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USMLE Step 3 > Neurology > Flashcards

Neurology Flashcards

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USMLE® Step 1 flashcards
1
Q

First step with any stroke suspicion before giving aspirin/TPA _________

A

CT Scan

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2
Q

Definition of TIA, neurological deficits resolving within ____ hours

A

24

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3
Q

Cryptogenic stroke is basically never the answer, requires ____ months of EKG/holter monitoring to rule out, and outer rule outs

A

1-3 months

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4
Q

Vertigo, nausea, vomiting, cannot describe faces are characteristic of ____ stroke

A

PCA

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5
Q

_____ stroke characterized by upper extremity predominant symptoms (weakness), aphasia, incontinence

A

ACA

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6
Q

in ____ stroke, eye deviate to same side of lesion, homonymous hemanipsia (L side stroke = L side ok) macular sparing, lower extremity predominant weakness,

A

MCA

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7
Q

stroke in the ____ results in vertical nystagmus, dysarthria, dystonia, ataxia, bilateral facial changes

A

vertebrobasilar artery

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8
Q

____ results in ipsilateral horners, vertigo, ataxia, ipsilateral facial weakness, contra-lateral body weakness

A

PICA stroke

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9
Q

One sided hemiparesis, one sided facial weakness/arm weakness_____ infarction

A

Lacunar

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10
Q

Unique characteristic of lacunar infarction_____

A

facial hemiparesis

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11
Q

___ is the time limit for TPA

A

4.5 hours , non severe stroke NIH<25. Only use if symptoms.

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12
Q

Is patient with ischemic stroke 8 months prior a candidate for TPA____

A

No, 1 year wait time

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13
Q

Surgery less than 6 weeks ago, is an indication for TPA___

A

No, for brain surgery have to wait 6 months , 3 weeks limit for traumatic CPR

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14
Q

Time limit for thrombectomy for stroke ____

A

24hrs , offers mortality + symptom benefit

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15
Q

First medication to give a stroke patient after CT Head_______

A

Aspirin

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16
Q

____ and ____ are side effects of ticlodipine, thats why no one uses this shit

A

TTP, Neutropenia

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17
Q

Most accurate test for cerebral venous thrombosis

A

MRV venogram

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18
Q

How is cerebral venous thrombosis treated : ____, switch to ____

A

LMWH, Warfarin

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19
Q

T/F : For TIA, dual anti-platelet therapy is indicated

A

True : Several weeks

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20
Q

Tests to do after Stroke

A

1) CT Head/MRI
2) ECHO/EKG
3) Carotid Duplex
4) Patient <50: Clotting disorder: ANA, anti phospho, protein S/C, Factor

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21
Q

Consider enderectomy if stenosis is >____, and patient is symptomatic

A

70%

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22
Q

Status epilepticus

1st Line____
2nd Line____
3rd Line____

4th Line_____

A

Lorazepam
Phosphophenytoin
Phenobarbital

Propofol

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23
Q

T/F: First time seizure requiring Benzo for status epilepticus needs treatment

A

Yes

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24
Q

Which drug has to be changed for a OCP using patient for seizure disorder_____

A

Lamotrigine, CYP potentiation, drug level too low

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25
Q

_____ seizure drug is associated with stevens johnson

A

levetiracetam (mutation SNP: HLA B1502)

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26
Q

_____ may be a treatment choice for parkinsons, among older patients>60, given fewer side effects

A

Amantidine

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27
Q

_____ is a parkinson like condition, with a hallmark symptom of ______ and mood swings

A

PSP

Vertical gaze palsy

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28
Q

_____ can occur with sudden withdrawal of parkinson medication

A

Rhabdomyalosis

Paradoxical: NMS like syndrome when starting anti psychotics, and when withdrawing

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29
Q

Levodopa related psychosis can be treated with _____

A

Quitiapine, pimavanserine (selective 5-HT3 agonist)

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30
Q

Essential tremor
1st Line : Propranolol
2nd Line: ________
3rd Line:_____

A

Primidone

Thalamus removal

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31
Q

Patients with MS receive ____ for nutritional support

A

Vitamin D, Calcium

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32
Q

____ is a CD20 inhibitor used for MS treatment

A

Ocrelizumab

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33
Q

Anticholinergics such as galantamine, donepizil, rivastigmine are used to treat _____ chronic condition

A

Alzheimers

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34
Q

CAD, PAD, Pregnancy are contra-indication for this migraine abortive______

Instead can use : _______

A

Triptans

metoclopramide, compazine (dystonia risk, give benadryl)
- Dopaminergic drugs

*Triptans cause vascular constriction

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35
Q

_____ is a the best prophylactic for cluster headaches

A

Ca2+ blockers (Verapmil)

36
Q

_____ characterized by double vision, tinnitus (cranial nerve palsies), headache among young, obese women

A

Pseudotumor Cerebri (poor re-absorption of CSF)

37
Q

Morphology of pneumococcal organism on gram stain____, of neisseria on gram stain_____

A

Gram + Diplococci

Gram - Diplococci

38
Q

____ is a meningitis that can happen with CD4<100.

A

Cryptococcus

39
Q

Cryptococcus
Dx:____
Tx:_____

A

India Ink stain, Crypto Ag

5FC/Amphoterecin —> Fluconazole

40
Q

_____ meningitis characterized by joint pain, bullseye rash, CN7 palsy

Tx: Ceftrioxone

A

Lyme

41
Q

Difference between Rocky mountain spotted vs Lyme______

A

Rash : Starts peripherally, moves inward for rocky mountain. Treatment is doxy for rocky mountain, ceftrioxone for lyme

42
Q

TB meninigitis CSF key feature____

A

High protein

43
Q

Treatment for TB Meningitis is RIPE + steroids, however ____ is exchanged for fluoroquinolone due to poor CNS penetration

A

Ethambutol

44
Q

_____ meningitis needs prophylaxis of close contacts

A

Neisseria

- Rifampin, Ceftrioxone, Cipro

45
Q

Miltefosine is a treatment for _____ encephalitis

A

Amoeba

46
Q

T/F: Brain biopsy needed for treatment of Encephalitis

A

False

47
Q

How to treat JC virus linked PML_____

A

Increase the CD4 count

48
Q

_____ DMARD is associated with PRES syndrome

A

Cyclosporine

49
Q

___ is a hallmark imaging finding of PRES

A

Posterior lobe vasogenic edema

50
Q

Ratio used to check for infection during SAH___

A

1 WBC: 500 RBC on CSF

51
Q

____ results in all position loss except vibration/position

A

Anterior spinal artery

52
Q

Edaravone is a medication used to treat ____

A

ALS (antioxidant)

53
Q

ALS patients can have a weird phenomena called_____, treated with Dextrometorphan/Quinidine

A

Pseudobulbar affect (inappropriate laughter, episodes of being emotionless)

54
Q

Carpal Tunnel treatment

1) Splint
2) ____
3) ____

A

Steroid injection

Surgical release

55
Q

_____ foot drop, difficulties with foot eversion after wearing boots

A

Peroneal nerve palsy

56
Q

Chronic regional pain syndrome, i.e having huge pain in a location without clear reason, is best treated with ____

A

Pramipexole (dopamine agonist), NSAID, gabapentine

57
Q

restless leg syndrome associated with ____ nutritional deficiency

A

Iron

58
Q

____ is the reverse of Guillan Barre, resulting in descending instead of ascending paralysis

A

Miller-Fisher, Gq1B antibodies, treated with plasmapheresis/IVIG

59
Q

AchR and ___ antibodies are associated with M.Gravis

A

Anti muscle specific antibody

60
Q

For patient presenting with mysthenia crisis/Guillan Barre, getting ____ is critical to assess risk of respiratory failure

A

Peak inspiratory pressure (PIP)

61
Q

______ type of stroke characterized by eyes deviating towards lesion (ipsilateral gaze palsy), upper extremity weakness, homonymous hemanopia that is macular sparing,

A

MCA stroke

62
Q

_____ stroke characterized by vertical nystagmus, dysarthria/dystonia (bulbar), ataxia, sensory changes head/neck

A

vertebro-basilar

63
Q

_____ stroke characterized by vertigo, horner syndrome, ataxia

A

PICA

Facial Hemiparesis = lacunar infarction

64
Q

When can you not use TpA within 3 - 4.5 hours in stroke _____

A

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

65
Q

Ticlodipine never used instead of plavix, because of ____ and ____

A

TTP, neutropenia

66
Q

______ seizure medication associated with stevens johnson, and also cannot be used with OCP otherwise eliminated inappropriately

A

Lamotrigine

67
Q

____ medicine is an serotonin inhibitor that can be used for Parkinsons with psychotic features

A

pimavanserin

68
Q

_____ is a risk if dopaminergic parkinsons medications are abruptly discontinued

A

Rhabdomyalosis

69
Q

____ is a parkinsonian like condition, however with more bulbar symptoms (dysphagia), less tremor, gaze palsy (vertical nystagmus)

A

PSP (Tx: Levodopa, amantadine, rivastigmine)

70
Q

Essential Tremor Treatment

1) Propranolol
2) _______
3) Thalamotomy

A

Primidone/Topiramate/Gabapentin

71
Q

____ is a CD20 drug used for MS, disease modifying agent

A

Ocrelizumab

Others : Natalizumab (PML risk), dimethyl fumarate, fingolimod

72
Q

Alzheimers treatments_____

A

Donepezil, rivastigmine (increases AcH, cholinesterase inhibitors)

73
Q

Treatment of normal pressure hydrocephalus (ataxia, incontinence, dementia)_____

A

VP shunt, LP will show normal pressure

74
Q

Treatment of normal pressure hydrocephalus (ataxia, incontinence, dementia)_____

A

VP shunt, LP will show normal pressure

75
Q

Migraine abortive treatment if triptan/ergotamine contraindicated (pregnancy, CAD)______

A

Anti emetic dopamine = reglan,

Contraindicated in CAD because triptans are vaso constricters

76
Q

Treatment of pseudotumor cerebri ____

A

Acetazolamide —> VP shunt, here LP will show elevated pressure

77
Q

Treatment of cryptococcus meningitis______

A

Serial LP, 5FC + Amphoterecin —> Fluconazole

78
Q

_____ encephalitis associated with ovarian teratomas

A

auto-immune

79
Q

Treatment of neurocystocercosis ____

A

Albendazole

80
Q

Posterior lobe vasogenic edema in the setting of hypertensive crisis _____

A

posterior reversible encephalopathy syndrome

81
Q

SAH can present with meningeal irritation, not always meningitis. For SAH____ is needed to properly embolize bleed, otherwise recurrent vasospasm may cause ischemic stroke

A

CT Angio

82
Q

Cape like distribution loss of sensation caused by spinal _____

A

syringomyelia

83
Q

____ causes loss of all sensation except vibration/position

A

Anterior spinal artery infarction

84
Q

____ is a cord hemitransection, causes ipsilateral position, contralateral pain

A

brown sequard

85
Q

ALS patients may have _____ inappropriate lability of emotions

A

pseudobulbar affect

86
Q

Treatment of chronic regional pain syndrome_______

A

Anti-dopamine (pramipexole/ropinerole, iron, NSAID)

87
Q

Treatment of LEMS

A

Amifampridine

USMLE Step 3 (19 decks)

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