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MTBs Step 2CK > Neuro > Flashcards

Neuro Flashcards

1
Q

Risk factors for stroke?

A

HTN, DM, Hyperlipidemia, Tobacco, A-fib, Valvular heart dz, DVT + PFO

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2
Q

Stroke vs TIA

A

Stroke >24hr

TIA<24hrs

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3
Q

sx of ACA stroke

A

contra muscular weakness, personality changes, urinary incontinence

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4
Q

sx of MCA stroke

A

contra weakness, eyes deviate tword lesion, contra homonymous hemianopsia with macular sparing, Apraxia/neglect(R infarct), Aphasia(L infarct = language)

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5
Q

PCA stroke sx

A

ipsilateral face, contra body, vertigo & horners

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6
Q

best initial test for stroke?

A

CT W/O contrast to check for hemorrhage

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7
Q

CT shows hemorrhagic stroke

tx?

A

no tx! just monitor. reverse anticoagulation(hep = protamine sulfate, war = K & FFP), Target BP: 140-160 = Nicardipine, Labetalol, Statin with target <70.

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8
Q

when do you use thrombolytics for stroke?

A

<3 hrs of sx

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9
Q

when do you do catheter to retrieve clot?

A

between 4.5-6/8hrs

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10
Q

partial seizure

simple vs complex?

A

*limited to 1 part of the body
simple = no LOC
comples = LOC

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11
Q

causes of generalized seizures

A

hi/low Na, hypoxia, hypoglycemia, CNS infection, trauma, tumor, stroke, decreased Ca, uremia, withdrawal, cocaine toxicity, decreased Mg

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12
Q

tx of status epilepticus?

A
  1. Benzo = Lorazepam
  2. Fosphenytoin > Phenyltonin(hypotension/heart blk)
  3. phenobarbital
  4. anesthesia!
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13
Q

tests to run during seizure

A
  1. Na, Ca, Glucose, O2, Cr, Mg
  2. CT
  3. MRI
  4. EEG
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14
Q

when can a patient be taken off seizure medications?

A

2yrs and no seizure but need to do a Sleep deprivation EEG afterward to tell you possibility of recurrance

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15
Q

Lewy body dementia

A

parkinsons + dementia

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16
Q

Shy-Drager Syndrome

A

parkinson w/primary orthostasis

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17
Q

Parkinsons Disease

sx?

A
  • loss of substantia nigra causing:
  • cogwheel rigidity
  • resting tremor
  • hypomimia(masklike, underreactive face)
  • micrographia(small writing)
  • orthostasis(dizzy when standing up)
  • Intact cognition and memory
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18
Q

Tx of mild parkinsons sx

A 
<60 = anticholinergic(benztropine, hydroxyzine): relieves tremors but can worsen dementia
>60 = amatadine
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19
Q

tx of severe parkinsons

A
  1. D-ag: Pramipexole, Ropinirole, Cabergoline
    - Levodopa/Carbidopa = great drugs but increased on-off phenomena
  2. COMT inhibitors(Tolcapone, Entacapone) = blocks metabolism of dopamine
  3. MAO inhibitors(selegiline, rasagiline)
  4. deep brain stimulation
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20
Q 
Multiple Sclerosis(MS)
sx?
A
  • CNS demylination:
  • optic neuritis
  • motor and sensory probelms and defects of the bladder
  • fatigue
  • hyperreflexia
  • spasticity
  • depression
  • INO
  • sexual dysfunctions
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21
Q

dx of MS?

A
  1. MRI showing periventricular white lesions

2. CSF showing “oligoclonal bands”(not unique)

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22
Q

tx of MS?

A

steroids
fatigue = amantadine
spasticity = baclofen or tizanidine

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23
Q

tx of essential tremor vs parkinsons tremor

A 
essential = propanolol
parkinsons = antichol(benztropine/hydroxyzine) if <60 or Amantadine if >60
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24
Q

Alzheimer’s Disease(AD)

sx?

A

*progressive loss of memory in pt >65

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25
Q

Alzheimer’s Disease(AD)

dx?

A

order: head CT, B12, T4/TSH, RPR/VDRL

* CT will show diffuse, symmetrical atrophy

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26
Q

Alzheimer’s Disease(AD)

tx?

A

anticholinesterase medications = donepezil, rivastigmine, galantamine, memantine

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27
Q 
Frontotemporal Dementia(Pick's Disease)
sx? dx? tx?
A

personality and behavior problems present 1st then they get memory loss

CT/MRI shows frontal and temporal atrophy

treat just like alzheimers = anticholinesterase(donepezil, rivastigmine, galantamine, memantine)

28
Q

Normal Pressure Hydrocephalus(NPH)

sx? dx? tx?

A

Wet, Weird, Wobbly!
Wet: urinary incontinence
Weird: dementia
Wobbly: wide based gait ataxia

dx: LP & CT
tx: shunt

29
Q

Huntington’s Disease/Chorea

sx?

A

~30s, family history, dementia, psychiatric disturbance with personality changes, Chorea/movement disorder

30
Q

Huntington’s Disease/Chorea

mutation?

A

AD CAG repeat on Chrom 4

31
Q

Huntington’s Disease/Chorea

tx?

A

Tetrabenazine for movement & Antipsychotics for other sx

32
Q

Tension Headache

sx? tx?

A

constant pressure, lasts 4-6hrs, usually bilateral

tx: NSAIDs n shit

33
Q

Migraine

sx? tx?

A

aura of bright flashing lights, Scotomata, abnormal smells

tx: abortive: sumatriptan, Ergotamine
ppx: CCB, TCA, SSRI

*if 4+ HA per month = propanolol ppx

34
Q

person gets 4+ HA a month. tx?

A

propanolol

35
Q

Cluster HA

sx? tx?

A

HA are exclusively unilateral +/- unilateral with redness and tearing of the eye & rhinorrhea. frequent and high intensity.

tx: abortive = triptans or 100% O2
ppx: CCA like verapamil

36
Q

Trigeminal Neuralgia

sx? triggers? tx?

A

CN5 pain

triggers: chewing, touching face, saying Twords
tx: carbamazipine, lamotriginine, baclofen or surgical decompression

37
Q

Post-herpetic Neuralgia

sx? tx?

A

residual pain following resolution of herpes(shingles), vesicular lesions, painful dermatomal rash
tx: acyclovir to decrease incidence and Amytrip/gabapent/carbamazapine/phenytonin for pain

38
Q

when do you vac for shingles?

A

> 60 yoa

39
Q

Temporal Arteritis

sx? tx?

A

sx: tenderness of the temporal area(pain w/brushing hair), jaw claudication, visual disturbance
tx: steroids

40
Q

Pseudotumor Cerebri

sx? dx? tx?

A

obese young women with a HA & dbl vision on exam = papilledema; associated with Vitamin A use.

dx: increased CSF pressure
tx: weight loss, ACETAZOLAMIDE, surgery, stop vitA, steroids, decompression

41
Q

Benign Positional Vertigo(BPV)

sx? tx?

A

vertigo(NV, horizontal nystagmus= peripheral), positive dix-hallpike maneuver(vertigo with changes in position) no hearing loss
tx: meclizine

42
Q

Vestibular neuritis

sx? tx?

A

sx: inflammation of 8CN = vertigo and dizziness not related to positional shit.
tx: meclizine

43
Q

Labyrinthitis

sx? tx?

A

inflammation of cochlear portion of inner ear = vertigo, hearing loss, tinnitus & self limiting
tx: steroids & meclizine

44
Q

Meniere’s Disease

sx? tx?

A

sx: vertigo, hearing loss & tinnitus with remitting and relapsing episodes(MULTIPLE EPISODES).
tx: salt restriction and diuretics

45
Q

Acoustic Neuroma

sx? tx?

A

sx: 8th CN tumor that can be related to neurofibromatosis, hearing loss, tinnitus, vertigo
tx: resection

46
Q 
Subarachnoid Hemorrhage(SAH)
sx?
A

sudden or severe HA, stiff neck, photophobia, LOC(50%), FND(30%), fever

47
Q 
Subarachnoid Hemorrhage(SAH)
tx?
A

angiography to determine the site of bleeding, embolize, shunt of hydrocephalus, NIMODIPINE PO to prevent stroke

48
Q

what drug do you give in subarachnoid hemorrhage that will prevent stroke?

A

Nimodipine

49
Q

Syringomyelia

sx? tx?

A
  • fluid filled widening of the spinal cord
    sx: loss of pain, temp in the upper extremities bilaterally in a cape-like distribution over the neck and shoulder and down both arms

tx: MRI then surgery

50
Q

Subacute Degeneration of the Cord

A

cause: B12 or neurosyphillus
sx: no position or vibration

51
Q

Cord Compression

sx? tx?

A

sx: pain and tenders of the spine + hyperreflexia
tx: steroids

52
Q

Anterior Spinal Artery Infarct

sx?

A

all sensation loss expect Position and vibration(these down posterior column),

53
Q

Brown-Sequard Syndrome

sx?

A

loss of ipsilateral position, vibratory sense, contralateral pain and temperature.

54
Q

Amyotrophic Lateral Sclerosis(ALS)

sx? UMN? LMN?

A

upper and motor neuron sx that often starts in arms. seen in 20-40yoa, death 3-5 yrs afterward

  • UMN: hyperreflexia, upgoing toes, spasticity, weakness
  • LMN: wasting, fasciculations, weakness
55
Q

tx of Amyltrophic lateral sclerosis(ALS)

A

riluzole

56
Q

Charcot-marie-Tooth Disease

sx?

A
  • demylination of peripheral nerves
  • decreased motor and senory
  • wasting in legs, decreased DTR, tremors, Pes Vavus(HIGH FOOT ARCH), distal weakness & sensory loss
57
Q

Radial nerve palsy

A

saturday night palsy = wrist drop

*crutches use compresses nerve

58
Q

Restless Leg Syndrome tx

A

pramipexole or ropinirole

59
Q

Myasthenia Gravis

sx? dx? tx?

A
  • ab to ACh receptros at NMJ
    sx: protosis, weakness, worse at the end of the day, weak muscles of masticaion
    dx: endrophonium(AChE inhibitor)
    tx: pyridostigmine or Neostigmmine(AChE inhibitor)
60
Q

person with myasthenia gravis. what do you need to look out for?

A

thymoma

61
Q

Tuberous Sclerosis

sx? tx?

A

seizures, mental deterioration, retinal lesions

SKIN: adenoma sebaceum(red face nodules), Shagreen Patches(leathery patches on trunk), Ash leaf spots(hypopigmented spots)

tx: control seizures

62
Q

Neurofibromatosis

sx? tx?

A

sx: soft flesh-colored lesions on skin +peripheral nerves, CN 8 tumors, Cafe-au-lait spots +/- gliomas
tx: decompress CN8

63
Q

Sturge-Weber Syndrome

tx? sx/

A

sx: seizures, port wine stain, CNS eye shit, Calcifications of angiomas, hemiparesis
tx: control seizures

64
Q

which 4 causes of vertigo will have hearing loss? whats the big difference between the two?

A
  • Labyrinthitis = acute w/hearing loss and tinnitis
  • Meniere’s disease = chronic = multiple episodes w/hearing loss and tinnitis
  • acoustic neuroma = ataxia w/hearing loss and tinnitis
  • Perilymph Fistula = hx of trauma w/hearing loss and tinnitis
65
Q

causes of peripheral vertigo?

A

meniere disease, labyrinthitis, BPPV, perilymphatic fistula

66
Q

which 2 types of vertigo have no hearing loss ? what the difference between them?

A

BPPV = veritgo with head movement

Vestibular Neuritis = vertigo regardless of head movment

67
Q

Idiopathic Intracranial HTN

rf? sx? dx? tx?

A

Idiopathic Intracranial Hypertension:

  • RF: overweight women of childbearing age, possible link to some meds(vit A, tetracyclines)
  • SX: HA, TRANSIENT VISSION LOSS(PAPILEDEMA), PULSATILE TINNITUS, diplopia
  • PE: papilledema, peripheral Visual Field defect, CN 6 palsy
  • DX: MRI & LP(>250)
  • TX: stop meds, weight loss, acetazolamide

MTBs Step 2CK (20 decks)

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