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step 2 ck neurology > N2 > Flashcards

N2 Flashcards

1
Q

pseudodementia?

A

Is when an elderly patient with a depressed mood present with dementia
Defect in attention, concentration, executive function, and memory with poor effort during testing
reversible with treating the underlying depression

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2
Q

Differential?

A

Alzheimer(Dementia and may have depression)
But the absence of other dementia symptoms like apraxia, agnosia, and aphasia absent in pseudodementia
Parkinsons (may have depression and dementia) but will have a movement disorder
Aging (will have depression but no cognitive impairment)

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3
Q

Apraxia?

A

Is a neurological disorder characterized by the inability to perform learned (familiar) movements on command, even though the command is understood and there is a willingness to perform the movement?
Both the desire and the capacity to move are present but the person simply cannot execute the act.

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4
Q

Agnosia?

A

is the loss of the ability to recognize objects, faces, voices, or places.

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5
Q

Hallucination inpatient with Parkinson’s?

A 
If Post mediation
 Dopamine agonist(Premipixole)
 Dopamin precursor(Levodopa)
If not started medication
  By disease itself
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6
Q

Managment?

A

Changing pramipexole to levodopa

Low dose second-generation antipsychotic(e.g quintapin)

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7
Q

Lewis body dementia diagnosis criterion?

A 
2 of 4 criterion
  Visual hallucination
   Parkinsonism
   REM sleep disorder
   fluctuation of cognition
Diagnose in Parkinson if symptoms occur before 1 year after Parkinson diagnosis
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8
Q

Alzheimer fetcher?

A 
Early
Insidious short-term memory loss
Language deficit
Apraxia
Late
Spatial disorientation
Latter personality change
middle/late
Psychotic fetcher (Paranoid delusion common)
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9
Q

Risk factor?

A 
Female
Old age
Head trauma
Family history
Down syndrome
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10
Q

Brain imaging?

A

Cortical atrophy
Reduced hippocampal volume
Medial temporal lobe atrophy

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11
Q

General paresis?

A

dementing illness occur in late or tertiary syphilis
decrease concentration, memory loss, personality change, dysarthria, tremor of hand and lip, and mild headache
RPR may be negative but need FTA test

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12
Q

What to investigate in patients with dementia?

A

syphilis
hypothyroidism
B-12

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13
Q

Lweis bodie dementia pathology?

A

Lewis bode( Intracytoplasmic eosinophilic inclusion(Alpha synuclin) in substantia nigra,rapha nucli,loccus cerilous and substansia inanimota)

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14
Q

Managment?

A

Levodopa-Carbidopa for parkinson
Anticholinesterase inhibitor for dementia
Low dose second-generation antipsychotic for persistent psychotic symptom

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15
Q

Treatment of myasthenia crisis?

A

intubate for sign of RF
Corticosteroid or another immunosuppressant if CS ineffective
Plasmapheresis
Immunoglobulin
Hold the physostigmine if the patient intubated to reduce secretion and aspiration risk

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16
Q

Brain tumor manifestation?

A 
Headache with one of the following
Nausea and vomiting
Focal nurologic deficit
Symptoms worsen during the night and factor increase ICP(bending and coughing)
Sign of ICP support diagnosis
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17
Q

Hemiplegic migraine?

A

Occur in children

neurologic deficit lasts within hours

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18
Q

Nuroglycopinia?

A

Lasts within hour
headache and nausea
Focal nurologic deficit

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19
Q

When do we consider stoping phenytoin?

A

Seizure free for > 2 year and if
Low seizure recurrence risk
Wants to be pregnant

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20
Q

Low seizure recurrence risk?

A

Normal MRI
Normal EEG
absent family history
positive initial response to therapy

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21
Q

Fetal hydantoin syndrome?

A 
orofacial cleft
microcephaly
dysmorphic facial feucher
cardiac defect
nail/digit hypoplasia
22
Q

managment of brain metastasis?

A

surgery in a patient with good survival
followed by stereotactic radiosurgery or whole-brain radiation therapy for non-responsive one
SR or WBR for difficult for access tumor,small and disseminated

23
Q

Common location?

A

gray and white matter junction

24
Q

dystonia characteristics?

A

repetitive
rhythmic
sustained muscle contraction
abnormal posture

25
Q

how to D/t from chorea?

A

chorea is not repetitive or rhythmic

movement from one part to other

26
Q

vascular dementia neurologic finding?

A

Cortical(large area involvement)–hemispheric lesion presentation as stroke
Subcortical–small area(urinary incontinence,abnormal gait,psychiatry symptome,focal neurologic symptome0

27
Q

Tetanus clinical manifestation?

A

musle spasm trigerd by stimuli
lockjaw
Autonomic dysfunction(HTN.tachycardia,Fever)

28
Q

pathogenesis?

A

toxin-mediated inability to release inhibitory neurotransmitter(GABA and Glycine)

29
Q

cause of spinal compression?

A

Trauma
Infection
malignancy

30
Q

D/t spinal compression from a degenerative disease?

A

compression case back pain worse at night unlike degenerative one

31
Q

epidural abscess symptoms?

A

fever
back pain
neurologic finding

32
Q

cause?

A

S.A is a common etiology
Distal infection
Spinal procedure
IV drug user

33
Q

What about transverse myelitis?

A 
Both common in immunocompromised
but TM
Segmental inflamation
Sensory level
flaccid weakness and no fever
both can cause urinary retention
34
Q

urinary retention and sensory level indicate lesion site?

A

Urinary retention–lesion above S2

sensory deficit level indicates 2 spinal roots above lesion level.

35
Q

managment of epidural compresion?

A

Immediate neurosurgical evaluation
MRI of the spine while evaluated
High dose steroid for metastatic compression

36
Q

Angle-closure glaucoma symptoms?

A 
Headache
Nausea
Vomiting
Occular pain
decrease visual acuity
conjunctival redness
corneal opacity
mid dilated pupil
37
Q

Initiating event for closure?

A

Factor increase pupillary dilation
anticholinergic
sympathomimetics
deem light

38
Q

Diagnosis?

A

Tonometry(IOP measurment)

Gonioscopy(angle measurment)

39
Q

how to differentiate AACG from cluster headaches and migraines?

A

M and CH has
recurrent attack
start at a young age
in cluster horner syndrome(pupillary constriction)

40
Q

Optic neuritis?

A

acute eye pain
visual loss
afferent pupillary defect
common in MS

41
Q

corrected ESR?

A

(age + 10)/2

42
Q

common mood disorder in PD patients?

A

MDD

43
Q

Multiple sclerosis future?

A

women age 15-50

disseminated in time and space lesion

44
Q

pathophysiology?

A

The demyelinating disease involves the cerebrum, brain stem, optic nerve, and spinal cord.

45
Q

Managment?

A

Acute attack with high dose corticosteroid and plasma exchange if not respond to corticosteroid
immunomodulatory(natalizumab,interferon-alpha and galatamir) for persistent symptoms

46
Q

Imaging and LP?

A

hyperintense white matter lesion in the area affected

LP:if diagnosis dilemma–oligoclonal IgG band

47
Q

Intraparenchimal heamorage?

A

commonly occur while on activity
commonly affect basal ganglia, cerebellar nuclei, pons, and thalamus.
rapidly progress(unlike IS, SAH–maximal at onset)
headache, nausea, and vomiting

48
Q

Putamen injury sign?

A

contralateral Hemi motor /sensory deficit-IC injury

Eye gaze towards the lesion–Frontal eye field injury

49
Q

symptoms of CN 3 palsy?

A

pupillary dilation

eye down and outward

50
Q

Cause?

A

Pupil sparing
ischemia–HTN, DM, hyperlipidemia, and advanced age
Pupil Involving
Compression-aneurysm, tumor–Do MRI or CT angiography

51
Q

indication for thrombolytic in ischemic stroke?

A

ischemic stroke with the measurable deficit
present within 3-4.5 hr of symptom
No contraindication
after hemorrhagic stroke ruled out by non contrast CT

step 2 ck neurology (5 decks)

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