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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
Q

High suspicion for temporal arteritis and elevated ESR. Next step?

A

Immediate high dose steroids, delay may cause vision loss.

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26
Q

Vertigo with change in position. No hearing problems or ataxia. Diagnosis? Physical exam finding associated with this? Treatment?

A

Benign positional vertigo
Positive Dix-Halpike maneuver
Treat with Meclizine (antivert)

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27
Q

Vertigo not associated with change in position. No hearing problems or ataxia. Diagnosis?

A

Vestibular Neuritis

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28
Q

Acute vertigo with hearing loss and tinnitus. Diagnosis?

A

Labyrinthitis. Also responds to meclizine.

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29
Q

Chronic remitting vertigo with hearing loss and tinnitus. Diagnosis? Treatment?

A

Meniere’s disease. Treat with salt restriction and diuretics.

30
Q

Vertigo with hearing loss, tinnitus, and ataxia. Diagnosis? Treatment?

A

Acoustic neuroma. Treat with surgical resection

31
Q

Acoustic neuroma associated with what conditions?

A

Neurofibromatosis and Von Recklinghausen’s disease

32
Q

Presentation of Wernicke-Korsakoff syndrome?

A 
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
Q

Meningitis patient, CSF gram stain shows Gram-positive diplococci. What organism?

A

Pneumococcus

34
Q

Meningitis patient, CSF gram stain shows gram-negative diplococci. What organism?

35
Q

Meningitis patient, CSF gram stain shows gram-negative pleomorphic, coccobacillary organisms. What organism?

A

Haemophilus

36
Q

Meningitis patient, CSF gram stain shows gram-positive bacilli. What organism?

37
Q

Empiric treatment for bacterial management?

A

IV ceftriaxone, vancomycin and steroids

38
Q

Best CSF fluid analysis to identify bacterial meningitis?

A

Cell count. If thousands of neutrophiils present, bacterial meningitis until proven otherwise.

39
Q

HIV patient with meningitis and CD4 <100. Treat for? What test do you order to evaluate?

A

Cryptococcus meningitis.
Best initial test - India ink
Most accurate - Cryptococcal antigen

40
Q

Treatment for cryptococcal meningitis?

A

Start with amphotericin and 5-flucytosine. Add oral fluconazole. Continue fluconazole indefinitely until CD4>100

41
Q

Treatment for Lyme disease?

A

IV ceftriaxone or penicillin

42
Q

Rash that starts on wrists and ankles and moves centripetally towards center, also fever and headache. Diagnosis?

A

Rocky Mountain Spotted Fever

43
Q

Treatment of Rocky Mountain Spotted Fever?

A

Doxycycline

44
Q

CSF findings in TB meningitis?

A

Very CSF protein level. Stain positive 10% of time. Culture requires 3 high-volume taps.

45
Q

Risk factors for Listeria meningitis?

A

Neonatal, elderly, HIV-positive, patients with no spleen, on steroids, or immunocompromised

46
Q

Patient with neisseria meningitidis meningitis. Who needs prophylaxis, and what agent do you use?

A 
Close contacts (household members, those who share utensils, cups, kissing)
Prophylaxis with rifampin, ceftriaxone or cipro
47
Q

Almost all cases of encephalitis in U.S. caused by what organism?

A

Herpes Simplex virus

48
Q

Clinical presentation of encephalitis? What tests do you do?

A

Fever with AMS. Order head CT and PCR of CSF.

49
Q

Patient with fever, headache, and focal neurological deficits. CT shows ring-enhancing lesion. Differential diagnosis?

A

Infection (toxoplasmosis) or malginancy

50
Q

Ring-enhancing lesion on CT brain in HIV-negative patient. Next step?

A

Brain biopsy

51
Q

Ring-enhancing lesion on CT brain in HIV-positive patient. Next step?

A

Treat for toxoplasmosis (pyrimethamine and sulfadiazine) for 2 weeks and then repeat CT.

52
Q

Management of Progressive Multifocal Leukoencephalopathy?

A

Nothing specific. Treat HIV and raise CD4 count.

53
Q

Patient from foreign country with siezures. CT hows multiple 1 cm cystic lesions. Diagnosis? Treatment?

A

Neurocysticercosis. Treat with albendazole and steroids.

54
Q

Are focal deficits ever seen in concussions?

55
Q

Sudden severe headache. Photophobia, stiff neck, LOC. No fever. Diagnosis?

A

Subarachnoid hemorrhage.

56
Q

Best initial test for Subarachnoid hemorrhage?

A

Head CT. Most accurate test would be lumbar puncture

57
Q

Management of subarachnoid hemorrhage?

A
  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
Q

Which sensory nerves will be preserved in anterior spinal artery infarction?

A

Position and vibratory senses, These travel down posterior columns.

59
Q

Presentation of Brown-Sequard syndrome?

A

Loss of ipsilateral vibration and propioception and contralateral pain and temperature

60
Q

Suspicion of cord compression. Most urgent step?

A

Administer steroids to decrease swelling.

61
Q

Upper and lower motor neuron signs. Diagnosis?

A

Amytrophic Lateral Sclerosis

62
Q

Treatment for Amytrophic Lateral Sclerosis?

A

Riluzole, acts by blocking accumulation of glutamate

63
Q

Radial nerve palsy, or “Saturday night palsy” presentation?

A

Wrist drop. Patient fell asleep on arm or had arm draped over back of chair with pressure on it.

64
Q

Peroneal nerve palsy presentation?

A

Foot drip with inability to evert foot. Patient usually wears high boots that press back of knees

65
Q

Presentation of Reflex Sympathetic Dystrophy or “Chronic Regional Pain Syndrome?”

A

Patient with previous injury to extremity. Light touch causes severe burning pain.

66
Q

Treatment for Reflex Sympathetic Dystrophy?

A

NSAIDS, gabapentin, occasionally nerve block or surgical sympathectomy

67
Q

Treatment for Restless Leg Syndrome?

A

Pramipexole or Ropinirole

68
Q

Guillain-Barre patient, what do you monitor serially for impending respiratory failure?

A

Peak inspiratory pressure

69
Q

Treatment for Guillain-Barre?

A

IVIG or plamapheresis. Steroids don’t do anything

70
Q

Suspect Myasthenia Gravis, best initial and most accurate test to order?

A

Anti-acetylcholine receptor antibodies

71
Q

Step-wise treatment for Myasthenia Gravis?

A
  1. Pyridostigming or Neostigmine
  2. Thymectomy (if patient <60)
  3. Prednisone
  4. Azathiprine and Cyclosporine

Medicine (10 decks)

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