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PNCE > Neuro > Flashcards

Neuro Flashcards

1
Q

concussion sx

A

HA, dizzy, confusion, amnesia, blurred vision
no focal neuro findings

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2
Q

concussion TestOC

A

TBI w/ LOC: CT w/o contrast (negative)
MRI if sx 7-14d

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3
Q

concussion tx

A

abnormal test: inpatient admission
normal: admit if GCS <15/ bleeding diathesis or oral anticoags, assoc seizure
no high risk: outpt f/u w/o imaging
avoid sports 1wk, reveal for clearance
rest for at least 24h

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4
Q

post concussive syndrome tx

A

analgesics, antiemetics
cognitive therapy

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5
Q

TBI MCC

A

MVA

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6
Q

TBI sx

A

focal neuro deficits
confusion, HA, dizzy
seizures, cerebral edema

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7
Q

TBI test

A

TBI w/ LOC: CT w/o contrast (fx, midline shift, bleed)
GCS
closed injury: dura mater intact
open injury: dura mater injured

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8
Q

TBI tx

A

mild: monitor 24h, refer to cognitive therapist
athletes: no contact sports 1wk, reeval gradual recovery

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9
Q

bells palsy nerve

A

CN7 facial nerve

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10
Q

CN7 exits out the skull where

A

stylomastoid foramen

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11
Q

bells palsy sx

A

does not spare forehead
loss of wrinkle

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12
Q

bells palsy tx

A

prednisone w/in 72h
severe: valacyclovir x 1wk

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13
Q

traumatic facial nerve palsy tx

A

surgical decompression of nerve repair

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14
Q

lateral rectus palsy nerves

A

CNVI abducens nerve - motor
LR6, SO4

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15
Q

MC ocular nerve palsy

A

lateral rectus palsy

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16
Q

lateral rectus palsy sx

A

horizontal diplopia
estropia (medial deviation of affected eye)
strabismus

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17
Q

trigeminal neuralgia TOC

A

carbamazepine

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18
Q

reversible complication of liver failure

A

hepatic encephalopathy

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19
Q

hepatic encephalopathy tx

A

lactulose 1st line
rifaximin

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20
Q

reyes syndrome MCC

A

kid who took aspirin

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21
Q

reyes syndrome sx

A

sudden N/V/D
delirium, seizures, hepatomegaly, minimal jaundice

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22
Q

reyes syndrome test

A

CT head: diffuse cerebral edema
dec glu, inc ammonia, inc hepatic enzymes

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23
Q

reyes syndrome tx

A

1st line: mannitol, glycerol, dexamethasone (neuro protection)
supportive

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24
Q

wernicke encephalopathy due to

A

thiamine (B1) deficiency

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25
Q

MCC wernickes encephalopathy

A

chronic alcoholism

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26
Q

wernicke encephalopathy sx

A

triad: ataxia, confusion, bilateral horizontal nystagmus
gait: slow wide based small steps

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27
Q

wernicke encephalopathy tx

A

supportive
agressive high dose IV thiamine

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28
Q

wernicke encephalopathy complication

A

Korsakoff syndrome (chronic irreversible), amnesia, disorientation

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29
Q

cluster HX sx

A

unilateral periorbital pain
lasts <2h

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30
Q

cluster HA tx

A

initial: sumatriptan subQ, 100% oxygen

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31
Q

cluster HA prophylaxis

A

verapamil (CCB)

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32
Q

migraine ha tx

A

sumatriptan or ergotamine
prochlorperazine (antiemetic)
NSAID

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33
Q

prophylaxis migraine HA

A

BB
topiramate
TCA
valproic acid

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34
Q

sumatriptan or ergotamine CI

A

HTN, CVD

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35
Q

migraine in pregnancy tx

A

acetaminophen
promethazine (antiemetic)
NSAIDS

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36
Q

metaclopramide, promethazine (dopamine blocker) AE

A

EPS/dystonic reaction: give w/ diphenhydramine

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37
Q

tension HA tx

A

Acute: NSAIDS or acetaminophen

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38
Q

tension HA prophylaxis

A

amitriptyline (TCA)

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39
Q

MCC encephalitis

A

HSVI

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40
Q

encephalitis sx

A

AMS (24+h)
F, HA, focal neuro deficits (hemiparesis, CN palsy)

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41
Q

encephalitis test

A

CT of head or MRI (most sensitive for HSV): temporal lobe edema
LP

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42
Q

encephalitis involves cn

A

CN II, IV, VI, VII

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43
Q

encephalitis tx

A

supportive
HSV: acyclovir IV ASAP

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44
Q

monitor if give acyclovir IV

A

kidneys

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45
Q

AIDS + meningitis

A

cryptococcus neoformans

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46
Q

cryptococcus neoformans meningitis test

A

CSF: inc opening pressure, variable pleocytosis, inc protein, dec glucose
india ink stain: encapsulated yeast forms

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47
Q

meningitis <1mo

A

GBS (streptococcus agalactiae)
ampicillin + cefotaxime or amino glycoside

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48
Q

MCC meningitis 1mo-18yo

A

N. meningitidis (assoc w/ petechial rash)
S. pneumo

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49
Q

MCC meningitis 18y-50y

A

S. pneumo
N. meningitidis (assoc w/ petechial rash)

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50
Q

meningitis tx 1mo-50yo

A

ceftriaxone/ cefotaxime + vanco

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51
Q

meningitis >50yo

A

S. pneumo
listeria
ampicillin + ceftriaxone/ cefotaxime +/- vanco

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52
Q

MCC bacterial meningitis

A

S. pneumo
N. meningitidis

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53
Q

meningitis sx

A

F, stiff neck, AMS
+brudzinski
+kernig
petechial rash w/ neisseria
s. pneumo cough
hx of sinusitis/pneumonia

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54
Q

meningitis test

A

1st: blood culture (neutrophils)
2nd: abx
3rd: CT of head + LP (definitive)

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55
Q

meningitis tx

A

steroids (dexamethasone) before abx
adult: vanco + cef
infant: ampicillin + cefotaxime
>50/ immunocomp: vanco + cef + ampicillin

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56
Q

viral aseptic meningitis MCC

A

enterovirus (Echovirus, coxackie)
HSV

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57
Q

viral aseptic meningitis sx

A

+meningeal sx
+brudzinski
+kernig
sx not as intense as bacterial
no focal neuro deficits/ seizures

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58
Q

HSV meningitis sx

A

skin lesion (primarily involves temporal lobe)
aphasia, olfactory hallucinations, personality changes

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59
Q

Mumps meningitis sx

A

parotid swelling

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60
Q

west nile meningitis sx

A

flaccid paralysis w/ rash

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61
Q

RMSF meningitis sx

A

red maculopapular rash on wrists and ankles

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62
Q

lyme meningitis sx

A

erythema migrans
bilateral facial nerve palsy
circa arrhythmias

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63
Q

VZV meningitis sx

A

vesicles in dermatomal distribution

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64
Q

viral aseptic meningitis test

A

LP: lymphocytes, normal glucose
patchy lobe enhancement

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65
Q

HSV meningitis test

A

RBC in CSF

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66
Q

viral aseptic meningitis tx

A

empiric abx until viral cause confirmed
supportive: NSAIDS for fever

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67
Q

HSV meningitis tx

A

IV acyclovir

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68
Q

meningococcemia MCC

A

N. meningitidis

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69
Q

meningococcemia sx

A

meningitis + septicemia
sudden onset, rapid progression. F, hypoTN, HA, nuchal rigidity
AMS, petechial rash w/ grey necrotic centers

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70
Q

meningococcemia test

A

clinical
confirm w/ BC w/ gram stain and LP

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71
Q

meningococcemia tx

A

vancomycin + ceftriaxone

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72
Q

essential tremor tx

A

propranolol + primidone

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73
Q

huntington dz MOA

A

autosomal dominant
HTT (repeated CAG) on chromosome 4
more repeats = earlier onset w/ each generation
CAG: caudate loses ACh and GABA

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74
Q

huntington dz sx

A

initial: chorea, hyperreflexia, athetosis, irribilitity, personality changes, inappropriate laughing/crying
advanced: progressive dementia

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75
Q

athetosis

A

slow snakelike movements in Huntington’s

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76
Q

huntington dz test

A

huntington disease test
definitive: genetic testing (PCR) and counseling
CT: cerebral and caudate atrophy
PET: dec glu metabolism in caudate nucleic and putamen

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77
Q

huntington tx

A

sx and supportive
tetrabenazine
antipsychotics, SSRI, psychotherapy

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78
Q

Parkinson MOA

A

depletion of dopaminergic neurons in basal ganglia
substantia nigra
Lewy bodies

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79
Q

Parkinson sx

A

resting tremor (pill rolling)
cogwheel rigidity
bradykinesia
postural instability, shuffling gait
masked facies
dementia: late finding

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80
Q

myerson sign

A

parkinsons
tapping bridge of nose causes blinking

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81
Q

Parkinson tx

A

no cure
1st line: levodopa/carbidopa (if new psychosis, dec dose)
<65yo: pramipexole or ropinerole +/- levo/carb
>65: + amantadine

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82
Q

levodopa AE

A

induce psychosis in elderly pts w/ dementia

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83
Q

COMT (entacarpone, tolcapone) AE

A

brown colored urine

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84
Q

anticholinergics AE

A

BPH
glaucoma

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85
Q

Tourettes assoc w/

A

ADHD
OCD

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86
Q

tourettes dx

A

clinical
motor ticks and at least 1 vocal tic for >1y
onset before 18yo
not explained by substance or other med conditions

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87
Q

tourettes tx

A

CBT
guanfacine
clonidine (can be adjunct)
haloperidol
risperidone
tetrabenazine

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88
Q

meningioma assoc w/

A

neurofibromatosis (NF2)

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89
Q

menengioma sx

A

benign, slow growing
chronic HA worse upon awakening
seizure, focal deficit, AMS

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90
Q

meningioma test

A

MRI of head w/ contrast: intensely enhancing well defined lesion attached to the dura
brain bx: spindle cells in whirled pattern psammoma bodies

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91
Q

meningioma tx

A

surgical resection
radiation if unresectable

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92
Q

glioblastoma multiforme sx

A

rapid progression w/ poor prognosis
MC in adults
chronic HA worse upon awakening
triad: irregular respirations, HTN, bradycardia
inc ICP
visual disturbances

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93
Q

glioblastoma multiforme test

A

MRI w/ contrast: single lesion
variable ring of enhancement surrounded by edema, may cross midline. butterfly glioma
brain bx: necrotizing tissue

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94
Q

glioblastoma multiforme tx

A

surgery, chemo rad

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95
Q

MC malignant primary brain tumor

A

glioblastoma multiforme

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96
Q

medulloblastoma sx

A

MC in children
HA, vomiting, ataxia
CN VI palsy
dysmetria

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97
Q

medulloblastoma test

A

MRI: solid homogenous contrast enhanced mass
obstruction of 4th ventricle
hydrocephalus

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98
Q

medulloblastoma tx

A

surgical w/ chemo rad

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99
Q

pseudotumor cerebri sx

A

young obese female w/ hx vitamin A toxicity, use of OCP, steroids, or tetracyclines
inc ICP w/ unidentifiable cause
HA worse w/ straining, visual disturbance
CN VI palsy, diplopia w/ lateral gaze
retrobulbular pain, tinnitus

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100
Q

pseudotumor cerebri test

A

CT r/o mass
MRI usually normal
Most accurate: LP (inc opening pressure)

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101
Q

pseudotumor cerebri tx

A

acetazolamide
operative: optic nerve sheath fenestration

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102
Q

MC form of dementia

A

alzheimers

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103
Q

alzheimers MOA

A

dec Ach
slow and progressive

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104
Q

alzheimers sx

A

short term progressive memory loss
functional impairment

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105
Q

alzheimers test

A

mini COG/MMSE
MRI
CT: brain atrophy, narrowing of gyro and widening of sulci, ventricles enlarged
CSF: tau protein
definitive: brain bx (neurofibrillary tangles and amyloid plaques)

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106
Q

alzheimers tx

A

donepezil, galantamine, rivastigmine
late stage: memantine

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107
Q

delirium criteria

A

confusion assessment method algorithm
3/4
acute onset/ fluctuating course
inattention
disorganized thinking
altered level of consciousness

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108
Q

delirium sx

A

tx underlying, DC causative meds
avoid restraints or atypical antipsychotics
haloperidol/risperidone if life threatening
benzo worsen delirium

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109
Q

dementia test

A

MMSE 24 or less, PHQ9
CT: cerebrocortical atrophy, ventricular dilation, prominent cortical sulci

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110
Q

dementia tx

A

no cure
memantine

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111
Q

types of dementia

A

alzheimers
vascular
frontaltemporal
diffuse lewy body
creutzfelt Jakob

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112
Q

creutzfeldt Jakob disease sx

A

dementia at a early age from misfolded proteins
rapid progressing, cognitive impairment
seizures, myoclonic jerks triggered by startling

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113
Q

creutzfeldt Jakob disease test

A

LP (14-3-3 protein in CSF)
EEG: sharp triphasic wave complexes
brain bx: spongiform encephalopathy

114
Q

creutzfeldt Jakob disease tx

A

N/A
onset to death within months

115
Q

frontotemporal dementia (picks dz) MOA

A

degeneration of frontal and temporal lobes of brain
abn nerve cell proteins (pick bodies)

116
Q

frontotemporal dementia (picks dz) sx

A

personality and social behavior changes
aphasia, memory deficits
+ palmomental and palmar grasp reflexes

117
Q

frontotemporal dementia (picks dz) tests

A

clinical
MRI: atrophy of frontotemporal lobes
definitive: brain bx (pick bodies)

118
Q

frontotemporal dementia (picks dz) tx

A

supportive
SSRI
monitor for development of ALS

119
Q

Lewy body dementia MOA

A

accumulation of Lewy bodies
Ach and Dopamine

120
Q

Lewy body dementia sx

A

visual hallucination (children/animals)
Parkinsonism (bradykinesia, rigidity)
delusions, cognitive fluctuations, trembling

121
Q

Lewy body dementia test

A

clinical
brain autopsy: Lewy bodies

122
Q

Lewy body dementia tx

A

cognitive sx: donepezil, galantamine, rivastigmine
motor sx: levodopa
avoid dopaminergic rx
quetiapine for AVH

123
Q

normal pressure hydrocephalus MOA

A

dec CSF absorption

124
Q

normal pressure hydrocephalus sx

A

wet, weird, wobbly
urinary incontinence, dementia, shuffling/ wide based gait/ ataxia

125
Q

normal pressure hydrocephalus test

A

inial: MRI (ventriculomegaly)
confirm: high volume LP (normal opening pressure)

126
Q

normal pressure hydrocephalus tx

A

shunt placement

127
Q

vascular dementia RF

A

HTN
CAD
atherosclerosis
HLD
smokers

128
Q

vascular dementia MOA

A

damage to brain cells d/t lack of blood/oxygen

129
Q

vascular dementia sx

A

sudden stepwise decline
focal neuro deficits

130
Q

vascular dementia temporal sx

A

memory problems

131
Q

vascular dementia parietal sx

A

loss of speech (aphasia)

132
Q

vascular dementia frontal sx

A

personality changes

133
Q

vascular dementia tests

A

CT/MRI: ischemia
MMSE

134
Q

vascular dementia tx

A

prevent future stroke (anticoagulant tx)
ASA, clopidogrel, statin, ACE)
PT/OT

135
Q

cerebral palsy MCC

A

prematurity

136
Q

cerebral palsy sx

A

spastic (MC, hallmark) = inc muscle tone, inc DTR, seizures, toe walk
non-spastic: dystonia, chorea, dysphasia
ataxic: shaky uncoordinated movements, poor balance
all types: intellectual disability, seizure, joint contracture, ADHD

137
Q

cerebral palsy test

A

cranial US: neonates- hemorrhage, hypoxic injury, structural abnormalities
MRI: Infants- detect causative lesion

138
Q

cerebral palsy tx

A

improve quality of life
baclofen- muscle relaxer
diazepam
anti epileptics for seizures

139
Q

multiple sclerosis MOA

A

chronic progressive demyelination of brain and spinal cord
oligodendrocytes disorder
episodic relapsing remitting

140
Q

multiple sclerosis sx

A

optic neuritis (MC)
trigeminal neuralgia
babinski
uhthoffs phenomenon
Lher mitts sign
charcots neuro triad

141
Q

charcots neuro triad

A

nystagmus
staccato speech
intensimal tremor
seen in MS

142
Q

uhthoffs phenomenon

A

worse w/ heat

143
Q

Lher mitts sign

A

neck flexion causes lighting rod to spine down leg
seen in MS

144
Q

Marcus gunn pupil

A

pupils dilate when light from unaffected eye to affected eye

145
Q

multiple sclerosis test

A

BIT and MAT: T2 weighted MRI w/ ngaldinium
LP and CSF: oligoclonal glands (inc IgG), lymphocytic pleocytosis
MRI: Dawsons fingers, white matter plaques

146
Q

multiple sclerosis tx

A

exacerbation 1st line: cyclophosphamide or methylprednisolone
2nd: plasma exchange
spasticity: baclofen

147
Q

multiple sclerosis maintenance tx

A

1st line: Beta interferon, glatiramer acetate

148
Q

myasthenia gravis associated w/

A

Thomas and thyrotoxicosis

149
Q

myasthenia gravis MOA

A

autoimmune destruction of Ash receptors at neuromuscular junction and blocks transmission

150
Q

myasthenia gravis sx

A

easy fatigue
ptosis (ice pack test= improves)
proximal muscle weankess
improved w/ rest, worse w/ activity
diplopia, normal DTR, prolonged chewing

151
Q

myasthenia gravis test

A

initial: AChR ab test
MAT: edrophonium tension test

152
Q

myasthenia gravis tx

A

1st line: pyridostigmine
procedural: IVIG or plasmaphoresis

153
Q

myasthenia gravis complication

A

thyme
thymectomy <60 then prednisone if thymectomy or initial tx doesn’t work

154
Q

myasthenia gravis avoid

A

FQ
aminoglycosdes

155
Q

pyridostigmine AE

A

cholinergic crisis

156
Q

carpal tunnel test

A

hand elevation test
tinel
phalan
durkans test
confirm: nerve conduction study

157
Q

tinel test

A

carpal tunnel
tap on solar side of hand

158
Q

phalens test

A

back of hands placed together
carpal tunnel

159
Q

carpal tunnel tx

A

volar splint
definitive: surgical release of transverse carpal ligament

160
Q

carpal tunnel MOA

A

medial nerve trapped by transverse carpal ligament

161
Q

complex regional pain syndrome sx

A

previous soft tissue injury
extreme pain to light touch, skin changes, swelling
allodynia
dec ROM and strength

162
Q

complex regional pain syndrome tx

A

clinical

163
Q

complex regional pain syndrome tx

A

1st line: PT/OT + NSAIDS, gabapentin. psych intervention

164
Q

complex regional pain syndrome prevention

A

vitamin C can help

165
Q

Guillain barre syndrome MOA

A

demyelinating polyneuropathy of peripheral nerves
Schwann cell demyelination

166
Q

Guillain barre syndrome MCC

A

bacterial (campylobacter jejuni)

167
Q

Guillain barre syndrome sx

A

hx of GI infx or URI
ascending flaccid paralysis (ground to brain)
dec/ absent DTR
bilateral facial nerve palsy
potential respiratory failure

168
Q

Guillain barre syndrome test

A

LP: inc CSF protein, albuminocytologic dissociations but normal WBC
check vital capacity (r/o respiratory failure)
EMG: dec conduction velocity

169
Q

Guillain barre syndrome tx

A

high dose IVIG
plasmapheresis
CS

170
Q

Guillain barre syndrome complications

A

respiratory failure d/t diaphragm = needs ventilation in ICU.
prednisone CI

171
Q

neuralgia parenthetica

A

upper thigh numbness
obese/pregnant
tx” loose clothing, weight loss

172
Q

common peroneal neuropathy

A

proximal fibula injury
foot drop
tx w/ ankle splint

173
Q

radial nerve palsy

A

Saturday night palsy
from drinking, crutches, or humeral shaft fx
wrist drop, can’t extend wrist
tx w/ wrist splint

174
Q

ulnar nerve palsy

A

elbow injury
decreased finger adduction/ thumb grasp
4th/5th digit paresthesia

175
Q

central cord syndrome sx

A

upper extremities affected more than lower
complete loss motor function upper extremities

176
Q

focal onset seizures

A

involves single cerebral hemisphere at onset
aware
impaired awareness

177
Q

generalized onset seizures

A

involves both hemispheres at onset
tonic clonic
myoclonic
absence

178
Q

tx focal onset seizures

A

carbamazepine
phenytoin

179
Q

tx tonic clonic and myoclonic seizure

A

levetiracetam
valproic acid

180
Q

tx absence seizures

A

ethosuxamide
valproic acid

181
Q

status epileptics criteria

A

seizure lasting more than 5 min or >2 seizures w/o resolution of post ictal state

182
Q

status epileptics causes

A

withdrawal from anti epileptic drugs
hyponatremia
TCA toxicity
brain lesion/injury

183
Q

status epilepticus tx

A

ABC –> IV access + rectal diazepam
first line: benzo (IV lorazepam)
if does not respond in 1min, additional lorazepam
unresponsive 10-20m” IV fosphenytoin or IV phenytoin
benzos –> phenytoin -> phenobarbital

184
Q

IV phenytoin AE

A

hypotension if administered quickly

185
Q

childhood exanthem that can cause febrile seizures

A

HHV6 roseola
high grade fever for 3-5d then rash

186
Q

febrile seizure MRI indication

A

meningeal signs (stiff neck, AMS)
incomplete immunization (H. flu type B or s. pneumo 6-12mo)
antecedent abx use (can mask meningitis sx)

187
Q

MC type cerebral aneurism

A

berry

188
Q

cerebral aneurism sx

A

enruptured: asx, HA/pain behind one eye, vision problems, ptosis, unilateral facial weakness/numbness, speech difficulty
ruptured: sudden severe HA (thunderclap), LOC, vision prob, neck stiffness, emergency

189
Q

cerebral aneurism test

A

initial: CT angiography, MRI/ MRA

190
Q

cerebral aneurism tx

A

enraptured: surgery or observation
ruptured: surgical clipping or end-vascular coiling

191
Q

most significant cause of morbidity in pts w/ TBI

A

diffuse axonal injury

192
Q

diffuse axonal injury sx

A

traumatic deceleration injury, results in vegetative state
sx out of proportion w/ CT
LOC instant and later develop vegetative state

193
Q

diffuse axonal injury test

A

CT: minute punctate hemorrhages w/ blurring go of gray white interface
MRI more sensitive

194
Q

cause of epidural hematoma

A

head trauma -> pterion- MMA damage

195
Q

epidural hematoma sx

A

LOC then lucid interval (slow bleed several hrs before onset sx)
N/V, HA, focal deficits
arterial bleed: fast

196
Q

epidural hematoma test

A

non contrast CT: hyper dense mass, biconvex (lemon) shape
ballot cross suture lines
shift of midline

197
Q

epidural hematoma tx

A

emergency
craniotomy

198
Q

subdural hematoma MOA

A

bleeding between dura mater and arachnoid mater
rupture of bridging veins

199
Q

subdural hematoma RF

A

elderly (brain atrophy)
alcohol abuse
shaken baby syndrome

200
Q

subdural hematoma sx

A

days to weeks
venous bleeding: slow
increased ICP sx
any elderly w/ neuro sx
child: shaking baby= child abuse

201
Q

subdural hematoma test

A

non contrast CT: crescent shape (banana), concave
crosses suture lines

202
Q

subdural hematoma tx

A

evacuation
small: catheter
large: craniotomy

203
Q

subarachnoid hemorrhage MCC

A

trauma, AV malformation
non traumatic: ruptured (berry) aneurism: MC location ACA

204
Q

subarachnoid hemorrhage genetic causes

A

autosomal dominant PKD
marfan
Ehlers danlos

205
Q

subarachnoid hemorrhage sx

A

work HA of my life “thunderclap”
no focal neuro sx
rapid progression
vision changes, confusion, seizures

206
Q

subarachnoid hemorrhage test

A

non contrast CT: do LP if CP negative
cerebral angiogram
gold standard: LP = xanthochromia (yellow color of CSF d/t breakdown of RBC)

207
Q

subarachnoid hemorrhage LP CI

A

traumatic subarachnoid hemorrhage

208
Q

subarachnoid hemorrhage tx

A

surgical clipping
control BP: PO nimodipine Q4h
supportive

209
Q

intracranial hemorrhage MOA

A

due to hemorrhagic stroke
bleeding inside brain
inc ICP

210
Q

intracranial hemorrhage MC location

A

basal ganglia

211
Q

intracranial hemorrhage MCC

A

trauma
non traumatic: HTN (location: putamen of basal ganglia)

212
Q

intracranial hemorrhage sx

A

abrupt
AMS, coma, dizzy, N/V
neuro sx worsen within 30-90m

213
Q

intracranial hemorrhage test

A

stat CT of brain
LP for xanthochromia
coag panel (PT, PTT, INR) and plt

214
Q

intracranial hemorrhage tx

A

ICU, ABC
DOC nitroprusside
mannitol, diuretics
no steroids

215
Q

stroke/ CVA MC type

A

thrombotic

216
Q

stroke/ CVA RF

A

HLD
Afib
recent MI
DM
Smoking
HTN

217
Q

stroke/ CVA ACA

A

feet and legs
contralateral hemiparesis
LE and trunk weakness/numb

218
Q

stroke/ CVA MCA

A

hands/arm/face
language weakness, dec sensation
bilateral vision abnormalities
aphasia, neglect, cannot perform learned actions

219
Q

stroke/ CVA PCA

A

visual abnormalities
blindness

220
Q

stroke/ CVA lacunar

A

focal motor/sensory deficits
loss of coordination
difficulty speaking
contralateral hemiparesis

221
Q

stroke/ CVA basilar

A

CN abnormalities
full body weakness, dec sensation
vertigo

222
Q

locked in syndrome

A

plegia of head, body, muscles
can blink and vertical movement

223
Q

stroke/ CVA test

A

non contrast CT: loss of grey white interface
MRI, CTA
CBC, coag, plt
cardiac monitor, EKG
NIH stroke scale

224
Q

stroke/ CVA tx

A

ABC
thrombolytics: TPA/alteplase (w/in 4.5h of onset)
ASA
swallow assessment

225
Q

TPA indictions

A

<4.5h of onset
BP<185/110
low bleed risk

226
Q

TIA MOA

A

brain w/o blood supply for brief period of time (<24h)
blood flow restored before permanent damage occurs

227
Q

TIA RF

A

uncontrolled HTN
smoking
afib
MC d/t embolus

228
Q

TIA sx

A

unilateral facial palsy
arm weakness, speech difficulty
transient monocular blindness
sx resolve <1-2h

229
Q

TIA internal carotid sx

A

amaurosis fugax
weakness contralateral hand

230
Q

TIA ICA/MCA/ACA sx

A

cerebral hemisphere dysfunction

231
Q

TIA PCA sx

A

somatosensory deficits

232
Q

TIA vertebrobasilar sx

A

brainstem/cerebellar sx

233
Q

TIA test

A

NIH stroke scale
BIT: head CT w/o contrast (negative)
resolve <24h
MRI/MRA of head/neck
carotid doppler

234
Q

TIA tx

A

monitor
statin + anti HTN + anti plt (ASA or plavix) + anticoagulant (heparin)
thrombolytics CI

235
Q

triptan CI

A

ergot derivatives (dihydroergotamine)
CAD, PAD, HTN
pregnancy/breastfeeding

236
Q

triptan AE

A

inc BP
paresthesia
dizziness
coronary ischemia

237
Q

migraine prophylaxis

A

> 3 attacks/mo or long lasting attacks >12h
BB (propranolol/metoprolol)
TCA: amitriptyline
anti convulsant: topiramate/valproate
CCB: verapamil

238
Q

phenytoin MOA

A

blocks voltage gated Na channels
stops seizure propagation

239
Q

phenytoin AE

A

CNS depression
SLE like syndrome
gingival hyperplasia

240
Q

carbamazepine MOA

A

inc refractory period of voltage gated Na channels
inhibits action potential generation

241
Q

carbamazepine AE

A

hepatotoxic
SIADH
teratogenic
drug induced hyponatremia

242
Q

lamotrigine MOA

A

blocks voltage gated Na channels and glutamate receptors

243
Q

lamotrigine AE

A

SJS

244
Q

ethosuximide MOA

A

blocks thalamic Ca channels

245
Q

ethosuximide AE

A

GI distress
SJS

246
Q

med used for seizures in pregnant woman and children

A

phenobarbital

247
Q

valproic acid AE

A

pancreatitis
hepatotoxicity
iatrogenic
tremor

248
Q

DOC myoclonic seizure

A

valproic acid

249
Q

topiramate AE

A

weight loss
intermenstrual spotting
dec efficacy of OCP
paresthesia

250
Q

ALS MOA

A

leu Gehrigs disease
necrosis of both upper and lower motor neurons -> progressive motor degeneration

251
Q

ALS sx

A

muscle weakness
loss ability to initiate control motor movements
mixed upper and lower motor signs
bulbul sx
sensation, urinary sphincter, and voluntary eye movement spared

252
Q

ALS tx

A

riluzole reduces progression up to 6mo
fatal within 5y of onset

253
Q

astrocytoma location

A

infratentorial in children
supratentorial in adults

254
Q

astrocytoma types

A

pilocytic (grade I)
diffuse (grade II)
anapestic (grade III)
glioblastoma multiforme (grade IV)
subependymal giant cell

255
Q

pilocytic ast rocytoma

A

juvenile astrocytoma (grade I): localized. most benign. MC children and young adults

256
Q

diffuse astrocytoma (grade II)

A

types: fibrillary, gemistocytic, protoplasmic
invade surrounding tissues but grow relatively slow

257
Q

anapestic astrocytoma

A

grade III
rare but aggressive

258
Q

MC primary CNS tumor in adults

A

glioblastoma multiforme (grade IV astrocytoma)

259
Q

subependymal giant cell astrocytoma

A

ventricular tumors associated w/ tuberculosis sclerosis

260
Q

astrocytoma test

A

CT or MRI w/ contrast (I-II non enhance), III-IV enhance
brain bx

261
Q

pilocytic astrocytoma brain bx

A

form sacs of fluid (cystic) or enclosed within cyst
Rosenthal fibers: eosinophilic corkscrew fibers

262
Q

diffuse astrocytoma brain bx

A

contain micro cysts and mucus like fluid

263
Q

anaplastic astrocytoma brain bx

A

tentacle like projections that grow into surrounding tissue
difficult to remove during surgery

264
Q

glioblastoma astrocytoma brain bx

A

may contain cystic material, calcium deposits, blood vessels of mixed grade of cells

265
Q

pilocytic astrocytoma tx

A

surgical excision
+ rad if not completely removed

266
Q

diffuse astrocytoma tx

A

surgery if tumor is accessible and can be completely removed
rad for adjunct or unresectable tumors

267
Q

anapestic astrocytoma tx

A

surgery -> XRT +/- chemo after rad or tumor recurrence

268
Q

astrocytoma grade IV astrocytoma tx

A

surgery -> XRT (radiation therapy + chemo

269
Q

CNS lymphoma RF

A

immunosuppression
EBV

270
Q

CNS lymphoma sx

A

focal deficits
ocular sx

271
Q

CNS lymphoma test

A

CT/MRI w/ contrast: ring enhancing lesino
bx

272
Q

CNS lymphoma tx

A

chemo: MTX more effective chemo (give w/ colonic acid/leucovorin)
radiation, CS
surgery usually ineffective

273
Q

oligodendroglioma brain bx

A

soft grayish pink calcified tumors
areas of hemorrhage or cystic
chicken wire capillary pattern w/ fried egg shaped tumor

274
Q

ependymoma etiology

A

cells that one the ventricles and part of the spinal column
MC seen in 4th ventricle and spinal cord

275
Q

ependymoma sx

A

infant: inc head size, irritability, sleeplessness, vomiting
older child/adult: N/V/H

276
Q

ependymoma test

A

CT/MRI w/ contrast
brain bx: perivascular pseudorosettes

277
Q

retinal hemangioma associated w/

A

von hippel Lindau syndrome

278
Q

neurofibromatosis type I sx

A

need 2 of the following
>6 fate au lait spots
freckling: esp axillary, inguinal
lisch nodules of iris
>2 neurofibromas or > plexiform neurofibroma
optic pathway gliomas

279
Q

neurofibromatosis type 2 sx

A

neurologic lesions: bilateral vestibular schwannomas, meningiomas
optic lesions
skin lesions

280
Q

fibromyalgia tx

A

TCA (amytriptiline)

PNCE (33 decks)

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