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PANCE 2024 > Neurological > Flashcards

Neurological Flashcards

1
Q

What bacteria is often immunized AGAINST in meningitis and Epiglottis

A

HIB

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2
Q

Parkinson’s usually in who and what do they have [2]

A

Men with Head trauma

Postural instability // pill rolling tremor

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3
Q

What is myersons sing

A

Tap on the bridge of the nose = repetitive blink

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4
Q

Essential tremor vs. Parkinson’s

A

Essential = worse with activity

Parkinson’s = improves with activity

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5
Q

Essential tremor treatment

A

Propanolol

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6
Q

When can you confirm diagnosis of Parkinson’s

A

Lewy bodies post mortam

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7
Q

Management of Parkinson’s

A

Clinical Dx : bradykinseia + tremor or rigidity

Levodopa ; but be weary of wearing off periods —> dyskinesia side effects

Ropinrole [dopamine agonist] = used in young adults for monotherapy

Refractory = deep brain stimulation

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8
Q

MAOi concerns in Parkinson’s

A

Blood pressure spikes especially with alcohol

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9
Q

Glioblastoma common presentation ; due to

A

Chronic headache ; transformation of the glial cells

Worse lying supine or in the morning N/V vision changes // seizure

1 year survival rate

RADIATION OF THE HEAD

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10
Q

Biopsy of Glioblastoma

A

Psuedopalisading pleomorphic tumor

Parallel wall to each other making a WALL

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11
Q

MRI with what contrast is best to see Glioblastoma

A

Gadoliunium

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12
Q

Dementia vs. Delirium

A

Dementia = chronic insidious ; not caused by illness ; SHORT TERM MEMORY LOSS ; course slow decline

Delirium = short term cognitive defects ; often have recent illness ; course fluctuates ; disorganized thoughts

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13
Q

What type of dementia occurs with Alzheimer’s to = mixed dementia

A

Vascular dementia

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14
Q

Vascular dementia often follows what

A

Stroke

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15
Q

what type of dementia often has hallucination

A

Lewy body dementia

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16
Q

Behavior changes and word difficulty occurs in what type of dementia

A

Frontotemporal

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17
Q

Check what labs for dementia workup

A

CBC
TSH
B12

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18
Q

What supplement can help Alzheimer’s

A

Vitamin E supplements [decreases rate of decline]

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19
Q

MS ocular sxs

A

Optic neuritis = color vision loss, central vision loss

Inter nuclear opthalmoplasia = cant look to left or right but can go cross eyed

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20
Q

3 stages of MS

A

Relapsing remitting
Primary progressive
Secondary progressive

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21
Q

MS sxs can be exacerbated by what

A

HEAT

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22
Q

Imaging studies for MS

A

MRI w/ G = Dawson’s fingers, Hyperintense T2 plaque

LP = IgG oligoclonal bodies

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23
Q

MS treatment

A

High dose IV Steriods = acute exacerbations

MABs IV for long term therapy

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24
Q

Myasthenia Gravis most common sxs

A

Ptosis and Diplopia

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25
Q

MG affects who?

A

Younger women

Older men

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26
Q

MG affects what cellular structure

A

Post synaptic membrane of the acetylcholine

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27
Q

MG muscle weakness is what?

A

Fatiguable worse with movement

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28
Q

ICE pack test for MG

A

Improves ptosis

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29
Q

Lab test for MG

A

Increase with serum levels of acetylcholine receptor antibodies

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30
Q

Rule out what if you think MG

A

Thymoma

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31
Q

MG Management

A

ACHe Inhibitor = pyridostigmine or neostigmine

Thymectomy

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32
Q

TIA how quick must sxs resolve?

A

Within 24 hours !

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33
Q

1 eye vision loss with TIA to think of

A

Amaurosis fugax = mono ocular vision loss

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34
Q

Calculate what for TIA treatment

A

ABCD ^ 2

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35
Q

Carotid TIA management

A

Carotid endartectomy

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36
Q

Most common type of stroke

A

Ischemic stroke

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37
Q

Anterior circulation issues

A

Lowe extemity
Shuffling gate - wernickees ecenphalopathy
Sensory loss

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38
Q

MCA = middle cerebral artery infarct sxs

A

FAST ; classic stroke

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39
Q

PCA = posterior cerebral artery infarct think what sxs

A

Visual agnosia
Homonymous hemnaopsia

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40
Q

Basilar artery stroke

A

Locked in syndrome

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41
Q

Verterbral artery sxs

A

Horners syndrome

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42
Q

Ischemic / non ischemic / hemm stroke best image

A

Non con CT

then, MRI or CTA

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43
Q

Most important thereapy for ischemic stroke

A

TPA = Thrombolytics

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44
Q

How long can you wait to use TPA in stroke

A

Less than 4.5 hours of symptom onset

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45
Q

Lower BP less than waht in ischemic stroke

A

220/120

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46
Q

Ischemic stroke gets DAPT for how long

A

21 days

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47
Q

area of the brain MC effected in hemmorhgic stroke

A

Putamen !

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48
Q

What is Cushings reflex ; assoc with what?

A

Elevated BP
Bradycardia
Irregular respirations +/- stupor coma ‘

Hemm stroke

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49
Q

Management Hemm Stroke

A

Reverse any anticoagulation
Control Bp
HOB to 30 degrees
Anti seizure if epileptic

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50
Q

SAH is a rupture of what

A

Anuerysm ; circle of Willis = saccular area

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51
Q

Sudden headache ; photophobia and neck stiffness
N/V worse headache of life

A

SAH

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52
Q

SAH with bleeding may have what

A

Cushing reflex

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53
Q

SAH get a CT normal ; get what and what is it gonna show

A

LP- xanthochromia

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54
Q

SAH with coil or clip what is the complication ; how do you decrease risk

A

Re bleed of anuerysm ; nimodipine [CCBs]

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55
Q

Subdural hematoma is common in what

A

Alcohol use disorder

Bridging VIENS

Crosses suture LINES

A,B,C

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56
Q

Subdural hematoma also can have what

A

Cushing’s syndrome

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57
Q

Subdural hematoma is what shape ; management

A

Crescent shape —> Crosses suture lines

5mm = midline’s shift of 10 mm = craniotomy with burr holes

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58
Q

Epidural hematoma associated with what findings and what arteries

A

Basilar skull fracture

Middle Cerebral artery

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59
Q

Think what for epidural hematoma

A

Lucid interval of normalancy

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60
Q

Epidural hematoma looks like

A

Convex that does not cross suture lines

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61
Q

Epidural treatment

A

Neuro emergency! Craniotomy

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62
Q

Both hemisphere involved in seizures = ; and only one =?

A

Generalized

Focal = impaired or retained awareness

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63
Q

Generalized seizure risk factors

A

Alcohol

Family history

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64
Q

2 types of focal seizures

A

Simple vs. Complex

Simple = maintnatined awareness

Complex = altered level of awareness

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65
Q

Diagnosis of epilepsy

A

2 or more unprovoked seizure more than 24 hours apart

1 unprovoked seizure that has a high change of reoccurrence

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66
Q

1st line focal seizures mangement ; prophylactic

A

Benzo’s

Vlaprioc
Carbamazepine
Lamotrogine

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67
Q

Transient paralysis persists less than 48 hours after focal seizure is called

A

Todds paralysis

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68
Q

EEG for generalized absent seizures

A

3Hz spike and wave discharges

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69
Q

1st line for absent seizures and alternate

A

Ethosuxaximide

Valproate = alternate

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70
Q

1st thing to think of when seziure folks have a relapse

A

Didn’t take their medications

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71
Q

Tonic clonic seizures

A

Loss of consciousness —> muscle contraction —> rhythmic jerk
Lasts less than 5 mins
+/- Bowel bladder incontinence

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72
Q

Myoclonic seizure

A

Brief muscle contraction or jerk

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73
Q

Atonic seizure

A

Sudden loss of muscle tone collapse

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74
Q

Labs to get for seizures

A

Glucose

Tox screen

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75
Q

EEG for generalized seizures

A

Spikes no waves ; sharp waveform

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76
Q

1st line active seizure ; alternate

A

Benzos

2nd = valproic acid , levitirecam [GOOD IN PREG, RECTAL] ; fosphenytion ; topiramate

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77
Q

Generalized seizure usually has what

A

Post ictal state ; very confused

Posterior shoulder dislocation

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78
Q

Status epilepticus lasts how long and what mangement

A

Longer than 5 mins or repeat without return to level of consciousness [think ETOH]

IV Benzos

79
Q

liver vs. kidney encephlopathy

A

liver = ETOH

kidney = ammonia

80
Q

2 endogenous labs in Altered level consciousness

A

CBC / CMP

81
Q

GCS mild mod severe

A

13-15
9-12
3-8

82
Q

GCS usually in concussion

A

13-15

83
Q

admission for concussion criteria

A

Age over 65 ; intoxication ; soft tissue injury above the clavicle ; distractor injury present

84
Q

sxs longer than 14 days or worsen do what

A

get MRI with neuropsych eval

85
Q

primary sxs in post concussion syndrome

A

headache

86
Q

post concussion syndrome are more at risk for what later in life

A

Alzheimer’s

parkinsons

87
Q

tearing of bridging veins

A

subdural hematoma

88
Q

subdural hemtoma is what shape

A

concave ;

lucid interval before AMS
Older patient
aphasi ; hemiplesia
weakness

–> course to herniation : blown pupils

89
Q

MC location of subdural hematoma

A

frontotemporal region

90
Q

epidural hematoma [4]

A

-middle meningeal artery
-skull fx [temporal region]
-Lucid then LOC
Rapid deterioration

CRESCENT SHAPE

91
Q

cerebral contusion CT scan course

A

altered GCS 10-11 –> 24 hours later BLEEDS and BLOSSOM

TXM = medical > surgery

92
Q

diffuse axonal injury think what force

A

shear of axon ; jumping off a building

-usually comatose
-micro hemorrhages

TXM = medical > surgical [decrease the swelling]

93
Q

DAI shows what lesions

A

punctate black hole lesions

94
Q

what valvular abnormality is a common cause of syncope

A

aortic stenosis

95
Q

lacunar infarct think

A

small occlusions
long standing HTN / DM

96
Q

TIA is usually a result of what

A

Embolic stroke

97
Q

3 meds that are good post TIA

A

Statin ; ASA ; clopiogrel x 90 days

+/- AC = afib

*carotid endardectomey over 70% occlusion

98
Q

ischemic stroke MC

A

middle cerebral artery [ typical stroke sxs ]

99
Q

middle cerebral artery stroke

A

contralateral hemiparesis ; homonymous hemianopia

100
Q

posterior cerebral artery stroke

A

memory impairment ; homonymous hemianopia

101
Q

basilar artery infarct

A

ipsilateral bulbar or cerebellar signs

102
Q

vertebral artery infarct

A

ipsilateral sensory loss in face ; ataxia contralateral hemiparesis

103
Q

CTA is going to be helpful to look for what

A

occluded vessel in the setting of ruled out hemorrhage

104
Q

seizure –> weakness

A

todds paralysis ; get CT non con

105
Q

when can you give thrombyltics for ischemic stroke

A

4.5 hours of sxs onset
[last known normal]

106
Q

what is the Bp cut off for rTPA

A

185/110

107
Q

best imaging for ischemic stroke

A

MRI

108
Q

inter cranial atherosclerosis stroke prevention

A

Plavix- Clopidogrel

109
Q

MC of intraparenchymal hemorrhage

A

HTN ; present with headache–>comatose

110
Q

MC location for hypertensive stroke

A

basilar ganglia

111
Q

best Bp lowering drugs for ICH management

A

labetolol // nicardipine = 140 systolic goal

112
Q

ICP osmotic agent

A

mannitol

hyperventilation = decreases ICP

113
Q

MC cause SAH

A

trauma > anneurysmal

114
Q

aneurysmal SAH can develop

A

3rd CN palsy; anisocoria and ptosis

115
Q

def test for SAH

A

cerebral angio

–> LP = xanthochromia

116
Q

what is a good prophlyactic for SAH workup

A

keppra for anti seizure care

117
Q

MC locations for cerebral aneurysm

A

anterior communicating artery

posterior communicating artery

118
Q

Most AVM lie where

A

MCA

119
Q

Bells Palsy can t do what

A

raise their eyebrows

lower motor neuron issue

120
Q

seizure that starts in one area then progresses over the rest of the body

A

jacksonian march

121
Q

top 3 meds for generalized seizures

A

Levetiracetam = safe in pregnancy

valproic acid

phenytoin

122
Q

focal seizure 3 meds

A

carbamazepine

valproic acid

phenytoin

123
Q

complex partial seizure medication management

A

lacosamide

124
Q

renally vs liver processed seizure meds

A

renal = keppra

liver = valproic acid

125
Q

minor neuro cognitive disorders drug of choice + lifestyle

A

Donepazil

126
Q

4 types of reversible dementias

A

hypothyroidism
b12 deficiency
thiamine deficieny
Normal pressure hydrocephalus

127
Q

beta amyloid plaques think what

A

Alzheimer’s

128
Q

2 drugs for alzheimers disease

A

donepazil

memantine

129
Q

lewy body vs. frontotemporal demtentia

A

lewy body = parkinsonion movements ; little strokes

frontotemporal = angry

130
Q

delirium can have what types of amnesia

A

anterograde and retrograde

131
Q

confabulation think what

A

korotsakoffe syndrome

132
Q

uremic encephalopathy treatment of choice

A

dialysis

133
Q

MS ; [4]

A

motor weakness, optic neuritits

MRI = ologlonal bands ; white plaques around the ventricles

134
Q

ptosis diplopia chewing difficulties

A

myasthenia gravis

135
Q

cerebral palsy

A

spasticity and hyperreflexia

PT and Speech therapy
Botox or Baclofen

136
Q

essential tremor

A

exacerbated by stress
not as disabling
ETOH helps
proponal treatment

137
Q

huntingtons

A

autosomal dominant; high children effected ; need to counsel

chorea dementia

138
Q

parkinsons is a lack of

A

dopamine

139
Q

treatment parkinsons

A

levedopa /carvodopa–>

amantidine first

140
Q

coprolalia

A

tics - yelling obsentities

141
Q

CRPS happens after what

A

a single limb after trauma

142
Q

guillain barre [4]

A

post campylobacter
weakness in the “rubbery” legs
txm = Plasmapheresis ; IVIG
may require intubation; good prognosis

143
Q

if you suspect vasculitis peripheral neuropathy what is the diagnostic

A

bx

144
Q

MC type of encephalitis

A

Viral

fever–> LOC –> stiff neck

get LP ; + Leukocytosis

145
Q

MC bacterial meningitis

A

strep pneumonia

Listeria = pregnant pts

146
Q

bacterial meningitis Community acquired TXM

A

cephalosporin + vanco + acyclovir

-ceph + vanco + ampicillin = listeria TXM

cefipime + vanco = Staph A. TXM

“ Think CAVs or Cv for Staph. “

147
Q

opening pressure in encephalitis and bacterial meningitis are both what

A

elevated !

148
Q

cells that predominate bacterial meningitis

A

PMNs!

149
Q

bacterial meningitis has ___ glucose

A

DECREASED

150
Q

MC brain tumor

A

glioblastoma

151
Q

benign brain tumor commonly

A

meningioma

152
Q

semmes wienstein filament represents what

A

the proective threshold ; that will show defecits in diabetic patients in various areas of the feet and hands

153
Q

huntingtons does not have what

A

seizures

154
Q

essential tremor genetics

A

autosomal dominant

155
Q

myasthenia gravis usually has a what that you have to get a what for

A

thymoma

CT of the chest

156
Q

immediate post ictal suspect what

A

up going plantar reflex

157
Q

cerebral palsy most commonly presents with what sxs

A

spasticity of the limbs [starting in the legs]

158
Q

in treatment of bells palsy dont forget what management

A

artificial tears

159
Q

diplopia difficulty chewing ptosis and arm weakness think what two things

A

myasthenia gravis

thymectomy

160
Q
A
161
Q

Can a MCA stroke result in aphasia

A

YES ; reactive ; nonsensical aphasia

162
Q

Can a MCA stroke result in aphasia

A

YES

163
Q

What is a good intervention for hospitalized dementia patients

A

Uninterrupted sleep

164
Q

CSF analysis Guillenne Barre

A

Post URI or Campy infection ; bilateral leg paralysis/weakness upper spread; peripheral paresthesias

Normal = WBCs, RBCs, Glucose

Low = Protein

165
Q

Loss of anocutaneous reflex = what nerve roots

A

S2-S4 ;

Positive straight leg test and lumbosacral pain

166
Q

Gait pattern of Parkinson’s

A

Narrow base ; small stride gait

167
Q

If you give prochlorperazine for migraine what three things should you consider

A

IV administration

You can +/- give with NSAIDS, APAP

Give it also with IV benedryl to decreased akathisia sxs

168
Q

Migraine 1st line in pregnancy

A

APAP

169
Q

JME treatment option

Juvenile myoclonic epilepsy

A

Valprioc acid; may require life long therapy

170
Q

2 drugs of choice for Alzihiemers treatment

A

Donepazil

Rivastigmine

171
Q

Why do nerve conduction studies not help radiculopathy

A

Because they don’t work at the root, they work further down and can be normal if the lesion is proximal to the root ganglia [dorsa]

Because the action potential at the SNAP is still normal [good conduction] when a signal is sent

172
Q

Describe lithium tremor

A

Likely starts after med start.
Limited to the hands and UE.
Non progressive.
Decreases over time.

173
Q

Lacunar infarct Risk factor and location

A

RF = HTN

Location = deep brain matter; sprain the white/gray matter junction

174
Q

Fluent aphasia is a result of a lesion where?

A

Wernickes ; posterior ; temporal lobe ; supplied by the MCA

175
Q

Vestibulocerebellar sxs are consistent with an infarct where [ataxia, dizzy, nystagmus]

A

Posterior or Anterior Inferior Cerebellar
PAIC

176
Q

Posterior cerebral artery injuries generally have what defect prominent

A

Visual

177
Q

What is the ABCD2 score for TIA

A

It established admission criteria

A=age over 60

B= Bp [high]

C=clinical sxs consistent

D= duration of sxs over 60 mins to less than 10 mins

D= presence of Diabetes

2 = Admit.

178
Q

Guillen Barre is a demyelination of what features

A

Peripheral nerves w/ autonomic features that are worse with progressive nerve disturbances.

179
Q

If Parkinson’s motor sxs are not well controlled on L/C do what

A

Add amantadine or selegelline

180
Q

Why is NCS the next step of carpal tunnel does not improve with splinting

A

To confirm nerve compression = decreased nerve conduction

To confirm tunnel release surgery efficacy

181
Q

B12 vs. ETOH dependency

A

Decreases B12

Leading to progressive bilateral muscle weakness—> paralysis

Gait impairment common

B12 = a produce of MEAT , DAIRY , and EGGS

182
Q

With cerebral artery infarct think

A

Contralateral weakness

183
Q

MC etiology of cerebral artery infarct

A

Cardiac embolization due to AFIB ; = thrombus in the left atrial appendage

184
Q

Ischemia of the spinothalmic tract results in what

A

Pain and temperature deficits

185
Q

What can cause Parkinson’s psychosis

A

Progression of disease

High doses of L/C [ dopamine precursor ]

or

Pramipexole [ dopamine agonist ]

if due to meds = decrease the dose
other sxs should be normal // Psychosis most concerning
if sxs are brutal and require above meds + Antipsychotic

186
Q

Good Parkinson’s medication in younger patients with tremors

A

Benztropine [anticholinergic]

Older Patient Risk - cognitive impairment and urinary retention

187
Q

What nerve is at risk in temporal bone fractures

A

Facial nerve

188
Q

Where do trigeminal nerve branches exit and what injuries put it at risk

A

Sphenoid bone, mid face

Orbital or Anterior facial trauma

189
Q

Thalamic hemmorhage in a middle aged individual think what

A

Cocaine use

190
Q

Best imaging for MS brain

A

MRI showing lesions in white matter; periventricular areas

191
Q

Does diffuse Axonal injury show up on CT

A

YES

192
Q

HIV neuropathy is most commonly treated with

A

Gabapentin

193
Q

Fatiguable weakness think

A

Myasthenia gravis

194
Q

Infraoribital fx affects nerve areas where

A

Lips and cheeks

PANCE 2024 (15 decks)

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