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step 2 ck > NEUROLOGY > Flashcards

NEUROLOGY Flashcards

1
Q

diagnosis:
weakness in LEs, flaccid paralysis and loss of pain + urinary retention following descending throacic aortic aneurysm surgery

A

spinal shock due to anterior spinal cord infarction

a potential complication of thoracic aortic aneurysm repair

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2
Q

MS treatment

A

IV methylprednisolone

plasma exchange if unresponsive

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3
Q

tx for pseudotumor cerebri

A

acetazolamide

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4
Q

amaurosis fugax

A

painless rapid and transient (<10min) monocular vision loss = like a curtain

d/t emboli from atherosclerosis in carotid artery

evaluate with duplex u/s of the carotid

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5
Q

open angle glaucoma
vs
acute closure glaucoma

A

open angle = insidious onset with gradual peripheral vision loss = tunnel vision; cupping of optic disc and increased itnraocular pressure

acute closure = acute onset with severe eye pain and blurred vision, nausea and vomiting (tx iv acetazolamide)

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6
Q

wide based gait after years of heavy alcohol use but cognition intact?

resolution possible?

A

alcoholic cerebellar degeneration
(degeneration of purkinje cells in cerebellar vermis) = alcohol neurotoxicity

alc cessation will prevent progression but not return to normal fxn

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7
Q

recurrent acute severe periorbital pain at night with autonomics (ipsilateral miosis, lacrimation) but not vision changes

dx?
tx?

A

cluster headaches

abortive tx is 100% oxygen

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8
Q

why is it important to assess symmetry in forehead innervation in bells palsy?

A

if forehead muscles are spared, this suggests intracranial lesion (central palsy)

vs a peripheral palsy where you lose ipsilateral forehead innervation

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9
Q

folic acid supplementation will correct anemia, however if it is given alone….

A

neuologic deficits will progress due to vitamin B12 deficiency

must give B12 WITH folic acid!

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10
Q

differences in how a stroke in the following places presents
1 MCA (mid cerebral artery)
2 ACA
3 PCA

A

1 MCA –> contralateral weakness/sensory loss, homonymous hemianopsia (loss of the opposite field so deviate toward lesion), and aphasia

2 ACA –> personality change/confusion, urinary incontinence, leg > arm weakness

3 PCA –> ipsilateral sensory loss of face, contralateral sensory loss of limbs, limb ataxia

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11
Q

tx of nonhemorrhagic and hemorrhagic stroke

A

<3 hrs since onset = thrombolytics

> 3 hrs = aspirin or add dipyridamole or switch to clopidogrel

hemorrhagic = nothing

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12
Q

every stroke patient should be started on ____ regardless of LDL

A

statin

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13
Q

when to operate on carotid stenosis?

A

> 70% stenosis

do not operate with 50% or under

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14
Q

HA that is more common in men?

A

cluster

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15
Q

HA with jaw pain and visual change

A

giant cell temporal arteritis

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16
Q

HA with diplopia (CNVI palsy) and obesity

A

pseudotumor cerebri

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17
Q

HA with tearing/rhinorhea

A

cluster HA

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18
Q

what do you do FIRST if you suspect giant cell arteritis?

A

start steroids without waiting for the biopsy results!!

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19
Q

migraine tx

ppx?

A

triptans + ergotamine as abortive tx

ppx propanolal

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20
Q

tx for cluster ha

prophylaxis?

A

triptans, ergotamine, or 100% oxygen

ppx verapamil

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21
Q

tx for pseudotumor cerebri

A

weightloss and acetazolamide (decrease csf) +/- ventriculoperitoneal shunt if needed

22
Q

bandlike ha?

tx?

A

tension ha

tx with nsaids and acetaminophen

23
Q

knifelike pain in face?

tx?

A

trigeminal neuralgia

carbamazepine or oxcarbazepine

24
Q

zoster vaccine is indicated in…

A

all people 60+ to prevent shingles(herpes zoster)

25
Q

status epilepticus
def?
best tx?

A

persistent seizure
benzodiazepine (IV lorazepam or diazepam)

if it persists, then give phenytoin or fosphenytoin(less s/e)

after that, next step would be phenobarbital

26
Q

side effects of phenytoin

A

hypotension

AV block

27
Q

when do you start antiepileptic drugs after a SINGLE seizure

A

usually you dont

you DO when:
was status epilepticus or had focal neurologic signs
abnormal eeg or lesion on ct
or
family hx of seizures
28
Q

tx for absence seizures

A

ethosuximide

29
Q

contrast vs no contrast on head ct/mri

A

use contrast when youre looking for lesions

dont use contrast if youre looking for bleeding!!

30
Q

anterior spinal artery infarction

A

posterior column intact (position and vibration)
flaccid paralysis below level of lesion and loss of DTRs
loss of pain and T

31
Q

2 main causes of loss of position and vibration sense (posterior cord)

A

B12 def and neurosyphilis = both lead to subacute degeneration of the cord

32
Q

brown sequard syndrome

A

unilateral hemisection

loss of pain and T on contrlateral side and lose motor and positon/vibration on ipsilateral side

33
Q

syringomyelia
def?
dx?
tx?

A

fluid filled dilated spinal canal leading to loss of pain and T bilaterally across upper back and arms = capelike distribution of atrophy

MRI

surgical intervention + drainage

34
Q

tuberous sclerosis versus neurofibromatosis

A

TS = neuro abnormalities + skin nodules (adenoma sebaceum or ash leaf) + retinal lesions or cardiac rhabdomyomas

NF= neurofibromas (fleshy lesions on peripheral nerves) + CNVIII tumors + afe au lait spots + meningioma/glioma

35
Q

sturge weber syndrome

A

port wine stain on face
seizures
and
CNS effects ( homonymous hemianopsia, hemiparesis, mR)

calcified angiomas on xray

36
Q

essential tremor
presentation?
tx?

A

occurs at both rest and intention

caffeine makes it worse, alcohol makes it better

propanolol

37
Q

parkinsons
mech?
presentation?
dx?

A

loss of substantia nigra (dopamine down)

tremor, cogwheel rigitdity, gait, bradykinesia

clinical dx, no test

38
Q

what are the only drugs that can slow the progression of parkinsons?

A

MAO inhibitors (rasageline, selegiline)

39
Q

single most effective med for parkinsons?

duration can be exxtended by?

A

levodopa-carbidopa

comt inhibitors (tolcapone, entacapone) to block dopamine metabolism

40
Q

tx for restless leg syndrome

A

dopamine agonists like pramipexole

41
Q

huntington disease
presentation?
dx?
tx?

A

choreoform movements + dementia + behavior change

genetic test, CAG repeats, caudate nucleus invovlement

cannot be reversed; tetrabenzine for dyskinesia and haloperidol or quetiapine for psychosis

42
Q

Multiple sclerosis
presentation?
dx?
tx?

A

multiple neruo deficits often with visual effects like internuclear ophthalmoplegia (inability to adduct one eye with nystagmus in other), fatigue, cerebellar issues, hyperreflexia

MRI shows white plaques in the white matter of brain (central) +/- oligoclonal bands in csf

tx for acute attack = high dose steroids
prevention = Beta interferon

43
Q 
ALS
presentation
dx
tx
mc cause of death?
A

loss of upper and lower motor neurons, NO sensory loss
weakness starting in 20-40yo

dx electromyography shows loss of innervation in multiple muscle groups

tx: riluzole (prevent progression) and baclofen for spasticity

respiratory failure

44
Q

charcot marie tooth disease
presentation
dx
tx

A

loss of motor and sensory –> wasting of legs, loss of distal sensory and DTRs, tremor
*look for foot deformity with HIGH ARCH (pes cavus)
dx electromyography
NO tx

45
Q

nerve deficits = name the nerve
1 hypothenar wasting + 4th/5th finger pain
2 wrist drop/crutch use
3 pain/numbness on outerside of 1 thigh
4 pain numbness in ankle and sole that is worse with walking
5 decreased foot dorsiflexion and eversion
6 thenar wasting, first 3 fingers pain

A 
1 ulnar
2 radial
3 lateral cutaneous nerve
4 tarsal tunnel (tibial nerve)
5 peroneal
6 median
46
Q

paralyzed side of face

1) can wrinkle forehead on affected side?
2) cant wrinkle affected side?

A

1 stroke

2 bell palsy

47
Q

gullain barre syndrome

A

autoimmune damage of multiple peripheral nerves (myelin sheaths)
NO CNS involvement
associated with campylobacter jejuni

ascending weakness and loss of reflexes

tx IVIG OR plasmapheresis (not both, no steroids)

48
Q

myasthenia gravis

A

ab against ach receptors in nmj

double vision, chewing weakness, normal pupillary responses
weakness with sustained activity

dx ach receptor antibodies or electropmyography, or edrophonium test

tx neostigmine or pyridostigmine

49
Q

tx for myasthenia crisis (severe overwhelming weakness in M patient)

A

IVIG or plasmapheresis

50
Q

alzheimers
frontotemporal type?
tx

A

mc cause of dementia
see symmetric atrophy on mri

frontotemporal = emotional/social appropriateness/behavior is first sign, memory is later

donezepil, rivastigmine, or galantamine (all increase ach)

51
Q

acute rapid dementia with myoclonic jerks, normal ct

csf with 14-3-3 protein

A

creutzfeldt jakob disease

step 2 ck (16 decks)

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