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Neurology Flashcards

1
Q 
Bacterial Meningitis: ETIOLOGY/Pathogens for:
NEWBORNS
INFANTS
TODDLERS - 6Y/O
TEENAGERS + YOUNG ADULTS
ADULTS
A

NEWBORNS: Group B Strep
INFANTS; E. Coli
TODDLERS- 6 y/o: Haemophilis Influenza (HIB)
TEENS: Neisseria Meningitidis
ADULTS: Strep Pneumoniae (70% of all cases are Strep)

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2
Q

Kernig’s vs Brudzinksi’s

A

Kernig: Pt is supine with hips and knees flexed to 90 degrees. Positive Kerning’s is pain with extending the knee with hips flexed
Brudzinski’s: pt is supine, when neck is flexed, pt will involuntarily flex hips and knees

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3
Q

Petechial rash associated with what infection?

A

Nesseria Meningitidis

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4
Q

LP for meningitis

A 
Elevated WBC (from normal of 5 to up to 10,000 during infection)
Protein elevated (normal 5-60, elevated to 100-500)
Decreased glucose (normal is 60% of serum, during infection down to 40%)
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5
Q

Bacterial Meningitis tx

A

Newborns and infants: gentamicin and ampicillin
Young children-early adulthood: 3rd gen Cephalosporin + vanco or chloramphenicol
Adults: PCN
Follow tx with serial LPs

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6
Q

Essential Tremor tx?

A

Avoid triggers (fatigue, stress, caffeine)

1st: B blockers
2nd: anti-epileptics: topiramate, gabapentin
2nd: BZDs

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7
Q

What chromosome affected by Huntington’s?

A

4

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8
Q

CT findings in Huntington’s

A

Atrophy of caudate nucleus and cerebral atrophy

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9
Q

TX of chorea in Huntington’s

A

Typical and atypical neuroleptics: olanzapine, risperidone haldol

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10
Q

What vaccination greatly reduces Meningitis in infants?

A

H Flu

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11
Q

Triad sx for normal pressure hydrocephalus

A

Gait disturbance
Urinary incontinence
Dementia

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12
Q

How many pts with syphilis will develop neurosyphilis?

A

7%

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13
Q

Argyll Robertson pupils

A

Pupils react poorly to light but well to accommodation

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14
Q

S/S Tabes Dorsalis (late stage syphilis)

A 
Impaired proprioception vibratory sense
Loss of DTRS at knees and ankles
Argyll Robertson pupils
Lightning pains
Progressive ataxia
Impaires sensation
Weakness and hypotonia of muscles
Joint damage (Charcot's joints) especially LE
Neurogenic bladder with overflow incontinence
Optic atrophy with visual loss
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15
Q

DX Syphilis

A

CSF pleocytosis , + VDRL, or FTA-ABS (fluorescent treponemal Ab absorption) in serum

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16
Q

TX syphilis

A

IV Pen G 18-24 million U/day x 10-14 days

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17
Q

TX syphilis if PCN allergic

A

Mild PCN allergic: Ceftriaxone 2g IV qd x 10-14d
Anaphylaxis with PCN: densensitation to B lactams under direction of allergist

Serum VDRL titer should decrease after therapy
FTA-ABS remain reactive for life
CSF WBCs are normal 6 months after tx completed, if CSF WBCs are still abnormal after 6 months, pt needs to be retreated

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18
Q

Most common meningitis pathogen in adults?

A

Strep pneumoniae

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19
Q

Infant with irritability, lethargy, anorexia and bulging fontanelles, suspect what?

A

meningitis

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20
Q

TX viral meningitis

A

Symptomatic: analgesics for HA, antiemetics for nausea, not required to be inpatient. Excellent prognosis: 1-2 weeks

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21
Q

ABX therapy for meningitis (empiric) age 2 mo-adult

A 
Ceftriaxone + vanco. Add ampicillin if elderly.
Consider corticosteroids (dexamethasone)
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22
Q

Viral encephalitis: most common pathogen?

A

HSV (70% mortality rate if left untreated). Typically affects the temporal lobe. PCR very sensitive and specific. CT with contrast 60% positive. MRI: 90% have temporal lobe abnormalities.

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23
Q

CLinical manifestations West Nile virus?

A

diffuse paralysis + peripheral neuropathy

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24
Q

TX CMV encephalitis

A

Gancivlovir+ Foscarnet. Watch for SIADH syndrome.

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25
Name 3 associated conditions with Bell's Palsy
``` Diabetes Pregnancy Herpes Zoster Positive family history Immunodeficiency ```
26
S/S Myasthenia Gravis
Diplopia Ptosis, weakness of eye closure ( in 90% of pts) Difficulty chewing Regurgitation of fluids Dysphagia Nasal speech or low voice volume Disease then progresses until weakness noted in the limbs, neck and respiratory muscles. PUPILS ARE NORMAL
27
Myasthenia Gravis associated with what other disorders
SLE, RA, thymic tumors, thyrotoxicosis (because it is an autoimmune disease)
28
Diagnostics for Myasthenia Gravis?
Serum anti-Ach receptor antibody levels EMGs, Thyroid function, CXR (r/o thymoma) Tensilon test (goal is to abate muscle weakness in 1-2 minutes) Neostigmine 1.5mg IM improves weakness in 10-15 min Ice pack test: place ice pack on eyelids to cool muscles x 1 minute, test for ptosis
29
Tx Myasthenia Gravis
Anti cholinesterase agents: Pyridostigmine 15-90mg q 6 hours and 180mgLA bedtime Neostigmine 15mg before activity or meals OBSERVE for cholinergic crisis (nausea, vomiting, sweating, pallor, salivation, colic, diarrhea, meiosis, bradycardia)
30
Parkinson's Patho: loss of what neurotransmitter?
Dopamine
31
What area of the brain affected in Parkinson's?
Substantia nigra
32
Pharmacologic management Parkinson's
Dopamine agonists: Parlodel, Mirapex, Requip MAO inhibitors: selegiline, rasagiline Levodopa + peripheral dopa decarboxylase inhibitor (bc levodopa does not cross BB barrier well): Sinemet Amantadine: antiviral that allows release of dopamine from presynaptic storage sites Anticholinergis: useful for the tremor
33
Adverse effects of levodopa/carbidopa?
Dyskinesias: include head wagging, restlessness, grimacing, lingual-labial dyskinesia Psychiatric: Depression, nightmares, hallucinations
34
Simple partial seizure: definition
consciousness is preserved. Types: motor (focal twitching of extremity), somatosensory (flashing lights, paresthesias), autonomic (pallor, flushing, sweating, vomiting), psychic (dysphasia, distortion of memory, forced thinking, fear, deja vu)
35
Complex partial seizures: definition
focal seizure activity with transient impairment of consciousness (illusions or hallucinations): automatisms (lip smacking, repeated swallowing), Jacksonian march if motor, usually begin with an aura
36
Most common type of adult seizure?
Complex partial
37
Absence seizure is what type of seizure?
Generalized (abrupt LOC) | 60% of absence seizures spontaneously remit
38
Atonic
loss of postural tone (drop attacks) resulting in falls
39
TX Absence seizures
Valproic acid, ethosuxamide, lamictal
40
TX partial seizures
carbamazapine, neurontin
41
Status epilepticus: definition
continuous seizure activity or frequent seizures without return to baseline > 15-20 minutes duration. Is the most common neurologic emergency
42
TX status epilepticus
- Airway and o2, consider intubation - CMP and to screen - Give thiamine and D50 - Lorazepam 0.02mg/kg, valium or versed similar doses - Load with Dilantin, rate not to exceed 50mg/min due to risk of arrhythmias or hypotension IF PERSISTENT ACTIVITY AT 30-60M : add Dilantin 5-10mg/kg, Phenobarbital 50-100mg/min IF MORE THAN 60MIN: Pentobarbitol load or propofol
43
What percent of strokes are hemorrhagic vs ischemic?
Ischemic: 80% Hemorrhagic: 20%
44
Why would you do an LP in a pt with suspected CVA?
If suspicious for SAH and negative CT scan. Look for xanthochromia. Only perform LP if no contraindications
45
Use of tPA?
Within 3 hours of symptoms First R/O hemorrhage with CT. Can give intra-arterial tPA if within 6 hours of sx and have identified an acute occlusion.
46
Prognosis of TIA?
1/3 of pts continue to attacks without sequelae 1/3 of pts spontaneously resolve 1/3 of pts suffer brain infarction
47
Cluster HA's have a familial predisposition?
No
48
Triggers for Cluster HA?
ETOH | Nitrates and other vasodilators
49
TX Cluster HAs
100% O2 x 20m pt upright Subcutaneous or nasal triptans Methylsergide, prednisone, verapamil, lithium
50
Basal migraine: definition
typical migraine except visual phenomena occupy total of both visual fields. Also may include vertigo, staggering, dysarthia, diplopia, tingling of hands and feet and perioral areas.
51
Danger signs for migraines
- Worsening pattern - associated focal neurologic deficit - associated fever or neck pain - first or worst - new onset 50 y/o
52
Preventive meds for migraine
-B blockers -CCBs ACEI and ARBS NSAIDs
53
Pseudotumor Cerebri (aka Benign Intracranial HTN, not benign FYI) associated with what etiologies?
Obese young women OCPs Tetracycline Vitamin D
54
Bell's Palsy vs Stroke: facial weakness?
Stroke does not affect the ability to close the eye or raise affected brow.
55
What does the CSF look like in SAH?
Bloody. Or Xanthochromia (yellow, from degraded RBCs). Need to do an RBC count on the first and last tube from the LP. If the last tube does not have RBCs it was from a traumatic LP, NOT from SAH.
56
What does the CSF show in MS?
Oligoclonal bands
57
What WBC type in viral vs bacterial meningitis?
Bacterial: polymorphic leuks (Polys) Viral: lymphocytes or monocytes
58
``` DTRs, what level? Achilles Patellar Biceps Triceps ```
``` Achilles: S1/S2 Patellar (quad): L3/L4 Biceps: C5/6 Triceps: C7/8 (aka 1/2, 3/4, 5/6, 7/8) ```
59
HA with papilledema concerning for what?
Brain tumor
60
Severe HA with visual loss or blurred vision, papilledema and negative MRI?
Suspicious for brain tumor but negative MRI R/O. HA with visual loss concerning for Pseudotumor Cerebri. Normal mental status.
61
TX of pseudotumor cerebri?
Weight loss Diuretics Steroids Repeat LP to remove CSF and decrease ICP
62
When is it appropriate to lower BP in a pt with ischemic stroke?
If other indications like angina or HF Pts receiving tPA Lower cautiously to
63
Most severe complication of temporal arteritis?
Blindness from thrombosis of ophthalmic artery
64
Temporal arteritis: 50% of pts report what other sx?
Muscle aches consistent with Polymyalgia Rhematica
65
Most common intracerebral neoplasm
glioma
66
Horner's syndrome
Unilateral
67
Demyelination of posterior and lateral columns associated with what disease process?
B12 deficiency
68
Sensory disturbance of the middle finger indicates hernia room of disc in what region?
C7 | C5 is thumb side
69
Middle cerebral artery infarct causes what?
Contralateral hemiparesis | Aphasia
70
Manifestations ALS
Asymmetric muscle weakness Atrophy Fasiculations Hypereflexia
71
Sx wernickes encephalopathy
Nystagmus Gaze palsies Gait ataxia (Thiamine deficiency, involves oculomotor, abducens)
72
Glasgow coma scale evaulates what 3 areas?
Eye opening Best motor response Best verbal response \=12 minor injury
73
Broca's
Speech. Pts can usually understand but cannot perform motor output of speech

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