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Neuro > MTB 3 > Flashcards

MTB 3 Flashcards

1
Q

What percentage of carotid stenosis do we operate on? Don’t we operate on?

A

Greater than 70%

We don’t operate on 50%

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2
Q

Risk factors that must be controlled in carotid stenosis?

A

DM HbA1C must be < 7%
HTN
LDL < 100
Stop tobacco smoking

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3
Q

Dx for HA upon bending over to tie laces (Positional)?

A

Colloid cyst of 3rd ventricle

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4
Q

Migraine HA Presentation

A 
Visual disturbance
Photophobia
Aura
Related to menses, emotions, food
N/V
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5
Q

Cluster HA Presentation

A

Frequent
Short duration
High intensity
Men more than Women

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6
Q

What is tx for Cluster HA?

A

100% Oxygen
Ergots
Sumatriptan

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7
Q

What is pseudotumor cerebri ass’d with?

A

Chronic lung dz
Addisons
Tetracycline

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8
Q

HA ass’d with Vit A toxicity?

A

Pseudotumor cerebri

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9
Q

HA w papilledema and diplopia? Why diplopia?

A

Pseudotumor cerebri

CN 6

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10
Q

HA presents with tearing, red eye w rhinnorhea?

A

Cluster HA

- current, in “clusters” over time

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11
Q

HA ass’d with Horner syndrome? Ipsi or Contra?

A

Cluster HA

Ipsilateral

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12
Q

What must be assessed for with HA and red eye?

A

Glaucoma

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13
Q

Retroorbital HA that starts suddenly, peaks rapidly, lasts about 2 hours?

A

Cluster HA

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14
Q

HA with scalp tenderness, ass’d with polymyalgia rheumatica?

A

Temporal Arteritis

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15
Q

Pt with 1st time convulsion + > 35 yoa, what must we rule out?

A

Brain tumor

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16
Q

HA that is Bilateral?

A

Tension HA

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17
Q

HA in young men, ass’d with alcohol?

A

Cluster

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18
Q

Are Cluster HA’s uni or bilateral?

A

Unilateral

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19
Q

Tx for Migraine HA?

A

Triptans

Ergotamine

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20
Q

Testing for Pseudotumor cerebri?

A

CT or MRI to R/O intracranial mass lesion

LP: Increased Pressure (otherwise Normal)

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21
Q

Most accurate test for Giant cell arteritis?

A

Bx

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22
Q

Migraine PPX tx?

A 
TCAs (Amitriptyline)
Beta blockers
CCBs - Verapamil
SSRIs
Botulinum
Valproic Acid
Topiramate
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23
Q

Tx for tension HA?

A

NSAIDs

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24
Q

Tx for Pseudotumor cerebri?

A

Weight loss

Acetazolamide

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25
Q

Pseudotumor cerebri Tx if medical does not work?

A

Ventriculoperitoneal shunt

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26
Q

Effective tx in cluster HA but not migraines?

A

100% Oxygen
Prednisone
Lithium

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27
Q

PPX for Cluster HA?

A

CCBs

Preventive tx not necessary

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28
Q

Trigeminal Neuralgia Tx?

A 
CN V
Carbamezapine
Phenytoin
Baclofen
Gabapentin
Lamotrigine
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29
Q

Who gets a Zoster vaccine?

A

All persons > 60 yoa to prevent shingles

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30
Q

Electrolyte disturbances that cause seizures?

A 
Hypo or Hypernatremia
Hypoglycemia
Hypocalcemia
Hypomagnesemia
Hypoxia
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31
Q

Causes of seizures

A 
VITAMINS
Vascular
Infxn
Traum
AI
Metabolic 
Idiopathic
Neoplasm
pSychiatric
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32
Q

Definition of status epilepticus

A

Recurrent or continuous seizure that lasts 5-30 minutes

33
Q

Best initial tx of status epilepticus

Mangement if ineffective

A

Benzo - Lorazepam or diazepam IV
If persists -> Phenytoin or Fosphenytoin
Still persists -> Phenobarb
Still -> NM Blocking agent: Succinylcholine, Vecuronium, Pancuronium to allow for intubation
General anesthesia - Midazolam or Propofol

34
Q

Which has fewer AE’s: Phenytoin or Fosphenytoin?

A

Fosphenytoin

35
Q

Long term AE’s for Phenytoin?

A 
IV - HyptoTN, AV block
Vertigo
Ataxia
Gingival Hyperplasia
Hirsutism
Rash
LA
36
Q

What is a partial seizure?

A

Focal to one part of body

I.e. Just leg or just arm

37
Q

What is a simple v complex seizure?

A

Simple - in tact consciousness

Complex - LOC

38
Q

Describe a tonic clonic seizure

A

Grand mal
Generalized
Varying phases of muscular rigidity (tonic) then jerking of muscles (clonic)

39
Q

What is the first line tx for a Partial seizure?

A

Carbamazepine

Phenytoin

40
Q

What is a partial w secondary generalization?

A

Tonic clonic manifestation - diffuse muscle aches
Increased CPK
Tongue biting
Loss of bladder control

41
Q

What is a complex seizure?

Presentation?

A

LOC w automatisms

Chewing, picking hand movements, lip smacking

42
Q

Absence (Petit mal) seizure EEG pattern?

A

Generalized, symmetric 3-Hz spike and wave discharge pattern

43
Q

What is Lennox-Gustant syndrome

A

Pediatric seizure syndrome
Less than 7 yoa
Mental Retardation

44
Q

Do we start antiepileptic drugs for a single seizure?

A

No. Unless:
it is status epilepticus
Fam Hx
Abnormal EEG

45
Q

When do we discontinue seizure meds? How do we test for this?

A

When pt has been seizure free for 2 years

Test with sleep deprivation EEG

46
Q

Intracranial HTN = ICH
Pressure
Causes

A

IC pressure > 20 mmHg

Trauma, lesion, hydrocephalus, impaired CSF outflow

47
Q

Sx’s seen in ICH

A

Sx’s: Diffuse HA, worse in morning, N/V early in day, visual changes, papillaedema, confusion, somnolence, Cushing reflex (HTN + bradycardia)

48
Q

Cerebral Salt wasting syndrome

Pathophys

A

Inappropriate secretion of vasopressin, causes H2O retention

  • Increased secretion of ANP/BNP causing cerebral salt wasting -> HYPOnatremia
  • resolves in 1-2 wks
49
Q

What is commonly ass’d with ICH?

A

SIADH

50
Q

How is presentation of SAH different from meningitis?

A

SAH

  • very sudden in onset
  • LOC
51
Q

Best initial test for SAH

A

CT w/out contrast

52
Q

Most accurate test for SAH

A 
LP Puncture - if FN CT
CSF: 
- Xanthochromia - 4-6 hrs to develop
- Increased WBCs
- Ratio of WBCs/RBCs is normal
53
Q

What should one suspect if WBC/RBC ratio is increased? (WBC count exceeds normal)

A

Meningitis

54
Q

Normal ratio of WBC/RBC in CSF?

A

One WBC for every 500-1000 RBCs

1:500

55
Q

“Boot shaped” hemorrhage?

A

SAH

56
Q

EKG of SAH

A

Large or inverted T waves = cerebral T waves

- excessive sympathetic activity

57
Q

How do we find the site of aneurysm?

A

Angiography

58
Q

When do we use contrast in CT/MRI of head?

A

Detection of mass or lesion - cancer or abscess

NOT with blood

59
Q

Tx for SAH

A
  1. Nimodipine prevents ischemic stroke
  2. Embolization (coiling)
  3. Ventriculoperitoneal shunt if hydrocephalus develops
  4. Seizure ppx - Phenytoin to prevent
60
Q

Complication w Nimodipine

A

First 24 hours -> Rebleeding

Days 3-10 -> Vasospasm

61
Q

Embolization or surgical clipping for SAH?

A

Embolization

62
Q

Pt presents with burning pain and paralysis in UE, relative sparing of LE?

A

Central cord syndrome

- elderly pts secondary to forced hyperextension of their neck

63
Q

Spinal cord problem ass’d with burst fracture?

A

Anterior cord syndrome

64
Q

What is presentation of anterior cord syndrome?

A

Total loss of motor function below the level of the lesion w loss of pain and temp on both sides below lesion

65
Q

Test for anterior cord syndrome?

A

MRI

66
Q

Loss of all fnc except for posterior column, flaccid paralysis below level of lesion, loss of DTRs at level of lesion, loss of pain and temp?

A

Anterior Spinal Artery Infarction

67
Q

What causes subacute combined degeneration of cord?

Presentation

A

B12 Deficiency
Neurosyphilis
- Affect the posterior column - so position and vibration are lost

68
Q

How does spinal trauma present?

A

Acute onset of limb weakness/sensory changes below level of injury
Sphincter fnc impaired
Loss of DTRs followed by hyperreflexia below level of trauma
Tx: glucocorticoids

69
Q

Pt presents with motor and sensory deficit, change in bowel/bladder dysfunc, after after having an epidural catheter?

A

Epidural hematoma from a traumatic insertion

70
Q

What is transverse myelitis?

A

Inflammation of the spinal cord causes axonal demyelination

71
Q

How does transverse myelitis present?

A

Weakness, numbness of limbs

Ass’d with CMV, spinal cord injury

72
Q

Brown Sequard Syndrome

A

2 Ipsi, 1 Contra
Unilateral hemisection of SC from injury
Loss of pain/temp on Contra
Motor Fnc + position/vibration - Ipsi

73
Q

Loss of pain/temp bilaterally upper back and both arms?

A

Syringomyelia
Capelike distribution
Will also have loss of reflexes and muscle atrophy

74
Q

What is Syringomyelia ?

A

Fluid filled dilated central canal

- Tumor or trauma

75
Q

What is communicating Syringomyelia ass’d with?

A

Arnold Chiari

76
Q

Nocturnal HA + morning vomiting?

A

Intracranial pathology

77
Q

Most accurate test for Syringomyelia?

A

MRI

78
Q

Tx for Syringomyelia?

A

Surgical removal of tumor

Neuro (3 decks)

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