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[1b] a- step 3 > ✅NEUROLOGY > Flashcards

✅NEUROLOGY Flashcards

1
Q

Pts with [Dementia with Lewy Bodies (DLB)] are extremely sensitive to _____ and it may cause what side effects?-3

A

DLB at the DMV

ANTIPSYCHOTICS

________________

  • Dementia INC
  • MichaelJFox PARK INC
  • autonomic dysfunction
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2
Q

Dementia with Lewy Bodies (DLB) CP - 3

A

DLB at the DMV

  1. Dementia confusion periodically
  2. MichaelJFox Parkinsonism (PARK + hamp) tht does NOT respond to dopaminergic tx
  3. Visual Hallucinations

Lewy Body= [LABS (Lewy α-synuclein BodieS)] that are Eosinophilic intracytoplasmic accumulations

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3
Q

Dementia with Lewy Bodies (DLB) CP - 3

A

DLB at the DMV

  1. Dementia confusion periodically
  2. MichaelJFox Parkinsonism (PARK + hamp) tht does NOT respond to dopaminergic tx
  3. Visual Hallucinations

Lewy Body= [LABS (Lewy α-synuclein BodieS)] that are Eosinophilic intracytoplasmic accumulations

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4
Q

[Dementia with Lewy Bodies (DLB)] Tx- 2

A

1. Rivastigmine AChinesterase inhibitor

  1. [2nd Gen Antipsychotic] for visual hallucination
    * REMEMBER THAT DLB PTS ARE SENSITIVE TO ANTIPSYCHOTICS*
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5
Q

Frontotemporal Pick’s Dementia

Sx -2

A

Prounouced Frontal & Temporal lobe atrophy –>

[Socially inappropriate Behavior] + aphasia

OCCURS MORE IN FEMALES!!!

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6
Q

A: Demographic of Frontotemporal Pick’s Dementia?

B: Mode Of Inheritance

A

A: 50-60 yo Females (Alzheimer = > 60)

B: Auto Dominant

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7
Q

Early Findings of Alzheimer’s - 4

A

CLAV –> HANDU

Cognitive PROGRESSIVE ⬇︎

Language ⬇︎

Anterograde immediate memory loss

Visualspatial disorientation (loss in ur own neighborhood)

Onsets after 60 yo

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8
Q

Clinical Criteria for diagnosing Alzheimer’s -5

A

CLAV –> HANDU

  1. GOE 2 Cognitive deficits
  2. Worsening Memory
  3. Consciousness intact
  4. Onsets after 60 yo
  5. No other Systemic/Neuro DO to cause cognitive defects
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9
Q

Normal Pressure Hydrocephalus Sx (3); Which is earliest to present?

A

⬇︎CSF absorption –> Wacky, Wobbly & Wet!

Wacky (memory loss)

Wet (Urinary Incontinence from compressing periventricular cortico-cortical white fibers traveling to sacral micturition center)

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10
Q

Normal Pressure Hydrocephalus characteristics - 4

A

Wacky, Wobbly & Wet!

  1. Idiopathic
  2. Episodic
  3. Elderly
  4. Does not ⬆︎ SubArachnoid space volume

Etx: ⬇︎Arachnoid villi CSF Absorption vs obstruction

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11
Q

Alzheimer’s Dz etx (3)

A

Alzheimers etx = CHA

**Cleavage, Hemorrhage, (ACh⬇︎) **

  1. Cleavage of [chromo 21 transmembrane amyloid precursor glycoprotein] –> β-amyloid which accumulates–> [Neuritic Senile plaques] in temporal lobe early on.
  2. Hemorrhages Spontaneously occur in Occipital/Parietal lobes (image) from β-amyloid deposition in cerebral vessels
  3. ACh ⬇︎ in the [Basal nc. of Meynert] & Hippocampus 2/2 β-amyloid accumulation –> defective [Choline Acetyltransferase] in those areas –> Alzheimer Sx (CLAV–>HANDU)
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12
Q

Alzheimer’s Dz etx (3)

A

Alzheimers etx = CHA

**Cleavage, Hemorrhage, (ACh⬇︎) **

  1. Cleavage of [chromo 21 transmembrane amyloid precursor glycoprotein] –> β-amyloid which accumulates–> [Neuritic Senile plaques] in temporal lobe early on.
  2. Hemorrhages Spontaneously occur in Occipital/Parietal lobes (image) from β-amyloid deposition in cerebral vessels
  3. ACh ⬇︎ in the [Basal nc. of Meynert] & Hippocampus 2/2 β-amyloid accumulation –> defective [Choline Acetyltransferase] in those areas –> Alzheimer Sx (CLAV–>HANDU)
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13
Q

Late Findings of Alzheimer’s - 5

A

CLAV –> HANDU

Hallucinations

Agnosia (unable to recognize things via 5 senses)

Neuro ∆ (seizure/myoclonus)

Dyspraxia (unable to do things from before)

Urinary Incontinence

Onsets after 60 yo

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14
Q

Alzheimer’s tx - 7 ; Which medication should be used last?

A

CLAV –> HANDU

  1. Donepezil - AChnesterase inhibitor
  2. Tacrine - AChnesterase inhibitor
  3. Rivastigmine - AChnesterase inhibitor
  4. Galantamine - AChnesterase inhibitor
  5. Memantine - NMDA R Blocker: USE LAST
  6. Respite Care for Caregivers (ex: Adult day program)
  7. Atypical antipsychotics - Olanzapine vs Risperidone (for acute psycosis)
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15
Q

Alzheimer’s tx - 7 ; Which medication should be used last?

A

CLAV –> HANDU

  1. Donepezil - AChnesterase inhibitor
  2. Tacrine - AChnesterase inhibitor
  3. Rivastigmine - AChnesterase inhibitor
  4. Galantamine - AChnesterase inhibitor
  5. Memantine - NMDA R Blocker: USE LAST
  6. Respite Care for Caregivers (ex: Adult day program)
  7. Atypical antipsychotics - Olanzapine vs Risperidone (for acute psycosis)
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16
Q

Late Findings of Alzheimer’s - 5

A

CLAV –> HANDU

Hallucinations

Agnosia (unable to recognize things via 5 senses)

Neuro ∆ (seizure/myoclonus)

Dyspraxia (unable to do things from before)

Urinary Incontinence

Onsets after 60 yo

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17
Q

Normal Pressure Hydrocephalus characteristics - 4

A

Wacky, Wobbly & Wet!

  1. Idiopathic
  2. Episodic
  3. Elderly
  4. Does not ⬆︎ SubArachnoid space volume

Etx: ⬇︎Arachnoid villi CSF Absorption vs obstruction

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18
Q

Normal Pressure Hydrocephalus Sx (3); Which is earliest to present?

A

⬇︎CSF absorption –> Wacky, Wobbly & Wet!

Wacky (memory loss)

Wet (Urinary Incontinence from compressing periventricular cortico-cortical white fibers traveling to sacral micturition center)

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19
Q

Clinical Criteria for diagnosing Alzheimer’s -5

A

CLAV –> HANDU

  1. GOE 2 Cognitive deficits
  2. Worsening Memory
  3. Consciousness intact
  4. Onsets after 60 yo
  5. No other Systemic/Neuro DO to cause cognitive defects
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20
Q

Early Findings of Alzheimer’s - 4

A

CLAV –> HANDU

Cognitive PROGRESSIVE ⬇︎

Language ⬇︎

Anterograde immediate memory loss

Visualspatial disorientation (loss in ur own neighborhood)

Onsets after 60 yo

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26
Q

Memantine MOA ; Indication

A

Blocks Glutamate from binding to NMDA Receptor; Moderate to Severe Alzheimer’s

27
Q

Memantine MOA ; Indication

A

Blocks Glutamate from binding to NMDA Receptor; Moderate to Severe Alzheimer’s

28
Q

Name the Major UMN signs (5)

A

UMN signs = Weak MESH

Weakness

[Spastic Gait & Paralysis] (partially from disproportionate Extensor weakness)

[Exaggerated Reflexes (Babinski)]

Mental Status change

HemipLegia

29
Q

Parkinsonism Clinical signs (8)

A

PARK & hamp

[Pill Rolling Resting 4-6 Hz unilateral Tremor] worst with Rest & Mental Task

[Rigidity Cogwheel]

BradyKinesia

[AReflexia posturally] –>Shuffling Gait/Fall when turning or stopping

+

  • hypOphonic speech
  • Autonomic ⬇︎ (constipation / bladder problems / orthostatic hypOtension)
  • micrographia
  • poker masked face
  • PARK = primary signs*
31
Q

3 Main causes of Spinal Cord Compression

A
  1. DJD Disc Herniation (Smoking risk factor)
  2. [Epidural Staph a. Abscess (think IV drug user vs DM)]
  3. Tumor (Prostate/Renal/Lung/Breast/Multiple Myeloma mets)

Dx = MRI, Positive Straight Leg, Classic S/S

DJD=Degenerative Joint Disease

32
Q

Etx of Parkinsons Disease

A

[LABS (Lewy α-synucleinBodieS)] accumulation in [substantia nigra pars compacta] –>degeneration –> ⬇︎Dopamine release and ⬇︎ stimulation of Striatum which –> allows Globus pallidus internal to continuously inhibit [VA/VL Thalamus from stimulating motor cortex]

33
Q

Where are Brain Metastasis typically found? - 2

A

Gray White Junction vs Watershed Zones

  • Brain metastases are multifocal and spherical*
  • Most common= [LUNG NonSOLC] > Breast/Colon/Kidney/Melanoma*
34
Q

Name the Lower Motor Neuron signs - 4

A

LMN signs (FAAW) - Fasciculations / Atrophy & Areflexia / Weakness

35
Q

Bromocriptine MOA ; Indication

A

Dopamine PostSynaptic R Agonist ; Parkinson’s

36
Q

Parkinsonism is often caused by ____ or _____

Name 2 rare causes of Parkinsonism

A

Common = [Substantia nigra pars compacta degeneration] vs [D2 Blocker Drugs]

rare = Toxic levels of CO2 or ManGanese

PARK & hamp

40
Q

Name the 3 components of EPS-ExtraPyramidalSymptoms

A

EPS = DAD

[Drug-induced Parkinsonism]

Akathisia (restlessness)

Dystonia (sudden twisted posture worst with activity)

Tx = Benztropine vs Diphenhydramine

41
Q

Parkinson’s Dz Tx - 6

A

“Eat SALADS after you Park”

  1. [Levodopa (Dopamine Precursor) + Carbidopa]
  2. Amantidine
  3. Anticholinergics
  4. [Dopamine PostSynaptic Agonist] (NonErgot: Ropinirole vs. Pramipexole) & (Ergot:Bromocriptine)
  5. Selegiline
  6. Surgery
    - Pallidotomy: Destructive of [Globus Pallidus:internal]
    - SubThalamic nuc. inhibition with electrode
    - ANT Choroidal a ligation
42
Q

How is [Brain Death] diagnosed? -4

A
  1. Brainstem functions ABSENT (pupil, pain response, gag, corneal)
  2. CORTEX functions ABSENT
  3. Spinal Cord (Deep Tendon Reflex) are +/-
  4. APNEA TEST FOR CONFIRMATION
43
Q

Serotonin Syndrome Clinical Presentation (8)

A

“Serotonin gave me the SHIVERS!”

Shivering

[Hyperreflexia & Myoclonus]

INC Temp

[Vitals instability] (tachycardia vs. tachypnea vs. HTN)

Encephalopathy (Confusion vs. Agitation)

Restlessness

Sweating

Italicized = Triad Sx

44
Q

How do you treat Refractory Serotonin Syndrome

A

Cyproheptadine

(antihistamine with anti-serotonergic properties)

45
Q

Describe Neuroleptic Malignant Syndrome - 5

A

RARE SE of Any Dopamine Blocker (Antipsychotics vs. GI meds) that –> FEVER

  • [Fever > 40C]
  • Encephalopathy (Confusion)
  • Vitals unstable (INC HR / RR / BP from autonomic dysfunction)
  • Enzymes ⬆︎ (CPK)
  • [Rigitidy lead pipe] (Tremor)
46
Q

What’s the best way to approach treatment for [Neuroleptic Malignant Syndrome]-2

A

Treat [Rigiditiy lead pipe] with Dantrolene (inhibits Ca+ release from sk. muscle sarcoplasmic reticulum)

+

supportive care

47
Q

Why does Fluoxetine need __ weeks to washout before starting a MAOI?

A

5

________________

SSRI + MAOI ➜ SEROTONIN SYNDRONE (SHIVERS)

48
Q

Name the Serotonergic Drugs -5

A
  1. SSRI
  2. SNRI
  3. TriCyclic Antidepressants
  4. Tramadol
  5. MDMA
49
Q

Which 2 drugs are contraindicated with Serotonergic drugs?

A
  • MAOI
  • Linezolid
50
Q

Sciatica etx ; Clinical Presentation - 3

A

“Having Sciatica makes you break LAWS”

  • [Lower Back pain w/radiation down POSTERIOR thigh –> lateral foot]
  • Ankle jerk reflex ABSENT (this can occur naturally with age!)
  • Weak Hip Extension
  • [S1 n PosteroLateral compression at L4-5 or L5-S1] –> UMN signs
51
Q

Sciatica tx ; dx?

A

“Having Sciatica makes you break LAWS”

NSAIDs + APAP = 1st line as Sciatica sx are self limited

Dx = CLINICAL (Only use MRI for confirmation of disc herniation if sensory/motor deficit, cauda equina syndrome sx or epidural abscess r/o)

52
Q

What is the femoral nerve responsible for? -5

A
  1. MOTOR EXTENDS KNEE
  2. REFLEX Knee Jerk
  3. SENSORY Anteromedial thigh
  4. SENSORY medial lower leg
  5. SENSORY arch of foot
53
Q

Most common [1° CNS Tumors] in Adults (3)

A

GMS

Glioblastoma astrocytoma (GRADE 4 - MALIGNANT - 2nd MOST COMMON to Metastasis)

MeninGioma benign

SChWannoma

Brain Metastasis=MOST COMMON ADULT BRAIN CA

54
Q

List the n. roots associated with Common Peroneal n.

A

L4-S2

foot is dropPED (Peroneal Everts & Dorsiflexes)

  • Commonly caused by L5 Radiculopathy*
  • Dx: Knee MRI vs EMG*
55
Q

List the n. roots associated with Tibial n.

A

L4-S3 (Three)

can’t walk on TIPtoes (Tibial Inverts & Plantarflexes)

Commonly caused by L5 Radiculopathy

56
Q

Most common [1° CNS Tumors] in Pediatrics-3 ; what’s the only one that’s supratentorial?

A

PEDs

Pilocytic Astrocytoma = MOST COMMON and can be Supratentorial OR infratentorial

Ependymoma (found in 4th Vt)

meDulloblastoma PNET = 2nd most common

Ependymoma and meDulloblastoma are infratentorial POST fossa(image)

57
Q

List the n. roots associated with Common Peroneal n.

A

L4-S2

foot is dropPED (Peroneal Everts & Dorsiflexes)

  • Commonly caused by L5 Radiculopathy*
  • Dx: Knee MRI vs EMG*
58
Q

What are the functions of the Common Peroneal n. -2

A

L4-S2

foot is dropPED (Peroneal Everts & Dorsiflexes)

  • Commonly caused by L5 Radiculopathy*
  • Dx: Knee MRI vs EMG*
59
Q

List the n. roots associated with Tibial n.

A

L4-S3 (Three)

can’t walk on TIPtoes (Tibial Inverts & Plantarflexes)

Commonly caused by L5 Radiculopathy

60
Q

List the n. roots associated with Tibial n.

A

L4-S3 (Three)

can’t walk on TIPtoes (Tibial Inverts & Plantarflexes)

Commonly caused by L5 Radiculopathy

61
Q

Functions of the Obturator n.-2

A
  1. MOTOR Leg ADDuction
  2. SENSORY medial thigh

________________

usually from pelvic trauma or surgery

[1b] a- step 3 (16 decks)

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