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COMLEX Level 3 > Neurology > Flashcards

Neurology Flashcards

1
Q

stroke symptoms

A

> 24 hours
permanent residual neurologic deficits
ischemic or hemorrhagic
spares upper third of face

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2
Q

TIA symptoms

A

<24hrs
resolve completely
may only have amaurosis fugax
never hemorrhage

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3
Q

young stroke patient likely:

A

vasculitis or hypercoaguable state

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4
Q

anterior cerebral artery stroke

A

contralateral profound LE weakness
contralateral mil UE weakness
personality changes or psychiatric disturbance
urinary incontinence

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5
Q

middle cerebral artery stroke

A 
contralateral profound UE weakness
aphasia
apraxia/neglect
eyes deviate TOWARD lesion
contralateral homonymous hemianopsia
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6
Q

posterior cerebral artery stroke

A

prosopagnosia (inability to recognize faces)

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7
Q

vertebrobasilar artery stroke

A 
vertigo
nausea/vomiting
"drop attack"
vertical nystagmus
dysarthria
sensory changes in face and scalp
ataxia
bilateral findings
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8
Q

posterior inferior cerebellar artery stroke

A

ipsilateral face
contralateral body
vertigo and Horner syndrome

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9
Q

lacunar infarct stroke

A 
absence of cortical deficits
ataxia
Parkinsonian signs
sensory deficits
hemiparesis (most notable on face)
possible bulbar signs
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10
Q

ophthalmic artery stroke

A

amaurosis fugax

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11
Q

best initial diagnostic test for stroke

A

head CT without contrast

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12
Q

most accurate image of brain for stroke

A

MRA

- can be positive within 30-60mins of stroke

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13
Q

head CT in stroke

A

best initial diagnostic test
sensitive for blood
needs 3-5d before it can detect nonhemorrhagic stroke with >95% sensitivity

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14
Q

MRI in stroke

A

achieves >95% sensitivity for a nonhemorrhagic stroke within 24hrs

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15
Q

MRA in stroke

A

most accurate image of brain for stroke

can be positive within 30-60mins of stroke

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16
Q

treatment of stroke/TIA depends on:

A

time elapsed

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17
Q

when can tPA be used

A 
within 3-4.5hrs
a stroke that is not severe, NIHSS > 25
age < 80
no diabetes with history of stroke
no anticoagulation
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18
Q

absolute contraindications to tPA

A

history of hemorrhagic stroke
presence of intracranial neoplasm/mass or a bleeding disorder
active bleeding or surgery within 6wks, cerebral trauma or brain surgery within 6 months, or nonhemorrhagic stroke within 1yr
suspicion of aortic dissection

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19
Q

when tPA is not given

A

remove clot with catheter (useful up to 24hrs after stroke)

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20
Q

treatment of stroke

A

tPA within window
remove clot within window
nonhemorrhagic: start statin

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21
Q

what is indicated in all stroke/TIA patients

A

antiplatelet therapy

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22
Q

antiplatelet therapy after tPA

A

start after 24hrs

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23
Q

antiplatelet therapy for small strokes

A

NIHSS <6 or TIA
dual antiplatelet therapy: aspirin & clopidogrel
stop clopidogrel after several weeks, but continue aspirin indefinitely

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24
Q

antiplatelet therapy for large strokes

A

aspirin

if pt was already on aspirin, add dipyridamole or switch aspirin to clopidogrel

25
Q

other things to control with stroke

A

hypertension, diabetes, and hyperlipidemia

26
Q

when is PFO closure next step in management?

A

when pt has an embolic appearing cryptogenic ischemic stroke and right to left shunt

27
Q

cerebral venous thrombosis signs/symptoms

A

headache over several days (can mimic SAH)
same weakness and speech difficulty seen in stroke
LP normal
OCPs contraindicated

28
Q

most accurate test in CVT

A

MRV

29
Q

treatment of CVT

A

LMW heparin followed by direct oral anticoagulant

30
Q

direct oral anticoagulants

A

edoxaban, apixaban, rivaroxaban, dabigatran

31
Q

further management following a stroke

A

move the clock forward: determine origin of stroke

  • paradoxical emboli through PFO need closure; also indicated if cryptogenic and left to right shunt
  • use DAPT for first several weeks
32
Q

further management following a TIA

A

same as stroke, but no thrombolytics

33
Q

what’s indicated in alll patients with stroke/TIA?

A

echocardiogram: anticoagulation for clots, possible surgery for valve vegetations
carotid doppler/duplex: endarterectomy for stenosis >70%, but not if 100% only if pt is symptomatic
EKG and holter if EKG normal: DOACs indicated for all stroke/TIA with Afib/Aflutter

34
Q

what to do if stroke is <50 and no pmhx

A

ESR, VDRL or RPR, ANA, dsDNA, protein C, protein S, factor V leiden mutation, antiphospholipid syndromes

35
Q

hypertension goal after stroke

A

at least <140/90 in diabetic

36
Q

diabetic goal after stroke

A

same glycemic control as general population: HgA1c <7%

37
Q

hyperlipidemia goal after stroke

A

LDL < 70 mg/dL

add statins for all nonhemorrhagic strokes

38
Q

status epilepticus therapy

A

benzo (lorazepam)
if persists after move clock 10-20mins and add fosphenytoin
if persists after move clock 10-20mins, add keppra
if seizure persists after moving another 10-20mins, add general anesthesia (pentobarbital, thipental, midazolam, propofol)

39
Q

diagnostic tests for seizure

A

electrolytes: sodium, calcium, glucose, oxygen, creatinine, and magnesium
head CT (urgently); if -, consider MRI later
urine tox
liver and renal function
EEG if other tests do not reveal etiology

40
Q

treatment of seizure - single seizure

A

chronic AEDs not indicated unless strong family history of seizures, abnormal EEG, status epilepticus that required benzos, or uncorrectable precipitating cause (tumor)

41
Q

treatment of seizures - chronic

A

first-line: keppra, depakote, carbamazepine, phenytoin (all equal)
second-line: gabapentin, phenobarbital, lacosamide, zonisamide

42
Q

treatment of seizures - absence/petit mal

A

ethosuximide

43
Q

side effects of carbamazepine

A

severe skin reactions (SJS)

associated with hyponatremia

44
Q

side effects of phenytoin

A

decreases folate levels

45
Q

Parkinson’s disease physical findings

A 
cogwheel rigidity
resting tremor
hypomimia
micrographia
orthostasis
intact cognition and memory
46
Q

treatment of mild parkinson’s

A

anticholinergic (benztropine or trihexyphenidyl if <60-70)

amantadine if >60-70

47
Q

treatment of severe parkinson’s

A 
unable to perform ADLs
dopamine agonists (pramipexole, ropinirole, rotigotine, apomorphine)
levodopa/carbidopa
48
Q

drugs that worsen PD

A

antiemetics that inhibit dopamine

metoclopramide, prochlorperazine, antipsychotics

49
Q

adverse effects of anticholinergics

A

memory loss
constipation
glaucoma
urine retention

50
Q

if initial meds do not control PD

A

COMT inhibitors (block metabolism of dopamine): tolcapone, entacapone, opicapone
MAOis: selegiline, rasagiline, safinamide
DBS

51
Q

shy-drager syndrome

A

PD characteraized by orthostatic hypotension

add fludrocortisone or midodrine

52
Q

what can be misdiagnosed as PD

A

progressive supranuclear palsy

can’t look up or down

53
Q

what if levodopa causes psychosis

A

add pimavanserin or quetiapine to control those symptoms

54
Q

essential tremor

A

tremor that is worse with action

55
Q

diagnostic test for essential tremor

A

none

56
Q

treatment of essential tremor

A

propranolol

57
Q

if tremor persists after 1-2wks

A

add primidone

58
Q

if tremor persists following primidone

A

switch to topamax or gabapentin

59
Q

if multiple medical therapies fail and severe tremor

A

thalamotomy

- unilateral is standard

COMLEX Level 3 (5 decks)

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