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RITE/PSBIM review > Neurology > Flashcards

Neurology Flashcards

1
Q

Dose of rtPA

A

0.9mg/kg IV

max 90mg

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2
Q

Indications for rtPA

A
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3
Q

Contraindications for rtPA

A
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4
Q

ABCD2 score for TIA that requires admission

A

> 3

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5
Q

most common site for a hypertensive hemorrhage?

A

Putamen

other common sites: thalamus, cerebellum, pons

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6
Q

What is the cut-off diameter for the intracranial bleed that will warrant surgical intervention?

A

> 3cm

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7
Q

most common cause of sporadic acute encephalitis in immunocompetent adults?

A

Herpes virus

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8
Q

What malignancy is the most common cause of brain metastases?

A

lung

But MELANOMAS have the greatest propensity to
metastasize to the brain

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9
Q

All patients with unexplained new onset seizures should undergo ____

A

brain imaging eg MRI or CT to search for an underlying structural abnormality

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10
Q

First line medications for generalized onset tonic clonic

A

Lamotrigine and Valproic acid

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11
Q

First line medications for focal seizures

A

Lamotrigine
Carbamazepine
Oxcarbazepine
Phenytoin
Levetiracetam

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12
Q

First line medications for typical absence

A

Valproic acid
Ethosuximide
Lamotrigine

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13
Q

First line medications for atypical absence and myoclonic,atonic

A

Valproic acid
Lamotrigine
Topiramate

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14
Q

Type of dementia suggested by early presence of visual hallucinations and tendency to have delirium

A

Dementia with Lewy bodies

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15
Q

Most common cause of dementia

A

Alzheimer’s dmentia

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16
Q

Rapidly progressive dementia with myoclonus

A

CJD

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17
Q

Characteristic imaging of Alzheimer’s disease

A

Entorhinal cortex and hippocampal atrophy

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18
Q

Characteristic imaging of CJD

A

Cortical ribboning, and basal gannglia or thalamus hyperintensity on DWI/FLAIR/MRi

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19
Q

First clinical manifestation of Alzheimer’s disease

A

memory impairment

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20
Q

Histopath findings in Alzheimer’s disease

A

Neuritic plaques composed of AB amyloid neurofibrillary tangles composed of phosphorylated tau

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21
Q

Acetylcholinesterase inhibitors that may be used for Alzheimer’s disease

A

Donepezil, Rivastigmine, Galantamine

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22
Q

NMDA inhibitor that may be used for Alzheimer’s disease

A

Memantine

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23
Q

Most common FTD syndrome

A

Behavioral variant

social and emotional systems dysfunction manifests as apathy, disinhibitrion, compulsivity, loss of empathy and oveeating

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24
Q

Cardinal features of Parkinson’s disease

A

Bradykinesia
Rigidity
Resting Tremor
Postural instability

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25
Q

Most common mutations associated with PD

A

Glucocerebrosidase

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26
Q

Why is levodopa routinely combined with decarboxylase inhibitor for PD?

A

prevents peripheral metabolism to dopamine and the development of nausea/vomiting

Levodopa remains the most effective symptomatic tx for PD

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27
Q

What do you call the decreasing duration of benefit of Levodopa ?

A

weaing off effect

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28
Q

Deep brain timulation of the _____ or ____ has largely replaced ablation surgery

A

Subthalamic nucleus or Globus pallidus interna

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29
Q

In which cases should patients undergo a neuroimaging study prior to LP?

A

Head trauma
Immunocompromised
Malignancies
Focal neurologic findings

In contrast, if bacterial meningitis is suspected, give antibiotics PRIOR to neuroimaging and LP

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30
Q

Most common pathogen causing acute bacterial meningitis in immunocompetent adults

A

S. pneumoniae

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31
Q

Pathogens that are implicated in acute bacterial meningitis following neurosurgical procedures especially shunting

A

S. aureus
CONS

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32
Q

Classic triad of meningitis

A

Fever
Headache
Nuchal rigidity

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33
Q

Empiric therapy for acute bacterial meningitis for chilcren >3 months and adults < 55

A

Cefotaxime/ Ceftriaxone/Cefepime + Vanco

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34
Q

Empiric therapy for acute bacterial meningitis for adults > 55 and adults of any age with alcoholism or debilitating illnesses

A

Ampicillin + cefotaxime/Ceftri/Cefepime + Vancomycin

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35
Q

Empiric therapy for acute bacterial meningitis for hospital acquired meningitis, posttraumatic or postneurosurgery meningitis, neutropenic patients or patients with impaired cell mediated imunity

A

Ampicillin + ceftazidime/meropenem + vanco

so dapat may coverage for P. aeuruginosa

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36
Q

Empiric treatment for L. monocytogenes

A

Ampi + Genta

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37
Q

Treatment course for the following pathogens for acute bacterial meningitis
Meningococcus
Pneumococcus
Gram neg
L. monocytogenes

A

Meningococcus - 7 days
Pneumococcus - 14 days
Gram neg - 21 days
L. monocytogenes -21 days

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38
Q

Adjunctive therapy with dexamethasone improves outcome from bacterial meningitis particularly if due to this pathogen

A

Pneumococcal

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39
Q

Prophylaxis for close contacts of acute meningitis

A

Rifampin 600 mg q12
- not for pregnant women

Alternative: Azithromycin x1 dose or
IM ceftriaxone (250 mg) x 1 dose

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40
Q

Procedure of choice that is rapid , sensitive, specific identification of viral meningitis

A

CSF PCR

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41
Q

Treatment for meningitis due to HSV, EBV and VZV

A

IV acyclovir followed by an oral drug for 7-14d

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42
Q

Most common etiologic agent for Viral meningitis

A

Enteroviruses

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43
Q

Most common etiologic agent for Viral encephalitis in immunocompetent adults

A

Herpesviruses

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44
Q

Causative agent that should be considered when focal findings are present and when involvement of the inferomedial frontotemporal regions of the brain is likely

A

HSV

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45
Q

Neuroimaging procedure of choice for viral encephalitis

A

MRI

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46
Q

Treatment for CMV encephalitis

A

Ganciclovi/ Foscarnet
Cidofovir

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47
Q

Classic triad of brain abscess

A

Headache
Fever
Focal neurologic deficit

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48
Q

Empiric tx for brain abscess in immunocompetent patients

A

Third or 4th gen + Metronidazole

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49
Q

Most common cause of chronic meningitis

A

TB

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50
Q

Myasthenia gravis is due to autoantibodies against

A

Acetylcholine receptors

however levels do NOT correlate with severity

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51
Q

Organ that must me checked when patient is diagnosed to have MG

A

Thymus

Thymus is abnormal in 75% of px (65% hyperplasia, 10% thymoma)

Chest CT/MRI may be used

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52
Q

Lambert Eaton is due to autoantibodies against

A

presynaptic calcium channels

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53
Q

Autoantibodies that are present in 40% of AcH receptor antibody negative patients with generalized MG

A

Muscle specific kinase

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54
Q

Diagnostic test for MG

A

Tensilon (Edrophonium)

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55
Q

Treatment of choice for MG

A

Anticholinesterase drug pyridostigmine (Mestinon)

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56
Q

Muscarinic side effects of pyridostigmine may be treated by

A

Atropine/ Diphenoxylate/ Loperamide

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57
Q

Mainstay of chronic immunosuppresive tx for MG

A

Glucocorticoids

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58
Q

Most common cause of hereditary neuropathy

A

Charcot Marie Tooth disease

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59
Q

Neuropathic disorders that may be considered if with symmetric proximal and distal weakness with sensory loss

A

GBS and CIDP

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60
Q

First line tx for painful sensory neuropathies

A

Lidoderm
TCA (amitriptyline, nortriptyline)
Gabapentin, Pregabalin
Duloxetine

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61
Q

in GBS, maximum weakness is usually reached within ____ week/s

A

2

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62
Q

Variant of GBS that presents with ophthalmopareis, facial diplegia, ataxia, areflexia

A

Fisher syndrome

Assoc with antibody to GQ1b

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63
Q

Most common neuropathies (what nerve/s)

A

Ulnar/Median nerve in the arm
Peroneal/Fibular in the leg

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64
Q

Involved nerve in Saturday night palsy

A

Radial nerve

Presents with wrist drop

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65
Q

What can be given to px with Duchenne’s muscular dystrophy to slow progression of disease

A

Glucocorticoids may slow progression of dse for up to 3 yrs

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66
Q

Type of dystrophy with scapular winging

A

Fascioscapularhumeral dystrophy

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67
Q

Vascular lesion seen in Osler Weber Rendu

A

Capillary telangiectasia

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68
Q

Window period (in hours) for giving thrombolytics for stroke

A

May be extended up to 4.5 hours

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69
Q

Head injury that shows lenticular shaped collection the frontal convexity

A

Epidural

l-E-mon shaped = Epidural

70
Q

Vessels involved in epidural hematoma

A

middle meningeal arteries

71
Q

Vessels involved in subdural hematoma

A

bridging veins

72
Q

Triad of Wernicke’s disease

A

Ophthalmoplegia, ataxia and confusion

73
Q

Duration of tonic clonic movements that would differentiate syncope vs seizure

A
74
Q

Classic EEG finding in absence seizure

A

generalized symmetric 3hz spike and slow wave pattern

75
Q

What antiseizure medication is associated with formation of renal stones

A

Topiramate

since it is a weak carbonic anhydrase inhibitor

76
Q

The only drug that prevents paroxysmal hemicrania

A

Indomethacin

77
Q

Type of headache that may be aborted by oxygen supplementation

A

Cluster

78
Q

Prophylactic tx for cluster headache

A

Verapamil, Topiramate, Melatonin, Lithium

79
Q

Abortive tx for SUNCT/SUNA

A

Lidocaine

80
Q

Prophylactic tx for SUNCT/SUNA

A

Lamotrigine
Topiramate
Gabapentin

81
Q

Only proven treatment for chronic tension type headache is

A

TCA eg. amitriptyline

82
Q

Most common pattern of nerve injury in HIV neuropathy

A

distal symmetric polyneuropathy

83
Q

Gold standard for examining CSF in px suspected to have neurosyphilis

A

VDRL

84
Q

Most common cause of SAH

A

Trauma

If outside trauma, ruptured saccular aneurysm

85
Q

Focal seizures that spread to involve both cerebral hemispheres to produce generalized seizures usually originate from which lobe of the brain?

A

Frontal

86
Q

What is the most common cause of
seizures in the older adults?

A

Cerebrovascular dse

87
Q

The triad of ipsilateral tongue weakness, weakness of contralateral upper and lower extremities, and contralateral loss of vibration and proprioception is characteristic of lesions involving which structure?

A

medial medulla

88
Q

What are the degenerative proteins in the ff dementia:
Alzheimers
FTD
Lewy body
Huntington dse
CJD

A

Alzheimers - AB/Tau
FTD -Tau
Lewy body- alpha synuclein
Huntington dse - polyglutamine repeats
CJD - prions

89
Q

Although seen only in a minority of patients, how does the classic headache associated with a brain tumor present?

A

Predominates in the morning and improves during the day

90
Q

Therapy with dexamethasone for acute meningitis is unlikely to be of significant benefit if it started > hours after antimicrobial therapy is initiated.

A

6

91
Q

Hemiparesis is the most common localizing sign of an abscess located in which region of the brain?

A

frontal

92
Q

Acute seizures occurring at the time of a stroke are most often seen in which type of strokes?

A

cardioembolic

93
Q

Aside from brain imaging, what is the only other diagnostic test needed prior to treatment with IV rTPA?

A

CBG

94
Q

Most common primary intracranial neoplasm

A

Astrocytoma

95
Q

Primary CNS lymphomas are commonly associated with this virus

A

EBV

96
Q

Most common primary brain tumor

A

Meningioma

97
Q

Most common mode of spread of tumors metastatic to the nervous system

A

Hematogenous

98
Q

Primary rad onco approach to brain metastases

A

SRS
It can sterilze visible lesins and produce local disease control in 80-90% of px
Can tx up to 10 lesions gowever confined to lesions <= 3 cm and is most effective in <= 1 cm

previously whole brain RT

99
Q

CSF glucose ____ and elevated CSF protein ___ are pedictive of increased mortality and poorer outcomes

A

<40mg/dL
>3g/L

100
Q

In acute viral meningitis PMNs may predominate in the first ___ hours

A

48 hours

101
Q

Treatment for subacute meningitis caused by C. neoformans

A

Amp B + Flucytosine

102
Q

Treatment for syphilitic meningitis

A

Aqueous Penicillin G 3-4 million units IV every 4 h for 10-14 days

103
Q

Possible tx option for JCV

A

5-HT2a receptor antagonist mirtazapine

104
Q

Stage of brain abscess formation wherein you can see ring enhancing capsules on imaging

A

Early capsule formation

105
Q

Stage of brain abscess formation wherein pus starts to form

A

Late cerebritis stage

106
Q

Minimum duration of tx for brain abscess

A

6-8 weeks

107
Q

Most common type of primary headache

A

tension type

108
Q

The release of this substance in the trigeminal nucleus triggers the underlying vascular mechanism of migraine headaches

A

Calcitonin gene related protein

109
Q

The only primary headache more common in males

A

Cluster headache

110
Q

Most common schwanommas

A

vestibular/ acoustic neuroma

NF2 have high incidence of vestibular schwanomma

111
Q

Most common cause of hemorrhagic metastasis in the brain

A

Lung CA

but greatest propensity to cause hemorrhage: melanoma, thyroid, kidney CA (these are just not as common as lung CA)

112
Q

Among patient who suffered from Acute Ischemic Stroke (AIS), a decrease in cerebral blood flow to zero causes death of brain tissue within

A

10 minutes

113
Q

most common cause of cerebral embolism overall

A

Nonrheumatic atrial fibrillation

114
Q

best sequence to detect brain infarction earlier than CT or other MR sequences.

A

Diffusion-weighted imaging (DWI)

115
Q

This is a new drug which functions as a plasminogen activator that has the added advantage of bolus dosing without 1-hour infusion (vs alteplase). It can improve efficiency for patients that need to be transferred to another facility or for those who will undergo endovascular therapy

A

Tenecteplase

T for transfer

116
Q

What constitutes ABCD2 score in TIA

A

Age- >= 60

BP (SBP >140 OR DBP >90)

Clinical symptoms (Unilateral weakness -2,
Speech disturbance without weakness -1)

Duration (>60 m -2, 10-59m -1)
Diabetes -1

117
Q

in SAH Once ICP is recorded, CSF drainage (if available), osmotic therapy, and blood pressure management can be tailored to maintain cerebral perfusion pressure (MAP - ICP) at least ____ mmHg.

A

50–70

118
Q

Most common seizure type resulting from metabolic derangements

A

Generalized Tonic clonic

119
Q

EMG pattern that may help distinguish spasms from brief tonic and myoclonic seizures.

A

Characteristic rhomboid pattern

120
Q

Most common syndrome associated with focal seizures with impairment of consciousness

A

Mesial Temporal Lobe Epilepsy Syndrome

Characteristic hippocampal sclerosis on MRI

121
Q

Treatment for Mesial Temporal Lobe Epilepsy Syndrome

A

Refractory to treatment with anticonvulsants but responds well to surgical intervention

122
Q

EEG finding in Mesial Temporal Lobe Epilepsy Syndrome

A

Unilateral or bilateral anterior temporal spikes

123
Q

Example of antiseizure drugs with mechanism
Inhibition of Na+-dependent action potentials in a frequency- dependent manner

A

Phenytoin, carbamazepine, lamotrigine, topiramate, zonisamide, lacosamide, rufinamide, cenobamate

124
Q

Example of antiseizure drugs with mechanism
Inhibition of voltage-gated Ca2+ channels

A

Phenytoin, gabapentin, pregabalin

125
Q

Example of antiseizure drugs with mechanism
Facilitating the opening of potassium channels

A

Ezogabine

126
Q

Example of antiseizure drugs with mechanism
Attenuation of glutamate activity

A

Lamotrigine, topiramate, felbamate, perampanel

127
Q

Example of antiseizure drugs with mechanism
Potentiation of GABA receptor function

A

Benzodiazepines and barbiturates

128
Q

Example of antiseizure drugs with mechanism
Increase in the availability of GABA

A

Valproic acid, gabapentin, tiagabine

129
Q

Example of antiseizure drugs with mechanism
Modulation of release of synaptic vesicles

A

Levetiracetam, brivaracetam

130
Q

Anti epileptic drug associated with gingiva hyperplasia

A

phenytoin

131
Q

Anti epileptic drug associated with SJS

A

Lamotrigine

132
Q

Initial tx of choice for status epilepticus

A

Benzodiazepine (Midazolam, Lorazepam, Diazepam)

133
Q

In typical amnestic AD, brain atrophy begins in the

A

medial temporal lobes

134
Q

most important risk factors for developing Alzheimer’s disease

A

age and family hx

135
Q

What constitutes the triad of Huntington’s disease?

A

Chorea, behavioral disturbance, and executive impairment

136
Q

Triad of Normal pressure hydrocephalus

A

clinical triad includes an abnormal gait (ataxic or apractic), dementia and urinary urgency or incontinence

137
Q

Slow vertical saccades are seen in what type of dementia causing dse?

A

Progressive supranuclear palsy

138
Q

What can be given to px with Lewy Body Dementia that is a selective inverse agonist of the serotonin 5-HT2A receptor that does not block dopamine receptors

A

Pimavanserin

Patients with Lewy Body Dementia should not be exposed to typical neuroleptics that can lead to a neuroleptic malignant syndrome and death, or anticholinergics or dopamine agonists that can exacerbate their symptoms.

139
Q

one dopamine agonist is comparable to levodopa, but must be administered parenterally

A

Apomorphine

140
Q

Most common parkinsonism?

A

Parkinson’s dse

141
Q

Only oral agent for PD that has been to shown to reduce dyskinesia without worsening parkinsonian feature

A

Amantadine

142
Q

Preferred prophylactic antibiotic for meningococcal meningitis contacts who are also pregnant

A

Ceftriaxone

Otherwise Rifampin

143
Q

What does F.A.S.T. stand for?

A

Facial weakness, Arm weakness, Speech abnormality, Time

144
Q

Illegal drugs that have strong association with stroke

A

Cocaine and amphetamine

145
Q

Among solid tumors,Leptomeningeal metastases are more commonly associated with which type of primary cancer?

A

breast, lung and melanoma

146
Q

Expected EEG findings in HSV encephalitis

A

periodic, stereotyped, sharp-and-slow complexes

147
Q

Progressive multifocal leukoencephalopathy is associated with what virus

A

JC virus

148
Q

Size of brain abscess that may be treated medically

A

2-3 cm

149
Q

Cushing reflex triad

A

Hypertension
Bradycardia
irregular breathing

150
Q

CSF abnormalitis in bacterial meningitis

A
151
Q

Treatment for meningtis due to H. capsulatum

A

AmB (0-7-1.0 mg/kg/day) for 4-12 weeks (total of 30mg/kg is recommended)

152
Q

Duration of chronic meningitis

A

> 4 weeks

153
Q

Etiology of chronic meningitis associated with multiple cyst in basal meninges with hydrocephalus

A

cysticercosis

154
Q

Treatment for SSPE

A

No definitive therapy for SSPE is available.

Treatment with isoprinosine (Inosiplex, 100 mg/kg per day), alone or in combination with intrathecal or intraventricular interferon-α, has been reported to prolong survival and produce clinical improvement in some patients but has never been subjected to a controlled clinical trial.

155
Q

Stage of brain abscess formation wherein central core of coagulative necrosis begins to form

A

Early cerebritis

156
Q

Stage of brain abscess formation wherein there is a well-formed necrotic center and dense collagenous capsule

A

Late capsule formation

157
Q

in TIA The risk of stroke after a TIA is ~___% in the first__ months, with most events occurring in the first __ days.

A

10–15
3
2

158
Q

Target BP to reduce risk of stroke

A

< 130/80

159
Q

Cerebellar hematomas >_ cm in diameter will require surgical evacuation

A

3

160
Q

How is sacculary aneurysm managed?

A

> Lower the SBP to below 160 mmHg using nicardipine, labetalol, or esmolol. Cerebral perfusion pressure targeted to 60–70 mmHg.

> Treatment with the calcium channel antagonist nimodipine (60 mg PO every 4 h) improves outcome

> Euvolemia is targeted. Free-water restriction is contraindicated

> Pneumatic compression stockings applied to prevent PE.

> Unfractionated heparin administered subcutaneously for DVT prophylaxis can be initiated within 1–2 days following endovascular treatment or craniotomy

161
Q

Headache symptoms that suggest a serious underlying condition

A
162
Q

MOA of rimegepant

A

CGRP antagonists

163
Q

When is triptan given in px with migraine

A

when aura is completed and headache has begun

164
Q

What migraine prophylactic medication is contraindicated could aggravate parkinson’s disease

A

flunarizine

165
Q

brain tumors has distinctive histopathologic feature of perinuclear clearing (giving rise to a “fried egg” appearance) and a
reticular pattern of blood vessel growth?

A

Oligodendrogliomas

166
Q

Mutation associated with oligodendroglioma

A

codeletion of 1p/19q

167
Q

extrinsic brain tumors that arise from the dura mater and are completely composed of neoplastic meningothelial (arachnoid cap) cells

A

meningoma

168
Q

Tumors with a strong propensity to metastasize
to axial skeleton

and has Tumors with a strong propensity to metastasize to axial skeleton

A

prostate CA, brain CA

169
Q

EEG finding in ATYPICAL absence seizure

A

EEG shows a generalized, slow spike- and-slow-wave pattern with a frequency of ≤2.5 per second

170
Q

EEG finding in atonic seizure

A

Brief, generalized spike-and-wave discharges → immediately by diffuse slow waves

RITE/PSBIM review (19 decks)

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