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PANRE > Neurology > Flashcards

Neurology Flashcards

1
Q

What do you see on autopsy of pt with Alzheimers disease?

A

Neurofibriallary tangles and senile plaques

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2
Q

Treating Alzheimers symptomatically, what 2 behavioral problems proab need treating?

A

Delusions: Risperidone, olanzapine or quetiapine. Avoid Haloperidol
Agitation: Trazodone, divalproex or carbamazepine: avoid anticholinergics

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3
Q

What class of drug can help improve cognition, AODL and apathy with Alzheimers?

A

Aceytlcholinesterase inhibitors: Donepezil, Rivastigmine, Galantamine. SE: N/V/Diarrhea and muscle cramps

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4
Q

Most common movement disorder of children?

A

Cerebral palsy

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5
Q

CP

A

A non-progresive disorder of movement and posture that results from a lesion of the immature brain

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6
Q

4 types of Pyramidal (Spastic) with CP?

A

Diplegia: Bil LE extreme spasticity
Quadriplegia: All limbs severely involvd, LE >UE
Hemiplegia: UE > Lower
Bilateral hemiplegia: all limbs involved

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7
Q

Extrapyramidal with CP.

A

Variable tone +/- hyperreflexia

1) Ataxic: diff coordinating purp. movements
2) Dystonic: Uncontrollable jerking, writhing and posture movements

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8
Q

Unilateral facial weakness of unkonown etiology

A

Bell’s Palsy

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9
Q

Bell’s Palsy S/S

A

Usu. facial paralysis in am and appears to come on overnight

  • Diff closing eye on affected side
  • Paralysis may be preceeded by pain by ear
  • Taste loss ant two thirds of tongue
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10
Q

Herpetic lesion noted in ext aud canal?

A

Ramsay Hunt Syndrome

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11
Q

Tx Bell’s?

A

Many resolve on their own, try Acyclovir/Corticosteroids

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12
Q

Most common neurologic syndrome in DM pts?

A

Sensorimotor Polyneuropathy

-Stocking glove pattern of numbness/tingling, loss of 2 point discrimination

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13
Q

Gullain-Barre syndrome?

A

Acute or subacute polyradiculoneuropathy 2 to an immune-mediated mechanism. Lymphatic infiltration and macrophage-mediated Dymyelination and axonal degenaration.

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14
Q

Ascending weakness, ataxia starting in feet–>legs then loss of deep tendon reflexes……following some type of infection

A

Think Gullain-Barre syndrome. Ground to Brain

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15
Q

What do you have to watch for with GB?

A

Resp failure, may need ventilator

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16
Q

TX for GB?

A

Get EMG, check spinal fluid

TX: Plasmapheresis and high doses of human immunoglobin

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17
Q

Myasthenia Gravis?

A

Think Mind to Ground—>Autoimm. disorder casues a decrease in Ach receptors at the motor endplate.
Females 20 and males in 50-60s

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18
Q

S/S MG?

A

affects eye muscles, causein ptosis and dipoplia. Other facial muscles affected. Increased and abnormal fatigue. Normal DTR

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19
Q

DX of MG?

A
  • Anticholinesterase chalenge test (Edrophonium or neostigmine) shows increased muscle strenght for a few seconds-minutes.
  • EMG
  • Serology testing
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20
Q

Reccurent episodes of freq headaches seperated by periods of beng headache free. More common in females by 6:1, Unilateral, Temporal with lacrimation. nasal congestion, ptosis?

A

Cluster headache

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21
Q

Tx Cluster headache?

A
  • High flow 02
  • Ergotamine tartate
  • Sumatriptan, lithium carbonate Can try Verapamil for ongoing.
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22
Q

Migraine SXMS?

A 
May be brought on by triggers
May have prodrome
\+/- Aura
Unilateral and throbbing
Photophobia, phonophobia, vomitting
Review tx for Migraines, dep on severity  NSAIDS< Caffeine, Sumatriptin, Ergotamine, Meperidine, Vascoconstictors (5 HT agonists)  BB, TCAs, CCB, Anticonvulsants
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23
Q

Most common type of primary headache disorder?

A

Tension headache

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24
Q

Tension headache S/S?

A

Recurrent attacks of diffuse, tight, bandlike, bil. pain

Tx with NSAIDS APAP

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25
Q

Infxn of brain parenchyma 2 to mosquitos or ticks?

A

Viral encephalitis

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26
Q

Dx of Viral enchephalitis?

A
  • CT head

- CSF analysis

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27
Q

CSF in viral encephalitis?

A 
Negative Gram Stain for bacteria
WBC greater than 50/mm with mononuclear leukocytes
Normal or decreased Glucose
Protien > 100 mg/dL
Normal C react protein
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28
Q

SS Viral encephalitis

A
  • meningeal irritation
  • headache
  • photophobia
  • stiff neck
  • Seizures
  • Decreased LOC
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29
Q

TX of viral encephalitis?

A

Acetominophen DOC fever and headache

Acyclovir

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30
Q

Bacterial Meningitis?

A

Inflammation of arachnoid, pia matter and CSF
**Medical emergency
can also be Pneumococcal and Staph aureus

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31
Q

S/S Bacterial Meningitis?

A

Fever, headache, vomitting, stiff neck

-Petichial rash

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32
Q

Kernig’s sign?

A

pt supine, hip knee flexed to 90 degrees, further extension casue pain in NECK or hamstring

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33
Q

Brudinski’s sign?

A

Flexion of neck with pt supine results in flexion of the hip and KNEE is positive.

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34
Q

CSF in Bacterial Meningitis?

A

Rapid antigen test for HIB, strep PNA, Group B strep, N Meningitidis, and E coli

  • WBC .>100
  • -Glucose < 40
  • Protein > 100
  • Elevated lactic acid
  • Elevated C reactive protein
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35
Q

Typical organisms in Neonate Bact Meniningitis?

A

Strep B, E coli, Listeria monocytogenes

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36
Q

Children < 15 year old Bact Meningitis

A

Strep Pna, N Meningitidis, HIB

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37
Q

Adults >15

A

Staph aureus, Gram neg Bacilli, N Meningitidis

38
Q

ALS?

A

Upper and lower motor neuron disorder of unknown cause with progressive muscle weakness

39
Q

ALS sxms

A

muscle weakness hands, faciculations, spasticity, dysarthria and dysphagia. Sensory system weakness

40
Q

ALS dx

A

history, EMG, Treat symptomatic

Riluzole may help for a few months FATAL in 3-5 years

41
Q

Essential Tremor?

A

Inhereted, autosomal dominant. Tx with Beta Blockers

42
Q

30-50 y.o.Pt presents with insidious onset of clumsiness and random, brief, fidgety movements?

A

Think Hunnington’s Disease

43
Q

Hunnington’s disease is….?

A

A genetic disorder characterized by choreiform movements, mental status decline, and personality changes. No cure, CT shows Cerebral atrophy.

Brisk reflexes, can’t maintain tongue protrusion.

44
Q

Chorea?

A

Chorea is characterized by brief, semi-directed, irregular movements that are not repetitive or rhythmic, but appear to flow from one muscle to the next

45
Q

Progressive, degenerative disease resulting from loss of Dopaminergic neurons in the Substancia Nigra?

A

Parkinson’s

46
Q

Classic Triad of Tremor, Cogwheel rigidity, Bradykinesia?

A

Parkinson’s

Also Masked facies, shuffling gait, dementia

47
Q

Tx for Parkinson’s?

A

Levodopa plus Carbidopa

Dopamine agonists (Bromocriptine, Pramipexole, Ropinirole)

Anticholinergics:
Amantadine, Selegiline

Surger stereotactic thalamotomy for disabling tremor

48
Q

Immune-initiated inflammatory Demyelination and axonal injury, greater in females 20-50 y.o.

A

Multiple Sclerosis

49
Q

Multiple sclerosis S/S?

A

weakness, numbness, tingling, unsteadiness in a limb. Spasticity with positive Lhermitte’s sign

50
Q

Sensation of electricity down the back with passive flexion of neck?

A

Lhermitte’s Sign for MS

51
Q

oligoclonal bands, CSF protein normal, CSF cell count less than 50, increased levels of myelin basic protein

A

Think CF for CSF testing

52
Q

Tx for MS?

A

Baclofen, diazepam for spasticity

Immunomodulatory therapy
Inteferon B-ib (Betaseron)

53
Q

Partial seizures: 2 types

A

Simple

Complex

54
Q

A 35 year old patient comes to your office because
his wife made him. He has been increasingly
irritable and moody. She has also noticed that he
is very restless. You order a CT scan which showes
cerebral atrophy as well as atrophy of the caudate
nucleus. What is the most likely diagnosis?

A

Hunnington’s

55
Q

An EEG showing generalized spikes and associated
slow waves should make you think of what
diagnosis?

A

Generalized or absence

56
Q

What is the most common primary intracranial neoplasm?

57
Q

Brief, abrupt and self limiting loss of consciousness, staring followed by rapid eye blinking for 3-5 seconds–No post-Ictal period

A

Absence seizure

58
Q

Loss of consciousness followed by tonic (stiffening) then clonic (rhythmic jerking), urin incontinence…then post ictal period

A

Tonic-Clonic seizure

59
Q

Seizure of tonic-clonic with high fever in a 6 month old to 4 years of age?

A

Febrile siezure

60
Q

Most important diagnostic in seizure?

A

EEG can get MRI

61
Q

Tx for status epilepticus?

A

Thiamine and glucose, Diazapem TOC (also Lorazapam)

Start Phenytoing immedietly. Greater than 30 min, intubate then start Phenobarbital, etc….

62
Q

Most common intracranial aneurysm?

A

Saccular ( BERRY) Usu located in Circle of Willis

63
Q

Fusiform aneurysm develops where?

A

basilar artery

64
Q

Dilation of cerebral ventricles 2 to prior CNS insult?

A

Normal pressure Hydrocephalus

65
Q

Phenytoin?

A

Stablizes neuronal cells by decreasing flux of sodium ions
Nystagmus, Ataxia, N/V, Gingival hyperplasia
TETROGENIC***

66
Q

Valporic Acid?

A

Enhances GABA action at the inhibitory synapses, reducing abnormal discharge in the brain.

Usual stuff but monitor for Liver toxicity

67
Q

A middle age male presents with unilateral
periorbital headaches occurring daily for several
weeks. These headaches are extremely painful.
Which type of headache is the most likely cause?

A

Cluster headache

68
Q

What percentage of strokes are ischemic? What

percentage are hemorrhagic?

69
Q

There is an MRI result of multiple foci of
demyelination in the white matter. What is the
most likely diagnosis?

A

Multiple Sclerosis

70
Q

Most common stroke?

71
Q

NPH?

A

Apraxia (wide shuffling gait), dementia, urin incontence, weakness, malaise, lethargy

72
Q

NPH?

A

High Pressure Lumbar Puncture
Enlarged ventiicles

Removal of CSF provides temp relief, Venticulo shunt is TOC

73
Q

TOC for Status Epilepiticus?

A

Ativan—Lorazepam

74
Q

If stroke less than 24 hours?

75
Q

Stroke work up

A

EKG, Carotid Doppler, CT scan—non-contrast is the initial first study.
MRI is most sensitive

76
Q

Thrombolytic therapy is the only effective method for acute tx for?

A

Ischemic Stroke
Must be started within 3 hours after onset, get CT to r/o hemorrhage.
BP must be less then 180/110

77
Q

Contraindications to thrombolytic therapy?

A

Major surgery or trauma in last 2 weeks

Evid of GI bleeding

78
Q

Tx of Hemmorhagic stroke?

A

Mannitol, hyperventilation, head elevation, Heparin if indicated. Need lower ICP

79
Q

Subarachnoid Hemmorrhage

A

Rupture of vessels on or near the surface of the brain or ventricles

80
Q

Most common cause of SAH?

81
Q

Worst Headache of my life!

A

Think SAH Also stiff neck with delirium possible

82
Q

Fundoscopic exam of SAH?

A

Well circumscribed, bright red, preretinal hemorrhages

83
Q

SAH imaging?

A

If CT negative, get lumbar puncture with high susp. Red blood cells in tube.

84
Q

Definitive imaging SAH?

A

Cerebral angiography definitive test of choice

85
Q

A patient presents to your office complaining of
a tremor in his right hand. He states after a beer
it goes away completely. What is the most likely
diagnosis?

A

Benign essential tremor or familial tremor

86
Q

What is the most common cause of subarachnoid

hemorrhage aside from trauma?

A

Ruptured cerebral aneurysm

87
Q

Which nerve root is responsible for the knee jerk

reflex?

88
Q

A patient complains of muscle weakness and

fatigability that improves with rest. What is the proab dx?

A

Mysathenia gravis

89
Q

A patient has an intracranial neoplasm causing
auditory illusions, olfactory hallucinations and
emotional changes. What lobe is the lesion likely?

A

Temporal lobe

90
Q

patient presents with inability to speak and right
sided weakness. He seems to understand speech
and follows commands well. What type of aphasia

A

Broca’s aphasia

PANRE (14 decks)

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