Pretest Neurology I

Front 1

Increased T1 signal in wall of left carotid artery caused by?

Back 1

carotid dissection - also causes sx of horner's syndrome

Front 2

def of T1 vs T2 weighted images?

Back 2

see: http://www.mribhatia.com/basicmritf1/index.html
in general:
T1 = denser material = brighter while T2 = denser material darker (think T2=2D's = dense=dark)
So if CSF < Gray matter < white matter < bone (in density) then:
T1 =csf = very dark, gray m=dark, white m=bright, bone = very bright
T2 = dense=dark so csf = very bright, gray m = bright, white m = dark, bone = very dark

Front 3

MS-like presentation in 5-8 y/o who then recovers after 6 mo and may/may not ever have another episode, while may have residiual sx. MRI shows subcortical or white-gray jxn hyperdensities like in MS, as well as periventricular hyperdensities?

Back 3

ADEM
acute disseminated encephalomyelitis

Front 4

Is T2 specific for demyelination?

Back 4

NO,
but may be used ie in MS to follow PROGRESSION of demyelination.
remember, T2 shows MS lesions as bright spots around periventricular space...
also t2 = 2D's = dense=dark

Front 5

triad of parkinsons?

Back 5

cogwheel rigidity,
resting tremor (can be elicited by distraction)
bradykinesia (shuffling gait, etc)
NOT weakness!

Front 6

types of tremors and causes?

Back 6

1 'resting tremor' = lost when distracted = due to substantia negra lesion ie parkinsons
2 'intention/kinetic tremor' = presnet upon performing task = cerebellar disease
3 tremor w/unspecific findings = may be due to spinal cord lesion

Front 7

ohter causes of choreiform movements besides huntington's?

Back 7

HUNTINGTON'S
RhD
Wilson's disease (hepatolenticular degenration)

Front 8

s/e's of phenytoin? normal levels of phyntoin?

Back 8

HI GLAND:
Hןirsutism
Impaired judgment
Gum hyperplasia/hypertrophy
Lethargy
Ataxia
Nystagmus (lateral="gaze evoked")
Dysarthria

AND arrhythmias if given in FAST IV infusion!!
normal levels = 20-30mg/dL

Front 9

impaired convergence caused by?

Back 9

normally w/ age
injury to midbrain

Front 10

weakness developing in proximal muscles causing difficulty getting up off toilet, seats, etc?

Back 10

primary muscle disease ie
poliomyelitis
OR
MG, Lambert Eaton

Front 11

tuning fork on forehead =? on ear?

Back 11

WEber test
Re?

Front 12

origin of purely vertical nystagmus?

Back 12

usually CENTRAL

Front 13

causes of nystagmus?

Back 13

idiopathic
congenital (it goes w/DS, # Albinism
# Aniridia
# Leber's congenital amaurosis
# Bilateral optic nerve hypoplasia
# Bilateral congenital cataracts
# Rod monochromatism
# Optic nerve or macular disease
# Persistent tunica vasculosa lentis.

acquired:
# Benign Paroxysmal Positional Vertigo [5]
# Head trauma
# Stroke (the most common cause in older people)
# Ménière's disease and other balance disorders
# Multiple sclerosis
# Brain tumors
# Wernicke-Korsakoff syndrome
Horners\

Toxicities:
# Alcohol intoxication (see above)
# Lithium
# Barbiturates
# SSRIs
# Phenytoin (Dilantin)
# Salicylates
MDMA = ecstasy

CNS:
* Thalamic hemorrhage
* Tumor
* Stroke
* Trauma
* Multiple sclerosis
* Cerebellar ataxia

Front 14

m/c lumbo/sacral nerve compressions? sx/signs?

Back 14

S1 (slipped disc =L5-S1)
and
L5 (disc= L4-L5)

sx = px in buttocks radiating down to back of leg/lat foot parasthesia (if L5)
signs = DECREASED achilles reflex due tto decr sensation in tendon reflex,
Px / compression elicited causing inability to do raise leg to 30deg on straight-leg testing

Front 15

compression radiculopathy affects nereve at which levels for cervical vs. l/s radiculopathy?

Back 15

BOTH = compression of nerve # that corresponds to Vert body BELOW the nerve's exit ie if b/w L4-L5, = L5 compression, and if C1-C2 = C2 compression. this is b/c in cervical spine, most slipped discs are lateral herniations and they impinge on the cervical nerves that exit laterally at level of vb below them (C2 exits b/w C1 and C2)
However, in the L/S region, nerves actually exit at level below their vbodies ie L5 actually exits BELOW L5 vb and b/wL5 and S1. HOWEVER, in the l/s region, compression usually occurs due to POSTERIORLATERAL herniation, causing impingement of the nerve still descending but entering lateral region of canal...thus, an L4-L5 slipped disc will herniate posteriolaterally and impinge on the nerve descending, this nerve exits b/e L5 and S1 and is thus L5...so L4-L5 slipped disc ALSO causes compression of nerve corresponding to lower vb = L5 (even though this nerve doesnt leave SC until it reaches L5-S1. Confusing?

Front 16

bilat decreased abduction of eyes ...imediately think?

Back 16

increased ICP!! -> causes stretching of both CN VI's (although can also cause unilateral)

Front 17

what's a hollenhorst plaque?

Back 17

atheroembolic lesions of chol/calcified deposits seen in retinal arterioles due to ath disease, seen along w/vision loss

Front 18

absent of retinal venous pulsations?

Back 18

15% normal
rest is pathological, due to INCREASED ICP!!!!

Front 19

Vertigo Workup:

Back 19

1) r/o dizziness by hx
2) r/o central causes ie brainstem stroke or posterior fossa hemorrhage disease by neg hx for vision changes, sudden onset, diplopia, dysarthria, weakness, impaired consc.
3) r/o ortho hotn by testing (hypovol, htn meds, and cv/autonomic disorders cause >10mmHg change from supine to sitting)
4)Do positional testing = normally see nystagmus but if DELAYED by 2-5 secs, and accompanied by vertigo, think peripheral lesions...if vertical and/or does not adapt/habituate w/repeated testing then think CENTRAL

Front 20

causes of peripheral vertigo?

Back 20

1) BPPV: intense, occurs w/changes of position, usually abates if pt stays still

2)vestib neuritis = inflammation (idio or viral) of v ganglia or nerve = intense vertigo weeks-months

3) Meniere's disease: due to excess pressure in endolymphatic system recurrent episodes of vertigo w/progressivley worsening hearing loss...tx= diuretics or salt restricton...if bad = surgery or gentamycin on side of affected ear to ablate vestib function!!
4) Acoustic neuroma = vertigo (more like "unsteadiness" though)+ hearing loss;

5)

Front 21

causes of cnetral vertigo?

Back 21

vbasilar isch or infarct affecting vestib nucleus
hemorrhage in bstem
encephalitis
tumors
demyelination
drugs/toxins ie gentamicin ('unsteadiness')
anemia
thyroid disorders
epileptic seizures involving parietal regions

Front 22

common severe cause of horner's?

Back 22

carotid dissection!!

Front 23

horner's syndrome vs. CNIII lesion/palsy?

Back 23

H: mIosis, ptosis (less prominent than cn III lesion), and anhydrosis (NOT seen if INTERNAL carotid dissection)
CNIII: myDriasis (psns disruption) + unopposed LR and SO (dilated, down and out), + Ptosis (more pronounced b/c affects lev palpebrae's innervation vs horner's affects symp stim to muscle only)

Front 24

describe blood findings on CT?

Back 24

blood is more dense than CSF, even more dense than gray or white matter! thus, a blood clot caused by subdural hematoma will show as a hyperdense crescent shaped mass on CT.

Front 25

subarachnoid hemm suspected...workup?

Back 25

brain CT...if normal still do LP for xanthacromia or elevated csf rbc's or incr opening pressure

Front 26

infectious cause of RBC's in CSF?

Back 26

herpes encephalitis

Front 27

tx for subarachnoid hemorrhage?

Back 27

Do cerebral angiogram and get neurosurg consult

Front 28

meningioma tx?

Back 28

surg resection...
possible anti-estrogens if due to brcxr/gyncxr but not tamoxifen b/c it paradoxically stim's meningioma growth!

Front 29

type II nfibrmoatosis? type I

Back 29

Cafe aulait spots
neurofibromatoses
acoustic neuromas
meningiomas


affects chrom 22

Front 30

causes of dysdiadokinesis?

Back 30

think children: cerebellar tumors
adults: MS, or parkinsons causing motor problems that affect ability to move and thus affect alternating movements

Front 31

lying w/eyes closed in dark room = what type of brain waves?

Back 31

alpha waves = 8-13Hz

Front 32

L occip lobe and splenium of corpus callosum lesion causes what sx?

Back 32

Alexia (can't read) w/o agraphia (cant write)

Front 33

workup of suspected CVA? tx?

Back 33

do Brain CT!!! if find lesion and do not find hemorrhage, and IF w/in 3 hrs of sx, give thrombolytic therapy (tPA)

Front 34

incr blood CPK + ESR levels + proximal muscle weakness + EMG abnormalities indicating primary muscle disease?

Back 34

think dermatomyositis or polymyositis:

Front 35

dermatomyositis vs polymyositis?

Back 35

d: + violet colored skin rash on extensors ie knuckles and jts,
andon muscle biopsy, differences:
dermato = perifascicular inflammatory (macrophage/lcyte) infiltration) while poly = wi/in the fascicules/fibers of muscles

Front 36

after what time does the CT for SAH decrease in sensitivity?

Back 36

up to 12 hrs detects 98% but then sensitivity decreases...so need to do LP also and look for xanthochromia = yellow pigment due to b/d of rbc's and release of bilirubin =yellow/green pigment

Front 37

increased ICPin obese woman that's pregnant or w/ hypervitaminosis?

Back 37

pseudotumor cerebri

Front 38

is there a risk to doing LP if suspect pseudotumor cerebri?

Back 38

no..LP does not cause herniation

Front 39

sx of pseudotumor cerebri?

Back 39

incr ICP in overweight woman, w/ hich CSF opening pressure but no other LP findings

Front 40

paradoxical pain in areas of recent sensory loss due to stroke?

Back 40

think thalamic stroke = thalamic pain syndrome...onset of px in areas of recent sensory loss

Front 41

nucleus ambiguous contains motor nuclei of what cn's? where is it located?

Back 41

9, 10...
located in ventrolateral medulla

Front 42

multiple hemorrhages seen on MRI via increasd hemosiderin (incr due to rbc b/d by macrophages) deposits in multiple places in brain, in elderly >70 adult?

Back 42

amyloid angiopathy = b amyloid (same as in alzheimers) causes weakening ov vessel walls...hemorrhage, etc.

Front 43

sah seen in iv drug user?

Back 43

suspect mycotic aneurysm rupture- do LP!!

Front 44

cortical lesion that does NOT change with enhanced vs unenhanced CT?

Back 44

blood hematoma...

Front 45

adr of lamotrigine if given to fast?

Back 45

severe rash!!

Front 46

what antiepileptic drug should you give to post cva pt who has seizures?

Back 46

give phenytoin b/c is fast acting

Front 47

diff b/w diffusion weighted imaging and CT?

Back 47

ct may not detect ischemic changes occuring for even up to 4-6 hours after event, while dwMRI is sensitive after even 5-10 mins

Front 48

m/c site for hematoma formation after hemorrhage from lenticulostriate vessel?

Back 48

putamen

Front 49

charcot-bouchard aneurysm?

Back 49

occurs in l/s vessels affecting: cnucleus, thalamus, pons, cerbellum, putamen, etc.

Front 50

m/c cause of SAH/brain hemorrhage under 40? 40-60?

Back 50

bleed from av malformation , m=w
over 40 w>m,= ruptured aneurysm

Front 51

size required for CT to pick up aneurysm?

Back 51

>5mm

Front 52

what does mycotic aneurysm mean?

Back 52

any bacterial/infectious agent causing decr vessel wall strength and causing aneurysm

Front 53

CN III deficit + headache: think what area of lesion?

Back 53

think brainstem: wehre III exits = just above pons, where pcomm (m/c) as well as post cerebral art or sup cerebelar art are...so aneurysm in any of these would produce cn III sx.

Front 54

tx for SAH?

Back 54

nimodipine = decreases chance of stroke
+ refer to neurosurgery!

Front 55

% of carotid stenosis pts w/ TIA's, txed by medication, that will still go on to have stroke?

Back 55

26%!

Front 56

LEFT VS RIGHT mlf syndrome vs bilat MLF?

Back 56

left mlf = mlf which innervates left MR is deficient therefore can't look RIGHT with your left eye.
right: cant look left with your right eye
both: cant move medially past midline w/either eye

Front 57

26% w/carotid stenosis >70% on meds still have stroke...what % if do carotid endarterectomy?

Back 57

after surgery = 9% will still have stroke!!

Front 58

aphasia cuased by parietal lobe hemorrhage, and causing difficulty repeating sentences but not difficulty understanding them?

Back 58

conduction aphasia

Front 59

most common remaining sx of broca's aphasia

Back 59

problem w/ syntax = constructing full sentences ...pt can use simple words but not full sentences

Front 60

language deficit often seen in severe hotn ie after MI?

Back 60

causes watershed infarct of MCA and PCA = diffuse neuronal death b/w frontal and temporal lobes = MIXED TRANSCORTICAL APHASIA=pt only repeats what is said to him, but no comprehension or spontaneous speech

Front 61

first language deficit often seen in dementia?

Back 61

anomia = difficulty naming things, while everything else w/ langauge is intact (repetition, comprehension, fluency

Front 62

broca's aphasia- like but with preserved repetition?

Back 62

transcortical motor aphasia ie due to small frontal embolic stroke

Front 63

wernicke's aphasia-like with preserved repetition?

Back 63

transcortical sensory aphasia ie due to lesion underelying cortex of wernicke's area, in white matter

Front 64

reason why IV lorazepam is better than IV diazepam for status epilepticus?

Back 64

b/c although both have rapid onset, IV L is long acting so doesn't need to be supplemented w/ phenytoin for prevention of seizures hours later

Front 65

antiepileptic that may cause arrhythmias if given in fast infusion?

Back 65

phenytoin

Front 66

simple partial seizure workup?

Back 66

MUST rule out focal brain lesion! do brain CT/ MRI! IF negative, then do EEG/holter to dx simple partial seizure if possible.

Front 67

diff b/w onset of delirium tremens and alcohol w/drawl seizures?

Back 67

dt = 2-4 days after w/drawal
seizures= w/in 24 hrs after w/drawal

Front 68

infantile spasms plus parosxymal flexions of body and profoundly disorganized EEG ("Hypsarrhythmia")

Back 68

West syndrome

Front 69

pt w/ hx of west syndrome (infantile spasms) who begnis to have mental decline w/ seizures of 1-2Hz generalized spike-wave discharges?

Back 69

Lennox-Gastaut syndrome

Front 70

m/c cause of myoclonic seizures?

Back 70

BJME benign juvenile myoclonicepilepsy = sx of involuntary jerkign when waking up in kids...also may be triggered by light flashes or loud sounds (think cats)

Front 71

persistent FOCAL motor sei\ure ie hand keeps twitching for hours ie after surgical procedure

Back 71

epilepsia partialis continua

Front 72

longterm tx for complex partial seizures in young women?

Back 72

carbamazepine or pheynytoin but cuases hirsutism, gingival hyperplasia, IGLAND, etc.

Front 73

infantile spasms + retardation + hypsarrhythmia (abnormal, variable eeg changes)

Back 73

West syndrome -a generalized seizure disorder

Front 74

Tx for West Syndrome?

Back 74

ACTH... and vigabatrin

Front 75

Tx for absense seizures?

Back 75

ethosuximide, if cannot use, give vproic acid

Front 76

Tx for preeclampsia (seizure prevention)? tx for abating an eclamptic seizure in pregger

Back 76

both= mgso4
if eclampsia and baby is term , also, deliver, c-section if necessary!

Front 77

hemicranial throbbing, aura, nausea, vomiting, photophobia, phonophobia = what type of migraine?

Back 77

classic

Front 78

headache very severe w/ blindness or vis changes and or irritbility to frank psychosis, and even transient quadriplegia?

Back 78

basilar migraine!!

Front 79

lancinating jaw pains, often triggered by cold drinks/icecream, etc? tx?

Back 79

trigeminal neuralgia
tx = carbamazepine or phenytoin/gabapentin(other anticon's won't work!!)

Front 80

what other nerol disease is trigem neuralgia often cuased by?

Back 80

MS!!!, also acoustic schwannomas, basilar aneurysms, posterior meningiomas, etc = "symptomatic trigeminal neuralgia"

Front 81

LOS (loss of sens) over forehead along with ophthalmoplegia + intense sharp pain in and about the eye?

Back 81

Tolosa Hunt syndrome = inflamm dise of sup orb fissrure or cav sinus. spares pupillary fxn

Front 82

constant, deep pain of face, not stabbing/lancinating?

Back 82

atypical face pain

Front 83

tx to abort vs longterm prophylaxis of migraine?

Back 83

abortive: triptans, ergotamine
metoclopromide, NSAIDs, aspirin
proph: TCAs, propanolol, verapamil, vpacid

Front 84

when to give longterm prophyl for migraines?

Back 84

if more than 2 /month

Front 85

tx for fever, wt loss, incr esr, thickened temp artery?

Back 85

=temp arteritis
corticosteroid therapy (as for other vasculitides)

Front 86

csf finding in pseudotumor cerebri?

Back 86

NORMAL EXCEPT elevated opening pressure

Front 87

sx of, tx for pseudotumor cerebri?

Back 87

sx: hache, progressive vision loss, tinnitis, diplopia, shoulder and arm pain.
tx: lp, vpshunt, optic nerve sheath fenestration

Front 88

median nerve hand distribution sensory?

Back 88

the M plus thumb= 2nd, 3rd, 4th (1/2) digits + thumb

Front 89

median innervated muscles of hand|? Ulnar?

Back 89

all hand muscles = ulnar except lateral 2lumbricals and 3 thenar muscles- fpb, oppp, abdpb (addpb=ulnar)

Front 90

wrist drop...what nerve?

Back 90

compression of radial nerve (extensors) = "saturday night palsy" seen in alcoholics laying for long pds and compressing nerve

Front 91

if suspected subdural hematoma NON acute, what imaging and why?

Back 91

do MRI b/c CT scan may miss blood b/c by 3-5 days it has degraded into less dense fluid and may look just like brain tissue

Front 92

common neurolog problem seen in ppl on renal dialysis?

Back 92

chronic subdural hematoma!!

Front 93

coup injuries of brain?

Back 93

inferior frontal lobes and ant temporal lobe contusions

Front 94

tx for spinal cord injury?

Back 94

high dose iv methylprednisolone

Front 95

when must methylprednisolone be given after sc injury to have effect?

Back 95

w/in 8 hrs

Front 96

von Economo's encephalitis (e lethargica) has what inital effects? later?

Back 96

initial =disturbed eye movements...m/c sequela = severe, unremitting parkinsonism

Front 97

sarcoidosis has what neurolog effect?

Back 97

facial paresis! due to cn VII involvement w/o sensory loss

Front 98

poliomyelitis vs GB?

Back 98

pm = purely motor loss due to ant horn cell destruction by virus.
GB = autoimmune demyelination triggered by GI/resp inf.
both = ascending lower limb motor loss;
difference: CSF in GB has high protein (up to 500) but few cells. while PM = high protein AND high wbc' (lcytes). also, gb may have sensory loss while PM (like ALS) has only motor loss

Front 99

The lack of muscle, a high arch, and hammer toes are signs of the genetic disease.

Back 99

Charco-Marie-Tooth disease = demyelinating periph nerve disease affecting motor and sensory of feet

Front 100

m/c fungal meningitis in AIDS pt or i/c pt? Abscess in same?

Back 100

think cryptococcus neoformans
abscess = aspergillus

Front 101

puerto rican comes in w/ parapearesis?

Back 101

S. mansoni

Front 102

csf exam in CJakob disease?

Back 102

normal, mildly elevated protein
if test for protein 14-3-3 = proteinase resistant protein (Prp), positive

Front 103

recurrent meningitis m/c due to?

Back 103

csf leak ie through cribiform- hx of rhinorrhea or ears - otorrhea

Front 104

best CT to look for abscess or tumor?

Back 104

contrast ct

Front 105

m/c cause of ring enhancing lesions of brain in aids pt?

Back 105

toxo
AIDS lymphoma (do EBV PCR on CSF fluid)

Front 106

if need to do CSF check , but afraid of mass effect due to icp?

Back 106

may do ventricular CSF aspiration!

Front 107

tx for AIDS toxo inf of brain

Back 107

sulfadiazine and pyrimethamine

Front 108

PML is caused by? in aids pt, tx?

Back 108

JC virus! tx = HAART but prognosis is poor

Front 109

tx for hsv encephalitis?

Back 109

IV acyclovir

Front 110

csf findings in HSV encephalitis?

Back 110

incr protein
RBC's / xanthocromia. . .!!
and incr lymphocytes

Front 111

ameobic meningoencephalitis is caused by?

Back 111

acanthamoeba, hartmanella..
LETHAL form = Naegleria fowleri = brain eating amoeba!! caught when swimming in warm freshwater...

Front 112

undercooked pork ingestion or fecal contamination - causing cysts in brain? what organism?

Back 112

cysticercosis = Taenia Solium

Front 113

what diseases of brain have microglial nodules?

Back 113

CMV encephalitis - subependymal and subpial nodules
+ periventricular calcif.
HIV nodules: nodules around blood vessels throughout brain

Front 114

m/c means of spread of infection to brain causing abscess?

Back 114

blood, from lungs, heart, sinuses, ears

Front 115

tx of CMV retinitis?

Back 115

gancyclovir

Front 116

tx of rabies?

Back 116

supportive; immunization against rabies immediatley

Front 117

anti parkinsons drugs?

Back 117

amantadine,
dop agonists ie pramipexole

Front 118

how does neurosyphilis mimic brain tumor?

Back 118

gumma in brain looks like a tumor (is actually very rare)

Front 119

rabies tx?

Back 119

patients receive one dose of human rabies immunoglobulin (HRIG) and five doses of rabies vaccine over a twenty-eight day period. One-half the dose of the immunoglobulin is injected in the region of the bite, if possible, with the remainder injected intramuscularly away from the bite.

Front 120

also is the m/c cause of osteomyelitis and otitis externa in aids pt? m/c brain abscess in aids pt?

Back 120

aspergillus (also causes abscess i brain along w/ cryptococcus, candida, mucor,)...but m/c cause of abscess in brain in aids pt is TOXO

Front 121

m/c sx of brain abscess?

Back 121

headache!!

Front 122

most common pathogen of brain abscesses?

Back 122

strept..aer and anaer...but in aids pt = toxo

Front 123

an inherited disease that causes progressive damage to the nervous system resulting in symptoms ranging from gait disturbance (progressive staggerign and falling, onset before age 25) and speech problems to heart disease (afib, tc, hocomp)

Back 123

friedrich's ataxia

Front 124

6 mo onset of dementia, tremor, ataxia, and myoclonus in pt w/ basal ganglia increased T2 signals bilaterally,

Back 124

spongiform encephelopathy =CJacob's disease!

Front 125

tx for listeria monocytogenes meningitis

Back 125

amp and gent

Front 126

meningitis often seen in pts w/renal failure/ renal tplant, and i/c pts?

Back 126

list monocytogenes

Front 127

person receives growth hormone supplement..what brain disease may pt get?

Back 127

prions!!
gh is often prepped from cadavers

Front 128

cause of pml

Back 128

jc virus

Front 129

m/c cause of position sense loss

Back 129

dm neuropathy

Front 130

progressive loss of cognitive fx intelligence, and umn signs in child who had measles in past, with oligoclonal bands and increased igG fraction in csf?

Back 130

Subacute sclerosing panencephalitis...worsk like MS but demyelniation destruction is due to measles virus.

Front 131

what is bacillary angiomatosis? tx?

Back 131

neurovascular proliferative skin lesion seen in hiv pts with b henslea (cats) or b qintana (lice) encephalitis...affects pulvinar of posterior thalamus!

Front 132

v-H-L disease?

Back 132

tumors in multiple orgnas: brain, sc, retina - hemangioblastomas
retina -multiple angiomatoses
kidney and pancr - cysts
rcc
pheo

Front 133

m/c source of mets to brain?

Back 133

lung

Front 134

what ends up lodging in the gray-white jxn?

Back 134

bact from brian abscesses
seeds from cancerous spread

Front 135

precocious puberty + paroxysms of laughter (gelastic seizures) in kid?

Back 135

hypothalamus hamartoma

Front 136

hypopituitarism and visual field changes in kids?

Back 136

craniopharyngiomas - arise in the 3rd vent and sellar turcica

Front 137

cause of death in pts with posterior fossa tumors?

Back 137

transtentorial herniation or transforaminal herniation

Front 138

clear, yellow-brown,[3] oval to round, dome-shaped papules that project from the surface of the iris. These nodules typically do not affect vision, but are very useful in diagnosis.[1] They are detected by slit lamp examination.

Back 138

lisch nodules of NF type I

Front 139

NF I vs II?

Back 139

NF I is classic disease:
cafe au lait spots
skin hamartomas
lisch nodules (eye freckles)
Pheo (HTN) / Wilm's tumor (HTN)
optic gliomas

NF II:
acoustic schwannomas
bilateral tumors

Front 140

4 signs of parinaud's syndrome?

Back 140

vertigal gaze impairment,
large irreg pupils not reacting to light but to accomodation
eyelid abnorms = bilat lid retraction
OR bilat ptosis
impaired convergence or conv-retraction nystagmus (eyes rhythmically converge, retract into orbit on attempted upward gaze)

Front 141

parinauds syndrome seen in what 2 conditions?

Back 141

pineal region tumors,
obstr hydrocephalus causing dilation of suprapineal recess of third vent

Front 142

hydrocephalus may cause what in nkids?

Back 142

bilat setting sun sign - eyes deviated inward due to cn 6 palsies and downward b/c parinaud's syndrome

Front 143

woman w/ cancer develops progressive gait disturbances, dysmetria of limbs, wide based gait, and hypermetric saccades?

Back 143

paraneoplastic cerebellar degeneration - due usually to small cell lung cxr -
sending antibodies to cerebellum - causes eventual cerebellar atrophy
other sx = myoclonus, opsoclonus, diplopia, vertigo

Front 144

what antibodies are seen in br cxr /gyn subtype of paraneoplstic cerebellar degen (PCD)

Back 144

anti Yo = anti purkinje cell ab's

Front 145

sx of hypercalcemia?

Back 145

DECREASED muscle activity, decr reflexes, proximal weakness, and nausea, vomiting, lethargy...(ALL these are same for lambert-eaton syndrome)

Front 146

lambert eaton vs myasthenia gravis?

Back 146

LE is worse in morning, better in evening vs MG is opposite
LE also has xerostomia = dry mouth
LE also spares face

Front 147

underlying mech of Lambert Eaton?

Back 147

loss of fxn of voltage gated Ca channels at nmj due to autoantiboides IgG

Front 148

brain cells lost in hepatic failure?

Back 148

due to toxic metabolites, ASTROCYTES are lost
also, if alcoholic or b1 (thiamine) def, purkinje cells of cbl are lost

Front 149

ANY rapid increase in bp causing >210/112 mmHg?

Back 149

HYPERTENSIVE ENCEPHALOPATHY:
also see creberal edema,
papilledema,
retinopathy,
pot for intracerebral bleed
proteinuria, azotemia (BUN: Cr ratio <15)

Front 150

m/c neurological finding in Chronic renal failure?

Back 150

peripheral neuropathy

Front 151

tx for restless leg syndrome?

Back 151

clonazepam

Front 152

most reliable tx for peripheral neuropathy of chronic renal disease?

Back 152

renal transplant!

Front 153

acroparasthesia, sensory ataxia memory loss, and impotence, UMN signs in all extremities, sensorimotor neuropathy, anemia, and sore tongue, gastritis?

Back 153

b12 deficiency!!! chronic atrophic gastritis may be initial cause! look for anemia (pernicious)

Front 154

what lab tests must be done for any dementia?

Back 154

TSH for hypothyroidism
and B12

Front 155

B12 cofactor involved in what conversions?

Back 155

methylmalonyl CoA -> succinyl CoA
and
Homocysteine -> methionine

Front 156

what look for in urine for B12 def? in blood?

Back 156

methylmalonyl CoA!! and
in blood: low B12 and high homocysteine

Front 157

what tracts are affected in B12 def?

Back 157

lateral corticospinal= all extremity UMN signs: spasticity, rigidity, incr reflexes, incr primitive reflexes
posterior column = decr in vibratory and proprio (pos Romberg) sense
Spinocerebellar tracts = sensory ataxia
ALSO
LMN's are affected causing sensory+motor peripheral neuropathy

so in sum, may be confusing picture w/ both UMN signs first and later LMN (flaccidity, low reflexes due to periph neuropathy)

Front 158

loss of central vision (centrocecal scotoma) due to?

Back 158

optic neuritis of MS OR vit B12 deficiency OR
alcohol-tobacco excess causing B1+B12+riboflavin def = deficiency ambylopiaת OR אtert syphilis OR lebers optic atrophy (mito disease xlinked rec) OR IF ACUTE ONSET = methyl alcohol ingestion!

Front 159

periph neuropathy in pt tx'd for cough, pneumonia, hemoptysis, wt loss?

Back 159

TB tx INH causes decr B6..
so ALWAYS give pyridoxine (b6) when giving antiTB drugs!!

Front 160

diarrhea, dermatitis (hyperpig in sun affected regions ) and dementia in person who is veg and eats lots of corn? what def?

Back 160

pellagra!!!!! = Low B3=niacin =nicotinic acid b/c B3 levels are low in corn.

Front 161

hypersomnia + recnet onset obesity, also seen w/ OSA?

Back 161

OHS: obesity hypoventilation syndrome= Pickwickian syndrome = pulm htn caused by hypoxia from shallow breathing due to obesity -> plum htn also causes cor pulmonale, chf, etc in this!

Front 162

herpes encephalitis in non-i/c pt USUALLY presents first with?

Back 162

psychiatric changes! then -->complex partial seizure w/ olf aura, -> gen seizures, etc.

Front 163

what is marcus gunn pupil?

Back 163

= afferent pupillary defect (problem in optic nerve II sensing light, or retina sensing light, etc. ->positive swinging flashlight test =when given light, affected eye DILATES from being constricted before (as does unaffected/unilluminated) and both stay normally dilated...then when light swings to unaffected eye, both constrict normally : seen in MS

Front 164

classic example of light-near dissoc?

Back 164

argyll robertson pupil;
also part of parinaud's syndrome

Front 165

fetid odor and unconsciousness?

Back 165

= sign of metabolic disturbance:
prob due to drug/toxin od /suicide attempt causing hepatic encephalopathy ie CCl4 poisoning, etc

Front 166

normal adult EEG has background of? alzheimers? CJ disease?

Back 166

Alpha activity at 8-12 hz
alz= slowed backround, generalized
cj= spike and wave discharges

Front 167

28% of pt w/hydroceph who undergoes VP shunt may have what complic

Back 167

subdural hematoma!! b/c decr pressure allows brain to pull away from cranium and allows tearing of bridging vns

Front 168

drugs for alzh?

Back 168

achei's
tacrine (but s/e = hepatic dysfxn)
donepezil
and
memantine (other mech)

Front 169

type of aphasia seen in alzh dementia?

Back 169

transcortical sensory aphasia = diff understanding complex linguistic phrases; no problem repeating phrases

Front 170

cj disease sx?

Back 170

initial blurry vsion, diplopia, other vision changes
ataxia
cog decline
myoclonus
incr T2 signal at basal ganglia on MRI

Front 171

neurosyphilis CSF changes?

Back 171

lymphocytes predominate
slighly elevated protein! ie 150

Front 172

pendular convergence movements ofthe eyes in association with contractions of masticatory muscles ? dx?

Back 172

oculomasticatory myorhythmia due to Whipple's disease (T. whippelii)

Front 173

alien hand syndrome...dx?

Back 173

think PML in aids pt b/c affects subcortical regions of parietal/occipital lobes = visual illusions /phenomena.

Front 174

pt gets flu,then gets disturbed eye movements, then chorea, then parkinson type sx?

Back 174

post-flu parkinsonism = NOT reversible!! rare, seen in vonEconomico's encephalitis during Flu epideic of 1918-26

Front 175

huntington's anticipation effect occurs if gene passed down by mother or father? why?

Back 175

father - b/c sperm have incr chance of mutagenesis

Front 176

huntington's chorea may be unmasked by giving what?

Back 176

l-dopa

Front 177

progressive damage to substantia negra caused by what substance? = what disease? what distinguishing feature?

Back 177

use of high potency opiate MPTP
causes parkinsonism but evolves over weeks to months..!!