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PANCE > Neurology 2 > Flashcards

Neurology 2 Flashcards

1
Q

resting tremor?

A

Parkinson’s disease

tremor at rest, goes away with movement

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2
Q

What are the 2 types of action tremor?

A

physiologic = catecholamin’es, caffeine, nicotine, anxiety, ritalin, drug (overuse)

essential (genetic) = tremor with movement

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3
Q

What diseases have intention tremor? Describe it?

A

MS, cerebellar disease, CVA/brain injury

-tremor increases in severity as the hand moves closer to target

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4
Q

Treatment for resting tremor?

A

treat parkinson’s

  • balance dopamine and acetylcholine
  • levodopa/carbidopa
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5
Q

treatment for action tremor?

A

remove offending agents

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6
Q

treatment for essential tremor?

A

propranolol and primidone

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7
Q

patient comes in and has not been able to move very quickly, he has difficulty arising from a seating position, and difficulty with handwriting.. you suspect Parkinson’s… what are other symptoms?

A
  • resting tremor (pill rolling)
  • bradykinesia (slow, shuffling gait)
  • rigidity (cogwheel)
  • postural instability
  • expressionless (masked facies)
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8
Q

Treatment for Parkinson’s disease?

A

65 = levodopa/carbidopa

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9
Q

What is the pathophys of Parkinson’s disease?

A

degeneration of basal ganglia cells in the substantial nigra

-deficiency of dopamine and imbalance of dopamine and acetylcholine

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10
Q

How does levodopa work? Why combine with carbidopa?

A

for Tx parkinsons

-circulates in plasma to BBB where it crosses & is decarboxylated to dopamine

=we can’t give dopamine because it does not cross BBB

combine with carbidopa to lower doses of levodopa and reduce ADR

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11
Q

Amantadine?

A

mild anticholinergic

-helpful for mild parkinson’s symptoms

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12
Q

What class of drugs breaks down dopamine?

A

monoamine oxidase B inhibitor

selegiline

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13
Q

What are catecholamine-O-methyltransferase (COMT) inhibitors used for?

A

Parkinson’s

  • reduce metabolism of levodopa
  • (ex. tolcapone and entacapone)
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14
Q

rapid involuntary, non-repetitive or rhythmic movement involving the face, trunk, and limbs

A

chorea

huntington’s disease

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15
Q

What is the inheritance pattern for Huntington’s disease?

A

autosomal dominant

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16
Q

Treatment for Huntington’s Disease?

A
  • no known cure
  • symptomatic

Chorea: tetrabenazine
Chorea + psychosis = olanzapine, risperidone, haloperidol

PT/OT/ speech

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17
Q

What are symptoms of Huntington’s Disease?

A

Neurologic = chorea, dystonia, hyperreflexia

Cognitive = poor judgement, loss of insight, memory loss

Psych = aggression, delusion, anxiety, depression, disinhibition

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18
Q

DDX of choreiform disorder?

A
  1. Huntington’s Chorea
  2. Tardive dyskinesia = after use of antipsychotic drug and metoclopramide (N/V drug)
  3. Extrapyramidal syndrome = after antipsychotic like haldol (treat with benadryl)
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19
Q

Diagnosis and treatment for Tourette Syndrome?

A

tic (motor or phonic) occur several times per day for 1 year

treat symptoms

  • fluphenazine, pimozide, haloperidol
  • behavior therapy
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20
Q

symmetrical extremity weakness that began in the legs and ascents, DTR are decreased,

autonomic dysfunction (tachycardia, urinary retention)

A

Guillain- Barre

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21
Q

What is often the cause of Guillain-Barre?

A

infectious = campylobacter jejuni (most common)

other causes: minor infection, immunization, surgery

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22
Q

When does Guillain-Barre become life threatening?

A

when affects muscles of respiration or swallowing = resp failure!

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23
Q

How do you diagnose Guillain-Barre?

A

lumbar puncture = elevated CSF protein with normal WBC

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24
Q

Treatment for Guillain-Barre?

A

IVIG = plasma exchange (plasmapheresis)

-hospitalized to monitor resp status

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25
Q

patient presents with ptosis, diplopia, difficulty chewing, limb weakness, easily fatigue

weakness with everyday activities (brushing hair), improve with rest

A

myasthenia gravis

young women (20-30)
old man (70-80)
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26
Q

What is the pathophys of myasthenia gravis?

A

antibodies directed against the acetylcholine receptor on the muscle surface cause an increased rate of receptor destruction = leads to weakness

27
Q

How do you diagnose myasthenia gravis?

A

administer short-acting anti cholinesterase (edrophonium)

antibodies = autoantibodies acetylcholine receptor, autoantibodies to tyrosine kinase (MuSK)

28
Q

Treatment of myasthenia Gravis?

A

give cholinesterase inhibitor = pyridostigmine

-thymectomy if

29
Q

Drugs that cause myasthenia gravis?

A

-aminoglycoside ABX (neomycin, gentamicin, streptomycin, tobramycin)

  • magnesium sulfate
  • penicillamine
  • interferon-alpha
30
Q

patient first has visual problems, then complains of sensory loss and weakness in limbs, ataxia and paresthesias
-intention tremor

A

multiple sclerosis

31
Q

what is the first sign of multiple sclerosis?

A

optic neuritis and vision changes

32
Q

What is the pathophys of multiple sclerosis?

A

inflammation associated with multiple foci of demyelination in the CNS white matter

33
Q

Diagnose multiple sclerosis?

A

MRI: McDonald Criteria

CSF = oligoclonal bands

34
Q

Treatment for multiple sclerosis?

A
  • interferon Beta-1a
  • glatiramer acetatone
  • IV glucocorticoids
  • immunosuppressive (cyclophosphamide)
35
Q

What is the etiology of cerebral palsy?

A

-cerebral injury before birth, during delivery, or in perinatal period (hypoxia/ischemia)

36
Q

Patient presents with spasticity, lack of coordination, suppressed primitive reflexes (dyskinetic), ataxic

A

cerebral palsy

37
Q

Treatment for cerebral palsy?

A

supportive = PT/OT/Speech

if bilateral = at risk for hip dysplasia and monitor regularly

38
Q

Types of meningitis (5)?

A
  • bacterial
  • aseptic (viral)
  • encephalitis
  • granulomatous
  • brain abscess
39
Q

Causes for aseptic (viral) meningitis?

A

1 = enterovirus (coxsackievirus)

travel = Tb
rodent = CMV
Ticks = lyme, rock mountain spotted fever
Mosquitos: west nile virus
Sexual activity: HIV, syphilis, HSV
40
Q

fever, nuchal rigidity (brudzinski and kernig), and headache

A

bacterial meningitis

41
Q

Cause of bacterial meningitis?

A

Streptococcus pneumonia; N meningitidis

Group B strep and e coli =

42
Q

meningitis with petechial rash

A

N. Meningitidis

43
Q

Diagnose Meningitis?

A
  • Lumbar puncture
  • CSF analysis
  • elevated protein, WBC (neutrophils)
  • decreased glucose
44
Q

Bacterial Meningitis Treatment?

A
  • ABX = don’t delay!
  • neonate = ampicillin and cefotaxime
  • infant to 3 month = same combo
  • immmunocompetent = cefotaxime + vancyomycin
  • adult >55 = ampicillin + cefotaxime + vanco

-dexamethasone = most everyone get this

45
Q

signs of meningitis in neonates?

A
  • fever
  • hypothermia
  • irritability
  • poor feeding
  • bulging fontanella
  • nuchal rigidity
  • +CSF culture
46
Q

CSF findings for viral meningitis?

A
  • normal opening pressure
  • WBC low = lymphocytes or monocytes
  • normal protein, glucose, blood
47
Q

neurologic infection with change in mental status?

A

encephalitis (pt appear confused, agitated, obtunded, seizures)

48
Q

bite from an infected animal = present with hydrophobia, acrophobia, pharyngeal spasm

A

rabies = encephalitic form

49
Q

negri bodies on a patient who was bit by a dog?

A

rabies

50
Q

Treatment for rabies?

A
  • rabies immunoglobulin passive immunization

- rabies vaccine active immunization

51
Q

patient had the flu and then started vomiting/confusion, seizure (encephalopathy) in a child after exposure to salicylates (aspirin/pepto-bismol)?

diagnosis?

Treatment?

A

reye’s syndrome

hepatomegaly

labs = elevated aminotransferase activity, increased PT, hyperammonemia, hypoglycemia, metabolic acidosis

treatment = supportive

52
Q

Altered Mental Status Causes?

A

AEIOU-TIPS

  • alcohol/AAA
  • electrolyte/encephalopathies, endocrine problem
  • insulin - hypoglycmeia
  • opiates or overdose
  • uremia
  • trauma, temp, toxemia
  • infection (sepsis, meningitis)
  • psychogenic or PE
  • space occupying lesion/stroke/shock/seizure
53
Q

What is delirium?

A

acute syndrome - caused by medical condition, substance intoxication or withdrawal, medication ADR = causes temporary confusion and altered mental status

-short term and reversible

54
Q

Examples of delirium?

A
  • sepsis
  • sun downing
  • etoh withdrawal
  • opiate withdrawal
  • sun stroke
  • inhalation of fumes/smoke
55
Q

What is dementia?

A

disorder characterized by impaired memory + aphasia, apraxia, agnosia, executive function

irreversible altered mental status

56
Q

What are some types of dementia?

A
  • Alzheimer (most common)
  • Vascular (multi-infarct)
  • frontotemporal (Pick)
  • with lewy bodies
57
Q

older patient, steadily progressive memory loss = disorientation, language difficulties, inattention,

A

alzheimer disease

memory loss and difficultly with problem solving

58
Q

What are pathologic findings for Alzheimers?

A
  • neurofibrillary tangles (intracellular)

- plaques (extracellular)

59
Q

Treatment of Alzheimer’s?

A
  • acetylcholinesterase inhibitors = donepezil, galantamind, rivastigmine, tacrine
  • add memantine (NMDA antagonist to regulate glutamate)
  • antipsychotics for agitation
60
Q

Phenytoin ADR?

A
  • gingival hypertrophy
  • teratogenicity
  • nystagmus
61
Q

Carbamazepine ADR?

A
  • bone marrow suppression
  • rash (SJS)
  • teratogenicity (NTD)
62
Q

Valproic Acid ADR?

A
  • hepatotoxicity

- teratogenicity (NTD)

63
Q

MOA of triptan drugs?

A

vasoconstriction

  • selective agonist for serotonin receptors
  • inhibit release of vasoactive peptides

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