Neurology Flashcards
First step with any stroke suspicion before giving aspirin/TPA _________
CT Scan
Definition of TIA, neurological deficits resolving within ____ hours
24
Cryptogenic stroke is basically never the answer, requires ____ months of EKG/holter monitoring to rule out, and outer rule outs
1-3 months
Vertigo, nausea, vomiting, cannot describe faces are characteristic of ____ stroke
PCA
_____ stroke characterized by upper extremity predominant symptoms (weakness), aphasia, incontinence
ACA
in ____ stroke, eye deviate to same side of lesion, homonymous hemanipsia (L side stroke = L side ok) macular sparing, lower extremity predominant weakness,
MCA
stroke in the ____ results in vertical nystagmus, dysarthria, dystonia, ataxia, bilateral facial changes
vertebrobasilar artery
____ results in ipsilateral horners, vertigo, ataxia, ipsilateral facial weakness, contra-lateral body weakness
PICA stroke
One sided hemiparesis, one sided facial weakness/arm weakness_____ infarction
Lacunar
Unique characteristic of lacunar infarction_____
facial hemiparesis
___ is the time limit for TPA
4.5 hours , non severe stroke NIH<25. Only use if symptoms.
Is patient with ischemic stroke 8 months prior a candidate for TPA____
No, 1 year wait time
Surgery less than 6 weeks ago, is an indication for TPA___
No, for brain surgery have to wait 6 months , 3 weeks limit for traumatic CPR
Time limit for thrombectomy for stroke ____
24hrs , offers mortality + symptom benefit
First medication to give a stroke patient after CT Head_______
Aspirin
____ and ____ are side effects of ticlodipine, thats why no one uses this shit
TTP, Neutropenia
Most accurate test for cerebral venous thrombosis
MRV venogram
How is cerebral venous thrombosis treated : ____, switch to ____
LMWH, Warfarin
T/F : For TIA, dual anti-platelet therapy is indicated
True : Several weeks
Tests to do after Stroke
1) CT Head/MRI
2) ECHO/EKG
3) Carotid Duplex
4) Patient <50: Clotting disorder: ANA, anti phospho, protein S/C, Factor
Consider enderectomy if stenosis is >____, and patient is symptomatic
70%
Status epilepticus
1st Line____
2nd Line____
3rd Line____
4th Line_____
Lorazepam
Phosphophenytoin
Phenobarbital
Propofol
T/F: First time seizure requiring Benzo for status epilepticus needs treatment
Yes
Which drug has to be changed for a OCP using patient for seizure disorder_____
Lamotrigine, CYP potentiation, drug level too low
_____ seizure drug is associated with stevens johnson
levetiracetam (mutation SNP: HLA B1502)
_____ may be a treatment choice for parkinsons, among older patients>60, given fewer side effects
Amantidine
_____ is a parkinson like condition, with a hallmark symptom of ______ and mood swings
PSP
Vertical gaze palsy
_____ can occur with sudden withdrawal of parkinson medication
Rhabdomyalosis
Paradoxical: NMS like syndrome when starting anti psychotics, and when withdrawing
Levodopa related psychosis can be treated with _____
Quitiapine, pimavanserine (selective 5-HT3 agonist)
Essential tremor
1st Line : Propranolol
2nd Line: ________
3rd Line:_____
Primidone
Thalamus removal
Patients with MS receive ____ for nutritional support
Vitamin D, Calcium
____ is a CD20 inhibitor used for MS treatment
Ocrelizumab
Anticholinergics such as galantamine, donepizil, rivastigmine are used to treat _____ chronic condition
Alzheimers
CAD, PAD, Pregnancy are contra-indication for this migraine abortive______
Instead can use : _______
Triptans
metoclopramide, compazine (dystonia risk, give benadryl)
- Dopaminergic drugs
*Triptans cause vascular constriction
_____ is a the best prophylactic for cluster headaches
Ca2+ blockers (Verapmil)
_____ characterized by double vision, tinnitus (cranial nerve palsies), headache among young, obese women
Pseudotumor Cerebri (poor re-absorption of CSF)
Morphology of pneumococcal organism on gram stain____, of neisseria on gram stain_____
Gram + Diplococci
Gram - Diplococci
____ is a meningitis that can happen with CD4<100.
Cryptococcus
Cryptococcus
Dx:____
Tx:_____
India Ink stain, Crypto Ag
5FC/Amphoterecin —> Fluconazole
_____ meningitis characterized by joint pain, bullseye rash, CN7 palsy
Tx: Ceftrioxone
Lyme
Difference between Rocky mountain spotted vs Lyme______
Rash : Starts peripherally, moves inward for rocky mountain. Treatment is doxy for rocky mountain, ceftrioxone for lyme
TB meninigitis CSF key feature____
High protein
Treatment for TB Meningitis is RIPE + steroids, however ____ is exchanged for fluoroquinolone due to poor CNS penetration
Ethambutol
_____ meningitis needs prophylaxis of close contacts
Neisseria
- Rifampin, Ceftrioxone, Cipro
Miltefosine is a treatment for _____ encephalitis
Amoeba
T/F: Brain biopsy needed for treatment of Encephalitis
False
How to treat JC virus linked PML_____
Increase the CD4 count
_____ DMARD is associated with PRES syndrome
Cyclosporine
___ is a hallmark imaging finding of PRES
Posterior lobe vasogenic edema
Ratio used to check for infection during SAH___
1 WBC: 500 RBC on CSF
____ results in all position loss except vibration/position
Anterior spinal artery
Edaravone is a medication used to treat ____
ALS (antioxidant)
ALS patients can have a weird phenomena called_____, treated with Dextrometorphan/Quinidine
Pseudobulbar affect (inappropriate laughter, episodes of being emotionless)
Carpal Tunnel treatment
1) Splint
2) ____
3) ____
Steroid injection
Surgical release
_____ foot drop, difficulties with foot eversion after wearing boots
Peroneal nerve palsy
Chronic regional pain syndrome, i.e having huge pain in a location without clear reason, is best treated with ____
Pramipexole (dopamine agonist), NSAID, gabapentine
restless leg syndrome associated with ____ nutritional deficiency
Iron
____ is the reverse of Guillan Barre, resulting in descending instead of ascending paralysis
Miller-Fisher, Gq1B antibodies, treated with plasmapheresis/IVIG
AchR and ___ antibodies are associated with M.Gravis
Anti muscle specific antibody
For patient presenting with mysthenia crisis/Guillan Barre, getting ____ is critical to assess risk of respiratory failure
Peak inspiratory pressure (PIP)
______ type of stroke characterized by eyes deviating towards lesion (ipsilateral gaze palsy), upper extremity weakness, homonymous hemanopia that is macular sparing,
MCA stroke
_____ stroke characterized by vertical nystagmus, dysarthria/dystonia (bulbar), ataxia, sensory changes head/neck
vertebro-basilar
_____ stroke characterized by vertigo, horner syndrome, ataxia
PICA
Facial Hemiparesis = lacunar infarction
When can you not use TpA within 3 - 4.5 hours in stroke _____
1) Diabetic with prior stroke
2) Prior ischemic stroke within 1 year
3) Recent CPR
4) Surgery within 6 months
5) Any history of hemmorhagic stroke
6) Suspicion of aortic dissection
7) If neurological deficits have already resolved at time of arrival
Ticlodipine never used instead of plavix, because of ____ and ____
TTP, neutropenia
______ seizure medication associated with stevens johnson, and also cannot be used with OCP otherwise eliminated inappropriately
Lamotrigine
____ medicine is an serotonin inhibitor that can be used for Parkinsons with psychotic features
pimavanserin
_____ is a risk if dopaminergic parkinsons medications are abruptly discontinued
Rhabdomyalosis
____ is a parkinsonian like condition, however with more bulbar symptoms (dysphagia), less tremor, gaze palsy (vertical nystagmus)
PSP (Tx: Levodopa, amantadine, rivastigmine)
Essential Tremor Treatment
1) Propranolol
2) _______
3) Thalamotomy
Primidone/Topiramate/Gabapentin
____ is a CD20 drug used for MS, disease modifying agent
Ocrelizumab
Others : Natalizumab (PML risk), dimethyl fumarate, fingolimod
Alzheimers treatments_____
Donepezil, rivastigmine (increases AcH, cholinesterase inhibitors)
Treatment of normal pressure hydrocephalus (ataxia, incontinence, dementia)_____
VP shunt, LP will show normal pressure
Treatment of normal pressure hydrocephalus (ataxia, incontinence, dementia)_____
VP shunt, LP will show normal pressure
Migraine abortive treatment if triptan/ergotamine contraindicated (pregnancy, CAD)______
Anti emetic dopamine = reglan,
Contraindicated in CAD because triptans are vaso constricters
Treatment of pseudotumor cerebri ____
Acetazolamide —> VP shunt, here LP will show elevated pressure
Treatment of cryptococcus meningitis______
Serial LP, 5FC + Amphoterecin —> Fluconazole
_____ encephalitis associated with ovarian teratomas
auto-immune
Treatment of neurocystocercosis ____
Albendazole
Posterior lobe vasogenic edema in the setting of hypertensive crisis _____
posterior reversible encephalopathy syndrome
SAH can present with meningeal irritation, not always meningitis. For SAH____ is needed to properly embolize bleed, otherwise recurrent vasospasm may cause ischemic stroke
CT Angio
Cape like distribution loss of sensation caused by spinal _____
syringomyelia
____ causes loss of all sensation except vibration/position
Anterior spinal artery infarction
____ is a cord hemitransection, causes ipsilateral position, contralateral pain
brown sequard
ALS patients may have _____ inappropriate lability of emotions
pseudobulbar affect
Treatment of chronic regional pain syndrome_______
Anti-dopamine (pramipexole/ropinerole, iron, NSAID)
Treatment of LEMS
Amifampridine
