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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
When the pt with PD's response to dopaminergic begins to decline, what med class can be added?
MAO-B inhibitors. Selegiline, rasagiline.
26
MCC of complication/death after SAH (a pt that initially survives that rupture of an aneurysm)
Cerebral vasospasm
27
Most common cause of SAH
Trauma
28
Pts with parkinsons under the age of 60 with good management of ADL and minimal postural instability
Anti-cholinergic, such as trihexyphenyldyl or benztropine
29
Pts with parkinson over the age of 60 with good management of ADL and minimal postural instability
Amantadine. We want to avoid anticholinergics in the elderly population.
30
For increased effect in treatment of PD with carbidopa/levodopa, adjunctive therapy with what meds may be added?
DA agonists Pramipexole Ropinirole
31
How is the nausea of anti-PD medications managed?
Domperidone.
32
DOC in parkinson's psychosis
Atypical antipsychotics, particularly QUETIAPINE or risperidone.
33
Major diff between Parkinsons and Lewy body dementia
In PD, dementia comes AFTER movement d/o. In levy body, dementia comes before or along w/movement d/o.
34
1st and 2nd line for benign essential tremor
Propranolol Primidone
35
Best initial test in Wilsons
Slit-lamp exam
36
Ceruloplasmin in Wilsons
Low levels.
37
Gold standard test for Wilsons
Liver bx
38
Tx of Wilsons
Chelation with D-penicillamine
39
1st synapse for spinothalamic tract and decussation
First synapse at spinal cord (1-2 levels removed from entrance) 2nd neuron decussates at spinal cord and travels up.
40
Lateral spinothalamic tract
Pain and temperature
41
Anterior spinothalamic tract
Crude touch and pressure
42
Injury to DCML, spinal
IPSILATERAL loss of touch and vibration below injury
43
Injury to DCML in sensory cortex
Contralateral loss of fine touch and vibration
44
Lateral corticospinal tract
Extremity muscles
45
Anterior corticospinal tract
Axial muscles
46
How does a stroke to the MCA affect the face?
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
Why kind of stroke might cause urinary incontinence due to weakness in pelvic floor musculature?
ACA
48
Weber syndrome
Pyramidal tracts (gives us CST) --\>contralateral hemiplegia. CN III --\> ipsilateral. Penetrating branch of PCA
49
Benedikt's syndrome
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
Wallenberg syndrome
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
Generally, hearing loss &/or tinnitus accompanying your vertigo points to ..
Peripheral cause (e.g., vestibular neuritis). Problem in inner ear or cochlear nerve.
52
Which vertigo tends to last longer?
Central.
53
Anti-emetics prescribed for peripheral vertigo
Diphenydramine Metoclopramide Phenergan
54
Vestibulosuppressants/anti cholinergics prescribed for peripheral vertigo
Meclizine Scopolamine
55
Pathophys of Menieres disease
Unilateral, intermittent increases in perilymphatic volume, resulting in unequal vestibular function. This is why pts often c/o "feeling of fullness"
56
Tx of Meniere's disease
Mostly supportive but diuretics can also help
57
Acute onset of vertigo preceded by "pop" sensation in ear.
Perilymphatic fistula, due to rupture of bony capsule in inner ear, resulting in leakage of perilymphatic fluid into the middle ear.
58
Dix hallpike maneuver should elicit nystagmus with a fast phase toward .. ?
AFFECTED ear.
59
Disease association with ependymomas
Neurofibromatosis type I
60
Disease association with meningiomas
Neurofibromatosis type I
61
2 brain tumors associated with Li Fraumeni
Medulloblastoma Astrocytomas
62
Von hippel lindau is associated with which brain tumor?
Hemangioblastoma, generally in the cerebellum.
63
Which drugs are known for inducing cP450 system?
BCG-PQRS. Barbs Carbamazepine Griseofulvin Phenytoin Quinidine Rifampin St. Johns Wort
64
Downward displacement of cerebellar tonsils and medulla through foramen magnum
Arnold-Chiari
65
Most common pre-disposing condition for an intracranial hemorrhage
HTN
66
Rescue therapy for sudden akinetic episodes in PD
Apomorphine, subQ.
67
What is pseudo bulbar affect?
Inappropriate laughing or crying Yawning
68
In Huntingtons, what happens to acetylcholine levels?
They decrease.
69
Tx for chorea
Tetrabenazine, a DA antagonist.
70
Most common autonomic dysfunction seen in guillain barre
Tachycardia
71
What is Pickwickian syndrome?
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
First line for narcolepsy
Modafinil
73
Tx of cataplexy
Venlafaxine Fluoxetine Atomoxetine
74
2 insomnia tx that act at benzo receptor
Zolpidem Zalepton
75
What makes Esziopiclone unique?
May be used long term (its lunesta)
76
What is Remelteon's MOA?
Works at melatonin receptors therefore its nonaddictive. Avoid if hepatic insufficiency!!!
77
Why is thiamine given in a glucose infusion to alcoholics with hypoglycemia?
Glucose administration in the absence of thiamine can theoretically exacerbate damage to the mamillary bodies and worsen Wernicke's encephalopathy.
78
What is the MOA of the preferred medication in the treatment of RLS?
DA agonist
79
EEG wave forms in stage 1
theta
80
EEG wave forms in stage 3 and 4
Delta, low freq and high amp
81
EEG wave forms in REM
Beta, high freq low amp
82
MCC of blindness in pts over age 55
Macular degeneration
83
MCC of blindness in pts under 55
DM
84
MCC of blindness in blacks at any age
Glaucoma
85
Potential serious complication of corneal ulceration
HSV keratitis
86
Colored halos indicate?
Acute angle closure glaucoma (also SE of digoxin)
87
"Shallow anterior chamber"
Acute angle closure glaucoma
88
MCC of conjunctivitis appearing in the first 24 hours of life
Chemical conjunctivitis 2/2 abx prophylaxis.
89
Tx of orbital cellulitis
Immediate IV vanco and IV cefotaxime or ceftriaxone until afebrile and clinically improved. Then PO abx for 2-3 weeks.
90
Inflammation of internal melbomian sebaceous glands
Chalazion
91
Infection of external sebaceous glands of Zeiss or Moi (tender red swelling at LID MARGIN)
Hordeolum/stye
92
Infection of eyelids and lashes secondary to seborrhea
Anterior blepharitis
93
Painless, progressive decrease in vision manifested with difficulty driving at night ,reading road signs, or reading fine print
Cataracts
94
Near-sightedness is often an early mx of ?
Cataracts
95
Initial tx for acute angle closure
0.5% timolol, 1% apracolinidine, and 2% pilocarpine. 2 tabs of Acetazolamide, 250 mgs.
96
If refractory to initial tx in acute angle closure
Mannitol
97
BITOTS SPOTS Areas of abnormal squamous cell proliferation and keratinization of the conjunctiva, seen in Vitamin A deficiency.
98
SAH
99
Dx and tx
Bullous myringitis, note hte large reddish vesicles on the TM. Mycoplasma is common casue so treat iwth oral macrolides.
100
Risk factors for devo of cataracts
Prolonged sun exposure Trauma esp caustic DM Age Low education White
101
What is the difference between Arnold Chiari and Dandy walker
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
3 essential features of dandy walker
Agenesis of the vermis Cystic dilation of the 4th ventricle Enlargement of the posterior fossa

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