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DIT Step 2 > Neuro > Flashcards

Neuro Flashcards

1
Q

Posterior cerebral artery supplies what? what is deficit do?

A

Visual cortex affected. 4 star

middle cerebral is brocas and stuff, and and the anterior supplies legs

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2
Q

AICA occlusion?

A

Facial paralysis, vertigo, nystagmus, deafness tinnitus. NO MOTOR OR LIGHT TOUCH DEFICIT

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3
Q

PICA occlusion?

A

Wallenberg. Contralateral body and ipsilateral loss of pain and temp on face. Ipsilateral cerebellar defects like ataxia and past pointing

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4
Q

Broca aphasia

A

Nonfluent aphasia. Can comprehend but can’t speak.

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5
Q

Wernicke aphasia

A

Can produce words but can’t understand

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6
Q

Conduction aphasia

A

Can’t repeat. no ifs and or buts

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7
Q

Dorsal columns carry leg and arm sensation where?

What about in the corticospinal?

A

Arms outside, legs inside, just like a person. (arms are outside of legs)

Legs are lateral, so it is opposite.

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8
Q

What is not fed blood supply from anterior spinal artery?

A

The dorsal columns

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9
Q

Amyotrophic lateral sclerosis affects what tracks?

A

corticospinal (UMN symptoms: spastic paralysis EVERYTHING IS UP(per) so up spasticity and reflex)

Anterior horn: LMN symptoms
so flaccid paralsis as well (because synapsed before getting to anterior horn)

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10
Q

Poliomyelitis affects where?

A

Polio means gray, so it affects gray matter (anterior horn)

Flaccid paralysis

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11
Q

Tabes dorsalis affects where? Useful test for it

A

DORSALis affects dorsal, so impaired proprioception and gait/balance problems

Romberg test. Vision eliminated and patient has poor proprioception and they will tip over

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12
Q

*** B12 deficiency affects what?

WORK ON THAT

A

Dorsal columns and corticospinal tract.

So spastic bilateral and vibe sense loss

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13
Q

Brown squared is what?

A

ipsilateral loss of vibration and discrimination

Ipsilateral loss of vibe and discrimin
Ipsilatral spastic paralysis, ipsilateral flaccid paralysis
contralateral loss of pain and temp below the lesion

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14
Q

Argyll robertson pupil?

A

Tertiary syphilis. Accommodates but nonreactive to light.

Also have tabes dorsalis.

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15
Q

What brain lesion causes hemiballismus?

A

Subthal nucleus. It is flailing of the limbs.

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16
Q

*** What lesion causes agraphia?

A

Dominant parietal lobe

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17
Q

What lesion causes hemispatial neglect?

A

Nondom parietal lobe

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18
Q

Where does dorsal column decussate?

A

Medulla

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19
Q

Latreal corticospinal tract crosses wehre?

A

medullary pyramids

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20
Q

Meningitis and purpura?

A

Think neisseria

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21
Q

*** Meningitis with gram positive rods and coccobacilli is what bug?

A

Listeria list of shapes

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22
Q

Small pleomorphic gram negative coccobacilli in meningitis is what?

A

H influ

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23
Q

CSF is different in fungal/tb than it is in bacterial meningitis how?

A

WBCs are lymphocytes in fungal/tb where in bacterial it is neut

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24
Q

*** CT before lumbar puncture is when?

A

Seizure or focal defects or papilledema

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25
Q

*** What causes meningitis in less than a month old baby? What do you give?

A

E coli, GBS (always consider in sick kid) or listeria

Give amp with cefotaxime or gent

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26
Q

*** Over age of 60 meningitis? or debilitating disease

A

S pneumo is one, then listeria, then N meaning then gram negative

Treat empirically with
Ampicillin (listeria coverage), vanc, cefotaxime/ceftriaxone
GIVE IV DEXAMETHASONE

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27
Q

Longterm complicaitons of mening?

How do you help prevent them

A

Hearing loss, seizure disorder, intellectual disability, spastic paralysis (especially in kids)

DEXAMETHASONE

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28
Q

What causes viral meningitis?

A

enterovirus, so think echovirus, coxcaki, enterovirus.

Herpes can sometimes

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29
Q

Tx of viral meningitis?

A

Tylenol pain, IV fluids, bacterial meningitis excluded, ACYCLOVIR if suspicion of HSV or focal findings

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30
Q

Encephalitis HP?

A

Malaise headache neck pain vomit (just like meningitis)

BUT ALTERED Consciousness, or or change mental status or focal defects

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31
Q

What causes temporal lobe encephalitis?

A

Herpes

32
Q

*** West nile can cause severe symptoms which include what?

How do you dx?
How do you treat?

A

Flaccid paralysis by anterior horn involvement. Alterations in consciousness (encephalitis) and possible death

Dx serology for IgM
Tx supportive

33
Q

Reye sydnrome affects what?

H and P?

A

Encephalitis brain and liver. Significant hypoglycemia

Rash, vomit, elevated LFTs headache and lethargy

From aspirin after viral illness

34
Q

Brain abscess is caused by what?

They are ring enhancing lesions on MRI! b/c cavitation

A

think about history. IF ear infection, s pneumo. If in hospital with neuro surg think staph

35
Q

Treatment of abscess if from oral spread?

A

metronidazole with 3rd gen cep
corticosteroids
drainage

36
Q

If from hematogenous spread or near procedure in brain abscess give what?abscess?

A

Give cef and vanc
corticosteroids
drainage

37
Q

Poliomyelitis cause what symptoms?

Dx?

A

Muscle weakness and flaccid paralysis b/c motor neurons (MAKES SENSE B/c remember atrophied leg) anterior horns

Dx b/c antibody
LP for viral meningitis
Viral culture

38
Q

Reye syndrome does what three things?

A

Hypoglycemia, liver and brain issues

39
Q

*** Toxoplamosis is suspected if? Dx?

Tx?

A

Encephalitis in HIV with CD4 less than 100. Positive Toxo IgG antibody

Multiple ring enhancing lesions

Tx with sulfadiazine, pyrimethamine

40
Q

Tx of headaches

Tension headache:

Cluster

Migraine

A

tension: NSAIDs usually, maybe triptans

Cluster: 100% oxygen

Migrain: triptan, ergots (they are both constrictors, be careful with symptoms and pregnancy!!! can’t vasospasm preggers!

41
Q

***Migraine prophylaxis

A 
CCBs (verapamil)
Beta blockers
TCAs
NSAIDs
Antiseizure meedslike valproate

CONSIDER comorbiditis

42
Q

***Tx of psuedotumor cerebra?

A

Confirm with LP and rule out others with CT/MRI

D/c vitamine A, TCAs
Weight loss
ACETAZOLAMIDE
Invasive option: serial lumbar punction, shunting

43
Q

** Headache with extra ocular muscle palsy?

A

Cavernous sinus thrombosis, REMEMBER THE NERVES RUN THROUGH IT

44
Q

Bilateral trigeminal neuralgia?

How do you treat if not due to the pathology?

A

MS

tx anticonvulsants
FIRST LINE is carbamazapine

45
Q

Lacunar TIA?

A

occlusion of small arteries from middle cerebral to deep part of the brain

46
Q

TIA prompts what tests?

A

CT (faster for bleeding) or MRI (better for infarct), US of carotid, Echo for embolus eval, MRI or CT angiogram

Patent foramen or heart aneurysm

47
Q

Tx of TIA?

A

Antiplatelet, antilipid, anti htns

Antiplatelet: Clop or aspirin and dypyridamole
Antilpid: high statin in all patients
BP if over 140/90
Embolic: warfarin (Need bridge as following) and HEPARIN or dabigatran, rivaroxaban or apixaban

48
Q

What is dabigatran?

A

one of the embolic therapies to bridge with warfarin

49
Q

Carotid endarterectomy indications?

A

Symptomatic patients with narrowing of 70-99%, no need if 100% b/c compensated

Symptomatic men 50-70%

Asymptomatic if 80 or more and surgeon is experienced and life is expected 5+ years

50
Q

*** basilar artery occlusions cause what symptoms?

A

contralateral weakness.

If complete occlusion, you get hemiparesis and vertigo

51
Q

Lacunar arteries lesions

A

Variety of symptoms, focal or motor sensory deficits.

They are affecting just one side of the body.

ABSENT CORTICAL SIGNS

52
Q

Stroke contraindications for alteplase?

A

More than 4.5 hours old. Recent hemorrhage or surgery, hypertensive urgency

53
Q

What length of time is required for thrombolytics?

A

4.5 for systemic, if you can do it localized, you have up to 6 hours but need a specialist

54
Q

Other meds for strokes? Acute vs long term?

Read last line of this

A

Aspirin ASAP unless thrombolytis, then you wait 24 hours
Long term prevention of clop or aspirin and dyspyrdamole
High statins in all patients
Don’t treat hypertension acutely unless 220/120 or if have CAD

55
Q

Hemorrhagic brain bleeds keep BP at what? What else do you do?

A 
less than 200
Mannitol
Hyperventilation: PaCO2 of 25
Surgical decompression if necessary
Elevate bed
56
Q

First line treatment for trigeminal neuralgia?

A

Carbamazapine

57
Q

Two syndromes associated with berry aneurysms?

A

Ehler danlos and ADPKD

58
Q

Subarachnoid dx?

A

CT scan and if negative, getLumbar Puncture. Blood or yellow!

Cell count of first and last in lumbar puncture to make sure it is not from traumatic puncture!

59
Q

*** Meds to lower BP in subarachnoid? What is bp goal?

A

Goal is below 150 if cognitive function intact.

Labetalol is used, no nitros b/c they increase ICP
Nimodipine can be used
Tx is surgical clipping or coil

60
Q

Do you give phenytoin if subarachnoid hemorrhage?

A

no!

61
Q

Parenchymal hemorrhage is hemorrhagic stroke. BUT NOT SUBARACHNOID HEMORRHAGE! What is CT finding?

A

Focal motor or sensory deficits, headache, seizures, LOOK FOR CT for BRIGHT COLOR

62
Q

Adult with new seizure? What caused it?

A

Idiopathic, metabolic like hyponatremia or hypoglycemia, drugs, drug withdrawal, trauma, neoplasm

63
Q

*** Famous adult infections causing seizures?

A

Toxoplasmosis, neurocysticercosis, HSV

64
Q

What do you give to patients getting isoniazid?

A

B6 b/c it gets absorbed and could get seizures!

65
Q

Big time drugs causing med induced seizure?

A

Theophyline, Bupropion, narcotics, Psychostim, phenycyclidine (PCP), antipsych, antibiotics,

66
Q

*** Partial seizure is what?

What part of brain affected?

A

Only in part of the brain. Preceded by aura like burning tires

Temporal affected

67
Q

Simple partial vs complex?

A

Simple does not lose consciousness, but have purposeless movements or parenthesis

Complex partial: hallucinations POST ICTAL STATE! temporal lobe

68
Q

Petite mal EEG finding?

A

Aka absence seizures Three cycle per second spike wave pattern. no post octal state

69
Q

Tx for status epilepticus

How do you prevent recurrence in acute setting?

A

ABCs
IV/IM benzo
IV barb if no working
Phenytoin to prevent recurrance

70
Q

*** Phenytoin side effects

A

Phenytoin Has Given MDs Frustration

Peripheral neropathy
Hirsutism
GINGIVAL HYPERPLASIa
metabolic anemia from folate absorption issue
Drug induced Lupus
Steven Johnson
Fetal hydantoin
71
Q

fetal hydantoin syndrom is what?

A

Cleft lip, palate, congee heart disease, developmental delay

72
Q

*** Stephens johnson drugs?

A

Seizure drugs including lamotrigine, SULFAs and PENICILLINS and ALLOPURINOL

73
Q

Drugs that cause agranulocytosis?

A 
C drugs
Carbamazepine
Clozapine
Colchicine
PTU and methimazole
74
Q

What are two big side effects to remember for valproic aid and carbamazepine?

A

Hepatotoxic and spina bifida

75
Q

Cyp p450 inducers?

A

Coronas Guiness and PBRs induce chronic alcoholism

Carbamazepine
Griseofulvan
Phenytoin
Barbiturates
Rifampin
St. Johns Wart

DIT Step 2 (77 decks)

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