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Internal Medicine HYHO > Neuro > Flashcards

Neuro Flashcards

1
Q

what is acute colonic pseudoobstruction?

A

Autonomic disruption of the colon causes painful abdominal distension, the inability to poop, and vomiting

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2
Q

what causes acute colonic psuedoobstruction

A
  1. electrolyte imbalances
  2. trauma, recent surgery, infections
  3. medications
  4. Neurological disorders
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3
Q

imaging for acute colonic psuedoobstruction shows what

A

X-Ray will show colonic dilation, normal haustra, and a non dilated small bowel

CT scan will sow colonic dilation and NO anatomic obstruction

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4
Q

what are the symptoms of acute colonic pseduoobstruction

A

abdominal distension, vomiting, inability to poop, decreased bowel sounds, tympanic to percussion

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5
Q

complications of acute colonic psuedoobstruction

A

bowel perforation (gaurding, rigidity, reboudn tenderness)

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6
Q

management of acute colonic psuedoobstruction

A

NPO (bowel rest), nasogastric decompression and IV neostigmine if there is no improvement within 2 days

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7
Q

after an MI what interventions are aimed at achieving the most improvement for a patient’s long term prognosis?

A

time it takes to restore coronary blood flow - this will limit myocardial damage and improve cardiovascular mortality

*this is done by PCI or fibrinolysis

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8
Q

SIADH serum osmolality and urine osmolality levels

A

serum <275 mOsm/kg H20

urine <100 mOsm/kg H20

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9
Q

a patient with a hilar mass in the setting of weight loss, cough, and a significant smoking history is concerning for?

A

small cell lung cancer

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10
Q

small cell lung cancers can cause what paraneoplastic syndrome

A

SIADH

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11
Q

types of SIADH

A

mild hyponatremia: nausea and forgetfulness
severe hyponatremia: seizures and coma
Euvolemia: most mucus membranes, no edema

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12
Q

managemtn of SIADH

A

fluid restriction with salt tablets

for severe Na<120 - hypertonic saline

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13
Q

when adminsitering hypertonic saline you want to correct the sodium levels slowly with a rate of <8 mEq/L over the first 24 hours to prevent what complication

A

osmotic demyelination syndrome

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14
Q

what are the two most important risk factors for stroke on USMLE

A

hypertension and AFIB

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15
Q

ACA stroke signs

A

motor and sensory abnormalities of the contralateral leg

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16
Q

MCA stroke signs

A

motor and sensory abnormalities of the contralteral arm and face

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17
Q

dominant MCA strokes are usually on which side

A

left sided

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18
Q

dominant MCA stroke can lead to?

A

Wernicke or Broca Aphasia

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19
Q

nondominant MCA stroke can cause?

A

hemispatial neglect

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20
Q

what is hemispatial neglect

A

the inability to draw clockface

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21
Q

PCA stroke signs

A

prospagnosia ( inability to recognize faces)

contralateral homonymous hemianopsia with macular sparing

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22
Q

lateral medullary syndrome is caused by?

A

posterior inferior cerebellar artery (PICA) or vertebral artery ischemia

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23
Q

lateral medullary syndrome is also known as?

A

wallenberg syndrome

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24
Q

what are the symptoms of lateral medullary syndrome

A

dysphagia and ipsilateral horner syndrome

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25
Q

what is horner syndrome

A

ipsilateral miosis, partial ptosis, and anhidrosis

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26
Q

horner syndrome can be caused by what two things?

A

pancoast tumor, or lateral medullary syndrome

27
Q

what is the artery involved in medial medullary syndrome

A

anterior spinal artery

28
Q

what are the signs of medial medullary syndrome

A

ipsilateral tongue deviation

29
Q

what is the artery involved in lateral pontine syndrome

A

anterior inferior cerebellar artery (AICA)

30
Q

signs of lateral pontine syndrome

A

ipsilateral Bells Palsy (facial droop, ptosis)- cranial nerve 7

31
Q

weber syndrome is a stroke in what location

A

the midbrain

32
Q

what are the symtoms of weber syndrome

A

ipsilateral CN III palsy (down and out eye) with contralateral spastic hemiparesis (weakness)

33
Q

locked in syndrome is a stroke of what artery

A

Basilar artery

34
Q

signs of locked in syndrome

A

inability to move enitre body expect for the eyes

35
Q

gerstmann syndrome is a stroke of?

A

the angular gyrus of the parietal lobe

36
Q

what is the tetrad of syndrome from gerstmann syndrome

A
  1. agraphia (inability to write)
  2. acalculia (inability to do math)
  3. finger agnosia (cant identify fingers)
  4. left-right dissociation (cannot differentiate between left and right sides of the body)
37
Q

Hemiballismus is a stroke of what location?

A

subthalamic nucleus

38
Q

signs of a hemiballistic stroke

A

ballistic flailing of contralateral arm or leg

39
Q

what is the mechanism of lacular infarcts?

A

hypertension causes liphyalinosis which is atheromas in the small lenticulostriate (deep) arteries in the brain

this plaques cause ischemia in the brain which can lead to necrosis and reabsorption of tissue and forms tiny cavities called lacunae

40
Q

symptoms of a lacunar infarct

A

specific syndromes based on their location

pure motor hemiparesis, purse sensory stroke, ataxic hemmiparesis

41
Q

cortical stroke symptoms

A

aphasia, neglect, visual field losses

42
Q

what is wenicke aphasia

A

fluent aphasia where the patient can speak with a normal pace and use lots of words but it doesnt make any sense

“WORD SALAD”

comprehension is impaired, repition is impaired

43
Q

where is wernickes area located

what causes it

A

temporal lobe; caused by a L sided MCA infarct

44
Q

what is brocas aphasia

A

non-fluent aphasia

there is frustration in not being able to make sense

comprehension is NORMAL

repetition is impaired

45
Q

brocas area is located where and caused by what infarct

A

frontal lobe

caused by a L sided MCA infarct

46
Q

Conductive aphasia

A

stroke of the arcuate fasciulus which connects wernicke and brocas areas

repetition is impaired only

47
Q

global aphapsia

A

bascially brocas, acrcuate fasciculus and wenickes at the same time

no repetition, no comprehension, no word salad

48
Q

transcortical sensory aphasia

A

same presentation as wernicke but repeittion is intact

49
Q

transcorticol motor apahsia

A

same presentation as broca but repeptition intact

50
Q

what imaging is done to look for a stroke

A

non-contrast CT

51
Q

how does blood appear on a non contrast CT

A

hyperdense (bright)

52
Q

for an ischemic stoke what is given if symptom onsent has been within the past 4.5 hours ?

A

tPA (tissue plasminogin)

53
Q

what does the 4.5 hour window refer to

A

when the patient was last observed as normal

54
Q

if the 4.5 hour window has elapsed what do you do for an ischemia stroke

A

give aspirin

55
Q

ischemia strokes bp should be rapidly be broght down below the threshold of what? After meeting this threshold slower blood pressure control is done. AN increase in blood pressure can actually help perfusion of penumbric areas on ischemia

A

185/110

56
Q

what is the treatment of a hemorrhagic stroke (hyperdense CT)

A

do NOT give tpa

  1. lower the blood pressure rapidly so that systolic is less than 140mmhg
  2. reverse anticoagulation if the patient is on it (FFP for patients on warfarin)
57
Q

correction of hypernatremia too quickly with hypotonic aline can cause

A

cerebral edema

58
Q

correcting hyponatemia too quickly with hypertonic saline can cause

A

central pontine myelinolysis aka osmotic demyelination

causes locked in syndrome

59
Q

what is a hypercalcemic crisis

A

a deliruium like state caused by SEVERE hypercalcemia usually caused by malignancy or primary hyperparathyroidism

60
Q

treatment of hypercalcemia

A

normal saline
bisphophonates

61
Q

what is psuedotumor cerebri

A

increased intracranial pressure with no structural cause

causes: obesity, idopathic intracranial hypertension, OCP, isotretinonin, danazol

62
Q

reye syndrome

A

cerebral edema and hepatotoxicity from giving aspirin to children during a viral infection

63
Q

diffuse aconal injury

A

acceletation, deceleration, contact brain injury that causes axonal shearing and tearing and subsequent brain swelling

can have severe cognitive defects, motor or sensory dysfunction

64
Q
A

Internal Medicine HYHO (3 decks)

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