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neurology Flashcards

1
Q

tension headache character

A 
30 minutes to 7 days
Typically bilateral location
Pressure or tight quality
Does not prohibit activity
Not associated with nausea
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2
Q

tension headache tx

A

Treat acute headache with NSAIDs

A tricyclic antidepressant may be needed for prophylaxis

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3
Q

trigeminal neuralgia symptoms

A

Brief paroxysms of unilateral lancinating pain in the V2 or V3 distribution of the trigeminal nerve, often
triggered by light touch of the affected area

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4
Q

imaging needed for trigeminal neuralgia

A

MRI to rule out intracranial lesions and MS

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5
Q

tx for trigeminal neuralgia

A

Select carbamazepine for treatment

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6
Q

medication overuse headache symptoms

A

Chronic headache that occurs ≥10 days per month in patients using combination analgesics,
ergotamine products, or triptans; chronic headache that occurs >15 days per month in patients using
simple analgesics

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7
Q

chronic migraine characteristics

A

Headache occurring ≥15 days per month for >3 months
Headache possessing the features of migraine ≥8 days per month
Risk factors include migraine headache frequency or acute medication use >10 days per month

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8
Q

1st and 2nd line tx for migraisn

A

nsaids

then use triptans if lack of response or severe

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9
Q

treatment for . Migraine that is present on awakening, is associated with vomiting, or is found to escalate rapidly

A

intranasal triptans or subcutaneous

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10
Q

tx for migraine assoc nausea

A

Metoclopramide and prochlorperazine

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11
Q

indications to use prophylaxis for migraine

A

migraines do not respond to therapy
• headache occurs ≥10 days per month
• disabling headache occurs ≥4 days per month
• use of acute migraine medications is >8 days per month

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12
Q

options for ppx tx of migraines

A

amitriptyline, metoprolol, propranolol, timolol,

topiramate, valproic acid, and venlafaxine. Onabotulinum toxin A is indicated in chronic migraine.

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13
Q

contraindications to triptans

A

CAD and cerebrovascular disease, brainstem aura, and hemiplegic migraine.

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14
Q

characteristics of cluster headaches

A

Pain usually periorbital, duration 15-180 minutes, several times per day. Repeating over weeks then
disappearing for months or years. Unilateral tearing and nasal congestion or rhinorrhea, eyelid
edema, miosis and/or ptosis

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15
Q

tx of cluster headaches

A

acute - triptan and oxygen

chronic veramapil

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16
Q

symptoms of chronic paroxysmal hemicranias

A

Occurs at least five times daily lasting 2-30 minutes. Responds completely to indomethacin.

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17
Q

Short-lasting Unilateral Neuralgiform headaches with Conjunctival injection and Tearing

A

Dozens to hundreds of times per day, with durations of 1 to 600 seconds. Typically resistant to treatment.

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18
Q

Hemicrania continua symptoms

A

Persistent strictly unilateral headache that responds to indomethacin

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19
Q

red flag symptoms for headache (9)

A
  • first or worst headache
  • abrupt onset or thunderclap attack
  • progression or fundamental change in headache pattern
  • abnormal physical examination findings
  • neurologic symptoms lasting >1 hour
  • new headache in persons >50 years old
  • new headache in patients with cancer, immunosuppression, or pregnancy
  • association with alteration in or loss of consciousness
  • headache triggered by exertion, sexual activity, or Valsalva mane
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20
Q

testing for headaches when red flag symptoms are present

A

MRI over CT in nonemergency situations
• CT for suspected acute ICH
• ESR or CRP for suspected giant cell arteritis
• LP for suspected infectious or neoplastic meningitis or disorders of intracranial pressure

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21
Q

Subarachnoid hemorrhage

(SAH) clues

A

Sudden onset of “worst headache of my life”
Many patients have warning “sentinel” headaches
before SAH

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22
Q

carotid or vertebral dissection clues

A

Neck pain and ipsilateral headache; neurologic
findings in territory of involved vessel
tx with asa heparin or anticoag

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23
Q

clues for thrombosis of cerbral vein or dura sinus

A

Exertional headache, papilledema, neurologic
findings
Consider in hypercoagulable states, pregnancy, use of
oral contraceptives
Tx LMWH followed by warfarin

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24
Q

Reversible cerebral

vasoconstriction syndrome clues

A

Recurrent thunderclap headache syndrome, more
frequent in women. Associated with pregnancy,
neurosurgical procedures, exposure to adrenergic or
serotonergic drugs. Imaging shows strokes,
hemorrhages, or cerebral edema

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25
Q

Idiopathic intracranial hypertension (pseudotumor cerebri) is
characterized by

A

intracranial pressure without identifiable structural pathology. Patients are typically female, obese, and
of child-bearing age. Papilledema is nearly always present.

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26
Q

diagnose and tx pseudotumor cerebri

A

Diagnosis is confirmed by a CSF pressure >250 mm H2O with normal fluid composition. MRI may be normal or show small ventricles, widened optic nerve sheaths, or a partially empty sella.

tx acetazolamide

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27
Q

epilepsy diagnosis

A

two or more unprovoked seizures occurring more than 24 hours apart or one unprovoked seizure with a significant ongoing risk of further unprovoked seizure

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28
Q

Focal seizure without alteration of awareness

(formerly simple partial seizures) charateristics

A

Normal consciousness and awareness
Single neurologic modality (sensory, motor, olfactory, visual, gustatory) involving a
single region of the body, such as the hand or arm

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29
Q

Focal seizure with alteration of awareness

(formerly complex partial seizure) characteristics

A

Conscious but unresponsive or staring
Automatism (lip smacking, swallowing, or manipulating objects)
Postictal confusion

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30
Q

Primary generalized seizure characteristics

A

Loss of consciousness or awareness at onset
No prodromal or localizing symptoms
Whole-body stiffening (tonic) and/or jerking (clonic) seizures

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31
Q

Temporal lobe epilepsy

A

Focal seizures with alteration of awareness preceded by an aura before losing consciousness. Often unaware that they have become impaired and may have no recollection of the seizure. Medial temporal sclerosis is a characteristic finding on MRI.

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32
Q

Idiopathic (genetic)

generalized epilepsy

A

Any combination of tonic-clonic seizures, absence seizures, and myoclonic seizures. MRI typically normal. EEG may show generalized spike-wave abnormality.

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33
Q

Frontal Lobe epilepsy

A

Nocturnal complex seizures that awaken patients from sleep. Often associated with underlying structural
pathology (e.g., tumor, vascular malformations).

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34
Q

Myoclonic seizure

A

A generalized seizure associated with brief, lightning-like jerks of the arms, not associated with loss of
consciousness (misdiagnosed as “jitteriness”).

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35
Q

Convulsive status epilepticus

A

Characterized by continuous seizure for ≥5 minutes. Most common cause is low AED level. Complications
include aspiration pneumonia, fever, hemodynamic instability, acidosis, PE, and rhabdomyolysis;
associated with a mortality rate of approximately 20%.

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36
Q

symptoms of PNES

A
  • forced eye closure
  • long duration
  • hypermotor activity that starts and stops
  • pelvic thrusting
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37
Q

evaluation needed after first unprovoked seizure

A

• EEG (although a normal EEG does not rule out a seizure)
• CBC, electrolyte and glucose levels, and toxicology screen
• brain MRI (or head CT in an emergency)
• CSF examination if the patient has fever, prolonged altered mental status after the seizure, is immunosuppressed, or has
a severe headache

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38
Q

how do you diagnose PNES and what population is susceptible to pNES

A

Inpatient video EEG monitoring is required to make the diagnosis of PNES
PTSD in military

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39
Q

carbamazepine SE

A

interactions with other hepatically metabolized drugs and increased risk for osteoporosis and
hypercholesterolemia

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40
Q

• valproic acid SE

A

weight gain, hypercholesterolemia, PCOS, teratogenicity, hepatotoxicity

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41
Q

tompiramate and zonisamide SE

A

increased risk of kidney stones

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42
Q

• carbamazepine and oxcarbazepine SE

A

hyponatremia, pancytopenia

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43
Q

all AED have a potential SE of

A

drug hypersensitivity syndrome, SJS, and suicidal ideation

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44
Q

when can you stop AED

A

seizure free for 2-5 years

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45
Q

AEDs that are relatively safe in preg

A

lamotrigine (dose adjustment)

and levetiracetam

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46
Q

most common cause of status epileticus

A

low blood AED levels

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47
Q

tx for status epilepticus

A

First-line treatment is IV lorazepam, IV diazepam, or IM midazolam. Patients not taking AEDs should then be treated with phenytoin or fosphenytoin, administered after
5 minutes of continuous seizing

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48
Q

when is Surgical clipping or endovascular coiling of aneurysms are indicated

A

patients with aneurysms ≥7 mm in the posterior circulation or ≥12 mm in the anterior circulation.

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49
Q

all patients with TIA require

A
  • emergent head CT without contrast (to rule out intracranial hemorrhage)
  • ECG and telemetry or event monitoring (to rule out AF)
  • vascular studies (cerebrovascular ultrasonography or cerebrovascular MRA, CTA)
  • echocardiography (to rule out LV or valvular thrombus
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50
Q

abcd2 scoring system

A

Age ≥60 y 1

Blood pressure ≥140/90 mm Hg 1

Clinical Symptoms
• focal weakness with the TIA 2
• speech impairment without weakness 1

Duration of TIA
• ≥60 min 2
• 10-59 min 1

Diabetes mellitus present 1

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51
Q

what abcd2 score do you hospitalize

A

> /=3

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52
Q

what kind of stroke should you consider in older adults with persistent, acute-onset vertigo

A

vertibral basilar

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53
Q

how quickly do you need to administer tpa

A

within 3 hours or 4.5 hrs in selective patients

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54
Q

exclusion criteria for tpa

A
  • age >80 years
  • severe stroke
  • diabetes mellitus with a previous infarct
  • anticoagulant use

increased risk of bleeding, diagnosis of ICH, or SBP
>185 mm Hg and DBP >110 mm Hg

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55
Q

additional stroke treatment acutel

A
  • treat temperature >38.0 °C (100.4 °F) with acetaminophen
  • administer normal saline to maintain euvolemia
  • give aspirin, 325 mg, unless thrombolysis is planned
  • start DVT prophylaxis within 48 hours
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56
Q

only times to start antihypertensive therapy early in acute stroke instead of permissive htn

A
  • SBP is >220 mm Hg, DBP is >120 mm Hg, or MAP is >140 mm Hg
  • thrombolytic therapy is planned, and SBP >185 mm Hg or DBP >110 mm Hg
  • ACS, aortic dissection, or end-organ damage is present
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57
Q

whats considered a small SAH

A

<7 mm posterior or <12 mm anterior circulation can be monitored by MRI

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58
Q

most common location/cause of SAH

A

results from the rupture of saccular (“berry”) aneurysms of the circle of Willis.

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59
Q

eye symptoms in SAH

A

(third nerve palsy and dilated pupil

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60
Q

what should you do if SAH is suspected but CT negative

A

Do CSF to look for erythrocytes or xanthochromia.

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61
Q

Tx for SAH

A

• Treat ruptured aneurysms with surgical clipping or endovascular coiling within 48 to 72 hour
• Maintain BP <140/80 mm Hg to prevent rebleeding.
• Select oral nimodipine for 21 days to prevent vasospasm and improve
neurologic outcomes.

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62
Q

what needs to be done in the setting ICH and cocaine use

A

Cerebral angiography is indicated for patients <45 years of age with ICH related
to cocaine use

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63
Q

what score on mini mental is associated with dementia

A

<24

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64
Q

routine testing/imagining for dementia

A

Routinely obtain brain imaging with CT or MRI to detect nondegenerative causes that would alter management, such as cerebrovascular disease, neoplasm, subdural hematoma, or hydrocephalus. Screen all patients for depression.

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65
Q

when to obtain LP in dementia

A
  • rapidly progressive dementia
  • age of onset <60 years
  • history of malignancy or paraneoplastic disorders
  • suspicion for acute or subacute infection; immunosuppressed or immunodeficiency state
  • positive syphilis or Lyme serology
  • systemic autoimmune disease; suspected CNS autoimmune or inflammatory disorder
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66
Q

diagnose Gradual memory loss, aphasia, apraxia, agnosia, inattention, and decrease in
executive function

A

alzheimer disease

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67
Q

diagnose: Imaging or history positive for stroke responsible for impairment of at least
one cognitive domain
Common findings include focal neurologic findings, depression, pseudobulbar
palsy, gait abnormalities, and urinary difficulties

A

vascular neurodegenerative disorder

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68
Q

Mild parkinsonism characterized by postural instability and gait difficulty,
fluctuating cognition, delusions, and visual hallucinations

A

dementia with lewy body

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69
Q

Early and prominent personality changes, behavioral disturbances including
disinhibition and impulsivity, diminished frontal and/or temporal lobes on MRI,
onset before age 60 years

A

Frontotemporal dementia, behavioral variant

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70
Q

Dementia, shuffling gait, urinary incontinence, and ventriculomegaly in the
absence of past history of meningitis, SAH, or trauma

A

Normal-pressure hydrocephalus

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71
Q

Choreoathetosis and dementia, autosomal dominant pattern of

inheritance

A

Huntington disease

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72
Q

Prominent myoclonus, characteristic EEG pattern of triphasic sharp waves, CSF
protein 14-3-3, rapidly progressive onset at early age

A

Creutzfeldt-Jakob disease

73
Q

Early postural instability and falls, apathy, parkinsonism poorly responsive to
levodopa, and vertical gaze palsy

A

Progressive supranuclear palsy

74
Q

History of head injury followed by delayed development (10 years) of
impaired concentration, short-term memory, executive dysfunction, and
judgment; aggression, depression, irritability, violent behaviors, and
suicidality; and parkinsonism, unsteady gait, shuffling gait, and slurred speech

A

Chronic traumatic encephalopathy

75
Q

treatment for mild to mod dementia

A

(donepezil, rivastigmine, and galantamine)

76
Q

side effects of ach inhibitors

A

bradycardia, diarrhea, heart block, nausea and vomiting, and syncope

77
Q

best option to delay cog decline in moderate alzheimer

A

Memantine

78
Q

tx for lewy body

A

ach inhibitors

79
Q

tx for normal cephalic hydrocephalus

A

large volume LP

80
Q

parkinsons cause

A

degeneration of dopaminergic neurons in the substantia nigra of the midbrain

81
Q

parkinsons diagnosis requires 2 of the following

A

bradykinesia (slowed movement and decreased amplitude of repetitive movement)
• rigidity (cogwheel type)
• resting tremor (or with movement)
• postural reflex abnormality (falling)

82
Q

Early dementia within the first year of the appearance of parkinsonism is a
hallmark of

A

dementia with Lewy bodies.

83
Q

early signs of parkinsons

A

loss of smell, constipation, and acting out dreams may

precede the onset of motor symptoms by years

84
Q

cutaneous associatio with parkinsons

A

sebhoreic dermatitis

85
Q

Multiple system atrophy

A

Severe orthostatic hypotension and ataxia

MRI showing “necrosis” of the putamen and cerebellar atrophy

86
Q

Progressive supranuclear palsy

A 
Unexplained falls (typically backward), inability to move eyes vertically, and parkinsonian
features
87
Q

Medication-induced parkinsonism

A

Antiemetics (prochlorperazine, metoclopramide), antipsychotics (haloperidol),
reserpine, lithium, and methyldopa

88
Q

what are some concerns of levadopa and how to counteract them

A

associated with motor fluctuations,
including dyskinesias, and a “wearing-off” effect (enhanced parkinsonian symptoms). Initiating therapy with a dopamine
agonist (pramipexole, ropinirole) in patients younger than 65 years avoids the early appearance of these side effects

89
Q

side effects of dopamine agonist

A

sedation and an increase in compulsive behaviors such as gambling, shopping, and
hypersexuality

90
Q

manifestations of Essential tremor

A

Typically slowly progressive or stable over time
Bilateral postural or kinetic tremor; improves with alcohol
Family history positive in 50%

91
Q

treatment for essential tremor

A

Propranolol, primidone, or topiramate

92
Q

manifestation of huntingtons

A

Most common neurodegenerative cause of generalized
chorea
Also progressive dementia and psychiatric
manifestations
Autosomal dominant

93
Q

tx for huntingtons

A

Symptomatic treatment with

tetrabenazine and deutetrabenazine

94
Q

manifestations of Drug-induced dystonia

A

Tardive dyskinesia associated with choreiform and
dystonic craniofacial movements
Can be caused by neuroleptic, antiemetic, and
serotoninergic medications

95
Q

tx for drug induced dystonia

A

Stop the offending drug
Valbenazine, clonazepam, tetrabenazine,
anticholinergic agents, and clozapine`

96
Q

Cervical dystonia (torticollis) manifestations

A

Cervical muscle contractions resulting in abnormal

posture of the head and neck

97
Q

Cervical dystonia (torticollis) treatment

A

Botulinum toxin (first line)

98
Q

Tourette syndrome manifestations

A

Childhood onset, multiple complex motor tics, and

presence of vocal tics (e.g., echolalia)

99
Q

Tourette syndrome treatment

A

Reassurance or cognitive behavioral

therapy

100
Q

Myoclonus manifestations

A

Rapid, shock-like, jerky movements of isolated body parts
Underlying metabolic disorder, serotonin syndrome,
postanoxic, Creutzfeldt-Jakob disease, corticobasal
degeneration

101
Q

myoclonus treatment

A

Treat the underlying metabolic disorder

102
Q

what should you screen patients <40 years with “essential tremor” or dystonia for

A

Wilson disease with serum ceruloplasmin and

24-hour urine copper measurements.

103
Q

what is MS

A

episodes of dysfunction resulting from demyelinating lesions (plaques) in different areas of the CNS
(brain, brain stem including optic nerve, or spinal cord) at different times.

104
Q

what is Relapsing-remitting MS

A

Clinical episodes of neurologic dysfunction, typically lasting weeks before improving, that may lead
to the accumulation of disability.

105
Q

what is Secondary progressive disease in MS

A

Disappearance of evidence of clinical relapses in the relapsing-remitting form and by
progressive disability.

106
Q

what is Primary progressive MS disease

A

Progressive disability accumulation from the time of disease onset.

107
Q

Optic neuritis description

A

Subacute visual deficit in one eye along with pain with eye movement

108
Q

Afferent pupillary defect MS involvement

A

Paradoxical dilation of the pupil when light is rapidly shifted from the
unaffected to the affected eye

109
Q

Papillitis MS involvement

A

Inflammatory changes in the retina causing a flared appearance of the optic
disc

110
Q

Myelitis MS involvement

A

Focal inflammation within the spinal cord manifesting as sensory, autonomic,
or motor symptoms below the affected spinal level

111
Q

Lhermitte sign MS involvement

A

A shock-like sensation radiating down the spine or limbs induced by neck
movements

112
Q

Bladder MS involvement

A

Urinary frequency, urgency, or retention

113
Q

Cerebellum MS Involvement

A

ataxia and vertigo

114
Q

Brainstem MS involvement

A

(internuclear ophthalmoplegia) Inability to adduct one eye and nystagmus in the abducting eye

115
Q

Uhthoff phenomenon in MS

A

Transient worsening of baseline neurologic symptoms with elevations of body
temperature

116
Q

how to diagnose MS

A

evidence of CNS demyelination disseminated in both space and time as demonstrated through a combination
of documented clinical relapses, signs on physical examination, and the distribution of lesions on an MRI.

117
Q

CSF finding in MS

A

oligoclonal IgG bands or an elevated IgG index

118
Q

Treatment of MS flare

A

IV methylprednisolone followed by oral glucocorticoids speeds recovery from acute exacerbations, most effectively in acute
optic neuritis.

Treat fever and look for underlying cause of fever before starting steroids

119
Q

chronic treatment for MS after first flare

A

interferon beta or glatiramer acetate if imaging suggests MS.

120
Q

what vitamin is helpful additive for MS patients

A

Vitamin D added to interferon beta reduces the accumulation of MRI lesions and is recommended for all patients with MS

121
Q

Tx for r confirmed relapsing-remitting MS (RRMS).

A

Prescribe interferon beta or glatiramer acetate

122
Q

MS Spasticity tx

A

Physical therapy, stretching, massage therapy

Baclofen, benzodiazepines, cyclobenzaprine,
tizanidine

123
Q

MS Neuropathic pain

A

Carbamazepine, duloxetine, gabapentin,

pregabalin, topiramate

124
Q

MS Fatigue tx

A

Proper sleep hygiene, regular exercise

Amantadine, amphetamines, armodafinil,
modafinil

125
Q

MS Depression tx

A

Individual or group counseling

Antidepressants (SNRIs, SSRIs)

126
Q

MS cognitive dysfunction tx

A

Cognitive rehabilitation and accommodation
strategies
No medication has been proven effective

127
Q

MS mobility tx

A

Physical and occupational therapy; use of braces,
canes, rolling walkers, or electrostimulatory walkassist devices

Dalfampridine

128
Q

MS Urinary retention tx

A

Manual pelvic pressure, intermittent catheterization

129
Q

• Interferon agents are contraindicated in patients with …

A

Liver disease or depression

130
Q

is getting pregnant with MS increase risk of disability

A

NO

131
Q

does Combining glatiramer acetate with interferon beta provide greater therapy

A

NO

132
Q

what is Neuromyelitis optica

Devic disease

A

Recurrent episodes of myelitis and optic neuritis without the brain lesions typical of MS; NMO-IgG
autoantibody may be present

133
Q

what is Idiopathic transverse

myelitis

A

Subacute onset of weakness, sensory changes, and bowel/bladder dysfunction, typically after a viral infection
Distinguished from MS by the presence of complete myelitis, no oligoclonal bands or elevated IgG index in
the CSF, and no lesions on brain MRI

134
Q

b12 myelopathy characteristics

A

Paresthesias, lower-extremity weakness, and gait instability
Findings may include paraparesis, vibration and position sense loss, and sensory ataxia.
Anemia may be absent

135
Q

Copper deficiency myelopathy characteristics

A

Mimics vitamin B12 deficiency

May develop after bariatric surgery or from excessive zinc ingestion

136
Q

Infarction of the spinal

cord characteristics

A

Acute onset of flaccid paralysis or weakness and pinprick sensation loss below the level of the infarction
Potential causes include emboli, hypotension during cardiovascular/aortic surgery, and AV malformations

137
Q 
Clues to the cause of compression myelopathy:
• fever
• anticoagulation 
• cancer
• trauma
• elderly with chronic back/leg pain
A
  • fever — epidural abscess
  • anticoagulation — epidural hematoma
  • cancer — metastases
  • trauma — vertebral fracture
  • elderly with chronic back/leg pain — spinal stenosis
138
Q

tx for transverse myelitis

A

IV methylprednisolone

139
Q

Spinal cord compression caused by leukemia, lymphoma, myeloma, and germ cell tumors may be treated urgently with surgery or radiation?

A

radiation!

140
Q

signs of ALS

A

combination of upper motoneuron signs (e.g., hyperreflexia, spasticity, and extensor plantar
response) coexistent with lower motoneuron findings (e.g., atrophy and fasciculation). Sensory deficits are characteristically absent.

141
Q

how does ALS symptoms present

A

Muscle weakness in patients with ALS usually begins distally and asymmetrically, although 20% of patients have bulbar-onset
ALS with difficulty speaking and swallowing

142
Q

tx for ALS

A

Riluzole may increase survival by about 3 months. Begin noninvasive ventilatory support for patients with respiratory insufficiency. Placement of a percutaneous endoscopic gastrostomy tube is indicated when weight loss or swallowing difficulty occurs.

143
Q

cause of myasthenia Gravis

A

antibodies directed against the acetylcholine receptor, which results in impaired neuromuscular transmission.

144
Q

signs of MG

A

ptosis or diplopia (first manifestation in most patients)
• muscle weakness, including dysphagia and dyspnea
• positive anti–acetylcholine receptor antibody titer (found in 90% of patients; negative titer does not rule out MG)
• normal deep tendon reflexes and sensation
• decremental response to repetitive stimulation on EMG

145
Q

Difference between botulism and MG

A

cranial nerve involvement, including diplopia, dysphagia, and sluggish or nonreactive pupils, whereas the pupils are normal in MG

146
Q

Lambert Eaton symptoms

A

progressive proximal weakness and diminished tendon reflexes that improve
with repetitive movement of affected muscles

147
Q

diagnosing lambert eaton

A

Diagnosis is confirmed by detection of serum anti–voltage-gated calcium channel
antibodies and the EMG finding of facilitation of motor response to rapid repetitive stimulation.

148
Q

what disease is lambert eaton associated with

A

SCLC

149
Q

how to diagnose MG

A

Single-fiber EMG can establish the diagnosis. Look for elevated serum TSH levels because of the association of MG with autoimmune thyroid disorders. Perform CT of the chest to detect thymoma.

150
Q

what drugs can precipitate MG crisis

A

aminoglycosides, quinolones, magnesium, β-blockers, or

calcium channel blockers as precipitants of myasthenic crisis

151
Q

Treatment for MG

A

pyridostigmine

Thymectomy if thymoma present

152
Q

Tx for MG crisis

A

plasmapheresis or IV immune globulin.

Pyridostigmine monotherapy should be avoided in this scenerio due to increased resp secretions

153
Q

diagnosis: Isolated anterolateral thigh numbness

without weakness

A 
Meralgia paresthetica (a compressive neuropathy
of the lateral femoral cutaneous nerve)

Tx: Locate and relieve pressure

154
Q

diagnosis Sensory loss over palmar surface of first
three digits and weakness with thumb
abduction and opposition

A

Median neuropathy (carpal tunnel syndrome)

155
Q

Diagnose: Numbness of the fourth and fifth fingers

and weakness of interosseous muscles

A

Ulnar neuropathy

Tx: Elbow splinting or elbow pads

156
Q

Diagnose: Pain, tingling, and numbness in great toe

and along medial foot

A

Tarsal tunnel syndrome

Tx Local glucocorticoid injection;
decompression surgery if severe

157
Q

Diagnose Upper and lower face weakness

A

Bells Palsy

Tx: Prednisone within 72 hrs

158
Q

Painful, Multiple, noncontiguous nerve deficits

mononeuritis multiplex

A

Vasculitis

159
Q

diagnose: Distal and symmetric (stocking-glove)

sensory or sensorimotor

A

Axonal polyneuropathies; diabetes and alcohol

are the most common causes;

160
Q

diagnose Severe unilateral leg pain, numbness,
proximal weakness, atrophy, and weight
loss

A

dm amyotrophy

161
Q

Diagnose: , ascending, areflexic paralysis and
paresthesias often preceded by GI
illness (usually Campylobacter infection);
CSF shows elevated protein and a
normal cell count (albuminocytologic
dissociation)

A

Guillain-Barré syndrome

Tx Plasma exchange or IV immune
globulin

Dont do steroids may slow recovery

162
Q

Diagnose: Progressive proximal motor and sensory
neuropathy that evolves over months.
Initial EMG and CSF findings similar to
Guillain-Barré syndrome

A

Chronic inflammatory demyelinating
polyneuropathy

Prednisone, plasma exchange, or IV
immune globulin

163
Q

Diagnose: Symmetric distal sensory neuropathy in
the setting of MGUS, multiple myeloma,
amyloidosis, and cryoglobulinemia

A

Paraproteinemic neuropathy

164
Q

How to differentiate myopathy from neuropathy

A

Myopathies typically present with symmetric weakness of the proximal muscles.
• Normal sensory and reflex examination differentiates myopathy from neuropathy.
• Serum CK level is elevated and falls in response to treatment.
• EMG confirms the presence of myopathic changes (low amplitude, short duration, and polyphasic motor unit potentials)

165
Q

Type of myopathy: Diffuse myalgia, proximal muscle weakness, delayed relaxation phase of deep tendon reflexes, and
elevation of CK

A

Hypothyroid myopathy

166
Q

Type of Myopathy: Myopathy, brisk reflexes, fasciculation, and ophthalmoplegia

A

Hyperthyroidism

167
Q

Type of Myopathy: Proximal muscle weakness, myalgia, fatigue, and osteomalacia-related bone pain

A

Vitamin D deficiency

168
Q

Type of Myopathy: Proximal weakness and myalgia, normal CK levels, and normal EMG findings

A

Glucocorticoid myopathy

169
Q

type of myopathy: Subacute toxic myopathy associated with rhabdomyolysis

A

statin myopathy

170
Q

Type of myopathy: Myotonia (manifested as delayed hand-grip release) and distal weakness

A

Myotonic dystrophies

171
Q

which statins are more likley to cause myopathy

A

Lipophilic statins (atorvastatin, simvastatin, and lovastatin) have a higher propensity to cause statin myopathy

172
Q

characteristics of meningioma

A

benign
. CT scan of the head will show a partially calcified, homogeneously
enhancing extra-axial mass adherent to the dura and an enhancing dural “tail.”

Tx resect growing or symptomatic meningioma

173
Q

common primary source for lung met

A

evaluate the patient for lung cancer, breast cancer,

and melanoma.

174
Q

Parenchymal metastases on MRI

A

multiple, ring-enhancing, centrally necrotic lesions

175
Q

What kind of brain met is likely in leukemia and lymphoma

A

leptomeningeal metastases

176
Q

first line tx for parynchamal or leptomeningial tumor

A

Glucocorticoids are a first-line treatment for parenchymal and leptomeningeal tumors.

177
Q

initial therapy for patients with leptomeningeal metastases from leukemia and lymphoma

A

Chemotherapy (methotrexate and cytarabine)

178
Q

cardinal features of brain death

A

coma, absence of brain stem reflexes, and apnea.

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