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Neuro Flashcards

1
Q

RF stroke

A

HTN
DM
Hyperlipidemia
Smoking

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2
Q

Causes of stroke

A

Ischemic - 85%

Hemorrhagic - 15%

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3
Q

Embolic origins of stroke

A 
#1 Heart - AF (MC), valvular disease, paradoxical DVT
#2 Carotid stenosis
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4
Q

MC artery occluded in stroke

A

Middle cerebral

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5
Q

Sx in MCA stroke

A

Weakness and sensory loss on opposite side
Homonymous hemianopsia (eyes look at lesion)
Aphasia

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6
Q

Sx in ACA stroke

A

Personality/cognitive defects (confusion)
Urinary incontinence
Leg more than arm weakness

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7
Q

Sx PCA stroke

A

LOC
Ipsilateral sensory loss in face and CN IX, X
Contralateral sensory loss of limbs
Limb ataxia

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8
Q

Best initial test for any stroke

A

CT head w/o contrast

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9
Q

Most accurate test for stroke

A

MRI

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10
Q

Why is CT done before MRI in stroke

A

R/O bleeding

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11
Q

Best initial therapy for stroke

A

3hrs - Aspirin

Hemorrhagic - Nothing

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12
Q

Patient on aspirin has stroke

A

Add dipyridamole
OR
Switch to clopidogrel

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13
Q

When is a Penumbra catheter indicated (clot retrieval)

A

Within 90min then thrombolytics if unsuccessful

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14
Q

Rx if damage valves caused stroke

A

Surgery

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15
Q

Rx if thrombi caused stroke

A

Heparin then warfarin to INR 2-3

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16
Q

How to determine heart source of stroke

A

Echo

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17
Q

Rx for AF on EKG which caused stroke

A

Warfarin to INR 2-3

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18
Q

EKG normal but suspected heart etiology of stroke

A

24-48hr Holter monitoring

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19
Q

Sx cerebrovascular disease w/ >70% stenosis

A

Surgical correction

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20
Q
A

No CEA

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21
Q

100% carotid stenosis

A

No CEA (that side is “protected”)

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22
Q

Control DM to prevent stroke

A

HbA1c

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23
Q

Control HTN to prevent stroke

A

140-160

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24
Q

Control LDL to prevent stroke

A
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25
Q

Control BP in Hemorrhagic stroke

A

Target - 140-160

>170 give Nicardipine, Enalaprat, Labetalol

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26
Q

MC headache

A

Tension

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27
Q

Light causing photophobia

A

Bright

Natural

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28
Q

Inducing factors in Migraines

A 
Visual disturbance
Photophobia
Aura
Menses
Food (men)
Emotions (women)
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29
Q

Features of Cluster headaches

A

Frequent
Short duration
High intensity
M 10x > W

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30
Q

Features giant cell arteritis

A

Visual disturbance
Systemic sx
Jaw claudication

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31
Q

Association with pseudotumor cerebri

A

Obesity
Venous sinus thrombosis
OCPs (taken off market)
Vit A tox

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32
Q

Physical findings in migraines

A

Rarely aphasia/numbness/dysarthria/weakness

- Looks like stroke

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33
Q

PE results on cluster HA

A

Red tearing eye with rhinorrhea (ipsi)

Occasional Horner’s

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34
Q

What must be evaulated for HA w/ red eye

A

Glaucoma

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35
Q

PE results for giant cell arteritis

A

Visual loss

Tenderness in temporal region (ipsi)

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36
Q

PE results for pseudotumor cerebri

A

Papilledema with diplopia from CN VI palsy

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37
Q

Dx test in 1st time migrain/cluster/pseudotumor cerebri presentation

A

Head CT to exclude masses

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38
Q

Features of tension HA

A

B/L
Lasts 4-6hrs
Temple/occipital pressure relieves

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39
Q

Dx sequence for pseudotumor cerebri

A

Head CT

LP for increased pressure

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40
Q

First step in management of giant cell arteritis

A

Steroids before Bx

Bx is most accurate test

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41
Q

NSAIDS AE

A 
Aseptic meningitis
↑LTs → Bronchoconstriction and ↑Mucous
Gastric ulcers
Interstitial nephritis
Papillary necrosis
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42
Q

Rx tension HA

A

NSAIDs and other analgesics

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43
Q

Rx Migraine

A

Triptans or ergotamine as abortive therapy

Proclorperazine for monotherapy w/ vomitting

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44
Q

Rx cluster HA

A

Triptans or ergotamine first
100% O2
Li

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45
Q

Rx temporal arteritis

A

Prednisone

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46
Q

Rx Pseudotumor cerebri

A 
Weight loss
Acetazolamide
Steroids
Repeated LP to lower pressure
VP shunt
Cut into optic nerve
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47
Q

Cluster HA PPx

A

Verapamil
Li
Prednisone

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48
Q

When to give PPx for migraines

A

3-14 per month

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49
Q

Best PPx for migraines

A

Propranolol

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50
Q

Other PPx for migraines

A 
CCBs
TCAs (not in elderly)
SSRIs (only with concurrent anxiety/depression)
Topiramate
Botox (good for breakthrough)
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51
Q

What is trigeminal neuralgia

A

Idiopathic CN V disorder

Overwhelming facial pain

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52
Q

Precipitants of trigeminal neuralgia attacks

A

Chewing
Touching face
Pronouncing certain words

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53
Q

Dx test in trigeminal neuralgia

A

None

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54
Q

Best Rx trigeminal neuralgia

A

Oxcarbazepine

Carbemazepine

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55
Q

Other Rx trigeminal neuralgia

A

Baclofen

Lamotrigine

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56
Q

Rx trigeminal neuralgia if meds fail

A

Gamma knife surgery

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57
Q

What is postherpetic neuralgia

A

Zoster reactivation along CN V

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58
Q

Is their pain with resolution of zoster vesicles in postherpetic neuralgia

A

15%

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59
Q

Rx postherpetic neuralgia

A

Antiherpes meds

- Acyclovir

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60
Q

Pain reduction in postherpetic neuralgia

A 
TCAs
Gabapentin
Pregablin
Carbamazepine
Phenytoin
Topical capsaicin
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61
Q

Prevention of zoster

A

Zoster vaccine

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62
Q

Types of seizures

A

Partial → focal
Absence
Generalized
Status epilepticus

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63
Q

Causes of generalized tonic/clonic seizures

A 
↓/↑ Na
↓ Glucose
↓ Ca
↓ Mg
Hypoxia
CNS infection/anatomic abnormality
Uremia
Hepatic failure
EtOH/barb/benzo withdrawal
Cocaine tox
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64
Q

When to do EEG for seizures

A

NL CT/MRI/metabolic panel

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65
Q

Confusion is to coma ans seizure as

A

Angina is to MI

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66
Q

What is epilepsy

A

Seizures of unclear origin

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67
Q

Best initial therapy for status epilepticus

A

Benzos

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68
Q

Subsequent status epilepticus meds if condition persists

A 
Phenytoin
Barbs
NM blockage
Generalized anaesthesia
Intubate
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69
Q

AE IV Phenytoin

A

Hypotension

AV block

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70
Q

When to start Rx for 1st time seizure

A

Status epilepticus
Abnormal EEG
FHx seizures

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71
Q

Rx absence seizures

A

Ethosuximide

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72
Q

Alternative seizure meds

A 
Gabapentin
Topiramate
Lamotrigine
Oxcarbazepine
Levetiracetam
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73
Q

When to discontinue seizure meds

A

Seizure-free for 2yrs

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74
Q

Best way to tell if there is possibility of seizure recurrence

A

Sleep deprivation EEG

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75
Q

Where are most aneurysms causing SAH

A

ACA in circle of willis

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76
Q

Most frequent conditions with brain aneurysms

A 
PCKD
Tobacco smoking
HTN
Hyperlipidemia
Alcoholics
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77
Q

MC presentation of SAH

A

Severe HA with meningeal irritation
- Stiff neck, photophobia, fever
LOC in 50%
Focal complications in 30%

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78
Q

Differences in SAH from meningitis

A

Very sudden

LOC

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79
Q

Best initial test for SAH

A

Head CT w/o contrast

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80
Q

Most accurate test for SAH

A

LP with blood

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81
Q

What is Xanthochromia

A

Yellowish discoloration of CSF 2/2 RBC breakdown

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82
Q

Normal WBC:RBC in CSF

A

1:500-1000

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83
Q

What does an elevated WBC:RBC in CSF indicate

A

Meningitis

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84
Q

How to locate aneurysm site

A

CT angiography

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85
Q

Rx SAH

A

Nimodipine - Prevent subsequent
Embolization - Prevent repeat
VP shunt - Only if there is hydrocephalus
Seizure PPx - Phenytoin only if there is seizure

86
Q

Why is preventing rebleading in SAH so important

A

50-70% who rebleed will die

87
Q

Who gets ASA

A

MVA

High velocity trauma

88
Q

Sx in ASA

A

No pain and temp
Position and vibration intact
Flaccid paralysis below infarct
Loss of DTRs

89
Q

Causes of subacute degeneration of the spinal cord

A

B12 def

Neurosyphilis

90
Q

Sx in subacute degeneration of the spinal cord

A

Position and vibration lost

91
Q

Features of spinal trauma

A

Acute limb weakness +/- sensory loss below lesion
Sphincter function impaired
Loss of DTRs at level
Hyperreflexia below lesion

92
Q

Rx spinal trauma

93
Q

Brown-Sequard features

A

Ipsi motor, position, vibration lost

Contra pain, temp lost

94
Q

What is syringomyelia

A

Fluid-filled dilated central canal

95
Q

Causes of syringomyelia

A

Tumor
Severe trauma
Congenital

96
Q

Sx of syringomyelia

A

Loss of pain and temp cape-like

Loss of reflexes and muscle atrophy

97
Q

Most accurate test for syringomyelia

98
Q

Best rx syringomyelia

A

Removal of tumor

Drainage of fluid

99
Q

Where do brain abscesses spread contiguously from

A

Sinuses
Mastoid air cells
Otitis media

100
Q

Extracranial causes of brain absceses

A

PN or endocarditis leading to bacteremia

101
Q

Sx of brain abscesses

A 
HA
N/V
Fever
Seizures
Focal neuro deficits
102
Q

Can CA give fever

103
Q

Best initial test for brain abscess

A

CT or MRI

w/ and w/o contrast

104
Q

Most accurate test for brain abscess

105
Q

Rx duration of brain abscesses

A

6-8wks IV then 2-3mos oral

106
Q

Empiric Rx brain abscesses

A

PCN + metro + ceftriaxone/cefepime

107
Q

High risk organism causing brain abscess after neurosurgery

A

Staph epi and MRSA

Give vanco instead of PCN

108
Q

Neuro abnormalities in tuberous sclerosis

A

Slowly progressing mental deterioration

Seizures

109
Q

Skin abnormalities in tuberous sclerosis

A

Ash leaf patches
Adenoma sebaceum
Shagreen patches

110
Q

Rx tuberous sclerosis

A

Control seizures

111
Q

Features of Neurofibromatosis

A

Neurofibromas
CN VIII tumors
Cutaneous hyperpigmented lesions (Cafe-au-lait spots)
Meningiomas and gliomas

112
Q

Rx Neuro abnormalities in tuberous sclerosis

A

None

CN VIII decompression

113
Q

Sturge-Weber presentation

A 
Port-wine stain of face
Seizures
Homonymous hemianopsia
Hemiparesis
Mental subnormality
114
Q

Skull XR in sturge-weber

A

Calcification of angiomas

115
Q

Rx in sturge-weber

A

Control seizures

116
Q

What is an essential tremor

A

Present at both rest and intention

117
Q

What is the best therapy for essential tremor

A

Propranolol

118
Q

What improves essential tremor

119
Q

What makes essential tremor worse

120
Q

What is parkinsonism

A

Loss of dopaniergic cells in the substantia nigra

121
Q

Common etiologies of parkinsonism

A 
Repeat head trauma (boxing)
Antipsychotic meds
Encephalitis
Reserpine
Metoclopromide
122
Q

MCC parkinsonism

A

Idiopathic

123
Q

Presentation of parkinsonism

A 
50-60
Tremor
Cogwheel rigidity
Bradykinesia
Shuffling gait
Hypomimia
Micrographia
Postural instability
Orthostasis
124
Q

Rx mild parkinsonism

A

Anticholinergics (benztropine, trihexyphenidyl)

Amantadine - release DA from substantia nigra

125
Q

Who is most likely to get amantadine for parkinsonism

A

> 60 who is intolerant to anticholinergics

126
Q

Anticholinergics AE

A

Dry mouth
Worsening BPH
Constipation

Worse in older pts

127
Q

What does severe parkinsonism mean

A

Can’t take care of themselves

128
Q

Best initial therapy in severe parkinsonism

A

DA agonists

  • Pramimexole
  • Ropinirole
129
Q

Most effective med for severe parkinsonism

A

Levodopa/carbidopa

130
Q

What is on/off phenomenon

A

Bradykinesia - not enough DA
Dyskinesia - too much DA

Seen in Levodopa/carbidopa

131
Q

Rx on/off phenomenon in parkinsonism

A

COMT inhibitors

132
Q

What do COMT inhibitors do

A

Extend Levodopa/carbidopa duration

133
Q

What are the COMT inhibitors

A

Tolcapone

Entacapone

134
Q

What do MAOIs do

A

Block DA metabolism

135
Q

What are the MAOIs

A

Rasagiline
Selegiline

Use as single agent or adjuvant to Levodopa/carbidopa

136
Q

What med class can slow the progression of parkinsonism

137
Q

What causes psychosis in parkinsonism

A

Parkinsonism meds

138
Q

Rx psychosis in parkinsonism

A

Antipsychotic like clozapine

Don’t stop parkinsonism meds

139
Q

What is Lewy-body dementia

A

Parkinsonism + Dementia

140
Q

What is Shy-Drager syndrome

A

Parkinsonism with orthostasis

141
Q

Rx spasticity

A

Baclofen
Dantrolene
Tizanadine

142
Q

What should you always check in a pt with RLS

A

Ferritin (usually low)

143
Q

Huntington’s Triad

A

Memory
Mood
Movement

144
Q

Defect in huntington’s

A

CAG repeat on chromosome 4

145
Q

Features of huntington’s

A

Choreaform movement
Dementia
Behavioral changes
30-50 w/ FHx

146
Q

Dx huntington’s

A

Genetic test

147
Q

Rx huntingtons’s

A

Dyskinesia - Tetrabenazine

Psychosis - Haloperidol, Quetiapine

148
Q

Features of Tourettes

A

Vocal tics, grunts, coprolalia
Motor tics
Obsessive compulsive behavior

149
Q

Cause of Tourettes

A

Idiopathic

150
Q

Rx Tourettes

A 
fluphenazine
Clonazepam
Pimozide
Methylphenidate
ADHD rx
151
Q

What is MS

A

Idiopathic demyelinating CNS disorder

152
Q

Most common presentation of MS

A

Focal sensory sx w/ gait and balance problems

153
Q

Other common MS presentations

A

Blurry vision from optic neuritis
Fatigue
Spasticity and hyperreflexia
Cerebellar deficits

154
Q

What is internuclear ophthalmopegia

A

Inability to adduct one eye w/ nystagmus in the other eye

Characteristic of MS

155
Q

Dx test for MS

A

MRI - Best initial and Most accurate

156
Q

What does LP show in MS

A

Mild protein elevation

157
Q

When to do LP in MS

A

MRI is equivocal

158
Q

Best initial therapy for acute exacerbations of MS

A

High dose steroids

159
Q

Other Rx MS to prevent relapse and progression

A 
Fingolimod
Natalizumab
Mitoxantrone
Azathioprine
Cyclophosphamide
160
Q

Which MS med can cause worsening of neuro deficits with an MRI showing new white matter hypodense lesions

A

Natalizumab

161
Q

What has Natalizumab associated with

162
Q

First choice Rx MS to prevent relapse and progression

A

Glatiramer

Beta-IFN

163
Q

What is ALS

A

Idiopathic loss of upper and lower motor neurons

164
Q

What to look for in ALS

A

20s-40s
Weakness of unclear etiology
Difficulty chewing and swallowing
Decrease in gag reflex - pooling of saliva and aspiration

165
Q

What is poor prognosis in ALS

A

Weak cough

Loss of swallowing

166
Q

Electromyography results in ALS

A

Loss of innervation in muscle groups

167
Q

Lab results in ALS

A

↓NIF

↑CPK

168
Q

Role of Riluzole in ALS

A

Reduce glutamate buildup

169
Q

Role of Baclofen in ALS

A

Treat spasticity

170
Q

Role of BIPAP/CPAP in ALS

A

Help with resp difficulties 2/2 muscle weakness

171
Q

MCC death ALS

A

Respiratory failure

172
Q

Management at end stage ALS

A

Tracheostomy and ventilator

173
Q

Features of Charcot-Marie-Tooth disease

A

Distal weakness and sensory loss
Wasting in the legs
Decreased DTRs
Tremor

174
Q

Lower extremity appearance in CMT

A

Foot deformity with high arch

Legs look like inverted champagne bottles

175
Q

Most accurate test for CMT

A

Electromyography

176
Q

MCC peripheral neuropathy

177
Q

Other causes of peripheral neuropathy

A

Uremia
Alcoholism
Paraproteinemias (MGUS)

178
Q

Best initial therapy for peripheral neuropathy

A

Gabapentin or Pregablin
TCAs
Seizure meds

179
Q

Biker, pressure on palms, trauma to medial elbow

A

Ulnar
Wasting of hypothenar eminence
Pain in 4th and 5th digit

180
Q

Pressure of inner, upper arm
Saturday night palsy
Pressure in axilla (crutches)

A

Radial

Wrist drop

181
Q

Nerve damage in obesity, pregnancy, sitting cross legged

A

Lateral cutaneous nerve of the thigh

Pain/numbness of outer aspect of one thigh

182
Q

Nerve damage that worsens w/ walking

A 
Tarsal tunnel (tibial nerve)
Pain/numbness in ankle and sole of foot
183
Q

Nerve damage in high boots, pressure on back of knee

A

Peroneal

Weak foot with decreased dorsiflexion and eversion

184
Q

Nerve damage in typists, carpenters, working with hands

A

Median
Thenar wasting
Pain/numbness in first 3 fingers

185
Q

Identifiable causes of CN VII palsy

A

Lyme
Sarcoidosis
Zoster
Tumors

186
Q

Differentiate Bell Palsy with Stroke

A

Stroke - Can wrinkle forehead

CN VII - Cannot wrinkle forehead

187
Q

2 specific features of Bell palsy

A

Hyperacusis - Stapedius can’t deaden sound

Taste disturbances - Anterior 2/3 tongue

188
Q

Most accurate test for Bell palsy

A

Electromyography and nerve conduction studies

Rare needed

189
Q

Rx Bell palsy

A

Steroids - Best initial therapy

60% resolve spontaneously

190
Q

Why does corneal ulceration happen in CN VII palsy

A

Eye has difficulty closing leading to dryness and ulceration

191
Q

What is GBS

A

Autoimmune demyelination of peripheral nerves

192
Q

What is GBS associated with

A

Campylobacter jejuni

193
Q

Features of GBS

A

Ascending weakness

Loss of DTRs

194
Q

What is the danger of GBS

A

Hitting the diaphragm - resp muscle weakness

Autonomic dysfunction - hypo/hypertension, tachy

195
Q

Most specific Dx test in GBS

A

Electromyography and nerve conduction studies

196
Q

CSF in GBS

A

Increased protein

NL cell count

197
Q

What values tell who may die from GBS

A

PFTs

  • Peak inspiratory pressure
  • FVC
198
Q

Rx GBS

A

IVIG

Plasmapheresis

199
Q

MCC death from GBS

A

Dysautonomia and Resp failure

200
Q

What is myasthenia gravis

A

Muscle weakness 2/2 autoAbs to acetylcholine receptors in NMJ

201
Q

Features of MG

A

Double vision
Difficulty chewing
Dysphonia - weakness of muscles at end of day

202
Q

PE findings of MG

A

Ptosis
Weakness in sustained activity
NL pupillary response

203
Q

Best initial test for MG

A

Acetylcholine receptor Abs

204
Q

Best test for MG pts w/o Abs

A

Anti-MUSK Abs

205
Q

Most accurate test for MG

A

Electromyography

206
Q

What imaging should be done in MG

A

Chest CT - Thymoma

207
Q

Best initial treatment for MG

A

Neostigmine or Pyridostigmine

208
Q

Most appropriate next step in MG if meds fail

A

60 - Prednisone

209
Q

Presentation of acute myasthenic crisis

A

Profound weakness or respiratory involvement

210
Q

Rx Acute MG crisis

A

IVIG or plasmapheresis

211
Q

What to give to MG pts to ween off steroids

A

Azathioprine
Cyclophosphamide
Mycophenolate

Step 2 CK (21 decks)

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