Neuro: Disorders Of Cognitive Function

Front 1

Causes of hypothermia and mental status change?

Back 1

Exposure to cold, ethanol or sedative drug tox, hypoglycemia, hepatic encephalopathy, Wernicke encephalopathy, hypothyroidism, shock

Front 2

What does yellowing of the skin indicate?

Back 2

Jaundice or B12 deficiency

Front 3

What white matter pathway connects Wernicke's area to Broca's area?

Back 3

Arcuate fasciculus

Front 4

What is preserved in transcortical aphasias?

What faculty is always intact?

Back 4

Wernicke's area, arcuate faciculus, Brocas area

Repetition

Front 5

What areas are damaged in unilateral apraxias?

Bilateral apraxias?

Back 5

contralateral premotor frontal cortex lesions

Bifrontal or diffuse cerebral lesions?

Front 6

What is asterixis a sign of in acute confusional state?

Back 6

hepatic, renal, pulmonary encephalopathy
drug intoxication

Front 7

What is the palmomental reflex?

Back 7

scratching along length of palm results in contraction of ipsilateral chin and perioral muscles

Front 8

When does tremulousness and hallucionations occur in alcohol withdrawal?

Other symptoms?

Back 8

Within 2 days after cessation of drinking

tremulousness, agitation, anorexia, nausea, insomnia, tachycardia, hypertension
Illusions and hallucninations in 25% of patietns

Front 9

Treatment for alcohol withdrawal?

Back 9

Diazepam or chlordiazepoxide?

Front 10

When do seizures occur in alcohol withdrawal?

Back 10

within 48 hours of abstinence

Front 11

When does delirium tremens occur relative to abstinence?

How long does it last at maximum?

Back 11

3-5 days after cessation of drinking

72 hours at most

Front 12

What are features of delirium tremens?

Back 12

confusion, agitation, fever, sweating, tachycardia, hypertension, hallucinations

Front 13

What causes death in delirium tremens?

Back 13

concommitant infection, pancreatitis, cardiovascular collapse, trauma

Front 14

Immediate treatment for delirium tremens?

Back 14

diazepam every 5 minutes
correction of electrolyte abnormalities, hypoglycemia

beta adrenergic block with atenolol is sometimes reccomended

Front 15

What should be used in case of PCP overdose?

Back 15

Benzos for sedation and muscle spasms
Antihypertensives, anticonvulsatns, dantrolene for hyperthermia

Front 16

Where should blood glucose levels be allowed to sit in DKA treatment?

Back 16

200-300 for 24 horus for reduction of risk of brain edema

Front 17

When does central pontine myelinosis occur?

Back 17

too rapid correction of hyponatremia

Front 18

What structures are affected and how in Wernicke's encephalopathy?

Back 18

nueronal loss, demyelination, gliosis in periventricular gray matter

Front 19

What is the classic syndrome associated with Wernicke's encephalopathy?

Back 19

ophthalmoplegia, ataxia, confusional state

VI most commonly affected
Ataxia affects gait, not arms
prominent loss of recall, recent memory

Front 20

What does a glutamine elevation in CSF indicate?

Back 20

Hepatic encephalopathy?

Front 21

Infection with which pathogens are associated with Reye syndrome?

Back 21

Influenza, Varicella

Front 22

Pathophysiology of pulmonary encephalopathy?

Back 22

hypoventilation --> hypercapnia --> decreased CNS flow

Front 23

Which immunosuppresive agents produce encephalopathy?

Back 23

tacrolimus, cyclosporine

Association with seizures, tremor, vesual disturbances, weakness, sensory symptoms, ataxia

OKT3 - encephalopathy, aseptic meningitis, seizures

Front 24

What areas do pneumococcus, H. Flu, and N meningitis favor?

Back 24

H. Flu and pneumococcus favor convexities, N. meningitides favors base of brain

Front 25

How common is petechial rash in N. meningitidis infection?

Back 25

50-60%

Front 26

Which cranial nerve is commonly involved in meningitis?

Back 26

VIII

Front 27

What sort of CSF cell count is found in TB meningitis?

Back 27

50-500 cells
Lymphocytic or mononuclear predominance

Front 28

When does syphilitic meningitis occur relative to primary infection?

What sort of CSF findings are there?

Back 28

within 2 years

Lymphocytic or mononuclear pleocytosis with 100-1000 cells
Protein elevations, glucose decreased
CSF VDRL positive
CSF gamma globulin bands on electrophoretograms

Front 29

Which viral encephalitides causing cell counts above 1000 cells?

Back 29

LCMV or HSV

Front 30

What disorder may mimic viral encephalitis that occurs after viral infections such as influenza, measles, chickenpox?

Back 30

immune-mediated encephalomyelitits

Front 31

Where are toxo lesions typically located in the brain?

Back 31

basal ganglia

Front 32

How should suspected CNS lymphoma management work in AIDS patient?

Back 32

If pt is being treated for toxo without relief --> brain biopsy
Treatment is corticosteroids and radiation

Front 33

Which fungal infection classically causes a PMN pleocytosis?

Back 33

Aspergillus

Front 34

What should be done for diagnosis in suspected mucor mycosis involving nasal mucosa?

Back 34

biopsy

Front 35

CSF test for coccidioides?

Back 35

Complement fixation testing

Front 36

What is done for coccidiodies meningitis refractory to therapy?

Back 36

intrathecal amphotericin through Ommaya reservoir

Front 37

What fungal agents is flucytosine routinely used for?

What is its major toxicity and when is it avoided?

Back 37

Candida, Cryptococus neoformans

bone marrow suppression - AIDs patients

Front 38

malaria prophylaxis?

Back 38

chloroquine phosphate

mefloquine if area is highly chloroquine resistant

Doxy and atovaquone/proguanil are also good

Front 39

How is cerebral malaria treated?

Back 39

chloroquine

if resistant use quinidine IV

Then oral therapy with chloroquine, amodiaquine, or sulfadoxine and pyrimehtamine
If chloroquine resistant use mefloquine, quinine, quinidine

Front 40

What does Sabin Feldman dye test titer test for?

Back 40

Toxo

Front 41

What causes primary amebic meningoencephalitis?

Back 41

Naegleria fowleri

Front 42

How does a person get angiostrongylus cantoesis meningitis? (transmission)

Where does it occur?

CSF finding?

Back 42

Endemic in southeast aisa, hawaii
ingestion of infected raw mollusks

CSF eosinophilia

Front 43

Which tumors metastasize to leptomeninges?

Which primaries have propensity for meningeal dissemination?

Back 43

ALL, non-Hodgkin lymphoma, melanoma, acute myelogneous leukemia, carcinoma of breast, Hodgkin lymphoma, carcionmoa of lung, carcinoma of GI tract, sarcoma

medulloblastomas, pneal tumors

Front 44

What blood pressure is required in chronic hypertensives to produce hypertensive encephalopathy?

Where does infarction tend to occur?

Back 44

250/150

brainstem primarily
subcortical gray and white matter regions

Front 45

CSF findings in lupus cerebritis?

Back 45

protein elevation
mononuclear pleocytosis

Front 46

Which drugs can induce TTP?

Back 46

ticlodipine, clopidogrel

Front 47

What occurs with Graustmann Straussler syndrome?

Back 47

dementia, ataxia

Front 48

What occurs with fatal familial insomnia?

Back 48

disturbances of sleep and autonomic, motor, endocrine function

Front 49

What is the second most common dementia after Alzheimer's?

Back 49

Dementia with Lewy Bodies

Front 50

Which drugs can be used with Lewy body dementia and which drugs should be avoided?

Back 50

Cholinesterase inhibitors work well

Avoid antipsychotics as EPS occurs frequently in this group

Front 51

CSF findings in HIV?

Back 51

mononuclear pleocytsois <50 cells
Elevation of protein <200
Oligoclonal bands

Front 52

When does meningovascular syphilis occur and how does it manifest?

Back 52

4-7 years following primary infection
TIAs and stroke

Front 53

Which nerves are involved in meningeal syphilis?

Back 53

II, VII, VIII

Front 54

How does general parsis manifestation of parenchymatous neurosyphilis occur?

Back 54

Gradual memory loss, altered affect, personality behavior. Grandiosity, depression, psychosis, focal weakness. Terminal featuers aer incontinence, seizures or strokes
Tremor of tongue, paucity of facial expresions, dysarthria, pyramidal signs

Front 55

How does taboparesis manifestation of parenchymatous neurosyphilis present?

Back 55

Argyll robertson pupils, lancinating pains, areflexia, posterior column sensory deficits with sensory ataxia, Romberg sign, incontinence, impotence, Charcot joints, gene recurvatum, Optic atrophy

Front 56

CSF findings in syphilis?

Back 56

protein elevation, increased gamma globulin, oligoclonal bands?

Front 57

What causes pellagra?

Neurological manifestations?

Systemic manifestations?

Back 57

nicotinic acid deficiency

dementia, psychosis, confusional states, pyramidal, EPS, cerebellar signs, polyneuropathy, optic neuropathy

diarreha, glossitis, anemia, erythrematous skin lesions

Front 58

In whom does marchiafava bignami syndrome occur?

Features?

Back 58

malnourished alcoholics

dementia, spasticity, syasarthria, gait disorder, coma

Degeneration of corpus callosum, subcortical white matter

Front 59

clinical presentation of dialysis dementia?

Treatment?

Back 59

myoclonus, dysarthria, seizures

diazepam

Front 60

Neurologic findings in vascular dementia?

Back 60

pseudobulbar palsy - dysarthria, dysphagia, pathologic emotionality
focal motor, sensory deficits, ataxia, gait apraxia, hyperreflexia, extensor plantar responses

Front 61

What are imaging findings of carbon monoxide poisoning?

Back 61

lucencies of dentate and basal ganglia nuclei

Front 62

What feature distinguishes other amensias from transient global amnesia ?

Back 62

Patient is obviously concerned about amnesia

Front 63

What areas of the brain degenerate in korsakoff's?

Back 63

dorsomedial thalamic nuclei

Front 64

What cancer is paraneoplastic limbic encephalitis most commonly associated with?

How does it present?

Back 64

small cell cancer of the lung

develoment over weeks
profound impairment of recent memory, corresponding to inability to learn new material
remote memory is less impaired, registration is unaffected
confabulation sometimes, anxiety or depression are common early features

Front 65

What cancer produces anti-Ta antibodies?

Back 65

testicular