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PANCE/EOC > Neurology #3 > Flashcards

Neurology #3 Flashcards

1
Q

Although a Bell Palsy may be idiopathic, it may also be related to

A

A herpes simplex virus reactivation

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2
Q

Symptoms of a Bell Palsy

A

-ipsilateral hyperacusis (ear pain)
-unilateral facial weakness or paralysis involving the forehead
-taste disturbance
(weakness and paralysis ONLY affects the face)

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3
Q

Although no treatment is required for a Bell Palsy, what medication, if started in the first 72 hours of symptom onset, reduces the time to fully recovery and increases likelihood of complete recuperation?

A

Prednisone

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4
Q

What is the pathophysiology Guillain Barre Syndrome?

A

Autoantibody attacks the myelin sheath of peripheral nerves after an infection

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5
Q

Etiologies of Guillain Barre Syndrome

A
  • Campylobacter Jejuni (MC)
  • GI or respiratory infections
  • EBV, HIV
  • Immunizations
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6
Q

Symptoms of Guillain Barre Syndrome

A
  • Symmetric ascending weakness and sensory changes
  • Weakness of respiratory muscles (breathing difficulties)
  • Decreased DTRs
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7
Q

Diagnostics for Guillain Barre Syndrome

A
  • Electrophysiologic studies: nerve conduction and needle electromyography (most specific)
  • CSF analysis: high protein with normal WBC count
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8
Q

Treatment for Guillain Barre Syndrome

A
  • Plasmapheresis or IVIG are first line

- Mechanical ventilation if needed

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9
Q

Myasthenia gravis is an autoimmune peripheral nerve disorder due to autoantibodies against

A

the acetylcholine receptor at neuromuscular junction on muscles, leading to weakness

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10
Q

Myasthenia Gravis is MC in young women and older men. It has a strong association with what genetic things?

A
  • Abnormal thymus gland (thymoma)
  • HLA-B8
  • HLA-DR3
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11
Q

Symptoms of Myasthenia Gravis

A
  • Ocular weakness: diplopia and ptosis
  • Generalized weakness worse with repeated muscle use
  • Respiratory weakness = myasthenia crisis
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12
Q

In an outpatient setting, what is the diagnostic of choice for myasthenia gravis?

A
  • Acetylcholine receptor antibodies (initial)
  • MuSK antibodies if ACR negative
  • Electrophysiology testing: most accurate
  • CXR, CT, MRI to determine if thymus gland abnormal in all patients
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13
Q

Diagnostics for Myasthenia Gravis in an emergent setting

A
  • Edrophonium (Tensilon) Test: brief improvement after administration
  • Ice pack test: to improve ocular symptoms
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14
Q

If the patient is having a myasthenic crisis, what is the treatment?

A

-Plasmapheresis or IVIG

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15
Q

For long-term treatment of myasthenia gravis, use…

A

-Acetylcholinesterase inhibitors: Pyridostigmine or Neostigmine

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16
Q

What are some medications that can exacerbate myasthenia gravis?

A
  • Fluoroquinolones (-floxacin)
  • Aminoglycosides (gentamicin, tobramycin, etc.)
  • Beta Blockers
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17
Q

Multiple sclerosis is an autoimmune, inflammatory demyelinating disease of the CNS that is associated with

A

axon degeneration of the white matter

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18
Q

MC type of multiple sclerosis

A

-Relapsing-remitting: episodic exacerbations

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19
Q

Symptoms of Multiple Sclerosis

A
  • Sensory disturbances followed by weakness and visual disturbances
  • Diplopia, optic neuritis
  • Trigeminal neuralgia
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20
Q

Physical exam findings of a patient with MS

A

-Upper motor neuron signs: spasticity, upward Babinski, hyperreflexia, rigidity

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21
Q

Regarding MS, what is Lhermitte’s Sign?

A

Neck flexion causes lightning-shock type pain radiating from the spine down the leg

22
Q

What is Uhtoff’s Phenomenon in MS?

A

-Worsening of symptoms with heat (exercise, fever, hot tub, weather, etc.)

23
Q

What is a Marcus-Gunn Pupil in MS?

A

-during swinging flashlight test, from unaffected eye into the affected eye, the pupils dilate

24
Q

Best initial and most accurate diagnostic for Multiple Sclerosis? What does it show?

A

MRI with gadolinium

-Hyperintense white matter plaques

25
Q

However, what does an LP show in MS? This is only performed if the MRI is negative

A

-Increased IgG and oligoclonal bands

26
Q

First line treatment for MS

A 
IV glucocorticoids (high dose)
-Plasmapheresis if no response to IV glucocorticoids
27
Q

What are the first line medications given to prevent relapse and progression of MS

A

-Beta-interferon or Glatiramer

28
Q

Most benign type of all astrocytomas and are most common in children

A

-Pilocytic Astrocytoma

29
Q

MC primary CNS tumor in adults

A

Glioblastoma Multiforme

30
Q

Symptoms of an astrocytoma

A
  • Headaches that wake patients up at night

- Increased intracranial pressure: headache, nausea, vomiting, stupor, ataxia

31
Q

Diagnostics for astrocytoma

A
  • CT or MRI with contrast

- Brain biopsy: most diagnostic

32
Q

Treatment for astrocytoma

A

-Surgical excision (chemo and radiation as well for Grade IV)

33
Q

What is the study of choice for a glioblastoma multiforme (the most common and most aggressive primary malignant CNS tumor in adults)?

A

MRI brain with contrast

34
Q

What does the brain MRI with contrast show?

A

Variable ring of enhancement with central necrosis and irregular margins

35
Q

Treatment for glioblastoma multiforme?

A

Surgical excision when possible, radiotherapy and chemotherapy

36
Q

Meningiomas are benign, slow growing tumors that most commonly arise from

A

The dura

37
Q

Although meningiomas are often asymptomatic, what are some symptoms that can occur due to the compression and displacement of the brain?

A

seizures or focal neurological signs

Fixed dilated pupil (CN III) common

38
Q

Diagnostics for meningioma

A
  • MRI with contrast of brain: ring enhancing lesion often attached to dura
  • Histology: spindle-cells in a whorled pattern. Psammoma bodies (round calcifications)
39
Q

Treatment for meningiomas

A
  • Asymptomatic: observation

- Symptomatic: surgical excision when possible

40
Q

An ependymoma is a tumor of the ependymal cells in the ventricles and parts of the spinal cord. Who is it most common in and where is it most common?

A

Most common in children

-In the 4th ventricle, spinal cord, and medulla

41
Q

What is delirium?

A

Acute, abrupt transient confused state due to an identifiable cause (due to medications, infections, electrolyte abnormalities, CNS injury, uremia, illicit drugs)

42
Q

Symptoms of Alzheimer Dementia (MC type of dementia)

A
  • Short-term memory loss (first symptom)
  • Progression to long-term memory loss and cognitive deficits
  • Behavioral and personality changes
  • Loss of motor skills, gradual in nature
43
Q

Although Alzheimer Dementia is a clinical diagnosis, there are two diagnostics that can be done to diagnose. What are they and what do you see?

A

MRI (preferred): cortex atrophy, white matter lesions

Histology: amyloid-beta protein deposition (senile plaques) in he brain. Neurofibrillary tangles of tau protein.

44
Q

Treatment for Alzheimer Dementia

A
  • Acetylcholinesterase Inhibitors: Donepezil, Tacrine, Rivastigmine, Galantamine.
  • NMDA Antagonist: Memantine: may be used as monotherapy or adjunctive
45
Q

Brain disease due to chronic ischemia and multiple infarctions (lacunar infarcts)

A

Vascular dementia

46
Q

What is the most important risk factor for vascular dementia?

A

Hypertension

-Others: DM, history of CVA, A-fib

47
Q

Symptoms of vascular dementia

A

-Stepwise progression of symptoms: random infarct, then decline –> stable, then another infarct, then decline, etc.

48
Q

Main prevention of vascular dementia?

A

Strict blood pressure control!

49
Q

localized brain degeneration of the frontotemporal lobes

A

Frontotemporal Dementia (Pick’s Disease)

50
Q

Symptoms of Pick’s Disease

A

marked changes in social behavior, personality, and language (aphasia) with eventual exercise and memory dysfunction

-Behavioral changes: socially inappropriate behaviors, apathy, hyperorality (binge eating, putting large amounts of food in their mouth, changes in taste preferences)

51
Q

On histology for Pick’s Disease, what is seen?

A

Pick bodies: round or oral aggregates of Tau protein seen on silver-staining of cortex

PANCE/EOC (63 decks)

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