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Neuro > MTB 2 > Flashcards

MTB 2 Flashcards

1
Q

Best initial therapy for peripheral neuropathy?

A

Pregabalin or gabapentin
TCAs
Seizure meds

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2
Q

Peripheral neuropathy in biker with pressure on palms of hands, trauma to medial side of elbow?

A

Ulnar N.
Wasting of hypothenar eminence
Pain in 4th and 5th fingers

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3
Q

PN w pressure of inner, upper arm; Sat night palsy, use of crutches?

A

Radial N.

Wrist drop

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4
Q

PN w obesity, pregnancy, sitting w crossed legs?

A

Lateral Cutaneous N of thigh

pain/numbness of outer aspect of one thigh

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5
Q

PN that worsens w walking?

A

Tarsal tunnel - Tibial N

Pain/numbness ankle and sole of foot

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6
Q

PN with high boots, pressure on back of knees?

A

Peroneal N.

Weak foot w/decreased dorsiflexion and eversion

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7
Q

PN seen in typists, carpenters, working w hands

A

Median N
Thenar wasting
Pain/Numbness in first 3 digits

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8
Q

CN 7 Palsy in stroke

A

Pt CAN wrinkle forehead on affected side

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9
Q

CN 7/Bells palsy hearing/taste changes?

A

Hyperacusis - CN7 supplies stapedius = shock absorber on middle ear ossicles
Taste - CN7 supplies sensation of taste anterior 2/3 tongue

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10
Q

Most accurate test for CN7 Palsy?

A

EMG

Nerve conduction

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11
Q

Complication with CN7 palsy?

A

Corneal ulceration

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12
Q

Ab MOA in Guillain Barre?

A

Molecular mimicry

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13
Q

Most specific test for Guillain Barre?

A

EMG

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14
Q

CSF findings for Guillain Barre?

A

Albuminocytologic Dissociation

  • Increased protein in CSF: 800
  • No increase in cell count
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15
Q

What test can differentiate who may die from Guillain Barre?

A

PFTs
- decreased FVC, peak inspiratory pressure
Death = dysautonomia and resp failure
Monitor resp fnc w serial measurements of bedside VC

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16
Q

TX for Guillain Barre?

A

IVIG
OR
Plasmapheresis

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17
Q

What test should be done before IVIG?

A

Check for IgA deficiency

- anaphylactic shock

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18
Q

What vaccine is CI in Guillain Barre?

A 
Trivalent influenza (egg)
Use Tamiflu
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19
Q

Tick Paralysis v Guillain Barre?

A 
Tick 
- Children at nape of neck
- Usually descending, but can be ascending
CSF: 
NO albuminocytologic dissociation 
TX: Remove tick
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20
Q

Myasthenia Gravis presentation

A

Double vision, difficulty chewing
Weakness of limb muscles - worse at END of day
Ptosis
Normal pupillary responses

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21
Q

Best initial test for MG?

A

Ach Receptor Ab

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22
Q

Most Accurate test for MG?

A

EMG

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23
Q

Alternative for erdophonium test?

A

Ice test: place ice on eyelids, decrease temp inhibits Ach esterase -> enzymatic activity requires increased temps that leads to increased Ach in NM Junction

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24
Q

Where do we see Trident tongue?

A

MG

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25
Q

What imaging test should be done with MG?

A

Chest Xray/CT/MRI

Look for thymoma or thymic hyperplasia

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26
Q

Best initial TX for MG?

A

Pyridostigmine = longer acting

Neostigmine

27
Q

Pathophys for MG?

A

Abs against Ach Receptors at NM Junction

Decreased Ach Receptors

28
Q

When is thymectomy done in MG?

A

If meds don’t work and pt is under age 60

If pt is over 60 - Prednisone

29
Q

What is done in an acute myasthenic crisis?

A

IVIG
Plasmapheresis
Endotracheal intubation

30
Q

Prior to thymectomy, what do we do?

A

Plasmapheresis to remove abs by squeezing thymus

Myasthenic crisis can precipitate.

31
Q

What are DDX for difficulty rising from a chair?

A
  1. Lambert Eaton
  2. Parkinson Dz
  3. Dermatomyositis
  4. ALS
  5. Hypothyroidism induced myopathy
32
Q

Lambert Eaton Myasthenic syndrome
Ass’d with
Presentation

A

Increased muscle strength on repetitive Ctx
Small cell Ca
DTRs absent, increased thirst, proximal muscles affected

33
Q

How do brain abscesses spread?

A

Contiguous infxn in sinuses, mastoid air cells, otitis media

34
Q

Presentation of brain abscess

A 
HA - nocturnal or morning
N/V
Fever 
Seizures
Focal neuro findings
35
Q

Best initial test for brain abscess

A

CT or MRI

Ring or contrast enhancing lesion w surrounding edema and mass effect

36
Q

Most accurate test for brain abscess

A

Brain Bx

37
Q

Tx for brain abscess

A

Empiric: PCN + metronidazole + Ceftriaxone/Cefepime

Vanco if recent neurosurgery (greater risk of resistant staph)

38
Q

Is brain bx needed for brain abscess?

A

Yes. necessary to determine precise organism

39
Q

Most common cancers that mets to brain?

A 
BLT KC
Breast
Lung
Thyroid
Kidney
Colon
40
Q

MC artery in stroke?

A

MCA

41
Q

What does MCA supply?

A 
Lateral surfaces of brain
Temporal lobe
Face, arms, hands - motor and sensory
Brocas
Wernickes
42
Q

Deficits seen with MCA stroke?

A

Weakness or sensory on Contralateral side
Homonymous hemianopsia - loss of visual field on opposite side of stroke - look twd side of lesion
Aphasia if on dominant side

43
Q

MCA stroke in non-dominant lobe?

A

Preserved speech, comprehension w confusion

Apraxia - unable to perform tasks when asked

44
Q

ACA stroke deficits?

A

Contralateral weakness/sensory loss - LE>UE (leg, foot, trunk)
Personality/Cognitive defect - confusion
Urinary incontinence
Leg more than arm weakness

45
Q

PCA stroke deficit?

A

Ipsilateral sensory of face, 9th and 10th CNs
Contralateral sensory loss of limbs
Limb ataxia

46
Q

How does a medial cerebellar infarction present?

A

Vermis
Vertigo
Nystagmus

47
Q

How does a lateral cerebellar infarction present?

A

Dizziness
Ataxia
weakness

48
Q

What is Wallenberg syndrome?

A

PICA infarction

  • Ipsilateral Facial sensory loss
  • Contralateral Body sensory loss
  • Vertigo, ataxia, dysarthria, dysphagia
  • Ipsilateral orners
49
Q

What to think of if we see vertigo and nystagmus?

A

Vestibulocerebellar impairment

50
Q

Best initial test in stroke?

A

CT without contrast

51
Q

Most accurate test in stroke?

A

MRI

52
Q

What is CN III Palsy w Contralateral Hemiplegia?

A

Weber

53
Q

What is CN III Palsy w Contralateral ataxia, athetosis?

A

Benedikt

54
Q

What is the Tx for a non-hemorrhagic stroke of less than 3 hrs?

A

Thrombolytics

55
Q

What is the Tx for a non-hemorrhagic stroke of more than 3 hrs?

A

Aspirin

56
Q

What is the Tx for a hemorrhagic stroke?

A

Nothing

57
Q

What is the Tx for a stroke pt already on aspirin?

A

Add dipyridamole
OR
Switch to Clopidogrel

58
Q

When is Heparin the answer in stroke?

A

Never. It causes hemorrhagic strokes

59
Q

What are AE’s of Ticlopidine?

A

Neutropenia

TTP

60
Q

When is carotid angioplasty and stenting the answer for strokes?

A

Never.

61
Q

When do we do endarterectomy?

A

Symptomatic cerebrovascular disease

More than 70% stenosis

62
Q

When do we do Holter in stroke pts?

A

Initial EKG is normal, to detect atrial arrthymias

63
Q

Do we use steroids in Guillan Barre

A

No. No proven benefit

64
Q

When is thymectomy CI?

A

Age over 60/65

Pre-pubertal

Neuro (3 decks)

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