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Master Review > Neurology > Flashcards

Neurology Flashcards

1
Q

When a patient arrives to the ER who has signs of a stroke, what is the first initial step?

A

get a CT scan without contrast

*need to know if it is hemorrhagic or ischemic stroke

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2
Q

What are two main differences between a TIA and a stroke?

A
  • a stroke will last longer than 24 hours
  • a stroke does NOT involve the upper third of the face (from the eyes up- patient will be able to move forehead)
  • A TIA lasts LESS than 24 hours
  • A TIA INVOLVES the upper third of the face
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3
Q

A TIA is always caused by?

A

emboli or thrombosis

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4
Q

Patient experiences a transient loss of vision in one eye. What is this called? And what artery must the emboli or thrombus be located in?

A
  1. amaurosis fugax

2. ophthalmic artery (first branch of the internal carotid artery)

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5
Q

Define cryptogenic stroke

A

A stroke with an unknown etiology

- can only be diagnosed after 1-3 months of EKG monitoring

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6
Q

Based on the following symptoms, which artery in the brain has a lesion?

  • PROFOUND LOWER extremity weakness
  • mild upper extremity weakness
  • personality changes or psychiatric disturbance
  • urinary incontinence
A

Anterior cerebral artery

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7
Q

Based on the following symptoms, which artery in the brain has a lesion?

  • PROFOUND UPPER extremity weakness
  • aphasia
  • apraxia
  • eyes deviate towards side of lesion
  • CONTRALATERAL homonymous hemianopsia with macular sparing
A

Middle cerebral artery

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8
Q

Based on the following symptoms, which artery in the brain has a lesion?

  • inability to recognize the face (prosopagnosia)
A

Posterior cerebral artery

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9
Q

Based on the following symptoms, which artery in the brain has a lesion?

  • vertigo
  • nausea and vomiting
  • loss of consciousness
  • dysarthria and dystonia
  • sensory changes in the face and scalp
  • ataxia
  • bilateral findings
A

Vertebrobasilar artery

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10
Q

Based on the following symptoms, which artery in the brain has a lesion?

  • ipsilateral face involvement
  • contralateral body
  • vertigo
  • horner syndrome
A

Posterior Inferior Cerebral Artery

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11
Q

Based on the following symptoms, which artery in the brain has a lesion?

  • absence of cortical deficits
  • ataxia
  • Parkinsonian signs
  • sensory deficits
  • hemiparesis (most notable in the face)
  • possible bulbar signs
A

Lacunar infarct

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12
Q

What is the most accurate test in diagnosing a stroke?

A

MRA

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13
Q

What is the time window to give tPA?

A

3-4.5 hours of onset of stroke

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14
Q

All patients with nonhemorrhagic strokes should have which medication added to their regimen if not already on it?

A

statin

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15
Q

What are the ABSOLUTE contraindications to giving tPA?

A
  • history of hemorrhagic stroke
  • presence of intracranial neoplasm/mass
  • has bleeding disorder
  • active bleeding
  • surgery within the last 6 months
  • CPR with chest compressions within the last 3 weeks
  • suspicion of aortic dissection
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16
Q

If the patient is in the appropriate time window to give tPA, what 4 conditions must be met before it is given?

A
  • patient should be <80
  • patient is not a diabetic with a previous stroke
  • does not use anticoagulation
  • NIH stroke scale is less than 25
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17
Q

If the patient has had the stroke over 4.5 hours, what is the best initial step?

A
  • Give the patient aspirin
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18
Q

What is the best way to remove a clot that caused a stroke?

A
  • removal of clot via catheter
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19
Q

If patient was already on aspirin and develops a stroke, which medication should you switch to?

A
  • clopidogrel
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20
Q

What is the time frame window to remove a clot that caused a stroke via catheter?

A
  • up to 24 hours of the initial onset of the stroke
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21
Q

Cerebral vein thrombosis can mimic?

A

subarachnoid hemorrhage

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22
Q

How does cerebral vein thrombosis present?

A

Patient will have headache developing over several days with weakness and difficulty with speech, as seen in a stroke victim.

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23
Q

What is the most accurate test to diagnose cerebral vein thrombosis?

A

MRV (magnetic resonance venography)

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24
Q

What is the treatment for cerebral vein thrombosis?

A
  • LMW heparin followed by warfarin for a few months after
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25
Q

Treatment for TIA?

A
  • aspirin and clopidogrel for the first several weeks after TIA
  • tPA is NOT indicated
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26
Q

What tests should be ordered after CT scan without contrast for patients suspected of stroke or TIA?

A
  • carotid doppler
  • echocardiogram
  • EKG and holter monitor
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27
Q

A young patient <50 y/o with no past medical history, in addition to the normal tests run after a stroke or TIA, what additional tests should be ordered?

A
  • ESR
  • VDRL or RPR
  • ANA
  • dsDNA
  • protein C
  • protein S
  • factor V leiden mutation
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28
Q

A patient on a statin due to hyperlipidemia, what is the goal of the LDL with the statin?

A

<70 mg/dL

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29
Q

When is an endarterectomy indicated?

A
  • Patient must be symptomatic AND must be >70 but <100 % stenosis of the artery
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30
Q

When is closure of a patent foramen ovale the next step in management?

A
  • patient has an embolic appearing cryptogenic ischemic stroke
  • right to left shunt detected by a bubble study
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31
Q

What is the initial medication used for a seizure?

A
  • benzodiazepines (BZD)
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32
Q

After giving lorazepam to a patient with status epilepticus, what is the next medication to add if the seizure continues after 20 minutes?

A
  • Fosphenytoin
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33
Q

Patient has been seizing for the last 40 minutes. Lorazepam and fosphenytoin have not stopped the seizure. What is the next line of therapy?

A
  • phenobarbital
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34
Q

If a patient is still seizing after 60 minutes, and lorazepam, fosphenytoin, and phenobarbital have not ceased the seizure, what is the next class of medication to use?

A
  • general anesthesia (propofol, pentobarbital, thiopental, midazolam)
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35
Q

Patient comes in with a seizure. After the seizure has ceased, what tests should be ordered?

A
  • CBC
  • CMP
  • glucose
  • Creatinine
  • Head CT
  • urine tox
  • EEG only if the other tests do not reveal anything
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36
Q

On the CCS exam, any time a patient has a seizure, who should be consulted?

A
  • Neurology
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37
Q

What are some first line medications for chronic seizures?

A
  • levetiracetam
  • valproic acid
  • carbamazepine
  • phenytoin
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38
Q

If a patient should need to be on lamotrigine, what test can be done to predict Stevens-Johnson syndrome?

A

HLA-B*1502

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39
Q

What are the safest seizure meds in pregnancy?

A
  • levetiracetam

- lamotrigine

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40
Q

What is the worst seizure med in pregnancy?

A
  • valproic acid
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41
Q

If a patient is on OCP, which seizure med will be affected and therefore will need a higher dose to maintain efficacy?

A
  • lamotrigine
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42
Q

What are some second line medications for seizures?

A
  • gabapentin
  • phenobarbital
  • lacosamide
  • zonisamide
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43
Q

Best treatment for absence or petit mal seizures?

A

ethosuximide

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44
Q

which seizure drug has the highest risk of hyponatremia?

A

carbamazepine

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45
Q

What are some drugs that can cause parkinsonian symptoms?

A
  • antispychotics >1st gen than 2nd gen
  • antiemetics that inhibit dopamine
  • prochlorperazine
  • metoclopramide
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46
Q

What are some physical findings in parkinson disease?

A
  • cogwheel rigidity
  • resting tremor
  • hypomimia ( a masklike, underreactive face)
  • micrographia (small writing)
  • orthostasis
  • intact cognition and memory
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47
Q

First line tx for patient >60 y/o with mild parkinson disease

A

amantadine

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48
Q

first line tx for patient <60 y/o with mild parkinson disease

A

benztropine or trihexyphenidyl

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49
Q

first line for patient with severe parkinson disease (cannot perform activities of daily living)

A
  • levodopa/carbidopa combo
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50
Q

Second line tx for severe parkinson disease

A

dopamine agonists, like pramipexole, ropinirole, cabergoline, rotigotine, apomorphine

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51
Q

What are some adjuncts to control parkinson disease if the primary treatment is not working alone?

A
  • COMT inhibitors, like tolcapone and entacapone

- MAO inhibitors, like selegiline, rasagiline, safinamide

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52
Q

Define shy-drager syndrome

A
  • parkinson disease with orthostatic hypotension
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53
Q

Tx for shy-drager syndrome

A
  • fludrocortisone or midodrine
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54
Q

MOA of midodrine

A
  • alpha 1 agonist (raises blood pressure)
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55
Q

What is the main difference between progressive supranuclear palsy and parkinson disease?

A
  • A patient with progressive supranuclear palsy cannot look up or down- vertical gaze paralysis
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56
Q

A patient with parkinson disease is on levodopa/carbidopa combo and develops psychosis. What can be added to the regimen to control the psychosis?

A
  • quetiapine or pimavanserin
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57
Q

A patient with Parkinson disease is admitted to the hospital. The medical staff is unaware that he is treated for parkinson disease. What can happen while he is in the hospital without parkinson treatment?

A
  • fever/rhabdomyolysis
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58
Q

define essential tremor

A
  • a tremor that occurs at rest and with intentions bilaterally
  • not associated with an illness
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59
Q

first line tx for essential tremor

A

beta-blockers, specifically propanolol

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60
Q

If patient still has an essential tremor after being on propanolol, what is the next adjunct medication?

A

primidone (antiepileptic medication)

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61
Q

Resting tremor in parkinson disease is treated with?

A

amantadine

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62
Q

What are some abnormalities associated with multiple sclerosis?

A
  • optic neuritis
  • motor and sensory issues
  • atonic bladder
  • fatigue
  • depression
  • hyperreflexia
  • spasticity
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63
Q

What is the best initial and accurate test for MS?

A

MRI

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64
Q

Patients with MS will show what on their lumbar puncture?

A
  • oligoclonal bands
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65
Q

LP is only performed when _____ with an MS patient.

A

the MRI is undiagnostic

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66
Q

Which drug class decreases the progression of MS?

A

anti-CD20 drugs

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67
Q

Baclofen or tizanidine treat ___ for MS patients.

A

spasticity

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68
Q

dalfampridine helps ____ with patients with MS.

A

increases walking speed

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69
Q

Amantadine is used to treat ___ in MS patients.

A

fatigue

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70
Q

MOA of alemtuzumab

A

anti-CD52 drug that inhibits lymphocytes and deters progression of MS

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71
Q

MOA of ocrelizumab

A

anti-CD20 drug for MS

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72
Q

what are three oral medications used in MS?

A
  • dimethyl fumarate
  • fingolimod
  • teriflunomide
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73
Q

All patients with memory loss must have which tests?

A
  • Head CT
  • B12
  • TSH
  • VDRL or RPR
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74
Q

WHat does a head CT scan show with a patient with alzheimer’s disease?

A
  • diffuse, symmetrical atrophy
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75
Q

What are first line treatment options for alzheimer’s dementia?

A
  • anticholinesterase drugs, such as donepezil, rivastigmine, and galantamine
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76
Q

define alzheimer’s disease

A
  • progressive memory loss in patients exclusively >65 y/o

- patients will eventually develop apathy and imprecise speech

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77
Q

What are the two physical methods of preventing falls in the elderly?

A
  • strength training

- exercise

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78
Q

What does a head CT scan show with a patient with pick disease (frontotemporal dementia)?

A
  • focal atrophy of the frontal and temporal lobes
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79
Q

How will a patient with Pick Disease present?

A
  • personality and behavioral changes occur first

- followed by memory loss

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80
Q

Tx for Pick Disease

A
  • anticholinesterase medications “stigmines”
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81
Q

What are the diagnostic tests for creutzfeldt-jakob disease?

A
  • MRI
  • brain biopsy- only if CSF did not show 14-3-3 protein
  • EEG
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82
Q

define lewy body dementia

A

parkinson disease + dementia

- patients will have very vivid, detailed hallucinations

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83
Q

What are the three symptoms of normal pressure hydrocephalus?

A
  • wet= urinary incontinence
  • wacky= dementia
  • wobbly= wide, based gait/ataxia
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84
Q

Tx for normal pressure hydrocephalus

A

placement of a shunt

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85
Q

What are the two tests that must be completed to diagnose normal pressure hydrocephalus?

A
  • ct of the head

- lumbar puncture

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86
Q

How will a patient with huntington disease present?

A
  • dementia
  • psychiatric disturbances with personality changes
  • chorea
  • young (far below age for alzheimer’s)
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87
Q

Inheritance for huntington disease is _____

A

autosomoal dominant

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88
Q

Tx for huntingdon disease

A

antipsychotics for psychiatric disturbances

- deutetrabenazine, tetrabenazine, and or valbenazine for the movement issues

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89
Q

If a patient with a headache is over 40 for their first episode, has a focal neurological finding, or the headache was sudden or severe, what should be completed first?

A
  • CT of head or MRI
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90
Q

What are some triggers for migraines?

A
  • cheese
  • caffeine
  • menstruation
  • OCPs
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91
Q

What is the best abortive therapy for migraines?

A

sumatriptan or ergotamine

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92
Q

What are the two contraindications for use of triptan drugs?

A
  • pregnancy

- coronary disease

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93
Q

Patients who cannot have triptans or ergotamine or have status migrainosus, should be given?

A

a dopamine antagonist, such as prochlorperazine, metoclopramide, chlorpromazine

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94
Q

If you have to use a dopamine antagonist for migraine treatment, what other medication should you add to prevent dystonia in the patient?

A

diphenhydramine

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95
Q

Main ADR of dopamine antagonists

A

QT prolongation

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96
Q

What is the criteria for needing prophylactic medication for migraines?

A

Having 4 or more migraines a month

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97
Q

What is first line prophylactic migraine med?

A

propanolol

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98
Q

What are second line prophylactic migraine meds?

A
  • CCBs
  • TCAs
  • SSRIs
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99
Q

Which type of migraine medication class make parkinson disease worse?

A

anti-dopaminergic

*dopamine antagonists

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100
Q

Why are triptan drugs dangerous in patients with pregnancy or coronary disease?

A
  • not only do they constrict blood vessels in the brain, but they also constrict vessels in the heart, which can provoke cardiac ischemia
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101
Q

Presentation of a cluster headache

A
  • unilateral
  • redness and tearing of the eye on the same side as the headache
  • rhinorrhea
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102
Q

tx for cluster headache for abortive therapy

A
  • triptan or 100% oxygen, steroids
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103
Q

tx for prophylaxis of cluster headaches

A
  • CCBs, such as verapamil
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104
Q

presentation of temporal arteritis

A
  • jaw claudication

- tenderness of the temporal area

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105
Q

What is the most accurate testing for temporal arteritis?

A

temporal artery biopsy

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106
Q

Tx for temporal arteritis

A

_ if it is suspected, give steroids. DO NOT DELAY treatment.

  • Delaying treatment may result in permanent vision loss.
  • DO NOT WAIT FOR BIOPSY TO GIVE STEROIDS
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107
Q

How does a pseudotumor cerebri present?

A
  • headache with sixth nerve palsy, visual field loss, transiently obscure vision, pulsatile tinnitus
  • papilledema
  • double vision due to sixth nerve palsy
  • usually seen in an obese young woman
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108
Q

What is the most accurate test for pseudotumor cerebri?

A

lumbar puncture

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109
Q

Treatment for pseudotumor cerebri?

A

1st line- weight loss and acetazolamide

2nd line- VP shunt and optic nerve sheath fenestration

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110
Q

When does intracranial hypotension occur?

A

due to CSF leak after LP

111
Q

What tests are needed for diagnosis of intracranial hypotension?

A

MRI and LP with low CSF pressure

112
Q

Tx for intracranial hypotension

A

blood patch to close off the leak

113
Q

If a CNS infection is suspected, what is the initial step in management?

A

Perform a LP

114
Q

After performing an LP in a patient suspected of meningitis, what is the next step of management?

A

get blood cultures and then start empirical antibiotic therapy

115
Q

When is an LP contraindicated?

A

Presence of papilledema or intracranial hypertension

116
Q

Gram + diplococci is specific for ____ causing meningitis

A

pneumococcus

117
Q

Gram - diplococci is specific for ____ causing meningitis

A

Neisseria

118
Q

Gram - pleomorphic coccobacilli is specific for ____ causing meningitis

A

Haemophilus

119
Q

Gram + bacilli is specific for _____ causing meningitis

A

listeria

120
Q

CSF will have ____ in cases of bacterial meningitis

A

elevated protein

121
Q

Glucose levels in CSF with bacterial meningitis will be less than ____

A

60%

122
Q

What is the empirical treatment with suspected bacterial meningitis? i.e. the CSF has many neutrophils present

A

start IV ceftriaxone, vancomycin, and steroids

*empirical treatment before you get the cultures back

123
Q

What is the most accurate diagnostic test for cryptococcal meningitis?

A

cryptococcal antigen

124
Q

Cryptococcal meningitis is more likely to be in a patient with ___

A

HIV with CD4 cells <100

125
Q

What is the treatment for cryptococcal meningitis?

A

amphotericin, 5-flucytosine, and fluconazole

126
Q

When can fluconazole be stopped in a patient with HIV with cryptococcal meningitis?

A

when the cd4 levels are above 100

127
Q

What are some symptoms of lyme disease?

A
  • joint pain
  • 7th cranial nerve palsy
  • rash with central clearing
128
Q

What is the most accurate diagnostic test for lyme disease?

A
  • western blot testing of the CSF
129
Q

tx for lyme disease with neurological symptoms

1st line tx for lyme disease without neurological symptoms

A

IV ceftriaxone- neurological lyme

doxycycline- without neurological symptoms

130
Q

What is the characteristic rash in rocky mountain spotted fever?

A

starts on the wrists and ankles and moves towards the center of the body

131
Q

tx for rocky mountain spotted fever

A

doxycycline

132
Q

Presentation of a patient with TB meningitis

A
  • usually an immigrant with a history of lung TB
  • symptoms occurred gradually from weeks to months
  • coughing, hemoptysis, fever
133
Q

What is the most accurate diagnostic test for TB meningitis?

A

acid fast culture

134
Q

What is the quickest test to diagnose TB meningitis?

A

PCR

135
Q

Tx for TB meningitis

A
  • RIPE therapy with steroids
  • r= rifampin
  • i= isoniazid
  • p= pyrazinamide
  • e= ethambutol or a fluoroquinolone
136
Q

If listeria is suspected to cause the meningitis, what is the treatment?

A
  • vancomycin, ceftriaxone, and ampicillin
137
Q

A patient has Neisseria meningitis. After initial therapy of ceftriaxone and vancomycin are given, what is the next step in management?

A
  • droplet isolate the patient for 24 hours

- provide rifampin to close contacts

138
Q

An adolescent with a stiff neck and a petechial rash is suggested of what bacteria as the cause of the meningitis?

A

Neisseria

139
Q

Who are at an increased risk for listeria meningitis?

A
  • elderly
  • neonates
  • immunocompromised
  • those on steroids
  • those with no spleen
140
Q

What are two types of amoeba that can cause meningitis?

A
  • Naegleria fowleri

- Acanthamoeba

141
Q

Which bone does the amoebas go through to infect the brain?

A

cribriform plate

142
Q

What is a primary symptom of a patient who has amoebic meningitis?

A

anosmia

143
Q

How to diagnose amoebic meningitis?

A

wet mount (will show mobile amoebae)

144
Q

Tx for amoebic meningitis

A

miltefosine ( second line amphotericin), steroids may help

145
Q

What are the two main symptoms in a patient with encephalitis?

A
  • fever

- confusion (AMS)

146
Q

What is the best initial diagnostic test for encephalitis?

A

head ct scan

147
Q

What is the most accurate test for diagnosing encephalitis?

A

pcr of the csf for hsv and vzv

148
Q

Almost all cases of encephalitis in the USA are caused by ?

A

herpes simplex virus

149
Q

HSV and VZV encephalitis are treated with?

A

acyclovir

150
Q

If a patient is resistant to acyclovir, what is the next line of therapy?

A

foscarnet

151
Q

MOA of acyclovir, valacyclovir, famciclovir, and ganciclovir?

A

they all inhibit DNA polymerase

152
Q

What is the main difference between acyclovir and foscarnet?

A

Acyclovir needs to be activated by thymidine kinase- like the other clovir drugs.

Foscarnet does NOT need to be activated by thymidine kinase, which is why it can be used in treatment resistant acyclovir HSV or VZV.

153
Q

Autoimmune encephalitis is treated by?

A
  • IVIG
  • steroids
  • removal of the teratoma
154
Q

A patient diagnosed with autoimmune encephalitis has what kind of teratoma in their history?

A
  • ovarian
155
Q

What will the CT scan show of a patient with a brain abscess?

A
  • ring enhancing lesion
156
Q

What is the treatment for a brain abscess in a patient who is HIV negative?

A
  • ceftriaxone and metronidazole until cultures come back *empirical tx
157
Q

A patient with a brain abscess who is HIV positive should be suspected of having?

A

toxoplasmosis gondii

158
Q

A patient suspected of having toxoplasmosis should be empirically treated with?

A

pyrimethamine and sulfadiazine for two weeks

159
Q

In a patient who is HIV negative but has a brain abscess shown on CT scan, what is the best next step?

A

brain biopsy

160
Q

What will the head CT scan show in a patient with neurocysticercosis?

A

multiple 1 cm cystic lesions

161
Q

Uncalcified neurocysticercosis is treated with ?

A

albendazole and praziquantel

*and steroids to prevent a reaction from the dying parasites

162
Q

What does an MRI show in a patient with posterior reversible encephalopathy syndrome?

A
  • vasogenic edema in the posterior lobes
163
Q

What can cause posterior reversible encephalopathy syndrome?

A
  • hypertensive crisis
  • preeclampsia
  • cytotoxic medications, such as cyclosporine
164
Q

How will the CT scan look in a patient with a concussion?

A

normal

165
Q

how will the CT scan look in a patient with a contusion?

A

ecchymosis

166
Q

How will the CT scan look in a patient with a subdural hematoma?

A

crescent shaped collection of blood

167
Q

How will the CT scan look in a patient with an epidural hematoma?

A

lens shaped collection of blood

168
Q

Tx for large subdural and epidural hematomas

A

craniotomy for drainage

169
Q

Management of a patient with a large intracranial hemorrhage with mass effect

A
  • need to get the intracranial pressure down–> intubate the patient and hyperventilate them
  • decreased the pCO2 to 28-32, which will constrict the cerebral blood vessels
  • give mannitol, which helps decrease intracranial pressure
  • surgical evacuation to get rid of the hemorrhage
170
Q

When is a PPI required for stress ulcer prophylaxis?

A
  • burn victims
  • head trauma victims
  • patients who have an endotracheal tube with mechanical ventilation
171
Q

Presentation of a subarachnoid hemorrhage

A
  • loss of consciousness
  • focal neurological deficits
  • worse headache of the patient’s life–> sudden and severe
  • photophobia and stiff neck

*presents like meningitis w/O FEVER

172
Q

Blood is an irritant and will bother the stomach and intestines as it is digested. What is the result?

A

diarrhea with melena

173
Q

Most accurate test of a subarachnoid hemorrhage

A

lumbar puncture

174
Q

Initial test for suspected SAH

A

CT head without contrast

175
Q

Tx for SAH

A
  • embolize the site of bleeding

- prescribe nimodipine to prevent stroke

176
Q

How do you find where the bleed is in a SAH?

A

angiography

177
Q

Tx for hydrocephalus

A

ventriculoperitoneal shunt

178
Q

When a patient presents to the ER for a possible stroke, before you send them to get the CT scan of the head w/o contrast, what should you do?

A
  • give something to control the blood pressure, such as labetalol
179
Q

Before you can give tPA to a patient, what 4 tests should you order?

A
  • CBC
  • PTT
  • PT
  • EKG
180
Q

Why is stroke more sensitive to time than any other tissue or organ damage?

A

Brain tissue has no glycogen stores. The brain almost solely uses glucose for energy.

181
Q

MOA of labetalol

A
  • nonspecific beta blocker (blocks beta 1 and 2), and specific alpha 1 blocker (peripherally)
182
Q

MOA of tPA

A
  • activates plasmin, which cleaves fibrin into d-dimers
183
Q

When a patient comes to the office with suspicion of parkinson disease, what should be tested for on examination?

A

orthostatic hypotension

  • those with parkinson disease when rising from a seated position, their autonomic nervous system takes some time to respond.
  • the normal increase in pulse rate and vasoconstriction is not occurring, which then leads to the orthostatic hypotension
184
Q

Patient with parkinson disease is given benzotropine. A couple days later, the patient comes in with dry mouth, urine retention, and abdominal pain. What other symptom should you ask if the patient has experienced?

A
  • memory loss

* AcH inhibitors decrease memory

185
Q

If amantadine and benzotropine fail in a patient with parkinson disease, what is the next line of therapy?

A
  • ropinirole or pramipexole (dopamine agonists)
186
Q

MOA of carbidopa

A

inhibits dopamine decarboxylase so that leveodopa stays in the brain longer so that by the time it reaches the blood brain barrier, there is a larger amount crossing over

187
Q

You should not drop a patient’s blood pressure more than ___ in the first day at the hospital.

A

25%

188
Q

What is the cause of a patient losing consciousness with a SAH?

A
  • increased intracranial pressure suddenly decreases CNS perfusion
189
Q

What is the body’s natural response to a SAH?

A

vasospasm

190
Q

What is the most common cause of SAH?

A

spontaneous rupture of a saccular aneurysm of the circle of willis

191
Q

A patient with Creutzfeld Jakob disease can go from normal to death in how much time?

A

3-6 months

192
Q

Prions in CJD causes what kind of encephalopathy?

A

spongiform

193
Q

What is the trinucleotide repeat found in Huntington Disease?

A

CAG

194
Q

MOA of memantine

A

NMDA receptor antagonist (N-methyl-D-asparate)

195
Q

What would you expect to find in CSF with a patient with viral meningitis?

A
  • normal or mildly elevated protein

- elevated WBCs

196
Q

When a patient has meningitis but the cause is unknown, must place patient in ____ because?

A
  • droplet isolation because it may be Neisseria bacteria; take patient out of droplet isolation once you known the cause of the meningitis
197
Q

What class of medication does vancomyocin belong to?

A

glycopeptide

198
Q

What are the three drugs that are glycopeptides?

A
  • vancomycin
  • teicoplanin
  • telavancin
199
Q

MOA of vancomycin

A

Inhibits the backbone polymers of the cell wall of gram + bacteria

200
Q

MOA of macrolides (like azithromycin)

A

inhibit ribosomes

201
Q

MOA of quinolones

A

inhibit DNA gyrase

202
Q

Gram stain shows positive cocci in clusters is specific for which bacteria?

A

Staphylococcus

203
Q

For which organism do steroids give the greatest mortality benefit in those with bacterial meningitis?

A

pneumococcus

204
Q

What is the most common neurological sequela from meningitis?

A

hearing loss due to meningitis affecting the 8th cranial nerve

205
Q

Meningitis most affects which part of the brain?

A

leptomeninges found in the arachnoid space

206
Q

Encephalitis affects what part of the brain?

A

brain parenchyma

207
Q

What is the mechanism of hydrocephalus developing as a complication of meningitis?

A

Inflamed arachnoid villi cannot drain CSF

208
Q

A patient becomes red after rapid infusion of vancomycin. Why? and what is the treatment?

A
  • Vancomycin provokes a histamine release from mast cells when infused rapidly.
  • Slow the rate down and the red color will go away
209
Q

Main symptom of lumbosacral strain

A

nontender to touch

210
Q

main symptom of cord compression

A

tender to touch

211
Q

symptoms of epidural abscess of the spine

A

tender to touch with fever

212
Q

main symptom of spinal stenosis

A

pain on walking downhill

213
Q

how does syringomyelia present?

A

loss of sensation of pain and temp in the upper extremities bilaterally in a cape-like distribution over the neck, shoulders, and down both arms

214
Q

how to diagnose syringomyelia?

A

MRI

215
Q

Tx for syringomyelia?

A

surgical

216
Q

What is the most urgent step with a patient with spinal cord compression?

A
  • get the swelling down via steroids
217
Q

How can spinal cord compression present?

A

bilateral lower extremity weakness, hyperreflexia, and possible bowel and bladder dysfunction

218
Q

A large spinal epidural abscess will be treated via?

A

surgical decompression

219
Q

When a spinal epidural abscess is suspected, what antibiotics should be given?

A

Oxacillin or nafcillin to protect against staph infection

220
Q

Which two senses are preserved in an anterior spinal artery infarction?

A
  • position

- vibratory

221
Q

How does brown-sequard syndrome present?

A
  • ipsilateral position, vibratory sense
  • contralateral pain
  • temperature
222
Q

What are examples of upper motor neuron injury signs?

A
  • hyperreflexia
  • upgoing toes on plantar reflex
  • spasticity
  • weakness
223
Q

What are examples of lower motor neuron injury signs?

A
  • wasting (atrophy)
  • fasciculations
  • weakness
224
Q

tx for ALS

A

riluzole or edaravone (an antioxidant)

225
Q

MOA of riluzole

A

blocks the accumulation of glutamate

226
Q

Define pseudobulbar affect

A

form of emotional lability or emotional incontinence characterized by intermittent episodes of laughter and crying

227
Q

Tx for pseudobulbar affect

A

dextromethorphan with quinidine

228
Q

What is the most common cause of peripheral neuropathy?

A

diabetes

229
Q

Tx for diabetic neuropathy

A

gabapentin or pregabalin

*TCAs can also be used but have a higher ADR profile

230
Q

What is the initial management of carpal tunnel syndrome?

A

splint

231
Q

When is surgery necessary for carpal tunnel syndrome?

A

When there is muscle atrophy

232
Q

Radial nerve palsy is aka?

A

Saturday night palsy

233
Q

How does radial nerve palsy present?

A

wrist drop

234
Q

Peroneal nerve palsy is usually caused by?

A

wearing high boots at the back of the knee

235
Q

How will peroneal nerve palsy present?

A

foot drop

236
Q

How does trigeminal neuralgia present?

A

excruciating pain in the face with minor contact or touching of the tongue behind the teeth

237
Q

1st line tx for trigeminal neuralgia

A

carbamazepine

238
Q

How does bells palsy present?

A
  • hemifacial paralysis of the upper and lower halves of the face
  • loss of taste of the anterior 2/3 of the tongue
  • hyperacusis
  • inability to close the eye at night
239
Q

Tx for Bells Palsy

A

steroids

240
Q

Bells palsy is usually caused from?

A

viral infection

241
Q

Define reflex sympathetic dystrophy

A
  • aka regional pain syndrome
  • seen in patients who have previous injury to the extremity
  • burning sensation with light touch
242
Q

1st line tx for reflex sympathetic dystrophy

A
  • pramipexole or ropinirole
243
Q

Restless leg syndrome is associated with which deficiency?

A

iron

244
Q

What is the most important factor in determining treatment for guillan-barre syndrome?

A

peak inspiratory pressure

*predicts who will have respiratory failure before it happens

245
Q

What is the presentation of Guillan-Barre syndrome?

A
  • ascending weakness with loss of deep tendon reflexes after having an illness (usually from C.jejuni)
246
Q

What are the characteristics of Miller Fisher Syndrome?

A
  • descending weakness
  • ocular/oculomotor palsies
  • antibodies against GQ1b
247
Q

How does myasthenia gravis present?

A
  • weakness that progresses as the day goes on
  • weakness with mastication
  • blurry vision from diplopia
  • drooping of eye lids
248
Q

What is the best initial test for myasthenia gravis?

A
  • Anti-ach receptor antibodies
249
Q

If the anti-ach receptor antibodies are negative in a suspected patient with myasthenia gravis, what is the next test to order?

A
  • anti-muscle specific kinase antibodies
250
Q

What is the best initial treatment for myasthenia gravis?

A
  • pyridostigmine or neostigmine
251
Q

Patients with myasthenia gravis on pyridostigmine or neostigmine with ADRs can be placed on ____ to help alleviate ADRs.

A
  • glycopyrrolate

* helps with drooling and diarrhea

252
Q

What is the treatment with a patient in myasthenia crisis?

A
  • IVIG or plasmaphoresis
253
Q

MOA of azathioprine

A

decrease t-cell function

254
Q

Presentation of lambert-eaton syndrome

A
  • hyporeflexia

- weakness that improves with repetitive movements

255
Q

What is the test for lambert-eaton syndrome?

A
  • anti-voltage gated calcium channel antibodies
256
Q

Tx for lambert-eaton syndrome?

A
  • amifampridine or dalfampridine
257
Q

Why would you order a CXR for a patient with myasthenia gravis?

A
  • they may have a thymoma that is causing their symptoms or thymic hyperplasia
258
Q

AcH receptors on muscles are ____

A

nicotinic

259
Q

AcH receptors in the lung, bladder, bowel, saliva, and eyes are _____

A

muscarinic

260
Q

What is the most accurate test for myasthenia gravis?

A
  • single fiber electromyography
261
Q

How does plasmaphoresis work in myasthenia gravis?

A

It removes the antibody that attacks acH receptors.

262
Q

MOA of IVIG in myathenia gravis tx

A

blocks macrophages that attack AcH receptors

263
Q

If patient is having no improvement with disease progression on an anticholinesterase inhibitor with MG, what is the next step?

A

thymectomy

264
Q

Patients on cyclosporine should have which function monitored?

A

renal

265
Q

What does GBS impair?

A

only muscular exertion; no effect on elastic fibers or the flexibility of the chest wall

266
Q

What is the most accurate test for GBS?

A

nerve conduction velocity testing

267
Q

WHat is a positive result for GBS on nerve conduction velocity testing?

A

decreased F-wave transmission

268
Q

What will most likely be found in CSF from LP in a patient with GBS?

A

high protein with normal cell count

269
Q

What is the mechanism of GBS that causes ascending paralysis?

A
  • antibodies attacking peripheral nerve myelin
270
Q

What are the three characteristics of cushing reflex?

A
  • hypertension
  • bradycardia
  • increased intracranial pressure
271
Q

What causes a dilated pupil on the site of the intracranial bleed?

A
  • compression of the third cranial nerve

* dilating the third cranial nerve would cause constriction

272
Q

What is the mechanism that causes a lucid interval in a patient with an intracranial bleed?

A
  • accumulation of blood in the skull decreasing perfusion

* the accumulation of blood increases intracranial pressure and decreases cerebral perfusion

273
Q

A patient with a suspected intracranial bleed who is having a further worsening change in altered mental status should have what next in their management?

A
  • intubated and hyperventilated
274
Q

What is the beneficial effect in hyperventilating an intracranial bleed?

A

decreased PCO2 constricts cerebral vessels

*cerebral vessels are very sensitive to concentrations of CO2

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