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Neruo Clerkship > 1 > Flashcards

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0
Q

Causes of limbic lesions

A

(ie memory, emotion, behavior, olfaction, motivation)

  • Herpes encephalitis
  • Paraneoplastic syndroms:
  • -Anti ma2 in testicular cancer
  • -anti NMDAR ovarian cancer like teratoma
  • -anti-hu small cell carcinoma
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1
Q

Argyll-Robertson pupils

A

Pupils in neurosyphilis that react to accommodation but not to direct light

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2
Q

Postperfusion syndrome symptoms

A

Post surgical problems with attention, concentration, short term memory, fine motor function, speed of mental and motor responses

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3
Q

Sx of concussive disorder

A

Sleep disturbance, mood change, poor concentration and memory, lightheadedness, nausea

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4
Q

pseudotumor cerebri (=IIH) dx

A

Normal MRI or slit like ventricles, diagnose with LP

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5
Q

tx for trigeminal neuralgia?

A

Carbamazepine

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6
Q

Intra axial lesion that enhances heterogeneously?

A

Glioblastoma

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7
Q

Extra axial lesion that enhacnes uniformly and is hyperdense on unenhanced CT?

A

Meningioma

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8
Q

what is the sella?

A

sits around pituitary

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9
Q

What do you do for tx of Menieres?

A

Labyrinth ablation and gentamicin

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10
Q

CSF findings in GBS

A

albuminocytologic dissociation, which is an elevation in CSF protein (>0.55 g/L) without an elevation in white blood cells

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11
Q

what CN can ICP involve?

A

6

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12
Q

Saccule

A

Linear and head tilts in vertical plane of head (in the inner ear)

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13
Q

Utricle

A

Horizontal plane linear movements and head tilts in the inner ear

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14
Q

Lateral/horizontal semicirc canal

A

Head turn L and R

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15
Q

Superior semicirc canal (anterior)

A

Head nod

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16
Q

Posterior semicirc canal

A

Head to shoulders

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17
Q

Type of nystagmus in BPPV

A

with dix hallpike maneuver produces mixed vertical torsionalvector nystagmus with fast phase beating upward and toward the affected hear

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18
Q

What part of the brain does this involve? Gaze evoked and persistent downbeat nystagmus

A

Central lesion involving cerebellum

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19
Q

Somatization Disorder

A

somatic complaints without a medical explanation

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20
Q

Oxcarbazepine (how it works, what its for, side effects)

A

Na channel
Partial seizure
Hyponatremia and sedation

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21
Q

Phenytoin (how it works, what its for, side effects)

A

NA channel
Partial seizure
Gingival hyperplasia, ataxia, coarse facial features

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22
Q

VAlproic acid (how it works, what its for, side effects)

A

Na channel, GABA
Partial and general
GI sx, NT defects, thrombocytopenia, wt gain, hair loss, accelerated loss of bone density

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23
Q

Phenobarbital (how it works, what its for, side effects)

A

GABA
Partial, gen
Sedation

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24
Q

Ethosuximide (zarontin) (how it works, what its for, side effects)

A

T type Ca channel
Ansemce
GI sx

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25
Q

Gabapentin (how it works, what its for, side effects)

A

Partial

Sedation, ataxia

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26
Q

LAmotrigine (Lamictal) (how it works, what its for, side effects)

A

Na channel, glutamate receptor
Partial, gen
SJS, rash

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27
Q

Topiramate (how it works, what its for, side effects)

A

Na channel, GABA
Partial, gen
Word-finding difficulty, renal stones, wt loss

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28
Q

Tiagabine (how it works, what its for, side effects)

A

GABA reuptake
Partial
Sedation

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29
Q

Levetiracetam (keppra) (how it works, what its for, side effects)

A

Partial, gen

Insomnia, anxiety, irritability

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30
Q

Zonisamide (how it works, what its for, side effects)

A

Partial, gen

Sedation, renal stones, wt loss

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31
Q

Which anti-epileptic drugs are P450 inducers?

A

Phenobarbitol, Phenytoin, carbamazepam

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32
Q

Carbamazepine (how it works, what its for, side effects)

A

Na channel
Partial
Hyponatremia, agranulocytosis, diplopia

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33
Q

Which anti-epileptic drugs are P450 inhibitors?

A

Valproic acid

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34
Q

Drugs that cause Parkinson’s-like movements

A

Anti-psych (akathisia)
Metoclopramide (reglan)
Valproate
Amphotericin B

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35
Q

Tx for when drugs cause parkinson like movements?

A

IV dephenhydramine (benadryl)

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36
Q

Which chemo drugs cause peripheral neuropathies?

A

docetaxel, paclitaxel, vincristine, platinum

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37
Q

Which chemo drugs cause cerebellar ataxia?

A

cytosine arabinoside or 5-fluorouracil

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38
Q

What is RPLS?

A

reversible posterior leukoencephalopathy syndrome (RPLS): due to HTN/preeclampsia and immunosupp drugs etc leading to HA, confusion, seizures, visual loss (occip lobe lesion)

Vascular injury with loss of autoregulation, hypertension, vasospasms, seizures, confusion and MRI/CT pic of posterior leukoencephalopathy leads to diagnosis

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39
Q

What drugs cause reversible posterior leukoencephalopathy syndrome (RPLS)

A

lots of chemo drugs and cyclosporine and tacrolimius (ie immunosupp)

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40
Q

Steroids cause what psychiatric problem

A

Steroid psychotic rxn

-agitation, sleep disturbance, paranoia leading to possible neuroleptic therapy

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41
Q

Carbamazepine (or other anti-epileptics) and azithromycin drug interaction

A

Causes ataxia, nystagmus and diplopia at higher levels

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42
Q

What drugs can aggravate hyponatremia caused by oxcarbazepine or carbamazepine?

A

taking HCTZ or levetiracetam (keppra)

43
Q

Anti-cholinergic OD causes what?

A

Tachycardia, blurred vision, fever, MS change and urinary retention (in elderly only).

44
Q

What kind of drug do anticholinergics counteract?

A

Neuroleptics

45
Q

Benzo withdrawal causes what sx

A

Agitation, tachycardia, serotonin syndrome

46
Q

What are you at risk for with migraines and depression?

A

SSRIs plus triptans cause serotonin syndrome

47
Q

Neuroleptic malignant syndrome

A

dd

48
Q

Periodic lateralizing discharges

A

EEG abnormality commonly seen in herpes encephalitis, focal brain lesions, nonketotic hyperglycemia, alcohol withdrawal, theophylline exposure

49
Q

Generalized periodic discharges

A

EEG abn seen in anoxic brain injury, CJD

50
Q

Stimulus-induced, rhythmic, periodic or ictal discharges

A

EEG abn: SIRPIDs/ictal discharges are most commonly seen in critically ill patients, even without neurologic illness

51
Q

Burst suppression

A

EEG abn commonly seen in anoxic encephalopathy or in the s/o meds like propofol or barbiturates

52
Q

If you have a bad reaction to phenytoin, what other anti-epileptics should you avoid?

A

carbamazepine and primidone —>these can also interact with warfarin

53
Q

What is juvenile myoclonic epilepsy?

A

Kids 12-18 get brief muscle twitch in the am. Ion channel issue

54
Q

Tx for juvenile myoclonic epilepsy

A

Levetiracetam

Valproic acid works too, but risk teratogenicity and PCOS in adolescent women

55
Q

Fetal exposure to which anti-epileptic is associated with lower IQ

A

Valproic acid

56
Q

Which anti-epileptic is associated with challenges in word finding?

A

Topiramate

57
Q

First line in status epilepticus ? Then what?

A

Use IV lorazepam then IV phenytoin/fosphenytoin if it continues, then intubate and give phenobarbital then induce coma with barbiturates, midazolam or propofol with continuous bedside EEG monitoring

58
Q

Pituitary apoplexy

A

Acute dec in blood to pituitary often after childbirth (Sheehan’s syndrome) that p/w HA, visual sx and adrenal insufficiency

59
Q

Common eye issue caused by steroids?

A

Cataracts (cloudy lens, pt can’t see out and you can’t see in)

60
Q

Amblyopia ex anopia

A

“Lazy eye” due to disuse. Patients won’t have stereoscopic vision ie depth perception

61
Q

Causes of INO in younger vs older people

A

Young: demyelination
Old: paramedian pontine perforating vessel stroke

62
Q

Optic neuritis sx

A

Pain on eye movement with central scotoma (ie macular defect)

63
Q

Papilledema sx

A

Abn fundus with enlarged blindspot (ie centrocecal scotoma–>macular defect including the blind spot)

64
Q

Temporal arteritis is associated with which disease?

A

Polymyalgia rheumatica (pain in hips and shoulders due to giant cell arteritis)

65
Q

If a patient has a posterior communicating aneurysm clipped with deterioration 3d later, what happened and how do you treat?

A

Vasospasm, tx with nimodipine

66
Q

sx of posterior communicating aneurysm rupture?

A

3rd n palsy with pupillary involvement

67
Q

Monoccular vision loss that can be improved by patient looking through a pinhole localizes where?

A

Monocular visual loss=lesion ant to optic chiasm (ie eye itself or optic nerve). If acuity is improved thorough the pinhole, problem is refractive or ocular, and not neurological

68
Q

Causes of ischemic optic neuropathies?

A

Surgery (prolonged anesthesia compressing artery, usually posterior), drugs like amiodarone, INF alpha, nasal decongestants, phosphodiesterase inhibitors, and systemic blood loss

–>if you have giant cell arteritis, tx is emergency steroids get esr

ION pw painless vision loss over hours to days ages 57-65. Blurred vision and altitudinal field defects

risk factors are HTN, diabetes, congenitally small optic cup

69
Q

Who does cryptococcal meningitis occur in?

A

Immunocomp, often HIV CD4 <100

70
Q

Consequences of cyrpotcoccal meningitis?

A

visual loss directly to optic n or due to icp

71
Q

Treatment for cryptococcal meningitis?

A 
Triple therapy
1. Amphotericin
2. 5-Flucytosine
3.Fluconazole
or lifelong intraconazole ppx
72
Q

How do you treat multiple enhancing brain lesions in an HIV pt?

A

Likely abscesses, tx with pyrimethamine/sulfadiazine and folic acid

73
Q

ppx for bacterial meningitis?

A

Cipro or rifampin PO 2 days (serogroup B not covered by vaccine)

74
Q

HSV encephalopathy has what CSF BC components?

A

Red and white

75
Q

What distinguishes crypto meningitis from others in the CSF?

A

Very high opening pressure

tx with ampho B and flucytosine

76
Q

Signs of TB meningitis?

A

Very low glucose in CSF, basilar meningitis, cranial neuropathies, inc ICP, hydrocephalus

77
Q

Most common cause of acquired epilepsy in areas like the DR?

A

Neurocysticercosis (t. solium)=tapeworm. Diagnose with enzyme-linked immunoelectrotransfer blot (EITB) assay. High rates of false negative with only one CNS lesion

78
Q

Albendozole

A

For tapeworm tx

79
Q

Pt presents with peripheral 7th nerve palsy/Bell’s palsy in the winter in chicago?

A

Since it’s not in the NJ summer, it’s not lyme. This is HSV

80
Q

How is HSV enceph treated?

A

Prednisone if the patient is seen within the first 48 hours and then add antivirals

81
Q

IV acyclovir is toxic to which organ?

A

Nephrotoxic causing acute tubular necrosis

–>slow infusion and patient hydration reduce risk

82
Q

HSV2 reactivation

A

Can lead to meningitis and genital herpes. Get recurrent radicular pain, saddle anesthesia and urinary retention
=most common cause of recurrent meningitis

83
Q

How long after surgery is meningitis infection most likely?

A

Most common within the first month but can occur even months or years postoperatively. CSF pleocytosis without bacterial growth is seen after posterior fossa surgery

84
Q

What is posterior fossa syndrome?

A

j

85
Q

Lyme disease manifestations in children

A

bilateral peripheral VII nerve palsies

86
Q

Congenital CMV sx

A

Hearing loss, spacticity, hyperintensities along ventricular margins on MRI

87
Q

Raw honey fed to a newborn puts them at risk for?

A

Tetanus

89
Q

Enterovirus D 68 causes what?

A

Paralytic disease

90
Q

AE drug that can be used to treat myoclonus

A

Levetiracetam (keppra)

91
Q

What is lance adams?

A

postanoxic myoclonus (exacerbated by movement), like after CPR

92
Q

What AEs treat lance adams?

A

Valproate, clonazepam, levitracetam

93
Q

What AEs treat lance adams?

A

Valproate, clonazepam, levitracetam

94
Q

Nutritional def or OD with afferent ataxia?

A

Vit E, B12, Cupper, or intoxication with pyridoxine

95
Q

Nutritional def or OD with afferent ataxia?

A

Vit E, B12, Cupper, or intoxication with pyridoxine

96
Q

What is resperidone?

A

Dopamine antagonist

97
Q

Sid eeffects of dopamin antagnoists including typical and atypical antipsychotics?

A

Tardive dystonia (involuntary repetitive movements from antipsychotics)

98
Q

Sid eeffects of dopamin antagnoists including typical and atypical antipsychotics?

A

Tardive dystonia (involuntary repetitive movements from antipsychotics)

99
Q

Trihexyphenidyl

A

used for parkinson tumor

100
Q

1st line for essentail tremor for someone with diabetes/asthma?

A

Primidone

101
Q

1st line for essentail tremor for someone with diabetes/asthma?

A

Primidone

102
Q

tx for trigeminal neuralgia?

A

carbemazepine

103
Q

What is donepezil?

A

ACHE inhibitor for alz

104
Q

What is donepezil?

A

ACHE inhibitor for alz

105
Q

What is bevacizumab?

A

VEGF inhibitor

Neruo Clerkship (1 decks)

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