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Neuro Flashcards

1
Q

PC:

  • CONTRA weakness or sensory loss
  • homonymous hemianopsia– looking towards side of lesion
  • aphasia
A

MCA

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2
Q

if you are right handed…

A

L dominant lobe

  • handedness
  • speech center
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3
Q

PC:

  • personality and confusion
  • urinary incontinence
  • legs> arms
A

ACA

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4
Q

PC:

  • IPSI sensory loss face, 9th, 10th CNs
  • CONTRA sensory loss limbs
  • limb ataxia
A

PCA

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5
Q

best initial test for stroke

A

non-contrast CT

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6
Q

diagnostic tests for stroke

A
  1. ECHO- PFO, surgical valve, thrombus
  2. EKG
  3. Holter
  4. carotid doppler– degree of stenosis
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7
Q

tx for haemorrhagic stroke

A

NO TX

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8
Q

tx for ischaemic stroke less than 3hrs

A

thrombolytics

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9
Q

tx for ischaemic stroke greater than 3hrs

A

aspirin

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10
Q

tx for ischaemic stroke greater than 3hrs and already on aspirin

A

ADD dipyridamole

or SWITCH to clopidogrel

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11
Q

additional tx to add in for stroke

A

statins!

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12
Q

experimental window for thrombolytics

A

3-4.5hrs

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13
Q

carotid angioplasty and stenting

A

NOOOOOOO proven benefit

ALWAYS the wrong answer

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14
Q

% carotid stenosis and tx

A

less than 50%= no tx

greater than 70%= endarterectomy

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15
Q

PC pseudotumor cerebri

A

RICP and CN 6 palsy

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16
Q

risk factors for pseudotumor cerebri

A
  • obese young female
  • venous thrombosis
  • OCP
  • vit A excess
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17
Q

dx for pseudotumor cerebri

A

LP increase pressure

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18
Q

tx for pseudotumor cerebri

A
  1. weight loss

2. acetazolamide

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19
Q

tx for cluster headaches

A
  • triptans
  • octreotide
  • ergotamine
  • 100% oxygen, lithium, prednisone= ABORTIVE, not for mgiraines
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20
Q

cluster prophylaxis

A

verapamil
prednisone
valproate

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21
Q

best preventitive tx for migraines– if 3 attacks/month

A

propanolol

valproate

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22
Q

tx trigeminal neuroalgia

A

oxcarbazepine or carbamezapine

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23
Q

trigeminal neuralgia that doesn’t improve with medication

A

gamma knife surgery

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24
Q

postherpetic neuralgia pain tx

A
  • TCA’s
  • gabapentin
  • pregabalin
  • carbamezapine
  • phenytoin
  • topical capsaicin
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25
Q

reduce incidence of postherpatic neurlagia

A

antiherpetic medications

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26
Q

clearly effective treatment for peripheral neuropathy?

A

NOOOPE

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27
Q

when to do EEG

A

when tried to exclude all the causes

including CT or MRI

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28
Q

seizures of unclear etiology=

A

EPILEPSY

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29
Q

treatment for status epileptics

A
  1. benzodiazepine
  2. fosphenytoin> phenytoin
  3. phenobarbital
  4. GA
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30
Q

an unresolving seizure tx

A

NEUROMUSCULAR BLOCKING AGENTS

  • succinylcholine
  • vecuronium
  • pancuronium
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31
Q

what to give before propofol

A

ventilator– since propofol can stop breathing

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32
Q

when to give anti epileptic drugs after first seizure– few circumstances

A
  1. PC= SE or focal neuro signs
  2. abnormal EEG or lesion on CT
  3. fam hx of seizures
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33
Q

best tx for epilepsy

A

NOT CLEAR

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34
Q

which anti epileptic has the fewest side effects

A

leviracetam (!!! SJS)

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35
Q

best tx for absence seizures

A

ethosuximide

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36
Q

alcohol withdrawal seizures tx

A

NOT NOT NOT NOT NOT with anti epileptic drugs

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37
Q

when to stop anti epileptic meds

A

2 years seizures free

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38
Q

how to check for possibility of seizure recurrence

A

sleep deprivation EEG

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39
Q

patient with epilepsy, and driving….

A

recommend find an alternate means of transportation

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40
Q

SAH vs. meningitis

A

SAH

  • more SUDDEN onset
  • LOC
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41
Q

best initial test for SAH

A

non-contrast CT

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42
Q

most accurate test for SAH

A

LP– xanthochromia

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43
Q

WBC: RBC ratio normal

A

1: 500
normal= SAH
abnormal= meningitis

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44
Q

why don’t you use contrast for bleeds in brain?

A

BECAUSE BLOOD= WHITE

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45
Q

mortality rate if have recurrence of SAH

A

50-70%

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46
Q

tx of SAH

A
  1. nimodipine
  2. embolization (coiling)> clipping
  3. VP shunt IF hydrocephalus
  4. seizure prophylaxis
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47
Q

seizure prophylaxis for SAH

A

PHENYTOIN

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48
Q

if embolization is not one of the choices…

A

surgical clipping

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49
Q

embolization for SAH is a type of

A

INTERVENTIONAL RADIAOLOGY

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50
Q

LOSS of all spinal functions, except position and vibration

LOSS DTR’s–> hyperreflexia

A

anterior spinal cord syndrome

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51
Q

LOSS of contralateral pain and temp

LOSS of ipsilateral vibration and position

A

brown sequard

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52
Q

loss of sphincter tone and acute weakness/ sensation loss

A

spinal trauma

53
Q

tx spinal trauma

A

glucocorticoids

54
Q

LOSS of pain and temperature cape like

A

syringomyelia

55
Q

big syringomyelia

A

LOSS of lateral corticospinal= LMN

56
Q

BIGGEST syringomyelia

A

LOSS of hypothalamospinal= PAM

57
Q

most accurate dx of syringomyelia

58
Q

tx syringomyelia

A
  • sx: tumor

- drainage fluid

59
Q

moa brain abscess

A

CONTINGUOUS– sinusitis, mastoiditis or

BSI– anything that causes BSI– pneumonia, endocarditis

60
Q

best initial test for brain abscess

61
Q

most accurate test for brain abscess

A

BIOPSY– determine organism

62
Q

CSF for brain abscess

A

not helpful

63
Q

LP for brain abscess

A

NOOOO contraindicated

64
Q

edema and contrast enhancement on CT

A
  • tumor
  • infection

CANNOT TELL THE DIFFERENCE

65
Q

empiric tx brain abscess

A

penicillin + metro + ceftriaxone (or cefepime)

66
Q

intention and exertion tremor

67
Q

BET improves with

68
Q

BET tx

A

propanolol

69
Q

MCC parkinsonism

A

idiopathic

70
Q

mild parkinson disease tx

A
  • anticholinergics

- amantadine

71
Q

anticholinergics in PD

A
  • benztropine
  • trihexyphenidyl

Tremor and Rigidity

72
Q

older patient intolerant of anticholinergics for PD

A

AMANTADINE

73
Q

severe parkinson disease tx

A
  • dopamine agonists
  • L-dopa/carbidopa
  • COMT inhibitors
  • MAO inhibirotrs
  • deep brain stimulation
74
Q

dopamine agonists for PD

A

BEST INITIAL tx

75
Q

L-dopa/carbidopa for PD

A

most effective

ON/OFF

76
Q

COMT inhibitors for PD

A

extend duration of L-dopa/Carbidopa by blocking the metabolism of dopamine

77
Q

MAO inhibitors for PD

A

single or adjunct
block metabolism of dopamine
POSSIBLY SLOW the progression

78
Q

deep brain stimulation for PD

A

Tremor and Rigidity

79
Q

only PD med that possibly slows the progression

A

MAO inhibitors

80
Q

severe PD presenting with psychosis

A

tx= antipsychotics

psychosis is secondary to the PD treatment

81
Q

parkinsonism + orthostasis

A

Shy Drager syndrome

82
Q

tx spasticity

A
  • baclofen
  • dantrolene
  • TIZANADINE
83
Q

RLS a/w

A

fe deficiency anaemia

84
Q

RLA tx

A

dopamine agonist

- pramipexole

85
Q

3M’s of huntingtons

A

Mood
Movement
Memory

86
Q

dx HD

A

GENETIC TEST

87
Q

tx dyskinesia in HD

A

tetrabenazine

88
Q

psychosis tx in HD

A
  • haloperidol

- quetiapine

89
Q

imaging HD

A

CT/MRI– caudate nucleus involvement

90
Q

sexual function MS

A

generally intact

91
Q

best initial test MS

92
Q

most accurate test MS

93
Q

oligoclonal bands MS

A

only found in 85%;

correct answer if equivocal or non diagnostic MRI

94
Q

visual and auditory evoked potentials for MS

A

WRONG WRONG WRONG WRONG WRONG ANSWER

95
Q

steroids in MS

A

shorten duration of exacrerbation

96
Q

natalizumab

A

alpha 4 integrin inhibitor

—> PML

97
Q

best initial MS relapse prevention meds

A
  • beta interferon

- glatiramer

98
Q

poor prognosis ALS

A

weak cough and swallowing

99
Q

dx of ALS

A

electromyography

100
Q

riluzole ALS

A

reduced glutamate buildup in neurons

MAY prevent progression of disease

101
Q

tx ALS spasticity

102
Q

other tx for ALS

A
  • CPAP
  • BiPAP
  • tracheostomy and maintenance ventilator
    since MCC death= resp failure
103
Q

CMT=

A

UMN + LMN + PES CAVUS

104
Q

mcc peripheral neuropathy

105
Q

peripheral diabetic neuropathy young

106
Q

peripheral diabetic neuropathy older

A

pregabalin

gabapentin

107
Q

risk factors for lateral cutaneous nerve of thigh

A
  • obesity
  • pregnancy
  • sitting with crossed legs
108
Q

worsening pain with waling, pain/numbness in ankle and sole of foot

A

TIBIAL NERVE–> tarsal tunnel syndrome

109
Q

random risk factor for peroneal palsy

A

HIGH BOOTS

110
Q

two additional things for facial nerve palsy

A
  • hyperaccusis

- taste disturbances

111
Q

dx test for facial nerve palsy

112
Q

complication of facial nerve palsy

A

CORNEAL ULCERATION

113
Q

what nerves does GBS affect

A

peripheral nerves

114
Q

most specific test for GBS

A

nerve conduction studies/ electromyography

115
Q

CSF in GBS

A

INCREASED protein with

normal cell count

116
Q

treatment of GBS

A
  • IVIG
    or
  • plasmapharesis
117
Q

wrong answers for tx of GBS

A

prednisone

plasmapharesis AND IVIG

118
Q

LFT’s GBS

A

DECREASE- FVC

DECREASE- peak inspiratory pressure

119
Q

pupils in mg

120
Q

best initial test for MG

A
  • AChR antibodies; if without–> anti-MUSK
121
Q

other test for MG, NOT done anymore in canada

A

edrophonium test

122
Q

most accurate test for MG

A

electromyography– decreased strength with repetitive stimulation

123
Q

imaging for MG

A

CHEST- CT with contrast OR MRI

—> thymoma

124
Q

best initial tx MG

A

neostigmine or pyridostigmine

125
Q

if tx fails in MG

A

T CELL SUPPRESSION

  • less than 60–> thymectomy
  • greater than 60–> prednisone, then imunosuppresants
126
Q

acute myasthenia crisis tx

A
  • IVIG OR

plasmaphresis

127
Q

diffuse symmetrical atrophy on MRI

A
  • AZD
  • chronic alcoholism
  • untx HIV
128
Q

CSF findings for CJD

A

14-3-3 protein

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