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Step2CK > Neuro and optho from Step Up > Flashcards

Neuro and optho from Step Up Flashcards

1
Q

ALS affects what tracts

A

corticospinal tract and ventral horn

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2
Q

poliomyeltisis affects what tracts

A

ventral horn causing flaccid paralysis

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3
Q

tertiary syphilis or tabes dorsalis affects what tracts

A

dorsal columns impairing proprioception and pain

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4
Q

what is spinal artery syndrome

A

bilateral loss of pain and temp below lesion and bilateral spastic paresis below with flaccid paralysis at the level

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5
Q

whats affected in spinal artery syndrome

A

corticospinal track, spinothalamic tract, ventral horn, lateral gray matter

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6
Q

What tracts does Vit B12 deficieny affect

A

dorsal columns and corticospinal tract leading to bilateral loss of vibration and discrimination with bilateral spastic paresis affecting legs before arms

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7
Q

what tracts are affected in syringomyelia

A

ventral horn and ventral white commissure

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8
Q

Signs of syringomyelia

A

bilateral loss of pain and temp below and flaccid at the level

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9
Q

what is brown sequard syndrome

A

ispi loss vibration and discrimination blow. ipsi spastic paresis below
ipsi flaccid paralysis at level
contra loss pain and temp below

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10
Q

what tracts are affected in brown sequard syndrome

A

all tracts on one side of the cord

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11
Q

Brudzinski

A

neck flexion in supine causes hip flexion

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12
Q

What rash is seen in N meningitis

A

petechiae

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13
Q

Tx meningtitis bacterial

A

cephalosporins usually 3rd gen

close contacts given rifampin or cipro for porphylaxis

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14
Q

what are signs of incrreased intracranial P

A

papilledema, focal neurologic deficits, pupil asymmetry

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15
Q

why no do LP if signs of intracranial P

A

increased risk of uncal herniation

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16
Q

Tx fungal meningitis

A

amphotericin B

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17
Q

Tx TB meningitis

A

RIPE

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18
Q

most common cause meningitis in newborn

A

Group B strep

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19
Q

common meningitis in 1 mo-2 year

A

strep pneumo and N meningitis

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20
Q

common cause meningitis 2-18 year

A

N meningitis

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21
Q

cause meningitis in 18-60+ y.o

A

S pneumo

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22
Q

CSF bacterial meningitis

A

increased PMNs
increased pressure
decrease glucose
increase protein

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23
Q

CSF in viral meningitis

A

increased lymphocytes
increased pressure
normal glucose
normal protein

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24
Q

Malaise, HA, comiting, neck pain, dec consciousness and change in mental status with focal neurologic deficitis

A

encephalitis

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25
Q

encephalitis due to mumps, sign

A

partodi swelling

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26
Q

West nile virus encephalitis Presentation

A

flaccid paralysis with maculopapular rash

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27
Q

LPs in encephalitis

A

increased WBCs and normal glucose

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28
Q

Tx encephalitis

A

maintain ICP, supportive care

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29
Q

What medication can cause encephalitis in children

A

Aspirin during viral illness- reyes

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30
Q

Radiology sign of brain abscess

A

ring enhancing lesion

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31
Q

Tx brain abscess

A

empiric until Bx back and surgical drainage

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32
Q

labs for poliomyelitis

A

polio specific Ab

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33
Q

What happens with rhabdovirus (rabies)

A

severe encephalitis with neuronal degeneration and inflammation

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34
Q

fear of water ingestion

A

rabies from laryngeal spasm

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35
Q

foaming at mouth

A

rabies

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36
Q

what you would see on Bx of rabies

A

negri bodies, round eosinophilic inclusions in neurons

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37
Q

Tx trigeminal neuralgia

A

carbamazepine, baclofen, phenytoin, gabapentin, valproate, clonazepam, other anticonvulsants

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38
Q

most common adult HA

A

tension

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39
Q

pain characteristic of migrain

A

unilateral and throbbing

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40
Q

which HA can cause periorbital pain and horners

A

cluster

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41
Q

Sx of tension HA

A

bilateral tightness, occipital or neck pain

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42
Q

what helps with cluster HA

A

100%O2 ergots and sumatriptan

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43
Q

Tx migraines

A

NSAID, ergots, sumatriptan, IV antiemetics, proph of TCA, beta blockers, CCBs

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44
Q

harsh systolic murmur

A

aortic stenosis

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45
Q

when to do carotid endarterectomy

A

> 60% males with no Sx
50% in Sx males
70% in Sx women

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46
Q

most common artery involved in embolic ischemic strok

A

middle cerebral a

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47
Q

if losing sensation to legs feet and toes, strok affected what a

A

anterior cerebral

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48
Q

lacunar a infarct cause

A

focal motor or sensory deficits loss coordination and difficulty speaking

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49
Q

basilar a infarct cause

A

CN abnormalities, contra full body weakness and decreased sensation, vertigo, loss coordination, difficulty speaking and visual abnormalities
may cause coma

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50
Q

imagin for suspected stroke

A

CT without contrast

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51
Q

Tx stroke

A

thrombolytic if within 3 hours of onset and no contraindications

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52
Q

What should you give to prevent additional strokes

A

antiplatelet Tx

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53
Q

Acute Tx hemorrhagic stroke

A

reverse anticoagulation, control BP monitor ICP with mannitol, hyperventilation and anesthesia

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54
Q

patient with stroke and high BP

A

do NOT Tx BP because need to maintain cerebral perfusion

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55
Q

What can cause parenchymal hemorrhage

A

HTN, AV malformation, brian aneurysm, stimulant abuse

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56
Q

Berry aneurysms are associated with what

A

ADPKD and ehlers danlos

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57
Q

LP in subarachnoid hemorrhage

A

RBC, xanthochromia and increased P

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58
Q

If SAH is suspected but negative CT

A

do LP

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59
Q

declining RBC count over successive collection tubes

A

traumatic LP

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60
Q

convex hyperdensity compressing brain

A

epidural

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61
Q

what artery is common cause epidural hematoma

A

middle meningeal

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62
Q

which hematoma can appear to cross midline

A

epidural

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63
Q

lens shape hematoma

A

epidural

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64
Q

what causes subarachnoid hemorrhages

A

rupture vessels between pia and arachnoid layers

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65
Q

what causes subdural hematoma

A

ruptured bridging veins after trauma between arachnoid and dura

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66
Q

signs subdural hematoma

A

slowly progressive HA and change in mental status, contra hemiparesis, increased DTRs

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67
Q

concave hyperdensity on CT

A

subdural hematoma

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68
Q

what is hurt in brocas aphasia

A

frontal gyrus

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69
Q

what is hurt in wernickes

A

posterior superior temporal gyrus

70
Q

what is conduction aphasia

A

fluent speech, word substitutions, attempts to correct words, word finding pauses

71
Q

what is global aphasia

A

nonfluent speech, poor comprehension, limb ataxia and difficulty producing words

72
Q

meaningless phrases with poor comprehension

A

wernickes

73
Q

generalized vs partial seizures

A

generalized involve entire cortex and partial is focal

74
Q

what can cause status epilepticus

A

withdrawal anticonvulsants, alcohol withdrawal, trauma, preexisting seizure disorder, metabolic abnormalities
>20 minutes

75
Q

which seizure has no LOC

A

simple partial

76
Q

which seizure has hallucinations and automatisms

A

complex partial

77
Q

EEG shows 3 cycle spike and wave pattern

A

absence seizure

78
Q

what drug is given to stop status epilepticus

A

benzo

79
Q

signs of PArkinson

A 
shuffling gait
masked facies
akinesia
rigidity cogwheel
tremor resting
80
Q

pill rolling resting tremor

A

parkinsons

81
Q

how to Dx ALS

A

Dx of exclusion

LMN signs at least 2 extremities and UMN in one region

82
Q

Tx ALS

A

riluzole

83
Q

what is main cause death in ALS patients

A

respiratory failure

84
Q

Inheritance Huntington and mutation

A

auto dominant. CAG repeats on chromosome 4. more repeats = earlier disease

85
Q

signs huntingtons

A

progressive rapid irregular involuntary movements (chorea) dementia, possible seizures

86
Q

adverse effects levodopa

A

nausea vomiting, anorexia, tachycardia, hallucination, modd changes, dyskinesia!!!

87
Q

how does amantadine work

A

increase synthesis and release or reuptake dopamine

88
Q

what helps with rigidity and bradykinesia in parkinsons

A

amantadine

89
Q

Radiology of huntingtons

A

CT or MRI show cuadate nucleus atrophy

90
Q

Tx for huntingtons

A

dopamine antagonists may improve chorea

91
Q

initial complains MS

A

vertigo, visual abnormalities, paresthesias, weakness, urinary retention

92
Q

late Sx of MS

A

poor movement control, difficulty speaking, sensory abnormalities, postural and positional instabilities, spasticity, increased DTRs and + babinski

93
Q

LP of MS

A

increased protein, mildly increased WBCs, oligoclonal bands and increased IgG

94
Q

what to order is suspect MS

A

MRI looking for white matter lsions

LP looking for oligoclonal bands

95
Q

Tx syringomyelia

A

surgical decompression, shunting and supportive care

96
Q

what causes labert eaton

A

Ab to presynaptic Ca channels

97
Q

tensilon test

A

when edrophonium is given, Myasthenia Sx improve

98
Q

What are the anticholinesterase drugs

A

neostigmine and pyridostigmine

99
Q

what must you do if you Dx someone with myasthenia gravis

A

do a chest CT looking for thymoma

100
Q

athetosis

A

writhing snakelike, cerebral palsy, huntington, wilson

101
Q

what causes hemiballismus

A

stroke in subthalamic nucleus. give haloperidol

102
Q

Most common brain tumor in adults

A

glioblastoma

103
Q

most common primary brain tumor in children

A

astrocytoma

104
Q

what is the most common Malignant brain tumor in children

A

medulloblastoma

105
Q

metastasis to brain go where

A

supratentorial

106
Q

if find intracranial tumor

A

search rest of body for primary

107
Q

NF1, con recklinghausen

A

Auto dominatnt on chrom 17

108
Q

NF2

A

auto dominant on chrom 22

109
Q

which NF causes bilateral acoustic neuromas

A

NF2

110
Q

signs NF 1

A 
cafe au lait spots
neurofibromas
axillary or inguinal freckles
optic glioma
iris hamartoma
bone lesions
relative with NF1
111
Q

half of sleep is in what stage

A

intermediate with sleep spindles and K complexes on EEG

112
Q

hwo do benzos work on sleep schedule

A

increase N2 decrease N3(deep sleep)

113
Q

Tx narcolepsy

A

modafinil, methylphenidate, pemoline

114
Q

patient in coma with pinpoint pupils

A

opioid overdose

115
Q

patient in coma with large nonreactive pupils

A

damage below midbrain, possible unclahernation

116
Q

if patient in coma, put ice water in ear and they have conjugate deviation toward water

A

intact midbrain

117
Q

decorticate

A

elbow flexed, legs extended

cortical or thalamic compression

118
Q

decrebrate

A

elbows extended and legs extended

midbrain involvement

119
Q

no response to pain in coma

A

pontine and medullary involvement

120
Q

most common seizure in children

A

febrile

121
Q

hydrocephalus in children with anatomic defects

A

arnold chiari type II and dandy-walker

122
Q

tay sachs

A

auto recessive

absence hexosaminidase A needed for lipid ganglioside metabolism

123
Q

risk factors tay sachs

A

ashkenazi jew, french canadian

124
Q

cherry red spot on retina

A

tay sachs

125
Q

prognosis tay sachs

A

death first few years

126
Q

risk factors for Neural tube defects

A

anticonvulsant use or poor folate intake, maternal DM

127
Q

how does quad screen detect NT defects

A

increased AFP and ACE

128
Q

risk factors Cerebral palsy

A

prematurity, IUGR, birth trauma, neonatal seizures or hemorrhage, perinatal asphyxia, multiple births, intrauterine infection

129
Q

types of CP

A

spastic– pyramidal tracts: increased tone, increased DTRs, weakness, gait abnormalities, mental retardation
dyskinetic– extra pyramidal: choreoathetoid, dystonic, ataxic that worsen with stress

130
Q

what maintains conjugate gaze when one eye abducts

A

Medial longitudinal fasciculus

131
Q

accomodation to near objects and nonreactive to light

A

argyll robertson pupil: syphilis, SLE or DM

132
Q

minimally reactive dilated pupil

A

adie pupil from abnormal innervation iris

133
Q

what can cause an absent ipsilateral eye adduction with lateral gaze

A

MLF lesion or MS

134
Q

myopia vs hyperopia

A

myopia focal point is anterior to retina

hyperopia focal point is posterior to retina

135
Q

amblyopia

A

developmental defect causing poor visual acuity and spatial differentiaion

136
Q

Tx amyblyopia

A

correct visual acuity in affected eye and patch unaffected eye to promote use of affected

137
Q

Anterior uveitis

A

pain and photophobia, slit lamp show inflammation of eye and keratin deposits on cornea

138
Q

posterior uveitis

A

mild vision abnormalities, eye inflammation and retinal lesions

139
Q

most common cause conjunctivitis

A

adenovirus

140
Q

risk factors open angle glaucoma

A

age, increased IOP, DM, black, myopia, family Hx

141
Q

vision loss in open angle

A

chronic from peripheral to central. see halo around light. cupping of optic disc

142
Q

Dx open agnle glaucoma

A

tonometry every 2-4 weeks

143
Q

Tx open angle glaucoma

A

topical beta blocker, alpha agonist(decrease production), PG analogues, cholinergic agonists(remove aqueous humor)

144
Q

risk factors closed angle glaucoma

A

increased age, asian, hyperopia, dilated pupils

145
Q

eye is inflamed and hard with dilated nonreactive pupil

A

closed angle glaucoma

146
Q

patient needing frequent changes of lens prescriptions

A

suspect open angle glaucoma

147
Q

Tx closed angle glaucoma

A

timolol, apraclonidine, pilocarpine eyedrops oral IV acetazolamide or IV mannitol

148
Q

most common cause bilateral vision loss in elderly

A

macular degeneration

149
Q

risk factors macular degeneration

A

white tobaco, FMH, inc age, prolonged sunlight, HTN female>male

150
Q

vision loss in macular degeneration

A

central to peripheral

possible retinal detachment

151
Q

Tx macular degeneration

A

Vit C E and beta carotene, copper and zine

intravitreal ranibizumab

152
Q

Tx retinal detachment

A

laster photocoagulation or crytotherapy

153
Q

what causes retinal vessel occlusion

A

atherosclerosis

DM HTN, thromboembolic disease

154
Q

sudden painless loss vision

A

retinary artery occlusion

155
Q

what you see on retinal a occlusion on fundoscopi

A

cherry red spot in fovea

156
Q

descriptions presentation retinal vein occlusion

A

more gradual painless loss vision

fundoscope shows cotton wool spots, edema, retinal hemorrhages and dilated veins

157
Q

what is used for otitis externa

A

polymyxin, neomycin, hydrocortisone, oral cephalosporins, cipro

158
Q

meniere disease

A

vertigo from distension of endolymphatic compartment of inner ear
acute vertigo for hours, nausea, vomiting, decreased hearing, tinnitus
will lose low frequency!

159
Q

conductive hearing loss

A

preserved bone conduction, air conduction shows low hearing threshold
abnormal rhinne

160
Q

sensorinueral hearing loss

A

impaired bone and air conduction. asymmetric weber, normal rhinne
from neural pathway deficit

161
Q

what type of hearing loss with acoustic neuroma

A

sensorineural

162
Q

risk factor alzheimer

A

increased age, FMH, trisomy 21, F>M

163
Q

cortical atrophy dementia

A

alzheimers

164
Q

what type med for alzheimer

A

cholinesterase inhibitors like donepezil and rivastigmine

165
Q

pick disease, frontotemporal

A

intracellular inclusions tau protein
has behavioral variant and aphasia variant
bilateral frontal atrophy

166
Q

Tx picks disease

A

SSRI trazadone, atypical antipsychotics

167
Q

lewy body dementia

A

intracell cortical inclusions lewy bodies (alpha synuclein)
fluctuating congnition, impaired attention, visual hallucinations, syncope, frequent falls, limb rigidity, bradykinesa or akinesia, gait distubrance

168
Q

which dementia has parkinsonian Sx

A

lewy body

169
Q

NPH

A

wet weird wobbly

LP show normal P but improves symptoms

170
Q

Tx NPH

A

VP shunt

171
Q

what not to use in delierium

A

benzos or anticholinergics

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