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STEP 2 > Neuro/Ophtho > Flashcards

Neuro/Ophtho Flashcards

1
Q

Risk factors for stroke

A

same as MI: HTN, DM, HLD, and tobacco

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2
Q

MCA stroke presentation

A

1) contralateral weakness or sensory loss
2) homonymous hemianopsia (loss of visual field on opposite side of the stroke, eyes look towards lesion)
3) aphasia

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3
Q

ACA stroke presentation

A

1) personality/cognitive defects
2) urinary incontinences
3) leg > arm weakness

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4
Q

PCA stroke presentation

A

1) ipsilateral sensory loss of face, 9th and 10th CNs
2) contralateral sensory loss
3) limb ataxia

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5
Q

Patient presents less than 3 hours since stroke onset

A

give them TPA (may give up to 4.5 hours in some places)

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6
Q

Patient presents more than 3 hours since stroke onset

A

ASA, if already on ASA add dipyridamole OR switch clopid (never give ASA and clopid together)

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7
Q

What does every patient with a stroke get started on?

A

statin

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8
Q

What score do you use to determine an A fib/flutter patient’s risk of stroke?

A 
CHA2DS2VASc Score 
CHF 
HTN
>/= 75
DM 
Stroke/TIA/thromboembolism (h/o...) 
Vascular disease 
65-74
Female

> /= 2 - anticoagulate

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9
Q

If patient with stroke has normal ECG…

A

place on Holter monitoring to detect arrhythmias (e.g. A fib) with greater sensitivity

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10
Q

What do you do with symptomatic 50%, 70%, and 100% carotid stenosis/occlusion?

A

70% - endarterectomy

50% / 100% - no endarterectomy

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11
Q

Carotid angioplasty and stenting for stroke patients consensus …

A

have no proven value

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12
Q

Most common HA

A

tension headache - dx of exclusion

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13
Q

Migraine triggers include

A

food, emotions, menses

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14
Q

Cluster HA features

A

frequent, short duration, high intensity

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15
Q

Pseudotumor cerebri asso with

A

obesity, venous sinus thrombosis, oral contraceptives, and vitamin A tox

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16
Q

Giant cell arteritis physical exam finding

A

tenderness of the temporal area

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17
Q

Giant cell arteritis significant lab

A

elevated ESR

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18
Q

Migraine abortive thx

A

Ergotamine or triptan

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19
Q

Cluster HA abortive thx

A

100% O2, prednisone, lithium

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20
Q

Cluster HA ppx

A

Verapamil

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21
Q

Migraine ppx

A

Propranolol; give if 3 attacks/month

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22
Q

Trigeminal neuralgia tx

A

Carbamazepine, oxcarbazepine, last resort: gamma knife surgery

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23
Q

Seizure of unclear etiology is called…

A

epilepsy

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24
Q

Confusion is to coma and seizure as …

A

angina is to MI

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25
Q

Status epilepticus tx

A

1) IV benzo (lorazepam, diazepam)
2) fosphenytoin
3) general anesthesia - give succinylcholine or vecuronium –> intubate –> give propofol or midazolam
4) phenobarbital

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26
Q

Which anti epileptic drug has the cleanest profile?

A

levetiracetam

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27
Q

Tx of atonic (no LOC; loss of tone) and myoclonic (no LOC, increase in tone) seizures

A

valproic acid

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28
Q

Standard of care when d/c’ing seizure medication

A

patient must be seizure free for 2 years, test for possibility of recurrence (e.g. sleep deprivation EEG)

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29
Q

Xanthochromia definition

A

yellow discoloration in CSF from breakdown of RBCs

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30
Q

Normal ration of WBCs to RBCs

A

1 to 500/1000

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31
Q

Most accurate test to dx subarachnoid hemorrhage

A

LP showing blood

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32
Q

Nimodipine use

A

CCB, prevents subsequent ischemic stroke

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33
Q

Spine disorder that results from B12 def and neurosyphilis

A

subacute combine degeneration of the cord, leads to loss of position and vibratory sensation

34
Q

Brown-Sequard syndrome

A

unilateral hemisection of spinal cord, loss of motor and position/vibratory sense on ipsilateral side right below the lesion, loss of pain/temperature on contralateral side 1-2 segments below lesion

35
Q

How to distinguish brain abscess from cancer?

A

biopsy

36
Q

Empiric tx for brain abscess (while waiting for bx results)

A

penicillin + metronidazole + ceftriaxone +/- vancomycin

37
Q

Tuberous sclerosis features

A

a neurocutaneous disorder

H - Hamartomas of CNS and skin 
A - Angiofibromas (red nodules on the face) 
M - Mitral regurg 
A - Ash leaf spots (hypopigmented) 
R - cardiac Rhabdomyoma 
T - Tuberous sclerosis 
O - autosomal dOminant 
M - metal retardation 
A - renal Angiolipoma 
S - Seizures, Shagreen patches (leathery plaques on trunk)

Tx - control seizures

38
Q

Neurofibromatosis types I and II

A

a neurocutaneous disorder

Type I

1) neurofibromas - soft, flesh-colored lesions attached to peripheral nerves
2) cafe au last spots (hyper pigmented)
3) meningiomas and gliomas

Type II

1) bilateral acoustic shwannomas
2) cataract

39
Q

Sturge-Weber syndrome

A

portwine stain on face, seizures, CNS deficits (homonymous hemianopsia, mental retardation), glaucoma

40
Q

Treatment of Parkinson’s (mild vs severe)

A

Mild:
1) anticholinergics (benztropine, trihexyphenidyl) - relieve tremor/rigidity
2) amantadine - increase release of DA
Severe:
1) dopamine agonists (pramipexole, ropinirole, rotigotine)
2) levodopa/carbidopa - asso w on/off phenomena (episodes of bradykinesia/dyskinesia)
3) COMT inhibitors (tolcapone, entacapone) - prevent peripheral metabolism of L-dopa; extend duration of 2
4) MAO-B inhibitors (rasagiline, selegiline) - block DA metabolism; only drugs with possibility of retarding the progression of Parkinsonism
5) deep brain stimulation

41
Q

Only drugs with possibility of retarding the progression of Parkinsonism

A

MAO-B inhibitors (rasagiline, selegiline)

42
Q

Shy-Drager syndrome

A

Parkinsonism predominantly with orthostasis

43
Q

Tx of Restless legs syndrome

A

DA agonists (pramipexole, ropinirole)

44
Q

Nucleotide repeat in Huntington’s

A

CAG, on chromosome 4

45
Q

Radiologic finding in HD

A

Head CT or MRI shows caudate nucleus involvement

46
Q

VMAT inhibitors used to treat dyskinesias

A

tetrabenazine and reserpine - lower DA versicle packing and release

47
Q

MS diagnostic tests and findings

A

MRI - periventricular white matter or plaques
LP - oligoclonal IgG
EMG - evoked potentials

48
Q

Drugs that prevent relapse and progression of MS

A

glatiramer, beta-interferon, fingolimod

49
Q

MRI gadolinium contrast reaction

A

nephrogenic systemic fibrosis (collegen deposits in soft tissues and fibrotic nodules develop in skin, heart, lung, liver), occurs in renal insufficiency

50
Q

ALS stands for

A

amyotrophic lateral sclerosis

51
Q

ALS features

A

loss of upper and lower motor neurons, sensory neurons and sphincter function spared

52
Q

ALS tx

A

riluzole - reduced glutamate build up in the neurons and may prevent progression of the disease
baclofen for spasticity
CPAP/BiPAP/tracheostomy and maintenance on ventilatory if respiratory difficulties

53
Q

Charcot Marie Tooth disease

A

genetic disorder of both motor and sensory innervation, leads to distal weakness and sensory loss, waiting in the legs, pes cavus, decreased DTRs, and tremor

54
Q

Ulnar nerve damage

A

wasting of hypothenar eminence

55
Q

Radial nerve damage

A

Saturday night palsy, using crutches, wrist drop

56
Q

Lateral cutaneous nerve of thigh damage

A

obesity, pregnancy, crossing legs

57
Q

Tarsal tunnel damage

A

worse with walking, pain/numbness in ankle and sole of foot

58
Q

Peroneal nerve damage

A

high boots, weak dorsiflexion and eversion

59
Q

Face paralysis (Bell’s vs stroke) and additional features

A

stroke - spares forehead
Bell’s - patient cannot wrinkle forehead

additional features:
hyperacusis (stapedius muscle)
taste disturbance (chorda tympani - anterior 2/3’s of tongue)

60
Q

Another name for GBS

A

GBS = Guillain-Barre Syndrome

aka acute inflammatory polyneuropathy

61
Q

GBS features

A

autoimmune damage of peripheral nerves, ascending weakness + loss of reflexes, may include autonomic dysfunction (hypo/hyperTN, tachycardia), leads to respiratory failure

62
Q

GBS - CSF finding

A

increased protein, normal cell count

63
Q

Important test to r/o respiratory involvement in GBS

A

PFTs - forced vital capacity and peak expiratory pressure - if both are decreased –> impending respiratory failure

64
Q

Tx of GBS

A

1) intubate 2) IVIG or plasmapheresis

NEVER STEROIDS

65
Q

Myasthenia gravis pathophys

A

antibodies against acetocholine (nicotinic) receptors at the neuromuscular junction, muscles that are used the most fatigue first (extra ocular, mastication)

66
Q

Myasthenia gravis dx

A

acetylcholine receptor antibodies > anti-MUSK (muscle specific kinase) > edrophonium

67
Q

Tx of myasthenia gravis

A

neostigmine and pyridostigmine, in patient under 60 with thymoma –> thymectomy (curative), in patient over 60 and disease refractory –> steroids or something that suppresses T cell function (azathioprine, tracrolimus, cyclophosphamide, mycophenolate)

68
Q

Tx of acute myasthenic crisis

A

IVIG or plasmapheresis

69
Q

Creutzfeldt-Jacob Disease

A

rapidly progressive dementia and myoclonus, CSF 14-3-3 protein, EEG periodic sharp wave complex

70
Q

Personality changes localize to which brain lobe?

A

frontal lobe

71
Q

List most common sites of hypertensive hemorrhage in descending order

A

1) basal ganglia (putamen)
2) cerebellar nuclei
3) thalamus
4) pons
5) cerebral cortex

72
Q

what are the 3 muscular dystrophies by inheritance and onset?

A

the x-linked recessives ones: Duchenne (early child) and Becker (child to teen)
the one autosomal recessive: Myotonic (teen to early adult)

73
Q

features of the x-linked recessive muscular dystrophies

A

Duchenne - early child onset; progressive weakness, Gower sign, calf pseudohypertrophy; develop scoliosis and cardiomyopathy; death from respiratory failure by 30

Becker - child to teen; mild Duchenne; develop cardiomyopathy; death from HF by 50

74
Q

features of autosomal recessive muscular dystrophy

A

Myotonic - teen to early adult onset; facial weakness, hand grip myotonia, dysphagia; develop arrhythmias, cataracts, balding and testicular atrophy/infertility; death from respiratory or HF

75
Q

different head swellings in newborn

A

Cephalohematoma - subperiosteal hemorrhage; does not cross suture lines; no skin discoloration

Caput succedaneum - hematoma superficial to periosteum; crosses suture lines

Subgaleal hemorrhage - blood between periosteum and aponeurosis d/t shearing fo emissary veins (connect extracranial veins with intracranial venous sinuses) during delivery; fluctuant, crosses suture lines

76
Q

workup for febrile seizure

A

none; if longer than 5 mins –> abort

77
Q

CN III palsy causes

A

ischemia/DM –> inner somatic fiber ischemia –> down and out gaze

compression –> outer parasympathetic fiber compromise –> impaired pupillary light reaction

78
Q

hypokalemia presentation and ECG findings

A

weakness, fatigue, muscle cramps; severe: paralysis and arrhythmias (U waves, flat and broad T waves, PVCs)

79
Q

early personality and behavioral changes (disinhibition, apathy), compulsive behaviors (hoarding, hyperorality), and executive dysfunction; memory deficits later

A

frontotemporal dementia

80
Q

open angle glaucoma

A

more common in African Americans, usually asx, high intraocular pressure, cupping of optic disc with loss of peripheral vision, initial mgmt with timolol eye drops, if continues to get worse, do trabeculo-plasty/-ectomy

81
Q

angle closure glaucoma

A

sudden osent blurred vision, severe pain, N/V, on exam: red eye with hazy cornea and fixed, dilated pupil

82
Q

situational syncope

A

is a form of reflex or neurally mediated syncope associated with specific triggers (micturition, defecation, cough); these triggers cause an alteration in the autonomic response and can precipitate a predominant cardioinhibitory, vasodepressor, or mixed response

STEP 2 (15 decks)

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