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DIT STEP 2 > NEUROLOGY > Flashcards

NEUROLOGY Flashcards

1
Q

5 main lacunar syndromes

A

Pure motor hemiparesis, pure sensory, ataxic hemiparesis, sensorimotor, dysarthria clumsy hand syndrome.

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2
Q

SAH blood pressure goal

A

<150

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3
Q

BP meds to avoid in SAH

A

Nitroprusside, nitroglycerine

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4
Q

BP rx preferred to lower BP in SAH

A

labetalol

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5
Q

Name some medications or med withdrawals known for causing seizures

A

Buproprion, Buspirone, Enflurane, Benzos/barbs/ethanol, anti-epileptics. Theophylline OD. B6 deficiency.

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6
Q

Myoclonic seizures DOC

A

Valproic acid

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7
Q

Top 3 meds to treat partial seizures

A

Lamotrigine, Carbamazapine, Phenytoin

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8
Q

What neurologic defects seen with an infarction of anterior cerebral artery

A

contralateral loss of sensory/motor in legs ,feet, trunk

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9
Q

Target BP in patient with ischemic stroke

A

BP<220

If getting tPA, <185/110.

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10
Q

Name some medications or med withdrawals known for causing seizures

A

Buproprion, Buspirone, Enflurane, Benzos/barbs/ethanol, anti-epileptics. Theophylline OD. B6 deficiency.

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11
Q

Myoclonic seizures DOC

A

Valproic acid

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12
Q

What neurologic defects seen with basilar artery infarction

A

CN abnormalities Contralateral full body weakness Altered RAS Visual

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13
Q

Herniation of a cervical disc affects which nerve root?

A

Nerve root above. aka C5-C6 herniation more likely affects C5.

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14
Q

Herniation of a lumbar disc affects which nerve root?

A

Nerve root below. aka L2-L3 herniation affects L3 nerve root.

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15
Q

Sx of spinal artery syndrome

A

bilateral loss of pain and temp (one level below lesion) Bilateral spastic paresis (below lesion) Bilateral flaccid paralysis (level of lesion)

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16
Q

Sx of brown sequard

A

Ipsilateral loss of vibration and discrimination (below lesion) Ipsilateral spastic paresis (below lesion) Ipsilateral flaccid paralysis (level of lesion) Contralateral loss of pain and temperature (below lesion)

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17
Q

Contraindications to tPA

A

Stroke/significant head trauma in past 3 months

Arterial puncture in non-compressible site in past

INR>1.7

BP>185/110

Platelets < 50

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18
Q

Best initial test for guillain barre

A

LP/CSF analysis

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19
Q

Most accurate test for guillain barre

A

EMG/nerve conduction studies

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20
Q

Most important measure to monitor in guillain barre

A

Pulmonary function tests (Vital capacity). Impending respiratory failure is predicted by:

Forced vital capacity <20

Max inspiratory pressure <30

Max expiratory pressure <40

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21
Q

What direction of nystagmus in central vertigo

A

Up-down, tends to be more visible with focused gaze.

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22
Q

What direction of nystagmus in peripheral vertigo

A

Side-to-side, tends to lessen with focused gaze.

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23
Q

Adults: brain cancer #1-3

A

GBM Meningioma Schwannoma

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24
Q

COMT inhibitors

A

Entacapone, tolcapone These are used to reduce fluctuations and adverse effects in PD, they DO NOT help any Parkinsons sx themselves.

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25
Q

When the pt with PD’s response to dopaminergic begins to decline, what med class can be added?

A

MAO-B inhibitors. Selegiline, rasagiline.

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26
Q

MCC of complication/death after SAH (a pt that initially survives that rupture of an aneurysm)

A

Cerebral vasospasm

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27
Q

Most common cause of SAH

A

Trauma

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28
Q

Pts with parkinsons under the age of 60 with good management of ADL and minimal postural instability

A

Anti-cholinergic, such as trihexyphenyldyl or benztropine

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29
Q

Pts with parkinson over the age of 60 with good management of ADL and minimal postural instability

A

Amantadine. We want to avoid anticholinergics in the elderly population.

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30
Q

For increased effect in treatment of PD with carbidopa/levodopa, adjunctive therapy with what meds may be added?

A

DA agonists Pramipexole Ropinirole

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31
Q

How is the nausea of anti-PD medications managed?

A

Domperidone.

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32
Q

DOC in parkinson’s psychosis

A

Atypical antipsychotics, particularly QUETIAPINE or risperidone.

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33
Q

Major diff between Parkinsons and Lewy body dementia

A

In PD, dementia comes AFTER movement d/o. In levy body, dementia comes before or along w/movement d/o.

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34
Q

1st and 2nd line for benign essential tremor

A

Propranolol Primidone

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35
Q

Best initial test in Wilsons

A

Slit-lamp exam

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36
Q

Ceruloplasmin in Wilsons

A

Low levels.

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37
Q

Gold standard test for Wilsons

A

Liver bx

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38
Q

Tx of Wilsons

A

Chelation with D-penicillamine

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39
Q

1st synapse for spinothalamic tract and decussation

A

First synapse at spinal cord (1-2 levels removed from entrance) 2nd neuron decussates at spinal cord and travels up.

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40
Q

Lateral spinothalamic tract

A

Pain and temperature

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41
Q

Anterior spinothalamic tract

A

Crude touch and pressure

42
Q

Injury to DCML, spinal

A

IPSILATERAL loss of touch and vibration below injury

43
Q

Injury to DCML in sensory cortex

A

Contralateral loss of fine touch and vibration

44
Q

Lateral corticospinal tract

A

Extremity muscles

45
Q

Anterior corticospinal tract

A

Axial muscles

46
Q

How does a stroke to the MCA affect the face?

A

CONTRALATERAL lower facial paralysis. Additionally, CN III to ipsilateral eye is affected, therefore the eyes tend to deviate TOWARDS the side of the lesion. Thats just bc if one eye moves laterally (due to the lesion), the other (normal) eye wants to do the same by reflex.

47
Q

Why kind of stroke might cause urinary incontinence due to weakness in pelvic floor musculature?

A

ACA

48
Q

Weber syndrome

A

Pyramidal tracts (gives us CST) –>contralateral hemiplegia. CN III –> ipsilateral. Penetrating branch of PCA

49
Q

Benedikt’s syndrome

A

Weber syndrome + affect of red nucleus and substantial nigra. CN III –> ipsilateral Pyramidal tracts (gives us CST) – > contralateral hemiplegia Red nucleus and substantia nigra – > severe gait disturbances.

50
Q

Wallenberg syndrome

A

PICA ! Facial sensory loss (ipsilateral .. CN VII) Body sensory loss (contralateral .. spinothalamic tract) Also, since we are losing VIII, dizziness and ataxia. Horner’s syndrome. Dysarthria as tracts of CN V are also affected.

51
Q

Generally, hearing loss &/or tinnitus accompanying your vertigo points to ..

A

Peripheral cause (e.g., vestibular neuritis). Problem in inner ear or cochlear nerve.

52
Q

Which vertigo tends to last longer?

A

Central.

53
Q

Anti-emetics prescribed for peripheral vertigo

A

Diphenydramine Metoclopramide Phenergan

54
Q

Vestibulosuppressants/anti cholinergics prescribed for peripheral vertigo

A

Meclizine Scopolamine

55
Q

Pathophys of Menieres disease

A

Unilateral, intermittent increases in perilymphatic volume, resulting in unequal vestibular function. This is why pts often c/o “feeling of fullness”

56
Q

Tx of Meniere’s disease

A

Mostly supportive but diuretics can also help

57
Q

Acute onset of vertigo preceded by “pop” sensation in ear.

A

Perilymphatic fistula, due to rupture of bony capsule in inner ear, resulting in leakage of perilymphatic fluid into the middle ear.

58
Q

Dix hallpike maneuver should elicit nystagmus with a fast phase toward .. ?

A

AFFECTED ear.

59
Q

Disease association with ependymomas

A

Neurofibromatosis type I

60
Q

Disease association with meningiomas

A

Neurofibromatosis type I

61
Q

2 brain tumors associated with Li Fraumeni

A

Medulloblastoma Astrocytomas

62
Q

Von hippel lindau is associated with which brain tumor?

A

Hemangioblastoma, generally in the cerebellum.

63
Q

Which drugs are known for inducing cP450 system?

A

BCG-PQRS. Barbs Carbamazepine Griseofulvin Phenytoin Quinidine Rifampin St. Johns Wort

64
Q

Downward displacement of cerebellar tonsils and medulla through foramen magnum

A

Arnold-Chiari

65
Q

Most common pre-disposing condition for an intracranial hemorrhage

A

HTN

66
Q

Rescue therapy for sudden akinetic episodes in PD

A

Apomorphine, subQ.

67
Q

What is pseudo bulbar affect?

A

Inappropriate laughing or crying Yawning

68
Q

In Huntingtons, what happens to acetylcholine levels?

A

They decrease.

69
Q

Tx for chorea

A

Tetrabenazine, a DA antagonist.

70
Q

Most common autonomic dysfunction seen in guillain barre

A

Tachycardia

71
Q

What is Pickwickian syndrome?

A

Obesity hypoventilation syndrome characterized by hypersomonlence, dyspnea, hypoxemia (causing cyanosis, polycythemia, and plethora) and pulmonary hypertension leading to right sided heart failure and peripheral edema.

72
Q

First line for narcolepsy

A

Modafinil

73
Q

Tx of cataplexy

A

Venlafaxine Fluoxetine Atomoxetine

74
Q

2 insomnia tx that act at benzo receptor

A

Zolpidem Zalepton

75
Q

What makes Esziopiclone unique?

A

May be used long term (its lunesta)

76
Q

What is Remelteon’s MOA?

A

Works at melatonin receptors therefore its nonaddictive. Avoid if hepatic insufficiency!!!

77
Q

Why is thiamine given in a glucose infusion to alcoholics with hypoglycemia?

A

Glucose administration in the absence of thiamine can theoretically exacerbate damage to the mamillary bodies and worsen Wernicke’s encephalopathy.

78
Q

What is the MOA of the preferred medication in the treatment of RLS?

A

DA agonist

79
Q

EEG wave forms in stage 1

A

theta

80
Q

EEG wave forms in stage 3 and 4

A

Delta, low freq and high amp

81
Q

EEG wave forms in REM

A

Beta, high freq low amp

82
Q

MCC of blindness in pts over age 55

A

Macular degeneration

83
Q

MCC of blindness in pts under 55

A

DM

84
Q

MCC of blindness in blacks at any age

A

Glaucoma

85
Q

Potential serious complication of corneal ulceration

A

HSV keratitis

86
Q

Colored halos indicate?

A

Acute angle closure glaucoma (also SE of digoxin)

87
Q

“Shallow anterior chamber”

A

Acute angle closure glaucoma

88
Q

MCC of conjunctivitis appearing in the first 24 hours of life

A

Chemical conjunctivitis 2/2 abx prophylaxis.

89
Q

Tx of orbital cellulitis

A

Immediate IV vanco and IV cefotaxime or ceftriaxone until afebrile and clinically improved. Then PO abx for 2-3 weeks.

90
Q

Inflammation of internal melbomian sebaceous glands

A

Chalazion

91
Q

Infection of external sebaceous glands of Zeiss or Moi (tender red swelling at LID MARGIN)

A

Hordeolum/stye

92
Q

Infection of eyelids and lashes secondary to seborrhea

A

Anterior blepharitis

93
Q

Painless, progressive decrease in vision manifested with difficulty driving at night ,reading road signs, or reading fine print

A

Cataracts

94
Q

Near-sightedness is often an early mx of ?

A

Cataracts

95
Q

Initial tx for acute angle closure

A

0.5% timolol, 1% apracolinidine, and 2% pilocarpine. 2 tabs of Acetazolamide, 250 mgs.

96
Q

If refractory to initial tx in acute angle closure

A

Mannitol

97
Q
A

BITOTS SPOTS

Areas of abnormal squamous cell proliferation and keratinization of the conjunctiva, seen in Vitamin A deficiency.

98
Q
A

SAH

99
Q

Dx and tx

A

Bullous myringitis, note hte large reddish vesicles on the TM. Mycoplasma is common casue so treat iwth oral macrolides.

100
Q

Risk factors for devo of cataracts

A

Prolonged sun exposure

Trauma esp caustic

DM

Age

Low education

White

101
Q

What is the difference between Arnold Chiari and Dandy walker

A

Arnold Chiari is when a narrow cranio spinal junction and a small posterior cranial fossa causes displacement of the cerebellum and medulla downward, leading to compression of CSF passage at the level of foarmen magnum (non cummunicating hydro cephalus). Type II is symptomatic and commonly associated with meningomyelocele and syringomyelia.

Dandy Walker is also around the 4th ventricle but this time it is a small cerebellar vermis that gives room to the fourth ventricle and expands in a cyst like structure, also could lead to hydro cephalus. Unlike Arnnold, THE POSTERIOR FOSSA IS LARGE.

102
Q

3 essential features of dandy walker

A

Agenesis of the vermis

Cystic dilation of the 4th ventricle

Enlargement of the posterior fossa

DIT STEP 2 (17 decks)

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