Neuro Flashcards - Neurology Concepts
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Questions and Answers

What is the next best step in diagnosis for a patient with 32F and paresthesias in the thenar region of the hand?

  • Electrophysiological testing (correct)
  • Tinel sign
  • Phalen maneuver
  • Flick test

    • What is the first treatment for carpal tunnel syndrome in a patient who cannot stop the offending activity?

  • Triamcinolone injection
  • NSAIDs
  • Wrist splint (correct)
  • Surgery

    • What is the treatment for cubital tunnel syndrome?

    Elbow splint

    What is cubital tunnel syndrome?

    <p>Ulnar nerve entrapment at the elbow</p> Signup and view all the answers

    What is Guyon canal syndrome?

    <p>Ulnar nerve entrapment at the wrist</p> Signup and view all the answers

    In a midshaft fracture of the humerus, which nerve is injured?

    <p>Radial nerve</p> Signup and view all the answers

    In a supracondylar fracture of the humerus, which nerve is injured?

    <p>Median nerve</p> Signup and view all the answers

    In a medial epicondylar fracture, which nerve is injured?

    <p>Ulnar nerve</p> Signup and view all the answers

    In a surgical neck of humerus fracture, which nerve is injured?

    <p>Axillary nerve</p> Signup and view all the answers

    What nerve injury is caused by a mastectomy leading to a post-operative winged scapula?

    <p>Long thoracic nerve</p> Signup and view all the answers

    Which muscle is innervated by the long thoracic nerve?

    <p>Serratus anterior</p> Signup and view all the answers

    What is the diagnosis for a 6-year-old with ECG showing miscellaneous arrhythmia and seizure-like episodes?

    <p>Adam-Stokes attack</p> Signup and view all the answers

    In a 75-year-old patient with episodes of loss of consciousness and a history of MI, what is the diagnosis?

    <p>Syncope</p> Signup and view all the answers

    What is the diagnosis for a patient with 33F + 1-week history of right-sided weakness + left-sided inability to feel temperature/pain + diminished vibratory sensation over right foot + brisk right-sided reflexes + right-sided Babinski sign?

    <p>Brown-Sequard syndrome secondary to viral infection.</p> Signup and view all the answers

    What is the most likely reason for a 59F patient with metastatic cancer who expresses wanting to die?

    <p>Inadequate pain control.</p> Signup and view all the answers

    What is the next best step in management for a 42F patient with a 3-month history of insomnia and discomfort while lying in bed?

    <p>Check serum iron and ferritin levels.</p> Signup and view all the answers

    What is the next best step in management for a 42F with insomnia and normal serum iron and ferritin?

    <p>D2 agonist - i.e., pramipexole or ropinirole.</p> Signup and view all the answers

    What disease is a patient with restless leg syndrome at increased risk for later in life?

    <p>Parkinson disease.</p> Signup and view all the answers

    What is the diagnosis for a 58M who loses consciousness while shaving and has a tilt-table test showing no abnormalities?

    <p>Carotid sinus hypersensitivity.</p> Signup and view all the answers

    What is the diagnosis for a 45F with hard exudates, cotton wool spots, and scattered hemorrhages seen on fundoscopy?

    <p>Diabetic retinopathy.</p> Signup and view all the answers

    What medication can cause tardive dyskinesia that is not an antipsychotic?

    <p>Metoclopramide.</p> Signup and view all the answers

    Which anti-depressant medication can cause seizures?

    <p>Bupropion.</p> Signup and view all the answers

    What is the most likely cognitive deficit after a frontal lobe injury in a car accident?

    <p>Conceptual planning.</p> Signup and view all the answers

    What does B1 administration decrease most significantly in a 56M with alcoholism and acute intoxication?

    <p>Anterograde amnesia.</p> Signup and view all the answers

    What is the treatment for a 56M with a 3-day history of alcohol withdrawal who develops tremulousness?

    <p>Chlordiazepoxide.</p> Signup and view all the answers

    What is the diagnosis for a 50F with high ESR, creatine kinase (CK), and proximal muscle weakness?

    <p>Polymyositis.</p> Signup and view all the answers

    What is the diagnosis for a 50F with high ESR, muscle pain, and stiffness but no mention of high CK or weakness?

    <p>Polymyalgia rheumatica (PMR).</p> Signup and view all the answers

    What is the main difference between PMR and polymyositis?

    <p>PMR has no proximal muscle weakness and a normal creatine kinase; polymyositis has high CK and weakness.</p> Signup and view all the answers

    What is the next best step in diagnosing polymyositis?

    <p>Anti-Jo1/-Mi2 antibodies or electromyography and nerve conduction studies.</p> Signup and view all the answers

    What is the diagnosis for a 59F with temporal headache, muscle pain, stiffness, and high ESR?

    <p>Temporal arteritis.</p> Signup and view all the answers

    What is the next best step in diagnosing a 68M with a history of prostate cancer now presenting with neurologic findings?

    <p>MRI of the spine.</p> Signup and view all the answers

    What is the next best step for a 65F with breast cancer and neurologic findings?

    <p>Intravenous high-dose dexamethasone.</p> Signup and view all the answers

    What is the diagnosis for a 72M with prostate cancer presenting with neurologic findings?

    <p>Epidural spinal cord compression.</p> Signup and view all the answers

    What is the next best step for a patient with brain cancer?

    <p>Steroids.</p> Signup and view all the answers

    What is the gold standard for diagnosing brain cancer?

    <p>Contrast head CT.</p> Signup and view all the answers

    What is the best method to diagnose a brain bleed?

    <p>Non-contrast CT.</p> Signup and view all the answers

    What is the next best step after a CT confirms an epidural hematoma?

    <p>Intubation and hyperventilation.</p> Signup and view all the answers

    What is the next best step after a CT confirms a subdural hematoma?

    <p>Craniotomy.</p> Signup and view all the answers

    What differentiates an epidural hematoma from a subdural hematoma on CT imaging?

    <p>Epidural hematoma appears as a lens-shaped bleed; subdural appears crescent-shaped.</p> Signup and view all the answers

    What is the diagnosis and treatment for a patient with blood pressure of 220/120 and confusion?

    <p>Hypertensive encephalopathy; give IV sodium nitroprusside.</p> Signup and view all the answers

    What is the diagnosis for a patient with BP of 220/120 after sodium nitroprusside is administered who experiences confusion?

    <p>Cyanide toxicity caused by nitroprusside.</p> Signup and view all the answers

    What drug can be given to prevent vasospasm after subarachnoid hemorrhage (SAH)?

    <p>Nimodipine.</p> Signup and view all the answers

    What is the diagnosis for severe headache and stiff neck?

    <p>Subarachnoid hemorrhage (SAH).</p> Signup and view all the answers

    What is the diagnosis for a brain bleed in a patient with Alzheimer’s?

    <p>Amyloid angiopathy (intracerebral hemorrhage).</p> Signup and view all the answers

    What is the next best step for an 87F with Alzheimer’s, low-grade fever, and delirium?

    <p>Do a urinalysis to look for UTI as a cause of delirium.</p> Signup and view all the answers

    What is the diagnosis for a viral infection with tinnitus, vertigo, and possible neurosensory hearing loss?

    <p>Labyrinthitis.</p> Signup and view all the answers

    What is the diagnosis for a viral infection accompanied by vertigo?

    <p>Vestibular neuritis.</p> Signup and view all the answers

    What is the treatment for an acute flare of multiple sclerosis (MS)?

    <p>IV steroids.</p> Signup and view all the answers

    What is the treatment between flares of MS when the patient is asymptomatic?

    <p>Interferon beta (IFN-beta).</p> Signup and view all the answers

    What is the treatment for spasticity in MS?

    <p>Baclofen.</p> Signup and view all the answers

    What type of incontinence is most common in MS?

    <p>Urge incontinence.</p> Signup and view all the answers

    What is the mechanism of multiple sclerosis?

    <p>T cell-mediated attack against oligodendrocytes.</p> Signup and view all the answers

    How is multiple sclerosis diagnosed?

    <p>MRI is the gold standard.</p> Signup and view all the answers

    What is the diagnosis for a 27F with intermittent headaches and blurry vision?

    <p>Optic neuritis (multiple sclerosis).</p> Signup and view all the answers

    What is the most specific eye finding in MS?

    <p>Medial longitudinal fasciculus (MLF) syndrome.</p> Signup and view all the answers

    How can you differentiate a cranial nerve III lesion from internuclear ophthalmoplegia (INO)?

    <p>INO patients can converge normally.</p> Signup and view all the answers

    What is the diagnosis for a 20F with stiffness of hands, frontal balding, and impaired relaxation of hypothenar muscles?

    <p>Myotonic dystrophy (CTG TNR disorder).</p> Signup and view all the answers

    What is the diagnosis for a cancer patient on cisplatin or vincristine who develops neuropathy?

    <p>Toxic neuropathy (chemotherapy-induced neuropathy).</p> Signup and view all the answers

    What electrolyte disturbances can cause confusion and/or seizures?

    <p>Hypo-/hypernatremia and hypercalcemia.</p> Signup and view all the answers

    What is the diagnosis for confusion in the setting of high BUN and creatinine?

    <p>Uremic encephalopathy.</p> Signup and view all the answers

    What is the diagnosis for floppy baby syndrome and the location of affected CNS/PNS?

    <p>Werdnig-Hoffmann syndrome (spinal muscular atrophy); anterior horns affected.</p> Signup and view all the answers

    What occurs after antipsychotic medication is started and the patient experiences muscle rigidity but no fever?

    <p>Acute dystonia.</p> Signup and view all the answers

    What occurs after antipsychotic medication is started and the patient presents with abnormal eye movements and a stiff neck?

    <p>Acute dystonia oculogyric crisis + torticollis.</p> Signup and view all the answers

    What occurs after antipsychotic medication is initiated with muscle rigidity and fever?

    <p>Neuroleptic malignant syndrome; treat with dantrolene.</p> Signup and view all the answers

    What diagnosis occurs after the administration of an antipsychotic med and the patient experiences restlessness?

    <p>Akathisia; treat with propranolol.</p> Signup and view all the answers

    What is the diagnosis for an antipsychotic medication that causes bradykinesia?

    <p>Drug-induced Parkinsonism; treat with amantadine or propranolol.</p> Signup and view all the answers

    What occurs after antipsychotic medication causes abnormal tongue movements?

    <p>Tardive dyskinesia; stop antipsychotic and switch to atypical.</p> Signup and view all the answers

    What is the treatment for diabetic neuropathic pain?

    <p>TCA (i.e., amitriptyline); second-line is gabapentin.</p> Signup and view all the answers

    What is the treatment for herpetic/post-herpetic neuralgia?

    <p>Gabapentin.</p> Signup and view all the answers

    What is the next best step for an 82M diabetic with neuropathic pain already taking carbamazepine and gabapentin?

    <p>Switch the meds to nortriptyline.</p> Signup and view all the answers

    How do you differentiate a cluster headache from trigeminal neuralgia?

    <p>Cluster headaches are in young males with nighttime pain; trigeminal neuralgia is triggered by stimuli.</p> Signup and view all the answers

    What is the treatment and prophylaxis for cluster headaches?

    <p>Treatment: 100% oxygen; prophylaxis: verapamil.</p> Signup and view all the answers

    What is the treatment and prophylaxis for trigeminal neuralgia?

    <p>Treatment: goes away on its own; prophylaxis: carbamazepine.</p> Signup and view all the answers

    What is the treatment and prophylaxis for migraines?

    <p>Treatment: NSAID and triptan; prophylaxis: propranolol.</p> Signup and view all the answers

    What is the diagnosis for a 32M with a diffuse headache relieved by acetaminophen and sleep?

    <p>Tension-type headache.</p> Signup and view all the answers

    What are the other high-yield uses for propranolol?

    <p>Migraine prophylaxis, akathisia, thyroid storm, essential tremor, hypertension management, esophageal varices prophylaxis.</p> Signup and view all the answers

    What is the most likely tumor in a 47M with bitemporal hemianopsia?

    <p>Prolactinoma.</p> Signup and view all the answers

    What is the most likely tumor in an 8M with bitemporal hemianopsia?

    <p>Craniopharyngioma.</p> Signup and view all the answers

    What is the most common primary brain cancer in children?

    <p>Pilocytic astrocytoma.</p> Signup and view all the answers

    What is the diagnosis for a 3F with morning vomiting and truncal ataxia?

    <p>Medulloblastoma of cerebellar vermis.</p> Signup and view all the answers

    What is the most common primary brain cancer in adults?

    <p>Glioblastoma multiforme.</p> Signup and view all the answers

    What is the diagnosis for a 44F with lupus presenting with irregular ring-enhancing lesions on head CT?

    <p>Primary CNS lymphoma.</p> Signup and view all the answers

    What is the treatment for Toxoplasmosis?

    <p>Sulfadiazine + pyrimethamine.</p> Signup and view all the answers

    What is the diagnosis for a neonate with intracranial calcifications, chorioretinitis, and hydrocephalus?

    <p>Congenital Toxoplasmosis.</p> Signup and view all the answers

    What is the diagnosis for a neonate with intracranial calcifications, deafness, hepatomegaly, and rash?

    <p>Cytomegalovirus (CMV).</p> Signup and view all the answers

    What is the diagnosis for a neonate with bilateral deafness due to maternal infection and no other information given?

    <p>Congenital CMV.</p> Signup and view all the answers

    What CNS tumors are seen in neurofibromatosis?

    <p>Oligodendroglioma + ependymoma + optic nerve glioma in NF1; meningioma in NF2.</p> Signup and view all the answers

    What is the diagnosis for a 50F with jaw pain, headaches, and normal ESR?

    <p>Temporal mandibular joint syndrome.</p> Signup and view all the answers

    What diagnosis is suggested by a 40F being treated for TB and having neurologic findings in extremities with possible seizure?

    <p>Vitamin B6 (pyridoxine) deficiency caused by isoniazid.</p> Signup and view all the answers

    What is the diagnosis for a 65F with metastatic breast cancer presenting with a suprapubic mass and decreased sphincter tone?

    <p>Metastases to cauda equina.</p> Signup and view all the answers

    What is the diagnosis for a 44M with saddle anesthesia and late urinary incontinence?

    <p>Cauda equina syndrome.</p> Signup and view all the answers

    What is the diagnosis for a 44M with perianal anesthesia and early urinary and fecal incontinence?

    <p>Conus medullaris syndrome.</p> Signup and view all the answers

    What dermatome senses pain when a 48M burns his thumb?

    <p>C6.</p> Signup and view all the answers

    What does CSF show in Guillain-Barre syndrome?

    <p>Albuminocytologic dissociation.</p> Signup and view all the answers

    What is the diagnosis for a 24M with weakness proximally and distally in lower limbs?

    <p>Guillain-Barre syndrome (GBS).</p> Signup and view all the answers

    What is the diagnosis for GBS?

    <p>Electromyography and nerve conduction studies.</p> Signup and view all the answers

    What is the mechanism of Guillain-Barre syndrome?

    <p>T cell attack against Schwann cells of the peripheral nervous system.</p> Signup and view all the answers

    What is the treatment for Guillain-Barre syndrome?

    <p>IVIG + plasmapheresis; steroids are the wrong answer.</p> Signup and view all the answers

    Study Notes

    Brown-Sequard Syndrome

    • Presentation includes right-sided weakness, left-sided loss of temperature and pain sensation, diminished vibratory sensation in right foot, brisk right-sided reflexes, and a right-sided Babinski sign.
    • Diagnosis is Brown-Sequard syndrome secondary to viral infection.

    Pain Management in Cancer Patients

    • A 59-year-old female with metastatic cancer and severe pain expressing desires to die likely indicates inadequate pain control, not major depression.
    • Importance of managing pain effectively in cancer patients.

    Insomnia and Restless Leg Syndrome

    • A 42-year-old female with a 3-month history of insomnia and discomfort in bed should have serum iron and ferritin levels checked; iron deficiency is a common cause of restless leg syndrome.
    • If iron levels are normal, consider D2 agonists like pramipexole or ropinirole for treatment.

    Risk Factors and Neurological Symptoms

    • Patients with restless leg syndrome have an increased risk of developing Parkinson’s disease due to the possible underlying dopamine transmission issues.
    • A 58-year-old male losing consciousness without abnormalities on tilt-table testing is diagnosed with carotid sinus hypersensitivity.

    Ocular Findings and Associated Conditions

    • Fundoscopy showing hard exudates, cotton wool spots, and scattered hemorrhages suggests diabetic retinopathy.
    • Tardive dyskinesia can occur from medications like metoclopramide, which is a D2 antagonist.

    Neurological Drug Effects

    • Bupropion is known for inducing seizures as a side effect.
    • Frontal lobe injury after an accident may result in deficits in conceptual planning.

    Alcohol and Thiamine Deficiency

    • Administering B1 (thiamine) to an acutely intoxicated 56-year-old male reduces the risk of anterograde amnesia, primarily associated with Wernicke's encephalopathy.

    Alcohol Withdrawal and Treatment

    • A 56-year-old male reducing alcohol intake from 12 to 4 beers daily may experience tremors; treatment should include chlordiazepoxide for delirium tremens.

    Muscle Weakness and Inflammatory Myopathies

    • A 50-year-old female with high ESR and creatine kinase levels presenting with proximal muscle weakness is diagnosed with polymyositis.
    • Polymyalgia rheumatica (PMR) presents with high ESR but no CK elevation or muscle weakness.

    Differential Diagnosis in Muscle Disorders

    • The key difference between polymyositis and PMR is that PMR does not involve proximal muscle weakness and typically has normal CK levels.
    • Diagnosis of polymyositis can involve tests for anti-Jo1 or -Mi2 antibodies and electromyography.

    Temporal Arteritis and Associated Conditions

    • Temporal arteritis presentation includes temporal headaches, muscle pain, stiffness, and elevated ESR; immediate treatment should involve IV methylprednisolone followed by biopsy.

    Neurological Findings and Cancer

    • In patients with a history of cancer, neurological findings necessitate MRI of the spine to check for metastases, with steroids administered first if indicated.

    Brain Tumors and Diagnostic Imaging

    • Contrast head CT is crucial to diagnose brain cancers, while non-contrast CT is used for detecting brain bleeds.
    • In cases of epidural hematoma, intubation and hyperventilation are prioritized post-CT confirmation.

    Managing Headaches

    • Subdural hematomas typically require craniotomy following CT confirmation.
    • Cluster headaches are treated with 100% oxygen, and prophylaxis involves verapamil.

    Types of Headaches and Their Treatments

    • Migraine treatment includes NSAIDs followed by triptans for acute attacks, and prophylaxis with propranolol.
    • Tension-type headaches are addressed with rest and potential caffeine tapering.

    Tumor Types and Characteristics

    • Prolactinomas are the most common pituitary tumors in adults, while craniopharyngiomas are most common in children.
    • Glioblastoma multiforme is the most common primary brain cancer in adults, presenting as a large, irregular mass on imaging.

    Congenital Infections and CNS Tumors

    • Congenital toxoplasmosis presents with intracranial calcifications, chorioretinitis, and hydrocephalus, while congenital CMV presents with deafness and rash.
    • Neurofibromatosis types I and II are associated with specific CNS tumors like optic nerve gliomas and meningiomas.
    • Ulnar nerve entrapment at the elbow leads to cubital tunnel syndrome; wrist injuries commonly lead to carpal tunnel syndrome.
    • Midshaft humeral fractures typically injure the radial nerve, leading to wrist drop.

    Guillain-Barré Syndrome

    • GBS features include ascending muscle weakness and albuminocytologic dissociation in CSF.
    • Treatment includes IVIG and plasmapheresis; steroids are ineffective.

    Peripheral Nerve Entrapments

    • The first step in treating carpal tunnel syndrome is wrist splinting, followed by steroid injections if necessary.
    • Cubital tunnel syndrome treatment focuses on elbow splinting.

    Seizures and Cardiac Arrhythmias

    • Adam-Stokes attacks result from arrhythmias leading to hypoxia of the brainstem, presenting with seizure-like episodes.

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    Description

    This quiz consists of flashcards focused on key neurology concepts, particularly relating to clinical cases. Each card examines symptoms, diagnoses, and patient scenarios relevant to neuroanatomy and pathophysiology, enhancing understanding of complex neurological disorders.

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