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step 2 ck neurology > N5 > Flashcards

N5 Flashcards

1
Q

depresion related dementia(psudodementia)?

A

Depresion symptoms preceds dementia

Resolve when depresion is treated

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2
Q

IE and strock?

A

can cause stroke by septic emboli

commonley involve MCA–lobar heamorage/infarction

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3
Q

Risk factor for heat stroke?

A

Strenous activity during hot or humuid weather
DHN and poor acclimatization
Lack of physical fittness and obesity
Medication:Anticolinergic,phenotiazin,Antihistamin,anticychotics, and TCA.

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4
Q

Clinical menifestation?

A 
Core temprature > 40
CNS dysfunction(AMS and seizure)
Renal failure
Hepatic failure
DIC
ARDS
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5
Q

Managment?

A 
Rapid cooling
Fluid resucitation
Electrolyte correction
Managment of end organ complication
No need of antipyretic
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6
Q

Cause of anterior spinal artery injury during trauma?

A

disk retropulsion and bone part during vertebral brust #

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7
Q

Anterior circulation?

A

MCA,ACA and ICA

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8
Q

Posterior circulation?

A

VA.BA and PCA

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9
Q

Anterior cerebral arthery stroke symptome?

A

Motor dysfunction and sensory loss pronounced in LE
Urinary incontinence
gait dyspraxia
primitive reflex(gasp,suckling may reaper)
abulia
emotional disturbance

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10
Q

Presbycusis?

A

Age related high frequancy hearing loss
Age related
Symmetric and bilateral SNHL(weber midline and AC>BC,like normal case)
Hear one to one spech in quite room
Presense of background noise impaire hearing

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11
Q

Conductive hearing loss?

A

weber latteralize to affected ear

BC>AC on affected ear

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12
Q

SNHL?

A

weber latteralize to normal ear

AC> BC on affected ear

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13
Q

Treatment of agitation?

A

Llow dose haloperidol

Should not be used in patient with lewis body dementia

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14
Q

Glucocorticoid induced myophaty?

A

Proximal muscle weakness and atrophy without pain and tenderness
More involve lower extremity
Normal ESR and CK

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15
Q

Polymyalgia rheumatica?

A

muscle pain and stiffnes in shoulder and pelvic girdle
tenderness with decrease range of motion at neack,shoulder and hip
respond rapidley to glucocorticoid
increase ESR and normal CK

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16
Q

Inflamatory myophaty?

A

Muscle pain,tenderness and proximal muscle weakness
Skine rash and inflamatory artheritis may seen
Increase ESR and CK

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17
Q

Statine induced myophaty?

A

muscle pain and tenderness with or w/o weakness
rare rhabdomyolysis
Normal ESR nd elevated CK

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18
Q

Hypothyroidism myophaty?

A

Proximal muscle pain,cramp and weakness
Delayed DTR and myoedema
Occational rhabdomyolysis
Normal ESR and elevated CK

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19
Q

Management of idiopatic ICH?

A

Acetazolamide(inhibit CA in choroid plexus –Decrease CSF production)
Add furosemide if not respond
if not respond to medical treatment–Surgical(Lp shunting and optic nerve sheth aspiration)
Corticosteroid and intermitent LP until surgical intervention done.

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20
Q

What about manitol?

A

Used for onley cerebral edema

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21
Q

Multiple system atrophy?

A

also called shy-Drager syndrome
a degenerative disease characterized by
1)Parkinsonism
2)Autonomic dysfunction(generalized)
3)Widespread neurological signs (cerebellar, pyramidal, and LMN lesion)
–accompanied bulbar dysfunction and stridor may be fatal
–antiparkinson drugs is ineffective
–always consider if parkinsonism patients present with generalized autonomic dysfunction

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22
Q

Managment?

A 
Volume expansion using
Fludrocortisone
Salt supplementation
Alpha adrenergic agonist
Application of a constrictive garment to LE
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23
Q

Raily-day syndrome?

A

Also called familial dysautonomia
Autosomal recessive syndrome
Feeding difficulty and low muscle tone
Gross dysfunction of the autonomic nervous system

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24
Q

Features suggesting MS?

A 
	Onset age 15-50
	Optic neuritis
	Lhermitte sign
	Internuclar optalmoplagia
	Fatigue
	Uhthoff phenomena (symptom exacerbation with heat)
	Numbness and Paratsesia
	Paraparesis and spasticiry
	Bowel and bladder dysfunction
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25
Memantine?
 Block glutamate receptor |  Used in mild and moderate Alzheimer
26
Creuzfeldt-Jakob disease?
Spongiform encephalopathy caused by prion disease rapidly progressive dementia, myoclonus behavioral abnormality sharp, triphasic, and synchronous discharge in EEG patient dies within one year of diagnosis
27
Phenytoin toxicity?
Occur in first dosing, dose adjustment, liver disease, renal disease, concomitant CYP450 drug inhibitor, rapid IV fosphenytoin, and factor decrease protein bounding.
28
Manifestation?
``` Cerebral dysfunction(horizontal nystagmus,ataxia,dymentria,nausea, slured speech and vomiiting) Sever toxicity:AMS,paradoxical seizure,comma and death Hypothension and bradyarrythemia(Rapid infusion) ```
29
Evaluation of first seizure episode?
``` CBC OFT Serum glucose Drug toxicology screening on urine Routine EEG for risk stratification after above laboratory done normal(epileptiform or non-epileptiform) ```
30
Patternof CN III lesion?
Motor and pupillary dysfunction----Midbrain injury/Compression Onley motor:--Ischemia Onley parasympathetic---compression
31
How to differentiate neuropathy due to pheripherial nerve compression and spinal compression?
In spinal compression, there will be back pain
32
Cause of corneal abrasion?
factor lead to cornial epithelial injury Trauma Contact lenses spontaneous
33
Clinical symptoms?
Severe eye pain Foreign body sensation Photophobia Decrease/normal visual acuity
34
Evaluation?
Pupillary reaction Inspect presence of foreign body Assess visual acuity and send to an ophthalmologist if decreased Corneal staining defect with fluorescein
35
Presence of corneal abrasion without pain indicates?
CNV or V1 brach lesion
36
Normal-pressure hydrocephalus clinical manifestations?
Wide based gait, shuffling with frequent fall Cognitive dysfunction Urinary urgency/incontinence Depressed affect UMNL in LE(but disease common in old>60 the DTR may below)
37
Diagnosis and managment?
Ventriculomegaly with CT/MRI Confirm by doing LP: Normal pressure and clinical Improvement ataxia after large volume CSF removal--miller-fisher test Definitive management is doing a ventriculoperitoneal shunt
38
Urinary urgency/incontinence with dementia?
NPH, Vascular dementia and late alzimer
39
What to do before Thymectomy in MG patients?
Thymectomy may result MG crisis--So adequate dose of physostigmine and corticosteroid before surgery
40
Thalamic pain syndrome?
Also called Dejerine-Rousy syndrome Develop several weeks to a month following acute stroke Severe paroxysmal pain in contralateral Body induced by light touch(allodynia) in the face and extremity due to VPL and VPM nuclei injury respectively. lacunar stroke due to atheroma closure of penetrating branch of PCA
41
optic neuritis finding?
``` Common in young wommen Unilateral visual loss Associated with MS Due to demylinating disease Eye pain during movment Afferent pupillary dysfunction Washed out colour vision Central scotoma Colour vision loss Fundoscopy may be normal(Infn occur behind optic disk)(a sign of acute inflammation(hemorrhage) in the acute case and atrophy in chronic case) Diagnose with MRI of brain and optic treat with IV corticosteroid ```
42
Sarcoidosis and facial palsy?
``` A patient will have INFP sign Hypercalcemia Bilateral parotid enlargement Cervical lymphadenopathy Treat with prednisolone ```
43
Hemorrhagic transformation?
Occur mainly in the first 48 hr after Ischemic stroke diagnosed. The patient clinical condition will deteriorate Common in large size IS or after thrombectomy Do non-contrast CT of head
44
Fronto-Temporal dementia?
Also, called pick disease mainly start the 40s and 50s 40% family history Due to damage of frontal and temporal lobe--FrontoTemporal atrophy in imaging Early personality and behavioral change(e.g disinhibition and apathy) Compulsive behavior(e.g hoarding and hyperorality) Executive dysfunction
45
How to D/T from hoarding disorder?
Start as teenage and progress with age | Inability to keep adipose things
46
what we consider if INFP prolong > 3 month?
Suspect diagnosis other than bells palsy
47
Bells palsy treatment?
Pridisolone is the main stay | We may consider adding acyclovir/vancyclovir
48
Cortical blindness?
Normal pupillary reaction
49
Central artery occlusion?
``` painless visual loss retinal whitning(cherry-red spot) ```
50
Macular degeneration?
Mainly affect older patient Yellow deposit in the periphery central visual loss develop progressively affect both eyes
51
retinal detachment?
loss pheripherial vision first
52
Cluster headaches?
Acute, Severe unilateral periorbital headache Mainly start at sleep and can occur 8-9 times per day and lasts up to 90 min Autonomic symptoms (miosis, salivation, and lacrimation) Normal neurologic finding unlike TN involving V1 Treat with 100 % oxygen and we can consider sumatriptan if no C/I(Px or IHD) Prophylactics(Verapamil.lithium) after the acute attack
53
herpes encephalitis?
MCC of sporadic encephalitis in the US MC IS due to HSV1 Fever Focal neurologic finding(AMS,FCND,ataxia,hyperreflexia and seizure) Behavioral abnormality(Hypomania, Klevier busy syndrome, and amnesia)
54
Diagnosis and managment?
CSF: Lymphocytosis, High RBC, High protein, Normal glucose HSV PCR is the gold standard Temporal lesion In MRI(preferred than CT) Treat with IV acyclovir
55
CJD diagnosis criterion?
``` Rapidly progressive dementia with >=2 of the following clinical criteria 1-myoclonus 2-akinetic mutism 3-Cerebellar or visual problems 4-pyramidal/extrapyramidal defect ```
56
Finding?
``` one of the following 1-periodic sharp wave complex in EEG 2-Positive 13-3-3 assay 3-Caudate nucleus and putamen atrophy Neuropathology: Spongiform change, neuronal loss without inflammation ```
57
Managment?
No treatment available | Fatal within 12 months of diagnosis
58
Risk factor for drug-related peripheral neuropathy?
``` Digoxine Metronidazole Amidadrone Floroquinolol Dapsone ```
59
CM?
Glove and stock neuropathy We May have to decrease DTR The motor will be spared
60
Management?
STop drug | if persist TCA,Gabapentine/...

step 2 ck neurology (5 decks)

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