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GK PANCE > Neuro > Flashcards

Neuro Flashcards

1
Q

What are the 3 branches of the trigeminal nerve affected in trigeminal neuralgia?

A
  1. ophthalmic branch (V1)
  2. maxillary branch (V2)
  3. mandibular branch (V3)
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2
Q

What aggravates trigeminal neuralgia attacks?

A

eating, tapping on the affected nerve, brushing teeth, temperature change

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3
Q

1st line tx for trigeminal neuralgia

A

carbamazapine (anticonvulsant)

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4
Q

What kind of medication is carbamazapine?

A

anticonvulsant

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5
Q

sudden unilateral electric shock-like pains in gums, cheek, chin, temporal forehead

A

trigeminal neuralgia

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6
Q

seizure confined to small area of brain (focal part of one hemisphere)

A

partial (focal) seizure

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7
Q

simple partial seizure

A

consciousness preserved

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8
Q

complex partial (temporal lobe)

A

aura → impaired consciousness

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9
Q

What physical movements are associated with partial (focal) seizures?

A

automatism:

  • lip smacking
  • manual picking
  • patting
  • coordinated motor movement (walking)
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10
Q

2 forms of partial (focal) seizures

A

simple & complex

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11
Q

2 types of generalized seizures

A

absence & tonic clonic (grand mal)

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12
Q

seizure where both hemispheres are involved(diffiuse brain involvement)

A

generalized seizures

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13
Q

brief lapse of consciousness & eyelid twitching

No Post Ictal Phase

A

absence

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14
Q

1st stage: LOC → rigidity→ arrest of respiration

2nd stage: repetitive rhythmic jerking for 2-3 mins → post ictal phase (flaccid coma/sleep, variable duration)

A

Tonic Clonic (grand mal) seizures

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15
Q

Which type of seizure is most common in childhood?

A

Absence seizure

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16
Q

Tx for absence seizure

A
  1. Ethosuximide
  2. Valproic Acid (2nd line)
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17
Q

Tx for tonic clonic (grand mal) seizures

A
  1. Valproid acid
  2. Phenytoin
  3. Carbamazapine
  4. Lamotrigine
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18
Q

sudden, brief, sporadic involuntary twitching

No LOC

What kind of seizure?

A

Myoclonus

“myo” = muscle

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19
Q

“drop attacks”

sudden loss of postural tones

What type of seizure?

A

Atonic

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20
Q

Repeated, generalized seizures w/o recovery > 30 mins

A

Status Epilepticus

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21
Q

Tx for status epilepticus

A
  1. Lorazepam or diazepam
  2. Phenytoin
  3. Phenobarbital
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22
Q

SES of Phenytoin

A

gingival hyperplasia, SJS, hirsutism

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23
Q

What hormone levels increase during seizure activity?

A

prolactin levels

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24
Q

Dx for seizures

A

EEG: localizes the lesion

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25
Q

SES of valproic acid

A

pancreatitis, hepatotoxicity

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26
Q

Which 3 anti-seizure meds can cause SJS?

A
  1. Lamotrigine
  2. Carbamazapine
  3. Phenytoin
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27
Q

Which anti-seizure medication is used for seizure prophylaxis?

A

Phenytoin

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28
Q

SES of Lamotrigine

A

SJS

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29
Q

SES of Phenytoin

A

erythema multiforme (SJS)

gingival hyperplasia

hirsutism

hypotension

arrhythmias w/rapid admin

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30
Q

SES of carbamazepine

A

Hyponatremia (MOA is blocking Na+ channels) → SIADH

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31
Q

Which benzo is most affective for seizures?

A

Lorazepam (shorter half life)

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32
Q

What reverses side effect of sedation when taking Benzo for seizure?

A

flumazenil

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33
Q

Dx for intracranial/intracerebral hemorrhage

A

Immediate non-contrast CT

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34
Q

Tx for intercerebral hemorrhage

A
  1. elevate head of bed
  2. anti-seixure PPX (Phenytoin)
  3. IV Mannitol if ↑ ICP
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35
Q

Cause of Parkinsons

A

idiopathic dopamine depletion–> failure to inhibit Ach in basal ganglia

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36
Q

Lewy bodies

A

Parkinsons

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37
Q

loss of pigment cells seen in substantia nigra

A

Parkinsons

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38
Q

1st sx of parkinsons

A

Resting tremor (pill rolling)

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39
Q

Myerson’s sign

A

associated with Parkinsons: tapping the bridge of nose repetitively causes a sustained blink

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40
Q

pull test

A

stand behind pt & pull shouldlers: patient falls or takes steps backwards

seen in parkinsons

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41
Q

most effective tx of parkinsons

A

levodopa/carbidopa

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42
Q

What medication can you use in young patients to delay the use of Levodopa in pts with Parkinsons?

A

Dopamine agonists: Bromocriptine, Pramipexole, Ropinirole

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43
Q

What medication would you use in a pt w/ Parkinsons who is <70 y/o w/ tremor predominance?

A

antocholinergics: Trihexyphenidyl, Benztropine

blocks excitatory cholinergic effects

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44
Q

CI to use of anticholinergics for Parkinsons

A

BPH, glaucoma

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45
Q

“wearing off phenomenon”

A

associated with levodopa, which is why it is given with carbidopa in parkinsons

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46
Q

caudate nucleus atrophy

A

huntingtons disease

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47
Q

chromosome 4 mutation

A

huntingtons disease

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48
Q

clinical presentation of tourettes

A

motor tics: face, head, neck

verbal tics: grunts, throat clearing, obscene words

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49
Q

Tx for tourette syndrome

A

habit reversal therapy

antipsychotics

alpha adrenergics

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50
Q

Patho of ALS

A

necrosis of upper and lower motor neurons that leads to progressive motor degeneration

51
Q

presentation of ALS

A

cannot initiate and control motor movements

Mixed upper and lower motor neuron signs:

Upper motor neurons: spasticity, stiffness, hyperreflexia

Lower motor neurons: progressive fasiculations, muscle atrophy, hyporeflexia

52
Q

Upper motor neuron presentations of ALS

A

spasticity, stiffness, hyperreflexia

53
Q

Lower motor neuron presentation of ALS

A

progressive fasiculations, muscle atrophy, hyporeflexia

54
Q

What movements are spared in ALS?

A

sensation

urinary sphincter

voluntary eye movements

55
Q

Tx for ALS

A

Riluzole

56
Q

Tx for restless leg syndrome

A

Dopamine agonists: Pramiprexole, Ropinirole

Gabapentin

57
Q

this disease has an increased incidence with campylobacter jejuni infection

A

guillan barre syndrome

58
Q

ascending symmetric weakness and paresthesias

A

GBS

59
Q

CSF findings in GBS

A

high protein with normal WBC

can rmr this becase campylobacter jejuni is found in meat (protein)

60
Q

Tx for GBS

A

Plasmapheresis: removes harmful circulating auto-antibodies that cause demyelination

IVIG

61
Q

what medication is contraindicated in GBS?

A

prednisone

62
Q

autoimmune antibodies against Ach

A

Myasthenia Gravis

63
Q

progressive muscle weakness with repeated muscle use & recovery after periods of rest

A

Myasthenia Gravis

64
Q

typical findings in myasthenia gravis

A

ocular weakness: diplopia, ptosis

Generalized muscle weakness: worsened w/use and relieved w/rest, respiratory musle weakness

65
Q

myasthenic crisis

A

respiratory failure

66
Q

How is a diagnosis made in Myasthenia Gravis?

A

+ Ach receptor antibodies

Edrophonium Tensilon test: rapid response to short acting IV edrophonium

67
Q

1st line Tx of Myasthenia Gravis

A

Ach inhibitors: Pyridostigmine or Neostigmine

68
Q

Pyridostigmine MOA

A

increases Ach by preventing breakdown of Ach

69
Q

Most worrisome S/E of Pyridostigmine

A

cholinergic crisis: weakness, N/V/D, pallor, sweating, salivation, diarrhea, miosis, bradycardia, resp failure

70
Q

How can you tell whether respiratory failure is due to a myasthenic crisis or cholinergic crisis?

A

Administer IV edrophonium

if flaccid paralysis improves: myasthenic crisis

If flaccid paralysis worsens: cholinergic crisis

71
Q

How to tx myasthenic crisis

A

plasmapheresis or IVIG

72
Q

myasthenic syndrome (Lamert eaton)

A

associated with small cell lung cancer

weakness improves with repeated use

73
Q

Lumbar puncture results of MS

A

Increased IgG in CSF

74
Q

what neuron involvement is seen in MS?

A

upper motor neuron involvement: spasticity and positive babinski (upwards)

75
Q

charcot’s neuro triad

A
  1. nystagmus
  2. staccato speech
  3. intentional tremor
76
Q

MS acute exacerbation Tx

A

Corticosteroids

plasmapheresis if unresponsive to CS

77
Q

Chronic mgmt of relapse-remitting/progressive MS disease

A

B-interferon or glatiramer acetate

78
Q

Tx for fatigue in MS

A

amantadine

79
Q

Bell Palsy

A

idiopathic unilateral CN 7/facial nerve palsy –> hemifacial weakness/paralysis

strong association with HSV reactivation

Lower motor neuron lesion

80
Q

Greatest risk factor of Bell Palsy

A

post URI

81
Q

Typical findings of Bell Palsy

A

sudden onset of ipsilateral hyperacusis (ear pain)--> unilateral facial paralysis (unable to lift affected eyebrow), taste disturbance (anterior 2/3)

82
Q

Tx for bell palsy

A

prednisone if started w/in 1st 72hrs

artificial tears

83
Q

headaches and papilledema

A

suspect idiopathic intracranial hypertension

84
Q

what drug can cause idiopathic intracranial hypertension?

A

tetracycline

85
Q

This HA is MC in obese women of childbearing age

A

idiopathic intracranial HTN

86
Q

HA worse with straining

visual changes that may lead to blindness if not treated

A

idiopathic intracranial HTN

87
Q

what will you see on fundoscopy in pt w/ idiopathic intracranial HTN?

A

papilledema

88
Q

diagnostic test of choice for Idiopathic intracranial HTN

A

CT scan 1st to r/o CNS mass

Lumbar puncture

89
Q

increased CSF pressure

what HA?

A

IIH

90
Q

Tx for IIH

A

acetazolamide

91
Q

Subarachnoid hemorrhage Tx

A

nimodipine

92
Q

study of choice if you suspect concussion syndrome in the acute setting

A

CT scan

93
Q

study of choice is prolonged symptoms of concussion syndrome >1-2 weeks

A

MRI

94
Q

Tx for concussion syndrome

A

cognitive and physical rest

95
Q

main clinical manifestations of concussion syndrome

A

amnesia and confusion

96
Q

1st line PPX for migraines

A

propanolol

97
Q

Other PPX meds for migraines

A

antiepileptics (topiramate, valproic acid), calcium channel blockers (verapamil), and antidepressants (amitriptyline)

98
Q

MC side effect of topiramate

A

paresthesias

99
Q

If O2 isnt effective in a cluster HA, what med should be used

A

sumatriptan

100
Q

amyloid deposition (senile plaques) in the brain, neurofibrillary tangles (tau protein)

A

alzheimer disease

101
Q

What does CT scan of Alzheimer’s show?

A

cerebral cortex atrophy

102
Q

cholinergic deficiency –> memory, language, visuospatial changes

A

alzheimers

103
Q

Tx for alzheimers

A

Ach-esterase inhibitors: Donepezil, Rivastigmine

NMDA Antagonist: Memantine

104
Q

Spastic Paralysis (hypertonia), Increased DTR

upward Babinski Reflex

A

Upper Motor Neuron

105
Q

Flaccid Paralysis (loss of muscle tone/hypotonia)

Decreased DTR

Fasiculations

Downward Babinski Reflex

Muscle Atrophy

A

Lower Motor Neuron Lesions

106
Q

What are examples of Upper Motor Neuron Lesions?

A

Stroke

MS

Cerebral Palsy

TBI

107
Q

Lower Motor Neuron Examples

A

GBS

Botulism

Polio

Cauda Equina Syndrome

Bell Palsy

108
Q

Transient episode of neuro deficits w/o acute infarction

A

TIA

109
Q

Cpx of TIA

A

amaurosis fugax: monocular vision loss (temporary “lamp share down on one eye”)

weakness of contralateral hand

Vertibrobasilar: brainstem/cerebellar sxs (gait, proprioception)

110
Q

Initial test of choice in TIA

A

CT scan

111
Q

Tx for TIA

A

ASA + Dipyridamole or Clopidogrel

112
Q

contralateral hemiparesis (weakness) + hypesthesia (decreased sensation)

ipsilateral hemianopsia gaze preference towards side of lesion

UE > LE

facial droop + aphasia

What kind of stroke?

A

Middle Cerebral Artery (YMCA)

113
Q

speech preserved

AMS, impaired judgement

contralateral weakness

LE> UE

What kind of stroke?

A

Anterior Cerebral Artery (ACA)

114
Q

Affects vision & thought

contralateral homonymous hemianopsia

Cortical blindness

What kind of stroke?

A

Posterior Cerebral Artery Occlusions

115
Q

affects the base = trunk so it can effect everything: vertigo, nystagmus, diplopia, dysphagia, syncope etc.

*crossed findings*

ipsilateral CN deficits

contralateral motor deficits

INC morbidity

What kind of stroke?

A

Vertebrobasilar artery occlusions

116
Q

This stroke is MC in DM and HTN

small vessel infarct

no impairments in cognition, speech, LOC or memory

A

Lacunar Strokes

117
Q

Dx for all strokes

A

1st test: Noncon CT

CT angiogram within 1st 6 hrs

Door to tPA in 90 min

118
Q

Tx for all strokes

A

IV tPA (onset s/s –> tPA = <4 hrs)

ASA or Ticlopidine (ASA allergy) + Heparin (ischemic strokes)

119
Q

BP cut off for Strokes

A

no lower than 160/100

120
Q

You can give Alteplase only when

A

there is no evidence of hemorrhage on non contrast CT

121
Q

Tx when a-fib found on ECG during a stroke

A

Heparin –> Warfarin INR 2.0 - 3.0

122
Q

Tx for SAH

A

Nimodipine

123
Q
A

GK PANCE (26 decks)

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