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Step3 > Neuro > Flashcards

Neuro Flashcards

1
Q

Stroke treatment

A

CT noncon to ensure no bleeding. Then if <3-4.5 hrs of sx, tpa. Else catheter retrieval and asa +/- dipyridamole

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2
Q

Cerebral artery stroke key sx

A
  • ACA - LE weakness, personality, UI
  • MCA - UE weakness, CL homon Hemianopsia, eyes deviate toward lesion
  • PCA - prosopagnosia
  • Vertebrobasilar- CBL and bst stuff (vertigo, n/v, nystagmus, drop)
  • pica - lateral medullary (ipsi face and cl body, Horner, vertigo)
  • lacunar - striatum and capsule - PD like, hemiparesis, bulbar, ataxia
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3
Q

Cerebral vein thrombosis - sx, imaging, tx

A

Subacute ha
MRV
Lmwh then warfarin for months

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4
Q

Stroke/TIA fup

A

After thrombolysis (if in window and symptomatic) and anticoag, echo, ekg and holter if ekg nml for afib, carotid u/s and endarterectomy for sx + stenosis 70-99%

  • esr, protein c and s, vdrl, ana etc if otherwise young and healthy
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5
Q

Status epilepticus management

A

Benzo—>fosphenytoin —> phenobarbital —> general

10-20 min bw steps to let tx work

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6
Q

Seizure initial work up

A

CMP, utox, head ct, ca and mg, neuro consult

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7
Q

Pregnancy safe AED

A

Lamotrigine and levetiracetam
Note OCPs and estrogen increase metab of lamotrigine

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8
Q

PD treatments

A

Initial: antichol (Benz, trihex) or amant of age>60

Severe: lev/carb, DA agonists (pramipex, ropin, caberg via patch, apomorphine) less effective but fewer AEs

Can add comt inhib (-capone), maoi (-giline), dbs, 5ht inhib antipsychotic (pimavanserin)

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9
Q

Essential tremor tx

A

Propan or other beta blocker, add primidone if persists after 1-2 wks, then switch to topiramate or gabapentin
Occurs at rest and with action

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10
Q

MS dx and tx

A

MRI!
Steroids for acute, then vit d, ca, dz modifying: anti-cd20 (ocrelizumab), beta interferon, glatiramer, mitoxantrone, natalizumab, fingolimod, dimethyl fumsrate, amant for fatigue, dalfampridine for walking, baclofen or tizan for spasticity

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11
Q

Work up of memory loss

A

Head ct, b12, thyroid, rpr/vdrl

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12
Q

Migraine tx

A

First, abortive with triptans or ergotamine

If status or contraindicated, give DA antag plus Benadryl to prevent dystonia

Ppx: beta blockers, alt = CCBs, tcas, ssris

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13
Q

Cluster headache sx and tx

A

Sx - unilateral pain, red and tearing eye, rhinorrhea

Tx - triptans or 100% O2 to abort, CCBs (eg verapamil) for ppx

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14
Q

Most common causes of encephalitis

A

HSV and VZV

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15
Q

Imaging to look for blood

A

CT without contrast

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16
Q

CSF - wbc dt infection or blood?

A

1:500 wbc to rbc is normal ratio. Increased ratio in infection

17
Q

ALS tx

A

Riluzole to block accum of glutamate (disease of both umn and lmn)

Also edaravone (antioxidant)

18
Q

RLS - common cause and tx

A

Iron deficiency
Tx: pramipexole or ropinirole (da agonists)

19
Q

GBS vs MG bs LEMS

A

GBS - ascending weakness with loss of DTRs often after virus, worry about resp failure
MG - descending weakness, worsens with use (Ig against AchR), assoc with thymoma, tx acetylcholinesterase inhib - stigmine) or thymoma, acute crisis can also cause resp failure —> ivig and plasmapheresis as in gbs
LEMS - descending weakness improves with use (Ig against Ca channels), assoc with lung cancer

20
Q

GBS vs MG vs LEMS

A
  • GBS: asc weakness and loss of dtrs after virus
  • mg: Ig against achr, tx with acetylcholinesterase inhib (stigmine) with antichol (glycopyrr) for AEs, sx worsen with use
  • LEMS: Ig against ca channels, sx improve with use, great with -fampridines to increase ach

Acute crisis in mg and gbs - worry about diaph weakness and resp failure —> ivig or plasmapheresis, steroids in MG (not gbs)

21
Q

ACS initial orders

A

EKG, trop, ckmb (both take 3-6 hours to rise, ckmb drops fast so good for reinfarction, myoglobin rises earlier), asa etc

22
Q

Mechanism of botulism

A

Prevent presynaptic ach release

23
Q

Dx of Mg

A

AchR ig first
If neg, musk
If neg, NCS or EMG

Tx - pyridostigmine, add steroids for escalation, everyone gets thymectomh even if no thymoma

24
Q

Cushing’s triad

A

Bradycardia, htn, and low resp rate
Seen in increased icp

25
Q

Epilepsy definition

A

At least two unprovoked seizures over 24 hours apart

26
Q

Dx and Tx for jme

A

EEG bl poly spike and slow wave, tx valproic acid

27
Q

Infantile spasms - what are they and how do we treat?

A

Epilepsy of infancy with bilateral spasms, delay, and hypsarrhythmia (disorganized eeg)

Tx corticoteopin and vigabatran

28
Q

ASM side effects

A

Valproic acid - low plt, liver injury, teratogen

Phenytoin - gingival hyperplasia

Cmz and oxcarb - Siadh —>hypona

29
Q

Mechanisms of pd meds

A

Carbidopa-levodopa da receptor stim
Mao b inhib prevent da breakdown
Amantadine increases da release
Comt inhib prevent breakdown of sinemet

30
Q

Carpal tunnel syndrome management

A

First splint
If that doesn’t work, do emg and ncs to confirm dx, then operate

31
Q

Tx for postherpetic neuralgia

A

Tca, gbp, pregab, then opioids or steroid injn if tx resistant

NSAIDs for herpetic neuralgia (<4mo since tx onset)

32
Q

What respiratory metrics do you monitor in GBS?

A

Vital capacity and negative inspiratory force

Versus Peak expiratory flow rate in obstructive lung disease

33
Q

Botulism mechanism

A

C botulinum toxin inhibits pre synaptic ach release at nmj

34
Q

Sleep terror vs nightmare

A

Sleep terror during nrem so don’t remember

Vs rem sleep behavior disorder act out rem dreams

35
Q

Parinaud syndrome

A

Tumor of pineal
Lose pupillary rxn, lose vertical gaze and optokinetic nystagmus, ataxia, headache

36
Q

Pt can’t let go when shakes hand, think…

A

Myotonic dystrophy
AD CTG repeat expansion
Classic presents in adulthood with myotonia and weakness esp in face so look flat, ptosis (cognitive and behavioral issues in kids, hypotonia etc in babies)

Also GI, cardiac, hypo ventilation, insulin resistance, hypogonad, cataracts, sleepy

Tx supportive

37
Q

MG treatment

A

Anticholinesterase meds for sx mgmt (eg pyridostigmine) plus immunosuppressant (eg prednisone, azathioprine), then try plasmapheresis, then ivig

Step3 (21 decks)

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