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Neurology > Week 2 > Flashcards

Week 2 Flashcards

1
Q

Through what mechanism does hyperventilation reduce ICP?

A

hyperventilation lowers PaCO2 and the cerebrovasculature responds, through autoregulation, by constricting

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2
Q

What is the classic description of pain secondary to lumbar spinal stenosis?

A

pain in the low back and legs accompanied by sensory changes that are exacerbated by extension of the spine and relieved by flexion

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3
Q

What is the classic triad of Wernicke’s encephalopathy?

A

altered mental status, ataxia, and oculomotor dysfunction

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4
Q

Describe the two types of breath-holding spells.

A
  • cyanotic: crying followed by breath holding, cyanosis, and LOC
  • pallid: minor trauma followed by breath holding, pallor, diaphoresis, and LOC
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5
Q

What are the symptoms of spinal cord compression? What are the most important steps in management?

A
  • early signs include progressive pain, symmetric weakness, hypoactive DTRs
  • pain is worse when lying down in contrast to DJD because the position leads to distention of the epidural venous plexus
  • late signs include sensory loss, hyperreflexia/babinski reflex, paraplegia, and loss of rectal sphincter tone
  • should start with glucocorticoids, an emergent MRI, and surgical consult
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6
Q

Mumps may cause what three infectious diseases?

A

meningitis, parotitis, and orchitis

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7
Q

The acute treatment of MS is what?

A

steroids with plasma exchange for refractory cases

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8
Q

What is the treatment for botulism?

A

equine serum heptavalent botulinum antitoxin

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9
Q

What is the classic tetrad of symptoms and treatment of neuroleptic malignant syndrome?

A
  • fever, confusion, rigidity, and autonomic instability

- treat with dantrolene and dopamine agonists

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10
Q

What focal deficits are suggestive of a vertebrobasilar stroke?

A

an alternating syndrome of contralateral hemiplegia and ipsilateral cranial nerve deficits with or without ataxia

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11
Q

Describe the two significant risk factors, clinical features, workup, and treatment of cerebral palsy.

A
  • risk factors are prematurity and low birth weight
  • it presents with non progressive motor dysfunction, most often including hypertonia, hyperreflexia, and equinovarus deformity
  • an MRI is the best first test followed by EEG and genetic or metabolic testing
  • treat with PT/OT, nutritional support, and antispastic medications
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12
Q

In what order should testing be done for a first time seizure?

A
  • begin with lab work
  • perform a CT if there is a risk for acute neurologic problems
  • follow this with an MRI and EEG to evaluate for potential etiologies of the stroke
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13
Q

Describe the genetics, pathogenesis, and structural changes that account for Huntington’s disease.

A
  • it is an autosomal dominant CAG trinucleotide repeat
  • this leads to a loss of GABA-ergic neurons
  • and imaging will show atrophy of the caudate nucleus and putamen
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14
Q

What are the symptoms of Huntington’s disease?

A
  • chorea which may initially appear as restlessness or patients may assimilate the movements into purposeful actions
  • other neurologic signs may include hyperreflexia and delayed initiation of voluntary saccades
  • executive dysfunction and psychiatric disturbances are also present
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15
Q

What are considered abortive and preventative medications for migraine headache?

A
  • abortive: NSAIDs, triptans, antiemetics, and ergots

- preventatives: topiramate, propanolol, TCAs, and valproate

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16
Q

How does a history of substance abuse affect your management of acute pain?

A
  • it shouldn’t affect the agents you choose, and opioids are still acceptable when indicated
  • instead, you should focus on close follow-up care of these patients to avoid relapse
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17
Q

What is Riluzole?

A

a glutamate inhibitor approved for treatment of ALS

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18
Q

Describe the workup and treatment of myasthenia gravis.

A
  • workup may include an edrophonium test or icepack test but acetylcholine receptor antibody assay is most specific
  • management should include a CT to evaluate for thymoma, possible thymectomy, and an acetylcholinesterase inhibitor with or without immunotherapy
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19
Q

Describe the presentation of Guillain-Barre.

A
  • often preceded by an URI or diarrheal illness
  • presents with bilateral leg weakness that ascends and leads to flaccid paralysis
  • accompanied by loss of reflexes and autonomic dysfunction
  • distal paresthesias are common but other sensory symptoms are uncommon
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20
Q

What does the CSF look like for those with Guillain-Barre?

A
  • the key feature is albuminocytologic dissociation (elevated protein with normal white cell count)
  • RBC and glucose levels should also be normal
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21
Q

Describe the symptoms and signs of lead poisoning.

A
  • presents with GI upset, neurologic deficits, and anemia
  • labs will show microcytic anemia, hyperuricemia, elevated venous lead level, elevated serum zinc proptoporphyrin level, and basophilic stippling on peripheral smear
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22
Q

What is the treatment for lead poisoning?

A

calcium disodium EDTA

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23
Q

What is the most common cause of CN III palsy?

A

ischemia secondary to diabetes mellitus

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24
Q

Describe the presentation and treatment of fibromyalgia.

A
  • presents with widespread pain, fatigue, and cognitive or mood disturbances with normal physical exam apart from point tenderness
  • treatment involves aerobic exercise, good sleep hygiene, and TCAs
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25
Q

Which four drugs are used to improve cognition in those with Alzheimer’s?

A
  • donepezil
  • rivastigmine
  • galantamine
  • memantine
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26
Q

What are the features of NF1?

A
  • cafe au lait spots
  • clustered freckles in the axilla and inguinal area
  • lisch nodules
  • optic gliomas
  • neurofibromas
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27
Q

Describe the presentation of Meniere disease.

A
  • recurrent episodes of vertigo lasting 20 minutes or more

- accompanied by sensorineural hearing loss, tinnitus, and a feeling of fullness in the ear

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28
Q

Describe the presentation of benign paroxysmal positional vertigo.

A
  • brief episodes of vertigo triggered by head movement

- nystagmus is elicited with the dix-hallpike maneuver

29
Q

Describe the presentation of vestibular neuritis.

A
  • an acute, single episode of vertigo that lasts days
  • typically following a viral syndrome
  • will have an abnormal head impulse test
30
Q

Describe the vestibulopathy caused by aminoglycosides.

A
  • since the vestibular organs are impacted bilaterally, there is not significant vertigo
  • instead patients have oscillopsia, a sensation of objects moving around in the visual field when looking in any direction, secondary to a deficient VOR
  • this often leads to gait disturbance and is accompanied by ototoxicity
  • on exam, head impulse test is abnormal
31
Q

Describe the key lab and imaging finding consistent with primary CNS lymphoma.

A
  • EBV DNA in the CSF is highly specific

- MRI will show a weakly ring-enhancing, solitary, periventricular mass

32
Q

What are the two preferred agents for treating essential tremor?

A

propanolol and primidone

33
Q

Describe the presentation, diagnosis, and treatment of optic neuritis.

A
  • presents with monocular vision loss, eye pain with movement, red desaturation, and an afferent pupillary defect
  • fundoycopic examination is typically normal
  • diagnosis is made with MRI of the orbits and brain
  • treat with IV corticosteroids
34
Q

What is the treatment of Guillain-Barre syndrome?

A

IVIG or plasmapheresis, there is no role for steroids

35
Q

In which form of dementia can haldol and other typical antipsychotics not be given for agitation?

A

DLB because these patients exhibit neuroleptic hypersensitivity and are likely to develop severe parkinsonism and impaired consciousness

36
Q

What is the most common cause of intraparenchymal hemorrhage?

A

hypertensive vasculopathy leading to charcot-bouchard aneurysms which later rupture

37
Q

What are the presenting symptoms of pseudotumor cerebri?

A

headache, transient visual symptoms, and pulsatile tinnitus

38
Q

What disease should be suspected if a patient presents with bilateral trigeminal neuralgia?

A

multiple sclerosis

39
Q

What are the characteristic aspects of vascular dementia?

A

a stepwise decline with early executive dysfunction and focal neurologic deficits

40
Q

Describe the pathogenesis and presentation of Friedreich ataxia.

A
  • it is an autosomal recessive GAA trinucleotide repeat
  • it presents with predominately neurologic dysfunction, including dysarthria, loss of reflexes, ataxia, and loss of vibration and position sense
  • associated features include cardiomyopathy, diabetes mellitus, kyphoscoliosis, and yes cavus
41
Q

What is acute cerebellar ataxia?

A

a syndrome of ataxia, nystagmus, and dysarthria which has an acute onset following infection

42
Q

What is the most common brain tumor in children?

A
  • low grade, pilocytic astrocytomas

- however, medulloblastomas are the most common posterior fossa tumor in children

43
Q

What is the most common brain tumor in children? What about in the posterior fossa?

A
  • low grade, pilocytic astrocytomas

- however, medulloblastomas are the most common posterior fossa tumor in children

44
Q

Describe the fundoscopic findings consistent with retinal artery and retinal venous occlusion.

A
  • arterial occlusion manifests as a whitened retina and a cherry red fovea
  • venous occlusion manifests with dilated and tortuous veins leading to scattered and diffuse hemorrhages, disk swelling, and cotton wool spots
45
Q

What is the most significant risk factor for stroke?

A

hypertension

46
Q

How is heat stroke defined?

A

by temperature greater than 104F/40C and CNS dysfunction

47
Q

What gross change does the brain undergo during status epilepticus?

A

cortical laminar necrosis

48
Q

What is the most common cancer to metastasize to the brain?

A

lung cancer

49
Q

What are the anti platelet guidelines following stroke?

A
  • should initiate aspirin therapy if not already taking this
  • if patients had a stroke on aspirin, add clopidogrel or dipyridamole
  • for patients with an intracranial larger-artery atherosclerosis, use aspirin and add clopidogrel for 90 days before discontinuing
50
Q

When should aspirin be given following ischemic stroke and why?

A

it should be given within 24 hours because it is the only anti platelet agent that is effective at reducing the risk of early recurrence of ischemic stroke

51
Q

Describe the algorithm for treating cancer pain.

A
  • begin with NSAIDs and acetaminophen
  • then add weak opioids like codeine, hydrocodone, and tramadol
  • then add short-acting strong opioids like morphine and hydromorphone
  • if patients require frequent dosing or dosing doesn’t last though the night, add oxycodone or fentanyl patches
52
Q

Capsaicin is a topical medication useful for treating what kind of pain?

A

neuropathic pain

53
Q

Intraparenchymal brain hemorrhage is most often secondary to what? What brain structure is usually involved and how does this present?

A
  • most often secondary to hypertension
  • usually involves the basal ganglia/putamen with the cerebellum coming second
  • presents with contralateral hemiparesis and hemisensory loss, homonymous hemianopsia, and gaze palsy
54
Q

Name three interventions that help prevent SIDS.

A
  • supine sleeping position (“Back to Sleep” campaign)
  • avoid exposure to cigarette smoke
  • don’t bed-share
55
Q

How is metastatic cancer to the brain treated?

A
  • surgical resection is preferred for solitary lesions
  • for multiple lesions, whole brain radiation is preferred
  • chemotherapy is only used when the primary cancer has been shown sensitive (e.g. SCLC)
56
Q

Describe the pathogenesis, presentation, and treatment of cephalohematomas.

A
  • they are subperiosteal hemorrhages that occur in neonates secondary to birth trauma
  • presents as scalp swelling that is firm, contender, without skin discoloration, and which doesn’t cross suture lines
  • most cases are uncomplicated and require no intervention but as the blood breaks down, the newborn is at increased risk for hyperbilirubinemia
57
Q

What is caput succedaneum and how can it be differentiated from cephalohematomas?

A
  • it is a swelling of the scalp superficial to the periosteum and galeal aponeurosis
  • unlike cephalohematomas it tends to cross suture lines and be present at birth rather than having a delayed presentation
58
Q

What is a subgaleal hemorrhage and how does it present?

A
  • it is a collection of blood between the periosteum and aponeurosis secondary to shearing of the emissary veins during delivery
  • it presents as a fluctuant scalp swelling that can move, cross suture lines, and will expand for days; typically accompanied by pallor and tachycardia
59
Q

What is a blepharospasm?

A

a form of focal dystonia which consists of bilateral and symmetric contraction of the orbicularic oculi, often in response to bright lights and relieved by light touch

60
Q

Alcoholic cerebellar degeneration typically presents in what way?

A

with progressive gait dysfunction, truncal ataxia, nystagmus, intention tremor, and dysmetria

61
Q

Describe presbycusis.

A

better known as age-related hearing loss, it is progressive bilateral and symmetric high-frequency sensorineural hearing loss secondary to degeneration of the inner ear or cochlear division of CN VIII

62
Q

Pulsatile tinnitus is suggestive of what two conditions?

A

either vascular malformations or pseudo tumor cerebri

63
Q

Single brain abscess are almost always attributable to which two pathogens? Why?

A

to viridian’s streptococci or S. aureus because they tend to extend from adjacent tissue infection

64
Q

What are the symptoms of uncle herniation?

A
  • ipsilateral hemiparesis from compression fo the contralateral crus cerebri
  • mydriasis and CN III palsy from compression of the oculomotor nerve
  • contralateral homonymous hemianopsia from compression of the ipsilateral PCA
  • altered consciousness from compression of the RAS
65
Q

Herpes zoster reactivation in the trigeminal nerve leads to what?

A

it most often affects the V1 branch leading to herpes zoster ophthalmic and potentially blindness

66
Q

Trigeminal neuralgia is caused by what?

A

compression of the trigeminal nerve root

67
Q

Within the brainstem, are motor or sensory nuclei positioned more laterally?

A

sensory nuclei tend to be more lateral

68
Q

Describe the etiology, presentation, diagnosis, management, and potential complications of mastoiditis.

A
  • it is most often due to Strep. pneumo as a complication of otitis media
  • presents with fever, otalgia, deviation of the ear, and mastoid tenderness
  • diagnosis is made by MRI of the head
  • should be treated with drainage and IV antibiotics
  • complications include CNS infection, facial nerve palsy, hearing loss, and labyrinthitis
69
Q

What are the features of tabes dorsalis?

A

sensory ataxia, lancinating pains, neurogenic urinary incontinence, and Argyll Robertson pupils

Neurology (2 decks)

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