Neurology Flashcards
What are several ways to distinguish Duchenne’s muscular dystrophy from spinal muscular atrophy?
SMA often presents in infancy, has fasciculations which Duchenne’s does not, caused by a defect in the SMN1 gene, and is autosomal recessive.
Both can present in infancy and childhood with muscle weakness, difficulty walking, the Gower maneuver, reduced reflexes, and pseudohypertrophy of the calves (although SMA less frequently)
What disorder does the loss of the ATM gene cause?
Ataxia-telangiectasia (A-T): An autosomal recessive disorder. Symptoms include ataxia (typically begins before the age of 5 years), telangiectasias in the eyes and skin, oculomotor apraxia, myoclonus, frequent infections, and choreathetoid movements, and a weakened immune system with increased risk of chronic infections, leukemia, and lymphoma.
What is the empiric regimen for suspected bacterial meningitis?
Ceftriaxone and vancomycin (add ampicillin in very young or very old)
From which sinuses does orbital cellulitis most frequently develop?
Ethmoid and maxillary
What is first line therapy for postherpetic neuralgia?
Oral tricyclic antidepressants (can also use gabapentin in patients with cardiac problems/frail elderly)
How does diabetic retinopathy appear on fundoscopic exam?
Simple: Microaneurysms, hemorrhages, exudates, and retinal edema.
Pre-proliferative: cotton wool spots
Proliferative/malignant: newly formed vessels
What is the main treatment for Guillain-Barré syndrome?
IVIG or plasmaphoresis
What medication prophylaxis is recommended for cluster headaches?
Verapamil
At what time of day do patients with intracranial masses most often have headaches?
At night or any time with body positioning that increases ICP.
In pt with suspected subarachnoid hemorrhage and a negative head CT, what should be the next diagnostic step?
LP. LP findings would include elevated RBCs, high protein, xanthochromia, and possibly elevated opening pressure.
Where’s the lesion in a patient with pronator drift?
Relatively sensitive and specific for upper motor neuron or pyramidal/corticospinal tract disease
What metabolic disturbance can occur after a tonic-clonic seizure?
Lactic acidosis
What medications are associated with idiopathic intracranial hypertension?
Tetracyclines and isotretinoin
What are treatments for idiopathic intracranial hypertension?
Acetazolamide is first-line therapy (inhibits choroid plexus carbonic anhydrase thereby decreasing CSF production). Furosemide can be added if pts continue to have sx. For pts refractory to medical therapy or have more severe sx such as vision loss, surgical intervention with optic nerve sheath decompression or LP shunting is recommended.
What is medial medullar syndrome?
Alternating hypoglossal hemiplegia. Typically due to a branch occlusion of the vertebral or anterior spinal artery. Patients develop contralateral paralysis of the arm and leg and tongue deviation towards the lesion. Contralateral loss of tactile and position sense can also occur with infarcts that extend dorsally
