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NEUROLOGY Flashcards

1
Q

KESADARAN (kuantitatif/kualitatif/cedera)

A

3: koma
4-8: stupor (CKB)
9-12: somnolen (CKS)
13-14: apatis/gelisah (CKR)
15: compos mentis

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2
Q

POLA NAFAS
1. Cheyne stokes:
2. Central neurogenic hyperventilation:
3. Apneustik:
4. Ataxic/biot:
5. Apnea:

A
  1. Hemisfer korteks bilateral
  2. Batang otak atas (midbrain)
  3. Batang otak tengah (pons bawah)
  4. Batang otak bawah (medulla oblongata)
  5. Medulla oblongata/C1-C2
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3
Q

POLA PUPIL
1. Dilated bilateral
2. Dilated unilateral
3. Constricted unilateral
4. Constricted bilateral (pinpoint)
5. Constricted bilateral (reaktif)

A
  1. Midbrain (tectal)
  2. CN III palsy (uncal herniation)
  3. Horner syndrome (sympathetic pathway)
  4. Pons
  5. Diensefalon/thalamus, metabolik
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4
Q

Tonus naik, ref fisiologis naik, ref patologis (+), klonus (+)

A

LESI UMN

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5
Q

Tonus turun/-, ref fisiologis turun/-, ref patologis (-), klonus (-), atrofi (+)

A

LESI LMN

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6
Q

≥6 bulan, kronis progresif, kemunduran kognitif signifikan ≥1 domain (memori, daya pikir, daya tangkap, belajar, orientasi, visuospasial, bahasa, daya nilai), eksklusi sebab lain, ketergantungan orang lain
1. Gangguan memori dan bahasa, plak beta amiloid
2. Riwayat stroke
3. Gangguan kepribadian, pick body
4. Halusinasi, parkinsonisme, alpha synuclein body
5. Tidak ketergantungan orang lain

A

DEMENTIA
1. ALZHEIMER
2. VASKULAR
3. FRONTOTEMPORAL/PICK
4. LEWY BODY
5. MCI

DONEPEZIL 5MG, rivastigmin, galantamin

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7
Q

Derajat Dementia

A

> 27: NORMAL
21-26: RINGAN
15-20: SEDANG
10-14: SEDANG-BERAT
0-9: BERAT

0-9-14-20-26

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8
Q

Amnesia (retro/antero), bingung, ophthalmoplegia, ataxia

A

SINDROM WERNICKE-KORSAKOFF

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9
Q

AFASIA
1. Lancar (+), paham (+), repetisi (+):
2. Lancar (+), paham (+), repetisi (-):
3. Lancar (+), paham (-), repetisi (+):
4. Lancar (+), paham (-), repetisi (-):
5. Lancar (-), paham (+), repetisi (+):
6. Lancar (-), paham (+), repetisi (-):
7. Lancar (-), paham (-), repetisi (+):
8. Lancar (-), paham (-), repetisi (-):

A
  1. ANOMIK
  2. KONDUKSI
  3. TRANSKORTIKAL SENSORIK
  4. WERNICKE —> AREA 22
  5. TRANSKORTIKAL MOTORIK
  6. BROCA —> AREA 44, 45
  7. TRANSKORTIKAL CAMPURAN
  8. GLOBAL
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10
Q

Defisit neurologis <24h lalu hilang

A

TIA

Aspirin 320mg PO loading, lalu maintenance 1x 80mg PO (risiko rendah), + klopidogrel 300mg PO bolus, maintenance 1x 75mg (risiko sedang-tinggi), DOAC/warfarin/heparin (AF, DVT)

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11
Q

Skoring Risiko TIA

A

Skoring ABCD2 [Age>60 (1), SBP/DBP >140/>90 (1), hemiparesis (2), afasia (1), durasi≥60m (2), <60m (1), DM (1)], ≤3 risiko rendah, ≤5 risiko sedang, ≤7 risiko tinggi

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12
Q

Defisit neurologis 24-72h lalu hilang

A

RIND

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13
Q

Sirkulasi Anterior Otak

A

Korteks serebri (motor, somatosensorik), basal ganglia, area broca/wernicke
1. ACA: hemiparesis/hemihipestesi kontralateral bawah&raquo_space;> atas
2. MCA: hemiparesis/hemihipestesi kontralateral atas&raquo_space;> bawah, afasia broca/wernicke
-Lenticulostriate a.: hemiparesis kontralateral atas = bawah

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14
Q

Sirkulasi Posterior Otak

A

Brainstem, serebelum, thalamus, korteks oksipital (visual)
1. PCA: macular-sparring hemianopsia homonim kontralateral, amnesia
- Thalamic a.: hemihipestesi kontralateral atas = bawah
2. VA/BA: hemiparesis alternans
3. AICA/PICA/SCA: ataksia, vertigo, dismetria

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15
Q

Defisit neurologis fokal/global mendadak, menetap >24h, semata mata disebabkan oleh gangguan vaskular
Fibrilasi atrial, CT hipodens/dot sign/insular ribbon sign, siriraj ≤-1

A

STROKE ISKEMIK

AKUT: stabilisasi, rTPA alteplase 0.9mg/kg IV (<6h, (-) [pendarahan, BP >185/110, PLT rendah, on anticoagulants]), trombektomi mekanis (<24h, NIHSS≥7), DAPT aspirin 320mg loading lanjut 1x 80mg + klopidogrel 300mg loading lanjut 75mg PO (>24h, NIHSS ≤4), loading aspirin saja (NIHSS≥5). PREVENTIF: BP<130/80, LDL<70, DAPT maintenance, antikoagulan (emboli)

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16
Q

Defisit neurologis fokal/global mendadak, menetap >24h, semata mata disebabkan oleh gangguan vaskular
Cushing triad [Hipertensi, bradikardi, RR iregular], kaku kuduk, thunderclap headache, mual muntah, penurunan kesadaran, CT hiperdens/stellate/star sign, siriraj >1

A

STROKE HEMORAGIK

Stabilisasi, head up 30 derajat, manitol 0.25-0.5g/kg IV, target BP 140-160 nikardipin 5mg/h IV uptitrasi 2.5mg @15m max 15mg/h / labetalol 20mg IV @10m max 300mg, nimodipin 6x 40mg (SAH); kraniotomi dekompresi (pendarahan serebelar>3cm/midline shift/TIK memburuk)

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17
Q

Trias [demam, nyeri kepala, meningeal sign (+)]
CSF PURULEN, DOMINAN PMN/GRANULOSIT, protein tinggi, glukosa rendah

A

MENINGITIS BAKTERI

Seftriakson 2x 2g IV + vankomisin 15-20mg/kg IV (18-50y), + ampisilin 4x 2g IV (>50y/imm. comp), ampisilin 50mg/kg IV + sefotaksim 50mg/kg IV / gentamisin 2.5mg/kg (0-28d), sesuai kultur jika sudah ada, deksametason 0.15mg/kg IV 30M SEBELUM AB

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18
Q

Trias [demam, nyeri kepala, meningeal sign (+)]
CSF jernih, dominan limfosit, protein tinggi, GLUKOSA NORMAL

A

MENINGITIS VIRUS

Asiklovir 3x 10mg/kg 2wk

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19
Q

Trias [demam, nyeri kepala, meningeal sign (+)]
CSF jernih/keruh, dominan limfosit, protein tinggi, glukosa rendah, gejala TB (+), BTA (+)

A

MENINGITIS TB

HRZE 2mo lalu HR 10mo

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20
Q

Trias [demam, nyeri kepala, meningeal sign (+)]
CSH jernih/keruh, dominan limfosit, protein tinggi, glukosa rendah, india ink (+)

A

MENINGITIS FUNGAL

Amfoterisin B 0.7-1mg/kg IV + flukonazol 800mg/d 2wk lalu 8wk

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21
Q

Demam, penurunan kesadaran, kejang

A

ENSEFALITIS

|&raquo_space;>viral

Seperti meningitis

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22
Q

Defisit neurologis fokal, demam, leukositosis, CT kontras (+) single ring enhancement

A

ABSES SEREBRI

Seftriakson 2x 2g IV / sefotaksim 3x 8g IV + metronidazole 3x 800mg IV, manitol 0.25-0.5g/kg IV; operasi (>2.5cm)

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23
Q

Defisit neurologis fokal, demam, leukositosis, CT kontras (+) multipel ring enhancement

A

TOKSOPLASMOSIS SEREBRI

Pirimetamin 200mg PO SD + klindamisin 4x 600mg IV

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24
Q

≥5 serangan, 4-72 jam, ≥2 (unilateral, berdenyut, sedang-berat, exa akt fisik), ≥1 (mual muntah, foto/fonofobia), exc TIA

A

MIGRAIN TANPA AURA/COMMON

Sumatriptan 30mg PO / 6mg SC, ibuprofen 4x 400mg PO (abortif), propanolol 1x 80-240mg, topiramat 1x 25-200mg / as valproat 1x 400-1000mg (profilaksis)

25
Q

≥2 serangan, ≥1 aura reversibel (visual/sensorik/bicara/motorik/batang otak/retinal), ≥3 (memberat ≥5 menit, ≥2 aura berturutan, 5-60 menit, unilateral, aura positif, nyeri kepala dlm 60 menit)

A

MIGRAIN DENGAN AURA/CLASSIC

Sumatriptan 30mg PO / 6mg SC, ibuprofen 4x 400mg PO (abortif), propanolol 1x 80-240mg, topiramat 1x 25-200mg / as valproat 1x 400-1000mg (profilaksis)

26
Q

≥10 serangan, 30 menit-7 hari, ≥2 (bilateral, mengikat, ringan-sedang, tdk exa akt fisik), (-) (mual muntah, foto/fonofobia)
1. <1 d/mo
2. 1-14d/mo
3. >15d/mo

A

TENSION TYPE HEADACHE
1. EPISODIK INFREKUEN
2. EPISODIK FREKUEN
3. KRONIK

Ibuprofen 2x 400mg / parasetamol 1000mg, amitriptilin 25mg PO (profilaksis)

27
Q

≥5 serangan, 15-180 menit orbita/supraorbita/temporal, ≥1 (ipsilateral: injeksi/lakrimasi, kongesti/rinore, hiperhidrosis, edema palpebra, ptosis/miosis, gelisah, 1-8x/d)

A

CLUSTER TYPE HEADACHE

Oksigen 100% 12 lpm 15-20m, sumatriptan 6mg SC (abortif), verapamil 3x 120mg (profilaksis)

28
Q

Serangan paroksismal sesuai persarafan hingga 2 menit, ≥1 (intensitas tinggi di permukaan spt tertusuk, trigger zone (+)), pola serangan sama, defisit neuro (-)

A

TRIGEMINAL NEURALGIA

Karbamazepin 2x 100mg max 1200mg/d; microvascular decompression

29
Q

Lumpuh m. fasialis, tidak bisa menutup mata/lagoftalmos, nyeri telinga, perubahan pengecapan, hiperakusis

A

BELL’S PALSY

Prednison 60mg/d taper off 10d, asiklovir 5x 800mg 10d

30
Q

Mual muntah di kendaraan, nistagmus (-)

A

MOTION SICKNESS

Melihat ke objek jauh, skopolamin transdermal 1mg patch (preventif), dimenhidrinat 50-100mg / meclizine 50mg, promethazine 0.25mg PO, antiemetik (preventif + kuratif)

31
Q

Vertigo berat posisional, mual muntah berat, gangg. pendengaran (+), defisit neuro (-), nistagmus unidireksional, head impulse/VOR (+), test of skew (-) deviasi
1. Dix hallpike (+)
2. Supine roll test (+)

A

VERTIGO PERIFER
1. BPPV KANALIS SEMISIRKULARIS POSTERIOR
2. BPPV KANALIS SEMISIRKULARIS LATERAL

Betahistine HCl 3x 12mg / betahistine mesylate 3x 12mg / dimenhidrinat 3x 50mg

Epley, semont, latihan brandt-daroff (BPPV posterior)
BBQ/lempert roll (BPPV lateral)

32
Q

Vertigo ringan, mual muntah minimal, gangg. pendengaran (-), defisit neuro (+), nistagmus multidireksional, head impulse/VOR (-), test of skew (+) deviasi

A

VERTIGO SENTRAL

Etiologis

33
Q

Tuli, tinitus, vertigo, tes gliserin (+) membaik, ≥2 ep vertigo 20 min - 12 h, SNHL frek rendah-sedang ≥1x, gejala aural

A

MENIERE DISEASE

Diet rendah garam <1.5g, batasi kafein alkohol, hidroklorotiazid 1x 50mg, betahistine mesilat 3x 16mg

34
Q

Vertigo saja

A

NEURITIS

35
Q

Tuli/tinitus, vertigo, infeksi telinga (+)

A

LABIRINTITIS

36
Q

Nyeri punggung bawah menjalar, laseque/SLR test (+), bragard test (+) SLR dorsofleksi nyeri, siccard test (+) SLR dorso jempol nyeri, MRI (+) protrusi diskus
1. Menjalar kaki dalam
2. Menjalar kaki luar
3. Menjalar telapak kaki

A

LUMBAR HNP
1. L4
2. L5
3. S1

Kompresi L4 = HNP L3-L4

NSAID, fisioterapi; injeksi CS epidural; disektomi/laminektomi

37
Q

Nyeri leher menjalar ke tangan, naffziger test (+) kompresi jugularis paresthesia, spurling test (+) tekuk leher samping paresthesia saat kompresi, lhermitte sign (+) tekuk leher depan parethesia, MRI (+) protrusi diskus

A

CERVICAL HNP

NSAID, fisioterapi; injeksi CS epidural; disektomi/laminektomi

38
Q

Fleksi leher berlebihan, WAITER’S TIP POSITION (lengan adduksi, rotasi internal, pronasi, pergelangan tangan fleksi)

A

ERB’S PALSY/PLEKSOPATI C5-C6

39
Q

Hiperabduksi lengan, CLAW HAND (supinasi, pergelangan tangan ekstensi, fleksi jari tangan)

A

KLUMPKE’S PALSY/PLEKSOPATI C8-T1

40
Q

Fr. kolum humerus, ggn rotasi eksternal bahu, atrofi deltoid

A

CEDERA N. AKSILARIS

41
Q

Fr. korpus humerus/epikondilus, parestesia punggung jari 1,2,3, Dorsofleksi pergelangan (-), DROP HAND (+)

A

CEDERA N. RADIALIS

42
Q

Parestesia telapak jari 1,2,3, phalen test (+), tinel test (+), flick sign (+), torniquet test (+), thenar wasting (+), BISHOP/APE HAND (+)

A

CARPAL TUNNEL SYNDROME (CTS)/CEDERA N. MEDIANUS

43
Q

Parestesia jari 4,5, tinel test (+), pinch sign (+), froment sign (+), jeanne sign (+), hipothenar wasting (+), CLAW HAND (+)
1. Fleksi siku lama, level siku
2. Bersepeda lama, level pergelangan

A

CEDERA N. ULNARIS
1. CUBITAL TUNNEL SYNDROME
2. GUYON CANAL SYNDROME

44
Q

Parestesia/kesemutan kaki medial dan telapak kaki, tinel test (+), tes dorsofleksi eversi (+) kebas, triple compression test (+)

A

TARSAL TUNNEL SYNDROME (TTS)/CEDERA N. TIBIALIS POSTERIOR

45
Q

Parestesia kaki lateral dan dorsal kaki, Steppage gait, tinel test (+), dorsofleksi (-), DROP FOOT (+)

A

CEDERA N. PERONEUS KOMUNIS

46
Q

Rw DM, parestesti glove-stocking (+)

A

NEUROPATI DM

47
Q

Didahului infeksi (C.jejuni/EBV), kelemahan/paralisis/arefleksia asendens, CSF disosiasi sitoalbumin (protein naik, WBC normal)

A

GUILLAIN BARRE SYNDROME (GBS)

IVIg 0.4mg/kg (anak), plasmapheresis (dewasa)

48
Q

Kelemahan otot (okular, bulbar, leher/ekstremitas, pernapasan) desendens membaik dengan istirahat, tensilon test/edrophonium chloride test (+), wartenberg test (+), iced pack eye test (+), counting test (+) sengau, SEROLOGI ANTI-ACHR/MUSK (+)

A

MYASTHENIA GRAVIS

PIRIDOSTIGMIN 3-4X 30-60 MG, prednison 1mg/kg; intubasi, plasmapheresis, IVIg 400mg/kg (krisis)

49
Q

Fekal oral, lesi LMN unilateral, rw vaksinasi (-)

A

POLIOMIELITIS

Suportif, OPV/IPV (pencegahan)

50
Q

Degenerasi dan Lesi LMN + UMN

A

ALS/LOU GEHRIG

Riluzol

51
Q

Demielinasi white matter CNS, CIS [penurunan visus, nyeri mata, diplopia, hemiparesis, hemihipestesia, ataksia, lhermitte (+)] RELAPSING REMITTING, MRI KONTRAS (+) PLAK DEMIELINASI, CSF (+) oligoclonal band

A

MULTIPLE SCLEROSIS

Metilprednisolon 1000mg IV 5d (akut), immunomodulator

52
Q

GERAKAN INVOLUNTER, Ireguler, tidak bisa diprediksi, seperti menari

A

CHOREA

53
Q

GERAKAN INVOLUNTER, (Tangan/kaki) Kuat, bertenaga, amplitudo besar

A

BALISMUS

54
Q

GERAKAN INVOLUNTER, (Tangan/kaki) lambat, writhing

A

ATETOSIS

55
Q

GERAKAN INVOLUNTER, REGULER DAN RITMIS
1. Saat istirahat:
2. Saat bergerak:
3. Saat stimulasi simpatis:
4. Saat menuju target zigzag:

A

TREMOR
1. RESTING/PILL ROLLING
2. POSTURAL ESENSIAL
3. POSTURAL FISIOLOGIS
4. INTENTION

56
Q

GERAKAN INVOLUNTER, Postur abnormal menetap

A

DISTONIA

57
Q

GERAKAN INVOLUNTER, Gerakan/vokalisasi repetitif

A

TICS

58
Q

TRAP [tremor istirahat (pill rolling tremor), rigiditas (cogwheel phenomenon), aki/bradikinesia, postural instability]

A

PARKINSON’S DISEASE

Levodopa/karbidopa 3x 100/25mg, selegilin 5mg/d, prampipeksol 3x 0.125mg

59
Q

Miosis, ptosis, anhidrosis, pancoast tumor (+)

A

HORNER SYNDROME

GAS (14 decks)

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