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Step 2 CK > Neurology > Flashcards

Neurology Flashcards

1
Q

Define stroke

A

Sudden onset of a neurological deficit from the death of brain tissue

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2
Q

Risk factors for stroke

A

HTN

DM

Hyperlipidemia

Tobacco

Same as those for MI

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3
Q

Weakness/sensory loss

Homonymous hemianopsia

+/- Aphasia

A

MCA stroke (more than 90% of cases)

  • Weakness/sensory loss on the contralateral side of the lesion
  • Loss of visual field on the opposite side of the stroke w/ eyes looking towards the side of the lesion
  • Aphasia if the stroke occurs on the same side as the speech center
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4
Q

Personality/congitive defects (e.g., confusion)

Urinary incontinence

Leg > arm weakness

A

ACA stroke

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5
Q

Sensory loss of the face

Sensory loss of the limbs on the opposite side

Limb ataxia

A

PCA stroke

  • Ipsilateral sensory loss of the face
  • Contralateral sensory loss of the limbs
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6
Q

The best initial therapy for a nonhemorrhagic stroke is:

A

< 3 hours since onset = thrombolytics

> 3 hours = ASA

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7
Q

Patient presents 6 hours after the onset of a nonhemorrhagic stroke and is currently taking aspirin daily, what is your initial therapy?

A

Add dipyridamole

or

Switch to clopidorgrel

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8
Q

Every patient with a stroke should be started on what type of long-term medication?

A

Statin (regardless of LDL)

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9
Q

True/False

Carotid angioplasty and stenting are of proven value for stroke patients

A

False

It is always a wrong answer

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10
Q

When is endarterectomy indicated?

A

> 70% stenosis of the carotid

If the stenosis is 100% no intervention is needed (no point in opening a passage that is 100% occluded)

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11
Q

Headache:

Bilateral “bandlike” pressure

Lasts 4-6 hours

Normal physical exam

A

Tension headache

Treat with NSAIDs and Acetaminophen

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12
Q

Headache:

Aura w/ photophobia

Related to food/emotions/menses

A

Migraine

Treat by avoiding triggers, taking NSAIDs and triptans (5-HT1 agonists)

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13
Q

When is prophylaxis indicated for migraine headaches and what is it?

A

When attacks occur 3 or more times per month

Propranolol or

Sodium valproate

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14
Q

Headache:

Episodic pain

Unilateral

Lacrimation

Eye reddening

Nasal stuffiness

A

Cluster headache

Treat with sumitriptan, octreotide, or oxygen

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15
Q

Prophylatic treatment for cluster headaches

A

Verapamil

or

Prednisone

or

Sodium valproate

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16
Q

What else should you evaluate for when someone presents with signs/symptoms of a cluster headache (specifically headache + red eye)?

A

Glaucoma

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17
Q

How do you diagnose pseudotumor cerebri?

A

Diagnosis cannot be made without a CT or MRI to exclude an intracranial mass lesion and a lumbar puncture (LP) showing increased pressure

Associated with obesity, venous sinus thrombosis, OCPs, and vitamin A toxicity

Look for papilledema with diplopia from 6th cranial nerve palsy (mimics brain tumor)

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18
Q

Treatment for pseudotumor cerebri

A

Wt loss + acetazolamide (decreases production of CSF)

Steroids help

Repeated LPs

Last resort = shunt or fenestrate the optic nerve

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19
Q

First step if someone is suspected of having Giant cell arteritis

A

Critical to start steroids without waiting for biopsy

Look for visual disturbance, systemic symptoms, and jaw claudication

Markedly elevated ESR

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20
Q

Difference in abortive therapy for migraine and cluster headache

A

Both can be interrupted with either ergotamine (5-HT1, DA, and NE) or one of the triptans (5-HT1)

Only cluster headaches respond to 100% oxygen, prednisone, and lithium

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21
Q

What is the best prophylatic therapy for migraines?

A

Propranolol

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22
Q

Treatment for trigeminal neuralgia?

A

Carbamazepine or oxcarbazepine

If unimproved by meds, gamma knife surgery

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23
Q

How to reduce the incidence of postherpetic neuralgia?

A

Treatment with antiherpetic medications

Steroids DO NOT help

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24
Q

Treatment for postherpetic neuralgia?

A

TCAs

Gabapentin

Pregabalin

Carbamazepine

Phenytoin

Topical capsaicin

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25
Q

Define epilepsy

A

Seizures of unclear etiology

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26
Q

Angina is to MI, as confusion is to:

A

coma and seizure

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27
Q

What is status epilepticus?

A

Status epilepticus (SE) is an epileptic seizure of greater than five minutes or more than one seizure within a five-minute period without the person returning to normal between them.

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28
Q

Treatment for Status Epilepticus

A
  1. Benzodiazepine
  2. Fosphenytoin
  3. Phenobarbital
  4. General anesthesia
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29
Q

Why is fosphenytoin preferred over phenytoin?

A

Fewer adverse effects

Phenytoin in a class 1b antiarrhythmic (when given IV it is associated with hypotension and AV block)

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30
Q

Indications for long-term treatment of a seizure

A

Status Epilepticus

Focal neurological signs

Abnormal EEG or lesion on CT

FHx of seizures

31
Q

Best treatment for epilepsy

A

Unclear

Levetiracetam, phenytoin, valproic acid, and carbamazepine all have nearly equal efficacy (Levetiracetam has the fewest adverse effects)

Ethosuximide is the best for absence seizures

32
Q

When can you discontinue antiepileptic drugs?

A

When the patient has been seizure-free for 2 years

Sleep deprivation EEG is the best way to tell if there is possibility of recurrence (lacks high sensitivity)

33
Q

Polycystic kidney disease

Tobacco

HTN

Hyperlipidemia

High alcohol consumption

A

Look out for aneurysms (i.e., SAH)

34
Q

Severe headache

Stiff neck and photophobia

Fever

A

SAH

35
Q

How does SAH differ from meningitis

A

SAH = very sudden in onset with LOC

and

normal WBC to RBC ratio

36
Q

How to diagnose SAH

A

Best initial test = CT without contrast

Most accurate = LP showing blood (only necessary for the 5% that have a falsely negative CT scan)

Normal WBC to RBC ratio is 1:500-1000

37
Q

Treatment for SAH

A

Nimodipine (CCB): prevents subsequent ischemic stroke

Embolization: better than surgical clipping at preventing repeated hemorrhage

Shunt: only if hydrocephalus develops

Seizure prophylaxis: phenytoin

38
Q

Best initial therapy for bacterial meningitis

A

Ceftriaxone and vancomycin

39
Q

Best initial test for brain abscess

A

head CT or MRI

Cancer and infection are indistinguishable based on imaging; biopsy is essential

40
Q

Empiric therapy for suspected brain abscess

A

Penicillin (vancomycin if indicated)

+

Ceftriaxone (or cefepime)

+

Metronidazole

41
Q

Neurological abnormalities

Adenoma sebaceum

Shagreen patches

Ash leaf patches

Retinal lesion

Cardiac rhabdomyomas

A

Tuberous Sclerosis

No specific treatment, control seizures

42
Q

Soft, flesh-colored lesions attached to peripheral nerves

Cafe au lait spots

A

Neurofibromatosis Type I (von Recklinghausen disease)

Eighth cranial nerve lesions may need surgical decompression to help preserve hearing

43
Q

Port-wine stain of the face

Seizures

A

Sturge-Weber Syndrome

44
Q

Tremor at rest and with exertion

Improved with alcohol

Worse with caffeine

A

Essential Tremor

The best therapy is propranolol

45
Q

Define parkinsonism

A

loss of cells in the substantia nigra resulting in a decrease in dopamine

PArkinson’s Disease = doPAmine Down

Alzheimer’s Disease = ACh Down

46
Q

Why is postural instability (aka orthostatic hypotension) seen with parkinsonism

A

The same slowness that results in bradykinesia (slow movements) results in the inability of the pulse and blood pressure to reset appropriately

47
Q

Treatment of mild Parkinson’s

A

Anticholinergic medications (benztropine and trihexyphenidyl)

Amantadine (definitely the answer in patients > 60 who are intolerant of anticholinergic adverse effects)

48
Q

Treatment for severe Parkinson’s

A

DA agonists (pramipexole and ropinirole) = best initial therapy

Levodopa/carbidopa = most effective

COMT inhibitors (tolcapone, entacapone) = extended duration of levodopa/carbidopa and decreased on/off phenomena

MAO inhibitors (rasagiline, selegiline)

Deep brain stimulation

49
Q

Which medication for Parkinson’s has the only possibility of retarding the progression of the disease?

A

MAO inhibitors

Rasagiline and selegiline

50
Q

Shy-Drager syndrome

A

Parkinsonism predominantly with orthostasis

51
Q

Define spasticity

A

painful, contracted muscles from damage to the CNS

often associated with MS

Treat with baclofen, dantrolene, or tizanadine

52
Q

Treatment for Restless Leg Syndrome

A

Pramipexole (DA agonist)

  • Iron supplementation if deficient*
  • Gabapentin or Ropinorole are alternatives*
53
Q

CAG trinucleotide repeat sequences on chromosome 4

A

Huntington Disease

54
Q

Treatment for Huntington Disease

A

Dyskinesia is treated with tetrabenazine (reversible depletion of DA, 5-HT, and histamine from nerve terminals)

Psychosis is treated with haloperidol or quetiapine

55
Q

Treatment for Tourette Disorder

A

Fluphenazine, clonazepam, or pimozide

Associated with ADHS (treat with methylphenidate)

56
Q

Define MS

A

Idiopathic disorder of CNS white matter

57
Q

What is internuclear ophthalmoplegia (INO)?

A

the inability to adduct one eye with nystagmus in the other eye

INO is characteristic of MS

58
Q

Diagnostic tests for MS

A

Best initial test = MRI

LP is only the answer in the 3-5% of patients with an equivocal or nondiagnostic MRI (looking for oligoclonal bands)

59
Q

Treatment for MS

A

High-dose steroids (shortens the duration of MS exacerbations)

Glatiramer and beta-interferon are the best first choice for prevention of relapse

60
Q

A patient with MS develops worsening neuro deficits with the use of a chronic suppressive medication. MRI shows new, multiple white matter hypodense lesions. What happened?

A

Likely taking Natalizumab (also used for Crohn’s), which has been associated with the development of PML

61
Q

Weakness of unclear etiology

Difficulty chewing and swallowing

Decrease gag reflex

A

ALS

62
Q

Weakness

Spasticity

Hyperreflexia

Extensor plantar responses

A

UMN lesion

63
Q

Weakness

Wasting

Fasciculations

A

LMN lesion

64
Q

Treatment for ALS

A

Riluzole reduces glutamate buildup and may prevent progression

Baclofen treats spasticity

CPAP and BiPAP help with repiratory difficulties (will ultimately need tracheostomy and maintenance on a ventilator)

65
Q

Most common cause of peripheral neuropathy

A

DM

Best initial treatment is pregabalin or gabapentin

66
Q

Difference in presentation between stroke and Bell Palsy

A

If the patient can wrinkle their forehead on affected side = stroke

If the patient cannot wrinkle their forehead on the affected side = Bell palsy

67
Q

Hyperacusis

Taste disturbances

A

Features of Bell’s Palsy

Hyperacusis because the 7th cranial nerve normally acts as a “shock absorber” on the ossicles of the middle ear

Taste disturbances because the 7th cranial nerve supplies the sensation of taste to the anterior 2/3 of the tongue

68
Q

Treatment for Bell’s Palsy

A

60% of patients have full recovery without treatment

The best initial therapy is prednisone

69
Q

What is the most common complication of Bell’s palsy?

A

Corneal ulceration

7th cranial nerve palsy makes it difficult to close the eye on the affected side, leading to dryness and ulceration

70
Q

Which infection is Guillain-Barre Syndrome associated with?

A

Campylobacter jejuni

71
Q

Ascending weakness

+

Loss of reflexes

A

GBS

72
Q

Diagnostic tests for GBS

A

Most specific = nerve conduction/electromyography (takes 1-2 weeks to become abnormal)

CSF will show increased protein and a normal cell count

PFTs are the most important initial test (decrease in FVC is the earliest way to detect impending respiratory failure)

73
Q

Best initial test for Myasthenia Gravis

A

Acetycholine receptor antibodies

  • For patients without these, get anti-MUSK antibodies (muscle-specific kinase)
  • Edrophonium test
  • Most accurate = electromyography
74
Q

Treatment for Myasthenia Gravis

A

Neostigmine or pyridostigmine

If unimproved, thymectomy in patients < 60 and prednisone if > 60

Step 2 CK (18 decks)

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