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step 2 ck neurology > N1 > Flashcards

N1 Flashcards

1
Q

Wernicke encephalopathy risk factors?

A

alcoholism(MC)
malnutrition
hyperemesis gravidarum

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2
Q

pathophysiology?

A

Vit B1 thiamin deficiency)

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3
Q

Clinical fetcher?

A

encephalopathy
oculomotor dysfunction
postural and gait ataxia

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4
Q

managment?

A

IV thiamine followed by glucose

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5
Q

Korsakov syndrome?

A

aterograde and retrograde amnesia
confabulation
less common than WE,80%
irreversible

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6
Q

Wernicke-Korsakoff syndrome?

A

Damage to medial dorsal nucleus of the thalamus, mammillary bodies.
Presentation is the combination of
Wernicke encephalopathy and Korsakoff syndrome.

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7
Q

Cerebellar examination?

A

finger to nose
heel to shine
If positive it indicates a cerebellar lesion

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8
Q

medication-induced delirium?

A

anticholinergic
benzodiazepins
opiates

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9
Q

Migraine symptom?

A

Episodic, severe,unilateral and throbbing headache
associated photophobia, phonophobia, and N/V
stay 4-24 hr
Aura

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10
Q

Aura symptom?

A 
Focal, reversible neurologic symptom preceding or accompany the headache
Occur in 25% of patients
Visual(loss of vision, a wavy line)
Sensory(paraesthesia or numbness)
Auditory(sound hearing and hearing loss)
Motor(tremor and weakness)
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11
Q

What risk increase with a patient who has migraine with aura?

A

Ischemic stroke risk

Stop factor that increases thrombosis risk(like OCP)

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12
Q

managment?

A

abortive

preventive

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13
Q

abortive?

A

NSAID
Triptans
Dihydroergotamine
Antiemetics

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14
Q

Preventive?

A 
Proflaxix
Lifestyle change(sleep,exercise diet)
Beta-blocker
Amitriptyline
Topiramate
Valproate
Botulinum toxin
Anti CGRP monoclonal Ab
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15
Q

pathogenesis?

A

release of vasoactive peptides (like Sub. P and CGRP) due to irritation of CNV.menings or B/D vessels.

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16
Q

Chemotherapy-induced neuropathy characteristics?

A

Usually, start a week of treatment
Symmetrical paresthesia of finger and toe sparing proximal one(Glove -Stock)
Early loss of ankle reflex/jerk
Loss of pain and To
Occasionally motor symptoms result in weakness and bilateral foot drop

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17
Q

causative drug?

A

Vinca alkaloid(vincristine)
PBD(e,g cisplatin)
Taxan(e.g-peclitaxin)

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18
Q

Anterior cerebral artery occlusion?

A

Sudden
contralateral loss of motor and sensation in lower extremity
Upper motor sign

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19
Q

How to differentiate from diabetic neuropathy?

A

IN DP–Motor Weakness comes late, years after the glove-stocking symptoms

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20
Q

What about in the case of spinal cord compression?

A

Gradual Sever back pain that worsens in a recumbent position/night.
UMN sign
early symmetric motor and sensory deficit
Decrease rectal sphincter tone

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21
Q

The diagnostic criterion for restless leg syndrome?

A

Urge to move leg and
Unpleasant sensation in legs or other bodies part that begins/worse during inactivity(lying down and sitting).
Unpleasant sensation in the leg that
relieved by movt,(walking and stretching)
worsen or only occur at night
A symptom not explained by another disease

The normal symptom are dysteasia (itching or crawling sensation), poor sleep, and No symptom of pheripherial neuropathy.

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22
Q

Secondary causes?

A 
IDA
Uremia
DM
MS and Parkinson disease
Pregnancy
Medication(antidepresant,metocloperamide
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23
Q

Treatment?

A

Mild/intermittent
suplement with Iron if ferritin <75
Use supportive measure(like massage, heating pad, and exercise)
Avoid triggering factors9medication)
Sever/persistent
First-line–Dopamine agonist–Pramipixol
Alternative–Alpha-2-delta-CC ligand(Gabapentin,encapril)

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24
Q

Cancer pain managment?

A

Mild
Moderate
Severe

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25
Mild?
Non--opioid | Acetaminophen and NSAID
26
Moderate?
weak opioid +- non-opoid Codeine Hydrocodone Tramadol
27
Sever?
Short-acting opioid Morphin Hydromorphone Then(If patient need a frequent injection and pain not controlled at night) Calculate total daily need and convert to long-term (especially patient not took opioid to reduce risk of respiratory depression) fentanyl patch oxycodone plus Short-acting opioid for breakthrough pain
28
Common tumor metastasize to bone(mainly back)
``` breast prostate lung renal multiple myeloma ```
29
Diffuse axonal injury fetcher?
The most common cause of death in traumatic brain injury Instantaneous loss of consciousness persistent vegetative state punctate hemorrhage with loss of white and gray matter differentiation on CT But MRI is more sensitive
30
Pathophysiology?
Acceleration--deceleration--rotational injury in brain part with high-density reference(gray and white matter)
31
Lacunar stroke symptoms?
Pure contralateral motor lesion(common) Contralateral arm, LE weakness --Posterior limb of IC Contralateral UM Facial bulsy--Genu of IC Pure sensory syndrome Ataxic hemiparesis Dysarthria--Clumsy hand syndrome Absent sensory, MS change, seizure, and cortical sign CT scan may be negative in first 6 Hr If striatum involved --movt disorder
32
pathophysiology?
HTN,DM, Hyperlipidemia and smoking---lipohyalinisis and atheroma formation in lenticular-striate artery--Ischemic infarction
33
Carotid artery dissection symptom?
due to brain hypoperfusion and embolism--hed/neck pain followed by horner syndrome(SG injury) Internal capsule Subcortical white matter(e.g IC,CR) Pons
34
carotid artery thrombosis?
Visual symptom | All sign of brain hemisphere injury
35
Clumsy hand syndrome?
The symptoms in the pure sensory type of lacunar syndrome are limited to "a persistent or transient numbness and mild sensory loss over one side of the body, including face, arm, and leg," without associated hemiparesis, visual field defect, brainstem dysfunction, memory loss, dyslexia, or other deficits. the base of pons or IC
36
Evidences for vascular demensia?
``` Early forgetfulness(unlike AD(memory deficit) Late-onset memory impairment Stepwise decrease in functioning Having risk for ischemic stroke Focal nurologic deficit In the early phase transient improvement ```
37
Imaging?
multiple Cortical and subcortical infarction with/without white matter injury
38
In the case of NPH?
Ataxia followed dementia and urinary incontinence
39
Tremor that occurs on activity?
Essential T Physiologic T cerebellar lesion
40
Essential tremor?
usually Bilateral involvement of hand, not leg Possible head involvement without dystonia Usually no other neurologic deficit improves with alcohol
41
Cerebellar lesion?
Usually have associated ataxia, dysmetria, and gait disorder | Tremor increase when reaching the target
42
Physiologic one?
Low amplitude-usually not visible under normal condition Acute onset with increase sympathetic activity (e.g drug, caffeine, anxiety, and hyperthyroidism) usually worse with movement and involve face and UE
43
essecial tremor managment?
Beta blocker-propranolol Anticonvulsant(Primidone and topiramate) BZD--restricted b/c of possible dependence Deep brain stimulation and thalamotomy--For significant
44
Type of gait?
``` Cerebral Gait apraxia(frontal get) Parkinsonian steppage Parkisonian ```
45
Cerebellar?
Staggering(to walk in an uncontrolled way, fall ver) Wide based Cerebellar swings from side to side(trunkal ataxia)
46
Gait apraxia(frontal get)?
``` Magnetic(freezing)--Difficulty in initiating foot Start and turn hesitation Dementia Incontinence frontal lobe sign ```
47
parkinsonian?
Short step Shuffling ( dragging one's feet along or without lifting them fully from the ground) Parkinson symptom
48
steppage(high steping)?
``` excessive flection of hip and knee slapping quality fall due to distal nerve injury/neuropathy Usually due to LS radiculopathy or Common peroneal nerve injury resulting in foot drop ```
49
Vestibular?
``` Unsteady Usually, fall one side nausea and vertigo Normal sensory, motor, and reflex Due to labyrinthitis and meniere disease ```
50
Gillian-Barie syndrome?
Paraesthesia or neuropathic pain Symmetric ascending weakness decrease/absent DTR Autonomic dysfunction(e.g arrhythmia and ileus Bulbar symptoms(dysarthria and respiratory compromise) recent URT or GI infection
51
Dysarthria?
difficult or unclear articulation of speech that is otherwise linguistically normal.
52
Diagnosis?
Clinical LP: High protein with normal WBC Abnormal electromyography and nerve conduction
53
managment?
Monitoring the autonomic and respiratory condition | IV Ig or plasmapheresis
54
normal CSF analysis value?
WBC:1-5 Protein < 40 Glucose 40-70
55
Medication-induced headache characteristics?
Nead daily headache insetting of acute headache meication Occur inpatient with underlying headache(e.g migraine) present > 3 month change in the pattern/worsening of an existing headache present upone awakening that improves for short period and rebound.
56
most common drugs that cause this and management?
butalbital containing product acetaminophen opioids managment is to stop the culprit drug and use preventive therapy for the underlying headache
57
Symptom of myasthenia crisis?
Sign of respiratory failure Exacerbation of generalized (proximal muscle weakness) and bulbar symptoms(e,g fatigable chewing, dysphagia, and nasal speech prior to the RF Presence of precipitating factors
58
precipitating factors and managment?
``` Infection surgery pregnancy medication manage this patient in ICU and intubate them ```
59
Medication?
Aminoglycoside Floroquinolol Beta blocker Macrolide
60
what about botulism?
prodromal GI symptoms will be there
61
West-Nile encephalitis?
Headache Fever Confusion Asymmetric limb paralysis
62
face motor innervation?
Upper part: Bilateral cerebral cortex | Lower part: from the contralateral cortex
63
symptoms of bells palsy?
Upper and lower face palsy Hyperacusis(weakness of stapedius) Loss of taste in anterior 2/3 (loss of Corda tympani nerve) Ipsilateral decreased lacrimation9due to parasympathetic nerve injury)
64
cryptococal meningitis feuture?
In HIV patient with CD4 < 100 Sign of Increased ICP Centrally umblicated skin lesion mimicking MC(due to hematogenous dissimination. Diagnose with LP(also used as therapeutic) On imaging, the patient may have no lesion except ventriculomegaly (due to yeast obstruct arachnoid vili)
65
Goldinium enhanced MRI used in?
PML(see white matter lesion)
66
acute dystonia?
sustained and sudden contraction of neck, mouth, eye, and tongue muscle. Present as torticollis, blepharospasm, and trismus Occur mainly after usage of first-generation antipsychotics(HTF) or metoclopramide
67
managment?
Anticholinergic (Benzothropin and trihexyphenidyl) | stop or reduce the dose of the inciting drug
68
Medial medullary syndrome sign?
contralateral paralysis(PT injury) Tongu deviate to the side of the lesion(hypoglossal nerve lesion) defect in position and vibration sensation(medial laminiscus) Is due to anterior spinal artery /Vertebral artery injury

step 2 ck neurology (5 decks)

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