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MTBs Step 3 > 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
Alzheimer's Disease(AD) | dx?
order: head CT, B12, T4/TSH, RPR/VDRL | * CT will show diffuse, symmetrical atrophy
26
Alzheimer's Disease(AD) | tx?
anticholinesterase medications = donepezil, rivastigmine, galantamine, memantine
27
``` Frontotemporal Dementia(Pick's Disease) sx? dx? tx? ```
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
Normal Pressure Hydrocephalus(NPH) | sx? dx? tx?
Wet, Weird, Wobbly! Wet: urinary incontinence Weird: dementia Wobbly: wide based gait ataxia dx: LP & CT tx: shunt
29
Huntington's Disease/Chorea | sx?
~30s, family history, dementia, psychiatric disturbance with personality changes, Chorea/movement disorder
30
Huntington's Disease/Chorea | mutation?
AD CAG repeat on Chrom 4
31
Huntington's Disease/Chorea | tx?
Tetrabenazine for movement & Antipsychotics for other sx
32
Tension Headache | sx? tx?
constant pressure, lasts 4-6hrs, usually bilateral | tx: NSAIDs n shit
33
Migraine | sx? tx?
aura of bright flashing lights, Scotomata, abnormal smells tx: abortive: sumatriptan, Ergotamine ppx: CCB, TCA, SSRI *if 4+ HA per month = propanolol ppx
34
person gets 4+ HA a month. tx?
propanolol
35
Cluster HA | sx? tx?
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
Trigeminal Neuralgia | sx? triggers? tx?
CN5 pain triggers: chewing, touching face, saying Twords tx: carbamazipine, lamotriginine, baclofen or surgical decompression
37
Post-herpetic Neuralgia | sx? tx?
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
when do you vac for shingles?
>60 yoa
39
Temporal Arteritis | sx? tx?
sx: tenderness of the temporal area(pain w/brushing hair), jaw claudication, visual disturbance tx: steroids
40
Pseudotumor Cerebri | sx? dx? tx?
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
Benign Positional Vertigo(BPV) | sx? tx?
vertigo(NV, horizontal nystagmus= peripheral), positive dix-hallpike maneuver(vertigo with changes in position) no hearing loss tx: meclizine
42
Vestibular neuritis | sx? tx?
sx: inflammation of 8CN = vertigo and dizziness not related to positional shit. tx: meclizine
43
Labyrinthitis | sx? tx?
inflammation of cochlear portion of inner ear = vertigo, hearing loss, tinnitus & self limiting tx: steroids & meclizine
44
Meniere's Disease | sx? tx?
sx: vertigo, hearing loss & tinnitus with remitting and relapsing episodes(MULTIPLE EPISODES). tx: salt restriction and diuretics
45
Acoustic Neuroma | sx? tx?
sx: 8th CN tumor that can be related to neurofibromatosis, hearing loss, tinnitus, vertigo tx: resection
46
``` Subarachnoid Hemorrhage(SAH) sx? ```
sudden or severe HA, stiff neck, photophobia, LOC(50%), FND(30%), fever
47
``` Subarachnoid Hemorrhage(SAH) tx? ```
angiography to determine the site of bleeding, embolize, shunt of hydrocephalus, NIMODIPINE PO to prevent stroke
48
what drug do you give in subarachnoid hemorrhage that will prevent stroke?
Nimodipine
49
Syringomyelia | sx? tx?
* 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
Subacute Degeneration of the Cord
cause: B12 or neurosyphillus sx: no position or vibration
51
Cord Compression | sx? tx?
sx: pain and tenders of the spine + hyperreflexia tx: steroids
52
Anterior Spinal Artery Infarct | sx?
all sensation loss expect Position and vibration(these down posterior column),
53
Brown-Sequard Syndrome | sx?
loss of ipsilateral position, vibratory sense, contralateral pain and temperature.
54
Amyotrophic Lateral Sclerosis(ALS) | sx? UMN? LMN?
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
tx of Amyltrophic lateral sclerosis(ALS)
riluzole
56
Charcot-marie-Tooth Disease | sx?
* demylination of peripheral nerves - decreased motor and senory - wasting in legs, decreased DTR, tremors, Pes Vavus(HIGH FOOT ARCH), distal weakness & sensory loss
57
Radial nerve palsy
saturday night palsy = wrist drop | *crutches use compresses nerve
58
Restless Leg Syndrome tx
pramipexole or ropinirole
59
Myasthenia Gravis | sx? dx? tx?
* 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
person with myasthenia gravis. what do you need to look out for?
thymoma
61
Tuberous Sclerosis | sx? tx?
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
Neurofibromatosis | sx? tx?
sx: soft flesh-colored lesions on skin +peripheral nerves, CN 8 tumors, Cafe-au-lait spots +/- gliomas tx: decompress CN8
63
Sturge-Weber Syndrome | tx? sx/
sx: seizures, port wine stain, CNS eye shit, Calcifications of angiomas, hemiparesis tx: control seizures
64
which 4 causes of vertigo will have hearing loss? whats the big difference between the two?
- 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
causes of peripheral vertigo?
meniere disease, labyrinthitis, BPPV, perilymphatic fistula
66
which 2 types of vertigo have no hearing loss ? what the difference between them?
BPPV = veritgo with head movement | Vestibular Neuritis = vertigo regardless of head movment
67
Idiopathic Intracranial HTN | rf? sx? dx? tx?
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 3 (30 decks)

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