoup injuries?
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Coup - injury at the site of trauma
Contrecoup - injury at the site opposite the point of impact of trauma |
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What is Cushing's triad?
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Response to increased ICP
Hypertension Bradycardia Respiratory irregularity |
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What are some methods of lowering ICP?
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Reverse Trendelenburg position
Hyperventilation Mannitol |
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What causes subdural hematoma?
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Ruptured bridging veins often after blunt head trauma
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What is the basic pathophysiology of Myasthenia Gravis?
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Autoantibodies against the nicotinic acetylcholine receptors at the NMJ which leads to muscle fatigue
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Why should CT be performed in a patient with Myasthenia Gravis?
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Rule out Thymoma
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What are treatment options for patients with myasthenia gravis?
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AChE inhibitors - pyridostigmine
Thymectomy Immunosuppressive drugs |
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What is the major risk factor for developing Lambet-Eaton syndrome?
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Small cell lung cancer
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What treatment is available for Duchenne's Muscular Dystrophy?
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None. Steroids may help, but not proven or dramatic
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Which is more severe - Duchenne's muscular dystrophy or Becker's muscular dystrophy?
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Duchenne is more severe and earlier onset
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What genetic disease is known to cause bilateral accoustic neuromas?
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Neurofibromatosis Type II
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What disease should you suspect if you find facial vascular nevi (port wine stain)?
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Sturge Weber
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What genetic disease features cavernous hemangiomas of the brain or brainstem?
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Von Hippel Lindau disease
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What is the primary clinical feature of syringomyelia?
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Bilateral loss of pain and temperature sensation over the shoulders
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What is the treatment of syringomyelia?
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Surgical - a syringosubarachnoid shunt
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What is the diagnostic procedure of choice for syringomyelia?
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MRI
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What ipsilateral deficits are seen below the lesion in Brown-Sequard syndrome?
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Hemiparesis and loss of position/vibration (dorsal columns)
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What contralateral deficits are seen below the lesion in Brown-Sequard syndrome?
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Loss of pain and temperature sensation contralaterally
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What treatment is indicated for poliomyelitis?
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None available - just a vaccination
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Name three causes of central vertigo -
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MS
Vertebrobasilar insufficiency Migrane |
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What is the most important aspect of the syncope workup?
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Identifying structural heart disease or ECG abnormalities
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What two drugs may be useful in treating absence seizures?
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Ethosuxamide
Valproic acid |
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What lab values are important to check immediately in an unfamiliar seizing patient?
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Calcium
Sodium Glucose BUN |
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What is the management of status epilepticus?
|
Establish airway
IV diazepam IV phenytoin 50mL dextrose solution |
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What specific areas of the nervous system are affected by ALS?
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Anterior horn cells and corticospinal tracts at many levels
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Name 4 causes of aphasia -
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Stroke (most common)
Trauma to brain Brain tumor Alzheimer's disease |
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Where is the decussation of the dorsal column pathway?
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in the median lemniscus at the junction between the spinal cord and brainstem
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Where is the decussation of the spinothalamic tract?
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In the spinal cord almost immediately after the ventral horn
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Where is the decussation of the corticospinal tracts?
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At the junction between the spinal cord and brainstem
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What visual defect manifests when there is an ischemic lesion in the left optic radiation?
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Contralateral hemianopsia
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Why is there often macular sparing when there's a lesion in the primary visual cortex?
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There is dual arterial supply to the macular region
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Where is the lateral gaze center?
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PPRF
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What results from a lesion to the right PPRF?
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Impaired conjugate gaze to the right side
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How do you test the visual field of an obtunded patient?
|
Visual threat test in the periphery of visual field
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Is the optic disk situated slightly nasally or temporally on the fundus?
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Nasally
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How do you describe Argyll Robertson pupils?
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Small pupils that are poorly reactive to light and often irregular in size and shape
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What diseases should be suspected in a patient with Argyll Robertson pupils?
|
MS (now most common)
Neurosyphilis |
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What are the top four causes of Horner Syndrome?
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Brainstem infarction (36%)
Thoracic neck tumor (14%) Cerebral hemorrhage/infarction (12%) Cavernous sinus tumor (7%) |
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Where is the lesion in a patient with Marcus Gunn pupil?
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The ipsilateral optic nerve
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How do you test extraocular muscles in an obtunded patient?
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Doll's head maneuver
Caloric stimulation |
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What lesion results in "one and a half syndrome"?
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A pontine lesion affecting the MLF and PPRF
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If a patient with one and a half syndrome can only abduct their right eye, is the lesion on the right or left side?
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Left side lesion of the pons
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What is the most common cause of amaurosis fugax?
|
Embolic material in the retinal arteries
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What pathology is suggested in a patient with eye pain exacerbated by movement, a central visual loss (scotoma) and unilateral disk swelling on fundus exam?
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Optic neuritis
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What is the treatment of temporal arteritis?
|
Immediate administration of corticosteroids
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What lesion results in superior quadrantanopia?
|
Lesion of the optic radiation in the temporal lobe
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What lesion results in inferior quadrantanopia?
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Lesion of the optic radiation in the parietal lobe
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What visual defect occurs in patients with unilateral visual cortex lesions?
|
Homonymous hemianopia often with macular sparing
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What is the most common underlying cause of INO?
|
MS
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What five nerves run through the cavernous sinus?
|
CN III
CN IV CN V1 CN V2 CN VI |
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What should you suspect if you hear a bruit while auscultating the orbit?
|
A carotid artery - cavernous sinus fistula or other vascular anomaly
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Where do the motor nerves of the extrapyrimidal system originate?
|
Basal ganglia and cerebellum
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Are fasciculations indicative of upper or lower motor lesions?
|
Lower
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In general, spasticity is due to lesions in what part of the nervous system?
|
Basal ganglia
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What is the definition of paraplegia?
|
Weakness in both legs
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An intact abdominal reflex depends on the integrity of which spinal levels?
|
T8-T12
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Is Babinski elicited by stroking the lateral or medial border of the foot?
|
Lateral
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How is the Chaddock maneuver performed?
|
Stroking the back of the foot just below the lateral malleolus and looking for a Babinsky-like response
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Does a patient with a unilateral cerebellar lesion fall towards or away from the side of the lesion?
|
Towards the side of the lesion
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What results from a lesion at the level of the right internal capsule?
|
Severe hemiparesis of the right limbs and face
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What nerve and spinal roots innervate the biceps muscle?
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Musculocutaneous (C5, C6)
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What nerve and spinal roots innervate the Triceps muscle?
|
Radial nerve (C8)
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What nerve and spinal roots innervate the iliopsoas muscle?
|
Femoral (L2, L3)
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What nerve and spinal roots innervate the gluteus maximus muscle?
|
Inferior gluteal (L5, S1, S2)
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What nerve and spinal roots innervate the hamstrings?
|
Sciatic (L5, S1)
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What nerve and spinal roots innervate the tibialis anterior muscle?
|
Peroneal (L4, L5)
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What nerve and spinal roots innervate the gastrocnemius muscle?
|
Tibial (S1, S2)
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What investigations should you consider when a patient presents with weakness?
|
Serum enzymes
EMG Nerve conduction velocity Muscle biopsy Myelography or spinal MRI |
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What are common initial symptoms in patients with MS?
|
Focal weakness
Numbness Tingling Loss or blurring of vision |
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What are the treatment options for MS?
|
Interferon B
Glatiramer acetate IVIg Corticosteroids for acute attacks |
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What is the treatment for tetanus?
|
Hospitalization in an ICU to monitor respiratory function
Tetanus Ig Penicillin or metronidazole for infection itself |
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Is spinal cord infarction more likely in the anterior or posterior spinal cord?
|
Anterior since there are two posterior spinal arteries
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What lesions cause pseudobulbar palsy?
|
Bilateral lesions to the corticobulbar pathways
|
|
|
What drug prolongs life in ALS?
|
Riluzole which blocks glutamatergic transmission in the CNS
|
|
|
Name two viruses that cause disease of the anterior horn cells -
|
Polio
West Nile Virus |
|
|
What nerve roots are damaged in Erb-Duchenne Paralysis?
|
C5, C6
|
|
|
How is the arm held in Erb-Duchenne Paralysis?
|
Internally rotated at the shoulder with a pronated forearm and extended elbow
|
|
|
What nerve roots are involved in Klumpke paralysis?
|
C8 and T1
|
|
|
What changes are seen in Klumpke paralysis?
|
Paralysis and wasting of the small muslces of the hand and long finger flexors and extensors
|
|
|
What are the features of cervical rib syndrome?
|
Weakness and wasting of the intrinsic hand muscles, especially the thenar eminence
|
|
|
What is the treatment for organophosphate toxicity?
|
Administer atropine every 5 minutes and pralidoxime every hour
|
|
|
What underlying conditions are associated with a higher prevalence of myasthenia gravis?
|
Thymic tumor
Thyrotoxicosis Rheumatoid arthritis SLE |
|
|
What are the three most common presenting symptoms of myasthenia gravis?
|
Diplopia
Ptosis Dysarthria |
|
|
What's the most common test for diagnosing myasthenia gravis?
|
Edrophonium test - to see if condition improves with the drug
|
|
|
What is the mainstay of treatment for myasthenia gravis?
|
Pyridostigmine
|
|
|
What muscles are affected in myasthenia gravis that are characteristically spared in Lambert Eaton?
|
Extraocular muscles
|
|
|
What is the treatment for Lambert Eaton syndrome?
|
Corticosteroids
Plasmapheresis IVIg |
|
|
What is the average age of presentation for..
Duchenne MD Becker MD? |
Duchenne - 5 yo
Becker - 11yo |
|
|
What neurologic condition is the Gomori stain used for?
|
Mitochondrial myopathies - shows "ragged red fibers"
|
|
|
What is MELAS syndrome?
|
Mitochondrial myopathy
Encephalopathy Lactic Acidosis Strokelike episodes |
|
|
Besides muscle weakness, what other symptoms may accompany myotonic dystrophies?
|
Cataracts
Frontal Baldness Cardiac abnormalities Intellectual changes |
|
|
What is the drug of choice for treating the myotonic dystrophies?
|
Phenytoin
|
|
|
Which spinal cord tract carries the pinprick and temperature sensation?
|
Lateral spinothalamic
|
|
|
Where is the likely lesion in a patient with normal sensation who has agraphesthesia?
|
Contralateral parietal lobe
|
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|
In polyneuropathy, is sensation loss greater proximally or distally?
|
Greater distally than proximally - stocking and glove pattern of sensory loss
|
|
|
What is the other name for acute idiopathic polyneuropathy?
|
Guillain Barre Syndrome
|
|
|
What two features are required for the diagnosis of Guillain Barre syndrome?
|
Progressive weakness in more than one limb
Distal areflexia with proximal areflexia or hyporeflexia |
|
|
Are steroids indicated for the treatment of Guillain Barre?
|
No, they may affect the outcome adversely or delay recovery and are not indicated
|
|
|
What percent of patients recover completely from Guillain Barre?
|
About 70-75%
~20% are left with mild neurologic deficits ~5% die |
|
|
What neurologic complications may be involved in Diphtheria infection?
|
Impaired ocular accomodation
Extraocular muscles and facial muscles may be affected, but pupillary responses remain intact |
|
|
Do the Charcot-Marie-Tooth disorders feature sensory or motor neuropathies?
|
Both
|
|
|
Which nerve is affected in Carpal tunnel syndrome?
|
Median nerve
|
|
|
What are some treatments for Carpal tunnel syndrome?
|
Local corticosteroid injections
Wearing a nocturnal wrist splint |
|
|
What nerve is susceptible to damage in the axilla when using crutches?
|
Radial nerve
|
|
|
Which nerve, when lesioned, classically produces foot drop?
|
Peroneal nerve
|
|
|
What are the classic symptoms of Tabes Dorsalis?
|
Impaired vibration and positional sense in legs
Ataxic gait Overflow incontinence |
|
|
What is "causalgia"?
|
Severe persistent pain, often burning in quality, that results from nerve trauma
|
|
|
What is "milkmaid's grasp"?
|
Difficulty maintaining muscular contraction in the hand - may be a form of chorea
|
|
|
What is the typical treatment for essential tremor (if it needs treatment at all)?
|
Propranolol twice daily
|
|
|
Where does the tremor of Parkinson's disease typically start?
|
Hands, feet or face
|
|
|
In which patients is carbidopa/levodopa therapy contraindicated?
|
Patients with narrow-angle glaucoma
Patients with psychotic illness |
|
|
What is the mechanism of selegiline?
|
MAOB inhibitor
|
|
|
What are surgical options in treating Parkinson's patients that are unresponsive to pharmacotherapy?
|
Thalamotomy or pallidotomy
|
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|
Which form of dementia is accompanied by gait disturbance, falls, supranuclear ophthalmoplegia, pseudobulbar palsy and axial dystonia?
|
Progressive Supranuclear Palsy
|
|
|
What is the typical treatment for patients with Huntington's disease?
|
D2 blockers like haloperidol to treat the movement disorder
|
|
|
What is the name for spontaneous, involuntary forced closure of the eyelids for a variable period of time?
|
Blepharospasm
|
|
|
What drug is effective in Wilson's disease?
|
Penicillamine - a copper chelator
|
|
|
What drugs are effective at treating neuroleptic malignant syndrome?
|
Dantrolene, bromocriptine, amantadine
|
|
|
What underlying pathology should be expected in a child with "Bobble-head syndrome" (rhythmic bobbing of the head)?
|
Progressive hydrocephalus
|
|
|
What drugs are commonly used to treat Tourette syndrome?
|
Clonidine
Haloperidol |
|
|
What type of drugs are useful in treating restless leg syndrome?
|
Dopamine agonists
Benzodiazepines |
|
|
How are febrile convulsions of childhood typically treated?
|
Usually it's not necessary
Prolonged convulsions (over 15 minutes) can be treated with diazepam |
|
|
How low do serum sodium levels need to fall to cause seizures?
|
Below 120 meq/L
|
|
|
How long does a seizure need to last to be called status epilepticus?
|
Over 30 minutes
|
|
|
What does the 3/s spike and wave pattern on EEG indicate?
|
Absence seizures
|
|
|
What is Jacksonian march?
|
Clonic movements of a single muscle group that spreads to involve contiguous regions of the motor cortex
|
|
|
Is valproic acid better for treating partial seizures or generalized seizures?
|
Generalized seizures
|
|
|
Is it better to increase the dose of an anticonvulsant, or add a second?
|
Usually it's better to increase the drug until the toxicity prohibits further increase
|
|
|
If a patient has an idiopathic seizure, what is the likelihood of recurrence?
|
33-50%
|
|
|
After a second idiopathic seizure, what is the likelihood of recurrence?
|
75% (time to start prophylactic treatment)
|
|
|
Should a patient with one idiopathic generalized seizure be started on anticonvulsants?
|
No, usually therapy begins after two seizures
|
|
|
Is aphasia a more common symptom of ischemia in the anterior or posterior circulation of the brain?
|
Anterior
|
|
|
Is Vertigo a more common symptom of ischemia in the anterior or posterior circulation of the brain?
|
Posterior
|
|
|
Are Drop Attacks a more common symptom of ischemia in the anterior or posterior circulation of the brain?
|
Posterior
|
|
|
What percentage of ischemic strokes are due to thrombosis vs. embolus?
|
67% due to thrombosis
33% due to embolus |
|
|
What causes most deaths in the first week after cerebral infarct?
|
Cerebral edema causing herniation
|
|
|
Ischemia of which cerebral artery is likely to lead to motor and sensory loss of the left leg?
|
Right ACA
Might also lose voluntary control of micturition |
|
|
What symptoms indicate ischemia in the superior division of the MCA?
|
Hemiparesis and hemisensory defect of the face, hand and arm
Possibly aphasia or neglect depending on dominance |
|
|
What symptoms indicate ischemia in the posterior cerebral artery?
|
Homonymous hemianopia with macular sparing
Possibly CN III palsy, anomic aphasia, alexia, visual agnosia |
|
|
What precipitates subclavian steal syndrome?
|
Physical activity of the ipsilateral arm
|
|
|
Occulsion of what artery causes Wallenburg syndrome?
|
Posterior inferior cerebellar artery
|
|
|
What are the symptoms of Wallenburg syndrome?
|
Ipsilateral cerebellar ataxia
Horner syndrome Facial sensory deficit Contralateral pain/temp deficit Nystagmus Vertigo |
|
|
What lesion most commonly causes pure motor hemiparesis?
|
Lesion of the internal capsule
|
|
|
What percentage of people over 65yo have a carotid bruit?
|
7%
|
|
|
What treatment is necessary following a TIA?
|
Aspirin
Heparin/Warfarin if caused by a cardiac embolus Endarterectomy if there is high grade carotid stenosis |
|
|
What are the two most common sites of hypertensive hemorrhage intracranially?
|
Putamen
Thalamus |
|
|
What are the pupils like in pontine hemorrhage?
|
Pinpoint pupils
|
|
|
What underlying disorder should be considered in an elderly patient with small hemorrhages at multiple sites?
|
Amyloidosis
|
|
|
Lesions to which two areas of the brain can lead to coma?
|
Brainstem reticular activating center
or Both cerebral hemispheres |
|
|
What should the ER management be of a patient who comes in comatose?
|
ABCs
IVs - Draw blood for studies Dextrose, thiamine, naloxone |
|
|
What are likely etiologies of sudden onset coma?
|
Vascular origin - brainstem stroke
Subarachnoid hemorrhage |
|
|
What is the most common cause of a fixed dilated pupil in a comatose patient?
|
Transtentorial herniation of the medial temporal lobe from a supratentorial mass
|
|
|
Describe decorticate posturing -
|
Flexion of the arm
Extension of the leg and ankle |
|
|
Describe decerebrate posturing -
|
Extension at the elbow
Leg extension |
|
|
Does decorticate or decerebrate posturing generally imply more severe brain dysfunction?
|
Decerebrate (elbow extension) implies more severe dysfunction
|
|
|
In a patient with intracerebral hemorrhage, are the eyes more likely to show conjugate deviation towards or away from the site of the bleed?
|
Towards the side of the bleed
|
|
|
What is the treatment for intracerebral hemorrhage?
|
Manage blood pressure
Surgical intervention is difficult |
|
|
What are the three most common presenting features of brain abscess?
|
Headache
Fever Disturbed consciousness |
|
|
For what non-infectious processes may LP be indicated for diagnosis?
|
SAH
Hepatic encephalopathy Meningeal malignancies |
|
|
At what spinal level does the conus medullaris terminate?
|
At about L1-L2
|
|
|
At what spinal level are the iliac crests?
|
L3-L4 interspace
|
|
|
What structure, when penetrated in an LP, makes a 'pop'?
|
Ligamentum flavum
|
|
|
What structures are better visualized on CT with contrast?
|
Abscesses and tumors
|
|
|
Are pituitary tumors better visualized with CT or MRI?
|
MRI - less interference by bony structures of the sella
|
|
|
Which modality can detect ischemia earlier after a stroke - CT or MRI?
|
MRI
|
|
|
Briefly describe the technique of myelography -
|
Injection of radiopaque contrast medium into the subarachnoid space allowing the visualization of the spinal subarachnoid system
|
|
|
What is the preferred method for assessing syringomyelia?
|
MRI
|
|
|
Can aphasic patients write?
|
No, except in very rare exceptions
|
|
|
Where is the lesion when a patient presents with Argyll-Robertson pupil?
|
In the tectum of the midbrain
|
|
|
Where is the lesion in a patient with Marcus-Gunn pupil?
|
Optic tract
Optic nerve Or Retina |
|
|
What is the best test to evaluate the integrity of the vermis?
|
As the patient to stand/walk and look for a wide-based stance/gait
|
|
|
What strength score (x/5) would you give a patient who can move against gravity but not against greater resistance?
|
3/5
|
|
|
What constitutes a 1/5 muscle strength rating on physical exam?
|
Palpable contraction but little visible movement
|
|
|
What pathology do you expect if you see an intracranial mass lesion that is intensely enhancing with a prominent dural tail?
|
Meningioma
|
|
|
Name the three drugs (in order) that you would use to try and abort status epilepticus -
|
First Lorazepam
Then Phenytoin Then Phenobarbital Short acting agents (midazolam, pentobarbital/propofol if that doesn't work) |
|
|
What is the mortality rate for patients in Status Epilepticus?
|
20%
|
|
|
Which cerebral sinus is the most common location for cerebral sinus thrombosis?
|
Transverse sinus
|
|
|
What lesion classically produces ballismus/hemiballismus?
|
Lesions in the subthalamic nucleus
|
|
|
What drugs do patients with essential tremor respond to?
|
Primidone
Propranolol Diazepam |
|
|
Name some characteristic dermatologic features in patients with tuberous sclerosis -
|
Ashleaf macules
Shagreen patch Adenoma sebaceum |
|
|
What drugs are used in the treatment of infantile spasms (regardless of etiology)?
|
ACTH
Clonazepam Valproic acid |
|
|
From which artery does the superficial temporal artery originate?
|
External carotid
|
|
|
What is the classic triad of Normal-Pressure hydrocephalus?
|
Dementia
Gait ataxia Urinary incontinence |
|
|
What neurologic disorders are AIDS patients at an increased risk for?
|
Toxoplasmosis
CNS lymphoma PML HIV-dementia CMV encephalitis Cryptococcal meningitis Neurosyphilis |
|
|
What should be involved in the work-up for TIA?
|
Carotid Doppler
Cardiac ECHO CT for evidence of evidence of prior infarctions |
|
|
What percentage of patients with TIA will have a disabling stroke within the next 5 years?
|
30%
|
|
|
What are some important causes of stroke in young patients?
|
Hypercoagulable states
Vasculitis Inherited disorders of lipid metabolism |
|
|
What is the first-tier management of raised intracranial pressure?
|
Hyperventilation
|
|
|
Which has a higher mortality rate: Epidural hematomas or Subdural hematomas?
|
Subdural hematoma has a much higher mortality rate - 60-90%
|
|
|
What is the most useful test in distinguishing between axonal and demyelinating peripheral neuropathies?
|
Nerve Conduction Velocity studies
|
|
|
What is the most common presenting complaint of spinal cord tumors?
|
Pain
|
|
|
Is the frog-leg position a sign of spacticity or hypotonicity in infants?
|
Hypotonicity
|
|
|
How is myotonic dystrophy inherited?
|
Autosomal dominant - CTG triplicate repeat expansion
|
|
|
What is the most common cause of peripheral neuropathy worldwide?
-Alcoholism -Syphilis -Diabetes -Leprosy |
Leprosy
|
|
|
What neurologic condition is treated with Riluzole?
|
ALS
Riluzole inhibits glutamate release |
|
|
What blood test helps diagnose ALS?
|
CK is elevated in 35-70% of cases
|
|
|
Which cranial nerve innervates the staepedius muscle and can lead to hyperacusis if damaged?
|
CN VII
|
|
|
If the left ear is irrigated with warm water, is there nystagmus towards or away from the stimulus?
|
Towards - to the left
|
|
|
What is the standard treatment for acute carotid artery dissection?
|
Heparin and then Warfarin
|
|
|
What endocrine disorders are associated with Carpal Tunnel Syndrome?
|
Diabetes Mellitus
Hypothyroidism Acromegaly Pregnancy Obesity |
|
|
Which nerve provides sensory innervation to the back of the hand?
|
Radial nerve
|
|
|
An increase in volume of endolymphatic fluid resulting in distension of the semicircular canals is the underlying pathophysiology for which disorder?
|
Meniere's disease
|
|
|
Bilateral INO is virtually pathognomonic for which disorder?
|
MS
|
|
|
What are the three major diseases that affect the neuromuscular junction?
|
MG
Botulism Lambert Eaton |
|
|
What cells make myelin in the CNS?
PNS? |
CNS - oligodendrocytes
PNS - Schwann cells |
|
|
What drug is used for prophylaxis against meningococcus?
|
Rifampin
|
|
|
What tumors (3) are associated with Von Hippel-Lindau?
|
Renal cancer
Retinal angiomas Pheochromocytomas |
|
|
Is HIV dementia more likely associated with movement disorders or seizures?
|
Movement disorders
Seizure is not a typical component |
|
|
What is the most common lesion location that gives rise to alien hand syndrome?
|
Corpus callosum
|
|
|
What is the most common primary brain tumor with onset in infancy?
|
Medulloblastoma
|
|
|
Do myopathies more commonly cause proximal or distal weakness?
|
Proximal weakness
|
|
|
What conditions are contraindications for using triptans?
|
Pregnancy
Vascular disease |
|
|
Which is more commonly triggered by alcohol - migrane or cluster headaches?
|
Cluster headaches
|
|
|
What is the most effective abortive treatment for cluster headaches?
|
O2 therapy
|
|
|
What is the first-line therapy for trigeminal neuralgia?
|
Carbamazepine
|
|
|
At what time of day is the headache of pseudotumor cerebri the worst?
|
At night and upon awakening
Worse when lying flat |
|
|
What is the name of the area of brain ischemia that is reversibly dysfunctional?
|
Penumbra
|
|
|
What is the average duration of a TIA?
|
~12 minutes
|
|
|
Is the occlusion of the MCA more often caused by thrombus or embolus?
|
Embolus
|
|
|
What are the signs and symptoms of ACA occlusion?
|
Contralateral leg weakness
|
|
|
What's the next step if you suspect SAH but the CT is negative?
|
LP
|
|
|
What is the first-line treatment for tonic-clonic seizures?
|
Valproic acid
|
|
|
What is the first-line treatment for partial seizures?
|
Carbamazepine
|
|
|
Which has the longest half-life:
Phenytoin Valproic acid Carbamazepine |
Phenytoin - 24 hrs
Carbamazepeine - 10-17hrs Valproic acid - 15 hrs |
|
|
Which antisiezure medication has the side effects of:
Gum hyperplasia, ataxia, peripheral neuropathy, lymphoproliferative disorders |
Phenytoin
|
|
|
Which antisiezure medication has the side effects of:
Hyponatremia, lymphopenia, Stevens-Johnson syndrome |
Carbamazepine
|
|
|
Which antisiezure medication has the side effects of:
Tremor, drowsiness, weight gain, hirsutism, liver failure |
Valproate
|
|
|
What is the name for prolonged simple partial seizures?
|
Epilepsia partialis continua
|
|
|
What is catamenial epilepsy?
|
Seizures in the perimenstrual period
|
|
|
Is breast feeding recommended for women on antiseizure medication?
|
Yes, it is allowed
|
|
|
What is Uhthoff phenomenon?
|
Symptoms of MS exacerbated by heat and exercise
|
|
|
What underlying pathology may make Lhermitte sign positive?
|
Demylination of cervical spinal cord - like in MS
|
|
|
What are the most common side effects of interferon?
|
Flu-like symptoms
|
|
|
Does Lambert-Eaton typically cause proximal or distal muscle weakness?
|
Proximal muscle weakness
|
|
|
Given the decline of polio, what is now the most common cause of acute flaccid paralysis?
|
Guillain Barre
|
|
|
Which fingers are most commonly affected by Carpal Tunnel syndrome?
|
Paresthesias and weakness of the thumb and index finger
|
|
|
What are the two most common mononeuropathies?
|
Carpal tunnel syndrome
Ulnar neuropathy |
|
|
Damage to which nerve causes the "claw-hand" deformity?
|
Ulnar nerve
|
|
|
What may cause an acute onset of polyneuropathy?
|
Porphyria
Guillain Barre Syndrome Heavy intoxication |
|
|
What is the fundamental difference between the Charcot-Marie-Tooth 1 (CMT1) diseases and the CMT2 diseases?
|
CMT1 diseases are due to demyelination
CMT2 diseases are due to axonal degeneration |
|
|
What disease manifests as progressive sensory motor demylination, cerebellar ataxia, and retinitis pigmentosa?
|
Refsum disease
|
|
|
Are steroids indicated for the treatment of a patient with Guillain Barre?
|
No, they have not been proven effective
Respiratory monitoring, IVIg or plasmapheresis are the appropriate managements |
|
|
What age group is most at risk for Myasthenia Gravis?
|
In women - 20-30
In men - 50-60 |
|
|
Characterize myotonia -
|
Prolonged contraction followed by slow relaxation
|
|
|
What is the treatment for Duchenne Muscular Dystrophy?
|
Prednisone helps slow the progression
|
|
|
Which disease has patients with "hatchet faced" appearance?
|
Myotonic dystrophy
|
|
|
What muscles are typically affected in myotonic dystrophy?
|
Facial muscles
Neck muscles Distal muscles |
|
|
What drug is used to help reduce myotonia in patients with myotonic dystrophy?
|
Phenytoin
|
|
|
Does hyperthyroidism more commonly cause weakness in the proximal or distal muscles?
|
Proximal muscle weakness
|
|
|
Do patients with hyperparathyroidism have hyper- or hyporeflexia?
Hypoparathyroidism? |
HyperPTH - hyperreflexia
HypoPTH - hyporeflexia |
|
|
What is the most common drug to cause autoimmune myopathy?
|
D-Penicillamine
|
|
|
What are the "inclusion bodies" made of in Inclusion Body Myositis?
|
Beta amyloid
|
|
|
Which has the worst prognosis -
Polymyositis Dermatomyositis Inclusion Body Myositis? |
Inclusion Body Myositis has the worst prognosis and tends to be a chronic, progressive disease
|
|
|
What is the treatment of choice in Polymyositis and Dermatomyositis?
|
1st line - glucocorticoids
2nd line - Azathioprine or MTX 3rd line - IVIg |
|
|
Does Friedrich's ataxia have greater proximal or distal weakness?
|
Distal weakness
|
|
|
The enzyme Superoxide Dismutase is mutated in some variants of which neurologic disease?
|
ALS
|
|
|
What neurologic disease classically presents with bilateral burning feet?
|
Riley-Day syndrome
|
|
|
Define allodynia -
|
The perception of normal sensation as painful
|
|
|
What neurologic syndrome features severe facial palsy associated with a vesicular eruption in the pharynx or auditory canal?
|
Ramsey Hunt syndrome
|
|
|
Which have a better prognosis:
Astrocytomas or Oligodendrogliomas? |
Oligodendrogliomas
|
