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Neuro review 1
| Question | Answer |
|---|---|
| A 41-year-old female presents to the ED with complaint of sudden onset of "worst headache of my life." A stat CT scan of her head is normal. Next appropriate step to diagnose the patient is: | Lumbar puncture* |
| most common abdominal cancer in children | neuroblastoma |
| To look for brain tumor in a CT, use | Contrast |
| Cranial nerve associated with the Sense of smell | I Olfactory* |
| Cranial nerve that transmits visual information to brain | II Optic* |
| Cranial nerve that innervates superior oblique muscle, which depresses, rotates laterally, and medially rotates the eyeball. | IV Trochlear* |
| Cranial nerve associated with sensation from face and innervates muscles of mastication. V1- ophthalmic. V2- maxillary. V3- mandibular. | V Trigeminal |
| Cranial nerve which innervates lateral rectus (abducts eye) | VI Abducens* |
| Cranial nerve with motor to muscles of facial expression, special sense of taste from anterior 2/3 of tongue, and secretomotor to salivary glands (except parotid) and lacrimal gland | VII Facial |
| Cranial nerve associated with senses sound, rotation and gravity (balance and movement) | VIII Vestibulocochlear |
| Cranial nerve associated with taste from posterior 1/3 of tongue. Secretomotor to parotid gland. Motor to stylopharyngeus. | IX Glossopharyngeal* |
| Cranial nerve associated with motor to muscles of tongue and other glossal muscles. important for swallowing (bolus formation) and speck articulation | Hypoglossal* |
| Cranial nerve that controls sternocleidomastoid and trapezius. Overlaps fxn with vagus. Damage: inability to shrug, weak head movement | Accessory |
| Glasgow comma scale assesses | Eye opening, verbal response, and motor response* |
| Untreated phenylketonuria results in | Mental retardation* |
| Increased muscle tone is called | Spasticity |
| Decreased muscle tone is called | Flaccidity |
| Rigidity that persists throughout the range of motion is called | Lead pipe rigidity |
| MCC of bacterial meningitis in a child less than 4 weeks | Group B strep* |
| MCC of bacterial meningitis in a child 4 to 6 weeks | H. flu, N. meningitides* |
| MCC of bacterial meningitis in a child over 6 weeks | S. pneumonia, N. meningitides* |
| Gold standard for diagnosis of meningitis | Lumber puncture* |
| Degenerative organic mental disease characterized by progressive intellectual deterioration and dementia | Alzheimer's disease |
| Paralysis or weakness of the muscle of the face supplied by the facial nerve | Bell's palsy |
| Demyelization disease of the peripheral nerves causing acute progressive weakness (an ascending paralysis) | Guillain-Barre syndrome |
| An autoimmune disorder of neuromuscular transmissions involving the production of auto-antibodies directed against the nicotinic acetylcholine receptors | Myasthenia gravis |
| First line therapy for myasthenia gravis is | Cholinesterase inhibitors |
| Treat acute cluster headache with | Oxygen and sumatriptan (Imitrex)* |
| Peak incidence of viral meningitis is in | Summertime* |
| Sensorium in encephalitis is | Impaired |
| Sensorium in meningitis is | normal |
| Most common cause of viral meningitis | Enteroviruses* |
| Inflammation in response to bacterial infection of the pia-arachnoid & fluid of the ventricles | Bacterial meningitis |
| Etiology of bacterial meningitis in in adults | Strep. pneumoniae |
| Treatment for bacterial meningitis in ages 3 months to 50 year old | Ceftriaxone & Vancomycin* |
| Involuntary repetitive contraction of agonist & antagonist muscles producing rhythmic oscillation about a joint at a regular frequency | Tremor |
| Treat Parkinson's disease with | Entacapone, carbidopa, levodopa* |
| Inherited disease characterized by dementia & chorea | Huntington's disease* |
| Huntington's disease is a genetic | Autosomal dominant |
| To treat choreoathetosis in Huntington's use | Clonazepam (klonopin)* |
| To treat dyskinesia and/or behavioral problems in Huntington's use | Haloperidol (Haldol) |
| To treat rigidity in Huntington's use | Baclofen (lioresal) |
| To treat depression in Huntington's use | Fluoxetine (Prozac) |
| Ataxia, Babinski sign, & optic neuritis are seen in | Multiple sclerosis* |
| Treat spasticity in multiple sclerosis with | Baclofen (lioresal) |
| Treat neuropathic pain in multiple sclerosis with | Gabapentin (Neurontin) |
| Treat multiple sclerosis with | Methylprednisolone* |
| Treat chronic fatigue in multiple sclerosis with | Amantadine |
| Treat relapsing multiple sclerosis with | Methotrexate & Azathioprine (Imuran) |
| Seizure manifested by focal motor symptoms (convulsive jerking), spread to different parts of the body | Simple partial seizure* |
| Seizure with impaired consciousness and automatisms (lip smacking, chewing) | Complex partial seizure* |
| Paroxysmal loss of consciousness & brief discontinuation of activity followed by abrupt recovery, with no recollection of the event | Absent seizure |
| Brief stare and change in facial expression, < 20 sec | Absence (petit mal) seizure* |
| Epileptic seizure longer than 30 minutes or absence of full recovery of consciousness between seizures | Status epilepticus |
| To treat an acute seizure use | Lorazepam (Ativan)* |
| If seizure persists for more than 5 minutes and Ativan has been given, give | Fosphenytoin (cerebyx) |
| In cerebral vascular disease, an LP will show | Xanthochromia (yellowish color) |
| Abrupt onset of headache associated with stiff neck & photophobia | Subarachnoid hemorrhage* |
| Subarachnoid hemorrhage is bleeding into the | Subarachnoid space |
| "worst headache of my life" | Subarachnoid hemorrhage* |
| The sudden onset of a focal and transient (< 24 hrs) neurological deficit due to brain ischemia | Transient ischemic attack (TIA) |
| Vise like headache | Tension headache* |
| Boring, peri-orbital headache | Cluster headache* |
| Shape of subdural hematoma | Crescent shape* |
| Shape of epidural hematoma | Lenticular hematoma |
| Type of bleed in subdural & epidural hematomas | Subdural - venous; epidural - arterial |
| Nuchal signs in meningitis are | Kernig's and brudzinski's signs* |
| Chronic deterioration of mental function sufficiently severe to interfere with daily living | Dementia |
| HA with aura symptoms | Migraine |
| Classic signs of Migraines | Pulsatile, throbbing |
| Migraine H/A are associated with what hormone imbalance? | Estrogen |
| treat vertigo with | meclizine |
| Headache behind the eyes, painful, lasting 2 hours at night. | cluster |
| A writing cramp | Focal dystonic |
| VIII. Vestibulocochlear Nerves | Hearing and balance |
| XI. Accessory Nerves | Control neck, larynx, and shoulder muscles |
| XII. Hypoglossal Nerves | Control tongue movements |
| Most common intracerebral neoplasm is a | Glioma* |
| Scoliosis treatment at 20 -40 degrees | Brace |
| Wernicke's area is located in the posterior of the | Superior Temporal gyrus |
| Most common solid brain tumor in kids | Astrocytoma* |
| Scoliosis is more common in | Females* |
| extensor hallucis longus (EHL) strength | L5 |
| LR6 SO4 all others 3 stands for | LR6--Lateral rectus (VI abductens) SO4--Superior Oblique ( IV Trochlear) 3--The remaining 4 eyeball movers = III |
| Thymine is given before glucose to prevent | Wernicke Encephalopathy |
| winning of the scapula is due to | Serratus anterior paralysis caused by damage to the long thoracic nerve |
| Define Tenosynovitis | inflammation of a tendon sheath |
| Cranial nerve that is a hook that closes the eyes | Facial (CN 7)* |
| Cranial nerve that are pillars that open the eyes | Oculomotor (CN 3)* |
| If the forehead and eye are not affected in a palsy, think | Stroke |
| Cranial nerve associated with the gag reflex | Vagus (X)* |
| Dermatomes C6 | Thumb |
| Dermatomes T4 | Nipple |
| Dermatomes T10 | Umbilicus |
| Dermatomes L5 | Great toe |
| Dermatomes S5 | Anal sphincter |
| Most common cause of subarachnoid hemorrhage | trauma |
| Most common cause of atraumatic subarachnoid hemorrhage | Ruptured brain aneurysm |
| Thunderclap headache or worst headache of my life | Subarachnoid hemorrhage |
| Brain hemorrhage associated with a lucid interval | Subdural hematoma |
| Bridging vessels tear during trauma in | Subdural hematoma |
| Worst form of cerebal palsy | Spastic quadriplegia |
| Using this medication class will make Guillain Barre syndrome worse | Steroids |
| "The sheets hurt" on my legs | Diabetic neuropathy |
| Ptosis, diplopia, cannot move eyes, weakness of skeletal muscle | Myasthenia Gravis |
| Best test for myasthenia Gravis diagnosis | Acetylcholine receptor anti-bodies* |
| Most common cause of chronic daily headache | Overuse of OTC |
| Treat cluster headaches with | High flow O2 and Imitrex shots* |
| Average age of onset for Multiple sclerosis | 20 to 40* |
| Key presentation for multiple sclerosis | New neurological symptom in a young person* |
| Most common type of multiple sclerosis | Relapsing remitting* |
| "Dawson's fingers" on MRI is classic for | Multiple sclerosis* |
| 20 to 40 y/o female with eye issues and white spots | Multiple sclerosis* |
| Seizure that involves pelvic thrusting is a | Pseudoseizure |
| Whole body convulsions with no pelvic thrusting | Tonic clonic seizure |
| All anti-epilepsy drugs meds contain a black box warning for | Suicide risk |
| This seizure drug should be avoided in women of child bearing age | depakote |
| Major disease of memory impairment in people over 85 yo | Alzheimer's |
| Gold standard test to diagnosis Alzheimer's disease | Brain biopsy |
| Drug class to treat Alzheimer's disease | Acetylcholine esterase inhibitors |
| Memory impairment that is associated with medication | Delirium |
| An action/ postural tremor of the hands | (Benign) essential tremor |
| the hand shakes when you reach for something or a yes or no head bob | (Benign) essential tremor |
| Tremor in Parkinson's is a | Rest tremor |
| Dopamine depletion in the basal ganglia | Parkinson's disease |
| Cogwheel rigidity | Parkinson's disease |
| Most common symptom at presentation of Parkinson's disease | Rest or pillrolling tremor |
| Tyramine restricted diets are required with which medication class | MAOIs |
| Sign where resistance to flexing hip 90 degrees while knee is fully extended | Kernig sign |
| Sign where flexion of the neck causes flexion of the hip | Brudzinski sign |
| Worst form of Spina bifida | Myelomeninocele |
| Test for the optic cranial nerve include | Visual acuity with snellen chart & visual fields by confrontation |
| Test for the Oculomotor cranial nerve include | Extra ocular movements & response to light and accommodation |
| cranial nerve that is a hook that closes the eyelid | Facial nerve (CN 7) |
| Three sensory divisions of trigeminal nerve | Ophthalmic, maxillary & mandibular |
| Motor functions of the trigeminal nerve | Temporal & masseter muscle strength & lateral movement of jaw |
| Motor function of the facial cranial nerve | Symmetry of facial muscles with raising eyebrows, smile, frown, purse lips, puffing cheeks, showing teeth & squeezing eyes shut |
| Sensory function of the facial cranial nerve | Taste sensation to the anterior 2/3 of tongue |
| Function of glossopharyngeal cranial nerve | Taste sensation to posterior 1/3 of tongue |
| Function of Vagus cranial nerve | Sensory innervation of pharynx & larynx; gag reflex |
| Upper motor neuron lesions | Increased tone & spasms, hyperreflexia, Babinski, clonus |
| Lower motor neuron lesions | Flaccid tone, fasciculation's, reduced reflexes |
| Test for coordination (cerebellum) | Rapid alternating movements, pass pointing & heel to shin testing |
| Tests for gait & station include | Posture, ambulation, turning & postural stability |
| Types of ischemic strokes include | Thrombus, embolism or systemic hypoperfusion |
| Types of hemorrhagic stroke include | Intracerebral, subarachnoid & subdural |
| Posterior circulation to the brain includes | Vertebral & basilar arteries |
| Signs & symptoms of anterior carotid circulation stroke | Aphasia, amaurosis fugax, hemiparesis, hemisensory deficit |
| Amaurosis fugax is | Transient monocular blindness |
| Signs & symptoms of vertebrobasilar stroke | Bilateral visual loss, diplopia, ataxia, vertigo, syncope, dysarthria & vomiting |
| Non-modifiable vascular disease risk factors | Age, male, African American, & family history of stroke |
| Modifiable vascular disease risk factors | Smoking, HTN, hypercholesterolemia, diabetes, atrial fibrillation |
| A stroke that affects both sides of the brain or multiple vascular distributions | Embolic stroke |
| MOA Plavix (clopidogrel) | Irreversibly binds P2Y receptor causing impaired aggregation for the life of the platelet |
| Adverse effects of Plavix (clopidogrel) | Rash, bleeding & rare reports of fatal TTP |
| Chronic stroke treatment | Aggrenox, Coumadin or pradaxa |
| Aggrenox is | Dipyridamole 200 mg/ aspirin 25 mg |
| MOA Aggrenox | ASA permanently inhibits thromboxane A2 via cyclooxygenase; dipyridamole limits adenosine uptake into platelet |
| Side effects of Aggrenox | HA, GI intolerance, bleeding |
| MOA of Dabigatran (Pradaxa) | Direct thrombin inhibitor |
| Patients with an acute stroke ipsilateral to a carotid stenosis of 70 - 95% should undergo | Endarterectomy (or stinting) |
| Patients with < 70% carotid stenosis, do | Serial imaging |
| Intracranial hemorrhage risk factors | Age, HTN, pregnancy, black, hemodialysis & amphetamine & cocaine use |
| Risk factors for brain aneurysm | Smoking, HTN, family members |
| Major risk for subarachnoid hemorrhage | Vasospasms & hydrocephalus |
| Tx of subarachnoid hemorrhage | Swallow, seizure prophylaxis & Nimotop (Nimodipine (CCB)) |
| Subdural hematoma will progress to | Chronic hygroma |
| Convex lesion on imaging | Epidural hematoma |
| Causes of cerebral palsy | Prematurity, intrauterine growth restriction, antepartum bleed & placental pathology |
| Define cerebral palsy | A group of non-progressive clinical syndromes characterized by motor and postural dysfunction |
| Spastic syndrome cerebral palsy | Hypertonia, hyperreflexia, clonus, Babinski sign, difficulty initiating individual movements |
| Spastic diplegia cerebral palsy | Affecting the legs |
| Spastic hemiplegia cerebral palsy | Affects more arms then legs, cortical |
| Athetosis | Slow smooth writing movements |
| chorea | Rapid unpredictable movements |
| Dystonia | Repetitive twisting of limbs & trunk |
| Dyskinetic syndromes seen in cerebral palsy | Athetosis, chorea, dystonia |
| Tx of generalized spasms in cerebral palsy | Tizanidine, benzodiazepine, lioresal, dantrium |
| Dorsal rhizotomy | Selective cutting of the dorsal root of the nerve root, interruption of the reflex arc; done in cerebral palsy |
| Cerebral palsy is associated with | Mental retardation, epilepsy & sensory impairment |
| Bell's Palsy | Sudden onset of unilateral facial weakness with hyperacusis, taste changes & post auricular pain |
| Treatment of Bell's palsy | Steroids started within 72 hrs |
| Classic finding of Guillain Barre is | Elevated CSF protein with no white cells |
| MC infections agent to cause Guillain Barre | campylobacter |
| Treatment of Guillain Barre includes | IVIG or plasmapheresis |
| Presentation of diabetic neuropathy | Pain, burning, numbness in legs, Allodynia |
| Allodynia is | The sheets hurt |
| MC muscle to become weak with Myasthenia Gravis | Ocular |
| Myasthenia Gravis | Disorder of the neuromuscular junction in which antibodies bind acetylcholine receptors preventing muscle contraction |
| Presentation of Myasthenia Gravis | Ptosis, diplopia, dysarthria, dysphagia, chewing, neck muscles, & limb muscle weakness |
| Treatment for Myasthenia Gravis | IVIG or plasmapherisis, mestinon |
| MOA of Mestinon (pyridostigmine) | Blocks breakdown of acetylcholine allowing more to stay in neuromuscular junction |
| Treatment of migraine headache | Triptans, ergotomine, antiemetics |
| Prophylaxis drugs in migraine | Propranolol, verapamil, lisinopril, & candesartan |
| Antidepressants for migraine headache | Elavil (amitriptyline) |
| Biggest risk factor for temporal arteritis | Age over 50 |
| Confirm temporal arteritis with a | Biopsy |
| Treatment for giant cell temporal arteritis | Long term steroids |
| Associated features of multiple sclerosis | Sphincter incontinence, depression, fatigue, sexual dysfunction, & cognitive decline |
| Treatment for multiple sclerosis | Interferon Beta |
| Side effects of interferon Beta include | Injection site reactions, flu like syndrome, depression, elevated LFTs & depression |
| Treatment for absence seizure | Ethosuximide, depakote, lamictal & klonopin |
| Treatment for tonic clonic seizures | Depakote, Topamax, Dilantin |
| Side effect of carbamazepine (Tegretol) | Dizzy, somnolence, Has, Hyponatremia, increased LFTs & low WBCs |
| Treatment in Alzheimer's disease | Aricept (Donepezil); Exelon (Rivastigmine); Razadyne (Galantamine) & Namenda (Memantine) |
| Treatment for essential tremor | Propranolol, mysoline, Topamax |
| MOA cardiodopa | Inhibit peripheral metabolism of levodopa into dopamine reducing side effects and allowing it to cross the blood brain barrier |
| Side effects of dopamine | Motor fluctuations, dyskinesia, nausea, somnolence, dizziness, & hallucinations |
| Classic triad of meningitis | Fever, nuchal rigidity & change in mental status |
| Strokes associated with A-fib are more likely to involve | Large cerebral vessels |
| Risk factors for stroke after an MI | Low ejection fraction, A-fib, advanced age, smoking, prior stroke |
| MCC of subarachnoid hemorrhage | trauma |
| Triptans include | Sumitripan, zolmitriptan, rizatriptan |
| MOA of triptans | inhibit release of vasoactive peptides, promote vasoconstriction, & block pain pathways |
| selective agonist for serotonin receptors in cranial arteries | triptans |
| Triptans are used for | Migraine |
| triptans with SSRI & MAOI can lead to | serotonin syndrome |
| ADRs of triptans | AMI type symptoms |
| Cholinesterase inhibitors include | donepezil, rivastigmine, galantamine, tacrine |
| Cholinesterase inhibitors are used for | alzheimer's disease |
| MOA of Cholinesterase inhibitors | increase cholinergic transmission by inhibiting cholinesterase at synaptic cleft |
| first line treatment for parkinson's disease is | levodopa with carbidopa (+/-) entacapone |
| dopamine agonist include | pramipexole, ropinirole |
| anticholinergics include | trihexyphenidyl, benztropine |
| selective MOA B Inhibitors include | selegiline, rasagiline |
| NMDA antagonist | amantidine |
| MOA of levodopa | circulates in plasma to BBB where it crosses & is decarboxylated to dopamine |
| Levodopa is metabolized in the periphery by what 2 enzymes | dopa decarboxylase & Catechol-O-methyl-transferase (COMT) |
| ADRs of parkinson therapeutics include | N/V, anorexia, orthostatic hypotension, vivid dreams, hallucinations, delusions, confusion, sleep disturbance |
| ADRs associated with Levodopa | On-Off syndrome & wearning off phenomenon |
| Anti-Epileptic drugs include | Phenytoin, Carbamazepine, Valproate, Gabapentin, Lamotrigine |
| Use of phenytoin | prevention of seizures following head trauma /NS |
| ADRs of Phenytoin include | Gingival Hypertrophy, fetal hydantoin syndrome, fetal anticonvulsant syndrome, SJS, Vit D deficiency, osteomalacia, drug fever, hepatotoxicity, nystagmus, death |
| Uses of carbamazepine | bipolar disorder, chronic pain syndromes, trigeminal neuralgia, seizures |
| ADRs of carbamazepine | SJS, Bone marrow suppression, drug fever, Vit D deficiency, osteomalacia, neural tube defects, IUGR |
| Uses of Valproic acid | mania associated with bipolar disorder, migraine prophylaxis |
| ADRs of Valporic acid | Hepatotoxicity, Hepatic failure, neural tube defects, increased riks of impaired cognitive function at 3 years |
| Uses of Gabapentin | postherpetic neuralgia |
| ADRs of Gabapentin | sedation |
| Uses of Lamotrigine | manage/ treat bipolar disorder |
| ADRs of Lamotrigine | Rash; SJS/TEN |
| Cushings triad is | HTN, respiratory depression & bradycardia |
| Cushings triad (reflex) relates to | Brain stem compression |
| Close contacts of patient with bacterial meningitis are given | Rifampin |
| Drug of choice for absence or petit mal seizure | Ethosuximide or valproic acid |
| Normal pressure hydrocephalus presents with | Dementia, gait disturbance & urinary incontinence |
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