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1
Q

anterior cord syndrome

associated with ____ fractures

A

infarct of anterior spinal a., ant 2/3 spinal cord affected

loss of
motor (gray and lcst)
pain and temp (acst, astt, lstt)

preservation of
position and vibratory sensation

associated with burst fracture of vertebra, eg jumping from building landing on feet

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2
Q

hemiballismus
what is it
what causes it

A

unilateral chorea of proximal muscles

vascular disease of contralateral STN subthamic nucleus

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3
Q

tetrabenazine moa

A
  • | VMAT2
    dec monoamine uptake and signaling
    (dopamine serotonin e ne h)
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4
Q

reserpine moa

A

depletes peripheral catecholamines, dec sns, vasodilation and sedation

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5
Q

what is chorea

what are 2 etiologies?

A

rapid irregular unpredictable involuntary muscle jerks

caudate and putamen cell losses
dopaminergic agonists

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6
Q

akathisia

colloquial synonymn

A

restlessness

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7
Q

postural tremor

A

tremor w holding position against gravity, eg holding arms outstretched

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8
Q

2 adjectives for tremor

A

rhythmic oscillatory

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9
Q

3 most common bugs in brain abscess

A

strep v
staph a
gnrs

so empiric tx ceftri vanc metro

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10
Q

empiric tx brain abscess

A

ceftri strep v
vanc staph a
metro gnrs

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11
Q

typical ct finding in hsv encephalitis

A

hypodense lesion in parietal lobe

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12
Q

when is pt at risk for nocardia brain abdcess

A

cd4 v100/mm3

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13
Q

tf

rhizopus causes brain abscesses

A

f
mucormycosis can spread from sinuses thru bone to brain but is highly destructive and necrotizing not abscess forming usually

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14
Q

tf

cerebral toxoplasmosis typically causes single ring enhancing lesion

A

f

multiple usually

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15
Q

when is pt at risk for toxoplasmosis

A

cd4 v100

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16
Q

tf

cd4 v100 is risk for toxo and nocardia both

A

t

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17
Q

single brain abscess usually results from

A

direct extension of sinusitis otitis media dental infection

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18
Q

central cord syndrome

A

hyperextension inj in eld w preexisting c-spine degenerative change – selective cst and lstt damage, maybe stt. ue motor weakness more than le as ue mn more midline, maybe some pain and temp loss from stt

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19
Q

brown sequard syndrome

A

hemisection of soinal cord eg from penetrating injury
below lesion
ipsi weakness spasticity vib and prop loss
contra pain temp loss

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20
Q

tf

cerebral contusion produces fnd’s

A

both

can oroduce fnd’s, but also ams and risk of seizure from edema

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21
Q

posterior cord syndrome

A

vib and prop loss and maybe weakness paresthesias urinary incontinence retention

eg from ms or vertebral a dissection

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22
Q

spondylosis

A

degeneration of spinal column from any cause, most commonly oa osteoarthritis

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23
Q

diff in pres of wilsons in kid/adolescent vs adult

A

kid/ado typically liver – asymp transaminitis to fulminant liver failure

adults typ neuropsych from tremor rigidity to depression catatonia paranoia

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24
Q

confirm dx of suspected wilsons

A

low ceruloplasmin v20
confirm w urine cu excretion
and slit lamp to look for kayser fleischer rings

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25
how to look for keyser fleischer rings in wilsons
slit lamp test
26
what causes the neurological sympx of wilsons
cu dep in basal ganglia
27
at what age does hemochromatosis typ present
after age 40
28
another name for mallory body
mallory hyaline
29
tf | mallory body = mallory hyaline, same thing
t
30
what do mallory bodies suggest
alcoholic hepatitis OR wilsons
31
tf | mallory bodies on liver biopsy are associated w wilsons
``` t mallory bodies assoc w alc hepatitis OR wilsons ```
32
liver bx in a1-antitrypsin deficiency
pas + , diastase resistant granules in hepatocytes
33
pas + , diastase resistant granules in hepatocytes on liver bx suggests
a1-antitrypsin deficiency
34
4 precipitators of myasthenic crisis
infection sx pregnancy child birth tapering immunosuppressants meds like aminoglycs an bb's
35
s&s | myasthenic crisis
general weakness oropharyngeal weakness/swallow difficulty resp insuffic dyspnea
36
tx myasthenic crisis
intubate for deteriorating resp status ivig plasmapheresis corticosteroids
37
precipitants, s&s, tx myasthenic crisis
sx inf preg labor taper immunosuppressant aminoglyc bb gen weak oropharyngeal weak swallow diff resp insuf dyspnea intubate for bad breathing ivig plasmapheres corticosteroids
38
what is syringobulbia
when fluid cavities (syrinxes.. eg congenital, tumor, trauma) affect brain stem causing eg ipsi tongue wasting, palatal weakness, vocal cord paralysis, trigeminal sensory loss
39
define bleeding diathesis
susceptibility to bleed | usually hypocoagulability caused by coagulopathy
40
define tabes dorsalis
syphilitic myelopathy causing demyelination of dorsal columns - impaired vib prop descriminatory touch unsteadiness, suddem lancinating pian, u incont
41
synonymn for reflex sympathetic dystrophy
complex regional pain syndrome
42
ai dry eyes dry mouth think...
sjogren syndrome
43
are symptoms of limbar spinal stenosis worse w standing and downhill walking or sitting and uphill walking
worse w standing and downhill walking ext of spine narrows canal flex of spine widens canal
44
rule out lumbar spinal stenosis w this test
mri
45
ankle brachial index
ankle bp / brachial bp | nl 1 - 1.4
46
normal ankle brachial index
1-1.4 | ankle ^ or = brachial
47
what do bone scans identify
high bone turnover | eg mets, fractures, osteomyelitis
48
wallenberg syndrome
- lateral medullary infarct of intracranial vertebral a - vestibulocerebellar vertigo fall to ipsi, horiz and vert nystag diplopia, ipsi limb atax - sensory loss of ipsi face pain temp (spinotrigem) contralat trunk limbs pain temp (spinothalam) - bulbar ipsi dysphag aspirate dysarth dysphon hoarseness diminished gag reflex (nuc ambig, cn IX and cn X) - autonomic ipsi horner hiccup impaired invol breathing espec in sleep
49
lesion if lateral cerebellum produces what sympx
ipsi atax w minimal dizziness
50
leaion of lateral medulla produces what symptoms
wallenberg syndrome - vestibulocerebellar vertigo fall to ipsi, horiz and vert nystag diplopia, ipsi limb atax - sensory loss of ipsi face pain temp (spinotrigem) contralat trunk limbs pain temp (spinothalam) - bulbar ipsi dysphag aspirate dysarth dysphon hoarseness diminished gag reflex (nuc ambig, cn IX and cn X) - autonomic ipsi horner hiccup impaired invol breathing espec in sleep
51
lateral mid pontine lesion sympx
ipsi mastication weakness tactile and position sense dim motor and sensory trigem nuclei
52
medial medullary syndrome
- medial pyramid contralat hemiplegia - medial lemniscus contralat tact vib position loss - hypoglossal nerve ipsi tongue weak deviate to lesion
53
medial mid pontine syndrome
contralat ataxic hemiplegia of face trunk limbs, maybe tact and position loss too
54
R ataxic hemiplegia of face trunk limbs, maybe tact and position loss too where is the lesion?
L medial mid pontine
55
L hemiplegia tact position vib loss R tongue dev where is the lesion?
R medial medulla | pyramid contra hemipleg, medial lemniscus contra tact vib position, hypoglossal nerve ipsi tongue motor
56
R mastication weakness tactile and position sense loss where is the lesion
R lateral mid pontine | motor and sens trigem nuclei
57
vertigo fall to L, horiz and vert nystag diplopia, L limb atax, L face sensory loss face pain temp, R trunk limbs pain temp loss, L dysphag aspirate dysarth dysphon hoarseness diminished gag reflex, L horner hiccup impaired invol breathing espec in sleep, other motor spared where is the lesion?
``` L lateral medulla ipsi vestibulocerebellar ipsi spinaltrigem contra spinalthalam ipsi nuc ambig cnIX cnX ipsi sypathetic ``` = wallenberg syndrome
58
Vimpat (lacosamide) use and moa
tx seizures | enhances slow inactivation of VNaCs, stabilizing neuronal membranes, inhibiting repetitive firing
59
generic for Vimpat
lacosamide tx seizures enhances slow inactivation of VNaCs, stabilizing neuronal membranes, inhibiting repetitive firing
60
brand for lacosamide
Vimpat tx seizures enhances slow inactivation of VNaCs, stabilizing neuronal membranes, inhibiting repetitive firing
61
generic for Dilantin
phenytoin tx seizures modulates neuronal VNaCs and CaCs
62
brand for phenytoin
Dilantin tx seizures modulates neuronal VNaCs and CaCs
63
Dilantin generic, use, moa
phenytoin tx seizures modulates neuronal VNaCs and CaCs
64
Aricept generic, use, moa
donepezil tx Alzheimer's -| AchE
65
Bipolar I define tx options avoid
1+ manic episode +/- hypomanic or depressive episode mood stabilizers Li+, VPA, carbamazepine, atypical antipsychotics (-piprazole, -apines, -idones) avoid antideps, can precipitate mania
66
Bipolar II define tx options avoid
1+ hypomanic episode 1+ depressive episode (tx options same as BP I) mood stabilizers Li+, VPA, carbamazepine, atypical antipsychotics (-piprazole, -apines, -idones) avoid antideps, can precipitate mania
67
sq nodules dark skin spots bilateral deafness in the family
neurofibromatosis 2 | AD tumor suppressor mut ch22
68
rank the following by stroke risk | htn dm hld smoking alc
htn #1 smoking ~ dm hld mild at best mod alc protective, inc hdl
69
typical presentation sympx of myasthenia gravis
extraocular diplopia ptosis bulbar dysphagia dysarthria ue symmetric proximal weakness
70
diplopia ptosis dysphagia dysarthria ue symmetric proximal weakness end of day
myasthenia gravis | ai abs to motor end plate ach rs
71
tf in myasthenia gravis sensation, reflexes, muscle bulk and tone, ANS usually intact
t
72
lesions of subcortical nuclei (eg basal ganglia) usually result in
extrapyramidal sympx rigidity, bradykinesia, tremor, chorea like in pd, hd,
73
ms typically affects women v50
t
74
tf | myasthenia gravis tends to affect proximal ue more than le
t | neck, prox ue, extraoc, bulbar
75
tx acute ms flare w debilitating sympx
iv methylprednisone | plasmapheresis if refractory to steroids
76
what are the ms dma's and when tkmo consider them
ifn b glatiramer acetate chronic maintainence in rrms or spms
77
trihexphenidyl moa uses
anticholinergic tx pd tx drug induced extrapyramidal sympx
78
beet bone hare bat hatter flask describe what class of se's
anticholinergic red dry hot mad blind full flush, anhydros dry mouth, hypertherm, delirium confusion, mydriasis, u retention b constipation headache glaucoma dizziness tachycard too
79
tf | headache and glaucoma are anticholinergic se's
t red dry hot mad blind full flush, anhydros dry mouth, hypertherm, delirium confusion, mydriasis, u retention b constipation headache glaucoma dizziness tachycard too
80
levodopa se's | donthe change w carbidopa?
nausea vomiting wo carbi | agitaton psychosis w or wo carbi
81
serotonin syndrome | and 2 drug classes that cause it
agitation confusion sometimes sz tachycard muscle rigidity ssri tca espec if coadmin w maobi selegiline
82
name 6 ssri's
``` citalopram escitalopram paroxetine fluoxetine fluvoxamine sertraline ```
83
ataxia telangiectasia
inherited autosomal recessive disorder with its onset in infancy characterized by progressive cerebellar ataxia, oculocutaneous telangiectasia, and immunologic deficiency. also cancer risk mut atm dna repair gene
84
choreoathetosis
chorea - irreg migrating contractions + athetosis - twisting and writhing both involuntary
85
inner ear disease thay causes episodes of vertigo
meniere disease
86
tf | increase dose of home pyridostigmine for myasthenia crisis after intubation
f hold ache inhibs to reduce airway secretions and aspiration risk, at least temporarily plasmapheresis pref to ivig and corticosteroids can consider azothioprine or myclophenoloate mofetil for immune immodulation if corticosteroids ineffective but take weeks to work

Medicine (13 decks)

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