N3 Flashcards

1
Q

Clinical findings of Alzheimer’s disease?

A

Early

Late

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2
Q

Early?

A
Anterograde amnesia(immediate recall affected, distant memories preserved)
Visuospatial deficit (lost in neighbor)
language difficulty(difficulty finding word)
Cognitive impairment with progressive decline
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3
Q

Late?

A

Neuropsychiatric(hallucination and wandering)
Dyspraxia(difficulty in performing learned motor skill)
Lack of insight regarding deficit
Noncognitive neurologic deficit(pyramidal and extrapyramidal motor, myoclonus, and seizure)
urinary incontinence

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4
Q

Cause and symptom of cochlear hair damage?

A

Metabolic load
Loud voice(High-frequency voice loss and base of cochlear hair cell damage)
a patient will have Sensorineural hearing loss
using earplug is preventive

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5
Q

cerebra hemorrhage fetcher?

A

2nd common site for IPH
Occipital headache radiate to the neck and shoulder
Nech stiffness(extension to 4th ventricle)
Nystagmus
Ipsilateral Hemi-ataxia(Corticopontocerebral fibers decussate twice)–vermis injury
ipsilateral Extremity ataxia–hemisphere injury
If expand–cranial palsy or stupor and comma
Decompress if size > 3cm

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6
Q

Hemineglect syndrome?

A

Damage of the non-dominant(usually left)hemisphere
Perform commands on the ipsilateral side
Not see contralateral space(detect by asking to write clock)
Agnosia(not know their defect)

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7
Q

Clinical presentation of Mystenia gravis?

A

Fluctuating and fatigable proximal muscle weakness
Occular(diplopia and ptosis)
Bulbar(dysphagia and dysarteria)
Respiratory(in crisis)

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8
Q

Cause of exacerbation?

A

medication(aminoglycoside,flouroquinolol)
NM blocking agent
Beta-blocker
MgSo4
Penicillamine
Physiologic stress(Inf.,Surgery,Px,childbirth)

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9
Q

Diagnosis?

A

Ice pack test(bedside)
Ach-R binding Ab(specific, diagnostic)
Chest CT(for all patient)

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10
Q

Managment?

A

ACE inhibitor(physostigmine)
Immunosuppressant for acute exacerbation
Tymectomy(Good clinical progresion enen patient w/o mass)

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11
Q

Corticosteroid indication in multiple sclerosis?

A

Acute exacerbation
disabling symptoms
plasmapheresis in refractory case

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12
Q

Meralgia paresthetica?

A

Pain, paraesthesia, and numbness in LFCN distribusion
Compression of LFCN by inguinal ligament
Due to tight belt, clothing and surgery
Obesity,surgery(arthroplasty),lumbar lordosis(Px) and DM increase the risk
Wt loss,behavior change and anticonvulsant(gabapentin in sever case)

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13
Q

Internuclear ophthalmoplegia?

A

affected side fails to adduct but contralateral eye abducts with horizontal nistagmus
Due to the heavy myelinated medial longitudinal fiber( paired neural tract that communicates CN III with Vl)injury

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14
Q

Cause?

A

Unilateral–Lacunar stroke with pontine artery

Bilateral–Multiple sclerosis

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15
Q

Treatment of Parkinson’s disease?

A
Anticholinergic (Triphenixidil)-especially for tremor
Levodopa
MAO inhibitor(selegiline) can be used for mild symptoms
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16
Q

What is pronator drift(involentary hand pronation on patient supinate on closed eye) indicates?

A

Upper motor lesion/pyramidal tract b/c affect more supinator muscle

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17
Q

Ischemic stroke present within 3-4.5 Hr?

A

Alteplase

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18
Q

IS without previous antiplatelet treatment?

A

Asprin

Start within 24 hours of symptoms

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19
Q

IS occur on a patient with Asprin?

A

Asprine +Clopidogril/dipyridamol

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20
Q

Stroke with evidence of atrial fibrillation?

A

Prolonged anticoagulant therapy

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21
Q

Stroke with large anterior circulation artery occlusion with presentation 24 hr of symptoms?

A

Mechanical thrombectomy(whether alteplase used or not) then Asprin

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22
Q

Patient with intracranial large artery atherosclerosis?

A

Asprin with clopidogril for 90 days then Asprin.

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23
Q

Unfractionated heparin/LMWH and acute stroke?

A

Not should be used increase the risk of bleeding

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24
Q

cause of subdural hematoma?

A

Rapture of bringing vien

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25
Risk factor?
Alcohol and elderly(cerebral atrophy and fall risk) Infants(thin-walled vessels) Anticoagulant use
26
clinical manifestation?
Acute Impaired consciousness, comma, and confusion Headache, nausea, and vomiting Chronic Headache, somnolence and confusion, lightheadedness Foccal nurologic deficite
27
Diagnosis?
Cresent shaped hyperdensity(acute) or hypodensity crossing the suture line
28
managment?
reverse/stope anticoagulant | surgical evaluation for symptomatic one
29
Primary CNS lymphoma?
One of AIDS-defining illness Caused by EBV patient present with, confusion, lethargy. seizure and focal neurologic deficit. Irregular, solitary, heterogeneous, and ring-enhancing lesion CSF finding of EBV is confirmatory
30
Complication of infection of orbit,face and sinous?
Cavernous sinus inflammation which results in thrombosis | Due to ven of the face are valvless
31
Symptom and sign of CVT?
Headache and vomiting Papilledema Binocular palsy Periorbital edema Hyperesthesia or hypoesthesia in V1 and V2 distribution usually bilateral due to cavernous veins are bilateral
32
Which cranial nerve affected?
``` CN pass through CS III IV VI(6 CN first affected) V1 V2 ```
33
Managment?
Aggressive antibiotic treatment | Reduce ICP to decrease the risk of herniation
34
Diagnosis?
MRI with magnetic resonance venography
35
papilledema pathophysiology?
ICP---Impaired axoplasmic flow---optic nerve head(blind spot) enlargement
36
Subclavian steal syndrome pathophysiology?
subclavian artery (usually the left by atherosclerosis b/c left SCA have Sharpe curving and high turbulent flow) blockage before giving vertebral artery--left arm ischemia---vertbrovasilar anastomosis--blood retrogradely move from ipsilateral vertebral artery to Ispsilateral SCA--vertebrobasilar insufficiency(VBA insufficiency symptoms).
37
Symptoms?
---------------Affected arm ischemia Pain, fatigue, and paraesthesia of affected arm Systolic B/P discrepancy b/n two arm(>15 mmHg) Bruit in supraclavicular noch in the affected side ----------------Vertebrobasilar insufficiency symptom Loss of vision in part or all of both eyes. Double vision. Vertigo (spinning sensation) Numbness or tingling. Nausea and vomiting. Slurred speech. Loss of coordination, dizziness, or confusion. Trouble swallowing. Symptoms exacerbated during affected UE exercise B/C exercise-induced vasodilation exacerbate steal--VBI symptoms will be exacerbated
38
Diagnosis and managment?
Doupler U/S and MRI angiography | managment will be lifestyle modification and stent placement
39
Most likely cause of both ischemic and hemorrhagic stroke?
Hypertension
40
Common cancer metastasized to the brain in order?
``` 1-lung 2-breast 3-unknown etiology 4--melanoma 5--Colon ```
41
Cracterstich?
Multiple Found in white and gray matter junction Vasogenic edema Steroid decrease edema and symptoms
42
cerebral toxoplasmosis?
``` Multiple ring-enhancing lesion CD4 <100 Fever Headache Altered mental status seizure ```
43
Neurocysticercosis?
New-onset seizure On imaging Cyst on multiple stages (non-ring enhancing, hypodense and have granuloma)
44
Effect of CO on the brain?
-------Brain(like other tissue) hypoxia by 3 mechanisms? Bind to Hb(decrease o2 binding) Shift Hb/O2 dissociation curve to left(affect unloading) Affect oxidative phosphorylation(complex IV inhibition) ------Symptoms Mild--headache, confusion, and dizziness Sever---MI, seizure, comma, and lactic acidosis In permanent effect---Bilateral globus pallidus hyperintensity b/c of susceptibility to hypoxia
45
Vasovagal(nurocardiogenic syncope) caracter?
caused by stress, severe pain, and prolonged standing Due to vagus nerve activation--Bradycardia and hypotension Have prodrome (feeling warmness, dizziness, nausea,pallor, diaphoresis and abdominal pain Usually resolves with second up to few minutes Good prognosis
46
orthostasis with syncope?
``` Autonomic dysfunction(will have Hx of Dm or PD) Hypovolemia (Hx of volume loss) ```
47
Other causes of syncope and their evidence?
``` LV outflow obstruction (syncope with exertion and systolic murmur) Ventricular arrhythmia (no prodrome with Hx of IHD/CMP Conduction impairment(previous Hx of fatigue and lightheadedness with ECG abnormality) Carotid hypersensitivity(carotid stimulation while standing precipitate syncope) ```
48
How to d/t from seizure?
absence of aura, postictal phase, body movt, unusual body posturing, and tongue laceration.
49
Tick-borne paralysis?
Occur when the thick stay in the skin for 4-7 day Due to the release of the neurotoxin ascending motor paralysis pronounced on one side and develop within hr to days Absent sensory and autonomic dysfunction Absent fever and prodromal symptoms Management Search and remove thick(improve by itself within an hour to days)
50
How to D/t from GBS?
``` Paralysis develop within hr to days(days to weeks in GBS) Normal CSF( Albuminocytologic dissociation in GBS) absence of autonomic symptoms (autonomic symptoms present in 70% of GBS patients. ```
51
Amitriptyline (TCA) mechanism of action and S/E?
The therapeutic effect is by inhibiting NE and serotonin S/E M1 blockage--Anticholinergic symptoms like constipation H1 blockage--lethargy Alpha-adrenergic blockage--orthostatic hypotension
52
Orthostasis?
is a normal physiological response of the sympathetic system to counteract a fall in blood pressure when a person is laying down and assumes the upright position
53
Orthostasis or orthostatic hypotension (OH)?
is a decrease in blood pressure that happens soon after standing or sitting up. Systolic gap >=20 Diastolic gap >10
54
Dix-Alpike test?
Used to diagnose benign paroxysmal positional vertigo which characterized by vertigo with or without nausea/vomiting with head movement.
55
Sensory Ataxia?
It occurs when the part of your nervous system outside of the brain and spinal cord injured. You have less sensation in your feet and legs from the nerve damage, so you have less feedback from your brain telling you where your body is in relation to the ground. Causes. Sensory ataxia can be a manifestation of sensory large fiber peripheral neuropathies and conditions causing dysfunction of the dorsal columns of the spinal cord due to a variety of disorders: infectious, auto-immune, metabolic, toxic, vascular, and hereditary diseases. The patient will have a positive Romberg test And unable to perform heal to shell test
56
Romberg test?
The patient is asked to remove his shoes and stand with his two feet together. ... The clinician asks the patient to first stand quietly with eyes open, and subsequently with eyes closed. ... The Romberg test is scored by counting the seconds the patient is able to stand with eyes closed.
57
Tandem test?
asses cerebellar ataxia
58
Ice pack test?
Used for MG Weakness improve by putting Ice on The cold environment inhibit ACE activity--improve symptoms But for diagnosis require a confirmatory test (Ab test)
59
Myoclonus?
Involuntary muscle relaxation or contraction that results in a limb or joint movement Caused by genetics, seizure, medication, and prolonged hypoxia.
60
Posthypoxic myoclonus(PHM)?
Usually occur after cardiac arrest Have two forms (acute and chronic) treat both by antiepileptic and supportive care
61
Acute?
also called myoclonus status epileptics(MSE) occur while patient on LOC and within 24 hr of insult Is generalized(symmetric) form If persist indicate poor prognosis
62
Chronic?
also called Lance Adam syndrome occur after days and weeks and the patient regains consciousness Have focal nature
63
Critically illness polyneuropathy?
Occur in a patient after prolonged ICU stay | Pheripherial weakness and decreased reflex
64
Trigeminal neuralgia?
Unilateral severe burning pain lasts for many seconds and rarely to weeks and months Exacerbated with minimal activity V2 and V3 affected mostly and rarely V1(when involved autonomic symptoms like rhinorrhea and lacrimation will be there). Due to CN V demyelination at the entry to pons(usually due to compression) Treat with anticonvulsant like carbamazepin if not responded surgery(decompression and radiosurgery can be considerd)
65
How to d/t from herpes zoster reactivation?
HZR Dermatomal distribution vesicle and rash will be there Blindness if involve V1(herpes ophthalmitis)
66
Clinica menifestation of Idiopatic intracranial HTN?
``` Global Headache Visual loss Pulsatile tinnitus Papilledema(enlarged blind spot) Diplopia(horizontal gaze palsy)--CN VI palsy ```
67
Tinnitus?
Is when you experience ringing or other noises in one or both of your ears
68
Diagnosis?
Normal Neuroimaging | LP: Elevated opening pressure(>250 mmHg) and normal CSF fluid analysis value
69
Risk factor?
Women in reproductive age | Drug(tetracycline,retinoid,GH and dantrolene)
70
managment?
wt loss | Acetazolamide
71
Dream enactment?
REM sleep behavioral disorder Occur when muscle atonia in REM is absent The patient will have repeated episodes of violent and autonomic complex motor behavior. Occur in the first 90 minutes of sleep(REM) and increase second half of sleep (REM frequancy increase)
72
Long-term association?
A patient will have an increased risk of future alpha-Synuclein inclusion disease(PD, LBD, and multiple system atrophy)
73
Bells palsy?
LM CN VII(involve lower and upper face) Mainly due to the Nurothropic virus reactivation(mainly HSV)--Inflammation--Demyelination and compression due to edema. Decrease lacrimation, loss of test in anterior 1/3 of the tongue, and hyperacusis. Treat with corticosteroid and acyclovir
74
Unilateral UMN inervated CN?
Vll (innervating the LMN) | Xll (innervating genioglosus(protrude the tongue anteriorly and deviate the tongue to the opposite side)
75
LAmbert-Eton syndrome?
Due to Ab blocking ca channels in a presynaptic cleft in the motor neuron terminal--defective ACh release Mainly related to underlying malignancy(MC:SCLCa) A patient will have proximal muscle weakness improved by activity Autonomic neuropathy(dry mouth) Absent DTR Diagnose with Treat with guanidine or 3,4 diaminpyridine Immunoglobulin or corticosteroid in refractory cases
76
Delirium manifestation?
Reduced/Fluctuation of LOC Decrease attention Associated with anxiety, agitation, and/or hallucination
77
predisposing factor?
``` Dementia Parkinson Disease Prior stroke Advanced Age Sensory impairment ```
78
Precipitating factor?
``` Drug Infection Electrolyte disturbance Metabolic condition Systemic illness CNS condition ```
79
Initial workup for suspected cognitive impairment?
Cognitive testing Laboratory testing Imaging
80
Cognitive testing?
MMSE(<24/30--MCI/Dementia) Montreal cognitive assessment(<26/30) Mini-cog(abnormal 3-word recall or clock-drawing test)
81
Laboratory?
Routine:CBC,TSH,VitB12 and CMP) Selective:Folate,Syphiliis and Vit D atypical(early onset) or suspected infection or maligancy:CSF analysis
82
Imaging?
Brain CT/MRI | atypical(having seizure activity): EEG
83
The first test to do inpatient with stroke?
Non-contrast head CT
84
sign of ulnar nerve injury?
above elbow: Sensory defect in medial 5.4th finger and motor paralysis of intrinsic hand muscle and FCU And FDP(decrease gripe strength) at wrist: all above except decreasing HG
85
Sign of cerebral amyloid angiopathy?
Parital and occipital lobe heamorage MCC of lobar hemorrhage in age >60 Mainly inpatient history of Alzheimer Confusion,lethargy,hemisensory loss and neglect(DHI). B-amyloid(same AD) protein accumulation in medium and small cerebral vessel--Rapture--ICH mainly during exercise.
86
Warfarin-induced ICH?
Supratherapeutic warfarin(high INR) Acetaminophen will exacerbate the toxicity Give immediately PCC and if not available FFP Lowering SBP < 140
87
Cervical spondylotic myelopathy?
Caused by degenerative disease of spinal vertebra--osteophyte in LB and SLL/LF--spinal channel stenosis--SC compression/interruption of SC supplying arthery Common in the older patient Neck pain radiating to shoulder and arm Lehermitte sign(electric shock-like pain radiate to spine) LMNL sign in UE(atrophy and flaccid paraysis) UMN signs in LE Unsteady gait
88
How to d/t ALS?
ALS: asymmetric paralysis and no Lehermitte sign
89
How to d/t spinal stenosis?
SS: Back pain and paralysis exacerbate walking and improve withstanding(pseudo claudication) Not involve UE
90
How to d/t MS?
No LMNL sign
91
preventive medication for migraine?
Topiramate Divalproex sodium TCA Beta blocker
92
when to give?
frequent(>4 month) or persistent(> 12 Hr symptom Disabling pain(affect work) Unable to take or unresponsive to abortive Tx Analgesic abuse-related headache
93
Huntington's disease symptoms?
Chorea and delayed saccade Depression, irritability, psychosis, or OCD Defect in executive function
94
finding?
CAG trinucleotide repeat Autosomal dominant GABA-ergic neuronal damage Caudate nucleus and putamen atrophy
95
managment?
Supportive | Die within 10-20 years
96
Locus coeruleus?
Produce NE Found posterior to the pons can be damaged in PD and Alzimer