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Rotation > Med 1 EOR - Neuro > Flashcards

Med 1 EOR - Neuro Flashcards

1
Q

autosomal dominant neurodegenerative d/o. Mutation chromosome 4. Neurotoxicity + cerebral, putamen + caudate nucleus atrophy. = behavioral change –> chorea –> dementia

A

huntingtons syndrome

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2
Q

CT/MRI of huntingtons shows what?

A

CT/MRI = cerebral + caudate nucleus atrophy.

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3
Q

prognosis + mgmt of huntingtons

A

fatal 15-20 yrs after presentation. Chorea mgmt: antidopaminergics (typical + atypical antipyschotics. Tetrabenzine, Benzos.

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4
Q

idiopathic dopamine (inhibitor) depletion → failure to inhibit Ach in basal ganglia. MC onset 45-65yo.

A

parkinsons

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5
Q

4 cardinal S+S of parkinsonism?

A

resting tremor (pill rolling)- better with intention
cogwheel rigidity
fixed facial expression
bradykinesia: shuffling gait

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6
Q

MRI: Cytoplasmic inclusions (lewy bodies), loss of pigment cells seen in substantia nigra.

A

parkinsons

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7
Q

3 txt options for parkinsons: what is the go-to? best for avoiding ADRs of the first line drug? for tremor predoninance?

A
  1. *levodopa/carbidopa (sinemet): most effective - “wearing off of bradykinesia” w/ longterm use
  2. *Dopamine agonists: bromocriptine, pramipexole, ropinirole. Used in young pts to delay use of levodopa (ADRs)
  3. Anticholinergics: trihexyphenidyl, benztropine - for <70yo w. Tremor predominance.
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8
Q

MC kids from rheumatic fever (group A strep) = antibodies against N-actyel-beta-glucosamine - involve basal ganglia + cortical structures.

A

syndeham chorea (post-infectious chorea)

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9
Q

txt options for syndenham chorea

A

chronic ABX for Group A strep - PCN G. severe symptoms =D2 blocker, carbamazepine, or valproic acid

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10
Q

pathologically enlarged ventricular size with normal opening pressures on lumbar puncture

A

normal pressure hydrocephalus

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11
Q

causes of normal pressure hydrocephalus (primary and secondary)

A

Causes: idiopathic (maybe congenital that shows symptoms later in life, cerebrovasc dz, decr CSF abs etc.
Secondary: MC intraventricular or subarachnoid hemorrhage

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12
Q

triad: 1. Dementia 2. gait disturbance 3. Urinary incontinence. Dont need all 3 but gait must be primary - “glued foot” - small steps + wide base.

A

normal pressure hydrocephalus

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13
Q

Dx of normal pressure hydrocephalus

A

Dx of exclusion then high-volume LP (30-50mL) + document gait before and after procedure.
MRI/CT = enlarged ventricles

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14
Q

txt for normal pressure hydrocephalus

A

reversible w/ VP shunt (lateral ventricle to abdomen)

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15
Q

necrosis of BOTH upper and lower motor neurons → progressive motor degeneration.
S+S: muscle weakness, loss of ability to initiate + control movements.
Upper: spastic, stiff, hyperreflexive
Lower: progressive bilat fasiculations, muscle atrophy, hyporeflexia, muscle weakness.

A

amyotrophic lateral sclerosis (ALS) - lou gherigs disease

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16
Q

prognosis + txt options for ALS?

A

riluzole (glutamate blocker): reduces progression up to 6mo. Fatal 3-5yrs after onset.

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17
Q

spasticity/hyperreflexive, varying degrees of motor deficits. Often associated w/ intellectual/learning disabilities.

A

cerebral palsy (brain injury during perinatal or prenatal period)

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18
Q

autoimmune peripheral nerve d/o (against Ach - nicotinic- postsynaptic receptor). MC young women. HLA-DR3. 75% have thymic abnormality (hyperplasia or thymoma).

A

myasthenia gravis

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19
Q

S+S of myasthenia gravis

A

progressive weakness w/ repeated muscle use + recovery after rest
Ocular weakness: diplopia, ptosis
generalized weakness, bulbar, respiratory!
MG crisis = flaccid paralysis + resp failure

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20
Q

Dx of MG ?

A

+ Ach receptor Antibodies

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21
Q

what is the Edrophonium (tensilon) test?

A

rapid response to short-acting IV edrophonium in limb MG

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22
Q

how do you distinguish cholinergic crisis from myasthenic crisis?

A

if flaccid paralysis improves w/ tensilon test = myasthenic crisis, worse = cholinergic crisis.

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23
Q

what is lambert-eaton syndrome and how do you distinguish it from MG?

A

Lambert eaton: MC assoc w/ small cell lung CA - antibodies against presynaptic voltage gated Ca+ channels prevents Ach release.
Unlike MG - weakness IMPROVES w/ repeated use.

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24
Q

what is guillan-barre? (what causes it and what is the patho?)

A

ACQUIRED inflam demyelinating polyradiculopathy of peripheral nerves. = slow nerve impulse = symmetric paresthesias and weakness. MC campylobacter jejuni, also respiratory of GI infections.

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25
Q

S+S of guillan barre?

A

ASCENDING bilateral weakness + paresthesias. Decreased DTRs. +/- bulbar muscles (swallowing difficulty) and resp. Muscles.
Autonomic dysfxn: tachy, BP control, breathing difficulties

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26
Q

CSF for guillan barre shows what?

A

high protein and normal WBC

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27
Q

Txt for Guillan barre? prognosis?

A

plasmapheresis (removes harmful circulating autoantibodies). OR IVIG (suppresses harmful inflammation/autoantibodies + induces remyelination.
prognosis: 60% full recovery in one year

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28
Q

what risks are increased with a depressed skull fx and what do you do for this?

A

increased risk infection, seizure, death. Txt: seizure prophylaxis, abx (5-7days cover for bacterial meningitis), tetanus prophylaxis.

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29
Q

autoimmune, inflammatory demyelinating dz of CNS. idiopathic. Assoc w/ axon degeneration of white matter of brain, optic nerve + spinal cord. MC women 20-40yo.

A

multiple sclerosis

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30
Q

3 types of MS

A

Relapsing-remitting: MC (episodic exacerbations)
Progressive decline
Secondary progressive: relapsing-remitting that becomes progressive

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31
Q

5 major S+S of MS

A
  1. sensory deficits (pain, fatigue, trigeminal neuralgia
  2. Optic neuritis (retrobulbar) - unilateral eye pain w/ eye movement, vision loss
  3. motor : upper motor neuron - spasticity, + babinski
  4. Spinal cord: bladder, bowel, sexual dysfxn
  5. Charcots neuro triad: nystagmus, staccato speech, intentional tremor.
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32
Q

Dx of MS: primary and confirmatory

A

clinical - @ least 2 episodes. MRI w/ gadolinium to confirm = white matter plaques hyperdensities. LP: incr IgG (oligoclonal bands).

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33
Q

Txt for MS exacerbations

A

Acute exacerbations: IV steroids (high dose) 1st line. +/- plasmapharesis

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34
Q

epidural vs subdural hematoma on CT

A

epidural: biconvex shape.
subdural: crescent shape, DOES cross suture lines

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35
Q

with what severity do you do an urgent evac or craniotomy for subdural hematoma? (parameters for clot thickness, midline shift, ICP)

A

.s+s of brain herniation or ICP (i.e. fixed dilated or asymmetric pupils), neuro deterioration since time of injury, clot thickness >10mm or >5mm midline shift. Or ICP >20mmHg.

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36
Q

AV malformations and cerebral aneursyms are usually asymp till rupture, then what are the S+S ?

A

severe HA +/- seizure, focal neuro deficits, vision loss

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37
Q

Neurotic plaques, overproduction or decreased clearance of extracellular deposits of amyloid beta peptides.

A

alzheimers dz

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38
Q

what is “sundowning”?

A

worse mental status in evening hours of those w/ dementia

39
Q

txt options for alzheimers

A

cholinesterase inhibitor (donepezil, galantamine, rivastigmine). Vitamin E. moderate-severe= memantine (cholinesterase inhibitor) +/- symptomatic txt.

40
Q

MG and alzheimers are both txted with what medication class?

A

cholinesterase inhibitors (i.e. rivastigmine)

41
Q

what txt should be considered for all pts with delerium

A

thiamine

42
Q

drug-induced movement disorders: what is the most common kind and drugs that cause it?

A

MC drug-induced parkinsonism - from any med that interferes w/ dopamine transmission (1st and 2nd gen antipsychotics.

43
Q

inheritance of essential tremor

A

autosomal dominant

44
Q

tremor: MC upper extremities and head (usually spares legs), also voice. Worse w/ emotional stress + intentional movement. Short relief w/ alcohol.

A

essential tremor

45
Q

txt options for trigeminal neuralgia

A

antiepileptics (carbamazepine or oxcarbazepine) (others - gabapentin, lamotrigine, baclofen. Or iv lidocaine ) Sx if refractory.

46
Q

MC and most aggressive of all primary CNS tumors in adults.

A

glioblastoma - either primary or secondary (stage IV astrocytoma from stage II or III)

47
Q

what is cushing’s reflex?

A

in severe cases of cerebral mass effect - triad: irregular respirations, HTN, bradycardia.

48
Q

CT/MRI and histology of glioblastoma

A 
CT/MRI = nonhomogenous mass w/ hypodense center + variable ring of enhancement surrounded by edema. May cross corpus callosum (butterfly glioma). 
Histology = necrotizing tissue, areas of hemorrhage, pseudopalisading (tumor cells line areas of necrosis)
49
Q

prognosis of glioblastoma

A

Poor prognosis (often <1yr survival)

50
Q

where are astrocytomas usually found?

A

kids: supratentorial, adults - infratentorial

51
Q

4 grades of astrocytoma

A

Pilocytic- grade I: juvenile: localized, “most benign”. MC young pts.
Diffuse - grade II: invade surrounding tissues but grow slow
Anaplastic- grade III: rare but aggressive
Glioblastoma multiforme- grade IV: MC primary CNS tumor in adults

52
Q

which astrocytoma grades are enhancing (defined, vascularity) vs nonenhancing on CT/MRI

A

Grade I-II nonenhancing, grade II-IV enhancing

53
Q

S+S of schwannoma (acoustic neuroma CN VIII)

A

unilateral sensorineural hearing loss is an acoustic neuroma until proven otherwise. also tinnitus, HA, facial numbness, vertigo

54
Q

weber test: normal, conductive loss , sensorineural loss

A

normal: both ears the same
conductive: lateralize to affected ear
sensorineural: lateralize to normal ear

55
Q

txt for acoustic neuroma

A

Sx or focused radiation

56
Q

MC bacteria causes of brain abscesses

A

MC staph aureus + strep viridans

57
Q

dx of brain abscess

A

MRI (diffusion weighted -DWI) = hyperintense. + CT-guided aspiration → gram stain and histology. Cultures of blood + CSF

58
Q

txt of brain abscess (from oral/ear/sinus, from hematogenous spread)

A

ABx + drainage
Empiric from oral/ear/sinus: metronidazole + ceftriaxone or ceftotaxime
Empiric from hematogenous spread: vancomycin + ceftazidime, cefepime or meropenem.

59
Q

1 cause of disability in US.

A

stroke

60
Q

anterior, middle and posterio cerebral arteries: from what vessel do they derive? stroke in each will cause what body part deficit?

A

Anterior cerebral artery (carotid): Leg control
Middle cerebral artery (carotid): Arm control
Posterior cerebral artery(from vertebral artery): visual issues

61
Q

what is the upper motor neuron lesion “posture” seen commonly long after CVA?

A

flexed arm + weak leg on ipsilateral side

62
Q

txt steps for ischemic CVA (if time for TPA or if not)

A

ABCs, fibrinolysis! (TPA in 4.5 hrs) lower ICP if herniating (mannitol, hyperventilation -shrinks blood vessels in brain, ventriculostomy/craniotomy)

Time over TPA: Head of bed 30 degrees +NPO (so they dont passively regurg stomach contents → PNA), ASA, BP control (but gradual b/c some tissue needs that perfusion!!), no hypotonic fluids (only NS! b/c itll make brain swell)

63
Q

S+S posterior circulation stroke

A

prodromal symptoms, crossed findings (one side of face and opposite side of body weakness), 5 Ds (diplopia, dizzy, dysarthria, dysphagia, dysmetria aka ataxia)

64
Q

anterior circulation stroke symptoms: dominant vs nondominant side?

A 
Non-dominant side (usually right): behavior, learning process, short term memory. Apraxia (loss of ability to execute purposeful movement). Anasognosia (unable to realize own condition), dysarthria (unable to articulate words) 
Dominant side (usually left): speech language. Aphasia (remembering words, speaking, writing), agraphia, decreased math comprehension.
65
Q

TIA symptoms in from internal carotid artery vs vertebro basilar?

A 
internal carotid artery (anterior)= amarosis fugax + weakness in contralateral hand. 
verterbro basilar (posterior): brainstem/cerebellar symptoms (gait, dizziness, vertigo).
66
Q

carotid endarterectomy if internal or common carotid have > ___% stenosis

A

70%

67
Q

meds after TIA

A

ASA + dipyridamole or clopiradgrel

68
Q

intracerebral hemorrhage stroke txt

A

ABCDEs → ICU. reverse anti-coags, decr BP,
lower ICP mgmt (if herniating) - mannitol, hyperventilation. Sx: ventriculostomy, cranatiomy.
seizure prevention.

69
Q

txt for HA: cluster? for all types?

what route of administration is best?

A

Cluster: O2 (higher conc is better) or intranasal lidocaine
All types: dopamine antagonists (droperidol, prochlorperazine, metoclopramide, chlorpromazine), triptans (when given at EARLY symptoms), NSAIDs (ASA, ibuprofen) , opiods (morphine)
Txt: faster is better. IV>IM>PO

70
Q

HA/migraine prophylaxis options

A

BBs/CCBs, SSRIs/ TCAs, topiramate/gabapentin

71
Q

2 types of partial/focal seizure

A

Simple: maintained consciousness.
Complex/temporal lobe: impaired consciousness. Starts focally. Auras- sensory/autonomic/motor sx that pt is aware of. Automatism: lip-smacking, manual picking, patting, coordinated motor movement.

72
Q

5 types of generalized seizure (abscence, tonic-clonic, myoclonus, atonic, status epilepticus)

A

Absence: staring, no post-ictal . MC kids
Tonic-clonic (grand mal): LOC → rigidity, resp arrest → clonic phase (repetative, rhythmic jerking) → postictal (flaccid coma/sleep). + auras as prewarnings.
Myoclonus: NO LOC. sudden, brief, sporadic invol. Twitch
Atonic: “drop attacks” - sudden loss of postural tone
Status epilepticus: repeat, generalized w/out recovery >30min

73
Q

EEG
______= bilateral symmetric 3Hz spike or normal.
_____ = generalized high-amplitude rapid spiking.

A

absence = bilateral symmetric 3Hz spike or normal. Grand mal = generalized high-amplitude rapid spiking.

74
Q

txt for abscence seizure vs grand mal

A

Absence: ethosuximide

Grand mal: valproic acid, phenytoin (blocks Na+ channels in CNS), carbamazepine, lamotrigine

75
Q

txt for status epilepticus

A

lorazepam/diazepam (benzos to increase GABA) → phenytoin → phenobarbital (barbituate - increase GABA axn)

76
Q

what labs can help differentiate pseudoseizure from real?

A

*prolactin levels increase with seizures - helps differentiate from pseudoseizure

77
Q

4 manifestations of tertiary syphilis

A
  1. Gumma: granulomas on skin + body tissues (bones)
  2. Neurosyphilis: HA, meningitis, dementia, vision/hearing loss, incontinence.
    “Tabes Dorsalis” (demyelination of posterior columns → ataxia, areflexia, burning, pain weakness)
  3. Argyl-robertson pupil: small, irregular pupil that constricts normally to hear accommodation but not to light.
  4. Cardiovascular: aortitis, aortic regurg, aortin aneurysms.
78
Q

screening vs confirmatory test for syphilis

A

screening - RPR or VDRL. Confirmatory: treponemal tests (FTA-ABS) -

79
Q

bacterial meningitis: what is most likely organism for each after group? txt for each? (<1mo, 1mo-18,, 18-50, >50)

A

<1mo : (MC- GBS, also Listeria monocytogenes) - txt: ampicillin +cefotaxime or aminoglycoside).
1mo-18yo: MC Neisseria meningitis (w/ petichial rash!), also S pneumo - txt: ceftriaxone + vancomycin
18-50yo: MC S pneumo, also neisseria meningitis (w/ petichial rash!) - txt: ceftriaxone + vancomycin
>50yo: S pneumo, Listeria monocytogenes - txt: ampicillin +ceftriaxone + vancomycin

80
Q

kernigs vs bruzinski signs

A

+ kernigs: unable to straighten knee w/ hip flexion. + brudsinski: neck flexion = knee/hip flexion

81
Q

CSF meningitis: bacterial vs viral vs fungal (WBCs, protein, glucose, appearance)

A

Bacterial: WBCs 100-100,000 and >80% neutrophils, high protein, DECREASED glucose. + gram stain. TURBID
Viral: WBCs 10-300, lymphocytes. Normalish protein, NORMAL GLUCOSE. CLEAR
Fungal: WBCs 10-200 lymphocytes. DECREASED glucose.

82
Q

when do you start abx for suspected meningitis?

A

empiric before LP! (based on most common organism for age)

83
Q

add-on medication for meningitis for S pneumo or H flu

A

dexamethasone

84
Q

txt for viral meningitis

A

supportive

85
Q

MC cause of encephalitis?

A

HSV 1

86
Q

what symptoms indicate encephalitis over meningitis ?

A

abnormal cerebral fxn (irritable, lethargy, behavior changes, seizure)

87
Q

Dx encephalitis: CSF, MRI (what lobe is MC involved)

A

CSF = same as viral meningitis (lymphocytosis, normal glucose) . imaging = temporal lobe MC involved.

88
Q

txt for encephalitis

A

supportive, control cerebral edema. HSV or no known cause - valacyclovir +/- immunoglobulin if immunocompromised. Worse prognosis than meningitis

89
Q

what do each of the 4 lobes of the cerebral cortex control?

A

Frontal lobe: planning + consequences (prefrontal), primary motor (frontal)
Parietal lobe: body sensation, somatosensory
Temporal lobe: hearing, complex visual images
Occipital lobe: vision

90
Q

what does the basal ganglia control?

A

voluntary motor movement, coordination, cognition, emotion

91
Q

what do the three parts of the brainstem control? (midrain, pons, medulla oblongata)

A

Midbrain: relays audio/visual info, eye movement
Pons: relay station between cerebrum + medulla (motor/sensory), regulates breathing
Medulla oblongata: vital body fxns (HR, breathing, autonomic fxns)

92
Q

txt for bells palsy

A

acyclovir or valcyclovir

93
Q

those CLOSELY exposed to meningitis should be given what drugs?

A

cipro, rifampin, or ceftriaxone

94
Q

why is ceftriaxone not given to those < 2months old for meningitis? (while its given for all other ages)

A

it can cause kernicterus (from increased bilirubin) = mental retardation

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