Neurology Flashcards
1
Q
Generalized Tonic-Clonic Seizures
A
Drugs: Valporic Acid, Phenytoin, Carbamazepine
Alt. drugs: Phenobarbital, Lamotrigine, Topiramate
2
Q
Partial Seizures
A
Drugs: Carbamazepine, Lamotrigine, Phenytoin
Alt. drugs: Felbamate, Phenobarbital, Topiramate, Valporic Acid
3
Q
Absence Seizures
A
Drugs: Ethosuximide, Valporic Acid
Alt Drugs: Lamotrigine, Levetiracetam, Zonisamide, Clonazepam
4
Q
Myoclonic and Atypical Absence Syndromes
A
Drugs: Valporic Acid
Alt Drugs: Clonazepam, Levetiracetam, Topiramate, Zonisamide, Felbamate
5
Q
Status Epilepticus
A
Lorazepam, Diazepam, Phenytoin, Phenobarbital
6
Q
Ethanol
A
Most frequently abused drug, causes Wernicke-Korsakoff syndrome in overdose and delirium tremens in withdrawal
7
Q
Thiamine
A
Used for prevention of Wernicke-Korsakoff syndrome
8
Q
Diazepam
A
Used for treatment of alcohol withdrawal
9
Q
Methanol
A
Wood alcohol, causes visual dysfunction due to formaldehyde accumulation
10
Q
Ethylene glycol
A
Found in antifreeze, causes nephrotoxicity due to oxalic acid accumulation
11
Q
Formepizole
A
Alcohol dehydrogenase inhibitor
12
Q
Disulfiram
A
Alcohol dehydrogenase inhibitor
13
Q
Midazolam
A
Used in acute anxiety attacks, anesthesia induction, preoperative sedation
14
Q
Diazepam
A
Used in seizure disorders (status epilepticus), alcohol withdrawal, tranquilizer
15
Q
Flunitrazepam
A
Date-rape drug
16
Q
Flumazenil
A
Antidote to benzodiazepine overdose
17
Q
Thiopental
A
Used in anesthesia induction, Lethal injection, Truth serum
18
Q
Phenobarbital
A
Used in seizure disorders in children, can precipitate porphyria, potent inducer of CYP450
19
Q
Parkinson’s Disease (PD)
A
Most common form of Parkinsonism
20
Q
Mutations of the LKKR2 gene
A
Most common cause of Familial PD
21
Q
Dopamine blocking agents
A
Most common cause of secondary Parkinsonism
22
Q
Protein misfolding & accumulation and mitochondrial dysfunction
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Most significant pathogenic mechanism in Parkinsonism
23
Q
Levodopa-carbidopa
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Mainstay therapy for PD
24
Q
Tremors
A
Major clinical effect of central-acting anticholinergic drugs
25
Amantadine
Most widely used antidyskinesia agent in patients with advanced PD and the only oral agent that has been demonstrated in controlled studies to reduce dyskinesia
26
Dementia
Most common cause of nursing home placement in PD patients
27
Essential tremor
Most common movement disorder
28
Dystonic tremor of PD
Major differentials for tremors
29
B-blockers or primidone
Standard drug therapies for essential tremors
30
Focal dystonias
Most common form of dystonia
31
Drug-induced dystonia
Most commonly seen with neuroleptic drugs or after chronic levodopa treatment in PD patients
32
SLE
Most common systemic disorder that causes chorea
33
Dystonia
Most common acute hyperkinetic drug reaction
34
Akathisia
Most common subacute drug reaction
35
Liver Biopsy
Gold standard for diagnosis of Wilson's disease
36
Tremor affecting the upper limbs
Most common psychogenic movement disorder
37
Diabetes mellitus
Most common cause of peripheral neuropathy in developed countries
38
Median neuropathy at the wrist and ulnar neuropathy at the elbow
Most common diabetic mononeuropathies
39
Seventh nerve palsy, followed by third nerve, sixth nerve, and, less frequently, fourth nerve palsies
Most common cranial mononeuropathies in DM
40
Trigeminal nerve
Most common mononeuropathies in scleroderma
41
Seventh nerve
Most common cranial nerve involved in sarcoidosis
42
Carpal tunnel syndrome
Most common mononeuropathies in uremia
43
Distal symmetric polyneuropathy
Most common form of peripheral neuropathy associated with HIV infection & usually seen in patients with AIDS
44
Lung cancer
Most common associated malignancy with neuropathies
45
GBS and myasthenia gravis
Most common causes of acute generalized weakness leading to admission in ICU
46
Guillain Barre Syndrome (GBS)
Manifests as rapidly evolving areflexic motor paralysis with or without sensory disturbance, associated with Campylobacter jejuni found in undercooked chicken
47
Myasthenia Gravis (MG)
Neuromuscular disorder characterized by weakness and fatigability of skeletal muscles, caused by a decrease in the number of available acetylcholine receptors (AChRs) at neuromuscular junctions due to an antibody-mediated autoimmune attack, associated with diplopia
48
Trainsient Ischemic Response (TIA)
Requires that all neurologic signs and symptoms resolve within 24 hrs (most last <1hr) regardless of whether there is an imaging evidence of new permanent brain injury
49
Stroke
Occurred in the neurologic signs last for more than 24 hours
50
Ischemic Penumbra
Tissue surrounding the core region of infarction is ischemic but reversibly dysfuncitonal
51
Lacunar Infarction
Refers to infarction following atherothrombotic of lipohyalinotic occlusion of a small artery (30-300 um)
52
4-10 minutes
Decrease in cerebral blood flow to zero causes death of brain tissue within
53
Nonrheumatic atrial fibrilation
Most common cause of cerebral embolism overall
54
Carotid bifurcation atherosclerosis
Most common source of artery to artery embolism
55
Common carotid bifurcation and proximal internal carotid artery
Atherosclerosis within the carotid artery occurs most frequently in
56
Transient symptoms (small vessel TIA)
Herald a small-vessel infarct
57
Hypertension
Most significant risk factor of stroke and TIA
58
Aspirin
Only antiplatelet agent that has proven effective for the acute treatment of ischemic stroke
59
Headache
Principal side effect of dipyridamole
60
Within 2 weeks of symptom onset (benefit is more pronounced in men>75 y.o.)
Endarterectomy for carotid atherosclerosis is most beneficial when performed
61
Hallmark of top of the basilar artery occlusion
Sudden onset of bilateral signs, including ptosis, papillary asymmetry or lack of reaction to light and somnolence
62
Plain cranial CT
Imaging modality of choice in patients with acute stroke to rule out bleed
63
Conventional x-ray cerebral angiography
Gold standard for identifying and quantifying atherosclerotic stenoses of arteries
64
Trauma
Bleeding into subdural and epidural spaces is principally produced by
65
Basal ganglia (especially putamen), thalamus, cerebellum, pons
Most common sites of hypertensive intraparenchymal hemorrhage
66
Putamen (Sentinel) sign: contralateral hemiparesis
Most common site of hypertensive hemorrhage
67
Cerebral amyloid angiopathy
Most common cause of lobar hemorrhage in the elderly
68
Choriocarcinoma Malignant melanoma Renal cell carcinoma Bronchogenic carcinoma
Most common metastatic tumors associated with intracerebral hemorrhage
69
>3cm in diameter
Most cerebellar hematomas of this diameter will require surgical evacuation
70
Seizure
Paroxysomal event due to abnormal excessive or synchronous neuronal activity in the brain
71
Epilepsy
Condition where a person has recurrent seizures due to underlying causes not associated with structural brain damage
72
Triad of Lennox-Gastaus Syndrome
1. Multiple seizure typers (usually generalized tonig-clonic, atonig, and atypical absence seizures)
73
Early childhood and late adulthood
Highest incident of seizures
74
Daydreamind and a decline in school performance recognized by the teacher
First clue of typical absence seizures
75
Electrophysiologic hallmark of typical absence seizures
Generalized, symmetric, 3-Hz spike-and-wave discharge that begins and ends abruptly, superimposed on a normal EEG background
76
Generalize tonic-clonic seizures
Main seizure type in 10% of all persons with epilepsy
77
Generalize tonic-clonic seizures
Most common seizure type resulting from metabolic derangements
78
Metabolic disorders
Degenerative CNS diseases
79
Anoxic brain injury
Pathologic myoclonus is the most commonly seen in association with
80
Mesial Temporal Lobe Epilepsy Syndrome
Most common syndrome associated with focal seizures with dyscognitive features
81
Febrile seizures
Most common seizures arising in late infancy and early childhood
82
First goal in the approach to seizure
Determine if event was truly a seizure
83
Valporic acid Lamotrigine
Best initial choice for the treatment of primary generalized tonig-clonic seizures
84
Valpotic acid
Drug choice in patients with generalized epilepsy syndromes having mixed seizure types
85
Key determinants in initiation and the monitoring of therapy
Clinical measures of seizure frequency and presence of side effects, not the laboratory values
86
First 3 months after discontinuing therapy
Most recurrences of seizure occur in the
87
Most common surgical procedure for patients with temporal lobe epilepsy
Resection of the anteromedial temporam lobe (temporal lobectomy) or a more limited removal of the underlying hippocampus and amygdala (amygdalohippocampectomy)
88
First task in the approach to CNS infection
Identify whether an infection predominantly involves the subarachnoid space (meningitis) or whether there is evidence of either generalized or focal involvement of brain tissue in the cerebral hemispheres, cerebellum, or brainstem
89
Bain tissue is directly injured by a viral infection
Encephalitis
90
Fever, headache, and nuchal rigidity
Classical clinical triad of meningitis
91
Headache, fever, focal neurologic deficit (present in <50%)
Classic clinical triad of brain abscess
92
Cerebritis
Non-encapsulated brain abscess
93
Nuchal rigidity ("stiff neck")
Pathognomonic sign of meningeal irritation and is present when neck resists passive flexion
94
Bacterial meningitis
Most common form of suppurative CNS infection
95
S. pneumoniae
Most common cause of meningitis in adults>20 years
96
Petechial or purpuric skin lesions
Important clue to diagnosis of meningococcal infection
97
Cerebral herniation
Most disastrous complication of increased ICP
98
S. pneumoniae and N. meningitides
Most common etiologic organisms of community-acquired bacterial meningitis
99
Enteroviruses, HSV type 2, HIV, Arboviruses
Most important agents in acute viral meningitis
100
Headache
Most common symptom of brain abscess
101
Combination of high dose parenteral antibiotics and neurosurgical drainage
Optimal therapy for brain abscess
102
Cranial MRI
Preferred diagnostic test for any patient suspected of having a brain tumor, and should be performed with gadolinium contrast administration
103
Neuroimaging
The only test necessary to diagnose a brain tumor
104
Dexamethasone
Glucocorticoid of choice for brain tumors because of its relatively low mineralocorticaoid activity
105
The only established risk factors for primary brain tumors
Exposure to ionizing radiation: meningiomas, gliomas, schwannomas Immunosuppression: primary CNS lymphoma
106
Most common primary brain tumor of childhood
Grade I astocytomas: pilocytic astrocytomas (WHO grade I)
107
Meningiomas
Most common primary brain tumor overall
108
Epstein-Barr Virus (EBV)
Frequently plays an important role in the pathogenesis of HIV-related primary CNS lymphoma
109
Medulloblastomas
Most common malignant brain tumor of chilhood
110
Grade IV astrocytoma (Glioblastoma)
Most common malignant brain tumor overall
111
Cerebral convexities
Where meningiomas are most commonly located
112
Dural metastasis
Main differential diagnosis for meningioma
113
Most common schwannomas
Vestibular schwannomas or acoustic neurons
114
Gray matter-white matter junction
Most common site of brain metastases
115
Supratentorial
85% of all brain metastases are
116
Lung and breast cancer
Most common sources of brain metastases
117
Melanoma
Malignancy with greatest propensity for brain metastasis, found in 80% of patients at autopsy
118
Prostate and breast cancer
Malignancies with propensity to metastasize to the dura and can mimic meningioma
119
MRI
Brain metastases are best visualized on ___ where they appear as well-circumscribed lesions
120
Melanoma, thyroid, kidney cancer
Cancers with greatest propensity to bleed
121
Lung cancer
Most common cause of hemorrhagic metastasis
122
Acute leukemia
Most common among hematologic malignancies to matastasize to the subarachnoid space
123
Breast and lung carcinomas and melanoma
Solid tumors that most frequently cause leptomeningeal metastases
124
Demonstration of tumor cells in CSF
Definitive method and often considered the gold standard to diagnose leptomeningeal metastases
125
Hematologic malignancies
CSF cytologic examination is most useful in
126
Thoracic spine, followed by the lumbar and then cervical spine
Part of the spine affected most commonly in epidural metastasis
127
Back pain
Presenting symptom of epidural metastasis in virtually all patients
128
MRI of the complete spine
Best test for epidural metastasis
129
Complete removal of the mass, typically anterior to the spinal canal
Surgical procedure of choice for epidural metastasis
130
Whole-Brain Radiotherapy (WBRT)
Standard treatment for beain metastases
131
Late delayed toxicity
Most serious toxicity from radiotherapy as they are often irreversible
132
Leukoencephalopathy
Complication seen most commonly after WBRT
133
Neurotoxicity
Second only to myelosupression as dose-limiting toxicity of chemotherapeutic agents
134
Vomiting that precedes headaches
Highly characteristic of posterior fossa brain tumors
135
Headache
Dominant symptom in temporal (giant cell) arteritis
136
Migraine, tension-type headache, and cluter headache
Most common primary headache syndromes
137
Trigeminovascular input from the meningeal vessels
Key pathway for pain in migraine
138
Migraine
Most disabling headache
139
Judicious use of one or more drugs that are effective in migraine
Mainstays of pharmacologic therapy in migraine
140
Severity of the attack
Most important factor in selection of the optimal regimen for a migraine patient
141
Most effective drug classes in the treatment of migraine
Anti-inflammatory agents, 5-HT, 1B/1D receptor agonists (triptans), and dopamine receptor antagonists
142
Most efficacious of the triptans
Rizatriptan and eletriptan
143
Periodicity
Core feature of cluster headache
144
Most satisfactory treatment in cluster headache
Administration of drugs to prevent cluster attacks until the bout is over
145
Subarachnoid hemorrhage
Most serious cause of secondary headache
146
Most evident in the morning and improves during the day
Classic headache associated with a brain tumor
147
Sympathetic Effects
Myrdiasis, sweating, increased heart rate, bronchodilation, GU and GI contraction, uterine relaxation and contraction, vasodilation of the skeletal muscles, vasoconstriction of the skin and GI tract, ejaculation
148
Adrenergic receptors
Alpha-1 (for smooth muscle contraction in sphincters, radial muscle of the iris, vasoconstriction)
149
CN III (Oculomotor nerve)
Cranial nerve for opening of eyelids, contraction of most EOMs, accommodation and pupillary constriction
150
CN VII (Facial nerve)
Cranial nerve for specail sensation (taste) of the anterior 2/3 of the tongue
151
CN V (Trigeminal nerve)
Cranial nerve for general sensation (e.g. pain) of the anterior 2/3 of tongue
152
CN VII (Facial nerve)
Cranial nerve for facial muscles
153
CN V (Trigeminal nerve)
Cranial nerve for facial sensation and muscles of mastication
154
Acetylcholine (Ach)
Found in various sites (e.g. ANS and NMJ), decreased in HUntington's dementia and Alzheimer's dementia
155
Norephinephrine (NE)
Found in the locus ceruleus of the pons, for arousal/wakefulness
156
Dopamine
Found in the substantia nigra, decreased in Parkinson's disease, increased in schizophrenia, for fine-tuning of movements
157
Serotonin
Found in the median raphe of the brainstem, derived from tryptophan, converted to melatonin, involved in mood and sleep
158
Glycine
Found in spiral interneurons, main inhibitory neurotransmitter
159
GABA
Found in the brain, main inhibitory neurotransmitter, from glutamate
160
Glutamate
Excitatory neurotransmitter in the CNS
161
Hippocampus
Output pathway from reward and punishment centers, lesions here will produce anterograde amnesia
162
Thalamus
Helps seach memory storehouses, lesions here will produce retrograde amnesia
163
Beta waves, Alpha waves, Delta waves
Waves in the EEG of alert, sleeping, and relaxed individuals, respectively
