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Neurology Flashcards

1
Q

Symptoms of middle cerebral artery stroke?

A

More upper extremity weakness

  • aphasia
  • apraxia/neglect
  • Eyes deviate toward side of lesion
  • Contralateral homonymous hemianopsia
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2
Q

Contraindications to thrombolytic therapy in acute stroke?

A
  • Current or hx of hemorrhagic stroke
  • Intracranial mass or neoplasms
  • Active bleeding or surgery in the past 6 weeks
  • Presence of bleeding disorder
  • Traumatic CPR within the past 3 weeks
  • Suspicion for aortic dissection
  • Cerebral trauma or brain surgery in past 6 months
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3
Q

Management of status epilepticus?

A
  1. Benzos (ativan)
  2. Fosphenytoin
  3. Phenobarbital
  4. General anesthetic (pentobarbital, thiopental, midazolam or propofol)
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4
Q

First line agents for long-term management of seizures?

A

Valproic acid, carbamazepine, phenytoing, levetiracetam (keppra). Also lamotrigine, but higher risk of stevens-johnson syndrome.

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5
Q

Second line agents for long-term management of seizures?

A

Gabapentin and phenobarbital

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6
Q

Best agent for absence or petit mal seizures?

A

Ethosuximide

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7
Q

Parkinson under age 60, best treatment for mild symptoms?

A

Anticholinergics (Benztropine)

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8
Q

First line agent for severe Parkinson’s?

A

Levodopa/Carbadopa or dopamine agonists (Pramipexole, ropinirole, cabergoline)

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9
Q

Second line agents for severe Parkinsons?

A

COMT inhibitors (Tolcapone, entacapone), MAO inhibitors (Selegiline, Rasagiline), can also do deep brain stimulation in severe refractory cases.

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10
Q

CT or MRI for if suspicious of Multiple Sclerosis?

A

MRI. CT is rarely useful

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11
Q

If MRI non-diagnostic of multiple sclerosis, what do you do next and what are you looking for?

A

Lumbar puncture, looking for oligoclonal bands

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12
Q

Initial and long-term management for multiple sclerosis?

A

Initial - Steroids

Long-term - Beta interferon, glatiramer, mitoxantrone, or natalizumab

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13
Q

Memory loss in an older patient, tests to order?

A

CT head, B12, TSH, RPR or VDRL

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14
Q

First and second line treatment for alzheimer’s?

A

First line - Anticholinesterase (donepezil, rivastigmine, galantamine)
Second line - Memantine

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15
Q

Rapidly progressive dementia and presence of myoclonus in a relatively young patient, diagnosis?

A

Creutzfeldt-Jakob Disease

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16
Q

Work-up for Creutzfeldt-Jakob disease?

A

EEG, MRI (not usually helpful). Definitive diagnosis is brain biopsy. Can also do lumbar puncture to look for 14-3-3 protein in CSF.

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17
Q

Patient with involuntary closure of the eye triggered by light and cigarette smoke, diagnosis and treatment?

A

Blepharospasms (a focal dystonia). Treated with botox.

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18
Q

Urinary Incontinence, AMS, ataxia. Diagnosis?

A

Normal Pressure Hydrocephalus

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19
Q

Migraine triggers?

A

Cheese, caffeine, menstruation, OCPs

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20
Q

Best abortive therapy, best prophylactic therapy for migraines?

A

Abortive - Sumatriptan or Ergotamine
Prophylaxis - beta-blockers (propranolol)
Alternate prophylaxis - CCB, TCAs, SSRIs

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21
Q

Characterestic of cluster headaches?

A

Unilateral with redness/tearing of the eye and rhinorrhea occurring multpile times in a short period of time

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22
Q

Best abortive therapy, best prophylactic therapy for cluster headaches?

A

Abortive - triptans, 100% oxygen

Prophylaxis - verapamil

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23
Q

Diagnostic testing for temporal arteritis?

A

ESR. Diagnostic is temporal artery biopsy

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24
Q

Obese young woman with headache, double vision and papilledema? Diagnosis and treatment?

A

Pseudotumor Cerebri

Lumbar puncture with elevated opening pressure. Treat with acetazolamide, weight loss, vp shunts for refractory cases.

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25
High suspicion for temporal arteritis and elevated ESR. Next step?
Immediate high dose steroids, delay may cause vision loss.
26
Vertigo with change in position. No hearing problems or ataxia. Diagnosis? Physical exam finding associated with this? Treatment?
Benign positional vertigo Positive Dix-Halpike maneuver Treat with Meclizine (antivert)
27
Vertigo not associated with change in position. No hearing problems or ataxia. Diagnosis?
Vestibular Neuritis
28
Acute vertigo with hearing loss and tinnitus. Diagnosis?
Labyrinthitis. Also responds to meclizine.
29
Chronic remitting vertigo with hearing loss and tinnitus. Diagnosis? Treatment?
Meniere's disease. Treat with salt restriction and diuretics.
30
Vertigo with hearing loss, tinnitus, and ataxia. Diagnosis? Treatment?
Acoustic neuroma. Treat with surgical resection
31
Acoustic neuroma associated with what conditions?
Neurofibromatosis and Von Recklinghausen's disease
32
Presentation of Wernicke-Korsakoff syndrome?
``` In a patient with known alcoholic history: Wernicke's encephalopathy: Confusion Ophthalmoplegia Ataxia Thought (memory) impairment Korsakoff’s psychosis: Retrograde amnesia (severe memory loss) Anterograde amnesia Confabulation Kan’t be bothered – lose interest in things quickly. ```
33
Meningitis patient, CSF gram stain shows Gram-positive diplococci. What organism?
Pneumococcus
34
Meningitis patient, CSF gram stain shows gram-negative diplococci. What organism?
Neisseria
35
Meningitis patient, CSF gram stain shows gram-negative pleomorphic, coccobacillary organisms. What organism?
Haemophilus
36
Meningitis patient, CSF gram stain shows gram-positive bacilli. What organism?
Listeria
37
Empiric treatment for bacterial management?
IV ceftriaxone, vancomycin and steroids
38
Best CSF fluid analysis to identify bacterial meningitis?
Cell count. If thousands of neutrophiils present, bacterial meningitis until proven otherwise.
39
HIV patient with meningitis and CD4 <100. Treat for? What test do you order to evaluate?
Cryptococcus meningitis. Best initial test - India ink Most accurate - Cryptococcal antigen
40
Treatment for cryptococcal meningitis?
Start with amphotericin and 5-flucytosine. Add oral fluconazole. Continue fluconazole indefinitely until CD4>100
41
Treatment for Lyme disease?
IV ceftriaxone or penicillin
42
Rash that starts on wrists and ankles and moves centripetally towards center, also fever and headache. Diagnosis?
Rocky Mountain Spotted Fever
43
Treatment of Rocky Mountain Spotted Fever?
Doxycycline
44
CSF findings in TB meningitis?
Very CSF protein level. Stain positive 10% of time. Culture requires 3 high-volume taps.
45
Risk factors for Listeria meningitis?
Neonatal, elderly, HIV-positive, patients with no spleen, on steroids, or immunocompromised
46
Patient with neisseria meningitidis meningitis. Who needs prophylaxis, and what agent do you use?
``` Close contacts (household members, those who share utensils, cups, kissing) Prophylaxis with rifampin, ceftriaxone or cipro ```
47
Almost all cases of encephalitis in U.S. caused by what organism?
Herpes Simplex virus
48
Clinical presentation of encephalitis? What tests do you do?
Fever with AMS. Order head CT and PCR of CSF.
49
Patient with fever, headache, and focal neurological deficits. CT shows ring-enhancing lesion. Differential diagnosis?
Infection (toxoplasmosis) or malginancy
50
Ring-enhancing lesion on CT brain in HIV-negative patient. Next step?
Brain biopsy
51
Ring-enhancing lesion on CT brain in HIV-positive patient. Next step?
Treat for toxoplasmosis (pyrimethamine and sulfadiazine) for 2 weeks and then repeat CT.
52
Management of Progressive Multifocal Leukoencephalopathy?
Nothing specific. Treat HIV and raise CD4 count.
53
Patient from foreign country with siezures. CT hows multiple 1 cm cystic lesions. Diagnosis? Treatment?
Neurocysticercosis. Treat with albendazole and steroids.
54
Are focal deficits ever seen in concussions?
No
55
Sudden severe headache. Photophobia, stiff neck, LOC. No fever. Diagnosis?
Subarachnoid hemorrhage.
56
Best initial test for Subarachnoid hemorrhage?
Head CT. Most accurate test would be lumbar puncture
57
Management of subarachnoid hemorrhage?
1. Angiography to localize bleeding 2. Embolize bleeding (superior to surgical clipping) 3. Place VP shunt if hydrocephalus develops 4. Start PO nimodipine (Ca blocker that prevents stroke)
58
Which sensory nerves will be preserved in anterior spinal artery infarction?
Position and vibratory senses, These travel down posterior columns.
59
Presentation of Brown-Sequard syndrome?
Loss of ipsilateral vibration and propioception and contralateral pain and temperature
60
Suspicion of cord compression. Most urgent step?
Administer steroids to decrease swelling.
61
Upper and lower motor neuron signs. Diagnosis?
Amytrophic Lateral Sclerosis
62
Treatment for Amytrophic Lateral Sclerosis?
Riluzole, acts by blocking accumulation of glutamate
63
Radial nerve palsy, or "Saturday night palsy" presentation?
Wrist drop. Patient fell asleep on arm or had arm draped over back of chair with pressure on it.
64
Peroneal nerve palsy presentation?
Foot drip with inability to evert foot. Patient usually wears high boots that press back of knees
65
Presentation of Reflex Sympathetic Dystrophy or "Chronic Regional Pain Syndrome?"
Patient with previous injury to extremity. Light touch causes severe burning pain.
66
Treatment for Reflex Sympathetic Dystrophy?
NSAIDS, gabapentin, occasionally nerve block or surgical sympathectomy
67
Treatment for Restless Leg Syndrome?
Pramipexole or Ropinirole
68
Guillain-Barre patient, what do you monitor serially for impending respiratory failure?
Peak inspiratory pressure
69
Treatment for Guillain-Barre?
IVIG or plamapheresis. Steroids don't do anything
70
Suspect Myasthenia Gravis, best initial and most accurate test to order?
Anti-acetylcholine receptor antibodies
71
Step-wise treatment for Myasthenia Gravis?
1. Pyridostigming or Neostigmine 2. Thymectomy (if patient <60) 3. Prednisone 4. Azathiprine and Cyclosporine

Medicine (10 decks)

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