Deja - Internal - Neurology Flashcards
1
Q
What is RIND?
A
Neurologic deficits that lasts >24h and <3wks.
2
Q
2 greatest risk factors for a stroke?
A
- HTN
2. Smoking
3
Q
2 MC etiologies for ischemia:
A
- Thrombotic etiology 2o to atherosclerosis.
2. Embolic etiology which is usually either cardiac in origin or from carotid arteries.
4
Q
MC etiology of a CVA:
A
Ischemia.
5
Q
Infarct in the deep gray matter associated with HTN and atherosclerosis:
A
Lacunar infarct.
6
Q
MC source of emboli that leads to stroke:
A
Carotid atheroma.
7
Q
Thalamus, internal capsule, and cerebral white matter deficit causing FLEXION of the upper extremities:
A
Decorticate posturing.
8
Q
Upper brainstem deficit causing EXTENSION of the upper extremities:
A
Decerebrate rigidity.
9
Q
Occlusion of MCA supplying the DOMINANT hemisphere:
A
- Contralateral hemiparesis.
- Hemisensory deficit.
- Aphasia.
- Homonymous hemianopsia.
10
Q
Occlusion of MCA supplying the nondominant hemisphere:
A
- Contralateral hemiparesis.
- Hemisensory deficit.
- Homonymous hemianopsia.
- Confusion.
- Apraxia.
- Body neglect on contralateral side.
11
Q
Occlusion of ACA:
A
- Broca aphasia.
- Contralateral weakness of lower extremity.
- Incontinence.
12
Q
Occlusion of PCA:
A
- Homonymous hemianopsia with MACULAR SPARING.
- CN III palsy.
- Aphasia + Alexia if DOMINANT hemisphere is affected.
13
Q
Occlusion of PICA:
A
- Vertigo.
- Ataxia.
- Contralateral pain and temperature disturbance.
- Dysphagia.
- Dysarthria.
- Ipsilateral Horner syndrome.
14
Q
Occlusion of AICA:
A
- Deafness.
- Tinnitus.
- Ipsilateral facial weakness.
- Gaze palsy.
15
Q
Occlusion of ophthalmic artery:
A
Amaurosis fugax (transient monocular blindness).
16
Q
1st study to order if you suspect a stroke in a patient?
A
CT of head WITHOUT contrast to rule out active bleeding.
17
Q
What other studies can be done to further assess the stroke patient?
A
- MRI to evaluate for subacute infarction.
- Carotid Doppler US to rule out carotid artery stenosis.
- Echocardiogram to rule out embolic sources.
18
Q
TIA treatment:
A
Start with aspirin. If fail, give plavix (clopidogrel).
19
Q
When would you consider a carotid endarterectomy?
A
If the patient had carotid artery stenosis >70%.
20
Q
Cardioembolic stroke treatment:
A
Anticoagulation with heparin or Coumadin.
21
Q
Treatment that improves outcome in a patient who present with an EMBOLIC stroke with symptoms beginning <3hr ago?
A
tPA.
22
Q
Single most useful test to evaluate seizures?
A
EEG.
23
Q
What tests should be done on a patient suspected to have had a seizure?
A
- Complete neurologic examination.
- Check for incontinence, tongue lacerations, other injuries to the body to distinguish from syncope.
- Lab: CBC, electrolytes, Ca, glucose, O2, LFTs, BUN, Cr, RPR, ESR, Urine tox screen.
- MRI/CT can also be done to rule out a mass.
24
Q
Factors that increase the risk of having a seizure?
A
- History of having a seizure in the past.
- CNS tumor.
- CNS infection.
- Trauma.
- Stroke.
- High fever in children.
- Drugs.
25
Todd paralysis:
Postictal state in which there are focal neurological deficits that lasts 24-48hs.
Usually associated with focal seizures.
26
2 types of generalized seizures:
1. Tonic-clonic seizures.
| 2. Absence seizures.
27
Phenytoin - Side effects:
1. Agranulocytosis.
2. Gingival hyperplasia.
3. Hirsutism.
28
Valproic acid - Side effects:
1. Hepatotoxic.
2. Thrombocytopenia.
3. Neutropenia.
29
Carbamazepine - Side effect:
Aplastic anemia.
30
What test is used to diagnose meningitis?
Lumbar puncture with CSF analysis including Gram stain, cultures.
31
How is a brain tumor diagnosed?
CT with contrast/MRI with gadolinium localizes the lesion and a biopsy is used to get the histologic class of the tumor.
32
What is the MC mesodermal tumor?
Meningioma.
33
How are most brain tumors treated?
1. Surgical excision and radiation.
| 2. Medulloblastomas also require chemotherapy and schwannomas are treated with surgery alone.
34
Who is at higher risk for developing MS?
1. Those with a family history of MS.
2. Those who lived up until puberty in northern latitudes or temperate climates.
3. Females. (2:1)
35
What is the typical course of MS?
Multiple progressive neurologic alterations that wax and wane and cannot be explained by a single lesion.
36
Signs and symptoms of MS:
1. Limb weakness.
2. Paresthesias.
3. Optic neuritis.
4. Nystagmus.
5. Scanning speech.
6. Intranuclear ophthalmoplegia.
7. Vertigo.
8. Diplopia.
37
Lhermitte sign:
Shock-like sensation down the spine when patient flexes their neck.
Also known as the "barber chair phenomenon".
38
What can be seen on MRI on a patient with MS?
MRI shows multiple, asymmetric, periventricular plaques with multiple areas of demyelination.
39
What does the CSF show in an MS patient?
Oligoclonal bands - Elevated IgG.
40
MS treatment:
Steroids during acute episodes and IFN-β to prolong remission.
41
What is the underlying pathology in ALS?
Slow progressive loss of upper and lower motor neurons in CNS.
42
What are the clinical signs and symptoms of ALS?
1. Asymmetric, progressive muscle weakness initially with fasciculations which present clinically as difficulty swallowing.
2. Upper + Lower motor neuron signs on physical exam.
3. NO bowel or bladder involvement.
43
How is ALS diagnosed?
Clinically --> Combination of UPPER + LOWER motor symptoms in 3 or more extremities.
An EMG will show widespread denervation and fibrillation potentials in at least 3 limbs.
44
What is the main treatment for ALS?
Supportive care.
45
What do ALS patients ultimately die from?
Respiratory failure.
46
What is Guillain-Barre?
Autoimmune, demyelinating disorder affecting the peripheral nerves (particularly motor fibers).
47
Bacterial infection associated with Guillain-Barre?
C.jejuni
48
What often precedes Guillain-Barre?
Bacterial infection causing diarrhea, specifically with Campylobacter, viral infection, or vaccination.
49
Clinically, how does Guillain-Barre present?
SYMMETRIC ASCENDING PARALYSIS.
| Eventually progress to paralysis of the diaphragm, leading to respiratory failure.
50
What tests would you do to diagnose Guillain-Barre syndrome?
Lumbar puncture and EMG.
51
What would you see in the CSF after a lumbar puncture in Guillain-Barre?
Incr. Protein; Normal cell count --> Known as albuminocytologic dissociation.
52
What interventions should be undertaken in a patient with Guillain-Barre syndrome?
Monitor respiratory function very closely and intubate if needed.
--> Plasmapheresis and IVIG.
53
Prognosis of Guillain-Barre?
Good.
54
MC type of headache:
Tension headache.
55
Signs and symptoms of a tension headache?
Bilateral, band-like, dull, most intense at neck/occiput, worsened with stress.
56
What psychiatric disorder is it most commonly associated with headache?
Depression.
57
What is the MC age group with tension headache?
Between 20-50.
58
Headache with rhinorrhoea, unilateral, stabbing, retro-orbital, ipsilateral lacrimation, ptosis, and nasal congestion.
Cluster headache.
59
Headache with photophobia, nausea, aura, and being unilateral?
Migraine.
60
Common triggers for migraines:
1. Menstruation.
2. Stress.
3. Foods.
4. Alcohol.
61
Risks of temporal arteritis - Associated with?
Polumyalgia rheumatica.
62
How is it diagnosed?
Must do a temporal artery biopsy.
| Elevated ESR is just a screening test.
63
MCC of SAH?
Trauma.
64
MC underlying cause of a spontaneous SAH?
Aneurysm rupture.
65
MC heritable disorder associated with SAH?
AD PKD.
66
How is an SAH diagnosed?
1. CT shows subarachnoid blood (dark).
2. LP shows bloody CSF with xanthocromia.
3. Cerebral angiography to find berry aneurysms.
67
Symptom of berry aneurysm rupture?
CN III palsy.
68
MC location for a berry aneurysm?
Anterior communicating artery (30%), followed by posterior communicating artery. Then MCA.
69
Sequence of events in an epidural hematoma?
Patient has a lucid interval lasting from minutes to hrs followed by a loss of consciousness and hemiparesis.
70
What can cause a "blown" pupil in a patient with an epidural hematoma?
Uncal herniation.
71
What is seen on CT in a patient with an epidural hematoma?
Convex (lens shaped) hyperdensity that does NOT cross the midline.
72
What vessels are involved in a subdural hemorrhage?
Bridging veins.
73
In what population are subdural hematomas most common?
Elderly + Alcoholics.
74
Course of events in a subdural hematoma?
Patient can have symptoms similar to dementia since mental status changes and hemiparesis can present subacutely.
75
What is seen on CT in a patient with a subdural hematoma?
Crescent-shaped, concave hyperdensity that may cross the midline.
76
What does RIND stand for?
Reversible ischemic neurologic deficit.
