Neurology Shelf Exam

Front 1

Nonspecific signs/symptoms of increased ICP

Back 1

Headaches (on awakening, dependent on head position, progressive)

AM nausea/vomiting

Papilledema (swollen optic disc)

Seizures

Front 2

Diagnostic test for CNS neoplasm

Back 2

MRI w/ and w/o gadolinium

Brain biopsy is only definitive way to dx

Front 3

Ways to control elevated ICP

Back 3

Steroids
Mannitol
Hyperventilation

Front 4

Differential dx of ring-enhancing brain lesion

Back 4

Metastatic cancer
Brain abscess
Glioblastoma multiforme
Lymphoma
Toxoplasmosis

Front 5

Brain tumor in a transplant recipient or AIDS patient

Back 5

Primary lymphoma

Front 6

Most common sites of brain metastasis

Back 6

Lung
Breast
Skin
Kidney
GI

Front 7

Pathognomonic for neurofibromatosis II

Back 7

Bilateral schwannomas

(otherwise is unilateral)

Front 8

CSF reveals malignant cells, elevated protein and lymphocytes, decreased glucose

+ focal neurologic deficits

Back 8

Meningeal carcinomatosis (cancer metastasizes to meninges via blood)

Tx w/ intrathecal chemo

Front 9

Hearing loss, tinnitis, loss of balance, nystagmus, motor sensory deficits of face; imaging shows mass

Back 9

Schwannoma (cerebellopontine angle)

Front 10

ICP is determined by

Back 10

Volume of brain
Volume of blood
Volume of CSF

Front 11

Secondary insults to brain s/p trauma

Back 11

Hypotension
Hypoxia
Hypercapnia (causes vasodilation --> increased ICP)
Increased ICP
Intracranial mass effect (subdural or epidural hematoma)
Anemia

Front 12

Normal ICP

Back 12

5-15 mm H2O

ICP>20 is worrisome

Front 13

Effects of increased ICP

Back 13

Decrease in cerebral perfusion pressure ---> hypoperfusion --> loss of autoregulation --> cerebral vasodilation --> vasogenic edema --> increased ICP

Systemic BP becomes sole determinant of cerebral blood flow

Transtentorial herniation may result

Front 14

Bilateral fixed and dilated pupils suggest

Back 14

Increased ICP

Front 15

What is target MAP in the context of ICP

Back 15

Mean arterial pressure > 80 mmHg

ICP <20 mm Hg

This keeps cerebral perfusion pressure >50 mm Hg (normal)

Front 16

Sgns of basilar skull fracture

Back 16

Raccoon eyes - periorbital ecchymoses

Battle's sign - postauricular ecchymoses

Hemotympanum

CSF rhinorrhea/otorrhea

Front 17

Cushing's triad

Back 17

Hypertension, bradycardia, respiratory irregularity

Front 18

Treatment of increased ICP

Back 18

ABCs
Lower ICP:
- Reverse Trendelenburg position if spine is cleared
- intubation + hyperventilation (decreased paCO2 --> prevents cerebral vasodilation)
- maintain PaCO2 at 30-35
- Mannitol
- Narcotics for sedation
- NM paralysis (vecuronium or pancuronium)
- Lower body temperature

Front 19

Risk factors for subdural hematoma

Back 19

Brain atrophy (EtOH, elderly)

Pts undergoing anticoagulation

Front 20

Signs of subdural hematoma

Back 20

Headache
Decreased level of consciousness (mass effect)
Cortical dysfx

Front 21

Mechanism of myasthenia gravis

Back 21

Autoantibodies against nicotinic acetylcholine receptors of NM junction --> reduced postsynaptic response to acetylcholine

Front 22

Proximal, asymmetric mm weakness with preservation of sensation and reflexes, worse with exercise

Back 22

Myasthenia gravis

Front 23

Dx test for myasthenia gravis

Back 23

Acetylcholine receptor antibody test

EMG shows decremental response to repetitive stimulation of motor neurons

Edrophonium (Tensilon) test - improvement w/ anticholinesterase meds

Front 24

Myasthenia gravis associated with?

Back 24

Thymoma

Front 25

Tx for myasthenia gravis

Back 25

AChE inhibitors
Thymectomy
Corticosteroids; azathioprine, cyclosporine
Plasmapheresis (removes Ab to acetylcholine receptors)
IV immunoglobulin therapy for acute exacerbation

Front 26

Myasthenic crisis

Back 26

Diaphragm and intercostal fatigue --> respiratory failure

Low threshold for intubation

Front 27

Lambert-Eaton is associated with?

Back 27

Small cell lung cancer

Front 28

Lambert Eaton mechanism

Back 28

Autoantibodies against presynaptic calcium channels

Front 29

Proximal muscle weakness, hyporeflexia, symptoms improved with repeated use

Back 29

Lambert Eaton

Front 30

Inheritance of duchenne's MD

Back 30

X linked recessive

Mutation of dystrophin gene --> mm cell structure

Front 31

Progressive, symmetric mm weakness starting in childhood with pelvic girdle affected

Back 31

Duchenne's MD

Front 32

Signs/symptoms of Duchenne's

Back 32

Gower's manuever (hands to get up)

Enlarged calf muscles - pseudohypertrophy as fat replaces mm

Wheelchair confinement, resp failure, death in 30s

Front 33

Causes of syringomyelia

Back 33

Cranial base malformation (Arnold-Chiari)

Intramedullary tumors

Traumatic necrosis of spinal cord

Front 34

Bilateral loss of pain and temp sensation in caplike distribution

Muscle atrophy of hands and thoracic scoliosis

Preservation of touch

Back 34

Syringomyelia (collection of fluid in spinal cord --> central cavitation of cervical cord)

Front 35

Tx for syringomyelia

Back 35

Syringosubarachnoid shunt (surgical)

Front 36

Diagnosis of Duchenne's MD

Back 36

Serum creatine phosphokinase

DNA testing

Front 37

Contralateral loss of pain and temperature

Ipsilateral hemiparesis

Ipsilateral loss of position/vibration

Back 37

Brown-Sequard (spinal cord hemisection)

Front 38

Tracts affected in syringomyelia

Back 38

Lateral spinothalamic tracts

Front 39

Tracts affected in Brown-Sequard

Back 39

Spinothalamic
Corticospinal
Dorsal columns

Front 40

Lower extremity weakness or plegia
Back pain
Sensory deficits below level of lesion
Sphincter disturbance (urinary retention)

Back 40

Transverse myelitis (often after viral infection)

Front 41

Causes of Horner's syndrome (ipsilateral ptosis, miosis, anhydrosis)

Back 41

Idiopathic (most common)
Pancoast tumor (superior sulcus)
Internal carotid dissection
Brainstem stroke
Cervical spine injury

Front 42

Asymmetric muscle weakness, absent DTR, atrophic/flaccid muscles, normal sensation

Back 42

Poliomyelitis

Front 43

Aphasia is more common when which hemisphere is involved?

Back 43

Left

Front 44

Visual spatial deficits are more common when what hemisphere is involved?

Back 44

Right

Front 45

Crossed hemiplegia (ipsilateral face and contralateral body) can be localized where?

Back 45

Brainstem (corticospinal tract, dorsal columns, spinothalamic tract cross but CN do not)

Front 46

Spinal cord injury - how to localize?

Back 46

Level of lesion corresponds to sensory level (pinprick felt above level but not below)

Front 47

Localize this lesion:

Weakness, atrophy, sensory deficits in dermatomal pattern, +/- fasciculations and diminished DTRs

Back 47

Roots (radiculopathy) or
Peripheral nerves

Front 48

Meniere's disease

Back 48

Vertigo
Tinnitus
Hearing loss

Front 49

Differences between central and peripheral vertigo:

Back 49

Central: gradual onset, mild intensity, associated neurologic findings, mild nystagmus (multidirectional and vertical)

Peripheral: Sudden onset, severe intensity, rapidly refractory, unilateral vertical nystagmus

Front 50

Tilt-table testing used for

Back 50

Dx neurocardiogenic syncope (if episodes are recurrent, unexplained, no structural heart disease)

Front 51

Causes of epilepsy

Back 51

4 Ms:
Metabolic (Hyponatremia, uremia)
Mass lesions
Missing drugs (withdrawal, noncompliance)
Misc (pseudoseizures, eclampsia, hypertension)

4 I's:
Intoxications
Infections
Ischemia
Increased ICP

Front 52

Features of simple partial seizures

Back 52

Consciousness intact
May involve transient unilateral clonic-tonic movements

Front 53

Features of complex partial seizures

Back 53

Consciousness impaired
Postictal confusion
Automatisms
Olfactory/gustatory hallucinations

Front 54

Impaired consciousness, no loss of postural tone or continence, no postictal confusion

Back 54

Absence seizures

Front 55

Labs to order in unfamiliar seizing pt

Back 55

Serum glu, Ca, sodium, BUN

Front 56

Drugs of choice for generalized tonic-clonic and partial seizures

Back 56

Phenytoin, carbamazepine

Phenobarbital, valproate, primidone

Front 57

Drugs of choice for petit mal (absence) seizures

Back 57

Ethosuximide
Valproate

Front 58

ALS affects what areas?

Back 58

UMN/LMN:
Anterior horn cells
Corticospinal tracts
Corticobulbar

Front 59

Progressive muscle weakness first noted in legs/arms, no associated pain, muscle atrophy

Exam findings: Muscle cramps and spasticity, fasciculations, impaired speech/swallowing, wt loss/fatigue, DOE/orthopnea

Back 59

ALS

Front 60

Normal and unaffected even in late stages of ALS

Back 60

Bowel/bladder control
Sensation
Cognitive fx
EOM

Front 61

Seen on EMG in myopathy

Back 61

No electrical activity at rest, but amplitude decreases with mm conraction

Front 62

EMG findings for MS, GBS

Back 62

Decreased nerve conduction velocity

Front 63

Riluzole MOA

Back 63

Glutamate-blocking agent used to delay death in ALS (3-5 mo)

Front 64

Receptive, fluent aphasia
Impaired comprehension of written or spoken language

Back 64

Wernicke's

Front 65

Broca's aphasia

Back 65

Expressive, nonfluent aphasia
Speech is slow, requires effort

Front 66

Where is lesion?

Aphasia + fluent speech

Back 66

Posterior to central sulcus

Front 67

Where is lesion?

Aphasia + nonfluent speech

Back 67

Anterior to central sulcus

Front 68

Brief, frequent attacks of severe lancinating facial pain

No motor or sensory paralysis

Back 68

THIS IS TRIGEMINAL NEURALGIA

Jaw, lips, gums, maxillary

Front 69

Drug of choice for trigeminal neuralgia

Back 69

Carbamazepine
Baclofen
Phenytoin

Spont resolution in 85% cases

Front 70

Localize lesion:

Weakness is usually observed only in the lower face and tongue; extraocular, upper facial, pharyngeal, and jaw muscles are almost always spared

Back 70

Corticobulbar (unilateral)

Front 71

Localize lesion:

dysarthria, dysphagia, dysphonia, and emotional lability accompany bilateral facial weakness and a brisk jaw jerk.

Back 71

Pseudobulbar palsy (bilateral corticobulbar tracts)

Front 72

Localize lesion:

Homonymous visual field defect

Back 72

Cortical/subcortical

Front 73

Difference in presentation, LMN vs. myopathy

Back 73

LMN = distal weakness

Myopathy = proximal weakness

Front 74

Symmetric weakness of pelvic or shoulder girdle muscles

Back 74

Myopathy

Front 75

weakness of the lower two-thirds of the face with preservation of the upper third suggests?

Back 75

UMN lesion

Front 76

failure of vertical gaze
dysarthria
dysphagia
extrapyramidal rigidity
gait ataxia
dementia

Back 76

Progressive supranuclear palsy

Front 77

In PSP what lobe abnls predominate

Back 77

Frontal lobe

Front 78

Pathology of PSP

Back 78

Atrophy of dorsal midbrain, GP, STN

Front 79

Argyrophilic round intraneuronal inclusions

Back 79

Pick bodies (frontotemporal dementia)

Front 80

Rapidly progressive dementia with pyramidal signs, myoclonus, cerebellar or extrapyramidal signs

Periodic sharp waves in EEG

Back 80

CJD

Front 81

Presence of protein 14-3-3 in CSF

Back 81

CJD

Front 82

HIV associated dementia shows what on MRI

Back 82

Cortical, subcortical atrophy

Front 83

Neuropathy (paresthesias, sensory ataxia, visual loss, orthostatic hypotension), memory loss

Anemia, sore tongue

Back 83

Dementia due to Vit B12 deficiency

Front 84

Lowering ICP

Back 84

Raising head of bed
Hyperventilation
Use of osmotic diuretic

Front 85

Red desaturation can be seen early in what problems?

Back 85

Early optic nerve problems (e.g. optic neuritis)

Front 86

Pupillary constrictor is innervated by?

Back 86

Parasympathetic fibers of third nerve

Front 87

Pupillary dilator is innervated by?

Back 87

Cervical sympathetic system

Front 88

Sympathetic system pathway

Back 88

First order: Ipsilateral posterolateral hypothalamus to intermediolateral cell columns (C8-T1)

Second order: synapse in suprior cervical ganglion (pre-ganglionic)

Third order: Travel along internal carotid artery into cavernous sinus --> pupillodilator muscle

Front 89

Compression of third nerve

Back 89

Dilated pupil (Parasympathetic fibers on outside, motor fibers on inside)

Front 90

Adie's pupil

Back 90

Dilated (interruption of parasympathetic supply from ciliary ganglion)

segmental contraction, light-near dissociation

Front 91

Light-near dissociation

Back 91

Pupillary constriction to light is greater than to near stimulus (NORMAL)

In LND: DEFECT in light response --> constriction to light < near response

Front 92

Adie's pupil (dilated, interrupted parasympathetic supply) can be demonstrated using?

Back 92

0.1% pilocarpine --> contraction in affected pupil > normal pupil

Front 93

"Dimming out" vision, precipitated by changes in posture, can occur many times/day

Back 93

Optic disc swelling

Optic neurotis, ischemia

Front 94

Ilsilateral optic disc atrophy due to compression by space-occupying lesion in frontal lobe and papilledema in contralateral optic disc due to increased ICP

Back 94

Foster-Kennedy syndrome

Front 95

Painful visual loss; worse with exercise/hot baths; retro-orbital pain, loss of color discrimination, central scotoma, variable fundi

Back 95

Optic neuritis (IV methyprednisolone)

Front 96

Asymptomatic; enlarged blind spot with initially normal visual acuity; glistening hyaline bodies in fundi

Back 96

Drusen or pseudopapilledema

Front 97

Morning headache, ataxia, transient visual obscuration, central acuity spared, no color loss, enlarged blind spot, bilateral disc hyperemia

Back 97

Increased intracranial pressure

Front 98

Sudden painless visual loss in pt >50 yo, associated with HTN, DM

Back 98

Ischemia

Front 99

Incomitant gaze (degree of misalignment varies with direction of gaze) suggests what etiology?

Back 99

Neurological (vs. ophthalmologic)

Front 100

Oblique diplopia worse on downgaze when affected eye is adducted

Back 100

CN IV lesion (SO intorts and depresses)

Front 101

Destruction of abducens nucleus in brainstem

Back 101

Complete ipsilateral conjugate gaze palsy (connection to contralateral third nerve through MLF)

Front 102

Inability to adduct right eye in left lateral gaze + nystagmus of abducting left eye

Back 102

R internuclear ophthalmoplegia (MLF lesion)

Front 103

Upgaze disturbance, convergence-retraction nystagmus on attempted upgaze, light near dissociation of pupils

Back 103

Parinaud's

Pineal tumor compressing dorsal midbrain

Front 104

Vestibulo-ocular reflex

Back 104

Rotates eyes in the direction opposite to head movement

Front 105

Voluntary saccades arise from?

Back 105

Frontal eye field and superior colliculus contralateral to direction of gaze

Front 106

Child between 2-7 yo following viral infection presents with acute onset limb, gait ataxia, dysarthria

Back 106

Postinfectious cerebellitis

Front 107

Acute/subacute onset of truncal, gait, limb ataxia; dysarthria; ocular dysmetria or nystagmus associated with cancer

Back 107

Paraneoplastic cerebellar degeneration (gyn or small cell lung cancer --> nl MRI, assoc with autoantibodies)

Front 108

Progressive ataxia in childhood with loss of reflexes, spasticity and extensor plantar responses, impaired vibration and position sense

Back 108

Friedrich's ataxia (AR)

Arms more affected than legs

Front 109

Brief episodes of ataxia, vertigo, nausea, vomiting caused by mutations of?

Back 109

Inherited episodic ataxia (EA-1): voltage gated K channel

EA-2: voltage gated calcium channel --> longer attacks w/ interictal nystagmus and progressive irreversible ataxia later in disease

Front 110

Insidious onset of progressive gait impairment, dysarthria in early adult life with mild-mod cognitive decline later on

Back 110

Spinocerebellar ataxias (CAG expansion)

Autosomal dominant

Front 111

Triad of ATAXIA, AREFLEXIA, OPHTHALMOPLEGIA in postinfectious autoimmune process

Back 111

Miller Fisher syndrome --> ataxia due to proprioceptive loss (not cerebellar dysfx)

Front 112

Cerebellar vermal lesions assoc with?

Back 112

Truncal and gait ataxia

Front 113

Cerebellar hemispheric lesions assoc with?

Back 113

Ipsilateral limb ataxia

Front 114

Affected leg is stiff and does not flex at hip, knee, or ankle

Leg is circumducted (scrape floor with toes)

Arm held in flexion and adduction, does not swing freely

Back 114

Hemiparetic gait

Front 115

Spastic gait with increased adductor tone and legs tend to cross during walking

Back 115

Scissoring gait (paraparetic/bilateral hemiparesis)

Front 116

Electrical-like painful sensation (short paroxysms) in face

Triggered by tactile stimulus

Back 116

Trigeminal neuralgia

Front 117

headache in a young obese woman, worse in AM, worse when recumbent, accompanied by pulsatile tinnitus and blurring precipitated by valsalva maneuver

Back 117

Idiopathic intracranial HTN

(pseudotumor cerebri --> impaired resorption of CSF)

Front 118

Broca's aphasia: where is the lesion

Back 118

Posterior part of inferior frontal gyrus in dominant (left) hemisphere

MCA territory

Front 119

Broca's aphasia - deficits?

Back 119

Impaired fluency
Impaired repetition
Normal comprehension

Front 120

Huntington disease triad

Back 120

Chorea, behavioral change/personality disorder, dementia

Front 121

Diagnosis of Huntington's

Back 121

Family h/x
Clinical signs
Caudate atrophy
>40 CAG repeats

Front 122

Pathology in Huntington's disease

Back 122

Destruction of caudate and putamen (striatal and nigral GABAergic neurons)

Loss of neurons in cerebral cortex

Front 123

Personality change, speech disturbance, inattentiveness, extrapyramidal signs, progressive dementia

Back 123

Pick dementia

Front 124

Rapidly progressive dementia with pyramidal signs, myoclonus, cerebellar or extrapyramidal signs, periodic sharp waves in EEG

Back 124

CJD

Front 125

CSF findings on CJD

Back 125

Normal but presence of 14-3-3- protein (sensitive and specific)

Front 126

Progressive dementia with neuropathy (paresthesias, sensory ataxia, visual loss, orthostatic hypotension), memory loss, anemia, sore tongue

Back 126

Vit B12 deficiency

Front 127

50% theta slow wave activity

Back 127

Stage 1 sleep

Front 128

Sleep spindles and K complexes

Back 128

Stage 2 sleep

Front 129

20-50% delta wave activity

Back 129

Stage 3 sleep

Front 130

>50% delta activity

Back 130

Stage 4 (slow wave sleep)

Front 131

A typical night of sleep

Back 131

4-6 cycles, lasting 90 min each (stage 1 absent after first sleep cycle)

Front 132

REM sleep with age

Back 132

Decreases from 20-25% per night to 15-20% per night

Front 133

REM sleep over course of night

Back 133

REM accounts for greater proportion of sleep as night progresses

Front 134

Drug that suppress stages 3 and 4 of sleep

Back 134

Benzos

Front 135

Drug that suppress REM sleep

Back 135

Antidepressants and alcohol

Front 136

Restless leg syndrome tx

Back 136

Dopaminergic agents e.g. ropinirole, pramipexole

Anticonvulsants, opioids, benzos

Front 137

What can happen to restless leg syndrome symptoms with dopaminergic tx?

Back 137

Augmentation: symptoms occur earlier in the day

Front 138

Narcolepsy components:

Back 138

Excessive daytime sleepiness with narcolepsy, cataplexy, sleep paralysis, hypnagogic hallucinations

Front 139

Pathophysiology of narcolepsy/cataplexy

Back 139

Loss of hypocretin secreting neurons in hypothalamus

Front 140

Dx of narcolepsy

Back 140

CSF with hypocretin <110

Multiple sleep latency test

Front 141

Cataplexy tx with?

Back 141

TCAs clomipramine
Sodium oxabate
SSRIs, atypical antidepressants

Front 142

Foster Kennedy Syndrome

Back 142

Ipsilateral anosmia
Ipsilateral optic atrophy
Contralateral papilledema

Front 143

Tx for chorea

Back 143

Neuroleptics e.g. haloperidol (anti-dopaminergic)

Front 144

Childhood onset of Parkinsonism with bradykinesia and rigidity, dystonia, myoclonus, seizures

Back 144

Westphal variant, Huntington's diease

Front 145

Dystonia

Back 145

Sustained muscle contractions

Front 146

Etiology for dystonia

Back 146

Abnl low basal ganglia output structures

Front 147

Cardinal features of Parkinson disease

Back 147

Tremor at rest
Rigidity
Hypokinesia
Postural instability

Front 148

Sensory involvement in Parkinson disease

Back 148

Loss of sense of smell
Pain
Speech disturbance
Autonomic disturbance
Depression

Front 149

Early onset dementia
Delusions and hallucinations
Fluctuations in consciousness
Myoclonus

Back 149

Dementia with Lewy bodies

Front 150

Supranuclear downgaze palsy and square wave jerks, upright posture, frequent falls

Back 150

Progressive supranuclear palsy

Front 151

Levodopa is broken down peripherally by?

Back 151

Gut: aromatic amino acid decarboxylase (carbidopa inhibits)

Peripheral: COMT (entacapone, tolcapone inhibit)

Front 152

Dopaminergic agent requiring conversion

Back 152

Levodopa

Dopamine agonists e.g. pramipexole, ropinirole, bromocriptine act directly

Front 153

Symptomatic tx in Parkinson's

Back 153

Selegiline, rasagiline (MAO-B inhibitors)

Anticholinergics (trihexyphenidyl, diphenhydramine)

Amantadine (NMDA receptor antagonist)

Front 154

Reduces cardinal features of parkinson's + drug-induced dyskinesias

Back 154

Amantadine

Front 155

Agents causing drug-induced Parkinsonism

Back 155

Antipsychotics, antiemetics e.g. metoclopramide, prochlorperazine

Front 156

Arching spasms of back, neck, stereotypical repetitive movements of tongue, jaw

Back 156

Tardive dyskinesia

Front 157

Risk factors for tardive dyskinesia

Back 157

Advanced age
female gender
Coexistent brain damage

Front 158

Tx for tardive dyskinesia

Back 158

Increased doses of dopamine receptor blockers
Dopamine depletion (reserpine, tetrabenazine)

Front 159

Hemisection of spinal cord produces?

Back 159

Ipsilateral hemiparesis
Ipsilateral loss of fine touch and vibration sensation
Contralateral loss of pain and temperature below level of lesion

Front 160

Anterior cord syndrome

Back 160

Bilateral spinothalamic tract (loss of pain and temp)

Bilateral weakness (corticospinal tract)

Preservation of dorsal columns (fine touch, proprioception, vibration)

Front 161

Central cord syndrome

Back 161

Bilateral loss of pain and temp sensation, weakness of upper extremities (motor fibers to legs are lateral and thus spared).

Preservation of fine touch

Front 162

Complete loss of motor and sensory function of upper and lower extremities + resp difficulty

Preserved reflexes mediated by CNs

Loss of autonomic function

Back 162

High cervical spine cord injury

Front 163

Air in acute EDH suggests?

Back 163

Fracture of sinuses or mastoid air cells

Front 164

Initial evaluation for suspected epidural hematoma

Back 164

Noncontrast CT (homogenous density, high density, convex)

Front 165

Characteristics of delirium

Back 165

Cognitive impairment
Impaired attention
Fluctuating course

Front 166

When is a head CT indicated for concussion?

Back 166

LOC!!!!
Persistent headache
Emesis
Age >60 years
Drugs/EtOH
Persistent anterograde amnesia
Soft tissue or bony injury above clavicles
Seizure

Front 167

Post-concussion syndrome

Back 167

Irritability
Depression
Insomnia
Subjective intellectual dysfx
Anxiety
Fatigue

Front 168

Return to Play - Grade 1 concussion

Back 168

At least 15 min out, assessed at 5 min intervals

Front 169

Return to Play - Grade 2 concussion

Back 169

Removal from game -->return after 1 wk

Front 170

Return to play - Grade 3 concussion (+LOC)

Back 170

ER evaluation --> 1 week if exam nl

2 wks if LOC prolonged

Front 171

Atherosclerosis affects which brain vessels?

Back 171

Carotid bifurcation
Major intracranial vessels
Vertebral artery

Front 172

Lacunar strokes associated with?

Back 172

(small vessels)

Occlusive disease of penetrating arteries in brain

Assoc with HTN, DM

Front 173

Tx of ischemic stroke

Back 173

tPA (within 3 hrs)
Antiplatelet drugs (aspirin, clopidogrel, dipyridamide)

Front 174

Complications of subarachnoid hemorrhage (delayed)

Back 174

Vasospasm
Acute hydrocepalus

Front 175

Imaging type for detecting hyperacute ischemic injury caused by vasospasm

Back 175

Diffusion-weighted MRI

Front 176

Carotid dissection predisposing factors

Back 176

Fibromuscular dysplasia
Ehlers-Danlos
Marfan

Front 177

Carotid dissection often assoc with?

Back 177

Ipsilateral ptosis + miosis (Horner's)

Headache

Recent head/neck injury

Front 178

Drugs for absence seizures

Back 178

Valproate, lamotrigine, ethosuximide, zonisamide

Front 179

Automatisms - e.g. bilateral cycling, swimming movements - with post-ictal period, appear to be awake but do not respond normally to environment

Back 179

Complex partial seizure

Front 180

Seizure with preservation of consciousness (focal), + aura

Back 180

Simple partial seizure

Front 181

Momentary lapses in awareness without automatisms (can have blinking or lip smacking), no aura

Back 181

Absence seizures

Front 182

Aura involving abd sensation, fear, unreality, deja-vu

Back 182

Temporal lobe seizure

Front 183

Aura involving electrical sensation, tingling, numbness

Back 183

Parietal lobe

Front 184

Aura involving visual changes

Back 184

Occipital lobe seizures

Front 185

Characteristic pathologic changes for complex partial seizures

Back 185

Mesial temporal sclerosis

Front 186

SPECT findings for complex partial seizures

Back 186

Hypoperfusion of bilateral frontal and parietal assoc cortex

Hyperperfusion of mediodorsal thalamus and rostral brainstem

Front 187

Acute LOC without nausea, sweating, abd discomfort, regained consciousness quickly without confusion

Back 187

Cardiogenic syncope

Front 188

Causes of syncope

Back 188

Cardiogenic
Exertional (cardiac outflow obstruction)
Vasovagal
Epileptic seizure
Orthostatic

Front 189

Nonepileptic syncope w/u includes

Back 189

ECG, Echo, Holter monitor, orthostatics

Front 190

Unilateral, periorbital/cheek pain
Onset in teens, 20s
Precipitated by fatigue/stress, diet, sunlight, hormones

Dull ache --> stabbing pain
+ Assoc symptoms

Back 190

Migraine

Front 191

Precipitous headache in temporal region, unilateral, pain + stiffness in neck, shoulders, back, pelvic girdle

Back 191

Temporal arteritis (assoc with polymyalgia rheumatica)

Front 192

Post-spinal headache characteristics

Back 192

Better when lying down, can be assoc w/ n/v

Front 193

Sudden pulsatile head pain involving entire head, before or after orgasm

Back 193

Postcoital cephalgia

Front 194

Headache in young obese woman with menstrual irregularities, + visual disturbances

Back 194

Benign intracranial hypertension

Front 195

Sudden orbital or eye pain + n/v beginning after use of anticholinergic meds

Back 195

Acute glaucoma

Front 196

Orbital or neck pain + Horner syndrome after trauma

Back 196

Carotid dissection

Front 197

Headache assoc with brain tumor

Back 197

Typical tension or migraine headache occurring frequently, may wake pt from sleep

+ Focal abnls

Front 198

Sudden onset headache with n/v/ stiff neck, fast decompensation, "worst headache"

Back 198

Subarachnoid

Front 199

Abortive therapy for migraine

Back 199

Triptans
Ergotamine
Dihydroergotamine
Midrin: Isometheptene mucate (vasoconstrictor), dichloralphenazone (muscle relaxant), acetaminophen

Front 200

Triptan mechanism

Back 200

5HT-1D receptor agonists

Front 201

Side effects of triptans

Back 201

N/V
Numbness/tingling


CI if h/o CAD or HTN

Front 202

Prophylactic tx for migraines

Back 202

Anticonvulsants (topiramate)
Beta-blockers (propanolol)
Calcium channel blockers (verapamil)
Antidepressants

Front 203

Chronic daily headache characteristics

Back 203

Headache >15 days/month, >4 hrs/day
H/x of episodic migraines

Front 204

Tx for chronic daily heacahe

Back 204

Removal of acetaminophen or aspirin (analgesic rebound worsens headaches)

Tramadol, propoxyphene (analgesic) - bridging
Anticonvulsants, antidepressants, beta blockers and calcium channel blockers
Botulinum toxin

Front 205

Botox is useful for what types of chronic daily headache?

Back 205

Trigger points of head pain
Cervical pain or spasm

Front 206

Posterior cortical dementia

Back 206

Intellectual functioning lost --> behavior preserved

e.g. Alzheimer's (early involvement of recent memory, language dysfx, apraxia, agnosia)

Front 207

The only "lower neurological fx" to be impaired in early Alzheimer disease

Back 207

Olfaction

Front 208

Imaging in AD shows?

Back 208

Cortical atrophy (parietal, temporal, hippocampal)

Front 209

Degeneration of cholinergic cells projecting from basal forebrain (nucleus basalis of Meynert) to cortex

Seen in?

Back 209

Alzheimer's

Front 210

Insidious decline in cognitive function in pts with cerebrovascular disease (e.g. HTN) --> diffuse subcortical white matter changes on imaging

Back 210

Binswanger disease (vs. STEPWISE decline in multi-infarct)

Front 211

Medical causes of dementia

Back 211

Wernicke encephalopathy (B1)
Vit B12 deficiency
Hypothyroidism
HIV
Neurosyphilis
Normal press hydrocephalus
MS, Huntington, neoplastic

Front 212

Dementia
Executive dysfx
Motor parkinsonism
Fluctuating cognition
Hallucinations
Sensitivity to neuroleptics
Sleep-related disorder

Back 212

Diffuse Lewy Body dementia

Front 213

Paresthesias in hands and feet
Loss of vibratory sense

+ pathological lesions in dorsal columns and lateral corticospinal tracts

Back 213

Subacute combined degeneration (vit B12)

+ beefy tongue, premature whitening of hair, megaloblastic anemia

Front 214

Nerve conduction studies in Vit B12 deficiency

Back 214

Demyelination and denervation

Front 215

Acute, unilateral loss of visual acuity or visual field + ocular pain in a young adult

Back 215

Optic neuritis

Front 216

Optic neuritis is assoc with?

Back 216

Multiple sclerosis
Sjogren
Guillain Barre
HIV infection

Front 217

Optic neuritis tx

Back 217

IV corticosteroids (hasten recovery but have no effect on visual fx or recurrence)

Front 218

Tx for optic neuritis dx in MS

Back 218

Interferon beta 1a

Front 219

Weakness + stiffness
Tingling/pins and needles, numbness, band around torso

Limb tremor, ataxia, scanning speech (cerebellar)

Optic neuritis and trigeminal neuralgia

Back 219

Multiple sclerosis

Front 220

Charcot's triad

Back 220

Intention tremor
Dysarthria
Nystagmus

Front 221

Severe, lancinating maxillary or mandibular pain - brief

Back 221

Trigeminal neuralgia (carbamazepine)

Front 222

Bright lesions on T2-weighted imaging, in corpus callosum and periventricular regions + inferior to tentorium

Back 222

MS

Front 223

Imaging technique to detect MS

Back 223

T2 weighted images
FLAIR (fluid attenuated inversion recovery)
Decreased N-acetylaspartate measured by SPECT


+ CSF - IgG and oligoclonal bands

Front 224

Tx for MS

Back 224

IV steroids (do not decrease future attacks)

Immunomodulation
- Interferon b-1a
- interferon b-1b
- Glatiramer acetate (synthetic polypeptide of myelin basic protein)

Front 225

Tx for MS patient with secondary progressive or worsening relapsing-remitting disease

Back 225

IV mitoxantrone (antineoplastic immunomodulatory agent)

Front 226

Oligoclonal bands are found in?

Back 226

SLE
Neurosarcoidosis
SSPE
Subarachnoid hemorrhage
Syphilis
CNS lymphoma

Front 227

Multiple neurologic symptoms 1-3 weeks post-infection or vaccination in young adult/children

Back 227

Acute Disseminated Encephalomyelitis

Front 228

Pathology of ADEM

Back 228

Perivenular demyelination, relative sparing of axons

(peripheral subcortical cerebral white matter, thalami)

Front 229

Distinguish between MS and ADEM

Back 229

Post-infection
Early-onset ataxia
High lesion load on MRI
Involvement of deep gray matter (thalami)
Absence of oligoclonal bands

Front 230

Tx for ADEM

Back 230

Corticosteroids can shorten duration of disease

Front 231

Mechanism of botulinum toxin

Back 231

Binds presynaptic cholinergic receptors on motor nerve terminals --> inhibit acetylcholine release --> disrupted neurotransmission between nerve and end plate on muscle

Front 232

Cancers that metastasize to brain

Back 232

Lung
Breast
Kidney
Skin
Uterus

Front 233

Non-neoplastic malformations involving neurons and glia near hypothalamus, involving neuroendocrine fx (precocious puberty or acromegaly); pts may experience paroxysms of laughter

Back 233

Hypothalamic hamartomas

(gelastic seizures = paroxysmal laughter)

Front 234

Pt with AIDS and tumor that can directly invade optic nerve

Back 234

Primary lymphoma

Front 235

Hepatic encephalopathy causes changes to what cells?

Back 235

Increased astrocytes

Front 236

HTN encephalopathy will show what CSF changes?

Back 236

Mod increase in CSF protein (<100)

Front 237

Neuro consequence of chronic renal failure

Back 237

Peripheral neuropathy - symmetric, distal, mixed sensorimotor due to axonal degeneration

Improved with dialysis

Front 238

Tx for restless leg syndrome

Back 238

Gabapentin
Clonazepam
L-dopa
Dopamine agonists
Opiates

Front 239

Type of visual field cut seen in vit B12 deficiency

Back 239

Centrocecal scotoma

Front 240

Cancers that metastasize to brain

Back 240

Lung
Breast
Kidney
Skin
Uterus

Front 241

Non-neoplastic malformations involving neurons and glia near hypothalamus, involving neuroendocrine fx (precocious puberty or acromegaly); pts may experience paroxysms of laughter

Back 241

Hypothalamic hamartomas

(gelastic seizures = paroxysmal laughter)

Front 242

Pt with AIDS and tumor that can directly invade optic nerve

Back 242

Primary lymphoma

Front 243

Hepatic encephalopathy causes changes to what cells?

Back 243

Increased astrocytes

Front 244

HTN encephalopathy will show what CSF changes?

Back 244

Mod increase in CSF protein (<100)

Front 245

Neuro consequence of chronic renal failure

Back 245

Peripheral neuropathy - symmetric, distal, mixed sensorimotor due to axonal degeneration

Improved with dialysis

Front 246

Tx for restless leg syndrome

Back 246

Gabapentin
Clonazepam
L-dopa
Dopamine agonists
Opiates

Front 247

Type of visual field cut seen in vit B12 deficiency

Back 247

Centrocecal scotoma

Front 248

Anemia, dermatitis, memory deficits in diet limited to corn

Back 248

Pellagra
(nicotinic acid or tryptophan)

Front 249

spinocerebellar degeneration, polyneuropathy, pigmentary retinopathy - deficiency in?

Back 249

Vit E (early childhood)

Front 250

obesity + hypersomnia + sleep apnea

Back 250

Pickwickian syndrome (hypoxemia, pulm HTN)

Front 251

EEG findings with hepatic encephalopathy

Back 251

Triphasic waves

Front 252

Normal background posterior-dominant rhythm on EEG

Back 252

alpha 8-12 Hz

Front 253

Gait d/o in NPH looks like?

Back 253

Apraxic gait (like Parkinson gait)

Front 254

NPH on CT/MRI

Back 254

Enlarged temporal/frontal horns of lateral ventricles out of proportion to cortical atrophy; blunted frontal horns

Front 255

Language disturbance in Alzheimer's

Back 255

Decreased fluency
Dysnomia
Transcortical sensory aphasia

Repetition intact

Front 256

Type of dementia in Huntington's

Back 256

Subcortical - impaired executive fx and concentration

no aphasia, apraxia, amnesia (classical cortical features)

Front 257

Headache, dementia, psychosis, decreased consciousness, myopathic weakness, delay in relaxation phase of reflexes (hung up reflex), cerebellar ataxia

Back 257

Hypothyroidism

Front 258

Seizures, myoclonus, ataxia, supranuclear gaze disturbance, hypothalamic dysfx, dementia, pendular convergence movements of eyes w/ masticatory mm movement (oculomasticatory myorhythmia)

Back 258

Whipple disease (T. whippelii)

Front 259

Areas affected by progressive multifocal leukoencephalopathy (JC virus)

Back 259

Subcortical white matter - occipital, parietal --> visual complaints, alien hand syndrome

lesions do not enhance

Front 260

Which drugs enhance chorea in Huntington's disease?

Back 260

Dopaminergic (L-dopa, bromocriptine, lisuride)

Front 261

Trihexylphenidyl MOA

Back 261

decreases acetylcholine transmission --> can be used to counteract parkisonian side effects for neuroleptic drugs

Front 262

Blepharospasm, forceful jaw opening, lip retraction, neck contractions, tongue thrusting, idiopathic in 6th decade

Back 262

Meige syndrome

Tx: botulinum

Front 263

Tx for tremor that comes on with action, involves arms/head, diminished with EtOH

Back 263

Beta-blockers
Primidone (anticonvulsant)

Front 264

Side effect of metoclopramide hydrochloride (Reglan)

Back 264

parkisonism, tardive dyskinesia

Front 265

Lhermitte sign

Back 265

Electrical sensation radiating down spine when neck is passively flexed (spinal cord disease, MS)

Front 266

Tx to reduce freq of MS flares

Back 266

Interferon beta-IB
Glatiramer (immunomodulator)

Glucocorticoids to tx acute flare

Front 267

Developmental regression at 6 month, extensor posturing + rigidity, myoclonic seizures (defect in NAA metabolism --> elevated levels in brain), brain has spongiform appearance

Back 267

Canavan disease

Front 268

Symptomatic tx for MS

Back 268

Baclofen (antispasmodic)
Tizanidine (a2-agonist, muscle relaxant)
Benzodiazepine

Front 269

Bilateral optic neuritis + transverse myelitis (paraparesis, bladder/bowel dysfx, sensory deficit)

Back 269

Neuromyelitis optica (more likely to develop relapsing-remitting MS)

Front 270

Male children in first few months of life, + nystagmus, limb tremors, optic atrophy, chorea, seizures, gait ataxia

Demyelination with sudanophilic staining

Back 270

Sudanophilic leukodystrophy (Pelizaeus-Merzbacher disease)

Front 271

Intracranial calcifications that follow gyral pattern of cerebral crotex --> railroad tracks on XR

Back 271

Sturge-Weber

Front 272

Lateral ventricles with typical batwing conformation

Back 272

Agenesis of corpus callosum

Front 273

Children with scaly erythematous rash on face, episodic ataxia

Hartnup disease - deficiency in?

Back 273

tryptophan (precursor for nicotinamide) and other neutral amnio acids

Front 274

Polycystic liver disease
Polycystic kidney disease
Retinal angiomas (telangiectasia)
Cerebellar tumors
Hemangiomas, adenomas, hemangioblastomas

Back 274

von Hippel-Lindau

Front 275

Erythrocytosis with cerebellar signs
Microscopic hematuria
Hepatosplenomegaly

Back 275

Von Hippel Lindau

Front 276

Acanthocytes
Posterior column and spinocerebellar degeneration
Retinitis pigmentosa

Back 276

Abetalipoproteinemia

Front 277

Associated with Arnold-Chiari type 2 (downward displacement of cerebellar tonsils into foramen magnum)

Back 277

Spina bifida

Front 278

Retinal problem assoc with tuberous sclerosis

Back 278

Retinal phakoma (gliomatous tumors)

CNS calcifications, ash-leaf spots, renal tumors, cardiac rhabdomyomas, seizure disorders

Front 279

enlargement of the fourth ventricle; a partial or complete absence of the cerebellar vermis, the posterior midline area of cerebellar cortex responsible for coordination of the axial musculature; and cyst formation near the internal base of the skull.

Back 279

Dandy-Walker malformation

Front 280

Effect of EtOH on developing brain

Back 280

impaired neuronal migration --> MR, learning disabilities, hyperactivity, microcephaly

Front 281

proximal muscle weakness in cancer patient

Back 281

Dermatomyositis (paraneoplastic) - but not assoc with CNS tumors

Front 282

man with problem relaxing grip, hypersomnolence, premature baldness, testicular atrophy, cataracts

Back 282

Myotonic dystrophy

Front 283

EMG pattern for myotonic dystrophy

Back 283

"Dive bomber pattern"

(repetitive discharges with minor conduction defect)

Front 284

Signs of poor prognosis in ALS

Back 284

Facial fasciculations
Diaphragmatic weakness

Front 285

Most common site of CNS atrophy associated with chronic alcoholism

Back 285

Superior vermis

Front 286

organophosphate toxicity

Back 286

Severe motor polyneuropathy (UMN and LMN)

anticholinesterase activity = headache, vomiting, abd cramps, sweating, wheezing

Front 287

Toxic lead exposure

Back 287

Brain edema --> herniation

Low levels = ataxia, tremor, bilateral NEUROPATHIES

Front 288

Pyridostigmine, physostigmine, edrophonium are?

Back 288

Anticholinesterase

Front 289

Atropine is a?

Back 289

Anticholinergic

Front 290

Toxicity:

Personality change, tremor, ataxia in a paper/pulp/electrochemical plant

Back 290

Mercury

Damage to cerebellum, calcarine cortex of occipital lobe (visual field constriction)

Front 291

Toxicity: wrist and finger drops and mild sensory abnormalities in distribution of radial nerves

Back 291

Lead toxicity

+ abd pian, constipation, anemia, basophilic stippling, lead lines along gingival margin

Front 292

Toxicity: Mucosal irritation, hemolysis, tonic-clonic seizures, polyneuropathy, psych changes

Back 292

Arsenic

Front 293

Toxicity: peripheral neuropathy, degeneration of posterior columns/dorsal roots assoc with rye ingestion

Back 293

Ergot

Front 294

Toxicity: Parkinsonism

Back 294

MPTP
Manganese inhalation by miners

Front 295

Toxicity: Confusion, headache, coma/posturing/seizures --> delayed neurologic deterioration with parkinsonian features 1-3 weeks after initial event

Back 295

CO

Hypodensities in globus pallidum

Front 296

Contralateral hemiparesis, retardation, seizures, glaucoma, intracranial calcifications assoc with leptomeningeal angiomatosis

Back 296

Sturge-Weber (port wine stain)

Front 297

Effects of HTN on retina

Back 297

Segmental narrowing of arterioles
Nicking (arteriolar-venular compression)
Arteriolar straightening

Front 298

Retinal microaneurysms are associated with?

Back 298

DM

Front 299

Osteomyelitis of the petrous pyramid leading to abducens and trigeminal nerve injury

Back 299

Gradenigo syndrome (facial pain and diplopia)

Front 300

Trauma to the face is most likely to injure which mm of the eye?

Back 300

Superior oblique (CN 4) --> impaired intorsion of eye --> slight head tilt

Front 301

Eye nerve most likely affected by varicella zoster

Back 301

CN 4

Shares nerve sheath with V1 (herpes zoster spreads to face along trigeminal nerve)

Front 302

MLF syndrome

Back 302

weak adduction of affected eye
abduction nystagmus of contralateral eye

Front 303

Jerky downward motion of both eyes with slow return

Back 303

Ocular bobbing - pontine damage

slower than downbeat nystagmus
+ brief tonic interval before slow return

Front 304

Transient loss of vision caused by disease of arteries - which artery?

Back 304

Internal carotid (emboli)

Front 305

Bilateral dilated pupils in otherwise healthy woman +/- absent tendon reflexes

Back 305

Adie tonic pupil (most often benign; degeneration of ciliary ganglion)

Front 306

Absence of thiamine in EtOHic leads to?

Back 306

Periaqueductal and mamillary body lesions --> autonomic failure

Front 307

Decremental response of muscles to repetitive stimulation of nerve at low frequency

Incremental response to repetitive stimulation at high frequency

Back 307

Botulism

Front 308

Bugs most responsible for meningitis in 6 mo old

Back 308

H. flu
Strep neumo
N. meningitidis

<3 mo old
Group B strep
E. coli
Listeria

Front 309

Signs of cauda equina compression

Back 309

Loss of bowel and bladder control
Paraparesis/paraplegia

Front 310

Deteriorating consciousness, autonomic disturbances (hypotension, hypothermia), ocular motor problems, gait difficulty in an alcoholic

Back 310

Wernicke encephalopathy --> hemorrhagic necrosis

Front 311

Acute severe fever, tachypnea, tachycardia, rigidity --> diffuse segmental muscle necrosis

Back 311

Malignant hyperthermia

Front 312

Fourth nerve palsy (superior rectus)

Back 312

Difficulty looking down and medially (can't go down stairs)

Front 313

Evidence of basilar skull fracture

Back 313

Periorbital ecchymosis (raccoon eyes)
Ecchymosis over mastoid region (Battle sign)
Hemotympanum
CSF rhinorrhea/otorrhea

Front 314

Person with head trauma has multiple punctate hemorrhage on MRI - reason?

Back 314

Diffuse axonal injury - swelling in white matter, corpus callosum, upper brainstem.

Front 315

Tx for trigeminal neuralgia

Back 315

Carbamazepine
Phenytoin
Baclofen

Front 316

Tx for incontinence in MS

Back 316

Imipramine
Oxybutynin (anticholinergic)

Front 317

Tx for spasticity

Back 317

Baclofen
Tizanidine

Front 318

Tx for status epilepticus

Back 318

Lorazepam/Diazepam IV
+ phenytoin in conjunction to prevent relapse (IV)

Front 319

Tx of glioblastoma multiforme

Back 319

Complete gross resection + radiation therapy