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Neurology 2 Flashcards

1
Q

Atonic seizures clinical features

A

Falling down + no warning signs + brief loss of consciousness + deny loss of consciousness

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2
Q

Preferred study for vascular imaging in TIA

A

Carotid duplex US

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3
Q

AED for patients with osteoporosis

A

Lamotrigine (others induce p450 system, which increases breakdown of vitamin D)

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4
Q

Contraindications for using donepezil or acetylcholinesterase inhibitors for dementia

A

Sick sinus syndrome, LBBB, *asthma, angle closure glaucoma

*ulcer disease

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5
Q

Med to use for dementia if patient has contraindication to donepezil

A

Memantine

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6
Q

progressive supranuclear palsy clinical features

A

Stu walking across the room + sitting on taxi + eyes looking down to the floor + business executive by window/presentation = rapidly progressive gait dysfunction and falls + executive function loss + vertical gaze palsy (inability to move eyes up, called Parinaud syndrome).
Location: Jacquie Carrico’s apartment

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7
Q

Treatment of trichotillomania

A

SSRIs

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8
Q

How to differentiate etiology of cranial nerve 3 palsy

A

Parasympathetic fibers run on outside (compression), which leads to mydriasis (down and out blown pupil with aneurysm) → With DM2 it will be down and out without mydriasis

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9
Q

Myasthenia gravis clinical features

A

Moon astronaut walking extremely slowly and sluggishly and ACTH is painted on the rocket ship + he’s four eyed/worsening fatigue + difficulty opening eyes + diplopia.

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10
Q

Myasthenia gravis treatment

A

There are huge pyramids on the moon/Pyridostigmine is first line (acetylcholinesterase inhibitor). /Thymectomy is first line.

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11
Q

Cranial nerve 3 palsy presentation

A
  • pupil blown down and out
  • ptosis
    (Confirm)
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12
Q

medication-overuse headache (MOH) clinical features

A
  • patient taking daily analgesics (NSAID, triptans, opiates, butalbital) and headache getting worse (defined us using greater than 15 days out of the month)
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13
Q

treatment of medication-overuse headache (MOH)

A
  • immediately discontinue offending analgesic agent
  • bridging agent (typically have worsening after med discontinuation so need short 1-2 week steroid course to control HA)
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14
Q

Clinical features of idiopathic intracranial hypertension

A
  • vision changes
  • chronic daily HA
  • worsening when lying flat
  • MRI abnormalities (posterior scleral flattening, empty sella)
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15
Q

Imaging features of metastatic brain tumors

A
  • located at gray-white matter junction
  • multiple
  • large vasogenic edema
  • circumscribed margins
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16
Q

Cerebral amyloid angiopathy clinical features

A

elderly patient + multiple lobar hemorrhages

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17
Q

clinical features of intracerebral hemorrhage from AVMs

A
  • usually younger people (10-40) + hemorrhage extending into ventricles or subarachnoid space (not limited to lobar area)
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18
Q

Rupture berry aneurysm clinical features

A
  • sudden onset of severe headache + confusion + occasionally fever + *nuchal rigidity
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19
Q

treatment of otitis externa

A
  • remove debris
  • topical antibiotic (*quinolone)
  • topical steroid
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20
Q

Management of refractory otitis externa

A
  • culture ear canal + refer to ENT
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21
Q

outpatient CAP therapy

A

IF no comorbid conditions – augmentin OR doxy
IF comorbid conditions (DM2) or recent abx use or hx of drug-resistant strep pneumo –> beta-lactam antibiotic + macrolide OR quinolone

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22
Q

Determining dispo for pneumonia

A 
- CURB-65 (admit if 1 or more)
Confusion
Urea (greater than 20)
Respirations (greater than 30)
Blood pressure
Age over 65
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23
Q

bulimia treatment

A
  • SSRI
  • nutritional rehab
  • CBT
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24
Q

Indications for valve replacement with MR

A
  • symptomatic
  • EF less than 60%
  • end systolic dimension greater than 40
  • pTHN or new onset AF
  • NOT moderate atrial dilation
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25
Q

mononeuritis multiplex clinical features

A
  • asymmetric + multiple peripheral neuropathies (sensory and motor) + painful
  • typically in patients with underlying vasculitis, connective tissue disease, or systemic disorders (DM2)
  • steppage gait or wrist drop
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26
Q

treatment of mononeuritis multiplex

A
  • treat primary disease process
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27
Q

Other MS clinical features

A
  • usually starts before age 50

- NO affect on peripheral nervous system (thus no polyneuropathy)

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28
Q

how to reduce incidence of central line infections

A
  • daily chlorhexidine baths (skin disinfection)
  • antibiotic-impregnated catheters
  • never use guide wire technique to replace
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29
Q

Highest risk central lines for infection

A

femoral highest, IJ second highest, subclavian least likely

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30
Q

Management of patient with lyme disease with persistent symptoms after treatment

A
  • this is “post-lyme disease syndrome”

- no further management, just supportive care

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31
Q

WPW ECG

A

Short PR interval + delta wave + widened QRS

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32
Q

WPW clinical features

A

young patient + often asymptomatic + occasional symptomatic SVT (manifesting as palpitations, lightheadedness, presyncope or syncope, chest pain, or SCD)

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33
Q

Most commonly associated SVT with WPW

A

AVNRT (regular and narrow complex)

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34
Q

when to admit TIA patients

A
  • RF’s (multiple recurrent TIAs, AF, symptom duration over an hour, hypercoagulopathy, symptomatic internal carotid artery stenosis over 50%)
  • high ABCD2 score (predicts risk of stroke within next 48 hours)
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35
Q

Next step after positive acetylcholine receptor antibody for MG

A

1) start treatment
2) ***TSH
3) CT chest to rule out thymoma

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36
Q

Features of diplopia in MG

A
  • fatigable (generally presents at night, resolves when covering other eye)
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37
Q

Differentiating MG from Horner syndrome

A

Horner = impaired pupillary response (confirm)

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38
Q

Carotid dissection (ICA dissection) etiology + presentation

A
  • following head or neck trauma or spontaneous
  • acute neuro deficits + *unilateral HA (which may radiate to neck)
  • transient vision loss + ipsilateral partial Horner syndrome
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39
Q

Vertebral dissection presentation + vertebral dissection vs. carotid dissection

A
  • thunderclap HA, horner syndrome, neuro deficits, nystagmus, ataxia, dysarthria
  • unlike carotid dissection, NO aphasia or weakness
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40
Q

treatment of carotid artery dissection

A
  • just like ischemic stroke, except also anticoagulation
  • lytics (if within 4.5 hours of symptom onset)
  • anti platelet therapy + anticoagulation
41
Q

First step in management of brain met

A

IF new-onset headache or focal neurological deficits –> IV steroids (to reduce vasogenic edema and mass effect)

42
Q

Appearance of brain met on MRI

A
  • ring-enhancing lesion

- vasogenic edema

43
Q

Met on DWMRI vs an abscess

A
  • brain mets don’t cause restricted diffusion on DWMR (whereas, an abscess dose)
44
Q

WBRT vs surgery in general for brain mets

A 
WBRT = multifocal brain mets
Solitary = surgical resection
45
Q

Interventions associated with decreased rate of decline of mild cognitive impairment

A
  • physical exercise
  • cognitive activities
  • active social interactions
46
Q

Treatment of myasthenic crisis

A
  • plasma exchange or IVIG

* steroids also added for longer-term symptom relief

47
Q

other features of idiopathic intracranial hypertension

A
  • “whooshing” tinnitus (
  • papilledema
  • pulsatile headache
  • diplopia or blurry vision
48
Q

papilledema appearance

A

blurring of optic disk margins

49
Q

initial management of idiopathic intracranial hypertension

A
  • acetazolamide

- weight loss

50
Q

Presentation of vestibular schwannoma

A

*sensorineural hearing loss + chronic ipsilateral tinnitus + *vertigo + dysequilibrium

51
Q

Presentation of cerebellar stroke

A

acute-onset vertigo + Nausea and vomiting + ataxia

52
Q

Presentation of acute labyrinthitis

A

vertigo + ataxia + hearing loss

53
Q

acute labyrinthitis vs. vestibular schwannoma

A

labyrinthitis = 1-2 days then then gradually improves

vestibular schwannoma = months

54
Q

brain abscess clinical features

A
  • single or multiple ring-enhancing lesions at grey-white matter junction
  • significant edema
  • fever and leukocytosis often absent
55
Q

Primary CNS lymphoma clinical features

A

single lesion + severely immunosuppressed (CD4 count less than 50)

56
Q

PML clinical features

A
  • CD4 count less than 200

- multifocal areas of white matter demyelination on brain MRI with no mass effect or edema

57
Q

Janeway lesion description from endocarditis

A
  • erythematous macules on the palms
58
Q

Management of pituitary incidentalomas

A
  • Check for pituitary hyperfunction
  • Visual field testing
    IF no clinical features of pituitary hormonal hyper function – measure prolactin
59
Q

Only lab test required to thrombolytic therapy for ischemic sroke

A

Good glucose

60
Q

Indication for thrombolytics in acute ischemic CVA

A

Within 4.5 hours of symptom onset

61
Q

Indication for ASA in acute ischemic CVA

A
  • within 24-48 hours of first onset
  • **if timing of CVA is unknown, time of onset is when the patient was last known normal
  • hold for 24h if patient receives thrombolytics
62
Q

BP goals in acute ischemic stroke

A

1) Lytics given = Lower BP to 185 over 110 before giving, then maintain 180/105 for 24h
2) Lytics not given = 220 over 120

63
Q

Management of acute ischemic stroke in patient who isn’t TPA candidate

A

Aspirin + evaluate for mechanical thrombectomy

64
Q

When you can discontinue lung cancer screening based on when person quit

A

Patient hasn’t smoked for 15 years

65
Q

PRES clinical features

A
  • thunderclap headache
  • hemiparesis
  • seizures
  • altered mentation
  • visual impairment
66
Q

imaging in RES

A
  • symmetrical hyperintense T2 signal abnormalities in the subocrti al white matter of posterior parieto-occipitaq lobes
67
Q

Cushing reflex in brain bleeds clinical features

A

HTN + bradycardia + Cheyne-stokes breathing

68
Q

Presentation of bleed in the pons

A
  • deep coma and total paralysis within minutes

- pinpoint reactive pupils

69
Q

Presentation of bleed in the thalamus

A
  • upgaze palsy
  • miosis
  • contralateral hemiparesis and hemisensory loss
  • eyes deviate Toward hemiparesis
70
Q

Presentation of bleed in the basal ganglia

A
  • contralateral hemiparesis and hemisensory loss
  • homonymous hemianopsia
  • gaze palsy
71
Q

workup of suspected myasthenia graves in patient that is AchR-antibody negative

A

Test for muscle-specific tyrosine kinase receptor antibodies

72
Q

Halos around lights can also be seen in

73
Q

Treatment of acute dystonia

A
  • anticholinergics (benztropine, trihexyphenidyl)

- diphenhydramine

74
Q

NPH clinical features

A
  • wet, wobbly, wacky
  • urinary incontinence is a late feature so may be absent initially
  • can have parkinsonism like features (shuffling gait, UMN signs – hyperreflexia, increased tone)
75
Q

Treatment of NPH

A

ventriculoperitoneal shunting

76
Q

Meniere disease clinical features

A

vertigo (lasting 20 minutes to several horus) + sensorineural hearing loss + tinnitus OR fullness in ear (not all have tinnitus)

77
Q

Meniere disease management

A
  • salt, coffee, nicotine, alcohol restriction

- diuretics

78
Q

cerebellar vertigo

A
  • sudden onset, persistent vertigo
79
Q

Meningitis treatment

A
  • vanc + CTX
    IF over 50 OR immunocompromised – add ampicillin
    *if hospital acquired (neurosurgery) or penetrating skull trauma – need pseudomonas coverage (except for zosyn, which doesn’t have CNS penetration)
80
Q

Things to avoid post TPA

A
  • early enteral feeding

- no AC or anti platelet within the first 24 hours until repeat CT head shows no hemorrhagic conversion

81
Q

Antiepileptic drug that is teratogenic

A

valproic acid

82
Q

Evaluation + Management of subarachnoid hemorrhage + why

A

Ct head then CT-A ASAP with end-vascular approach to stabilizing the aneurysm (this will prevent rebreeding, which is the major cause of death within the first 24 hours)
- nimodipine is given to prevent recurrent vasospasm,, which doesn’t typically happen until 3 days after

83
Q

workup of foot drop

A

IF back pain, weakness of leg abduction –> L spine MRI (due to L5 lumbosacral radiculopathy associated with back pain)
IF weakness of foot dorsiflexion, eversion, and toe extension + no pain –> nerve conduction studies (due to common perineal nerve compression)

84
Q

Management of post concussive syndrome following TBI

A
  • reassurance (self-limiting, should resolve within weeks to months)
    IF severely disabling or very long term – neuropsychological testing
85
Q

Initial steps in treatment of bacterial meningitis

A

IF head CT required before LP –> start empiric steroids and antibiotics before CT or LP (since CT can take up to 6 hours, you shouldn’t delay treatment, even though it will reduce LP yield)
IF no head CT required –> LP prior to treatment

86
Q

Indications for head CT before LP

A
  • AMS
  • focal neuro deficits
  • immunocompromised
  • new-onset seizure
  • papilledema
  • history of CNS disease
87
Q

Todd’s palsy clinical features

A

Focal weakness following a seizure

88
Q

Glue sniffing or solvent toxicity

A
  • AGMA that progresses to RTA with marked hypokalemia + hypophosphatemia
  • above can lead to severe weakness
89
Q

Treatment of post-herpetic neuralgia

A
  • TCA’s

- gabapentin or pregabalin

90
Q

CIDP clinical features

A
  • slowly progressive weakness + sensory loss + diminished or absent reflexes
91
Q

nystagmus features differentiating peripheral from central vertigo

A 
central = greater than 1 min duration + not inhibited by fixation of gaze
peripheral = never purely vertical + inhibited by fixation of gaze + less than 1 minute duration
92
Q

Management of hallucinations in lewy body dementia

A
  • quetiapine
93
Q

Treatment of rem sleep behavior disorder

94
Q

management of cognitive impairment in lewy body dementia

A
  • cholinesterase inhibitors (donepezil, memantine)
95
Q

core features of alzheimer

A
  • short term memory loss
  • language deficits
  • spatial disorientation
96
Q

other core feature of vascular dementia

A

early executive dysfunction

97
Q

most common cause of death in ALS

A

respiratory failure (median survival of 5 years)

98
Q

coronary occlusion that can cause heart block

A

RCA or sometimes left circle (AV node supply)

*not LAD

99
Q

Determining when patients need PCI for coronary lesions

A
  • only if clinical or ECG manifestations of myocardial ischemia (not degree of stenosis alone)

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