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OME Cards > Neuro > Flashcards

Neuro Flashcards

1
Q

How do you diagnose pseudo-seizure disorder?

A

Inpatient 24 hour EEG with video monitoring and induction of seizure with stimuli and sleep deprivation.

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2
Q

What is a possible treatment for neurogenic bladder?

A

neurogenic bladder can be side effect of MS

Use bethanechol to induce spasms in the bladder

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3
Q

How is stroke related to depression?

A

Stroke places patients at high risk for depression. Use of SSRI or SNRIs is indicated, unless contraindications exist.

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4
Q

What is the diagnosis of cluster headache?

A

Cluster headaches require one time brain imaging.

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5
Q

What is pseudodementia?

A

do not have dementia at all, just the depression that manifests as it

Fix the depression, fix the dementia. Treat depression with anti-depressants such as citalopram.

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6
Q

What is Eaton-lambert syndrome?

A

Paraneoplastic syndrome that presents with large-muscle weakness that improves with use.

Caused by the production of antibodies against presynaptic calcium channels.

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7
Q

How do you treat status epilepticus?

A

Escalation of therapy for status epilepticus is Benzos –> Levetiracetam –> Midazolam and Propofol –> Phenobarbital

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8
Q

How will Creutzfeldt-Jakob disease present?

A

Young dementia, rapid decline, and myoclonus is CJD.

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9
Q

What is myasthenia gravis?

A

Antibodies against acetylcholine-receptors

Weakness that worsens with use

Can be due to thymoma (do thymectomy)

Treat with stigmine (pyridostigmine)

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10
Q

What is Normal pressure hydrocephalus?

A

Weird, Wobbly, and Wet patient. This is dementia, ataxic gait, and urinary incontinence.

Get LP to diagnose

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11
Q

What is the treatment for Normal pressure hydrocephalus?

A

Removal of CSF is key to improve the condition and prevent worsening, a Ventriculoperitoneal shunt (VP Shunt) is required to maintain intracranial pressures at normal levels and reverse the dementia.

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12
Q

What is Cauda Equina syndrome?

A

Saddle anesthesia, loss of bowel and bladder continence in the setting of back pain.

Treat with IV steroids

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13
Q

How is a stroke diagnosed?

A

1st test- CT

Best test- MRI

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14
Q

Carotid stenosis treatment?

A

If carotid stenosis > 70% or > 60% with symptoms then you do a carotid endarterectomy.

If DVT, then heparin to Coumadin bridge.

If no clot, then just start Coumadin (no need for heparin bridge)

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15
Q

What is non-convulsive status?

A

Seizing but no outward signs of seizure activity

considered in the ICU setting with continued altered mental status after anoxic brain injury or trauma

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16
Q

Diagnosis of Myasthenia Gravis?

A

acetylcholine receptor antibody testing and positive anti-muscle-specific tyrosine kinase antibodies

a CT scan of the chest should be obtained to rule out thymoma.

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17
Q

What is Fronto-temporal dementia, or Pick’s disease?

A

loss of social graces often presenting as hypersexuality or violence, later in dz will lose memory.

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18
Q

What is Parkinson’s disease?

A

Pill rolling tremor at rest
cog- wheel rigidity

α- synuclein (intracellular eosinophilic inclusions)

< 65 + functional we use dopamine agonists (pramipexole) –> levodopa/carbadopa later in dz

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19
Q

What is brain death?

A

Absence of brainstem reflexes AND the absence of cortical function.

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20
Q

What is persistent vegetative state?

A

Brainstem reflexes are intact (eyes open/close, cough, pupillary, corneal reflex etc) BUT cortical function is lost forever (speech, memory, personality etc)

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21
Q

What if seen in a patient is indication of death?

A

Presence of either lividity (dark blue pooling of venous blood in dependent areas) or rigor mortis

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22
Q

What is lewy body dementia?

A

combination of dementia and Parkinsonian symptoms

verbal problems and visual hallucinations

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23
Q

First thing to do for a stroke?

A

If you think stroke get a CT scan to rule out a bleed

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24
Q

What is sensorineural hearing loss?

A

Lateralization to the normal ear on Weber testing and better air conduction is indicative of a cranial nerve lesion and central cause for vertigo. Evaluate with MRI.

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25
Q

What is conductive hearing loss?

A

Weber test should lateralize to the affected ear and the Rinne test should be louder when in contact with bone.–> peripheral cause

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26
Q

How is myasthenia gravis daignosed?

A

1st test- anti-acetylcholine receptor antibodies that block the binding of acetylcholine to the end-plate at the post-synaptic junction

Best test- EMG (electromyography)

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27
Q

Indication of impending brain herniation.

A

Cushing triad

1) widening pulse pressure
2) Irregular respirations
3) Bradycardia

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28
Q

Syringomyelia

A

Syringomyelia commonly occurs in patients with Arnold-Chiari malformations and is characterized by bilateral loss of pain and temperature one level below the lesion with bilateral flaccid paralysis at the level of the lesion.

It is commonly caused by cystic dilation of the central spinal canal.

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29
Q

consciousness can be assessed via the Glasgow coma scale (GCS)

A 
Eye Response 
Spontaneous: 4 
To verbal command: 3 
To pain: 2 
None: 1   
Verbal response 
Oriented with normal conversation: 5 
Confused speech: 4
Inappropriate speech: 3 
Incomprehensible sounds: 2 
None: 1   
Motor response
Obeys commands: 6 
Localizes painful stimuli: 5 
Withdrawal to painful stimuli: 4 
Abnormal flexion (decorticate): 3 
Abnormal extension (decerebrate): 2 
None: 1

Total Possible Points: 15

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30
Q

GCS and need for intubation

A

GCS 13= Minor injury
GCS 9-12= Moderate injury
GCS 8 or less = severe injury

Intubation is indicated for patients with a GCS less than 8.

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31
Q

poisoning and its antidotes

A

Carbon monoxide poisoning= 100% oxygen

Amyl nitrite= cyanide poisoning

Dimercaptosuccinic acid or EDTA= Lead poisoning

Methylene blue= methemoglobinemia

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32
Q

autosomal recessive condition

A

25% normal
50% carrier
25% affected

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33
Q

TCA overdose

A

most common manifestations on electrocardiogram of TCA overdose is a wide QRS complex and prolonged QT interval. Patients need immediate infusion of sodium bicarbonate (NaHCO3) to help prevent cardiac collapse and fatal ventricular tachyarrhythmias.

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34
Q

Guillain- Barre syndrome labs

A

Normal opening pressure

Normal white blood cell count

Normal glucose

Large increase in protein (100 to 1000 mg/dL)

Clear yellow appearance

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35
Q

Histological/Structural findings of Alzheimer’s dementia

A

Neurofibrillary tangles made of hyper-phosphorylated tau protein

Senile plaques made of extracellular beta-amyloid Aβ plaques.

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36
Q

Huntington’s disease

A

Autosomal dominant
Trinucleotide cysteine-adenosine-guanine (CAG) repeat expansion on chromosome 4

Caudate atrophy

choreiform movements, behavioral change (depression), and executive impairment (memory imparment not typical until LATE in Dz)

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37
Q

Histological/Structural findings of Frontotemporal Dementia

A

Pick bodies (round inclusions of hyperphosphorylated tau proteins)

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38
Q

Histological/Structural findings of Lewy body dementia

A

Lewy bodies (α-synuclein aggregates)

39
Q

Histological/Structural findings of Creutzfeldt-Jakob disease

A

Parenchymal vacuolation (spongiform cortex)

Prions (β-pleated sheets resistant to proteases)

40
Q

Empiric Antibiotic Coverage for Less than 1 month old

A

Common Pathogens:
Streptococcus agalactiae
Escherichia coli
Listeria monocytogenes

Empiric Antibiotic choice
Ampicillin plus cefotaxime
OR
Ampicillin plus an aminoglycoside

41
Q

Empiric Antibiotic Coverage for 1 month to 23 months

A 
Common Pathogens:
Streptococcus pneumoniae
Neisseria meningitidis
S. agalactiae
Haemophilus influenzae
E. coli

Empiric Antibiotic choice: Vancomycin plus Third-generation cephalosporin

42
Q

Empiric Antibiotic Coverage for 2 years to 50 years

A

Common Pathogens:
N. meningitidis
S. pneumoniae

Empiric Antibiotic choice:
Vancomycin plus Third-generation cephalosporin

43
Q

Empiric Antibiotic Coverage for

A 
Common Pathogens:
S. pneumoniae
N. meningitidis
L. monocytogenes
Aerobic gram-negative bacilli

Empiric Antibiotic choice:
Vancomycin plus Third-generation cephalosporin plus Ampicillin

44
Q

Study phases

A

Preclinical- testing on animals

Phase 1- Testing on healthy volunteers (<100)- is drug safe?

Phase 2- Testing on patients (100-300)- efficacy?

Phase3- Testing on patients (300-3,000)- therapeutic effect

Phase 4- Post marketing surveillance- long term effects

45
Q

Brown-Sequard syndrome

A

Affects all of the tracts on one side of the spinal cord

Ipsilateral loss of vibration & proprioception

Ipsilateral weakness

Contralateral loss of pain and temperature below the lesion

46
Q

Syringomyelia

A

Syrinx (fluid-filled cavity) then develops within the central canal

Bilateral loss of pain and temperature, often in a cape-like distribution, with bilateral flaccid paralysis at the level of the lesion and relative sparing of the dorsal columns

47
Q

Middle cerebral artery (MCA) occlusion

A

Symptoms are usually more profound in the face and arms

Contralateral hemiparesis (weakness)
Contralateral hypesthesia (decreased sensation)
Contralateral hemianopia (blindness in half of the visual field)
Gaze preference toward the side of the lesion.
48
Q

Posterior cerebral artery (PCA) occlusion

A

vision and thought, producing contralateral homonymous hemianopia, symptoms of cortical blindness, and other visual disturbances. Signs of altered mental status and memory impairment are also likely

49
Q

Emergent Treatment of Hyperkalemia (CIGAR-B)

A

C- Calcium gluconate (P IV) or Ca chloride (C IV)
I- Insulin (activates NaK pump)
G- Glucose (to prevent hypoglycemia)
A- Albuterol ((activates NaK pump)
R- Remove K from STOOL w/ Patiromer or sodium polystyrene sulfonate
Remove K from urine w/ furosemide or hemodialysis if ESRD

50
Q

Budd-Chiari syndrome

A

Occlusion of hepatic veins or inferior vena cava

common in myeloproliferative disorders like polycythemia vera, tumors, and hypercoagulable states

Ascites

51
Q

Spectrum of Monoclonal Gammopathies

A

< 10%= MGUS, No symptoms

10-60%=
No symptoms: Smoldering myeloma
Symptoms (CRAB): Multiple Myeloma

≥60%= MM

52
Q

Graves disease

A

TSH Decreased

Thyroxine Increased

Radioactive Iodine Uptake High

53
Q

Surreptitious ingestion- Exogenous

A

TSH Decreased

Thyroxine Increased

Radioactive Iodine Uptake Low

54
Q

Hashimoto thyroiditis

A

TSH Increased

Thyroxine Decreased

Radioactive Iodine Uptake- not used for hypo

55
Q

Pulmonary embolism (PE)

A

Commonly normal findings on chest x-ray unless very large–> wedge shaped infarct (hampton hump)

Lucency at the location of the embolus (Westermark sign)

56
Q

Granulomatosis with polyangiitis (Wegener granulomatosis)

A

small vessel vasculitis, C-ANCA

triad of sinusitis, lung cavitary lesions, and glomerulonephritis

57
Q

Alport syndrome

A

X-linked gentic disorder

Family history of hematuria

Loss of kidney function and sensorineural hearing impairment

58
Q

Goodpasture syndrome

A

Antiglomerular basement membrane antibodies that activate the complement system and damage the basement membranes within the lungs and kidneys

Electron microscopy reveals linear line deposition of IgG and complement component 3 (C3)

59
Q

Treatment for Goodpasture syndrome

A

Treatment includes plasma exchange and immunosuppression with corticosteroids and cyclophosphamide

60
Q

IgA nephropathy

A

Deposition of the IgA antibody in the glomerulus

Episodic frank hematuria occurs in nearly 40% of all cases and usually starts within a day of an upper respiratory tract infection (compare to strep glom 2 weeks)

Associated w/ henloch purpura (systemic version of this?)

61
Q

Huntington disease

A

cytosine-adenine-guanine (CAG) repeats in the huntingtin gene on chromosome 4

Autosomal dominant pattern

62
Q

Prophylactic/preventative therapy of migraine headaches

A

Amitriptyline, venlafaxine, a beta blocker (propranolol), or topiramate

botox if more than 15 headaches/ month and nothing else works

63
Q

Persistent neutropenic fevers

A

If treated with antibiotics and still no improvement, Consider addition of a broad-spectrum antifungal agent in the absence of an other obvious cause.

64
Q

Lewy body dementia

A
  • Fluctuating cognition with variations in attention
  • Recurrent, detailed visual hallucinations
  • REM sleep disorder
  • Parkinsonian features: bradykinesia, rest tremor, rigidity

Eosinophilic cytoplasmic inclusion bodies within the substantia nigra and locus coeruleus of the brain.

65
Q

Alzheimer disease

A

Most common cause of dementia in the elderly

Senile plaques and neurofibrillary tangles

66
Q

Postdural puncture headaches

A

Headache after getting epidural

1) Conservative management
2) Epidural blood patch (EBP)- inject patient’s blood into the epidural space to create a blood clot to compress the area of cerebrospinal fluid leakage
3) Transnasal sphenopalatine block/ Greater occipital nerve block

67
Q

Malignant hyperthermia

A

Abnormal ryanodine receptors on sarcolasmic reticulum react to anesthetics with unregulated flow of calcium into the cytoplasm and resulting in muscular tetany

Tx: Dantrolene (antagonizes these ryanodine receptors on the sarcoplasmic reticulum.

68
Q

Intracranial berry aneurysms are associated with what diseases?

A

1) Polycystic kidney disease
2) Ehlers-Danlos syndrome
3) Pseudoxanthoma elasticum
4) Moyamoya syndrome
5) Glucocorticoid-remediable aldosteronism

69
Q

Occlusion of the basilar artery

A

Bilateral pontine infarction–> quadriplegia, inability to speak or swallow

Consciousness, vertical eye movements, and the ability to blink are spared.

70
Q

How to diagnose orbital cellulitis?

A
  • Orbital cellulitis is a vision threatening condition

- Contrast enhanced CT scan or MRI needs to be urgently performed to confirm the diagnosis of orbital cellulitis

71
Q

Otosclerosis

A

Autosomal dominant (AD) inheritance pattern

Overgrowth of the middle ear bones, most commonly the stapes, which interferes with sound conduction

Tx: Hearing amplification or surgery (stapedectomy)

72
Q

Conductive hearing Loss

A

Rinne test: Bone conduction > air conduction

Weber test: Lateralizes to affected ear, Midline if bilateral

Examples include outer and middle ear etiologies

73
Q

Sensorineural Hearing Loss

A

Rinne test: Air conduction > bone conduction

Weber test: Lateralizes to nonaffected ear, Midline if bilateral

Examples include Inner ear etiologies

74
Q

Trinucleotide cytosine-guanine-guanine (CGG) expansion

A

Fragile X syndrome

Mutation in the FMR1 gene. Clinical features include intellectual delay, facial dysmorphism, and autism

75
Q

Trinucleotide cytosine-thymine-guanine (CTG) expansion

A

Myotonic dystrophy

Muscle weakness, myotonia, cardiac-endocrine-gastrointestinal disease, and intellectual delay

76
Q

Trinucleotide guanine-adenine-adenine (GAA) expansion

A

Friedreich ataxia

Clinical features include ataxia, sensory loss, weakness, diabetes mellitus, and cardiomyopathy

77
Q

Creutzfeldt-Jakob disease (CJD)

A

Rapid progression of cognitive and motor decline

Myoclonus (quick involuntary muscle jerks)

End-stage CJD can manifest as akinetic mutism

78
Q

Pathophysiology of CJD

A

Caused by prions

Fatal within 1 year of symptom onset

79
Q

Diagnosis of CJD

A

Periodic sharp waves seen on EEG

Elevated 14-3-3 proteins in the CSF

MRI abnormalities in the caudate/putamen

80
Q

Lyme Neuroborreliosis

A

Advanced Lyme disease can cause post-viral cerebellar ataxia and is tested by the finger to nose test.

A positive test indicates a lesion within the cerebellum

81
Q

frontotemporal dementia (FTD)

A

Personality change, disinhibition (eating multiple meals a day), and her relatively young age of onset (in her 60s).

Pick bodies consisting of hyperphosphorylated tau proteins

82
Q

Hyperphosphorylated tau proteins can be found in both Alzheimer disease (AD) and Frontotemporal dementia FTD

A

In FTD, tau proteins are found as intracytoplasmic round aggregates

In AD, tau proteins are described as intracellular neurofibrillary tangles.

83
Q

Glioblastoma multiforme

A

Most common and worst prognosis

“butterfly glioma”

Dx: MRI- lobulated, ring enhancing lesions that cross corpus collusum

Tx: Surgery, radiation, chemo (temozolomide)

84
Q

Ependymoma

A

Most commonly present in the 4th ventricle, and may result in an obstructive hydrocephalus

Histology: Perivascular pseudorosettes

85
Q

Hemangioblastomas

A

Benign central nervous system vascular neoplasms and are most often found in the cerebellum

May produce erythropoietin, leading to secondary polycythemia

Histology: Foamy cells and high vascularity

If found with retinal angiomas, is associated with von Hippel-Lindau syndrome

86
Q

Medulloblastomas

A

Tumors of childhood

Obstructive hydrocephalus due to compression of the 4th ventricle

Differentiated from an ependymoma with MRI by observing that an ependymoma will extend further into the lateral recess of the 4th ventricle and into the cerebellopontine angle

87
Q

Anterior cerebral artery (ACA)

A

Paralysis or weakness of the contralateral lower extremity

Urinary Incontinence anosmia

88
Q

Posterior cerebral artery (PCA)

A

Supplies the occipital lobe

Cortical blindness and contralateral homonymous hemianopsia with macular sparing

May also not be able to recognize faces, objects, places

89
Q

Middle Cerebral artery (MCA)

A

Contralateral paralysis/ sensory loss of the face and upper limbs

Aphasia if dominant (Left)

hemi-neglect if non- dominant side (Right)

90
Q

Top of the basilar syndrome is caused by an embolus lodging in the rostral basilar artery.

A

If a stroke does not localize laterally, there is a good chance there is a lesion of the basilar artery.

91
Q

Basilar artery stroke

A

impaired consciousness, pupillary abnormalities, neuro-ophthalmic abnormalities, especially of vertical gaze, and acute confusional state

92
Q

Lateral medullary syndrome/ Wallenberg syndrome

A

Often caused by an ipsilateral vertebral artery or posterior inferior cerebellar artery occlusion

93
Q

Anterior Circulation arteries

A
  • MCA
  • ACA
  • Lenticulostriate artery
94
Q

Posterior circulation arteries

A
  • ASA
  • PICA
  • AICA
  • PCA
  • Basilar Artery

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