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neuro clerkship > neuro stuff > Flashcards

neuro stuff Flashcards

1
Q

What are symptoms of tuberous sclerosis

A 
Neuro= Seizures, possibly slowing mental deterioration
Skin= Adenoma Sebacium ( reddened facial nodule) 
Shagreen patches ( lethary patches on trunk)
Ash leaf ( hypopigmented patches) 
Retinal lesions 
Cardiac Rhabdomyomas
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2
Q

Things seen in Neurofibromatosis

A
  • Neurofibromas - skin colored lesions attaches to peripheral nerves
  • 8th cranial nerve tumors ( ringing or hearing loss)
  • Hyperpigmented spots ( cafe au lait spots)
  • Meningioma or glioma
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3
Q

Things seen with Sturge- Weber syndrome

A 
port wine stain on face
Seizures
Homonomous hemianopsia
Hemiparasis
Calcification of angiomas
leptomeningeal capillary-venous malformation (leptomeningeal angioma) involving the brain and eye
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4
Q

What makes an essential tremor worse and what makes it better

A
  • Caffeine makes it worse

- Propranolol makes better as well as alcohol

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5
Q

What do you need to diagnose Parkinsons disease

A
  • no test so have to do it baised on symptoms.
  • gait
  • Orthostasis ( light headed when stand up)
  • tremor
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6
Q

What are causes of Parkinsonism

A
  • trauma such as boxing
  • Antipsychotics such as Thorazine
  • Reserpine
  • Metaclopromide ( dopamine antagonist)
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7
Q

What is med that should be used for patients with mild symptoms who cant handle anticholinergic medications due to its side effects.

A
  • Amantadine
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8
Q

What are drugs you can use for severe Parkonsins disease

A

Dopamine agonists- ( use bec less side effects)
Pramipaxol
Ropinirole
Bromocriptine or cabergoline

Levodopa carbadopa

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9
Q

What drugs do you use to extend duration of levodopa/carbodopa

A
  • COMT inhibitors = Tolcapone or Entacapone
  • blocks metabolism of dopamine
  • when response therapy is inadequate or pt is experiencing on/ off phenomenon

or can give MAO inhibitors rasagiline/ selegaline
- cant give red wine with this because inc blood pres

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10
Q

What is the problem in people with Huntington disease

A
  • CAG trinucleotide repeat on chrom 4
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11
Q

What are symptoms of Huntington disease

A
  • Choreaform movement (dyskinesia)
  • Dementia
  • Behavioral changes- irritability, moodiness
  • Onset ages 30-50
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12
Q

What are treatment options for dyskinesia and psychosis in a Huntington disease pt

A
  • tetrabenazine

- Haloperidol or Quetiapine

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13
Q

What does Internuclear ophthalmoplegia

A

It is when you cant adduct one eye with nastagmus of the other eye.

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14
Q

What is the disease where it will be a young girl in cold area with either eye pain, blurred vision, INO

A

MS

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15
Q

What is best initial and most accurate test for MS

A

MRI

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16
Q

What are drugs used to prevent relapse of MS

A 
Glatiramir
Beta- interferon
Natalizumab
Mitoxatrone
Fingolamod- Only oral 
Dalfampridine- Is used to increase walking speed
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17
Q

What does ALS impair

A

It impairs both upper and lower motor neurons. Spares the sensory system.

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18
Q

What are common symptoms to see in a Pt with ALS

A 
weakness starting in 20-40s
upper and lower motor signs
Trouble chewing and swallowing
Decrease in gag reflex
frequent episodes of aspiration which can cause pneumonia
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19
Q

What is an abnormal lab value that you will see in ALS

A

CPK elevation

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20
Q

What is the reason to give Riluzole in pts with ALS.

A

Delays disease progression

Reduces glutamate buildup in Neurons.

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21
Q

What are the possible treatments for pts with ALS

A

Riluzole
Baclofen (spacticity)
CPAP machine ( increase energy and moves uvula out of way)* very important
Tracheostomy when disease progresses because you could put someone on ventilator at night.

22
Q

What are losses and symptoms with Charcot-Marie-Tooth Disease

A
  • Both motor and sensory innervation (wasting in legs, dec DTR, Tremor)
  • Foot deformity with high arch (pes cavus)
  • legs look like inverted champagne bottles
23
Q

What is most accurate test for charcot-marie-tooth disease

A

Electromyography

24
Q

What are causes of Peripheral Neuropathy

A
  • DM
  • Uremia
  • Alcoholism
  • paraproteinemias (MGUS)
25
Q

If you are biking, putting pressure on palms of hands, on your elbow a lot what nerve will it affect?

A

Ulner nerve

26
Q

If you have ulnar nerve neuropathy what will you see?

A
  • wasting of hypothenar eminence, 4th and 5th digit pain.
27
Q

If you are putting pressure on inner upper arm, humerus bone what nerve will you affect?

A

Radial nerve

28
Q

What will be reported symptoms of pt with Radial nerve palsy?

A
  • Wrist drop

- Pt wont be able to extend the wrist

29
Q

What nerve root is lateral cutaneous?

A

L2

30
Q

What are symptoms of pt who has neuropathy of lateral cutaneous

A

pain and numbness of outer aspect of thigh

31
Q

What nerve will be affected with pressure on the back of knee or pt that is crossed leg?

A

Peroneal nerve

32
Q

What are symptoms of pt when they have peroneal nerve palsy

A

Weak foot

- decreased dorsiflexion and eversion

33
Q

What do you think diagnosis is if pt states “ face feels stiff” “ pulled to one side” , “ sounds are extra loud” ,
“ I cant taste sweet things”

A

7th cranial nerve palsy or bells palsy

  • Supplies stapedius muscle.
  • Supplies sensation to anterior 2/3 of tounge
34
Q

Most “accurate” test for bells palsy

what would you do for pt with bells palsy

A
  • electromyography and nerve conduction studies

- nothing and give them steroids

35
Q

What is best initial therapy for bells palsy

A

prednisone

36
Q

What are symptoms of Guillain-Barre syndrome

A

ascending weakness and loss of reflexes

37
Q

What will you see in CSF in pts with Guillain- Barre

A
  • Increased protein

- Normal cell count

38
Q

Most specific diagnostic test for Guillain Barre

A

EMG/ nerve conduction studies.

39
Q

Best initial test for Myasthenia Gravis

A

Acetylcholine receptor antibodies

40
Q

Most accurate test for Myasthenia Gravis

A

Electromyography (shows decreased strength)

41
Q

What is best imaging to do for pt with Myasthenia Gravis test

A

Chest something…. xray, ct, MRI

42
Q

What is most likely diagnosis when pt had sudden onset of severe headache, neck stiffness, photophobia, fever and possible loss of consciousness

A
  • Subarachnoid Hemorrhage.
43
Q

Best initial test for Subarachnoid Hemorrhage

A

CT w/o contrast

44
Q

Most accurate test for pt with Subarachnoid Hemorrhage

A

Lumbar puncture

45
Q

What is normal ratio of WBC to RBC in CSF

A

1 WBC to every 500-1000 RBCs

46
Q

What will the ratio of WBC to RBCs be like in pt with Subarachnoid Hemorrhage

A

normal 1 WBC to 500-1000 RBCs

47
Q

What may a EKG show in a Pt with a Subarachnoid Hemorrhage

A

may show a large or inverted T wave

  • suggests myocardial ischemia
  • from excessive sympathetic activity
  • if SH then you wont want to give asprin or other blood thinning meds.
48
Q

What is a common secondary affect from a Subarachnoid Hemorrhage

A

Ischemic stroke from vasoconstriction. (give nimodipine)

- hydrocephalus ( will need a shunt)

49
Q

What medication should you give a patient after an ischemic stroke

A
  • Nimodipine ( Calcium channel blocker)

- Dont need to give meds for seizure prophalaxis

50
Q

What are drugs to treat dementia, how do they work, what is a consequence of them.

A
  • Donepezil, rivastigmine, galantamine
  • increase ACH
  • Make Parkinsons worse
51
Q

What is protein thatyou look for with Creutzfeldt Jakob disease and where do you find it

A

In CSF

14-3-3 protein

neuro clerkship (5 decks)

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