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PANCE > Neuro > Flashcards

Neuro Flashcards

1
Q

Status epilepticus

- define

A
  • 5+ min continuous seizure OR more than 1 seizure without full return to consciousness between
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2
Q

Status epilepticus

- mgmt

A
  • 1st: Benzodiazepines (lorazepam, etc.)
  • 2nd: Phenytoin or fosphenytoin, valproic acid, phenobarbital, levetiracetam
  • 3rd: Pentobarbital, propofol
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3
Q

Myasthenia Gravis

  • patho
  • MC age/sex
  • assoc with what
A
  • autoimmune ab vs. acetylcholine postsynaptic receptors
  • MC young F
  • Assoc with thyme tumors, thyrotoxicosis, SLE, RA
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4
Q

Myasthenia Gravis

- clinical

A
  • ptosis (External ocular muscles MC affected
  • diplopia
  • diff chew/swallow
  • diff breathing
  • extremity weakness
  • sx worse with use, better with rest
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5
Q

Myasthenia Gravis

- dx

A
  • Blood serum assay: acetylcholine receptor ab

- additional testing: Tensilon test, electrophysiologic studies

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6
Q

Myasthenia Gravis

- mgmt

A

Anticholinesterase drugs: neostigmine and pyridostigmine

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7
Q

Levels of consciousness (5)

A
  1. alert
  2. lethargic/somnolent: dries to sleep, drowsy, responds to Q or commands
  3. Obtunded: mostly sleeps, hard to wake, confused, mumbles
  4. Stupor: unconscious, motor response, groans
  5. Coma: unconscious, no response to pain or stimulus
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8
Q

Horner syndrome

- 3 sx

A
  • miosis
  • ptosis
  • anhidrosis
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9
Q

Alzheimer’s Disease

- patho

A
  • deficient in acetylcholine
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10
Q

Alzheimer’s Disease

- mgmt

A
  • want to increase acetylcholine
  • cholinesterase inhibitors: Donepezil, rivastigmine, galantamine
  • NMDA receptor antagonist: memantine
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11
Q

Pick’s Disease

  • aka
  • clinical
A
  • frontotemporal dementia

- disinhibition, hyperorality, compulsive behavior, loss of empathy, apathy

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12
Q

Diabetic neuropathy

- screening

A

Type 1 for more than 5 years and type 2 immediately: annual screening

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13
Q

Diabetic neuropathy

- mgmt

A
  • Glycemic control

- TCAs and anticonvulsants (gabapentin)

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14
Q

TIA

- dx

A
  • clinical, CT to rule out stroke

- sx <60 minutes

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15
Q

TIA

- mgmt

A
  • prevent future stroke/TIA
  • antiplatelet therapy, control HTN, DM, lipids
  • possible carotid revascularization
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16
Q

SAH

- overview

A
  • MC rupture of aneurysm
  • sentinel HA 6-20 days before rupture
  • exertion may trigger rupture
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17
Q

SAH

- clinical

A
  • LOC > HA worst of life
  • Neck stiff, nausea, AMS
  • Blood in CSF
  • +/- seizures
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18
Q

SAH

- dx

A
  • Noncontrast CT

- LP - xanthochromia

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19
Q

SAH

- mgmt

A
  • coil/clip aneurysm

- Nimodipine (CCB) to reduce vasospasm

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20
Q

Concussion

- clinical

A
  • +/- brief LOC
  • dizzy
  • confused
  • amnesia
  • lack coordination
  • HA
  • n/v
  • slurred speech
  • mood disturbance
  • light/sound disturbance
  • sleep disturbance
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21
Q

Concussion

- when to return to care

A
  • persistent vomiting
  • Worse HA
  • blurry vision
  • seizure/incontinence
  • excessive sleepy/confusion
  • neuro deficits (weakness, numbness)
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22
Q

Concussion

- mgmt

A
  • NSAIDs
  • Rest
  • return to sport after ll sx have completely resolved without aid of medication
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23
Q

Intracerebral Hemorrhage

- overview

A
  • older >50 yo
  • Hx HTN and atherosclerotic RF
  • neuro defects (like ischemic)
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24
Q

Intracerebral Hemorrhage

- mgmt

A
  • HTN control
  • ICP control
  • reverse coagulopathies
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25
Q

Tourette Syndrome

- overview

A
  • hyperkinetic movement disorder

- motor and phonic tics: can be voluntarily suppressed

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26
Q

Tourette Syndrome

- common comorbidities

A
  • OCD

- ADHD

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27
Q

Tourette Syndrome

  • dx
  • mgmt
A
  • clinical, all imaging normal
  • antidopaminergic drugs: tetrabenazine preferred, alpha-adrenergic: clonidine, topiramate
  • habit reversal training
28
Q

Meningitis

- MC bacteria

A
  • strep pnuemo
  • Neisseria meningitis
  • Listeria
29
Q

Meningitis

- clinical

A
  • fever
  • nuchal rigidity
  • HA
  • AMS
  • elevated WBC
  • thrombocytopenia
30
Q

Meningitis

- dx

A
  • LP for CSP analysis
31
Q

Meningitis

- mgmt

A
  • empiric abx as soon as LP and cultures done
  • 3rd gen ceph + vancomycin
    • ampicillin if >50 to cover for listeria
  • Dexamethasone
32
Q

What type bacteria is N. Meningitis

A

gram-negative diplococci

33
Q

Wernicke Encephalopathy

- cause

A

Thiamine (B1) deficiency

34
Q

Wernicke Encephalopathy

- clinical

A
  • encephalopathy
  • oculomotor dysfunction
  • gait ataxia
35
Q

Wernicke Encephalopathy

- mgmt

A
  • IV thiamine

- ALWAYS thiamine before glucose!!

36
Q

Rabies Exposure

- mgmt postexposure

A
  • Rabies immune globin: day 0

- Rabies vaccine: Days 0, 3, 7, 14

37
Q

Rabies

  • type of bug
  • transmission
A
  • RNA virus > CNS

- exposure to saliva from infected animal: bats, raccoons, skunks, foxes

38
Q

Rabies

- clinical

A
  • prodrome: nonspp
  • Paresthesias that travel proximal from bite
  • encephalitis: fever, hydrophobia, pharyngeal spasm, hyperactivity
  • Paralytic: ascending paralysis and flaccid limbs
  • coma then death
39
Q

Febrile seizure

  • MCC
  • ages
  • temp
A
  • viral illness
  • 3 mo to 5 years
  • Temp > 38C
40
Q

MS

- overview

A
  • immune-mediated inflammatory dz attacks myelinated axons in CNS
  • F > M
  • 15-45 years
41
Q

MS

- Sx

A
  • neurologic manifestations: weakness, numbness, gait issues, diplopia, etc.
  • Urinary hesitancy or urgency
  • fatigue, worse with heat
  • optic neuritis (unilateral eye pain worse with movement, diplopia, scotoma, color vision loss, blurry vision)
42
Q

MS

- type of pupil response

A

Marcus-Gunn

43
Q

MS

- MC form

A

relapsing-remitting

44
Q

MS

- dx

A
  • 2+ diff regions central white matter affected at two different time periods
  • MRI: dx test of choice, ovoid-shaped plaques
  • LP: oligoclonal bands and Ig
45
Q

MS

- mgmt

A
  • methyprednisolone for acute relapses
  • Plasmapheresis
  • interferon beta-1a/ib
46
Q

Lewy Body Dementia

- clinical

A
  • attention, executive function, visual perceptual ability defects
  • *visual hallucinations
  • parkinsonism
  • cog fluctuations
  • REM sleep behavior disorders
47
Q

Guillain-barre Syndrome

  • overview
  • RF
A
  • immune-mediate polyneuropathy of peripheral nerves

- RF: c. jejune infection, immunizations, sx, trauma

48
Q

Guillain-barre Syndrome

- clinical

A
  • symmetrical ascending weakness, difficulty walking
  • spread proximally to UE
  • autonomic and respiratory dysfunction
  • absent reflexes
49
Q

Guillain-barre Syndrome

- dx

A
  • CSF: elevated protein (albuminocytologic dissociation)
50
Q

Guillain-barre Syndrome

- mgmt

A
  • plasmapheresis
  • IVIG
  • mechanical ventilation if needed
51
Q

Brain abscess

- MC pathogenesis

A
  • direct extension
52
Q

Encephalitis

- MCC

A

Herpes simplex virus (HSV 1)

- dx via PCR of CSF

53
Q

Adult brain tumor

  • MC type
  • MC location
A
  • glioblastoma

- supratentorial

54
Q

Child brain tumor

  • MC type
  • MC location
A
  • medulloblastoma

- infratentorial

55
Q

Brain tumor

- clinical

A

chronic HA worse when wake up

56
Q

Tonic Clonic seizure

- mgmt

A
  • lamotrigine
  • levetiracetam
  • topiramate
  • valproate
57
Q

Parkinson’s Disease

- patho

A
  • decreased dopamine

- lack of acetylcholine inhibition

58
Q

Parkinson’s Disease

- clinical

A
  • pill rolling, resting tremor
  • bradykinesia
  • cogwheel rigidity
  • postural instab
  • gait dysfunction
  • masked facies
59
Q

Parkinson’s Disease

- mgmt

A
  • 1st line: carbidopa-levodopa
  • adjunct: bromocriptine, pramipexole, ropinirole
  • anticholinergic for younger its: benztropine
60
Q

GCS

  • score range
  • Each section
A 
3-15
EYES
- spontaneous
- opens to command
- opens to pain
- none
TALKS
- oriented
- confused, but can answer
- inappropriate response
- incomprehensible
- none
MOTORS
- obeys commands
- purposeful movement to pain
- withdraws from pain
- abnl flexion
- abnl extension
- none
61
Q

cerebral aneurysm is linked to what non-neuro dz

A

polycystic kidney dz

62
Q

Pseudotumor Cerebri

  • overview
  • aka
  • MC affected
A
  • idiopathic elevated ICP
  • idiopathic intracranial HTN
  • Obese women in childbearing years
63
Q

Pseudotumor Cerebri

- clinicla

A
  • HA
  • photopsia
  • visual disturbance/loss
  • back pain
  • pain behind eyes
  • visual field defects
  • papilledema
64
Q

Pseudotumor Cerebri

- dx

A
  • dx of exclusion
  • LP: always, elevated opening pressure with normal CSF analysis
  • MRI/CT: nl
65
Q

Pseudotumor Cerebri

- mgmt

A
  • lose weight
  • stop drugs
  • acetazolamide to dec CSF fluid production

PANCE (14 decks)

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